Glucocorticoid Use and Risks of Ocular Hypertension and Glaucoma

To the Editor.  —Dr Garbe and colleagues¹ incriminate highdose inhaled corticosteroids in the increased risk of ocular hypertension and open-angle glaucoma. However, several substantial criticisms can be made regarding this study.The distinction between ocular hypertension and glaucoma, the case definition, is not of minor importance as claimed by the authors. In the report by Garbe et al, 51% of cases did not receive any treatment for glaucoma, which is unusual. One would expect that these at-risk subjects would be followed up by their ophthalmologists within 4 to 6 months; this could be verified by the authors.In this older population, COPD from cigarette smoking is probably more frequent than asthma per se; both conditions are often treated with inhaled corticosteroids, although the indication for steroids in COPD is controversial. Cigarette smoking is a known risk factor for development of cataract² and cardiovascular diseases.³ On one hand, topical glucocorticoids usually