Elsevier

Ophthalmology

Volume 116, Issue 4, April 2009, Pages 652-657
Ophthalmology

Original article
Use of Inhaled and Oral Corticosteroids and the Long-term Risk of Cataract

Presented at: Association for Research in Vision and Ophthalmology Annual Meeting, April 2008, Fort Lauderdale, Florida.
https://doi.org/10.1016/j.ophtha.2008.12.001Get rights and content

Objective

Longitudinal associations between inhaled and oral corticosteroid use and 10-year incident cataract were examined.

Design

Population-based cohort study.

Participants

The Blue Mountains Eye Study examined 3654 Australians aged 49 years or older (1992–1994); 2335 were re-examined after 5 years and 1952 were re-examined after 10 years (75.1%, 75.6% of survivors, respectively).

Methods

Questionnaires were used to assess inhaled and oral corticosteroid use at baseline. Past users were participants who had used these medications for at least 1 month in the past but were not using them at baseline. Current users were those who were using these medications at baseline and had been doing so for at least 1 month. Ever users combined past and current users.

Main Outcome Measures

Lens photographs were obtained at each examination and graded for nuclear, cortical, and posterior subcapsular (PSC) cataracts following the Wisconsin Cataract Grading System. Participants without a specific subtype of cataract in either eye at baseline were considered to be at risk of that type of cataract developing over the 10-year follow-up. Incidence of each cataract subtype in this report refers to person-specific, first-eye incidence.

Results

At baseline, 103 participants were current and 120 past users of inhaled corticosteroids, and 31 were current and 147 were past users of oral corticosteroids. Current users had a greater risk of developing PSC cataract after adjustment for age and gender (inhaled: odds ratio [OR] 2.50, 95% confidence interval [CI] 1.33–4.69; oral: OR 4.11; 95% CI 1.67–10.08) and nuclear cataract (inhaled: OR 2.04, 95% CI 1.21–3.43; oral: OR 3.45, 95% CI 1.26–9.43) but not cortical cataract. Interaction between inhaled and oral corticosteroid use was significant for PSC (P = 0.01) and nuclear (P = 0.02) cataract incidence. In subgroup analyses, only individuals who used both inhaled and oral steroids were at increased risk of PSC cataract (after adjusting for age, sex, smoking, hypertension, diabetes, and education levels; OR 4.76, 95% CI 2.59–8.74), comparing ever users of both with users of neither.

Conclusions

High long-term risks of PSC and nuclear cataract development were found for users of combined inhaled and oral corticosteroids.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients and Methods

The BMES is a population-based cohort study of vision and common eye and systemic conditions in a population aged 49 years and older, resident of a defined 2-postcode region west of Sydney, Australia. At baseline (1992–1994), 3654 (82.4% of eligible) persons participated. Surviving participants were invited to attend follow-up examinations after 5 (1997–1999) and 10 years (2002–2004). The study was approved by the University of Sydney and the Sydney West Area Health Service Human Research

Results

Of the original cohort of 3654 baseline participants, 2335 (63.9% of the original cohort; 75.1% of survivors) were reexamined after 5 years and 1952 (53.4% of the original cohort; 75.6% of survivors) were reexamined after 10 years. Thus, a total of 2564 participants were reexamined at least once after the baseline examination. After excluding participants with the corresponding cataract types at baseline and those with either missing or ungradable lens photographs, there were 2030 participants

Discussion

In this population-based cohort of older Australians, an adverse long-term risk of PSC and nuclear cataract subtypes associated with the use of both inhaled and oral corticosteroids was confirmed, particularly among persons who were current users at the baseline examinations. Further stratified analyses showed that the adverse influence of inhaled corticosteroids on the development of these 2 cataract subtypes was evident only among participants who had ever used oral corticosteroids in the

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    Manuscript no. 2008-981.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Supported by the Australian National Health & Medical Research Council, Canberra, Australia (grant nos.: 974159, 211069).

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