Table 2

Drug induced ocular side effects: case-control, cohort, and cross sectional studies

Author (year)Study typeDrugAdverse reactionPopulation intervention and outcomeComments
Lakowski27 (1977)Case-controlOral contraceptive (OC)Colour vision alteration14 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-controlOral contraceptive (OC)Retinopathy43 cases and controls. Cases all IDDM (15 years+) and on OC 1 year. No change in retinopathy grade over timeSmall scale—statistical power not stated. May be biased because studied eye clinic attendees only
Klein29 (1990)Cross sectionalOral contraceptive (OC)Retinopathy384 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 techniqueSmall scale—statistical power not stated. Bias may have occurred because doctors may not generally prescribe pill to diabetics
Greven30 (1995)Cross sectionalOral 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 diabetesNo statistical analysis stated
Steinberg31 (1996)Cross sectionalErythropoietinHallucinations18 dialysis patients on erythropoietin with hallucinations. Significant association of hallucinations with diabetic retinopathy and age Convenience sample of all dialysis patients
Chen32 (1996) Cross sectionalInterferonRetinopathyChronic active hepatitis patients (n=34). 12/34 had retinopathy following interferon which disappeared on cessation of treatmentAuthors postulated that mechanism due to inherent vascular abnormalities caused by diabetes
Kawano33 (1996) Cross sectionalInterferonRetinopathy36/63 hepatitis C patients treated with interferon developed retinal haemorrhages and soft exudates in 4–8 weeks. 14 NIDDMsGreatest effect in diabetics
Ramamurthy34 (1997)Cross sectionalUrokinaseRetinal haemorrhage20 diabetics on dialysis. Eye examination before and after urokinase
Isaac35 (1991)Retrospective cohortPhenothiazinesCataracts4674 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' durationAlso found steroids and benzodiazepines increased risk of cataract
Clair36(1989)Case-controlAllopurinolCataractsFrom 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 significantPotential 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 sectionalAllopurinol“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 cataractsBackground incidence not stated. No statistical analysis
Leske38 (1991)Case-controlAllopurinol
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 sectionalCidofovirIritis and hypotoniaOf 43 patients with CMV retinitis, 26% developed iritis. Impaired visual acuity occurred in 5 eyesIritis more likely to occur in diabetics (p<0.05)
Pfefferman40 (1977)Cross sectionalPrednisoloneCataracts78 renal transplant patients. 2/78 with severe diabetic retinopathy. 20 controls. Correlation of cumulative prednisolone dose with cataracts. No statisticsHaemodialysis duration, age, and daily prednisolone dose not correlated with cataract
Cumming41 (1997)Cross sectionalInhaled steroidsCataracts3654 volunteers. Assessed diabetes, hypertension, inhaled and oral steroid use. Groups similar for sex, smoking, and diabetes. Ordinal regression gave adjusted ors of 1.8Some missing data on steroid usage and confounders
Garbe42 (1997)Case-controlOral glucocorticoidsOpen angle glaucoma and ocular hypertensionElderly 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 hypertensionWeak association but significant. Authors suggest regular IOP monitoring required in elderly on long term steroids
Yablonski43 (1978)Intervention studyDexamethasone (topical)Cataracts11 diabetics. One eye treated with 0.1% eye drops. 9 showed pathology (4 requiring surgery) in treated eyes. 1 patient developed cataracts in untreated eyeDifference was significant (p<0.005)
  • Indicates data obtained from abstract.