Q: I was diagnosed as having a premature development of a cataract in my left eye. The symptoms were discomfort on a sunny day and a feeling that there was something in my eye. No pain, just something there. The ophthalmologist gave me a thorough exam and the diagnosis stated above. He said my right eye had the beginning of one, but it has not been noticed. Besides surgery, are there glasses I could wear or drops that would make it clearer? I also see halos around lights when driving at night. This has been causing me anxiety and of course a fear that it will progress quickly. What course of treatment should I take? The symptoms have been noticeable for about four weeks. .
Nadia: Sorry for your troubles. You have just described the course of a steroid responder. Your pressure was fine for the first few weeks, but after being on a corticosteroid for several weeks your pressure began to rise. If inflammation is well controlled, most surgeons stop the steroid or switch to a weaker steroid if the pressure is hard to control. If you are on a non-steroidal anti inflammatory (NSAID), it makes it easer to get off of the steroid since these drops will still help control inflammation when the steroid is stopped. Sometimes it takes several months for the steroid pressure elevation to resolve. During that time, maximum medical management is attempted. If a patient already has weakened nerves from glaucoma, sometimes a glaucoma surgery must be used to lower the pressure and protect vision.
Corticosteroids have been used as drug treatment for some time. Lewis Sarett of Merck & Co. was the first to synthesize cortisone, using a complicated 36-step process that started with deoxycholic acid, which was extracted from ox bile .  The low efficiency of converting deoxycholic acid into cortisone led to a cost of US $200 per gram. Russell Marker , at Syntex , discovered a much cheaper and more convenient starting material, diosgenin from wild Mexican yams . His conversion of diosgenin into progesterone by a four-step process now known as Marker degradation was an important step in mass production of all steroidal hormones, including cortisone and chemicals used in hormonal contraception .  In 1952, . Peterson and . Murray of Upjohn developed a process that used Rhizopus mold to oxidize progesterone into a compound that was readily converted to cortisone.  The ability to cheaply synthesize large quantities of cortisone from the diosgenin in yams resulted in a rapid drop in price to US $6 per gram, falling to $ per gram by 1980. Percy Julian's research also aided progress in the field.  The exact nature of cortisone's anti-inflammatory action remained a mystery for years after, however, until the leukocyte adhesion cascade and the role of phospholipase A2 in the production of prostaglandins and leukotrienes was fully understood in the early 1980s.