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After treatment and remission

Eyes

Leukaemia treatment can sometimes affect the eyes years later — most often as cataracts and dry eye. This topic explains why, the signs and how the eyes are checked.

Last updated: ~3 min read
Glowing clear and misty discs side by side.
Figure 1.A clear lens and a clouded lens.

01Short answer

Three kinds of treatment mainly affect the eyes. First, steroids (dexamethasone, prednisolone), used for long periods in ALL treatment, can cause cataracts — clouding of the lens of the eye. Second, total body irradiation or cranial radiation also raise cataract risk; the higher the dose, the higher the risk. Third, chronic graft-versus-host disease (GVHD) after a stem cell transplant can affect the tear glands and cause dry eye (topic “Chronic GVHD”). A cataract develops gradually: vision becomes blurred, there is glare and night vision gets harder. It is treated with a simple, safe operation. Dry eye causes a gritty feeling, burning and redness; lubricating drops and other treatments help. The COG recommends a yearly vision check and regular eye specialist reviews for people at risk.

02Simple explanation

Main risks: steroids, radiation, chronic GVHD.

Most common: cataract and dry eye.

Cataract: blurred vision, glare.

Cataracts are treated with surgery.

Follow-up: a yearly eye check.

03Scientific explanation

Cataract: the COG notes a higher cataract risk after steroids, cranial radiation and total body irradiation; a yearly vision check and eye specialist review are recommended.

Radiation dose: according to the NCI, the lens is very sensitive to radiation; after total body irradiation cataracts usually develop within a few years.

Dry eye: according to the NEI, tears are either too few or evaporate too quickly; after transplant, chronic GVHD is a major cause.

Treatment: according to the NEI and NHS, cataract surgery replaces the cloudy lens with an artificial one; it is one of the most common and safest operations.

04What happens in the body?

What is a cataract?

It is clouding of the lens. The normally clear lens gradually becomes misty, so light does not reach the back of the eye clearly.

Which treatment affects the eyes?

Long-term steroids, cranial radiation and total body irradiation. After transplant, chronic GVHD can cause dry eye.

Dry eye

A gritty feeling, burning, redness, watering and sensitivity to light. The tear film protects and moistens the surface of the eye.

A thin shimmering layer on a smooth surface.
Figure 2.The tear film keeps the eye moist.

How are the eyes checked?

Visual acuity is tested and the eye specialist looks at the lens and eye surface with a special light (slit lamp); the back of the eye is checked if needed.

A beam of light directed at a round eye shape.
Figure 3.An eye examination — Eyes

Treatment and protection

When a cataract interferes with vision, it is operated on. For dry eye, your doctor can suggest lubricating drops and other methods. Sunglasses protect the eyes from ultraviolet light.

When to call your doctor

Worrying signs — fever, bleeding, new pain, breathlessness — should be reported to your doctor between visits too. Getting in touch early is always better than waiting.

05Eye follow-up

Steps.

Notice — Blurred vision, glare.1NoticeBlurred vision, glare.
Relief — Drops for dry eye (with your doctor).2ReliefDrops for dry eye (with your doctor).
Check — Regular eye specialist visits.3CheckRegular eye specialist visits.
Protect — Sunglasses, a hat.4ProtectSunglasses, a hat.
VisionVision is protected.
ComfortDry eye eases.
ProtectionEyes are shielded.

06Late effects on the eyes (simplified)

ProblemCauseWhat is done
CataractSteroids, radiationExam, surgery if needed
Dry eyeChronic GVHD, radiationDrops, eye specialist
Retina changesRadiation (rare)Eye specialist exam
InfectionWeak immunityUrgent review

* Your doctor decides which eye checks you need.

07Key terms

Lens
The clear structure inside the eye that focuses light.
Cataract
Clouding of the lens.
Dry eye
Not enough tears.
Ophthalmologist
An eye doctor.
Slit lamp
A device that shows the eye magnified.
GVHD
A reaction of donor cells against the body.

08Key points

  • Steroids and radiation raise cataract risk.
  • Report blurred vision.
  • Cataracts are treated with surgery.
  • Dry eye can be treated.
  • Have a yearly eye check.
  • Protect your eyes from the sun.

09Frequently asked questions

Will a cataract make me lose my sight completely?

No; surgery usually restores vision well.

Will I need glasses?

Sometimes; the eye specialist will decide.

Which drops should I use?

Choose drops together with your doctor.

Can I wear contact lenses?

With dry eye and after transplant, ask your doctor first.

Does this information replace medical advice?

No. This is general education; only your treating doctor can assess your situation.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. Will a cataract make me lose my sight completely?

  2. Will I need glasses?

  3. Which drops should I use?

  4. Can I wear contact lenses?

  5. Does this information replace medical advice?

My questions

12Sources

  1. Children's Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers
  2. National Cancer Institute (NCI). Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version
  3. National Eye Institute. Cataracts
  4. National Eye Institute. Dry Eye
  5. MedlinePlus (U.S. National Library of Medicine). Cataract
  6. NHS. Cataracts
  7. National Cancer Institute (NCI). Follow-Up Medical Care
  8. National Cancer Institute (NCI). Cancer Survivorship
  9. Cancer.Net (ASCO). Follow-Up Care After Cancer Treatment
  10. Leukemia & Lymphoma Society (LLS). Long-Term and Late Effects of Treatment
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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