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Glucocorticoid Use and Risks of Ocular Hypertension and Glaucoma-Reply

Edeltraut Garbe, MD; Samy Suissa, PhD; Jacques LeLorier, MD, PHD
JAMA. 1997;277(24):1930. doi:10.1001/jama.1997.03540480030022.
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In Reply.  —Dr Macris is concerned that there was no clear-cut definition of asthma in our study population. It was our intention to investigate ocular risks of inhaled steroids in all users of these drugs, not only patients with asthma. Regardless, there is no indication that the risk of ocular hypertension or open-angle glaucoma is associated with the underlying disease, so that the exact medical diagnosis is unimportant.Macris also points out that the high doses of steroids associated with an increased risk far exceed recommended doses in the United States. These high doses follow recommendations from treatment guidelines.1 Moreover, in Canada, Europe, and Australia, inhaled glucocorticoid preparations contain larger amounts of drug per puff than similar preparations in the United States. However, Macris is correct in stating that the systemic bioavailability of the inhaled steroid also depends on the delivery device. Because of the limited number of patients continuously exposed


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