Schizophrenia, psychotropic medication, and cataract.
OBJECTIVE
To compare the distribution of cataract types between psychiatric patients diagnosed with schizophrenia and the general population not exposed to psychotropic medication, and to compare cataract prevalence between users and nonusers of various psychotropic medications in the general community.


METHODS
Case-control.


METHODS
A total of 151 (93%) eligible patients from a community mental health service and 3271 (83%) eligible residents from the Melbourne Visual Impairment Project (VIP) were examined.


METHODS
All patients 40 years of age and older from a community mental health service and residents of nine randomly selected areas of Melbourne were eligible. Best-corrected distance visual acuity was determined using a 4-m logarithm of the minimum angle of resolution (LogMAR) chart. The presence of cataract was determined by photographs or slit-lamp examination using direct and indirect retroillumination. Anterior, cortical, nuclear, and posterior subcapsular cataracts were measured. Participants from the Melbourne VIP were classified as to whether they had taken benzodiazepams, phenothiazines, thioxanthenes, butyrophenols, tricyclic antidepressants, or monoamine oxidase inhibitors for at least 12 months during their lifetime.


RESULTS
The distribution of cataract type varied between persons with and without schizophrenia. Anterior subcapsular (ASC) cataract was significantly more prevalent (26%) in participants with schizophrenia from the community mental health service than Melbourne VIP participants (0.2%) not exposed to psychotropic medication (chi-square, 1 degree of freedom = 605.5, P = 0.001). This remained significant after controlling for age (odds ratios = 250, 95% confidence interval = 83.3, 1000). The distribution of the age-related cataract was similar across all groups of psychotropic medication users with the exception of the phenothiazine users. They had less of all types of the age-related cataracts, despite being slightly older than the control group (mean age, 60.0 vs. 58.4, t test = 0.85, P = 0.40). However, only cortical cataract in the phenothiazine group was statistically lower (chi-square, 1 degree of freedom = 3.96, P = 0.047).


CONCLUSIONS
This study has identified the need to investigate whether other newer agents, especially high-potency medications, cause ASC opacities if a certain threshold of exposure to psychotropic medications must be attained to develop cataract, or if schizophrenia itself is associated with cataract formation.
McCarty
C A
CA
Centre for Eye Research Australia, The University of Melbourne, Department of Ophthalmology, Vic.
Wood
C A
CA
Fu
C L
CL
Livingston
P M
PM
Mackersey
S
S
Stanislavsky
Y
Y
Taylor
H R
HR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D016022:Case-Control Studies; D002386:Cataract / Q000139:chemically induced / Q000453:epidemiology* / Q000473:pathology; D003156:Community Mental Health Services / Q000706:statistics & numerical data; D005260:Female; D006571:Heterocyclic Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007908:Lens, Crystalline / Q000187:drug effects / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008996:Monoamine Oxidase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D015995:Prevalence; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy*
D000928:Antidepressive Agents; D006571:Heterocyclic Compounds; D008996:Monoamine Oxidase Inhibitors; D011619:Psychotropic Drugs