How would you approach a postmenopausal patient on Letrozole who developed cataracts within the first six months of treatment?

While tamoxifen has been associated with ocular toxicity like cataracts, there has not been any conclusive or convincing connection between aromatase inhibitors and cataracts.

Since the alternative to aromatase inhibitors is tamoxifen which we know may be associated with cataracts, and given the lack of evidence to the same with aromatase inhibitors, I would not discontinue or switch from letrozole for that purpose only. The timing of the diagnosis of cataracts might have been a coincidence rather than a causal connection.

Of course, the decision needs to be made jointly with the patient after proper discussion.