Systemic corticosteroids do not adversely affect vision in the elderly

Purpose. To evaluate whether sustained large doses of systemic corticosteroids in a population at risk for glaucoma and cataracts would adversely affect vision, increase the IOP or rapidly cause clinically significant lens changes. Methods. Prospective randomized trial of temporal arteritis with methotrexate or placebo in addition to corticosteroids. Patient evaluations at start, 1, 3, 6, and 12 mos included examinations with threshold perimetry, EDTRS, Peli-Robson contrast testing, and grading of lens with a modified version of LOCSII. Results. 10 subjects were followed, receiving a cumulative dose of prednisone from 2077 to 8628 mg in 6 mos and 2128 to 9188 mg in 12 mos. New lens opacities developed in 3 subjects (all OU); all were only 1 grade, separate and minor. The changes were anterior cortical in 2 and posterior subcapsular in 1 subject. Acuity decreased 1 line in both eyes of 2/3, contrast decreased 0.15 log units in 2 eyes of 1/2, but the visual fields was unchanged. Baseline cortical and subcapsular cataracts did not change. New elevation of IOP > 21 mm Hg (22) occurred in 1 subject and the one with prior glaucoma had no rise in IOP. Conclusions. Large doses of corticosteroids can be used for systemic diseases without significant risk of visual loss in the elderly.