WTF.... Steroids --> Cataracts?

[mmglobal]

I had an eye exam yesterday. I now have grade one cataracts. That is not a big deal in the grand scheme of things. It's not too bad. If it gets bad, the cataract surgery is low risk, high success and should be waaaay better than lasik.

I had lasik done a couple of years ago. A few days after the procedure, my vision was great. A couple of weeks later, it was not so much. I've been considering a 're-do' and that is why I was having the exam. The Dr. said that normally they first see a 'trace' of cataracts. (a clouding of the lense) Beyond a trace, it's graded 1 to 4.

He said it's a little unusual for me to go from nothing to grade 1 without stopping at a trace. If it was genetic, I would have had it long ago. If it was age-onset, I'm way too young. He said the next likely cause was steriods. I believe it can be oral steroids and/or injections. I had 8 lumbar epidurals over a span of 3 years in the late 90's. Since 2009, I've been chasing the thoracic pain syndrome that has been ruining my life. This included one big panel of facet injections; 6 levels bilateral. Also, a handful of costo-veterbral injections, intercostal nerve blocks, and 2 thoracic epidurals this year. (Great news... the thoracic epidural have given me some very meaninful relief!!!)

I'm very surprised that with my 17 years of being a spine patient, I've not heard of this. I don't think it would have mattered and I would have still done these injections. But, I would think that as we get into more than just a few injections, that would be discussed as a risk factor.

I'm putting this out here so others having similar diagnostics and treatments might have the discussion with their doctors that I should have had.

Mark

PS, I've probably had 4 or 5 prednisone 'dose packs' during those 17 years, though none recently. These are moderate dose oral steroids.

[Maria]

I had lasik done back around 2000. Went to see Dr. Manger last summer re eval for re do. There was way more of a push to do the surgery even that day and get $500 off basically the same price I paid to have it done back in 2000 which was a fair sum.

I've been happy with the results but have noticed changes. During the last part of the very thorough exam I was told that if cataracts occurred that would change the improvement in my vision even with the surgery.

I was told at the time of the exam I have a slight cataract starting in one eye but nothing that needed surgery now. I have been told that over the last few years. I was concerned however that slight cataract could very quickly progress esp. at my age.

Ok I decided because of my age and what I was told about cataracts I didn't want to plunk out another $3500 for redo before checking this out further.

I went home and was talking with my upstairs neighbor who told me that at 61 she had laser eye surgery and then developed cataracts at age 63 and the surgery was useless plus it made it far more difficult to measure her lens I think for an implant or something like that. In fact as I was researching this I learned that laser eye surgery period makes this more difficult should cataracts occur and one is going to get an implant.

Ok so I decided glasses are fine for me with regard to reading and even distance though I need them far less for that. I went to a local optometrist and was fitted for one contact which works for the distance prob as well as wearing some newer script glasses.

BTW I had a posterior vitreous tear a few weeks after I went to Dr. Manger's office in my left eye and that had to be watched for the first 6 weeks or so re potential for retinal tear. That also made me very very glad I didn't have a retweak of my lasik surgery because posterior vitreous tears are more common in my age group and also for people that have myopathy or even had it before laser eye surgery.

Ok also .. I got ESIs over a span of 10 years plus have done a recent course of oral steroids (Medrol dose pack) and had cortisone shots over the last 30 years in my knee, my shoulder, etc.

I think that in some people it's possible there is an increased chance that steroid induced eye changes can occur but also cataracts are more common if one is out in the sun a lot and not wearing proper protective sunglasses as well as age related and just genetically influenced.

So I don't know Mark ...not sure the progression could be pinned on the steroids without some of the other potential factors weighing in there as well. Let us know what you find out upon seeing an eye specialist (or another) if you'll be doing that.

I went to Harvard Eye Clinic over near Saddleback Hospital in Laguna Hills and liked them very much. Also have a good ophthalmologist in LB that I used to see.

Good luck~ growing older sure is challenging!

[mmglobal]

Maria, thanks for the info.

I forgot to mention my decision. If the cataracts is advancing, the re-do is not very useful and presents unnecessary risk. I decided to wear contacts and glasses for the next 8-9 months and check on the cataracts. If it's advancing, I'll wait for the cataracts surgery. If it's stable, I'll have the re-do procedure.

Mark

[Maria]

Keep researching a bit with regard to redoing laser eye surgery and cataracts before doing a redo even if things do stabilize. Make a very well informed decision unless you feel that you're already informed enough. Good luck!

[jsewell]

Mark i am sorry about the cataracts. I see an opthalmologist as well as a retinal specialist. I have had macular hemmorhages in both eyes. I just went to my opthalmolosist this week too and i have now increased ocular pressure so i have to go back for a visual field test. I will try really hard to remember to ask the doctor about steroids and cataract risk. I spent 2 years on a pretty good dose of prednisone for an inflammatory muscle disease. then i have no idea how many spinal injections i have had over the last 7 years, but a lot. also i usually require steroids for 3 days after a lot of my surgeries, and the dose paks, how I love those things for the relief they bring . My dad died 2 years ago and had glaucoma , but no cataracts at the age of 80. My mom is 81 and just starting to get them so no really strong family history either. I will be watching for this , thanks for the warning.
Like you said Mark, i really would not stop getting the steroid injections anyway.
Judy