1. In a retrospective study from a large US health database, use of drugs from several different categories, including tricyclic antidepressants, insulin, and group III antiarrhythmics, was significantly associated with increased odds of cataract requiring surgery.
2. Sex hormone use in female patients was associated with decreased odds of cataract surgery.
Evidence Rating Level: 2 (Good)
Study Rundown: Though the main risk factor for cataract development is increasing age, external factors, including various systemic medications, have been associated in past studies with increased cataract incidence. This retrospective study aimed to explore associations between medications and need for cataract surgery in a US database of about 15,000 adults. Statistically significant associations with greater cataract incidence were observed for tricyclic antidepressants, insulin, group III antiarrhythmic agents, loop diuretics, minerals and electrolytes, selective serotonin reuptake inhibitors, and calcium channel blockers. A dose-response relationship was observed for each of these categories. The increase in odds of cataract surgery with drug exposure ranged from 120% for tricyclic antidepressants to 30% for calcium channel blockers. Sex hormone use in female patients was associated with a significant decrease in cataract risk. With the exception of mineral and electrolyte use, all of these medication exposures have been reported as possible risk factors in previous studies. Though the association of insulin with cataracts remained significant after adjustment for diabetes diagnosis, it is likely that confounding by the disease state itself accounts for at least part of many of these medication associations. This study is also limited by its use of survey data without information on duration of medication use. Though further study of both the physiological mechanisms underlying these associations is needed, this study and others like it suggest that additional vigilance for cataract development in older patients taking certain prescription drugs may be reasonable.
In-Depth [retrospective cohort]: Cross-sectional data collected via home interviews every two years between 1999 and 2008 were drawn from the National Health and Nutrition Examination Survey (NHANES). About 2,000 adults aged 40 or older with surgically treated cataract were included (9.6% of the study population). Medication use in the 30 days prior to the survey was self-reported. A total of 81 drug categories used by more than 0.5% of the population, excluding ophthalmic drugs, were analyzed using logistic regression adjusted for demographic factors. False discovery rate was controlled at 5% using the Benjamin-Hochberg procedure. Dose-response relationships were evaluated using categorization into tertiles by total 30-day dosage and logistic regression. The adjusted odds ratio of surgically treated cataract for tricyclic antidepressants was 2.21 [95% confidence interval (CI) 1.38-3.51, p=0.001], for insulin was 2.13 (95% CI 1.48-3.07, p<0.0001), and for group III antiarrhythmics was 2.00 (95% CI 1.25-3.19, p=0.004). The adjusted odds ratio for sex hormone use among women was 0.011 (95% CI 0.001-0.089, p<0.0001).
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