Effects of prednisolone on eyesight

[Groggrim]

I like the comment I recently read in a post about not tapering to zero but finding the lowest effective dose for symptoms relief. However my optician (yes optician!) wants me off pred by the time I next see him in 6 months. My recent eye exam showed up cataracts and slight changes in eye pressure that he says is caused by the steroids. Is he correct?

[piglette]

Yes it can happen, but I am not sure that your optician should be deciding on what drugs you take in the case of PMR or GMC.

[Gala123 in reply to piglette]

I agree with piglette. Yes, it is likely that cataracts can be caused or worsened by prednisolone. It can also cause glaucoma, which is much worse and cannot be corrected by a routine surgery. So, your optician is right to express concern. However, in such cases, the good practice is to assess if you still need the culprit medication and if you are getting the minimum effective dose, as well as if there is an alternative. This can only be assessed by your prescribing doctor/rheumatologist. It may be decided that staying on steroid is a benefit that outweighs the risk. Untreated inflammation can lead to quite terrible consequences, including developing GCA that can lead to blindness. So, I think, it is worth mentioning to your rheumatologist or GP (Whoever is treating your PMR) that you have cataracts and increasing eye pressure and see if they can assess your dose and tapering schedule and maybe prescribe a steroid-tapering medication if appropriate, but it is not up to your optician to give you tapering deadlines.

[DorsetLady PMRGCAuk volunteer]

I think you’ll find the comment is ‘you are not reducing relentlessly come what may to zero but to find lowest effective dose for symptoms relief.

Which isn’t the same thing - obviously the ultimate aim is to reach zero, but when, and only when your illness allows it.

And yes steroids can increase your eye pressures, and may increase the likelihood of Pred induced cataract.. but both can be dealt with easily - and it’s not a reason to stop the medication whilst you still have PMR. .. and certainly not if you have GCA.

[PMRpro Ambassador]

Could well be - existing cataracts can be made worse quite quickly by pred and one adverse effect is to raise occular pressures but usually they can be managed using eye drops. If raised pressures aren't managed, the longer term effect can be to cause glaucoma but good management should avoid that. Not sure if that is his remit - if it isn't, you need referral to the Eye Clinic.

Your optician may well think you should get off pred - but it isn't his place to decide how long you may need it for PMR, particularly in view of the small risk of you developing GCA. I trust he doesn't tell any GCA patients that!

[Groggrim]

It was his comment 'I want you off prednisolone when I see you in 6 months'. To me that is pressure that I don't need. I will continue as I am but also heed the warnings posted here. Thank you

[PMRpro Ambassador in reply to Groggrim]

Certainly is!! I would mention it to your GP who may support you in getting through to him it isn't that simple! If only it were ...

[Gc2596 in reply to Groggrim]

We are the same age and very similar timewise starting Pred at 15mg, July '24 for me. I had cataract surgery over 10 years ago. Fully remember the Optician asking if I'd taken steroids as 'young' for cataracts. The answer being "no". After surgery my eye pressure increased to a level which could cause Glaucoma and steroid drops were prescribed and all sorted. I went to the Opticians last week purely for a pressure check (free) being aware of possible pressure increase. Pleased to be told 'perfect' at 16 + 17. I was however, advised to have an annual eye test as opposed to 2 yearly. At least you are aware now going forward.

[Groggrim in reply to Gc2596]

Thank you for sharing. I have been on annual eye tests for a number of years.

[jarn in reply to Groggrim]

Everyone has mentioned, the optician has no right to be giving you those orders. As far as I know, he doesn't have the medical background. Perhaps you should be seeing an ophthalmologist who is more tuned in to the eye. All the comments you have received here are spot on. Good luck to you and your battle with the optician. As far as I know the Opticians primarily prescribe lens for spectacles

[Karenjaninaz in reply to Groggrim]

How dare this practitioner, who is not a medical doctor, make such a pronouncement. I see right through his ignorance. Fortunately you have decent, science based support here.

[NellOHE3]

I had similar and am off to the glaucoma clinic at the eye hospital tomorrow. Panic all round because I had BRVO before my PMR and have eye injections on a regular basis. My GP has been helping me taper as ‘quickly but safely’ as possible and I am now on 2mg for a while to see if it is the best dose to keep the PMR happy (it does, unless I try to do too much) but also to keep the glaucoma and cataracts at bay.