Neuro-ophthalmic complications of immune checkpoint inhibitor therapy: Current status and future directions

Since 2011, use of immune checkpoint inhibitors (ICI) in cancer immunotherapy dramatically expanded, both alone and combination with either a different treatment or two ICIs. With this increase have come myriad adverse effects from enhanced activation, including ophthalmic neurologic related events (irAE). Neuro-ophthalmic (NOirAE) associated ICIs are increasingly recognized their severity may actually limit potentially life-saving immunotherapy. NOirAEs comprise wide variety presentations involving the central peripheral nervous system. They cause afferent efferent visual dysfunction, among them optic neuropathy edema, orbital inflammatory disease, ocular myasthenia. While for irAEs typically involves immunosuppression corticosteroids, there is no expert consensus regarding best practices whether to stop ICI not. This state-of-the-art review explores pathophysiologic basis NOirAEs, provides framework categorizing within neuro-ophthalmology, discusses what needed close current knowledge gaps diagnosis management an increasing population patients requiring neuro-ophthalmic care.