Background/Purpose: Cataract is the most common ocular damage in SLE.  It is the second most frequent item in the SLICC/ACR Damage Index.  Apart from cumulative corticosteroid doses, there are virtually no reports on other risk factors for cataract in SLE population.  We report on a large prospective study of cataract risk factors in SLE.

Methods: The analysis was based on the follow-up experience prior to age 60 of 2109 SLE patients who had not had a cataract prior to cohort entry.  Patients saw their ophthalmologist every 6 months.  Cataract was defined by the SLICC/ACR Damage Index.  The rate of incident cataract was calculated in subsets defined by patient characteristics and history.  Multivariable logistic regressions were fit to identify predictors of cataract while controlling for potential confounding variables.

Results: The patients were 93% female, 54% Caucasian, and 39% African-American.  The analysis was based on 11,887 persons-years of follow up, with median follow up time of 4.1 years per patient.  During this follow-up we observed 157 new cases of cataract, for an incidence of 13.2 per 1000 persons-years.  We estimated that the risk of being diagnosed with a cataract by age 60 was 28%.  Table 1 shows the results of a multivariate regression model.  Adjusting for other predictors, a cumulative prednisone dose equivalent to 10 mg/day for 10 years was a strong predictor of cataract (RR=3.1, P=0.0005).  Disease activity measured by SLEDAI (P =0.0005) and higher systolic blood pressure (P =0.0006) were associated with cataract.  Duration of SLE, diabetes mellitus, smoking, cholesterol, renal involvement, immunological profile and medication history, other than prednisone, were not associated with cataract. 

Conclusion: Cataract development in SLE patients is multifactorial with cumulative prednisone doses, systolic blood pressure and disease activity all playing an independent role.

Table 1: Independent Predictors of Cataract Based on a Multivariable Model

 

Predictor	Comparisons	Rate Ratio (95% confidence interval)	P-value
Age	Per 10 year increase	2.0 (1.7, 2.4)	<0.0001
Mean Systolic BP during prior cohort visits > 140 mmHg	Yes vs. no	2.2 (1.4, 3.3)	0.0006
Mean total cholesterol	Per 50 mg/dl increase	1.1 (1.0, 1.2)	0.22
Diabetes mellitus	Yes/no	1.3 (0.9, 2.0)	0.22
Mean SELENA-SLEDAI	Per 2 point increase	1.3 (1.1, 1.5)	0.0005
Cumulative Corticosteroid     Exposure1	< 36492 mg vs. none 3650-10,9493 vs. none 10,950-36,4994 vs. none 36,5005 + vs. none	1.1 (0.5, 2.5) 1.1 (0.5, 2.3) 2.3 (1.3, 4.3) 3.1 (1.6, 5.7)	0.77 0.87 0.0065 0.0005

1 Includes prednisone history prior to cohort entry

2 Exposure equivalent to <10 mg/day for 1 year

3 Exposure equivalent to 10 mg/day for 1-3 years

4 Exposure equivalent to 10 mg/day for 3-10 years

5 Exposure equivalent to 10 mg/day for 10+ years

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prednisone-disease-activity-and-hypertension-independently-predict-cataracts-in-systemic-lupus-erythematosus-sle/