What Are Steroid-Induced Cataracts?

Steroid-induced cataracts are a type of lens clouding caused by long-term use of corticosteroids-medications used to reduce inflammation in conditions like asthma, rheumatoid arthritis, eczema, and autoimmune diseases. Unlike age-related cataracts that take years to develop, these can appear in as little as 2 to 4 weeks after starting steroid treatment. The most common form is a posterior subcapsular cataract (PSC), which forms right behind the lens’s natural focusing surface. This location is especially problematic because it sits directly in the path of light entering the eye, making even tiny cloudings cause major vision problems.

What makes these cataracts different isn’t just where they form, but how fast they grow. A 2023 review from Eyes on Eye Care found that patients on long-term steroid therapy develop noticeable lens changes within months, not years. The mechanism is specific: steroids interact with proteins in the lens, forming abnormal chemical bonds that cause proteins to clump together. These clumps scatter light instead of letting it pass cleanly to the retina, resulting in blurry, hazy, or glare-filled vision. This exact process has been observed only in steroid-induced cases, not in other types of cataracts.

How Do You Know You Have One?

If you’re on steroids and notice your vision changing quickly, pay attention to these signs:

• Blurry vision-especially when reading or doing close work
• Glare and halos around lights, making night driving dangerous
• Faded colors-reds and blues look washed out
• Double vision in one eye
• Difficulty seeing at night or in low light
• Reduced peripheral vision

These symptoms don’t come on slowly like typical aging cataracts. Many patients report noticing a big difference in just a few months. One patient described it as “like looking through a frosted window” when reading a book or using a phone. Another said headlights at night looked like “explosions of light,” forcing them to stop driving after dark. These aren’t rare complaints-research shows 92% of people with steroid-induced cataracts report blurry vision, and 83% struggle with glare.

Who’s Most at Risk?

Not everyone on steroids gets these cataracts, but certain factors raise the risk dramatically:

• Topical eye drops-used for uveitis or post-surgery inflammation-are the most common cause. A 2024 study in Saudi Arabia found topical steroids carry a 3.2 times higher risk than oral or inhaled forms.
• Dose and duration-taking more than 2,000 mg of beclomethasone (a common steroid) over time increases risk sharply. Even four months of continuous use can trigger changes.
• Children-those on long-term steroids for asthma or autoimmune conditions are especially vulnerable. Ocular side effects like cataracts and high eye pressure are common in this group.
• Existing eye conditions-people with diabetes or uveitis already have higher baseline risk, and steroids make it worse.
• Previous eye surgery-those with artificial lenses (IOLs) are more likely to develop posterior capsular opacification from steroids.

Interestingly, awareness doesn’t always prevent risk. The same 2024 study found that 73% of people who knew steroids could cause cataracts were still on long-term treatment. For many, the benefit of controlling a life-altering disease outweighs the vision risk.

How Are They Diagnosed?

Eye doctors use a tool called a slit-lamp biomicroscope to look at the lens in detail. This device shines a thin beam of light into the eye and lets the doctor see exactly where and how the clouding is forming. Because PSCs are so small at first, they’re often missed without this equipment. Many patients don’t notice symptoms until the cataract is already advanced.

Experts recommend baseline eye exams before starting long-term steroid therapy (defined as more than two weeks of use). After that, follow-ups every 3 to 6 months are advised for high-risk patients. The key is catching changes early-before they start affecting daily life. It takes ophthalmology residents 6 to 12 months of training to reliably spot early steroid-induced changes, so not all eye exams are equally thorough.

Can You Reverse It Without Surgery?

Unfortunately, once the protein clumps form, they don’t go away on their own. Stopping or reducing steroids might slow further damage, but it won’t clear the existing clouding. In some cases, lowering the steroid dose can help stabilize vision, especially if the cataract is still small. But if the steroid is needed to control a serious condition like lupus or severe asthma, stopping it isn’t an option. The risk of the underlying disease flaring up often outweighs the vision loss.

Some research is looking into antioxidants-like vitamin C or N-acetylcysteine-as possible protectors of the lens. The theory is that steroids reduce the eye’s natural defenses against oxidative stress, so boosting antioxidants might help. But as of late 2023, no proven prevention method exists. The best strategy remains early detection and careful monitoring.

What’s the Treatment?

The only proven way to restore clear vision is cataract surgery. This is a common, low-risk procedure where the cloudy natural lens is removed and replaced with a clear artificial one (IOL). The London Cataract Centre reports that 92% of patients see major improvement after surgery.

But here’s the catch: if you’re still on steroids after surgery, the new lens can still develop clouding over time. This is called posterior capsule opacification (PCO), and it’s more common in steroid users. In some cases, a second procedure called a YAG laser capsulotomy is needed to clear the back of the lens capsule. That’s why doctors often recommend waiting until steroid use is as low as possible before scheduling surgery-unless vision loss is already severely impacting safety or quality of life.

Patients who delay surgery because they’re afraid of losing their steroid control often end up with worse outcomes. Falling, struggling to read medications, or avoiding social situations due to poor vision can be just as dangerous as the original condition. The decision isn’t simple, but it’s one you shouldn’t make alone.

How Do You Decide What to Do?

This is where coordination between your doctor and your eye specialist matters. If you’re on steroids for a chronic illness, your rheumatologist, pulmonologist, or dermatologist should know you’re seeing an ophthalmologist regularly. Likewise, your eye doctor needs to know exactly what steroids you’re taking, how much, and for how long.

Studies show that when doctors communicate directly-through shared notes or joint appointments-patients have 37% less vision loss from steroid-induced cataracts. That’s not just a number. It means fewer falls, better independence, and more confidence driving or reading.

Here’s what to ask:

• “Is there a lower-dose steroid option?”
• “Can I switch to a non-steroid treatment for my condition?”
• “When should I schedule my next eye exam?”
• “If my vision worsens, how quickly should we consider surgery?”

Don’t assume your primary care doctor knows the eye risks of your medication. Many don’t. Take responsibility. Bring your eye exam results to your next appointment. Ask for a written summary of your steroid use and eye health to share with your care team.

What’s the Big Picture?

Steroid-induced cataracts aren’t rare. Experts estimate that 10-15% of all cataract cases in the U.S. are linked to steroid use-that’s 380,000 to 570,000 people a year. With over $12 billion spent globally on corticosteroids each year, and more conditions being treated with them, this problem is growing. By 2030, the number of at-risk patients is projected to rise by 1.8% annually.

The real issue isn’t the medication itself. It’s the lack of awareness. A 2024 study found that only 38.6% of people knew inhaled steroids could cause cataracts-even though they’re one of the most commonly prescribed forms. Many patients think “eye drops” are safe because they’re local, not systemic. But the eye doesn’t care how the steroid got there. It reacts the same way.

The good news? These cataracts are preventable with monitoring. They’re treatable with surgery. And they don’t have to ruin your life if you catch them early. The key is staying informed, asking questions, and never assuming your vision changes are just “getting older.”