These medicines (corticosteroids) are normally used to treat a large group of chronic medical situations, such as autoimmune disorders, inflammations and transplantation of the organs [1]. In spite of the fact that these drugs are largely helpful in the control of the disease activity and in the suppression of the inflammation, there is a range of possible side effects that may be linked to the prolonged corticosteroid therapy [2]. Among the serious and usually not mentioned effects of long-term use of corticosteroids is irritation of the visual condition. Changes in the ocular structures are easily caused by the use of corticosteroids and thus among them are cataracts, glaucoma, and central serous chorioretinopathy that both can affect the eyesight and lower the quality of life [3]. The patients under long term corticosteroid therapy use have the element of visual disturbances, which most of the time is not noticed because the effects can be mild or upcoming [4]. Because the diseases that corticosteroids are prescribed are chronic in nature, age-related effects of these drugs on the visual system are worthwhile to explore. Penetration of ocular complications among patients being administered corticosteroid treatment can be impacted by various factors including dose, the time the treatment is taken, concerning health, and hereditary proneness [5][6]. Thus, it is important to evaluate the visual changes in such patients to prevent the irreversible loss of vision and the enhancement of long-term treatment results [7]. Corticosteroids such as prednisolone, dexamethasone and hydrocortisone act in the role of cortisol, a hormone that is secreted by the adrenals. Such drugs are anti-inflammatory, immunomodulators, and controls different metabolic events [8]. They have contributed tremendously in the field of modern medicine since they have proven useful in the treatment of several conditions including rheumatoid arthritis, lupus, asthma and inflammatory bowel disease. Nonetheless, despite the fact that corticosteroids have a prominent beneficial effect as a therapy, its long-term use may produce such severe adverse outcomes as in the ocular system, especially [9]. Ocular corticosteroid ocular complications are complex and may engage many parts of the eye, such as the lens, optic nerve and retina. The formation of cataracts is one of the most widely followed visual disruptions, especially posterior subcapsular cataracts that are at potential risk to create impairment in clear visibility, glare, reading, or driving. It is not completely known how corticosteroids encourage the development of cataracts, but an understanding of this process includes how the structure of lens proteins changes and how oxidative stress puts up with lens opacification [10][11]. Another eye disease that has been associated with the use of corticosteroid is known as central serous chorioretinopathy (CSC). CSC is a condition associated with the build up of fluid below the retina causing impaired vision including, central vision, distorted vision among others [12]. It is believed that in corticosteroid users, the pathogenesis of CSC could be linked to the changes of the blood-retinal barrier and the enlargement of vascular permeability in circulation of the choroidal blood supply [13]. CSC is usually self-limiting and is resolved in most instances, but chronic or recurrent attack might cause permanent eye damage to the retina leading to considerably damaged vision. There are other ocular conditions that have been reported in corticosteroid users besides having these well-documented ocular conditions which include dry eye syndrome, retinal vascular occlusions and macular edema. Collective impacts of these situations may result in the fall in life quality, particularly, in the patient with already existing problems of long-term medical conditions [14].

Objective

This study aims to assess the prevalence and nature of visual changes in patients receiving long-term corticosteroid therapy.

This is a cross-sectional observational study conducted from January 2023 to June 2023 and a total of 255 patients were included in the study. The sample size was calculated using a confidence level of 95% and a margin of error of 5%. A non-probability consecutive sampling technique was used to select participants who met the inclusion criteria.

Inclusion Criteria:

• Adults aged 18 years or older
• Patients who have been on systemic corticosteroid therapy for at least six months for chronic medical conditions such as rheumatoid arthritis, lupus, inflammatory bowel disease, asthma, or organ transplant recipients
• Patients willing to participate and provide informed consent

Exclusion Criteria:

• Patients with a history of ocular diseases unrelated to corticosteroid use (e.g., diabetic retinopathy, age-related macular degeneration, hereditary retinal diseases)
• Pregnant women
• Patients who had undergone recent eye surgery (within the last 6 months)
• Patients with a history of other medications known to cause ocular side effects

Data Collection:

Data were collected using a combination of medical record reviews and systematically designed questionnare. A detailed review of the patients’ medical records was conducted to gather information on their medical history, type of corticosteroid therapy, dosage, duration of treatment, and any previous ocular assessments. A thorough ophthalmic examination was performed on all participants, which included visual acuity testing, intraocular pressure (IOP) measurement, slit-lamp examination, fundoscopy, and optical coherence tomography (OCT). These assessments were performed by an experienced ophthalmologist to identify any visual impairments, including cataracts, glaucoma, central serous chorioretinopathy, and other retinal conditions. The primary outcome of the study was the identification and prevalence of visual changes associated with long-term corticosteroid therapy. Specific ocular conditions, including cataracts, glaucoma, and central serous chorioretinopathy, were assessed as part of the evaluation.

