Prednisone

What is it?

Corticosteroid used to treat inflammatory conditions
Most common ophthalmic side effect: posterior subcapsular cataract, developing in 25% of patients who use prednisone 15 mg/day for 1 year or more, or equivalent doses of other corticosteroids

How does it appear?

Slowly progressive visual loss in both eyes, but may be asymmetric in two eyes
Opacity on posterior portion of crystalline lens, usually visible only with ophthalmoscope or slit lamp biomicroscope

What else looks like it?

Cataract as part of aging, intraocular inflammation, eye trauma
Refractive error, retinal or visual pathway disorder

What to do?

Warn patients that cataract is likely complication of chronic prednisone use
Refer patients who report visual impairment and are using prednisone chronically

What will happen?

Discontinuing prednisone does not reverse cataract but may halt its progression
Cataract extraction has high chance of restoring vision provided there are no other causes of vision loss