Drug induced ocular side effects: case-control, cohort, and cross sectional studies
| Author (year) | Study type | Drug | Adverse reaction | Population intervention and outcome | Comments |
|---|---|---|---|---|---|
| Lakowski27 (1977) | Case-control | Oral contraceptive (OC) | Colour vision alteration | 14 diabetic women on OC and 20 non-diabetic controls. Age matched. Similar duration of diabetes. All normal vision, nulliparous and no retinopathy. Significant (p<0.05) red/green deficiency in diabetic OC users. Subsequent report states main deficiency in yellow/blue areas44 | Small scale—statistical power not stated. Correlation of deficiency with duration of diabetes |
| Garg28(1993) | Case-control | Oral contraceptive (OC) | Retinopathy | 43 cases and controls. Cases all IDDM (15 years+) and on OC 1 year. No change in retinopathy grade over time | Small scale—statistical power not stated. May be biased because studied eye clinic attendees only |
| Klein29 (1990) | Cross sectional | Oral contraceptive (OC) | Retinopathy | 384 females under age of 40 all with IDDM. full medical and eye exam initially and at 2 years. No relation between OC use and degree of retinopathy. Multiple regression technique | Small scale—statistical power not stated. Bias may have occurred because doctors may not generally prescribe pill to diabetics |
| Greven30 (1995) | Cross sectional | Oral contraceptive (OC) | Retinal artery occlusion (RAO) | 21 females. Examined all factors likely to be associated with occlusion. 4/21 women on OC. 2/21 had diabetes | No statistical analysis stated |
| Steinberg31 (1996) | Cross sectional | Erythropoietin | Hallucinations | 18 dialysis patients on erythropoietin with hallucinations. Significant association of hallucinations with diabetic retinopathy and age | Convenience sample of all dialysis patients |
| Chen32 (1996) | Cross sectional | Interferon | Retinopathy | Chronic active hepatitis patients (n=34). 12/34 had retinopathy following interferon which disappeared on cessation of treatment | Authors postulated that mechanism due to inherent vascular abnormalities caused by diabetes |
| Kawano33 (1996) | Cross sectional | Interferon | Retinopathy | 36/63 hepatitis C patients treated with interferon developed retinal haemorrhages and soft exudates in 4–8 weeks. 14 NIDDMs | Greatest effect in diabetics |
| Ramamurthy34 (1997) | Cross sectional | Urokinase | Retinal haemorrhage | 20 diabetics on dialysis. Eye examination before and after urokinase | |
| Isaac35 (1991) | Retrospective cohort | Phenothiazines | Cataracts | 4674 patients with cataracts. Matched for age and sex. Used conditional logistic regression. Relative incidence of cataract was 3.5 higher in phenothiazine users of 3–5 years' duration | Also found steroids and benzodiazepines increased risk of cataract |
| Clair36(1989) | Case-control | Allopurinol | Cataracts | From pharmacy records of allopurinol users. 51 cases and 76 controls. Confounders age, sex, diabetes, and hypertension ruled out by logistic regression. Risk ration for cataract of 1.3 not significant | Potential bias in controls. Selection based on response to offer of free eye test, over 80% refused. Cases all had previous eye examinations |
| Liu37 (1991) | Cross sectional | Allopurinol | “Lens changes” | 53 gout patients from gout clinic. All on 300 mg daily for at least 18 months. High prevalence (25%) of thinning of clear zone of lens. 12% with cataracts | Background incidence not stated. No statistical analysis |
| Leske38 (1991) | Case-control | Allopurinol Oral steroids | Cataracts (various types) | 945 cases, 435 controls in eye hospital. Investigated nutrition, medical history, and other risk factors. Logistic regression gave adjusted ORs of 1.56, diabetes; 5.83, oral steroids; 2.48, allopurinol | “Lens opacities case control study”. Major study |
| Davis39 (1997) | Cross sectional | Cidofovir | Iritis and hypotonia | Of 43 patients with CMV retinitis, 26% developed iritis. Impaired visual acuity occurred in 5 eyes | Iritis more likely to occur in diabetics (p<0.05) |
| Pfefferman40 (1977) | Cross sectional | Prednisolone | Cataracts | 78 renal transplant patients. 2/78 with severe diabetic retinopathy. 20 controls. Correlation of cumulative prednisolone dose with cataracts. No statistics | Haemodialysis duration, age, and daily prednisolone dose not correlated with cataract |
| Cumming41 (1997) | Cross sectional | Inhaled steroids | Cataracts | 3654 volunteers. Assessed diabetes, hypertension, inhaled and oral steroid use. Groups similar for sex, smoking, and diabetes. Ordinal regression gave adjusted ors of 1.8 | Some missing data on steroid usage and confounders |
| Garbe42 (1997) | Case-control | Oral glucocorticoids | Open angle glaucoma and ocular hypertension | Elderly population. 9793 cases on treatment. 38 325 controls— randomly selected eye patients. Logistic regression adjusted for various confounders including diabetes. Adjusted odds ratio was 1.41 for current users of steroids for either glaucoma or ocular hypertension | Weak association but significant. Authors suggest regular IOP monitoring required in elderly on long term steroids |
| Yablonski43 (1978) | Intervention study | Dexamethasone (topical) | Cataracts | 11 diabetics. One eye treated with 0.1% eye drops. 9 showed pathology (4 requiring surgery) in treated eyes. 1 patient developed cataracts in untreated eye | Difference was significant (p<0.005) |
↵Indicates data obtained from abstract.