Use of Latency Models to Assess the Association between Use of Topical Corticosteroids (CS) and Incident Cataract among Eyes of Patients with Uveitis.

PURPOSE: Cataract is a leading cause of visual impairment related to uveitis. Time-to-development of cataract following topical corticosteroid use (CS) is not well characterized. We hypothesized that the time of greatest cataract risk following the use of topical CS could be identified using latency modelling.

METHODS: Eyes with anterior uveitis were followed over time for cataract in a large retrospective cohort study. In addition to uveitis activity (AC) and topical CS use at each visit, other covariates predictive of cataract incidence were available. Cox regression analyses with time-dependent covariates with the eye as the unit of analysis were used to assess cataract risk as a function of AC cell and CS drop use during two different 6-month exposure periods (Proximal: 1-185 days/Distal: 186-365 days prior to the current visit) after adjusting for other covariates.

RESULTS: In 6-month periods of disease inactivity (grade 0), there were strong associations between use of CS drops and cataract incidence: hazard ratio (HR)proximal = 2.0 (95% CI = 1.2, 3.3); HRdistal = 1.6 (95% CI = 0.9, 2.7). In periods of borderline activity (grade 0.5+), there was a strong association of CS use in the proximal: HR = 5.5 (95% CI = 1.7, 18.1), but not the distal period. In periods of clearcut disease activity (≥grade 1+) there was no association of CS use with cataract incidence.

CONCLUSION: Topical CS use is associated with higher cataract risk during inactive or borderline disease activity periods, but not during clearcut disease activity periods (during which anti-inflammatory effects may be beneficial).