Psychotropic medication and cataract: a review of case-control studies

Abstract

Ocular side effects are possible to occur as side effect of psychotropic drug treatment.  Antidepressants and typical antipsychotics have been associated with increased intraocular pressure, glaucoma, lenticular pigmentation, visual disturbances and cataract, whereas the risk of atypical antipsychotics and mood stabilizers remains unclear. The aim of our study was to review the case-control studies assessing the risk for cataract of three major classes of psychotropic medication: antidepressants, antipsychotics and mood stabilizers. Four studies assessed the risk of antidepressant drugs. A higher risk for cataract diagnosis or surgery was observed in three studies, especially on long-term use of antidepressants. One study could not identify a higher risk of antidepressant use in general, yet a higher risk was observed in patients younger than 65 years. Different types of antidepressant seem to carry different risks, with proposed harmful effects of dual mechanism and intermediate SERT affinity. Three studies suggested that the association of atypical antipsychotics and high potency typical antipsychotics with cataract is unlikely, or even that atypical antipsychotic drugs might be protective against cataract. However, there is inconsistency between the sparse preclinical and clinical evidence of their protective and harmful effects. Only one study suggested a possible association of mood stabilizers with cataract, despite the discrepant results on individual drugs. Concluding, these case-control studies cannot establish a harmful or protective causal relationship between psychotropic medication and development of cataract. Further research is needed in order to provide proper recommendations