Risk of cataracts in patients using typical and atypical antipsychotics: a systematic review

We conducted a systematic review to investigate the association between atypical antipsychotics (AAPs), typical antipsychotics (TAPs), and the development of cataracts. The PubMed, EMBASE, Web of Science, and Cochrane Library databases were systematically searched for studies evaluating the risk of cataracts during the treatment of schizophrenia with AAPs and TAPs. The primary outcome was the rate of cataract development under treatment, defined as the proportion of patients newly diagnosed with cataracts in the study population. Seven studies met the inclusion criteria, including two randomized controlled trials (RCTs), comprising 35,903 eligible patients. Most studies did not reveal a relationship between antipsychotics and cataracts; however, an increased risk has been reported when associated with other factors, such as metabolic diseases, which means that the relationship in subgroups remains inconclusive. These findings support a safe ocular profile of antipsychotics for schizophrenia in the general population when there are no ocular abnormalities or confounding factors that the condition may aggravate. Further RCTs are warranted to elucidate the potential association between antipsychotics and the risk of cataract development.