Findings published in the American Journal of Ophthalmology investigated the association between corticosteroid exposure and the risk of cataract development.
Let’s start with some background.
A link between systemic corticosteroids and cataracts has been reported for decades.
However, recent attention has been placed on the possible association between inhaled corticosteroids (ICS), used to treat chronic obstructive pulmonary disease (COPD) and asthma, and cataract development.
And the goal of this research?
While ICS likely have a lower chance of leading to cataracts than systemic corticosteroids, there is not enough research to confirm this.
Thus, this research sought to provide an updated overview on the association between cataract development and ICS use for COPD and asthma to provide greater knowledge regarding treatments for COPD and asthma patients.
Tell me about it.
Study authors ran a meta-analysis that examined risk of cataract development in accordance with corticosteroid use for asthma and COPD. The outcome variable of interest was the risk of cataract development.
Separate analyses were conducted for each type of study—cohort, cross-sectional, and case-control. Researchers also noted whether corticosteroids were systemic and/or inhaled.
A meta-regression was also conducted to observe the dose-response of ICS.
And the inclusion criteria?
Studies that met the following inclusion criteria were included:
- Original research regarding the risk of cataract development in patients prescribed corticosteroid for asthma and/or COPD
- Published within the last three decades
- English publications
- Reported odds ratio (OR) on cataract risk for asthma/COPD patients prescribed systematic/inhaled corticosteroids
The study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
So how many studies were identified?
A total of 19 out of 2,793 initial studies were included in the systematic review with a total of 1,274,878 individuals. Of this sample, 5% had cases of cataract and 78% were asthma and/or COPD patients prescribed corticosteroids.
Twelve of these studies were included in the meta-analysis. Odds ratio was reported as the most common effect size.
And the number who received treatment?
- Corticosteroids: 1,307 patients (1,368 eyes)
- NSAIDs: 1,479 patients (1,546 eyes)
- Combo: 687 patients (724 eyes)
Findings?
Patients prescribed asthma and COPD with ICS had a doubled risk of developing cataracts, according to the meta-analysis.
All studies included in the systematic review found that an average daily dose greater than 1,000 μg of ICS was associated with a significant increase in the risk of developing cataract.
How about the meta-regression results?
The meta-regression found a significant dose-response relationship between corticosteroid usage and cataract development.
What about IOP and complications?
A comparable rate of complications was noted among the NSAIDs and corticosteroids groups in five studies.
Similarly, IOP was comparable between these same groups at Day 1, 7, and 4 to 6 weeks, as well as between combination and corticosteroids groups at 4 weeks.
Any limitations?
A few …. Some studies did not define asthma or COPD.
Further, the observational design of the studies may have made it more difficult to identify associations with observational studies; it also made the findings more susceptible to bias.
Expert opinion?
High doses of corticosteroids significantly increases the risk of cataract development, and oral corticosteroids lead to a higher risk of cataract development than inhaled corticosteroids alone.
Patients who are prescribed high doses of corticosteroids can be screened for cataracts as a preventative measure. Study authors emphasized that “more research is needed on the best-possible corticosteroid treatment strategies.”