Prolonged use of ethambutol leads to vision loss in TB patients, says study by doctors of LV Prasad Eye Institute
Published in the Indian Journal of Ophthalmology, the study reveals that prolonged use of ethambutol, which is used as part of India's TB treatment programme due to its relatively low toxicity, combined with higher dosages, is linked to a sharp rise in cases of ethambutol-induced toxic optic neuropathy (ETON). It is a condition that damages the optic nerve and impacts vision.
The study also pointed out that the Central govt's National TB Elimination Programme (NTEP), which is implemented across the country, including in Telangana, uses ethambutol extensively.
In 2016, the NTEP extended the use of ethambutol from two to six months and also increased the dosage frequency to once daily from thrice a week. Since then, the ETON cases increased sixfold within three years.
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During the research, the LVPEI doctors examined 107 patients suffering from ETON, with around 58% of them being middle-aged (36 to 55 years), who took the drug for seven consecutive months. Doctors found that almost all of the patients experienced severe vision loss in both eyes, with the elderly (above 60 years) being the worst affected, despite the low toxicity levels of the drug.
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However, after they discontinued ethambutol, an 11-month follow-up found that the vision clarity of the patients started improving, except for the elderly.
'ETON has become more common and can lead to severe vision loss, especially in the elderly, individuals with low body weight, and those with kidney problems (renal dysfunction). Symptomps include change in vision, contrast or colour vision. There are smartphone-based apps which the patients can use to check vision and colour vision at home.
Dosage should be recommended as per body weight, age and kidney function.
Careful monitoring and early discontinuation of the drug are essential to prevent vision loss,' said Dr Virender Sachdeva, one of the authors.
In March this year, the World Health Organisation (WHO) pointed out that while India showed significant progress in reducing TB cases and improved treatment coverage, it is unlikely to meet the 2025 target set by the WHO's 'End TB Strategy'.
WHO's Global Tuberculosis Report 2024 stated that India had 26% of global TB cases and 26% of global deaths in 2023, the highest in the world.
According to officials in the Telangana health, family, and welfare dept, currently around 81 lakh people of the over 3.5 crore population (20%) in Telangana are TB-prone, with 10 lakh alone in Hyderabad. Official numbers tabled in Parliament showed that Telangana recorded 1.37 lakh TB cases and 2,663 deaths from July 2023 to Dec 2024.
Noting that the findings of the study will be reviewed, senior officials of the TB programme, health dept, said, 'After completing the 100-day action plan, we again launched a continuous plan in June this year to boost TB screening, awareness, and care in Hyderabad, rural areas, and urban slums. Special emphasis is being given to people above 60 years, those who drink and smoke, previous TB patients, family members of the present TB patients, and people with comorbidities.
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