Even Low-Level Steroids Can Impact Vision

Steroids — the legal kinds, such as Prednisone and Cortisone — are strong anti-inflammatory drugs that are helpful to people who suffer from serious diseases such as asthma, emphysema, arthritis, ulcerative colitis, eczema, lupus and multiple sclerosis. Whether taken orally, topically (for eyes) or via an inhaler, these are potent drugs that can reduce inflammation, control disease flare-ups, and sometimes even prevent death. But used too frequently and/or for long periods, they can lead to side effects in a variety of organs, including the eye.

WEIGHING THE BENEFITS AND THE RISKS

To limit side effects, oral, inhaled or topical ophthalmological steroids are often prescribed for a very short period of time. However, for many serious conditions, they must be used for longer periods of time. Chronic use of steroids can cause many well-known side effects, including weakened bones, fluid retention, high blood pressure, mood swings and confusion. Less well known is that they can also cause eye problems such as cataracts and glaucoma, notes David F. Chang, MD, a clinical professor of ophthalmology at the University of California, San Francisco and coauthor of Cataracts: A Patient’s Guide to Treatment. The good news is that cataracts are very treatable, as is glaucoma when detected early. Before prescribing steroids, Dr. Chang points out that doctors always try to make sure that the benefits of treatment outweigh the risks and disadvantages, and generally will limit their use to as short a time as possible.

Ophthalmologists themselves use steroid eye drops to treat a variety of potentially serious eye conditions, such as severe inflammation and to prevent rejection of corneal transplants. Other physicians may prescribe them for other reasons, for instance to reduce the severe itching caused by hay fever and allergies. However, because of the potential for cataracts and glaucoma, patients should be under an ophthalmologist’s care and supervision in these situations.

Finally, even steroid inhalers commonly prescribed for asthma and emphysema, such as Flovent and Advair, have the potential to cause cataracts and glaucoma. That these low-dose, frequently used steroid inhalers could potentially cause eye problems may come as a surprise to many people.

USE STEROIDS SAFELY

Here are some guidelines for safe usage:

  • Patients taking steroid pills or inhalers for chronic conditions should have a yearly eye exam. This is the best way to diagnose treatable problems such as cataracts and glaucoma, Dr. Chang emphasizes. For example, glaucoma has no early symptoms, so people may not realize it is developing — or that early treatment with eye drops may be necessary to prevent permanent vision loss.
  • If you require chronic steroid medication, ask your prescribing doctor what side effects you should watch for. If you already have glaucoma, notify your ophthalmologist if you end up needing steroids in the form of an inhaler or pills for a prolonged period of time.
  • If you are using steroid inhalers or pills, carefully follow your prescribing doctor’s instructions. He/she will generally want you to take the lowest effective dose for the shortest possible time. It is particularly important not to self-medicate with steroids, including eye drops containing steroids. These should always be used under the supervision of your doctor.
  • Do not abruptly stop taking oral steroids or using inhalers on your own. Withdrawal usually must be phased gradually, and stopping them too quickly may lead to serious medical problems. If you are experiencing side effects, discuss this with your prescribing physician rather than deciding on your own to stop them or reduce the dose.
  • Follow an anti-inflammatory diet. To fight inflammation, eat more nutrient-rich fresh fruits and vegetables (deeply colored blueberries and cranberries, dark green leafy chard and mustard greens, for instance). Cold-water fish such as salmon and tuna is rich in inflammation-fighting omega-3 fatty acids. Cut back on simple sugars and carbohydrates from processed foods (cookies, white bread, chips) and fast foods, which cause extreme fluctuations in blood glucose levels… and fried foods (particularly those with trans fat such as French fries), which encourage inflammation.

Steroids — whether as pills, inhalers or eye drops — should be reserved for serious illnesses. The dramatic benefits can make them seem like wonder drugs, but your doctor must always weigh the benefits against the potential side effects.