Cortical cataracts tied to systemic meds

Treatment with systemic medications, such as angiotensin converting enzyme (ACE) inhibitors, fibrates, and alpha-glucosidase inhibitors (AGIs), is associated with cortical cataract in Asians, according to a recent Singapore study.

“Findings from this study may suggest a possibility of these medications influencing the risk of cortical cataract, in addition to the influences of the diseases for which they were prescribed,” the researchers said. “To clarify this possibility, further longitudinal studies are essentially needed.”

Of the 8,965 enrolled participants (mean age, 57.6±9.8 years; 50.8 percent female), 27.0 percent (n=2,418) had cortical cataract. These patients tended to be older and were more likely to have comorbid conditions, such as hypertension, diabetes, and cardiovascular disease. All participants were drawn from the Singapore Epidemiology of Eye Diseases study. [Br J Ophthalmol 2020;104:330-335]

Thirteen systemic medications—including aspirin, ACE inhibitors, and angiotensin II receptor blockers—were found to share significant interactions with cortical cataract upon crude investigations.

However, after adjusting for sociodemographic and comorbidity covariates, as well as for the use of the potentially associated medications, only four remained statistically significant. ACE inhibitors, for example, seemed to exacerbate the risk of cortical cataracts by nearly 25 percent (odds ratio [OR], 1.24, 95 percent confidence interval [CI], 1.02–1.51; p=0.029).

Fibrates had a similar but stronger effect (OR, 1.57, 95 percent CI, 1.05–2.35; p=0.029), as did AGIs (OR, 1.77, 95 percent CI, 1.08–2.90; p=0.023). The use of insulin had the strongest impact on cortical cataract, raising its likelihood by almost 80 percent (OR, 1.79, 95 percent CI, 1.10–2.91; p=0.020).

ACE inhibitors, fibrates, and AGIs were robust to subgroup analysis according to comorbidities, while insulin lost its significance in diabetics.

Systemic medication also had significant effects on the severity of cortical cataract. The use of ACE inhibitors, calcium channel blockers, fibrates, AGIs, and insulin all correlated with worse disease.

Upon complete model adjustment, however, only fibrates (OR, 1.48, 95 percent CI, 1.06–2.06; p=0.021), AGIs (OR, 1.50, 95 percent CI, 1.01–2.23; p=0.046), and insulin (OR, 1.86, 95 percent CI, 1.25–2.77; p=0.002) remained statistically significant.

“Our results suggested that people taking ACE inhibitors, fibrates, and AGIs were more likely to have cortical cataract, independent of the presence of hypertension, hyperlipidaemia, or diabetes,” the researchers said.

“If their effect on cortical cataract is confirmed, such findings will help clinicians to make informed decisions when prescribing these medications, and patients treated with these medications would need regular monitoring by eye healthcare professionals,” they added.

Important study limitations included its cross-sectional design, the lack of information on dose and duration of medication use, and the failure to account for adherence. In seeking to validate the present findings, future longitudinal studies should also strive to cover these weaknesses.