Low-dose inhaled and nasal corticosteroid use and the risk of cataracts

¹ Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Center, Montreal, Canada; and Division of Respiratory Medicine, McGill University Health Center, Montreal, Canada.
² Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Center, Montreal, Canada; Dept of Epidemiology and Biostatistics and of Medicine, McGill University, Montreal, Canada.; and Dept of Respiratory Medicine, Mount Sinai Hospital and Respiratory Medicine Service, Centre Hospitalier Fleury, Montreal, Canada.
³ Dept of Ophthalmology, Royal Victoria Hospital, McGill University Health Center, Montreal, Canada.
⁴ Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Center, Montreal, Canada; and Dept of Epidemiology and Biostatistics and of Medicine, McGill University, Montreal, Canada.

^* To whom correspondence should be addressed. E-mail: Pierre.ernst{at}clinepi.mcgill.ca.

	Abstract

Orally inhaled corticosteroid (ICS) use has been convincingly linked to an increase in the risk of cataracts although the risk at lower doses in common use remains uncertain. The potential risk of cataracts with the use of nasal corticosteroids (NCS) is unknown.

We performed a matched nested case-control analysis in a population based cohort of elderly people who had been dispensed medications for airway disease as identified through a universal drug benefit plan.

ICS use was associated with a dose related increase in both the risks of all cataracts and the risk of severe cataracts requiring extraction (RR 1.24 95%CI 1.18-1.31 per 1000 mcg per day of beclomethasone or the equivalent) and the increase in risk of severe cataracts was apparent even at daily doses of 500 mcg or less (RR 1.14 95%CI 1.08-1.20). An excess risk with NCS was not apparent for severe cataracts (RR 1.03 95%CI 0.99-1.07 per 100 mcg).

We conclude that, among the elderly, even low doses of ICS are associated with a small but significant excess risk of cataracts requiring extraction. Such an excess risk was not observed with NCS.

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