To the Editor: A robust association between current fluoroquinolone use and retinal detachment was reported by Dr Etminan and colleagues.1 They stated that a group of residual confounders would need to be excessively large to change the results of the study. However, the cumulative effect of several important factors may account for, at least in part, the reported association.
Cataract surgery was considered in the regression model; however, there was no measure of several known risk factors after cataract surgery that have been significantly related to the rate of retinal detachment. In particular, complicated cataract surgery and a history of retinal detachment in the fellow eye were associated with odds ratios of approximately 20 and 12, respectively, for subsequent retinal detachment in a study by Tuft et al.2 The ethnicity of the study population has been demonstrated to contribute to a 3-fold variation in the reported incidence of retinal detachment in a large population-based study,3 while socioeconomic status of the study population and the proportion of ocular trauma have both been demonstrated to have independent associations with the incidence of retinal detachment.4
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