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Retinal Physician

Article

Standardizing Ocular Toxicity Grading for ADCs

Updated, anatomically specific scales aim to improve consistency in assessing ocular adverse events and guide dose modification in oncology trials. Physicians say their use in the real world remains variable.

Sarah Fackler, managing editor, Optometric Management
Retinal Physician February 1, 2026

Clinical Scorecard: Standardizing Ocular Toxicity Grading for ADCs

At a Glance

CategoryDetail
ConditionOcular toxicity associated with antibody-drug conjugates (ADCs)
Key MechanismsImproved consistency in assessing ocular adverse events and guiding dose modification
Target PopulationPatients receiving ADC therapies in oncology
Care SettingOncology trials and clinical practice

Key Highlights

  • Anatomically specific grading scales improve assessment consistency
  • Ocular toxicity occurs in up to 90% of patients on certain ADCs
  • New scales separate objective signs from subjective symptoms
  • Dose modifications guided by new scales have not resulted in irreversible ocular toxicity
  • High agreement with new scales compared to previous CTCAE version

Guideline-Based Recommendations

Diagnosis

  • Use anatomically specific terminology for ocular signs and symptoms
  • Incorporate clinical photographs for better assessment

Management

  • Provide explicit recommendations for dose modification based on grading
  • Consider dose delay, reduction, or discontinuation based on severity

Monitoring & Follow-up

  • Regular assessment of ocular symptoms and signs during ADC treatment
  • Document findings and communicate with medical oncologists

Risks

  • Potential for premature discontinuation of ADC therapy due to inconsistent grading
  • Awareness of novel ocular complications from ADCs and checkpoint inhibitors

Patient & Prescribing Data

Patients with cancer receiving ADC therapies

Conservative management of ocular AEs can often avoid treatment discontinuation

Clinical Best Practices

  • Utilize the new grading scales for assessing ocular toxicity in ADC patients
  • Maintain good communication with medical oncologists regarding patient management
  • Document ocular findings thoroughly and maintain a detailed drug treatment history

References