We thank Drs Epstein, Goldbloom, Kramer, and Reines for their interest in our report. We certainly agree that in highrisk patients, psychoactive agents with little or no cholinergic activity should be considered, and we did not mean to imply that the terms "psychoactive" and "anticholinergic" should be equated. However, a high-risk patient is one with an occludable angle, and such a situation is an indication for laser iridotomy.1,2 After iridotomy, any of these drugs can be given safely (except perhaps in the rare case of complete plateau iris syndrome). Therefore, one need not be concerned about what drugs to prescribe and what drugs not to prescribe. The important point for the psychiatric community is to be able to recognize the high-risk cases, most of which are found in patients with hyperopia.It should be noted that both fluoxetine hydrochloride and mianserin hydrochloride, a diperazinoazepine antidepressant that has
Ritch R, Krupin T, Henry C, Kurata F. Oral Imipramine and Acute Angle-Closure Glaucoma-Reply. Arch Ophthalmol. 1995;113(6):699. doi:10.1001/archopht.1995.01100060020010
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