Corticosteroids and Incident Glaucomatous Visual Field Loss

Abstract

Purpose: : To determine whether there is an association between corticosteroid use and incident glaucomatous visual field loss.

Methods: : In a prospective population-based cohort study among 3939 participants aged 55 years and above, ophthalmic examinations including measurement of the intraocular pressure, assessment of the optic nerve head and perimetry were performed at baseline and after an average follow-up duration of 9.8 years. The use of corticosteroids was monitored continuously during follow-up. The corticosteroids were stratified into five groups: ophthalmic steroids, steroid ointments, oral steroids, inhaled steroids and nose sprays. Associations between incident glaucomatous visual field loss and the use of corticosteroids were assessed using multivariate logistic regression models adjusted for age, gender, glaucomatous optic neuropathy (without visual field loss) at baseline and the duration of follow-up.

Results: : During follow-up, 108 participants (2.8%) developed glaucomatous visual field loss. Participants using ophthalmic steroids and steroid ointments had a 2.2-fold (95% CI 1.3-3.6; P=0.004) and 2.2-fold (1.2-3.9; P=0.007) higher risk of developing glaucomatous visual field loss. The attributable risks and population attributable risks were 52% (95%CI 29-81%) and 14% (8-22%) for ophthalmic steroids and 56% (25-78%) and 26% (12-36%) for steroid ointments.

Conclusions: : Ophthalmic steroids and steroid ointments appear to increase the risk of developing glaucoma. Prolonged use of these steroids should be discouraged, and if its use is deemed necessary some kind of glaucoma monitoring seems to be advisable.

Keywords: clinical (human) or epidemiologic studies: risk factor assessment • clinical (human) or epidemiologic studies: biostatistics/epidemiology methodology • clinical (human) or epidemiologic studies: outcomes/complications