Publication:

Antidepressants-a possibly risk factor for cataract development: a cross-sectional study

Background Few studies have reported the role of antidepressants as cataractogenic in humans.

Methods It’s a hospital based descriptive, cross-sectional study. 45 Patients were screened for antidepressant use and diminution of vision, 6 were dropped out. 39 patients with 78 eyes were finally enrolled. They were divided into two goups i.e., Group-I, with cataract (N=53) and Group-II, without cataract (N=25). Three clusters of antidepressants were assessed e.g., SSRI, SNRI and TCA with therapeutic dose (TD) and non-therapeutic dose (NTD) range. Psychiatric illness was diagnosed on DSM-5 and severity of depression on HAM-D. Best corrected visual acuity (BCVA) was converted from Snellen units to logarithm of minimal angle of resolution (log MAR) for statistical analysis. Cataract changes in eyes were seen on slit-lamp and classified on Lens opacities classification system-III (LOCS-III) criteria.

Results A total 78 eyes of thirty-nine (39) patients were evaluated. Thirty (38.46%) and forty-eight (61.53%) eyes belonged to males and females, respectively. Mean age of males (n=7) was 41.8±2.3 years and females (n=32) 40.2±1.0 years. In Group-I, out of (N=53) eyes that developed cataract 33 were females (62.26%) as compared to males 20 (37.7%). Group -II, out of (N=25) eyes, females without cataract were 15 (60%) as compared to males 10 (40%).  Therapeutic dose (TD) of antidepressants (AD) in Group-I had more cataract 37 (69.81%) as compared to non-therapeutic dose (NTD) 16 (30.1%). Most of the eyes with cataract 35 (66.03%) had AD exposure of more than 1 year that was possibly associated with increased risk of cataract development (OR 2.10; 95% CI, 0.79-5.55). Amongst users of antidepressants, SSRI was associated with increased risk of cataract development (OR 2.4; 95% CI, 0.72–7.94) with a female preponderance (OR 1.1; 95% CI, 0.41–2.91). Maximum number of eyes 34 (64.15%) that developed cataract had BCVA of ≥6/12 and minimum of 2 (3.77%) eyes had BCVA of ≤6/36. LOCS-III revealed 38 (71.69%) eyes (71.69%) having peripheral cortical cataract and 15 (28.30%) posterior sub-capsular cataract.

Conclusions There is a possible risk of association of cataract amongst user of antidepressants. The AD use of more than 1 year or longer had increased risk for development of cataract with a female preponderance. The highest risk was observed in the users of SSRI as compared to SNRI and TCA. Treatment exposure with antidepressant was longer for mild depression having more than two episodes.