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.
Received 15 August 2008; received in revised form 31 October 2008; accepted 1 December 2008. published online 25 February 2009.
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.
Available online: February 25, 2009.
1Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, Australia
2Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne, Melbourne, Australia
3School of Public Health, University of Sydney, Sydney, Australia
4Menzies Centre for Health Policy, Faculty of Medicine, University of Sydney, Australia
Correspondence: Jie Jin Wang, MMed, PhD, Centre for Vision Research, Westmead Millennium Institute, University of Sydney, Westmead Hospital, Westmead, NSW, Australia, 2145
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).
ABSTRACT