As Wilmer Eye Institute, Johns Hopkins Medicine’s ocular toxicity specialist, Meghan Berkenstock, M.D. is often one of the first medical professionals who can zero in on a trend of drugs causing problems in the medical system and determine how these issues can be treated in the eye. She shares her knowledge globally through publications and international presentations, visiting Colombia and Germany earlier this year to advance ophthalmology in its understanding of ocular toxicities.

We caught up with Berkenstock, who joined the Wilmer faculty in 2016, to learn about her interest in ocular toxicity, her work and what could be coming in the field.

How did you become interested in ocular toxicity?

I initially pursued ophthalmology because I enjoyed following patients over extended periods and found a passion for both surgery and medicine. Ophthalmology allowed me to merge these interests. I joined the ocular toxicity team at Hopkins, which combined my love for cataract surgery, uveitis patient care and partnering with medical sub-specialists. This marked the beginning of my focus on ocular toxicity.

As an ocular toxicity specialist, I monitor various medications, especially those used in clinical trials, and new drug developments. These medications can have side effects in the eye. My role involves staying at the forefront of these developments, identifying potential ocular toxicity trends, and then finding ways to treat them. I also write about these findings, contributing to the medical literature.

I'm excited about the potential to discover the "whys" behind eye conditions. Understanding the molecular and genetic basis of eye health can open up new avenues for prevention and treatment. It's a fascinating and promising aspect of my field.

You've been traveling internationally to present your findings. What's that experience like?

It's an incredible opportunity that Wilmer has provided me. Traveling the world to share my findings and engage with professionals from diverse cultures has been amazing. Wilmer has opened up doors that I had never thought were possible.

Earlier this year, you, along with colleagues Jennifer Thorne, M.D., Ph.D., and Bryn Burkholder, M.D., received the Clarkson Quality Improvement Award from the American Board of Ophthalmology for your commitment to high-quality patient care. What does this recognition mean to you?

The Clarkson Award is given yearly for an innovation in treatment with a broad reaching impact to promote the highest quality of care for our patients in ophthalmology, so it was an incredible honor. In addition to research on ocular toxicities, I also have studied ways to improve care for patients with ocular inflammation. These efforts led our uveitis division to improve treatment protocols by introducing a standardized set of tests for lab orders. This change has reduced missed or late lab draws for patients on high-risk immunosuppressive medications.

Are there any emerging issues or toxicities in ocular health that people should be aware of?

One notable issue is with antibody drug conjugates, a new class of medications. While they offer targeted treatment for cancer, they can also inadvertently affect the eye, particularly the cornea and conjunctiva. These medications are becoming more prevalent, and it's crucial for ophthalmologists and oncologists to be aware of the potential ocular complications.

For example, there were two medications that have recently been FDA approved for gynecologic malignancies — ovarian cancer and cervical cancer — and they can cause keratitis or conjunctivitis and can lead to ulceration.

How common are these issues, and how are they impacting patient care?

These complications affect approximately 50-80% of patients using these drugs, often leading to difficult decisions for both ophthalmologists and oncologists. Patients want these potentially life-saving treatments, but we need to assess the risks and benefits carefully. It's a new challenge for many doctors, requiring collaboration and expertise.

Where do you see opportunities for advancement or innovation in your specialty?

Ocular toxicity is an ever-evolving field. With new drugs constantly in development and expanding indications for existing medications, ophthalmologists need to pay attention. This can lead to advancements in understanding the intricacies of eye health and potentially prevent diseases instead of just treating them.