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J. J. Wang, E. Rochtchina, G. L. Kanthan, A. G. Tan, R. G. Cumming, P. Mitchell, Blue Mountains Eye Study; Systemic and Inhaled Corticosteroids and the Long-Term Incidence of Age-Related Cataract. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2871.
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We previously reported associations between self-reported inhaled steroid use and prevalence of posterior subcapsular (PSC) and nuclear cataract. In this analysis, we aimed to assess the longitudinal association between systemic and inhaled steroid use at baseline and the 10-year incidence of cataract.
The Blue Mountains Eye Study (BMES) examined 3654 participants aged 49+ years at baseline (1992-4); 2335 persons (75.1% of survivors) and 1952 persons (75.6% of survivors) were re-examined after 5 and 10 years, respectively. At each exam, lens photography was performed and questionnaires administered to obtain detailed information on the use of systemic and inhaled steroids. Cataract was assessed from lens photographs using the Wisconsin Cataract Grading System. Nuclear cataract was defined as opacity >standard 3. Cortical cataract was defined as cortical opacity ≥5% of the total lens area and PSC cataract as any present. Incident cataract was assessed in persons without the corresponding cataract type at baseline. Associations were assessed adjusted for age and sex, and additionally for smoking, hypertension, diabetes and education.
At baseline, 31 subjects were current and 147 were past users of systemic steroids; 103 were current and 120 were past users of inhaled steroids. Current steroid users at baseline had a higher risk of developing nuclear cataract (systemic: age-sex adjusted odds ratio [OR] 3.45, 95% confidence interval [CI] 1.26-9.43; inhaled: OR 2.04, CI 1.21-3.43), and PSC cataract (systemic: OR 4.11, CI 1.67-10.08; inhaled: OR 2.50, CI 1.33-4.69). The steroid effect was much stronger for current users of both steroid types: multivariable adjusted OR 15.35, CI 1.37-171.4 for nuclear cataract and OR 16.73, CI 4.46-62.7 for PSC incidence, compared to non-current users of both. No significant associations were observed for incident cortical cataract.
These longitudinal data not only reinforce our previous cross-sectional finding of adverse effects of inhaled steroids on the lens, but also suggest stronger combined risk from systemic and inhaled steroids on the development of both nuclear and PSC cataract.
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