To the Editor.
—I am concerned that the study on glucocorticoid use and risk of ocular hypertension or open-angle glaucoma by Dr Garbe and colleagues1 contains some serious flaws.First, the study examined the National Health Service database containing prescription drugs, diagnoses, and referrals for medical services rather than patient-specific information. Second, the inhaled glucocorticoid doses that caused an increased risk of glaucoma were very large. I calculated that the patients in this study would have had to use a minimum of 38 inhalations daily of a standard beclomethasone dipropionate preparation available in the United States; this far exceeds the recommended dose for this drug. Third, the patient population was aged 66 years or older and, as noted in the study, at risk for ocular hypertension. Fourth, there was no clear-cut definition of asthma in this population, and there were no pulmonary function studies performed that demonstrated reversibility
Macris N. Glucocorticoid Use and Risks of Ocular Hypertension and Glaucoma. JAMA. 1997;277(24):1929. doi:10.1001/jama.1997.03540480029019