Psoriasis Associated With Higher Cataract and Surgery Hazards
Key Takeaways
- Among newly diagnosed psoriasis patients in Taiwan, cataract and cataract-surgery hazards were higher than among matched people without psoriasis.
- PUVA and UVB phototherapy were associated with higher cataract odds.
- Biologics or Janus kinase inhibitors and conventional disease-modifying antirheumatic drugs were associated with lower cataract odds.
- Phototherapy exposure showed no clear dose–response relationship with cataract.
Investigators used Taiwan National Health Insurance Research Database records covering 2012–2023 for a retrospective matched psoriasis and cataract analysis. They compared 61,622 patients with newly diagnosed psoriasis with 61,622 people without psoriasis, matched on age, sex, and index year. Cox proportional hazards models assessed cataract and cataract surgery in those cohorts. Separately, nested case–control analyses matched psoriasis patients with each outcome to psoriasis patients without that outcome; conditional logistic regression examined associations between psoriasis-related phototherapy or systemic treatments and the respective ocular outcome. The treatment comparisons involved people with psoriasis, not the matched non-psoriasis controls.
Compared with matched people without psoriasis, those with psoriasis had an adjusted hazard ratio (HR) for cataract of 1.32 (95% confidence interval (CI), 1.24–1.40) and for cataract surgery of 1.41 (95% CI, 1.30–1.53). These associations were generally consistent across strata defined by age, sex, and psoriatic arthritis status.
Among outcome-matched people with psoriasis, psoralen plus ultraviolet A (PUVA) phototherapy was associated with cataract at an adjusted odds ratio (OR) of 1.88; ultraviolet B (UVB) phototherapy had an adjusted OR of 1.22. Biologics or Janus kinase inhibitors were associated with lower cataract odds (adjusted OR, 0.49), as were conventional disease-modifying antirheumatic drugs. Investigators found no clear phototherapy dose–response relationship, and treatment associations for cataract surgery followed a similar pattern.
The retrospective comparisons describe associations, not whether phototherapy causes cataract or systemic treatment prevents it. Cohort hazard estimates compare people with and without psoriasis over time, whereas treatment odds estimates compare outcome-matched groups within psoriasis; the measures address different questions and cannot be read as equivalent risks. The data describe an insured population in Taiwan; applicability to North American populations is not established.
The authors concluded that psoriasis was associated with higher hazards of cataract and cataract surgery, while phototherapy and systemic treatment categories showed opposing associations with those outcomes among people with psoriasis.
Clinician Questions
Can the cataract hazard ratio in psoriasis be used to estimate a patient's absolute cataract risk?
No. The adjusted hazard ratio compares cataract occurrence over time in people with newly diagnosed psoriasis against matched people without psoriasis in Taiwan; it is a relative comparison, not an absolute probability. Absolute cataract incidence and event counts were not provided, so the comparison alone cannot yield an individual's absolute cataract risk.
How long were patients with psoriasis followed for cataract in the Taiwan insurance analysis?
Taiwan National Health Insurance Research Database records span 2012–2023, but the length of follow-up for individual patients with psoriasis was not specified. Those database coverage dates do not describe each patient's observation time.
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