Data Analysis:

Data were analyzed using SPSS v26. Continuous variables such as age and corticosteroid dosage were summarized as mean and standard deviation, while categorical variables such as gender and underlying medical conditions were summarized as frequencies and percentages. The prevalence of ocular conditions such as cataracts and glaucoma were calculated, and subgroup comparisons based on corticosteroid dose, duration of therapy, and underlying condition were conducted using chi-square tests for categorical variables and t-tests or ANOVA for continuous variables. A p-value of less than 0.05 was considered statistically significant

Data were collected rom 255 patients with a mean age of 52.3 ± 14.6 years, ranging from 18 to 88 years. The average duration of corticosteroid therapy was 5.6 ± 3.4 years. Of the participants, 55.7% were receiving a high corticosteroid dose (≥ 20 mg/day), while 44.3% were on a lower dose (< 20 mg/day). The most common chronic conditions among participants were rheumatoid arthritis (35%), asthma (25%), and systemic lupus erythematosus (18%). A smaller proportion had inflammatory bowel disease (12%) or had undergone organ transplants (10%).

Table 1: Demographic and Baseline Characteristics of Study Participants

The corticosteroid therapy data indicated that 50% of the participants were on prednisolone, 30% on dexamethasone, and 20% on hydrocortisone. The average daily corticosteroid dose was 15.2 ± 6.8 mg, with the duration of therapy being 5.6 ± 3.4 years.

Table 2: Corticosteroid Therapy Characteristics

The study found that 55.7% of participants had at least one ocular condition. The most prevalent condition was cataracts (34.9%), with posterior subcapsular cataracts being the most common type (62.9%). Glaucoma was observed in 20.4% of participants, with 73.1% showing elevated intraocular pressure (IOP ≥ 21 mmHg). Other notable conditions included central serous chorioretinopathy (11.0%), dry eye syndrome (7.1%), and retinal vascular occlusions (3.1%).

Table 3: Prevalence of Ocular Changes in Study Participants

Macular Edema

2.7%

7

Higher corticosteroid doses (≥ 20 mg/day) were significantly associated with a higher prevalence of ocular complications. Among patients with cataracts, 45% of those on high-dose therapy developed cataracts, compared to only 20% of those on low-dose therapy (p = 0.002). Similarly, the prevalence of glaucoma was higher in the high-dose group (30%) compared to the low-dose group (12%) (p = 0.004). Central serous chorioretinopathy was also more common in the high-dose group (14.2%) compared to the low-dose group (7.1%) (p = 0.03).

Table 4: Association between Corticosteroid Dosage and Ocular Complications

The duration of corticosteroid therapy was significantly associated with the development of ocular conditions. Patients who had been on corticosteroids for more than 5 years had a higher prevalence of cataracts (40% vs. 24%, p = 0.03), glaucoma (28% vs. 15%, p = 0.02), and central serous chorioretinopathy (14.2% vs. 7.1%, p = 0.03) compared to those on therapy for less than 5 years.

Table 5: Association between Duration of Corticosteroid Therapy and Ocular Complications

Ocular complications significantly impacted visual acuity and quality of life. Among patients with cataracts, 67.4% had a best-corrected visual acuity (BCVA) of < 20/40, indicating significant visual impairment (p < 0.001). For glaucoma, 42.3% had BCVA < 20/40 (p = 0.004), and for dry eye syndrome, 28% had BCVA < 20/40 (p = 0.02). Interestingly, all patients with macular edema (100%) had BCVA < 20/40, indicating a severe impact on visual function.

