Background The use of systemic corticosteroids is a risk factorfor the development of posterior subcapsular cataracts, butthe association between inhaled corticosteroids and cataractsis uncertain.
Methods We conducted a population-based, cross-sectional studyof vision and common eye diseases in an urban area of the BlueMountains, near Sydney, Australia. We recruited 3654 people49 to 97 years of age; the participation rate was 82 percent.We collected information by questionnaire on potential riskfactors for cataracts, including the current or prior use ofinhaled corticosteroids (beclomethasone or budesonide). Photographsof the subjects' lenses were graded, without information onthe subjects, to determine the presence and severity of cortical,nuclear, and posterior subcapsular cataracts.
Results Three hundred seventy subjects reported using inhaledcorticosteroids, 164 currently and 206 previously. Among thesesubjects, after adjustment for age and sex, there was a higherprevalence of nuclear cataracts (relative prevalence, 1.5; 95percent confidence interval, 1.2 to 1.9) and posterior subcapsularcataracts (relative prevalence, 1.9; 95 percent confidence interval,1.3 to 2.8) than among the subjects with no inhaled-corticosteroiduse, but the prevalence of cortical cataracts was not significantlyhigher (relative prevalence, 1.1; 95 percent confidence interval,0.9 to 1.3). Higher cumulative lifetime doses of beclomethasonewere associated with higher risks of posterior subcapsular cataracts(P for trend <0.001); the highest prevalence (27 percent)was found in subjects whose lifetime dose was over 2000 mg (relativeprevalence, 5.5). Adjusting for the use of systemic corticosteroidsand other potential confounders had little effect on the magnitudeof the associations. The associations with posterior subcapsularcataracts, but not those with nuclear cataracts, were less markedwhen the analyses were restricted to subjects who had neverused systemic corticosteroids.
Conclusions The use of inhaled corticosteroids is associatedwith the development of posterior subcapsular and nuclear cataracts.
Source Information
From the Departments of Public Health and Community Medicine (R.G.C., S.R.L.) and Ophthalmology (P.M.), University of Sydney, and Westmead Hospital (P.M.) — both in Sydney, Australia.
Address reprint requests to Dr. Cumming at the Department of Public Health and Community Medicine, Bldg. A27, University of Sydney, Sydney, NSW 2006, Australia.
Suissa, S.
(2008). Medications to Modify Lung Function Decline in Chronic Obstructive Pulmonary Disease: Some Hopeful Signs. Am. J. Respir. Crit. Care Med.
178: 322-323
[Full Text]
Sun, C., Liew, G., Wang, J. J., Mitchell, P., Saw, S. M., Aung, T., Tai, E. S., Wong, T. Y.
(2008). Retinal Vascular Caliber, Blood Pressure, and Cardiovascular Risk Factors in an Asian Population: The Singapore Malay Eye Study. IOVS
49: 1784-1790
[Abstract][Full Text]
Liew, G., Mitchell, P., Wong, T. Y., Iyengar, S. K., Wang, J. J.
(2008). CKD Increases the Risk of Age-Related Macular Degeneration. J. Am. Soc. Nephrol.
19: 806-811
[Abstract][Full Text]
Bateman, E. D., Hurd, S. S., Barnes, P. J., Bousquet, J., Drazen, J. M., FitzGerald, M., Gibson, P., Ohta, K., O'Byrne, P., Pedersen, S. E., Pizzichini, E., Sullivan, S. D., Wenzel, S. E., Zar, H. J.
(2008). Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J
31: 143-178
[Abstract][Full Text]
Chapman, K. R.
(2008). Safer Inhaled Corticosteroid Therapy for Asthma. Pediatrics
121: 179-180
[Full Text]
Suissa, S., McGhan, R., Niewoehner, D., Make, B.
(2007). Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc
4: 535-542
[Abstract][Full Text]
Liew, G., Sharrett, A. R., Kronmal, R., Klein, R., Wong, T. Y., Mitchell, P., Kifley, A., Wang, J. J.
(2007). Measurement of Retinal Vascular Caliber: Issues and Alternatives to Using the Arteriole to Venule Ratio. IOVS
48: 52-57
[Abstract][Full Text]
Klein, B. E. K., Klein, R., Lee, K. E., Grady, L. M.
