Cushing’s patients at higher risk of developing cataracts at younger age
Study: Checkups should be every year, 3–5 years earlier than recommendations
People with Cushing’s syndrome, including those with Cushing’s disease, are at a higher risk of developing cataracts, causing blurry vision, than the general population, a study from Israel finds.
Cataracts, which occur when the eye’s lens becomes cloudy, also developed nearly three years earlier than in the general population, on average, in people who’d been previously diagnosed with Cushing’s syndrome. The findings suggest patients should be checked for cataracts every year, “beginning [three to five] years earlier than the current general recommendations,” the researchers wrote.
The study, “Cushing’s syndrome related to higher rates and earlier onset of cataract: A nationwide retrospective cohort study,” was published in Graefe’s Archive for Clinical and Experimental Ophthalmology.
Endogenous Cushing’s syndrome occurs when an excessive amount of the hormone cortisol is produced, leading to a range of symptoms. In its most common form, called Cushing’s disease, this is caused by a tumor forming in the pituitary gland.
Studies have found that some eye diseases occur more frequently with Cushing’s syndrome than in the general population and that the use of corticosteroids increases the risk of cataracts. Corticosteroids are lab-made steroids that mimic cortisol and are commonly used to treat inflammation.
Risk of cataracts and age
Here, researchers reviewed nationwide data from 609 people diagnosed with endogenous Cushing’s syndrome from 2000 to 2023 at an average age of 48.1 to assess the risk of cataracts developing. The patients were compared with 3,018 people from the general population, matching them for factors like age, sex, and socioeconomic status.
Of the 609 patients, 259 (42.6%) had Cushing’s disease and 206 (33.8%) had adrenal Cushing’s syndrome. The cause of Cushing’s syndrome was unknown for the others. There were about twice as many women than men.
Over an average of 14.6 years, cataracts developed more frequently in people with Cushing’s syndrome than in controls (28.1% vs. 25.5%), with patients being 34% more likely to develop cataracts than the general population. For those with Cushing’s disease, the risk was 39% higher.
Cataracts also appeared an average of 2.9 years earlier in people who’d been previously diagnosed with Cushing’s syndrome compared with people from the general population (64.7 vs. 67.6 years). They also appeared earlier in people who’d not yet been diagnosed with Cushing’s (64.9 vs. 66.8 years).
Current general guidelines “recommend annual [eye] examinations for individuals aged 65 and older and [eye] examinations every [one to three years] for those aged 55-64,” wrote the researchers, who suggest eye examinations for people with Cushing’s syndrome should happen “[three to five] years earlier than the general population, starting at ages 60-62.”
Among people with Cushing’s syndrome, being older or male increased the risk of developing cataracts by up to 76%. Diabetes, which can cause damage to blood vessels in the eyes, nearly doubled the risk of cataracts.
While there were no data on the type of cataracts and how severe they were, people with Cushing’s syndrome underwent cataract surgery — a procedure to remove the lens of the eye that has developed cataracts — slightly more frequently than the controls did (8% vs. 5.9%), although this difference wasn’t significant.
The study showed “endogenous [Cushing’s syndrome], particularly due to [Cushing’s disease], is associated with an increased risk of cataracts,” which “manifest at an earlier age compared to the general population, wrote the researchers, who noted their study was based on “real-world data and includes a heterogeneous population, making the findings likely applicable to the broader population of Cushing’s patients and not limited to the patients in this current study.”
“Our results aim to increase awareness regarding the importance of regular eye examinations for individuals with [Cushing’s syndrome], to detect the onset of cataracts, and to promptly refer patients for cataract surgery if necessary,” they wrote.
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