Background/Purpose:

Cataracts and glaucoma are among the main causes of impaired visual acuity and have a prevalence respectively of 9-17%  and 1-2% among subjects older than 70 years. Chronic glucocorticoid (GC) therapy is associated with an increased risk of developing cataracts and glaucoma and recommendations have been developed for monitoring these side effects in patients with rheumatic diseases.

The aim of this study was to assess the adherence to the existing recommendations for monitoring eye toxicity of chronic GC therapy and the prevalence of cataracts and glaucoma among systemic lupus erythematosus (SLE) patients followed at our Unit.

Methods: Retrospective analysis of clinical charts to evaluate epidemiological data (disease duration, age at last assessment), cumulative and mean daily dose of GC and administration of GC pulses, number and frequency of eye assessment during follow up. Presence/absence of cataracts and glaucoma as reported in the last available eye assessment.

Results: One hundred and seventy charts were examined, 34 (20%) of these (mean follow up 83.6±66.5; mean age 42,5±14,8 years) never underwent an eye assessment. The remaining 136 (mean follow up 152,5±99,8 months, age 45,4±12,5 years), underwent an eye assessment on average with an interval of 75±61,7 months. However, only 45 (33%) had received an evaluation during the previous 12 months. All these 170 patients were taking chronic CG therapy at a mean daily dose of 5,4±2.4 mg prednisone (PDN), and a mean cumulative dose of  27.6±20.5 gms. Out of the 136 patients with at least one eye assessment (mean PDN 5.5±2.4 mg, mean cumulative dose 29.8±21.5 gms), cataracts were observed in 39 patients (29%) and glaucoma in 4 patients (3%). Cataracts were diagnosed at a mean age of 46,5±10 years; the development of cataracts was associated with age, disease duration and cumulative GC dose (cataracts vs not cataracts: mean cumulative PDN dose 32,8 vs 20,4 gms; p<0,0001). Glaucoma was diagnosed at a mean age of 40,5±16 years; due to the small number of patients no correlations were made.

Conclusion: Although 80% of patients have at least one eye assessment, the adherence to recommendations is suboptimal as only 33% of patients underwent an eye assessment over the previous 12 months. As expected the prevalence of cataracts and glaucoma is higher than in the general population and these conditions occur early in the life of SLE patients. As not all patients have a recent eye evaluation our data could underestimate the real incidence of these two potentially severe conditions. An association between GC and cataracts is confirmed. These data reinforce the need to improve adherence to recommendations to eye monitoring among SLE patients under chronic therapy with GC.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/analysis-of-the-adherence-to-the-monitoring-of-glucocorticoid-eye-toxicity-and-of-the-prevalence-of-cataracts-and-glaucoma-among-patients-with-systemic-lupus-erythematosus/