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Ocular Safety Pilot Results

Robert D. Fechtner, MD; Albert S. Khouri, MD; Emilia Figueroa, MD; Marina Ramirez, MD; Martha Federico, LSW; Stephen L. Dewey, PhD; Jonathan D. Brodie, MD, PhD

Arch Ophthalmol. 2006;124:1257-1262.

Objective  To evaluate the ocular safety of short-term use of vigabatrin to treat cocaine and/or methamphetamine addiction.

Methods  Individuals who were actively using cocaine and/or methamphetamine were eligible for enrollment. Enrolled subjects were scheduled for comprehensive eye examinations at the beginning and end of the study. Visual field testing was performed at baseline and 1 week, 4 weeks, 8 weeks, and 1 month or more after discontinuing vigabatrin. Twenty-eight subjects received at least 1 dose of vigabatrin; however, only 20 subjects continued beyond the initial escalating vigabatrin dose phase to the treatment phase. Of these 20 subjects, 18 completed the study with full follow-up. Visual fields were evaluated subjectively by 2 glaucoma specialists and analyzed objectively for group and individual changes in quadrant mean sensitivity. The objective analysis was also repeated for superior field quadrants after excluding the uppermost peripheral points to minimize the eyelid effect. The main outcome measures were change of visual field, visual acuity, and ocular adverse effects.

Results  Vigabatrin seemed to help treat cocaine and/or methamphetamine addiction. Of 18 subjects, 16 had negative test results for cocaine and methamphetamine use during the last 6 weeks of the trial. No ocular adverse events were detected. The subjective evaluation did not reveal visual field constriction in any of the 18 evaluable participants. Objective group and individual analyses for quadrant mean sensitivity did not show any change from baseline in any quadrant. No changes in visual acuity were noted.

Conclusions  In this short-term pilot study, vigabatrin seemed to help treat cocaine and/or methamphetamine abuse. There was no evidence of ocular or visual field adverse effects.

Author Affiliations: Institute of Ophthalmology and Visual Science, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark (Drs Fechtner and Khouri); Codet Aris Vision Institute, Tijuana, Mexico (Drs Figueroa and Ramirez and Ms Federico); Department of Psychiatry, NYU School of Medicine, New York (Drs Dewey and Brodie); and Chemistry Department, Brookhaven National Laboratory, Upton, NY (Dr Dewey).

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