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| Author(s) | Objective | Design | Subjects (n) | Methods | Results | Adjusted variable | Conclusion |
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| (a) |
| Cumming et al. [25] | Cataract risk in patients (n = 3313) with current and previous ICS use | Cross-sectional study | 122 (3.7%) with asthma or other chest illnesses. Mean age 66 years. 1883 females | Slit lamp | PSC OR 5.1 (95% CI 1.3–19.8) with ≥1000 mg overall ICS use (current ICS use OR 3.0 (95% CI 1.7–5.1)) | Age, sex, SCS, smoking history, diabetes mellitus, hypertension, sun-related skin damage | Increased ICS dose is associated with cataract development |
| Lens |
| Photography | PSC OR 2.7 (95% CI 1.3–5.6) with ≥5 years ICS use |
| Questionnaire on current ICS use, comorbidity, and smoking history |
| Jick et al. [33] | Cataract risk in ICS-prescribed COPD or asthma (n = 103,289) | Retrospective cohort study | 1194 (1.2%) with cataract. Mean age 73 years. 58% females | GPRD | Cataract RR 2.5 (95% CI 1.7–3.6) with ICS prescriptions ≥40 | Age, sex, smoking history, diabetes mellitus, hypertension, glaucoma | Higher cataract risk in patients with increasing ICS use |
| Cataract RR 2.2 (95% CI 1.3–3.8) with ICS daily dose ≥1000 mg |
| Smeeth et al. [26] | ICS associated cataract in patients (n = 15,479) | Case-control study | 3058 (19.8%) asthma or COPD. Mean age 75 years. 64.6% females | GPRD | Cataract OR 1.32 (95% CI 1.21–1.44) if ever ICS user. OR 1.39 (95% CI 1.26–1.53) for current ICS user. High daily dose ICS (801–1600 μg) OR 1.46 (95% CI 1.23–1.74) | SCS, mean annual consultation rate, ocular or topical corticosteroids, smoking status, BMI, diabetes mellitus, hypertension, glaucoma | If patients had ever used ICS, they had significantly increased odds for cataract development |
| Ernst et al. [34] | Cataract risk with current ICS and NCS treatment (n = 101,805) according to national asthma standards | Prospective cohort study | 27,708. Mean age 78 years. Approx. 50% females. ≥4 years follow-up | National health databases | Cataract RR 1.27 (95% CI 1.20–1.40) with daily ICS ≥1000–1500 μg. RR 1.21 (95% CI 1.12–1.31) with NCS >100–200 μg | Topical corticosteroids, allopurinol, major tranquilizers, sex, prior hospitalization, and severity of respiratory disease, OCS, cardiovascular disease, diabetes mellitus, hypertension, rheumatic disease | Significant cataract risk with high-dose ICS |
| Garbe et al. [35] | Association of average daily ICS dose with cataract extraction in elderly (n = 10,214) | Case-control study | 3677 with cataract extraction between 1992-1994. 67.4% females. 79.1% ≥ 75 years | Provincial health insurance plan database (RAMQ database) with information on all prescriptions and medical services | Cataract extraction OR 3.06 (95% CI 1.53–6.13) with ICS cumulative use ≥3 years | OCS, age, sex, diabetes mellitus, hypertension, ocular steroids, glaucoma, number of physician claims for service | Significant association between cataract extraction and ICS use |
| Cataract extraction OR 3.40 (95% CI 1.49–7.76) with daily dose ICS >1000 μg |
| Miller et al. [36] | Daily ICS use and cataract risk in COPD patients (n = 53,191) | Prospective cohort study | 2941 (5.5%) cataract cases. 51.4% females. Age ≥45 years | GPRD | Cataract OR 1.29 (95% CI 1.05–1.59) with ≥10 ICS prescriptions in the last year | COPD hospitalizations, BMI, smoking status, statin use, depression, diabetes mellitus, rheumatoid arthritis, hypertension, oxygen use, nebulizer use, number of antibiotic prescriptions, concomitant asthma, long-acting beta2 agonists, short-acting bronchodilators, inhaled corticosteroid other than fluticasone propionate/salmeterol | ICS exposure not significantly associated with cataract risk |
| Flynn et al. [14] | Current ICS use and cataract risk in COPD (n = 4305) | Cohort study | 3243 (75%) ICS exposed. Mean age 65.5 years. 51.9% females | TARDIS database | Cataract OR 1.42 (95% CI 1.07–1.88) with cumulative ICS exposure | Age, sex, social deprivation score, previous ICS, history of OCS, smoking, BMI, primary and secondary cardiovascular disease history, renal failure, COPD severity, history of diabetes mellitus, history of admission with pneumonia | Association between ICS use and increased cataract risk |
| Nath et al. [32] | Cataract risk and prevalence in COPD (n = 405) | Prospective cohort study | COPD n = 357. Mean age 64.12 years. 104 (29.13%) females | Screening of ICS treated COPD in attending tertiary care center for tuberculosis and chest diseases | 58 (16.24%) cataract cases. Daily ICS dose equivalent to 501–1000 μg fluticasone propionate increased cataract prevalence | Diabetes mellitus, hypertension, other unnamed systemic diseases | Higher cataract prevalence with increasing ICS dose |
|
| (b) |
| Delcourt et al. [37] | Cataract risk factors in patients (n = 2468) ever prescribed OCS | Cross-sectional study | 153 (6.2%) with asthma. Mean age 70 years. 1386 females | Visual acuity measurement | PSC OR 3.25 (95% 1.39–7.58) with ≥5 years OCS use. OR 2.04 (95% 1.04–3.81) of cataract surgery with ≥5 years OCS use | Age, sex, smoking, diabetes mellitus | Increased cataract risk with increasing OCS prescriptions |
