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Increased Risk of Cataracts With Second-Generation Antipsychotics

August 21, 2019

By Will Boggs MD

NEW YORK—The use of second-generation antipsychotics (SGAs) is associated with an increased risk of cataracts in people with schizophrenia, researchers report.

"Mental health care professionals should suggest eye examination to their patients with schizophrenia annually, especially those receiving high-metabolic-risk SGAs," said Dr. Yu-Hsuan Joni Shao from Taipei Medical University, in Taiwan, and Rutgers School of Public Health, in Piscataway, New Jersey.

"Also, patients with diabetes and hyperlipidemia will want to closely monitor and control their metabolism-related diseases to prevent cataract formation," she told Reuters Health by email.

People with schizophrenia and other psychotic disorders have a higher risk of cataracts than the general population. Antipsychotic use has been associated with the development of cataracts and with metabolism-related diseases that can also increase the risk of cataracts, but little is known about the difference in cataract risk between first-generation (FGA) and second-generation antipsychotics.

For their study, online August 6 in Schizophrenia Research, Dr. Shao's team looked at data from the Registry for Catastrophic Illness Patient Database linked to the Taiwan National Health Insurance Research Database on more 13,000 patients with schizophrenia.

Among 10,014 propensity-matched patients (3338 taking FGAs and 6676 taking SGAs), patients who received SGAs had a 59% greater adjusted risk of developing cataracts compared with patients who received FGAs, a significant difference.

Compared with patients taking FGAs, the risk increase was significant among patients taking high-metabolic-risk SGAs (clozapine and olanzapine) with an adjusted hazard ratio of 2.57-fold, but not among patients taking low- and intermediate-metabolic-risk SGAs.

SGA use was also associated with a higher rate of hyperlipidemia (5.03% vs. 3.80% with FGAs), and both hyperlipidemia and diabetes were independently associated with an increased risk of cataracts.

In a stratified analysis, the cataract risk was significantly higher in SGA groups without diabetes or hyperlipidemia compared with the same FGA groups.

"Schizophrenia patients who have cataracts, diabetes, or hyperlipidemia may consider low-risk, intermediate-risk SGA, or even FGA over those high-risk drugs to decrease the risk of cataract formation or to delay the progression," Dr. Shao said.


Schizophr Res 2019.

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