Defining the Roles of Ophthalmologists and Optometrists in Managing ADC-Related Ocular Toxicities

In this segment, the expert faculty examines how medical oncologists should determine whether patients experiencing ocular toxicities from antibody–drug conjugates (ADCs) should be referred to optometry or ophthalmology. The panel highlights that this remains an evolving discussion across oncology and eye care. They explain that optometrists are well equipped to handle baseline eye exams and early-stage ocular adverse events—such as mild dry eye, early superficial keratopathy, or subtle vision fluctuations. Expert faculty emphasizes that many community optometrists provide exceptionally thorough evaluations and are fully capable of managing uncomplicated cases.

However, the panel stresses that more significant symptoms—such as marked vision changes, acute light sensitivity, severe keratitis, or rapidly progressive findings—warrant referral directly to ophthalmology. They note that optometrists should feel comfortable escalating care when needed. For baseline assessments, either provider type is acceptable, as long as a complete exam is performed; having documented baseline findings greatly aids ophthalmologists when evaluating later toxicities.