| Identifier |
Steroid_Side_Effects_Lee |
| Title |
Steroid Side Effects |
| Creator |
Andrew G. Lee, MD; Kristen Brown |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (KB) Baylor College of Medicine, Houston, Texas |
| Subject |
Steroid; Glaucoma; Cataract |
| Description |
Dr. Lee lectures medical students on the side effects of steroids relevant to neuro-ophthalmology. |
| Transcript |
"So, today I'm going to be talking to you about how steroid treatment can cause decreased visual acuity or decreased visual field as a side effect. And this is a known adverse effect of steroids and so you need to know that the ocular side effects of topical, nasal, intraocular, topical ocular or systemic steroids are glaucoma and cataract. So those are the two major things that we see in the eye that you have to worry about and that's because normally, as ophthalmologists, we're trying to give steroids to treat the cause of the vision loss, so usually that means giant cell arteritis or some inflammatory disease or inflammatory after growth or uveitis we're trying to treat somebody, and yet they keep getting worse. And so you could easily get trapped into a confirmation bias cycle where you think because they keep complaining that we have to keep giving more steroids. But if it's the steroid that's causing the problem, you actually should be giving less steroid. And so sometimes we get trapped between a rock and a hard place because we can't figure out is the disease or is it the treatment of the disease that's causing the problem. And so that means we have to make sure it's not glaucoma and not cataract. Now, normally cataract, that's easy to tell - we just use the slit lamp for that - but the glaucoma one can creep up on you. And so the differentiating feature, of course, of glaucoma is cup. So what we're going to be looking for is glaucomatous type cupping. The mechanism of steroid-induced glaucoma: the angle remains open but instead of it being primary open-angle glaucoma it's a secondary problem, but the angle is still open. It's thought that the trabecular meshwork has had steroid receptors at the level of the trabecular meshwork that are leading to upregulation of the production of extracellular matrix proteins, fibronectin, and other things that just plug up the meshwork. So the angle is open, it's not closed angle, but it gets plugged up with stuff: extracellular matrix, glycosaminoglycans, whatever is being upregulated. And that causes a secondary glaucoma. And so we really have to worry about patients who are on steroids. And that means we should be checking their intraocular pressure and we have to follow them with the visual field. And so you should be very worried about people who are getting worse, if they look like they're getting better from treatment of the steroid-responsive disorder that you're treating. And that means checking the pressure, doing the OCT of the nerve, looking for the distinctive finding, cupping, and checking the Humphrey visual field. And it's particularly important in younger patients because those are the patients you're not really thinking aren't going to have glaucoma. It's like a steroid-induced glaucoma, and it can come to you with patients who are either on inhaled steroids or have exposure to topical steroids and they didn't tell you about it, or they're receiving oral steroids but you didn't give it to them; they're getting it for some other reason from someone else. So you need to know about glaucoma and cataract but steroid-induced glaucoma and steroid-induced cataract." |
| Date |
2022-03 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-5890 |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s68jzgsa |
| Setname |
ehsl_novel_lee |
| ID |
1751096 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s68jzgsa |
