Binocular Anomaly, Color Vision Deficiency and Dry Eye in Patients with Cancer
Journal of Ophthalmic and Optometric Sciences,
Vol. 9 No. 2 (2025),
5 April 2025
,
Page 16-26
Abstract
Objective: To determine the prevalence of color vision disorders and dry eye in patients with cancer.
Patients and Methods: This cross-sectional study was conducted in 2019 at Imam Hossein Hospital, Tehran, Iran, and included 307 eyes from 165 patients with cancer before initiation of systemic chemotherapy. All participants underwent Schirmer I testing, binocular vision and ocular motility assessment, and color vision evaluation with Ishihara plates and the Farnsworth D15 panel. Posterior and anterior segment examinations were also performed.
Results: Data from 307 eyes of 165 patients were analyzed. The mean age was 54.26 ± 13.39 years (range, 18–86). Overall, 74.6 % of eyes showed some degree of dry eye. The mean Schirmer value was 8.65 ± 8.69 mm. Abnormal color vision was detected in 6.74 % of eyes by Ishihara and in 17.28 % by the D15 test. Exophoria was present in 58.8 % of patients and esophoria in 29.1 %, while 2.1 % demonstrated abnormal ocular motility.
Conclusion: Dry eye, color vision deficiency and heterophoria were more frequent among patients with cancer than in the general population, underscoring the need for routine ophthalmic screening and follow-up in oncologic care.
- Cancer
- Color Vision
- Schirmer Test
- Heterophoria
- Dry eye
How to Cite
References
World Health Organization. What is cancer? Geneva: WHO; 2019. Available from: https://www.who.int/cancer/en/.
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87-108.
Omran AR. The epidemiologic transition. A theory of the epidemiology of population change. Milbank Mem Fund Q. 1971;49(4):509-38.
Gersten O, Wilmoth J. The cancer transition in Japan since 1951. Demogr Res. 2002;7:271-306.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.
Kaasa S, Loge JH, Aapro M, Albreht T, Anderson R, Bruera E, et al. Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol. 2018;19(11):e588-653.
Mattiuzzi C, Lippi G. Current Cancer Epidemiology. J Epidemiol Glob Health. 2019;9(4):217-22.
Amirkhah R, Naderi-Meshkin H, Mirahmadi M, Allahyari A, Sharifi HR. Cancer statistics in Iran: towards finding priority for prevention and treatment. Cancer Press. 2017;3(2):27-38.
Chang AY, Purt B. Biochemistry, Tear Film. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
Terry MA. Dry eye in the elderly. Drugs Aging. 2001;18(2):101-7.
Sharma A, Hindman HB. Aging: a predisposition to dry eyes. J Ophthalmol. 2014;2014:781683.
Tavares Fde P, Fernandes RS, Bernardes TF, Bonfioli AA, Soares EJ. Dry eye disease. Semin Ophthalmol. 2010;25(3):84-93.
Messmer EM. The pathophysiology, diagnosis, and treatment of dry eye disease. Dtsch Arztebl Int. 2015;112(5):71-81.
Glover D, Jenkins W, Doney S. Modeling methods for marine science. Cambridge: Cambridge University Press; 2011.
Dohvoma V, Ebana Mvogo S, Kagmeni G, Emini N, Epee E, Mvogo C. Colour vision deficiency among biomedical students: a cross-sectional study. Clin Ophthalmol. 2018;12:1121-4.
Hasrod N, Rubin A. Defects of colour vision: a review of congenital and acquired colour vision deficiencies. Afr Vision Eye Health. 2016;75(10):a365.
Simunovic MP. Acquired color vision deficiency. Surv Ophthalmol. 2016;61(2):132-55.
Nunez JR, Anderton CR, Renslow RS. Optimizing colormaps with consideration for color vision deficiency to enable accurate interpretation of scientific data. PLoS One. 2018;13(7):e0199239.
Steffen H. Supranuclear eye movement disorders. Ophthalmologe. 2019;116(1):87-104.
Savini G, Prabhawasat P, Kojima T, Grueterich M, Espana E, Goto E. The challenge of dry eye diagnosis. Clin Ophthalmol. 2008;2(1):31-55.
Bowling B. Kanski’s clinical ophthalmology: a systematic approach. 8th ed. London: Elsevier; 2015.
Rahman A, Yahya K, Ahmed T, Sharif-Ul-Hasan K. Diagnostic value of tear films tests in type 2 diabetes. J Pak Med Assoc. 2007;57(12):577-81.
Karampatakis V, Karamitsos A, Skriapa A, Pastiadis G. Comparison between normal values of 2- and 5-minute Schirmer test without anesthesia. Cornea. 2010;29(5):497-501.
Serruya LG, Nogueira DC, Hida RY. Schirmer test performed with open and closed eyes: variations in normal individuals. Arq Bras Oftalmol. 2009;72(1):65-7.
Bron A, Abelson M, Ousler G, Pearce E, Tomlinson A, Yokoi N. Methodologies to diagnose and monitor dry eye disease: report of the Diagnostic Methodology Subcommittee of the International Dry Eye Workshop. Ocul Surf. 2007;5(2):108-52.
Lemp MA, Baudouin C, Baum J, Dogru M, Foulks GN, Kinoshita S, et al. The definition and classification of dry eye disease. Ocul Surf. 2007;5(2):75-92.
Reilly JL, Lencer R, Bishop JR, Keedy S, Sweeney JA. Pharmacological treatment effects on eye movement control. Brain Cogn. 2008;68(3):415-35.
