Another Reason to Hate Prednisone

Did your doctor ever warn you that cataracts are a possible side effect of steroid use?  I don’t think mine did.  I was warned about weight gain and thinning of the skin.  I was told how to taper off prednisone.  I was even told of the possibility of tendon rupture.  No discussion of eye care to delay cataracts ever took place.

Why do patients have to search to find information such as this?

Millions of Americans take corticosteroid medications daily to address a variety of health problems, from arthritis to asthma. While these prescription drugs often deliver considerable health benefits, users should be aware of the link between steroids and the risk for cataracts. Studies show that long-term use or high-doses of steroids can promote cataract formation.”

North Florida Cataract Specialists & Vision Care

Or this:

Prolonged use of glucocorticoids is a significant risk factor for the development of posterior subcapsular cataract.

PMID: 11952401

Or this:

Use of systemic corticosteroids is a well established risk factor for the development of posterior subcapsular cataracts (PSCs) in both children and adults.

PMID: 20621348

As well as this:

Cataract formation is a widely recognized potential complication of corticosteroid use.

American Academy of Ophthalmology

***

So why the heck aren’t doctors teaching us how to take better care of our eyes? Site after site says that people taking steroids should see an eye doctor. If the doctor notices cataracts, then you can be told how to slow their progression. Isn’t that a bit late? Why not tell us that to start with? Maybe we could postpone or even prevent their formation? Websites that bring up the topic shouldn’t treat the info as if it’s a national secret. Why not just publish what we can do?

Fortunately I finally found a doctor who’s willing to share that information. W. John W. Murrell, MD, shares these tips:

  • eat foods rich in antioxidants, especially Vitamin A
  • limit carbohydrates, which are not good for the eyes
  • wear UV-blocking sunglasses
  • stay hydrated

NeoVision Eye Center’s tips are similar:

  • eat leafy greens
  • eat fruits full of Vitamin C
  • consume Omega-3’s from salmon or nuts
  • wear UV-blocking sunglasses

Dang. Why all the secrecy? We should already be doing those things!

We all understand that patients are supposed to read the package insert that comes with our meds. I even do it most of the time. But to be honest, at some point I start skimming for highlights so that I know what could be a potential emergency, instead of studying as if it will be a category on Jeopardy! – I’ll take prednisone side effects for $300, Alex:  cardiovascular symptoms…, dermatologic symptoms…, endocrine (no kidding!)…, GI… On and on it goes. Well, way at the bottom of the page is a section on ophthalmic side effects. Sure enough, cataracts are listed. Even if I’d noticed that info there, I do not have the training or background to do anything about it. My doctor thinks the benefits outweigh the risks, so I’ll trust the professional.

But I honestly feel that I should have been explicitly told that it’s important to take steps to protect my eyes, just like I was told how to taper off prednisone once it was prescribed.

That said, prednisone isn’t solely to blame for cataracts in RA. The infinite inflammation that goes along with RA and other types of autoimmune arthritis includes inflammation in the eyes – uveitis. And that is its own special problem:

Cataracts are a frequent complication of uveitis…

PMID: 29739026

So What Are Cataracts, Anyway?

On rivers, a cataract is a waterfall. In our eyes, mature cataracts look like waterfalls because of the way the lens clouds up; worldwide, they are the leading cause of blindness. The cloudy lens is caused by proteins building up on the lens, hardening it.

Prevalence

Although common, cataracts are not inevitable. According to my daughter’s nursing textbook, 80% of people will eventually get cataracts, which means a fortunate 20% of the population won’t. Online, doctor’s websites give slightly different numbers: one-in-six forty-year-olds will already have the start of cataracts, and by age sixty, that increases to one-in-three, and to one-in-two by age eighty. So they’re very common, but not inevitable.

Symptoms

Here is where I was shocked. I’ve had symptoms for at least fifteen years and my eye doctor never said a word and never sent a letter to any of my other docs. I am so glad that I changed optometrists a year ago. That led to all sorts of adventures in 2021. And my two cents, for what it’s worth, is that if you’ve had symptoms for a while and your eye doctor has been ignoring them, it might be worth getting a second opinion.

  • bad night vision
  • halos around lights
  • double vision
  • need extra light to see
  • colors appear faded or yellowed
  • sensitivity to light
  • blurry/cloudy/dim vision
  • need frequent corrective lens adjustments

Treatment

Currently the only treatment is surgery. You’d think that they’d find a way to go in and scrub off the excess protein build-up, but that’s not how it works. The doctor makes a small incision and removes the eye’s lens. Some articles will say that they remove the cataract, which is misleading. They take out your entire lens!!! If all goes well, an artificial lens can then be inserted. Insurance (and medicare) considers this medically necessary and will typically pay.

However, they pay for a bare-bones basic lens to be inserted. These basic lenses, as the name monofocal suggests, focus at one point; you can choose if you want your vision corrected to drive or to read, and will need to wear glasses for the other activity (reportedly most people get distance monofocal lenses, then wear reading glasses for up-close work). If you can afford it and it will work for your particular situation, it’s possible to upgrade to multifocal, accommodative, or toric lenses – these have the potential of allowing nearly perfect vision (not always, but sometimes).

However, I happened upon a 2015 study suggesting that Lanosterol Reverses Protein Aggregation in Cataracts. and a more recent article suggesting that they’re experimenting with eye drops to dissolve cataracts. It looks like they’re having success doing this with pets, but less success in people. I’m willing to be a guinea pig to avoid having the lens of my eye removed!

Hope all is well with you, and that 2021 is treating you better than 2020 treated the world 🙂

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