Inhaled Corticosteroids and Likelihood of Cataract Extraction—Reply

In Reply: Drs Frantz and Shenenberger are concerned about our conclusion with respect to cataract, since we studied cataract extraction as an end point in our study. However, this end point has often been used as a surrogate parameter for cataract in epidemiologic studies. Walker et al¹ concluded that, in settings with relatively uniform access to medical care, the epidemiology of cataract extraction appears to follow the epidemiology of cataract closely enough to permit useful studies of cataractogenesis. Our conclusion is also supported by another study² that investigated cataract (and not cataract extraction) as an end point. Although the number of exposed cases and controls is small, the overall number of cases and controls is relatively large, which gives the study enough power to detect an increased risk. The uncertainty of the risk estimate for prolonged inhaled steroid use is reflected by the width of the confidence interval, which still indicates a significantly increased risk.