Reddy P, Grad O, Rajagopalan K. The economic burden of dry eye: a conceptual framework and preliminary assessment. Cornea. 2004;23(8):751-61.
McDonald M, Patel DA, Keith MS, Snedecor SJ. Economic and humanistic burden of dry eye disease in Europe, North America, and Asia: a systematic literature review. Ocul Surf. 2016;14(2):144-67.
Ma J, Pazo EE, Zou Z, Jin F. Prevalence of symptomatic dry eye in breast cancer patients undergoing systemic adjuvant treatment: a cross-sectional study. Breast. 2020;53:164-71.
Liu NN, Liu L, Li J, Sun YZ. Prevalence of and risk factors for dry eye symptoms in mainland China: a systematic review and meta-analysis. J Ophthalmol. 2014;2014:748654.
Sibel K, Murat I. Dry eye syndrome: an increasing problem with aging. Turk J Geriatr. 2019;22(3):237-43.
Shimazaki J. Definition and Diagnostic Criteria of Dry Eye Disease: Historical Overview and Future Directions. Invest Ophthalmol Vis Sci. 2018;59(14):DES7-12.
Kam KW, Di Zazzo A, De Gregorio C, Narang P, Jhanji V, Basu S. A review on drug-induced dry eye disease. Indian J Ophthalmol. 2023;71(4):1263-9.
Zhang X, Zhao L, Deng S, Sun X, Wang N. Dry Eye Syndrome in Patients with Diabetes Mellitus: Prevalence, Etiology, and Clinical Characteristics. J Ophthalmol. 2016;2016:8201053.
Shumye AF, Bekele MM, Tegegne MM, Eticha BL, Bayabil AZ, Birhan GS, et al. Symptomatic dry eye disease and its associated factors among adult patients with diabetes attending comprehensive specialised hospitals in Amhara Region, Ethiopia: a multicentre institution-based cross-sectional study. BMJ Open. 2025;15(3):e090721.
Yoo TK, Oh E. Diabetes mellitus is associated with dry eye syndrome: a meta-analysis. Int Ophthalmol. 2019;39(11):2611-20.
Birch J. Worldwide prevalence of red–green color deficiency. J Opt Soc Am A Opt Image Sci Vis. 2012;29(3):313-20.
Sharpe LT, Stockman A, Jägle H, Nathans J. Color vision and color blindness. Cambridge: Cambridge University Press; 1999.
Daryaeian M, Seifi M, Ramazani N. Frequency of color vision defect in students of Mashhad Dental School and evaluation of related factors. J Mashhad Dent Sch. 2013;37(3):221-8.
Modarres M, Mirsamadi M, Peyman GA. Prevalence of congenital color deficiencies in secondary-school students in Tehran. J Ophthalmic Vis Res. 1997;2(1):39-42.
Malek M, Ebrahemzadeh M, Arab Farashahi H, Besharati MR, Mortazavi Mehrizi M, Mozaian MR. Investigation of color blindness prevalence among students of Yazd Medical Sciences Universities. J Ophthalmic Vis Res. 2018;13(4):501-7.
Khalaj M, Barikani A, Mohammadi M. Prevalence of color vision deficiency in Qazvin. Zahedan J Res Med Sci. 2014;16(8):91-3.
Mashige KP, van Staden DB. Prevalence of congenital colour vision deficiency among Black school children in Durban, South Africa. BMC Res Notes. 201912(1):324.
Ugalahi MO, Fasina O, Ogun OA, Ajayi BG. Prevalence of congenital colour vision deficiency among secondary school students in Ibadan, South-West Nigeria. Niger Postgrad Med J. 2016;23(2):93-6.
Nguyen-Tri D, Overbury O, Faubert J. The role of lenticular senescence in age-related color vision changes. Vision Res. 2003;44(3):3698-704.
Dittmar M. Changing colour preferences with ageing: a comparative study on younger and older native Germans aged 19-90 years. Gerontology. 2001; 47(4):219-26.
Ostadimoghaddam H, Yekta AA, Heravian J, Azimi A, Hosseini SM, Vatandoust S, et al.. Prevalence of Refractive Errors in Students with and without Color Vision Deficiency. J Ophthalmic Vis Res. 2014;9(4):484-6.
Tamura S, Sato K. Age-related changes in visual search: manipulation of colour cues based on cone contrast and opponent modulation space. Sci Rep. 2020;10(1):21328.
Parikh RS, Parikh SR, Sekhar GC, Prabakaran S, Babu JG, Thomas R. Normal age-related decay of retinal nerve fiber layer thickness. Ophthalmology. 2007;114(5):921-6.
Susanna R Jr, Medeiros FA. The optic nerve in glaucoma. 2nd ed. New Delhi: Jaypee Brothers; 2006.
Chiappe JP, Nahum P, Casiraghi JF, Iribarren R. Prevalence of disc cupping in non-glaucomatous eyes. Medicina (B Aires). 2015;75(1):6-10.
Dandona R, Dandona L. Refractive error blindness. Bull World Health Organ. 2001;79(3):237-43.
Chen X, Jiang Y, Fan Q, Li L, Lu W, Wang Y. Association of Axial Length and Refraction with Near Horizontal Heterophoria in Chinese Children: An Observational Cross-Sectional Study. J Ophthalmol. 2022;2022:7549851.
- Abstract Viewed: 73 times
- pdf Downloaded: 78 times
