ASSOCIATION OF INHALED CORTICOSTEROID USE WITH CATARACT-EXTRACTION INELDERLY PATIENTS

Context.-The use of systemic corticosteroids is a known risk factor fo r the development of cataracts. Objective.-To determine whether treatm ent with inhaled corticosteroids is associated with cataract extractio n in the elderly. Design.-Case-control study. Setting.-Quebec universa l health insurance program for all elderly (provincial health insuranc e plan database [RAMQ database]). Patients.-RAMQ enrollees 70 years an d older. The 3677 cases were patients with a cataract extraction betwe en 1992 and 1994. The 21 868 controls were randomly selected from pati ents 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 catar act extraction in patients with prolonged cumulative exposure to inhal ed corticosteroids compared with nonusers. Results.-Excluding patients with systemic steroid treatment and after adjusting for age, sex, dia betes, systemic hypertension, glaucoma, ophthalmic steroids, and the n umber of physician claims for services, use of inhaled corticosteroids for more than 3 years was associated with undergoing cataract extract ion (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 (less than or equal to 1 mg) of these drugs, the OR was 1.63 (95% CI, 0.85-3.13) after 2 y ears. Conclusion.-Prolonged administration of high doses of inhaled co rticosteroids increases the likelihood of undergoing cataract extracti on in elderly patients. Further studies are needed to investigate the risk of developing cataracts for low to medium doses over longer perio ds.