Eye issues while on prednisone and Anterma

@nanniepie, It might be good to discuss your medications with your glaucoma specialist. Here are a couple of research articles that provide some information on the side effects.

-- Side Effects of Actemra: What You Need to Know: https://www.healthline.com/health/drugs/actemra-side-effects
-- Steroids and Glaucoma: What’s the Connection?: https://glaucoma.org/articles/steroids-and-glaucoma-whats-the-connection

Hello, it seems like some of us react differently to drugs, thus the long list of side effects.
Are you in the US? I was wondering that because Actemra isn’t approved for PMR in the US. One rheumatologist wanted to put me on it and put down GCA as a diagnosis so Actemra would be approved. Kevzara is the biological approved for PMR in the USA.

Prednisone definitely changes your vision. I had eye tests done every year while I was on prednisone and after I quit, then my eyesight changed again. It’s the double edged sword type of thing.

Eye issues are probably more of a Prednisone thing than an Actemra thing. I had many additional eye issues while taking Prednisone. Ironically I first started taking Prednisone for an autoimmune eye issue called uveitis which can cause vision loss.
https://www.yalemedicine.org/conditions/uveitis#:~:text=There%20are%20several%20causes%20of,blindness%20in%20the%20United%20States.
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High doses of prednisone were used for recurrent flares of uveitis. I had rapid onset and premature bilateral cataract formation at the age of 40. Bilateral cataract formation resulted in lens replacement surgery.

It is a misnomer but I was called a steroid responder because of glaucoma. A "steroid responder" in the context of glaucoma refers to someone who experiences a significant increase in eye pressure (intraocular pressure) when taking steroid medications. Fortunately my glaucoma was only a problem when I was on prednisone for usveitis. Of course, after PMR was diagnosed, glaucoma was a problem all the time. Now that I'm off prednisone glaucoma isn't much of a problem anymore.

Neurotrophic keratitis (NK) is now my biggest worry. Nobody has suggested that prednisone caused NK but I should never take prednisone again.

"Prednisone should be used with extreme caution in cases of neurotrophic keratitis as it can significantly increase the risk of corneal melting and perforation due to its inhibitory effect on corneal healing, making its use controversial in this condition; if considered necessary, it should only be used under close monitoring by an ophthalmologist."

For this reason, an opthalmologist is very involved in my care. She is very happy that I'm on a biologic to treat PMR. My ophthalmologist would prefer a different biologic to treat uveitis. However, she is very happy that Actemra works for PMR and keeps me off of prednisone.

I've been on prednisone since late June of 2024 for GCA. I started at 60 mg and have tapered down to 10. I have also been taking Actemra since August of 2024. I had some issues with my eyes early in my treatment, where they seemed slow to adjust to changes in light level as I was moving. As the prednisone dose decreased those problems cleared up. I see an ophthalmologist every few months to monitor for problems with cataracts, glaucoma, and pressure in my eyes. Those are known risks with prednisone. Like DadCue says, eye problems are more associated with prednisone than Actemra. I can't complain though, since the prednisone saved my vision and treated my PMR and GCA.

"I can't complain though, since prednisone saved my vision and treated my PMR and GCA."
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An ophthalmologist was the one who started me on high doses of prednisone for uveitis 35 years ago and about 20 years before PMR was diagnosed. When I was diagnosed with PMR, prednisone effectively treated recurrent flares of PMR and uveitis. I am extremely grateful to my original ophthalmologist for preserving my vision for 35 years. Prednisone was all that was used for uveitis 35 years ago before biologics (TNF inhibitors) became the standard of care. My original ophthalmologist had views similar to yours about treating uveitis with prednisone. He would say the following before he referred me to a uveitis specialist.

"Because cataract surgery is so safe and so widely performed ... it's actually easier to fix cataracts than uveitis. Similarly, if glaucoma develops, it is easy to lower eye pressure pretty effectively."

Now the uveitis specialist says I should have been on a biologic for uveitis years ago instead of prednisone. I had to explain to the uveitis specialist that the standard of care for PMR was prednisone instead of a biologic. Sometimes I think the uveitis specialist was instrumental in convincing my rheumatologist to try a biologic.