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December 2010

Macular Edema and Thiazolidinediones—Reply

Author Affiliations

Author Affiliations: Department of Biostatistical Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina (Dr Ambrosius); Department of Ophthalmology, University of Wisconsin, Madison (Dr Danis); Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health and Science University, Portland (Dr Riddle); Department of Epidemiology and Prevention, Wake Forest University, Winston-Salem, North Carolina (Dr Goff); Department of Medicine and the Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (Dr Gerstein); Department of Ophthalmology, Wake Forest University, Winston-Salem, North Carolina (Dr Greven); and the Division of Epidemiology and Clinical Research, National Eye Institute, National Institutes of Health, Bethesda, Maryland (Dr Chew).

Arch Ophthalmol. 2010;128(12):1631-1632. doi:10.1001/archophthalmol.2010.288

In reply

We appreciate the interest in our article1 expressed by Colucciello and Ryan. They take issue with our report of no association between recent thiazolidinedione exposure and macular edema in our baseline evaluation of the ACCORD Eye Substudy population, suggesting that our findings are inconclusive owing to exclusion of high-risk persons. They cite a single-patient case report,2 a report of 30 patients referred to a group specializing in retinal disease,3 and a database review of patients identified by new diagnosis of macular edema4 as evidence for greater risk related to use of a thiazolidinedione. In response we would make several points. First, while individuals known to have prior photocoagulation, high serum creatinine levels, or congestive heart failure were not enrolled in ACCORD, ours was not a low-risk population. The mean duration of diabetes was 10 years, 32% had known cardiovascular disease, 72% had microalbuminuria, 4% had macroalbuminuria, 21% had pretibial edema, 50% had retinopathy, and 6% had macular edema on the baseline examination.

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