(2006). Statin Use and Incident Nuclear Cataract. JAMA
295: 2752-2758
[Abstract][Full Text]
Ernst, P., Baltzan, M., Deschenes, J., Suissa, S.
(2006). Low-dose inhaled and nasal corticosteroid use and the risk of cataracts. Eur Respir J
27: 1168-1174
[Abstract][Full Text]
Gartlehner, G., Hansen, R. A., Carson, S. S., Lohr, K. N.
(2006). Efficacy and Safety of Inhaled Corticosteroids in Patients With COPD: A Systematic Review and Meta-Analysis of Health Outcomes. Ann Fam Med
4: 253-262
[Abstract][Full Text]
Leeder, S. R., Mitchell, P., Liew, G., Rochtchina, E., Smith, W., Wang, J. J.
(2006). Low Hemoglobin, Chronic Kidney Disease, and Risk for Coronary Heart Disease-Related Death: The Blue Mountains Eye Study. J. Am. Soc. Nephrol.
17: 279-284
[Abstract][Full Text]
Wechsler, M. E., Israel, E.
(2005). How Pharmacogenomics Will Play a Role in the Management of Asthma. Am. J. Respir. Crit. Care Med.
172: 12-18
[Full Text]
Chu, E. K., Drazen, J. M.
(2005). Asthma: One Hundred Years of Treatment and Onward. Am. J. Respir. Crit. Care Med.
171: 1202-1208
[Abstract][Full Text]
Malerba, M., Bossoni, S., Radaeli, A., Mori, E., Bonadonna, S., Giustina, A., Tantucci, C.
(2005). Growth Hormone Response to Growth Hormone-Releasing Hormone Is Reduced in Adult Asthmatic Patients Receiving Long-term Inhaled Corticosteroid Treatment. Chest
127: 515-521
[Abstract][Full Text]
Scanlon, P. D., Connett, J. E., Wise, R. A., Tashkin, D. P., Madhok, T., Skeans, M., Carpenter, P. C., Bailey, W. C., Buist, A. S., Eichenhorn, M., Kanner, R. E., Weinmann, G., the Lung Health Study Research Group,
(2004). Loss of Bone Density with Inhaled Triamcinolone in Lung Health Study II. Am. J. Respir. Crit. Care Med.
170: 1302-1309
[Abstract][Full Text]
Tattersfield, A. E., Harrison, T. W., Hubbard, R. B., Mortimer, K.
(2004). Safety of Inhaled Corticosteroids. Proc Am Thorac Soc
1: 171-175
[Abstract][Full Text]
Sin, D. D., Man, J., Sharpe, H., Gan, W. Q., Man, S. F. P.
(2004). Pharmacological Management to Reduce Exacerbations in Adults With Asthma: A Systematic Review and Meta-analysis. JAMA
292: 367-376
[Abstract][Full Text]
Roland, N. J., Bhalla, R. K., Earis, J.
(2004). The Local Side Effects of Inhaled Corticosteroids: Current Understanding and Review of the Literature. Chest
126: 213-219
[Abstract][Full Text]
Phillips, K, Oborne, J, Lewis, S, Harrison, T W, Tattersfield, A E
(2004). Time course of action of two inhaled corticosteroids, fluticasone propionate and budesonide. Thorax
59: 26-30
[Abstract][Full Text]
Leone, F. T., Fish, J. E., Szefler, S. J., West, S. L.
(2003). Systematic Review of the Evidence Regarding Potential Complications of Inhaled Corticosteroid Use in Asthma: Collaboration of American College of Chest Physicians, American Academy of Allergy, Asthma, and Immunology, and American College of Allergy, Asthma, and Immunology. Chest
124: 2329-2340
[Abstract][Full Text]
Bijlsma, J W J, Boers, M, Saag, K G, Furst, D E
(2003). Glucocorticoids in the treatment of early and late RA. Ann Rheum Dis
62: 1033-1037
[Full Text]
Purucker, M. E., Rosebraugh, C. J., Zhou, F., Meyer, R. J.
(2003). Inhaled Fluticasone Propionate by Diskus in the Treatment of Asthma: A Comparison of the Efficacy of the Same Nominal Dose Given Either Once or Twice a Day. Chest
124: 1584-1593
[Abstract][Full Text]
Smeeth, L, Boulis, M, Hubbard, R, Fletcher, A E
(2003). A population based case-control study of cataract and inhaled corticosteroids. Br. J. Ophthalmol.
