Deteriorating vision in a COPD patient (78/1700)

A 67yo man has deteriorating vision in his left eye. He has longstanding COPD and is on multiple
drug therapy. What single medication is likely to cause this visual deterioration?

a. B2 agonist
b. Corticosteroid
c. Diuretic
d. Theophylline

























answer:B

Patients maintained on systemic corticosteroids for many years in treatment of asthma, rheumatoid arthritis, prophylaxis of a renal graft rejection etc, may develop cataract. A dose of 15 mg prednisolone a day is regarded as safe in an adult for two or three years.
The cataract is typically posterior subcapsular and starts in the axial part of the lens. Its affect on vision is therefore early. Stopping steroids may stop progression but this is rarely possible because of the nature of the treated systemic disorder.
Rarely, posterior subcapsular cataract has been described following long-term use of local steroids to suppress uveitis.
Some miotics, particularly anticholinesterases, used to treat glaucoma or accommodative esotropia, have been reported to produce anterior subcapsular opacities.