In pediatric patients with atopic dermatitis (AD), there is an association between disease severity and the risk for the development of cataracts, according to the results of a population-based, retrospective, longitudinal cohort study published in JAMA Ophthalmology.
The investigators sought to explore the association of AD with subsequent cataract development and cataract surgery in a Korean pediatric population. The analysis used nationally representative data from the Korean National Health Insurance Service database between 2002 and 2013. Incident cases of AD, which comprised patients age <20 with AD and severe AD, were matched with 4 control groups with no AD-related insurance claims each using propensity scores derived from gender, age, residential area, and household income.
The primary outcome was the incidence probability of newly diagnosed cataracts and cataract surgery between the AD group (n=34,375) and the control group (n=137.500). Of the 34,375 patients with AD (47% girls; mean age, 3.47±4.96), 10.9% (n=3734) had severe AD. There were 137,500 matched controls.
The development of cataracts did not differ significantly in the AD and control groups (0.216% vs 0.227%, respectively; 95% CI, –0.041% to 0.063%; P =.32) or between the severe AD group and their matched controls (0.520% vs 0.276%, respectively; 95% CI, –0.073% to 0.561%; P =.06).
Patients in the AD group underwent cataract surgery more often than patients in the control group (0.075% vs 0.041%, respectively; 95% CI, 0.017%-0.050%; P =.02) and in the severe AD group compared with controls (0.221% vs 0.070%, respectively; 95% CI, 0.021%-0.279%; P =.03). Severe AD was significantly associated with both the development of cataracts (adjusted hazard ratio [aHR] 1.94; 95% CI, 1.06-3.58; P =.03) and the need for cataract surgery (aHR 5.48; 95% CI, 1.90-15.79; P =.002).
Overall, the absolute risk for the development of cataracts was rare in pediatric patients both with and without AD after 10 years of observation; the risk for requiring cataract surgery was even rarer. Although cataracts are a manageable medical condition, physicians should closely monitor cataract development in children with AD, particularly children with a severe form of the disorder.
Jeon HS, Choi M, Byun SJ, Hyon JY, Park KH, Park SJ. Association of pediatric atopic dermatitis and cataract development and surgery [published online June 7, 2018]. JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2018.2166