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Edeltraut Garbe, MD, MSc; Samy Suissa, PhD; Jacques LeLorier, MD, PhD, FRCPC

JAMA. 1998;280:539-543.

Context.— The use of systemic corticosteroids is a known risk factor for the development of cataracts.

Objective.— To determine whether treatment with inhaled corticosteroids is associated with cataract extraction in the elderly.

Design.— Case-control study.

Setting.— Quebec universal health insurance program for all elderly (provincial health insurance plan database [RAMQ database]).

Patients.— RAMQ enrollees 70 years and older. The 3677 cases were patients with a cataract extraction between 1992 and 1994. The 21868 controls were randomly selected from patients who did not have a diagnosis of cataract and matched to cases on the index date of the case.

Main Outcome Measures.— Odds ratio of cataract extraction in patients with prolonged cumulative exposure to inhaled corticosteroids compared with nonusers.

Results.— Excluding patients with systemic steroid treatment and after adjusting for age, sex, diabetes, systemic hypertension, glaucoma, ophthalmic steroids, and the number of physician claims for services, use of inhaled corticosteroids for more than 3 years was associated with undergoing cataract extraction (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.53-6.13). For high average daily doses of beclomethasone or budesonide (>1 mg), the OR was elevated after more than 2 years of treatment (OR, 3.40; 95% CI, 1.49-7.76), whereas for low to medium doses (1 mg) of these drugs, the OR was 1.63 (95% CI, 0.85-3.13) after 2 years.

Conclusion.— Prolonged administration of high doses of inhaled corticosteroids increases the likelihood of undergoing cataract extraction in elderly patients. Further studies are needed to investigate the risk of developing cataracts for low to medium doses over longer periods.

From the Potsdam Institute of Pharmacoepidemiology and Technology Assessment, Potsdam, Germany (Dr Garbe); the Division of Clinical Epidemiology, Royal Victoria Hospital and the Department of Epidemiology and Biostatistics, McGill University (Dr Suissa) and the Centre de Recherche, Hôtel-Dieu de Montreal, Université de Montreal (Dr LeLorier), Montreal, Quebec.

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