Inhaled Steroids and Cataracts

Male patient's eye with mature cataract, Close-up
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Steroid medications are taken for many different medical conditions. Many people think of steroids and immediately think of negative side effects such as weight gain, moon-face (facial swelling) and mood swings. Most people do not have many side effects when on short courses of steroids of 10-14 days or more. However, when taken for longer periods of time, there can be some very serious side effects.

When we ingest steroids or any medication, especially by mouth, the drug is absorbed from the stomach into our vascular system and travels to all parts of our bodies, including our eyes. As a result, doctors are very cautious when prescribing steroids. It is well documented that oral steroids taken for an extended period of time can increase your risk for developing cataracts

What Is a Cataract?

cataract is a clouding of the eye's lens. Cataracts are the leading cause of blindness among people older than 55. The lens is located behind the iris. It is responsible for focusing light on the retina, and for producing clear, sharp images. The lens has the ability to change shape. When it changes shape, it can increase or decrease in power, known as accommodation. With time, however, the lens hardens and loses its ability to accommodate.

The entire lens is contained within a lens capsule. As the eyes age, dead cells accumulate in the lens capsule, causing the lens to gradually become cloudy.

Light that would normally be focused by the lens is scattered around because of the cloudiness, so vision is no longer clear and sharp.

There are three main types of cataracts, nuclear, cortical and posterior subcapsular. We can develop one or all three of these cataracts as we get older. However, posterior subcapsular cataracts can be the most visually devastating.

In fact, posterior subcapsular tend to be more common in younger people. Posterior subcapsular cataracts can be caused by a variety of conditions such as diabetes. Some people are born with posterior subcapsular cataracts. One known cause of these types of cataracts is the prolonged use of oral steroids such as prednisone. The longer you take prednisone, the more at risk you are of developing posterior subcapsular cataracts.

Steroid Medications

Steroid medications are taken for many different medical conditions. Many people think of steroids and immediately think of negative side effects such as weight gain, moon-face (facial swelling), and mood swings. Most people do not have many side effects when on short courses of steroids of 10-14 days or more. However, when taken for longer periods of time, there can be some very serious side effects. When we ingest steroids or any medication, especially by mouth, the drug is absorbed into our vascular system and travels to all parts of our bodies, including our eyes.

As a result, doctors are very cautious when prescribing steroids. It is well documented that oral steroids taken for an extended period of time can increase your risk for developing cataracts.

Inhaled Steroids and Cataracts

Doctors also prescribe steroids in the form of inhaled medication, such as an inhaler for asthma. Some people use inhaled steroids on a daily basis. Naturally, doctors were concerned about how much of a risk inhaled steroids could have for causing cataracts in people who used them since we know that oral steroids can increase the risk quite a bit.

Research studies focused on inhaled steroids found that there was an increased risk of cataract with  higher dosages of the steroid. They also found that there was little to no increased risk in patients that took the lowest daily steroid dose, about 500 mcg (micrograms). But they found that the risk increased to 70% for those taking the highest dose, up to 1600 mcg. The risk also increased the longer a person took an inhaled steroid. Risk for developing those type of cataracts also increased if among older patients. Changes that occur to the lens of the eye that make us susceptible to develop normal “older-age” types of cataracts also make us more susceptible to developing posterior subcapsular cataracts when taking higher doses of steroids.

What You Should Know

The good thing about the study is that it showed that you would have to take much more than the recommended amount of inhaled puffs throughout the day to increase your risk for developing posterior subcapsular cataracts. Inhaled steroids vary quite a bit in the amounts of medication per puff. Most people take 1-2 puffs per day. Depending on the dosage, you may have to take at least six puffs per day or as much as 36 puffs per day to increase your risk.

Most researchers believe that more studies should be conducted to confirm this increased risk, as many factors go into play that affect cataract development.

Source

Smeeth, L. British Journal of Ophthalmology, vol 87: pp 1247-1251. "Risk of cataracts and glaucoma with inhaled steroid use in children." Oct 2003.

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