Defining Grade 1 Ocular Toxicities and When to Prioritize Baseline Eye Exams While Using ADCs

In this segment, the panel offers practical guidance on identifying and grading early ocular toxicities in patients receiving antibody–drug conjugates (ADCs). Expert faculty explains that grade 1 symptoms—such as mild dryness, grittiness, intermittent blurry vision that improves with blinking, or subtle light sensitivity—generally signal superficial corneal changes and do not impair daily activities. These early symptoms should prompt clinicians to initiate the referral process to ophthalmology or optometry, even if an appointment may take several weeks.

The discussion then turns to whether ADC therapy should be delayed until after an eye exam. The ophthalmologist emphasizes the value of baseline assessments, noting that chemotherapy and prior cancer therapies commonly cause underlying ocular surface disease, making baseline documentation crucial for interpreting later changes. However, they also recognize the practical challenge of delaying urgently needed cancer treatment. The panelists highlight that some ADCs, such as mirvetuximab soravtansine and tisotumab vedotin, require baseline eye exams, whereas others—like datopotamab deruxtecan—allow treatment initiation with ophthalmologic evaluation soon after.