| Slit lamp |
| Derby et al. [38] | Risk of cataract in patients (n = 289,371) with at least one previous OCS prescription | Retrospective cohort study | 198,307 (68.5%) with asthma or COPD. Half were ≥50 years. 56% females | GPRD | Cataract RR 4.6 (95% CI 3.7–5.7) with ≥10 OCS prescriptions | Age, sex, general practice, calendar time, prior patient history of hypertension, diabetes mellitus, renal failure, tobacco smoking | Increased cataract risk with increased OCS exposure |
| Ophthalmologist referral letters |
| Sweeney et al. [12] | Cataract and additional morbidity in patients (n = 7,195) | Cross-sectional study | 4503 (63%) females. 808 with SA. Mean age 59 years | Database information | Cataract OR 2.42 (95% CI 1.70–3.43) in severe asthma | Hospital admission, age, sex | Significant cataract risk in regularly prescribed OCS in SA |
| Sullivan et al. [17] | Occasional OCS prescription and association with adverse effects (n = 228,436) | Cohort study | 72,063 with asthma. Mean age 38 years. 47,293 females | Information from a large insurance claims dataset | Cataract OR 1.26 (95% CI 1.04–1.52) with ≥4 current OCS prescriptions in the past year | Age, sex, geographic region, years since index date, insurance type, use of non-OCS immunosuppressive medication, general comorbidity burden (total number of chronic conditions) | OCS significantly associated with cataract risk |
| Daugherty et al. [39] | Occasional OCS in severe asthma and cataract risk (n = 60,418) | Cohort study | 35,424. Mean age 54.8 years. 22,861 (64.5%) females | CPRD | Cataract HR 3.38 (95% CI 2.41–4.73) with a cumulative daily dose OCS ≥7.5 mg | Age, sex, smoking status, diabetes mellitus | Significant cataract risk with high mean cumulative daily dose of OCS |
| Barry et al. [11] | Regular OCS in severe asthma and cataract risk (n = 7195) | Cohort study | 808 with SA. Mean age 59 years. 507 (63%) females | OPCRD | Cataract OR 1.9 (95% CI 1.4–2.6) with ≥4 OCS prescriptions in two consecutive years | Age, sex, geographical region | Greater cataract risk with more prescriptions of OCS |
| Bloechliger et al. [18] | Current, previous, and past OCS use in asthma and cataract risk (n = 265,964) | Cohort study | 5336. Mean age 72.7 years. 68.9% females | CPRD | Cataract OR 1.43 with ≥4 OCS prescriptions per year and cumulative doses >2000 mg | Alcohol consumption, smoking status, BMI, current or past inhaled bronchodilators use, nonsteroidal anti-inflammatory drugs, platelet aggregation inhibitors, anticoagulants, proton pump inhibitors, vitamin D/calcium bisphosphonates, immunosuppressants, number of ICS prescriptions, Charlson comorbidity index | Increased cataract risk at higher doses and prescriptions of OCS |
| Price et al. [16] | Adverse events of SCS (98% OCS) treatment in asthma (n = 117,409) | Cohort study | Asthma n = 48,234 (21%), mean age 49 years. 15,585 (65%) females | OPCRD and CPRD | Significantly increased cataract risk with adjusted HR 1.50 (95% CI 1.31–1.73) | Sex, age, smoking status, BMI, type 2 diabetes mellitus, hypertension, peptic ulcers, depression, cardiovascular disease, antibiotic-treated infections, cumulative inhaled corticosteroid dose, airflow limitation with FEV1 < 80%, prior asthma medication use such as short-acting bronchodilators and long-acting beta2-agonists | SCS prescribed asthma patients had increased cataract risk |
| Walsh et al. [40] | Adverse effect of continuous or frequent OCS exposure in asthma and COPD (n = 367) | Cross-sectional study | Asthma and/or COPD n = 355 (97%), mean age 68 years. 177 (48%) females | Data collection through questionnaires and computerized records from general practices | Significantly increased cataract risk with OR 2.6 (95% CI 1.8–3.9) | Sex, age, BMI, cumulative ICS dose, cigarette consumption, alcohol intake, calcium intake, age at menopause, exercise currently and at age 15–20 years, daily activity | OCS exposure increased cataract risk in asthma and COPD |
|
| (c) |
| Toogood et al. [22] | PSC prevalence in patients (n = 400) treated regularly with ICS and OCS | Cross-sectional study | 48 (12%) with asthma. Mean age 61. 28 females | Slit lamp | 52.1% had lens opacity | Cumulative dose of ICS, age, years of asthma, sex, postmenopausal, arthritis, progesterone-estrogen use | Increased precursor cataract prevalence in ICS and OCS regularly treated patients |
| Wang et al. [21] | Cataract risk with past or current use of ICS and OCS use in asthma or other diseases (n = 3654) | Prospective cohort study | 2068. Mean age 63 years. 56% females. Three follow-up examinations | 1992–1994, 1997, and 2002: | PSC OR 4.1 (95% CI 1.67-10.08) in current OCS users. OR 2.5 (95% CI 1.33–4.69) in current ICS users | Age, sex, smoking, hypertension, diabetes mellitus, education | High cataract risk with ICS and OCS use |
| Lens photography |
| Slit lamp |
| Questionnaires on medical and demographic history. Current and previous medication |
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