Which type of cataract is most classically associated with long-term systemic steroid use?

• A. Posterior subcapsular cataract
• B. Cortical cataract
• C. Nuclear cataract
• D. Conventional cataract

Answer: (A)

Long-term systemic steroid use is classically linked to posterior subcapsular cataracts. These opacities form just in front of the posterior lens capsule and tend to cause noticeable visual disturbance, especially glare and reduced acuity during activities like reading or in bright light. The posterior subcapsular location is a hallmark that helps distinguish steroid-related changes from other cataract types. The suspected mechanism involves steroid-induced changes in the lens epithelial cells and fiber differentiation near the back of the lens, leading to opacification in that posterior region.

Other cataract types are not as specifically tied to steroids: nuclear cataracts develop in the central lens nucleus and are typically age-related, while cortical cataracts arise in the lens cortex with radial spoke-like opacities and are also more associated with aging and other risk factors. The term conventional cataract isn’t a standard, commonly used category for describing steroid-related changes.