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Our study showed significant increased risks (odds ratio, 21.5; 95% confidence interval, 4.0-115.5; P < .001) of contact lens–related Fusarium keratitis with the use of ReNu MultiPlus. We have not, however, inferred a causal relationship. The criteria for a cause and effect relationship include biological plausibility, a strong association, temporality of the association, a dose-response trend, lowering of risks with the removal of exposure, and consistency of findings across different studies.1 Our findings were not consistently replicated in Hong Kong or the United States.24

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