Prevalence of Steroid-Induced Cataract and Glaucoma in Chronic Obstructive Pulmonary Disease Patients Attending a Tertiary Care Center in India

Nath, Tirupati; Roy, Subham Sinha; Kumar, Himanshu; Agrawal, Rachit; Kumar, Santosh; Satsangi, SK

doi:10.22608/apo.201616

Cited by 20 publications

(27 citation statements)

References 8 publications

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“…Indeed, a constant oxygen supply is crucial for adequate organ function 44 ., andeven small changes in oxygen supply to the retina can result in tissue hypoxia and retinal changes 44 . In addition, exposure to corticosteroids may contribute to an increased risk of glaucoma and cataract, though results in patients with COPD are contradictory [45][46][47] . An earlier review demonstrated that structural and functional changes in the retinal microvasculature are more common and severe in patients with COPD compared to non-COPD controls, including increased retinal vessel diameter, lower retinal arterial oxygen saturation, impaired haemodynamics and increased resistive index of the orbital vessels 43 .…”

Section: Discussionmentioning

confidence: 99%

Structural analysis of retinal blood vessels in patients with COPD during a pulmonary rehabilitation program

Vaes

Spruit

Keer

et al. 2020

Sci Rep

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cardiovascular diseases are frequently present in chronic obstructive pulmonary disease (copD). population-based studies found associations between retinal vessel diameters and cardiovascular health, but it is unknown whether this also applies to COPD patients. Therefore, we measured retinal vessel diameters in copD patients and aimed to determine the association with cardiovascular risk factors, lung function, and functional outcomes. In addition, we investigated whether an exercisebased pulmonary rehabilitation (PR) program would change retinal vessel diameters, as a proxy for improved microvascular health. Demographics and clinical characteristics, including pulmonary function, exercise capacity, blood pressure, blood measurements and level of systemic inflammation were obtained from 246 patients during routine assessment before and after PR. Retinal vessel diameters were measured from digital retinal images. older age and higher systolic blood pressure were associated with narrower retinal arterioles (β: −0.224; p = 0.042 and β: −0.136; p < 0.001, respectively). Older age, higher systolic blood pressure and lower level of systemic inflammation were associated with narrower retinal venules (β: −0.654; −0.229; and −13.767, respectively; p < 0.05). No associations were found between retinal vessel diameters and lung function parameters or functional outcomes. After PR, no significant changes in retinal venular or arteriolar diameter were found. To conclude, retinal vessel diameters of COPD patients were significantly associated with systolic blood pressure and systemic inflammation, whilst there was no evidence for an association with lung function parameters, functional outcomes or other cardiovascular risk factors. Furthermore, an exercise-based PR program did not affect retinal vessel diameter. Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases 1. Although the diagnosis of COPD is based on spirometry, it is well recognized that COPD is associated with a range of systemic extrapulmonary effects 1. Indeed, comorbidities are frequently present and contribute to the severity of disease 2-4. Cardiovascular disease (including hypertension, coronary artery disease, congestive heart failure, stroke and peripheral arterial disease) is a common comorbidity in COPD 2,5. Smoking is the most important risk factor for the development of COPD, but it is also a major risk factor for the development of cardiovascular disease 6,7. Indeed, cigarette smoke not only affects the airway epithelium, but also causes vascular endothelial damage and loss of microvascular integrity in several organs, including the heart, brain, and kidney 8,9. In addition, systemic inflammatory processes, oxidative stress, and hypoxia may contribute

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Section: Discussionmentioning

confidence: 99%

Structural analysis of retinal blood vessels in patients with COPD during a pulmonary rehabilitation program

