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Comment & Response |

Statins and Cataract

Bruce I. Gaynes, OD, PharmD1
[+] Author Affiliations
1Department of Ophthalmology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
JAMA Ophthalmol. 2014;132(3):362-363. doi:10.1001/jamaophthalmol.2013.8265.
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To the Editor I read with interest the recent article by Leuschen et al1 describing the association between statin use and cataract. The article is informative; however, as thorough the study design maintained by Leuschen et al may be, introspection of the study methods does not, in my opinion, provide any useful or new information pertinent to risk of cataract in statin users.

As in all data-mining studies, it is lack of control over measurement technique that inherently reduces the defined validity of the study findings. This point is particularly important when using a clinical diagnosis of cataract as an outcome parameter. At issue, clinician-specific parameters for prompting a cataract diagnosis often are not well demarcated and may not have been equivalent among all examiners from whom data were collected. Indeed, all subjects in the age category examined by Leuschen et al could be classified as having some form of “cataract” depending on the particular motivation of the examiner. When and if a clinician decides to formally diagnose a patient as having a cataract are at best equivocal and are motivated by visual status, patient complaint, and/or clinical interpretation. In the present case, use of a clearly defined outcome event, notably cataract surgery, would have provided a means to significantly improve both the internal and external study validity by identification of a tangible, well-specified outcome parameter.

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March 1, 2014
Barbara E. K. Klein, MD, MPH; Kristine E. Lee, MS; Ronald Klein, MD, MPH
1Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin–Madison, Madison
JAMA Ophthalmol. 2014;132(3):366-367. doi:10.1001/jamaophthalmol.2014.225.
March 1, 2014
John B. Kostis, MD; Jeanne M. Dobrzynski, BA
1Cardiovascular Institute, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
JAMA Ophthalmol. 2014;132(3):363-364. doi:10.1001/jamaophthalmol.2013.8263.
March 1, 2014
Ishak Mansi, MD; Jessica Leuschen, MD; Eric M. Mortensen, MD, MSc
1VA North Texas Health Care System, Dallas2Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas3Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
4Wilford Hall Ambulatory Surgery Center, San Antonio, Texas5San Antonio Military Medical Center, San Antonio, Texas
JAMA Ophthalmol. 2014;132(3):363. doi:10.1001/jamaophthalmol.2013.8267.
March 1, 2014
Ishak Mansi, MD; Jessica Leuschen, MD; Eric M. Mortensen, MD, MSc
1VA North Texas Health Care System, Dallas2Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas3Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
4Wilford Hall Ambulatory Surgery Center, San Antonio, Texas5San Antonio Military Medical Center, San Antonio, Texas
JAMA Ophthalmol. 2014;132(3):364-365. doi:10.1001/jamaophthalmol.2014.40.
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