In a nation classified by the World Health Organization (WHO) under "high TB burden countries," the occurrence of Ethambutol-related Toxic Optic Neuropathy (ETON) must be closely monitored. With a sound national TB program that has increased the country’s TB case detection rate as well as treatment success rate over the years, the issue of adverse ocular effects of anti-TB treatment has yet to be clearly addressed. There is an urgent need for awareness of this condition in order to achieve early suspicion, detection, and prevention of irreversible damage to the visual system. This weblink project aims to gather nationwide data on ETON and describe its clinical profile in the country. Ultimately, the goal is to establish official recommendatory guidelines on monitoring the visual parameters of Filipino patients under TB treatment.

An Appeal to ALL Filipino EyeMDs

Outside the ophthalmic profession, many physicians and health-workers may not be fully aware of our experiences with ETON. Patients who experience blurring of vision from anti-TB treatment eventually end up seeking treatment in our clinics. Prescribing internists may not be notified of the occurrence of ETON. That we are seeing an anecdotal increase in the number of ETON cases must be transmitted to colleagues outside our specialty.

Ophthalmologists must take the lead in raising awareness of ETON locally. We cannot convince our colleagues unless we have the numbers, literally. By modest estimates based on our current TB incidence, there should be anywhere from 2,500 to 25,000 cases of ETON in the country each year. As the national fight against TB becomes more effective, will we see an upsurge in the cases of ETON in our clinics? Please submit your case reports so that the issue of ETON locally can transcend the level of “anecdotal” to evidence-based. The data we hope to gather from this registry will give a clearer picture of the actual incidence and clinical profile of ETON in the Philippines -- eventually forming the basis of official recommendatory practice guidelines on ETON. This can be jointly endorsed by the Philippine Academy of Ophthalmology (PAO), the Philippine Medical Association (PMA), and the Department of Health (DOH).

Please take some time to familiarize yourself with ETON by exploring this website. Available for your perusal are clinical materials that can help you detect and manage ETON cases in your clinics. There are several options on how to SUBMIT cases at your convenience. All it takes is a little time on your part to contribute to the success of this registry -- a truly worthwhile undertaking by the Filipino EyeMD.

This issue calls upon OUR profession. Let us set an example. Let us all contribute to this registry.

Richard C. Kho, MD
NOCP President
May 20, 2009