Vaes

Spruit

Keer

et al. 2020

Sci Rep

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“…The difference in IOP was statistically significant ( p < 0.001), although it was small: the observed pressure was 15.31 ± 3.27 mmHg for the inhaled glucocorticoid group versus 13.39 ± 1.95 mmHg for the control group. The study conducted by Nath et al in 2017 showed 57 out of 405 subjects to have had an IOP higher than 22 mmHg after the intake of inhaled glucocorticoids, although no mention of statistical significance was made [ 33 ]. The eight remaining articles did not show any significant effect of inhaled glucocorticoids on IOP [ 11 , 18 , 34 , 35 , 36 , 37 , 38 , 39 ].…”

Section: Resultsmentioning

confidence: 99%

The Effects of Intranasal, Inhaled and Systemic Glucocorticoids on Intraocular Pressure: A Literature Review

Wijnants

Stalmans

Vandewalle

2022

JCM

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Topical glucocorticoids are a well-known risk factor of intraocular pressure (IOP) elevation in one third of the general population and in up to 90% of glaucomatous patients. Whether this steroid response is caused by intranasal, inhaled or systemic glucocorticoids, is less known. This study presents an overview of the current literature on the topic, thereby providing guidance on when ophthalmological follow-up is indicated. A literature study was performed in Medline, and 31 studies were included for analysis. Twelve out of fourteen studies discussing intranasal glucocorticoids show no significant association with an elevated IOP. Regarding inhaled glucocorticoids, only three out of twelve studies show a significant association. The observed increase was either small or was only observed in patients treated with high inhaled doses or in patients with a family history of glaucoma. An elevated IOP caused by systemic glucocorticoids is reported by four out of the five included studies, with one study reporting a clear dose–response relationship. This review concludes that a steroid response can be triggered in patients treated with systemic glucocorticoids. Inhaled glucocorticoids may cause a significant IOP elevation when administered in high doses or in patients with a family history of glaucoma. At present, there is no evidence for a clinically significant steroid response caused by intranasally administered glucocorticoids.

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“…The reason of the discrepancy might be lower dosage of daily ICS and relatively smaller number of subjects in our study compared to the previous studies. 37 , 38 …”

Section: Discussionmentioning

confidence: 99%

Impact of cataract on health-related quality of life in a longitudinal Japanese chronic obstructive pulmonary cohort

et al. 2017

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Cigarette smoking increases the risk of developing both cataract and chronic obstructive pulmonary disease (COPD). The prevalence of cataract and the clinical characteristics of COPD patients with cataract were retrospectively investigated in a 2-year observational COPD cohort. We analyzed 395 patients with complete data on ophthalmologic evaluation (319 subjects with COPD and 76 subjects at risk of COPD). There was no difference in the prevalence of cataract between COPD patients and those at risk (47.0% vs. 42.1%, p = 0.44). Age ≥ 75 years, low body mass index, and hypertension were independently associated with cataract as a comorbidity in COPD. The incidence of exacerbation within 2 years was significantly higher in COPD patients with cataract than those without cataract (36.6% vs. 18.3%, p = 0.0019). COPD patients with cataract exhibited significantly higher COPD assessment test score compared to those without cataract (13.7 ± 8.9 vs. 11.5 ± 7.2, p = 0.0240). Overall St George’s Respiratory Questionnaire score and each component were significantly worse in COPD patients with cataract compared to those without cataract. COPD patients with cataract exhibited poor health-related quality of life and frequent exacerbations. The association between cataract and exacerbations of COPD deserves further attention.

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Prevalence of Steroid-Induced Cataract and Glaucoma in Chronic Obstructive Pulmonary Disease Patients Attending a Tertiary Care Center in India

Abstract: It is evident that higher doses and longer duration of inhaled corticosteroid in COPD patients are associated with a higher prevalence of cataract and glaucoma.

Cited by 20 publications

References 8 publications

Structural analysis of retinal blood vessels in patients with COPD during a pulmonary rehabilitation program

Structural analysis of retinal blood vessels in patients with COPD during a pulmonary rehabilitation program

The Effects of Intranasal, Inhaled and Systemic Glucocorticoids on Intraocular Pressure: A Literature Review

Impact of cataract on health-related quality of life in a longitudinal Japanese chronic obstructive pulmonary cohort

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