Steroid induced glaucoma prevalence

Ann Allergy Asthma Immunol . 2006 Apr;96(4):514-25.
Concerns about intranasal corticosteroids for over-the-counter use: position statement of the Joint Task Force for the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology.
Bielory L, Blaiss M, Fineman SM, Ledford DK, Lieberman P, Simons FE, Skoner DP, Storms WW; Joint Task Force of the American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology.
Source
Department of Medicine, UMDNJ-New Jersey Medical School, Newark, USA.
Abstract
The Joint Task Force for the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology was charged with formulating a position paper regarding the potential release of intranasal corticosteroids for over-the-counter use. We took the position that safety issues regarding this proposal would be our sole concern. We reviewed the literature to evaluate the frequency and severity of potential adverse events related to the administration of intranasal corticosteroids. We limited this review to 5 areas: (1) effects on growth, (2) ocular effects, (3) effects on bone, (4) effects on the hypothalamic-pituitary-adrenal axis, and (5) local adverse effects. After review of the available data, we concluded that intranasal corticosteroids should remain prescription-only drugs. Patients receiving an intranasal corticosteroid should be instructed in its use and that use should be monitored by a physician or an appropriately trained medical provider (eg, nurse practitioner or physician assistant) under the direct supervision of a physician. This conclusion was reached based on the evidence that corticosteroids administered by any route, including the intranasal route, have the potential to cause adverse effects in all the areas noted herein. Our conclusion was strengthened by the fact that these adverse effects can be insidious and therefore not evident for many years; there is the potential for overuse; patients could also have access to other forms of topically administered corticosteroids, thus increasing their total dose; and individuals vary in their susceptibility to corticosteroid-induced adverse effects. We were also influenced to take this position knowing that generally reassuring data regarding the use of respiratory tract-administered corticosteroids are based on mean data and that all such studies have shown outliers in whom adverse effects were evident. Thus, as stated, we recommend that intranasal corticosteroids remain prescription-only drugs.

If you have routine examinations and you develop glaucoma, the chances of serious vision loss from glaucoma are very remote. However, late detection or non-compliance may result in vision loss. One may think of glaucoma being analogous to a house on the beach. If a house is in good shape and is hit by a series of storms, then the house will survive the storms with little damage (high eye pressure with a healthy nerve). However, if the foundation of the house has been damaged by previous storms there is a significant chance that the house will either be further damaged or swept away by the storm (a damaged nerve can not take the excess pressure from glaucoma). Thus, the key to preserving vision is early detection with aggressive treatment. The chronic, progressive nature of the disease makes it difficult for the patient to faithfully take their medication - the key to preserving vision.

Fifteen kidney transplant recipients were studied ophthalmologically for periods of one to five years following the transplantation. All subjects received maintenance immunosuppressive therapy which included azathioprine (IMURAN) and corticosteroids. Two patients developed posterior subcapsular cataracts. Seven patients (47%) developed increased intraocular pressure and one of these had glaucomatous field loss and disk cupping. The increased intraocular pressure responded favorably to topical treatment while the patients were under continuous treatment with systemic steroids and immunosuppressive drugs.

The probabilities of success at 3 years for trabeculotomy for steroid-induced glaucoma vs trabeculotomy for POAG was % vs % for criterion A (P = .0008) and % vs % for criterion B (P < .0001), respectively. At 3 years, the success of trabeculotomy for steroid-induced glaucoma was comparable to trabeculectomy for steroid-induced glaucoma for criterion A (%; P = .3636), but lower for criterion B (%; P = .0352). Prognostic factors for failure of trabeculotomy for steroid-induced glaucoma were previous vitrectomy (relative risk [RR] = ; P = .0452 on criterion A, RR = ; P = .0360 for criterion B) and corticosteroid administration other than ocular instillation (RR = ; P = .0352 for criterion B).

Steroid induced glaucoma prevalence

steroid induced glaucoma prevalence

The probabilities of success at 3 years for trabeculotomy for steroid-induced glaucoma vs trabeculotomy for POAG was % vs % for criterion A (P = .0008) and % vs % for criterion B (P < .0001), respectively. At 3 years, the success of trabeculotomy for steroid-induced glaucoma was comparable to trabeculectomy for steroid-induced glaucoma for criterion A (%; P = .3636), but lower for criterion B (%; P = .0352). Prognostic factors for failure of trabeculotomy for steroid-induced glaucoma were previous vitrectomy (relative risk [RR] = ; P = .0452 on criterion A, RR = ; P = .0360 for criterion B) and corticosteroid administration other than ocular instillation (RR = ; P = .0352 for criterion B).

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