Table 6: Impact of Ocular Conditions on Visual Acuity and Quality of Life

It was the purpose of the study to assess the frequency and the types of visual changes which occurred in patients under long-term corticosteroid treatment due to chronic medical conditions. The findings indicate that the rate of having ocular complications related to corticosteroid use is also high, and the most widespread conditions that were identified include cataracts, glaucoma, and central serous chorioretinopathy. These results are in line with the existing studies which have raised the possibility of corticosteroids posing several eye side effects especially when they are used continuously. The investigation showed that 55.7 percent of the sample experienced at least one ocular complication with cataracts the most common (34.9 percent). The prevalence of the cataract cases was most predominant in all the posterior subcapsular cataracts (62.9%). Another side effect which is a documented sequela of long-time use of corticosteroids is cataracts, especially posterior subcapsular cataracts. They think that cataracts are caused by corticosteroids which cause oxidative stress and alter protein structure of the lenses to become cloudy or opaque. The same report revealed that the incidence of cataracts among patients receiving corticosteroids as treatment is high particularly at increased doses and prolonged administration [15][16]. The results of this investigation reinforce the idea that routine eye examination is vital in patients, who are under corticosteroid therapy, and preferably on high doses or long-term regimens. In this study, the second most frequent complaint entailed glaucoma, which occurred in 20.4 percent of participants whereas glaucoma showed intraocular pressure (IOP) elevation in 73.1 percent. A major problem with long-term corticosteroids users is glaucoma especially steroid-induced glaucoma. The corticosteroids have been found to elevate the IOP by lowering the outflow of aqueous humor in the eye and this creates a pressure [17]. This raised IOP may result in damage to the optic nerve and result in development of glaucomatous optic neuropathy as was incident in 73.1 percent of the glaucoma cases in this study.

This finding is supported by evidence that increase dose of corticosteroids are likely to cause glaucoma in patients [18].  The other important observation in this study was the case of central serous chorioretinopathy (CSC). This condition was prevalent in 11 per cent of the participants. CSC can be defined as a disease that is marked by the formation of fluid on the underside of the retina giving rise to visual disturbances, including a blurring and distortion of central vision. It is remembered to be related with corticosteroid use and the mechanism of action is thought to be mediated by the breakdown of the blood-retinal barrier with elevated vascular permeability where fluid is leaked. The increased rate of CSC in patients undergoing over 3-year general corticosteroid treatment reflects the possible long-term effect of taking corticosteroids on retinal conditions. Research has revealed that corticosteroids particularly in high dose and with long-term use have the propensity to enhance occurrence of CSC. The evidence that the earlier diagnosis and treatment of CSC the less permanent damage will occur in a retina of a patient and is exposed to long-term treatments of corticosteroids is only adding to the evidence base that this topic is a very real concern as a lack of attention to it is facing the risk of rotary damage to a view of a patient. The ocular conditions identified in this paper reflect greatly on the visual acuity and the quality of life. Visual acuity was significantly lower in patients with cataracts and glaucoma, where 67.4 percent of all patients with cataracts and 42.3 percent of all patients with glaucoma experienced visual acuity measured with a value of 20/40 or lower. This impairment of vision may impact negatively on normal activities like reading, driving and watching TV seriously.

The perceived quality of life changed significantly in these patients and 70 percent of the cataract patients and 60 percent of the glaucoma patients complained of the inability to carry out daily operations. The effect of visual impairments on the life of corticosteroid users is agreeable to the outcome of the other research studies, whereby the visual decline that is triggered by corticosteroid-induced visual impairments (cataracts, glaucoma) has been known to severely disrupt normal living functions of the patient. Although the study has brought meaningful information in regards to the ocular complication that come with long-term use of corticosteroids, the study has a number of limitations. To begin with, the cross-sectional type design implies that no causality is possible, and the study tells only about the picture of ocular health among corticosteroids users. There should be longitudinal studies that can establish the temporal relationship between use of corticosteroids and development of ocular problems. Second, the research was carried out at one tertiary care center and the conclusions might be not representative to other populations. The next studies are recommended to have other diverse sample in order to confirm the findings.

It is concluded that long-term corticosteroid therapy is associated with a high prevalence of ocular complications, including cataracts, glaucoma, and central serous chorioretinopathy. These conditions are significantly influenced by both the dosage and duration of corticosteroid treatment. The study found that cataracts were the most common complication, followed by glaucoma and central serous chorioretinopathy, all of which were linked to higher doses and prolonged use of corticosteroids. The visual impairments caused by these conditions have a notable impact on patients' quality of life, particularly affecting daily activities such as reading, driving, and other routine tasks. As many of these complications can be prevented or mitigated if detected early, the findings underscore the importance of regular ophthalmic evaluations for patients on long-term corticosteroid therapy, especially those receiving high doses or extended treatment durations.

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