Eyeworld

Complex Cataracts, The Simple Truths II Rosen Centre Hotel – Junior Ballroom Program Chair: David F. Chang, MD Saturday, October 22, 2011 Registration now open! www.EyeWorld.org Check online for program updates. EW CATARACT 26 August 2011 by Maxine Lipner Senior EyeWorld Contributing Editor Prostate cancer therapy may cause cataracts Androgen deprivation therapy may put lenses at risk M en who have under- gone androgen depri- vation therapy (ADT) have a 9% increased risk of developing cataracts, according to results pub- lished in the March issue of the Annals of Epidemiology. The study was inspired by the fact that other conditions such as di- abetes and cardiovascular disease have been linked to cataract devel- opment, according to Jennifer L. Beebe-Dimmer, Ph.D., assistant pro- fessor, Wayne State School of Medi- cine, and Karmanos Cancer Institute, Detroit. "A lot of the re- cent literature on androgen depriva- tion therapy would suggest that men on ADT are at an increased risk for developing diabetes and cardiovas- cular disease, and certainly we have seen in the last 5 years increases in abdominal obesity," Dr. Beebe- Dimmer said. "We know that some of these things are associated with cataracts, so it makes sense that cataract might be another adverse consequence of ADT." Included in the study were 65,852 prostate cancer patients iden- tified through the National Cancer Institute's Surveillance, Epidemiol- ogy and End Results (SEER) registry, which is linked with the Medicare database. "These patients were 66 years and older because those are the only patients that we have Medicare data on," Dr. Beebe- Dimmer said. "We excluded those patients who were 65 at the time of diagnosis because we wanted to make sure that we had at least 12 months of medical history informa- tion on these patients so that we could assess their history of co-mor- bidities and cataract diagnosis." However, investigators included patients with a history of cataract as long as it wasn't in both eyes. "Obvi- ously patients with one cataract were still at risk for further cataracts," Dr. Beebe-Dimmer said. Elevated cataract risk Results showed that those who un- derwent ADT tended to have an ele- vated risk for cataracts. "We did find a very modest elevation in the risk for cataract associated with andro- gen deprivation," Dr. Beebe-Dimmer said. "This was after adjustment for the conventional risk factors that we had data on." It also seemed as if the relationship between androgen dep- rivation and cataract was slightly stronger among those patients with- out a history of cataract. Dr. Beebe- Dimmer said this makes sense. "If there is a causal relationship you would assume that in the patients with a prior history there are other more important driving factors," she said. "Among those patients without a history, orchiectomy showed the strongest association." Results showed that men who underwent orchiectomy had a 26% risk of de- veloping cataracts compared with 9% for those on temporary ADT therapy. "We never expected to see a par- ticularly strong relationship because androgen deprivation therapy is so prevalent in this population and cataract is a fairly prevalent condi- tion," Dr. Beebe-Dimmer said. She is not ready to classify the relationship as causal, citing unmea- sured factors. "This was exploratory, and further study in populations where we could measure more accu- rately the co-morbidity associated with cataract and control for these things in the analysis would be opti- mal," she said. Possible mechanism Dr. Beebe-Dimmer theorizes that the potential mechanism for a link be- tween ADT and cataract would likely be tied to onset of diabetes or in- creasing weight in this population. "Those types of things would be the most natural explanation," she said. "I think that it's speculative at this point." She would like to see others conduct a prospective study on this. "One of the limitations of using SEER Medicare data was that these data weren't collected for this pur- pose, so we didn't get to gather all of the information that we needed," Dr. Beebe-Dimmer said. With the re- view data collected here, however, some misclassification is a possibil- ity. "If the cataract history wasn't in the Medicare claims files, we didn't pick that up," she said. "We could have patients with cataract surgery in both eyes prior to ADT initiation who were included because we didn't have all of that information." Going forward, if these results are born out, Dr. Beebe-Dimmer hopes that practitioners take a possi- ble connection under advisement. "ADT is the only thing that we have right now, but we would assume that for a man who is at an in- creased risk for diabetes, cataract, or cardiovascular disease, as other ther- apies surface for treatment of prostate cancer, these men might be better off on some of the other ther- apies," she said. "Hopefully this will educate physicians and patients about the adverse consequences of androgen deprivation." EW Editors' note: Dr. Beebe-Dimmer has no financial interests related to her com- ments. Contact information Beebe-Dimmer: 313-578-4209, dimmerj@karmanos.org Androgen deprivation therapy for prostate cancer may put men at risk for developing cataracts (pictured here) Source: National Eye Institute, National Institutes of Health Patients continued from page 26 ing laser vision correction as a fol- low-up procedure for residual astig- matism. "I'm pretty sure I would be fine with the one contact lens if that's the worst of it," Mr. Deane said. "In just the last few weeks I got a stronger monovision, and I'm re- lieved that I'm not going to have to put on reading glasses all of the time." Both Mrs. Kargman and Mr. Deane said they were pleased with the pre-op exams and consultations, as well as the surgeries and follow- up care that were provided. "Once you experience some- thing as great as this, the impact dawns on you," Mrs. Kargman said. "I think about this with such fervor. To this day, if you ask me what is the single most important thing I have done for myself medically, I would answer that this is it. We all do things to keep ourselves vital and young, and for me, this was it. This was a professional and easy experi- ence that has produced dramatic re- sults in my life." EW Editors' note: Dr. Henderson has financial interests with Alcon. Contact information Henderson: 781-487-2200, bahenderson@eyeboston.com 22-27 Cataract_EW August 2011-FINAL_Layout 1 7/27/11 3:41 PM Page 26

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