87: 1247-1251
[Abstract][Full Text]
Solomon, R., Donnenfeld, E. D.
(2003). Recent Advances and Future Frontiers in Treating Age-Related Cataracts. JAMA
290: 248-251
[Full Text]
Sin, D.D., Man, S.F.P.
(2003). Inhaled corticosteroids and survival in chronic obstructive pulmonary disease: does the dose matter?. Eur Respir J
21: 260-266
[Abstract][Full Text]
Panchapakesan, J, Mitchell, P, Tumuluri, K, Rochtchina, E, Foran, S, Cumming, R G
(2003). Five year incidence of cataract surgery: the Blue Mountains Eye Study. Br. J. Ophthalmol.
87: 168-172
[Abstract][Full Text]
Austin, R.J.H., Maschera, B., Walker, A., Fairbairn, L., Meldrum, E., Farrow, S.N., Uings, I.J.
(2002). Mometasone furoate is a less specific glucocorticoid than fluticasone propionate. Eur Respir J
20: 1386-1392
[Abstract][Full Text]
Younan, C., Mitchell, P., Cumming, R. G., Rochtchina, E., Wang, J. J.
(2002). Myopia and Incident Cataract and Cataract Surgery: The Blue Mountains Eye Study. IOVS
43: 3625-3632
[Abstract][Full Text]
Sin, D. D., Man, S. F. P.
(2002). Low-Dose Inhaled Corticosteroid Therapy and Risk of Emergency Department Visits for Asthma. Arch Intern Med
162: 1591-1595
[Abstract][Full Text]
Cates, C.
(2001). Extracts from ""Clinical Evidence"": Chronic asthma. BMJ
323: 976-979
[Full Text]
Schlienger, R. G., Haefeli, W. E., Jick, H., Meier, C. R.
(2001). Risk of Cataract in Patients Treated With Statins. Arch Intern Med
161: 2021-2026
[Abstract][Full Text]
O'BRIEN, A., RUSSO-MAGNO, P., KARKI, A., HIRANNIRAMOL, S., HARDIN, M., KASZUBA, M., SHERMAN, C., ROUNDS, S.
(2001). Effects of Withdrawal of Inhaled Steroids in Men with Severe Irreversible Airflow Obstruction. Am. J. Respir. Crit. Care Med.
164: 365-371
[Abstract][Full Text]
Harrison, T W, Wisniewski, A, Honour, J, Tattersfield, A E
(2001). Comparison of the systemic effects of fluticasone propionate and budesonide given by dry powder inhaler in healthy and asthmatic subjects. Thorax
56: 186-191
[Abstract][Full Text]
(2000). Question from the Clinician. Pediatr. Rev.
21: 393-394
[Full Text]
The Childhood Asthma Management Program Research G,
(2000). Long-Term Effects of Budesonide or Nedocromil in Children with Asthma. NEJM
343: 1054-1063
[Abstract][Full Text]
Suissa, S., Ernst, P., Benayoun, S., Baltzan, M., Cai, B.
(2000). Low-Dose Inhaled Corticosteroids and the Prevention of Death from Asthma. NEJM
343: 332-336
[Abstract][Full Text]
Lai, H.-C., FitzSimmons, S. C., Allen, D. B., Kosorok, M. R., Rosenstein, B. J., Campbell, P. W., Farrell, P. M.
(2000). Risk of Persistent Growth Impairment after Alternate-Day Prednisone Treatment in Children with Cystic Fibrosis. NEJM
342: 851-859
[Abstract][Full Text]
Hampson, J P, Harvey, J N
(2000). A systematic review of drug induced ocular reactions in diabetes. Br. J. Ophthalmol.
84: 144-149
[Abstract][Full Text]
(2000). The use of inhaled corticosteroids in adults with asthma. DTB
38: 5-8
[Abstract][Full Text]
(1999). Inhaled glucocorticosteroids in adults and children. CMAJ
161: s24-28
[Full Text]
Mitchell, P., Wang, J. J., Hourihan, F.
(1999). The Relationship Between Glaucoma and Pseudoexfoliation: The Blue Mountains Eye Study. Arch Ophthalmol
117: 1319-1324
[Abstract][Full Text]
Reid, I. R.
