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Nidhi Talwar, Bin Nan, Matthew Davis, Joshua D. Stein; Are Asthmatics on Chronic Corticosteroids Undergoing Eye Examinations to Monitor for Complications Associated with Chronic Steroid Use?. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5526.
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To determine whether patients with asthma who are receiving chronic inhaled or oral corticosteroids are receiving eye examinations to check for ocular complications associated with chronic steroid use such as cataract and glaucoma.
All individuals enrolled in a large national US managed care network who had a new diagnosis of asthma and were prescribed steroids for > 3 month duration were identified. The proportion of asthmatics receiving chronic steroids that underwent an examination by an ophthalmologist or optometrist within 12 and 24 months after they were determined to be on chronic steroid therapy was calculated. These proportions were compared with the proportions of eye examinations performed on asthmatics that were never prescribed steroids.
Among the 663,000 asthmatics in the study, 31,874 were prescribed steroids for > 3 months duration. At 12 months after they were determined they were on chronic steroid therapy, 7,293 of 20,738 individuals (35.2%) had >= 1 visit to an eye care provider. By comparison, among asthmatics who were not taking steroids, 12,464 of 58,647 (21.3%) had >= 1 eye care provider visits. At 24 months, 6,728 of 13,260 asthmatics (50.7%) who were receiving chronic steroids had >= 1 eye care provider visits compared with 10,706 of 31,664 (33.8%) asthmatics who were not prescribed steroids. The differences in proportions receiving eye examination between chronic steroid users and non-users of steroids were significant for each follow-up (all p less than 0.0001). Among the asthmatics aged >= 40 years who were receiving chronic steroids, 132 of 7,262 (1.8%) had >= 1 incident open-angle glaucoma diagnosis and 917 of 5,187 (17.7%) had >= 1 incident cataract diagnosis within a year of being identified as a chronic steroid user.
While a higher proportion of asthmatics who are receiving chronic therapy with corticosteroids undergo eye examinations to monitor for ocular complications of corticosteroid relative to asthmatics who are not on steroids, a considerable number chronic steroid users (nearly 50%) had no eye examinations to monitor for sight-threatening ocular complications of steroid use such as glaucoma and cataract up to two years after being classified as a chronic steroid user. Physicians who care for asthmatics need to be better educated about the ocular side effects associated with chronic steroid use and the importance of regular eye examinations in these patients.
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