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March 3, 1999

Inhaled Corticosteroids and Likelihood of Cataract Extraction

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(9):791-793. doi:10.1001/jama.281.9.791

To the Editor: In their article addressing the risk of cataract extraction in individuals using inhaled corticosteroids, Dr Garbe and colleagues1 conclude, "In summary, the results of our study demonstrate an increased risk of cataract for prolonged use of high doses of inhaled corticosteroids." We believe that this article does not provide the evidence to take a leap between risk of cataract extraction and risk of cataract overall. Since the focus of this article was to show a positive correlation between extraction and corticosteroid use, the final conclusion should mirror these objectives. Second, while Garbe et al studied a huge population, when all factors were taken into consideration, the pertinent population was quite small. According to the article, only 15 patients had cataract extraction between 1992 and 1994 with no major risk factors as defined by the article, did not receive systemic corticosteroids after the age of 65 years, and were using inhaled corticosteroids for longer than 3 years. This group was compared with a control group of 28 patients without cataract extraction who met the other criteria. Using such a small population always causes concern when such serious conclusions are being drawn.