Q:  Lamictal & Myopia

I was diagnosed with BP II in january 05 as well as ADHD several months later. I have responded well to a relatively low dose of lamictal (50mg day) I also have been taking 500 mg of metformin 3x day for several years to treat insulin resistance.  Shortly before starting on the lamictal I had my eyes checked and got a new prescription for my glasses because my myopia had continued a pattern of lessening.  Looking back, the subsequent trouble I had seeing started almost immediately after starting on the lamictal, but my insurance coverage was exhausted and my psychiatrist didn't warn me about ocular side effects so I didn't get my eyes checked until things got so bad I had no choice.  My myopia had increased drastically and after doing some research it looks like this is from the lamictal(15.5% of the epileptics who have side effects from this drug have increased myopia).  Recent blood work ruled out diabetes or other metabolic causes.  However I could only find limited information on this side effect. 
 
My questions are these:  is this a progressive side effect causing me to continue to lose visual acuity as long as I stay on this med? And is it permanent or will my vision revert if I go off the drug?  Finally, what other options are there if I need to discontinue the lamictal?

I am an artist and educator and my livelihood as well as quality of life are dependent on my visual perception and acuity.  I need to be able to make educated decisions about what to do, and any light you can shed on this would be greatly appreciated.
Thank you,


Dear Ms. G' -- 
Could you send me the source for that information on 15.5% getting increased myopia? I hadn't heard that one, didn't find it with my usual search approach.  Diplopia (double vision; versus myopia, nearsightedness), as a side effect, yes, I know about that one and see that in the literature at 15% -- in a report from a neurologist where they use much higher doses than we psychiatrists usually use, and certainly than your dose. Yet that's really irrelevant to your concern about myopia -- but I can't find any such data as you're quoting here.  "Blurred vision" is reported, and that could certainly be akin to what you're describing. This is listed as a common cause of treatment discontinuation (e.g. this summary), although none of my patients have ever had to do so for this reason. How about we pick up this thread next week with a look at your source?  If you'll write back here, same place, we'll take it from there. 

Dr. Phelps

Published February, 2006