We read with interest the article by Puustjärvi et al.1 The Scandinavian group has already demonstrated the efficacy of the fixed-ratio combination of timolol maleate and pilocarpine hydrochloride.2,3 Even so, some criticism as to the design of these studies has been raised.4,5 We agree with the authors1 that the combined preparation may improve compliance for patients who require both medications. However, we think that the patients were not properly selected and we disagree with the authors' statement that "the study was conducted in patients identified as requiring more than one medication for IOP control."1 We do not believe that patients who do not respond to monotherapy should automatically be defined as requiring two medications. It is very likely that many of the patients who had an intraocular pressure above 21 mm Hg while treated with pilocarpine only might have had a better response to timolol
Loewenstein A, Lazar M. Patient Selection in the Timpilo Study. Arch Ophthalmol. 1993;111(10):1313. doi:10.1001/archopht.1993.01090100019003
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