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Answer 4
  1. Changes in vision are self-limited; continue sildenafil or switch to a different PDE-5 inhibitor. Sildenafil has a strong affinity for the PDE-5 enzyme but a weaker affinity for the PDE-6 enzyme. The PDE-6 enzyme is found in rod and cone photoreceptors, and the resultant increase in cyclic guanosine monophosphate in these cells can cause moderate transient visual symptoms, such as photosensitivity, bluish hues, and blurred vision. Unless the patient cannot tolerate symptoms, a change in medication is not necessary. Switching to vardenafil or tadalafil may cause less visual disturbances. Discontinuing sildenafil and referral to an ophthalmologist are not necessary in this case.

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