Digitalis-Induced Visual Disturbances with Therapeutic Serum Digitalis Concentrations

1 November 1995 | Volume 123 Issue 9 | Pages 676-680

Objective: To assess the role of digitalis in the development of visual symptoms severe enough to warrant ophthalmologic consultation in patients who received digitalis and who had no other clinical or laboratory evidence of digitalis toxicity.

Design: Clinical case study.

Setting: Neuro-ophthalmology referral practice.

Patients: Six elderly patients (aged 66 to 85 years) who received digitalis were referred to ophthalmologists for evaluation of photopsia (five patients) or decreased visual acuity (one patient). No patient had chromatopsia or nonvisual clinical manifestations of digitalis intoxication at the time of examination.

Measurements: All patients had serum digitalis concentrations within or below the therapeutic range. In most patients, the electroretinographic cone b-wave implicit time was longer than normal.

Results: Discontinuation of digitalis therapy, which was possible in five patients, was followed by resolution of visual symptoms and by shortening of the b-wave implicit time. Characteristic features of digitalis-induced photopsia were its dependence on illumination and its tendency to be localized in peripheral visual fields.

Conclusions: In an elderly patient receiving digitalis, the development of photopsia characterized by innumerable points of light in the peripheral visual fields or a decrease in visual acuity raises the possibility that the patient's visual disturbance may have been digitalis induced. Digitalis-induced visual disturbances other than chromatopsia or disturbances of color vision may occur in elderly patients who have no other clinical manifestations of digitalis intoxication and who have a serum digitalis concentration within or below the therapeutic range.

Author and Article Information

From the Columbia-Presbyterian Medical Center, New York, New York; and University of Iowa and Veterans Affairs Hospital, Iowa City, Iowa.
Acknowledgments: The authors thank Dr. Scott Brody for doing the electroretinogram in patient 2; and Dr. J. Thomas Bigger, Jr., for his comments on the manuscript.
Grant Support: In part by research grants from the National Institutes of Health (R01 HL 10608-27, R01 EY 04138-10), an unrestricted grant from Research to Prevent Blindness (New York, New York), a generous gift from Dr. Frank D. Carroll, and a Veterans Affairs Merit Review Grant and Career Development Award. Dr. Kardon is the recipient of a James S. Adams Special Scholar Award from Research to Prevent Blindness.
Requests for Reprints: Vincent P. Butler Jr., MD, Department of Medicine, Columbia University College of Physicians & Surgeons, 630 West 168th Street, New York, NY 10032.
Current Author Addresses: Dr. Butler: Department of Medicine, Columbia University College of Physicians & Surgeons, 630 West 168th Street, New York, NY 10032.