(1999). Glucocorticoid Osteoporosis: Reid IR Glucocorticoid osteoporosis J Intensive Care Med 1999, 14231-242. J Intensive Care Med
14: 231-242
Löfdahl, C.-G., Reiss, T. F, Leff, J. A, Israel, E., Noonan, M. J, Finn, A. F, Seidenberg, B. C, Capizzi, T., Kundu, S., Godard, P.
(1999). Randomised, placebo controlled trial of effect of a leukotriene receptor antagonist, montelukast, on tapering inhaled corticosteroids in asthmatic patients. BMJ
319: 87-90
[Abstract][Full Text]
DEROM, E., VAN SCHOOR, J., VERHAEGHE, W., VINCKEN, W., PAUWELS, R.
(1999). Systemic Effects of Inhaled Fluticasone Propionate and Budesonide in Adult Patients with Asthma. Am. J. Respir. Crit. Care Med.
160: 157-161
[Abstract][Full Text]
Kupersmith, M. J, Langer, R., Mitnick, H., Spiera, R., Spiera, H., Richmond, M., Paget, S.
(1999). Visual performance in giant cell arteritis (temporal arteritis) after 1 year of therapy. Br. J. Ophthalmol.
83: 796-801
[Abstract][Full Text]
Lipworth, B. J.
(1999). Systemic Adverse Effects of Inhaled Corticosteroid Therapy: A Systematic Review and Meta-analysis. Arch Intern Med
159: 941-955
[Abstract][Full Text]
Malmstrom, K., Rodriguez-Gomez, G., Guerra, J., Villaran, C., Pineiro, A., Wei, L. X., Seidenberg, B. C., Reiss, T. F., for the Montelukast/Beclomethasone Study Group*,
(1999). Oral Montelukast, Inhaled Beclomethasone, and Placebo for Chronic Asthma: A Randomized, Controlled Trial. ANN INTERN MED
130: 487-495
[Abstract][Full Text]
Frantz, E. A., Shenenberger, D. W., Kao, N. L., Whitmore, S. E., Wasserman, S. I., Kemp, J. P., Rachelefsky, G. S., Fireman, P., Shapiro, G. G., Busse, W. W., Hassaballa, H., Garbe, E., Suissa, S., LeLorier, J.
(1999). Inhaled Corticosteroids and Likelihood of Cataract Extraction. JAMA
281: 791-793
[Full Text]
O'Callaghan, C., Barry, P.
(1999). Delivering inhaled corticosteroids to patients. BMJ
318: 410-411
[Full Text]
Herzog, A. G.
(1999). Proximal Myopathy Associated With Inhaled Steroids. JAMA
281: 37-37
[Full Text]
Nishimura, K., Koyama, H., Ikeda, A., Tsukino, M., Hajiro, T., Mishima, M., Izumi, T.
(1999). The Effect of High-Dose Inhaled Beclomethasone Dipropionate in Patients With Stable COPD. Chest
115: 31-37
[Abstract][Full Text]
ANDREW MCIVOR, R., PIZZICHINI, E., TURNER, M. O., HUSSACK, P., HARGREAVE, F. E., SEARS, M. R.
(1998). Potential Masking Effects of Salmeterol on Airway Inflammation in Asthma. Am. J. Respir. Crit. Care Med.
158: 924-930
[Abstract][Full Text]
Garbe, E., Suissa, S., LeLorier, J.
(1998). Association of Inhaled Corticosteroid Use With Cataract Extraction in Elderly Patients. JAMA
280: 539-543
[Abstract][Full Text]
Bowman, M. A., Nicklin, D. E.
(1998). New Developments in Family Medicine. JAMA
279: 1437-1438
[Full Text]
BARNES, P. J., PEDERSEN, S., BUSSE, W. W.
(1998). Efficacy and Safety of Inhaled Corticosteroids . New Developments. Am. J. Respir. Crit. Care Med.
157: S1-53
[Full Text]
Whitmore, S. E., Leiner, S., Corcoran, T. R., Bai, T. R., Garbe, E., Suissa, S., Cumming, R. G., Mitchell, P., Leeder, S. R.
(1997). Inhaled Corticosteroids and the Risk of Cataracts. NEJM
337: 1554-1555
[Full Text]
Previous
