A population based case-control study of cataract and inhaled corticosteroids

• Published in: British journal of ophthalmology Vol. 87; no. 10; pp. 1247 - 1251
• Main Authors: Smeeth, L, Boulis, M, Hubbard, R, Fletcher, A E
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.10.2003; BMJ; BMJ Publishing Group LTD; 2003 British Journal of Ophthalmology
• Subjects: Administration, Inhalation; Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Adrenocortical hormones; Aged; Analysis; Analysis of Variance; Biological and medical sciences; Blindness; Care and treatment; Case studies; Case-Control Studies; Cataract; Cataract - chemically induced; Cataracts; Chronic obstructive pulmonary disease; Clinical Science - Extended Reports; Complications and side effects; Corticosteroids; Dose-Response Relationship, Drug; Drug toxicity and drugs side effects treatment; Female; Health aspects; Health risk assessment; Humans; Male; Medical sciences; Methodology; Methods; Odds Ratio; Pharmacology. Drug treatments; Prevention; Respiratory therapy; Risk Assessment; Risk Factors; Risk factors (Health); Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Toxicity: eye; Visually disabled persons; United Kingdom; United Kingdom > UK; Human; Corticosteroid; Cataract; Toxicity; Case control study; Inhalation; Eye; Eye disease; Lens disease; Treatment; Lens; Dose; Anterior segment disease
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.87.10.1247

Background/aims: Exposure to systemic corticosteroid use is known to be associated with a risk of cataract. Whether low doses of inhaled corticosteroids are associated with an increased risk of cataract is not known. This study was undertaken to quantify the risk of cataract associated with the use of inhaled corticosteroids and assess whether there is a dose-response relation. Methods: A population based case-control study based on the General Practice Research Database in the United Kingdom. 15 479 people with cataract and 15 479 controls were matched for age, sex, practice, and observation period. Results: The crude odds ratio for the association between any recorded exposure to inhaled corticosteroids and cataract was 1.58 (95% CI 1.46 to 1.71), reduced to 1.10 (95% CI 1.00 to 1.20) after adjustment for systemic corticosteroid exposure and consultation rate. There was a dose-response relation, the adjusted odds ratio rising from 0.99 (95% CI 0.87 to 1.13) at daily doses up to 400 μg to 1.69 (95% CI 1.17 to 2.43) for daily doses greater than 1600 μg. The association was also stronger with increasing duration of use. Conclusion: Higher doses and longer duration of exposure to inhaled corticosteroids are associated with an increased risk of cataract. The lowest doses compatible with good control of airways disease should be used. The risk of cataract associated with high doses of inhaled corticosteroids needs to be more widely appreciated.