Chlorpromazine, Quetiapine Linked to Cataract Formation

A direct causal mechanism linking antipsychotics to cataract formation has not been established; however, one hypothesis is that they may affect signaling systems that increase protein aggregation in the lens, thus predisposing someone to cataract formation. Photo: Julie Tyler, OD. Click image to enlarge. Adverse events caused by any medication may sometimes be missed or go undetected in epidemiological studies or clinical trials. New research explores a potential link between first- (FGAs) and second-generation antipsychotic (SGAs) drugs and cataract development. To elucidate this relationship, Canadian researchers gathered data from the FDA Adverse Event Reporting System (FAERS) from 2003 to 2024 for reports of cataract associated with antipsychotics.Of the more than 12.3 million unique adverse events reported during the period, 34,879 were cases of cataracts and 372,107 reports concerned antipsychotic agents (10,274 FGAs; 361,833 SGAs). By reporting odds ratio (ROR), two drugs were found to have significantly higher odds of cataract being reported compared to other drugs: chlorpromazine and quetiapine; included in analysis was 10 total FGAs and 14 SGAs. In relation to sex, increased cataract reporting was observed for chlorpromazine in women but for both sexes with quetiapine. What’s more, this pattern also occurred in both drugs in the 18 to 44 and 45 to 64 age groups, with greater magnitude seen in the younger group.The authors of this study relay in their paper for Canadian Journal of Ophthalmology that these results align with previous reports and studies that established an association of antipsychotics—especially phenothiazines—with cataract formation. However, the finding of quetiapine in particular to be linked with cataract is a novel finding in humans, they noted,  although this link has been documented with the drug’s usage in dogs.Also confirmatory of a prior study is the finding that women had increased cataract reporting with chlorpromazine. As for the greater magnitude of increase in the younger group of patients, the authors speculate that this finding suggests cataract development or progression may occur due to non-age-related factors—like medication-induced cataracts.The investigators also point to the fact that those with serious mental illnesses possess high rates of comorbid medical disorders, with ophthalmological disorders reported at higher rates in those with serious mental illness. As well, this subset of patients also experiences higher rates of metabolic disorders, which is yet another factor that increases risk of cataracts. Related to this, many antipsychotic drugs are linked with metabolic abnormalities and weight gain, compounding another factor in elevating risk of cataract. What’s more, patients with serious mental illness have much higher rates of smoking than the general population, which could also contribute to increased likelihood of development.Along with the authors suggesting that their results emphasize a need for increased monitoring of patients with natural lenses in the younger population, they also relay that these results “have significant implications for patient education and counseling regarding cataract risk, particularly in the selection of antipsychotics for individuals both before and after cataract surgery.”Click here for the journal source. Lakhani M, Kwan ATH, Chaudry E, et al. A real-world population-based study on the association between cataracts and antipsychotics. Can J Ophthalmol. June 9, 2025. [Epub ahead of print].