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Use of inhaled and oral corticosteroids and the long-term risk of cataract.

Abstract

OBJECTIVE

Longitudinal associations between inhaled and oral corticosteroid use and 10-year incident cataract were examined.

DESIGN

Population-based cohort study.

PARTICIPANTS

The Blue Mountains Eye Study examined 3654 Australians aged 49 years or older (1992-1994); 2335 were re-examined after 5 years and 1952 were re-examined after 10 years (75.1%, 75.6% of survivors, respectively).

METHODS

Questionnaires were used to assess inhaled and oral corticosteroid use at baseline. Past users were participants who had used these medications for at least 1 month in the past but were not using them at baseline. Current users were those who were using these medications at baseline and had been doing so for at least 1 month. Ever users combined past and current users.

MAIN OUTCOME MEASURES

Lens photographs were obtained at each examination and graded for nuclear, cortical, and posterior subcapsular (PSC) cataracts following the Wisconsin Cataract Grading System. Participants without a specific subtype of cataract in either eye at baseline were considered to be at risk of that type of cataract developing over the 10-year follow-up. Incidence of each cataract subtype in this report refers to person-specific, first-eye incidence.

RESULTS

At baseline, 103 participants were current and 120 past users of inhaled corticosteroids, and 31 were current and 147 were past users of oral corticosteroids. Current users had a greater risk of developing PSC cataract after adjustment for age and gender (inhaled: odds ratio [OR] 2.50, 95% confidence interval [CI] 1.33-4.69; oral: OR 4.11; 95% CI 1.67-10.08) and nuclear cataract (inhaled: OR 2.04, 95% CI 1.21-3.43; oral: OR 3.45, 95% CI 1.26-9.43) but not cortical cataract. Interaction between inhaled and oral corticosteroid use was significant for PSC (P = 0.01) and nuclear (P = 0.02) cataract incidence. In subgroup analyses, only individuals who used both inhaled and oral steroids were at increased risk of PSC cataract (after adjusting for age, sex, smoking, hypertension, diabetes, and education levels; OR 4.76, 95% CI 2.59-8.74), comparing ever users of both with users of neither.

CONCLUSIONS

High long-term risks of PSC and nuclear cataract development were found for users of combined inhaled and oral corticosteroids.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Centre for Vision Research, Department of Ophthalmology, University of Sydney, Sydney, Australia. jiejin_wang@wmi.usyd.edu.au

    , , , ,

    Source

    Ophthalmology 116:4 2009 Apr pg 652-7

    MeSH

    Administration, Inhalation
    Administration, Oral
    Arthritis
    Asthma
    Cataract
    Cohort Studies
    Female
    Follow-Up Studies
    Glucocorticoids
    Humans
    Incidence
    Lens Capsule, Crystalline
    Male
    Middle Aged
    New South Wales
    Photography
    Risk Factors
    Surveys and Questionnaires

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    19243828

    Citation

    Wang, Jie Jin, et al. "Use of Inhaled and Oral Corticosteroids and the Long-term Risk of Cataract." Ophthalmology, vol. 116, no. 4, 2009, pp. 652-7.
    Wang JJ, Rochtchina E, Tan AG, et al. Use of inhaled and oral corticosteroids and the long-term risk of cataract. Ophthalmology. 2009;116(4):652-7.
    Wang, J. J., Rochtchina, E., Tan, A. G., Cumming, R. G., Leeder, S. R., & Mitchell, P. (2009). Use of inhaled and oral corticosteroids and the long-term risk of cataract. Ophthalmology, 116(4), pp. 652-7. doi:10.1016/j.ophtha.2008.12.001.
    Wang JJ, et al. Use of Inhaled and Oral Corticosteroids and the Long-term Risk of Cataract. Ophthalmology. 2009;116(4):652-7. PubMed PMID: 19243828.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Use of inhaled and oral corticosteroids and the long-term risk of cataract. AU - Wang,Jie Jin, AU - Rochtchina,Elena, AU - Tan,Ava Grace, AU - Cumming,Robert G, AU - Leeder,Stephen R, AU - Mitchell,Paul, Y1 - 2009/02/25/ PY - 2008/08/15/received PY - 2008/10/31/revised PY - 2008/12/01/accepted PY - 2009/2/27/entrez PY - 2009/2/27/pubmed PY - 2009/4/25/medline SP - 652 EP - 7 JF - Ophthalmology JO - Ophthalmology VL - 116 IS - 4 N2 - OBJECTIVE: Longitudinal associations between inhaled and oral corticosteroid use and 10-year incident cataract were examined. DESIGN: Population-based cohort study. PARTICIPANTS: The Blue Mountains Eye Study examined 3654 Australians aged 49 years or older (1992-1994); 2335 were re-examined after 5 years and 1952 were re-examined after 10 years (75.1%, 75.6% of survivors, respectively). METHODS: Questionnaires were used to assess inhaled and oral corticosteroid use at baseline. Past users were participants who had used these medications for at least 1 month in the past but were not using them at baseline. Current users were those who were using these medications at baseline and had been doing so for at least 1 month. Ever users combined past and current users. MAIN OUTCOME MEASURES: Lens photographs were obtained at each examination and graded for nuclear, cortical, and posterior subcapsular (PSC) cataracts following the Wisconsin Cataract Grading System. Participants without a specific subtype of cataract in either eye at baseline were considered to be at risk of that type of cataract developing over the 10-year follow-up. Incidence of each cataract subtype in this report refers to person-specific, first-eye incidence. RESULTS: At baseline, 103 participants were current and 120 past users of inhaled corticosteroids, and 31 were current and 147 were past users of oral corticosteroids. Current users had a greater risk of developing PSC cataract after adjustment for age and gender (inhaled: odds ratio [OR] 2.50, 95% confidence interval [CI] 1.33-4.69; oral: OR 4.11; 95% CI 1.67-10.08) and nuclear cataract (inhaled: OR 2.04, 95% CI 1.21-3.43; oral: OR 3.45, 95% CI 1.26-9.43) but not cortical cataract. Interaction between inhaled and oral corticosteroid use was significant for PSC (P = 0.01) and nuclear (P = 0.02) cataract incidence. In subgroup analyses, only individuals who used both inhaled and oral steroids were at increased risk of PSC cataract (after adjusting for age, sex, smoking, hypertension, diabetes, and education levels; OR 4.76, 95% CI 2.59-8.74), comparing ever users of both with users of neither. CONCLUSIONS: High long-term risks of PSC and nuclear cataract development were found for users of combined inhaled and oral corticosteroids. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/19243828/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(08)01254-2 DB - PRIME DP - Unbound Medicine ER -