In recent years, there has been an explosion of research articles using large population databases in clinical research; ophthalmology is no exception. In 2012, using the British Columbia Ministry of Health database, we published one of the first population-based pharmacoepidemiologic studies1 that found an elevated risk of retinal detachment (RD) (relative risk, 4.50; 95% CI, 3.56-5.70) with oral fluoroquinolones (FQs). Since 2012, several large epidemiological studies on this topic have been published with conflicting results.2-4 For example, Kuo et al2 used the national health database of Taiwan and undertook a retrospective cohort study. Measured covariates and potential confounders were appropriately adjusted for using propensity score analysis. The overall relative risk for RD was found to be 2.07 (95% CI, 1.45-2.96). However, exposure to FQ was defined as greater than 3 consecutive prescriptions. It wasn’t clear from the study why this definition of exposure was used. This means that, by design, participants could not have experienced an RD before the first 3 prescriptions, leading to a survival bias referred to as immortal time bias, which usually underestimates the true risk.
Etminan M, Maberley DAL. Improving Reporting Quality in Ophthalmologic Observational Studies That Use Big DataThe Case of Retinal Detachment Associated With Fluoroquinolone Use. JAMA Ophthalmol. 2018;136(6):611–612. doi:10.1001/jamaophthalmol.2018.0987
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