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In reply
Our study showed significant increased risks (odds ratio, 21.5; 95% confidence interval, 4.0-115.5; P < .001) of contact lens–related Fusarium keratitis with the use of ReNu MultiPlus. We have not, however, inferred a causal relationship. The criteria for a cause and effect relationship include biological plausibility, a strong association, temporality of the association, a dose-response trend, lowering of risks with the removal of exposure, and consistency of findings across different studies.1 Our findings were not consistently replicated in Hong Kong or the United States.2 - 4
In Singapore, both ReNu MultiPlus and ReNu with MoistureLoc were withdrawn from the market in February 2006 and the number of Fusarium keratitis cases decreased soon after.
Only ReNu with MoistureLoc was withdrawn in the United States and there was a subsequent decrease in the number of cases, although there is no good evidence to indicate a “precipitous drop.” We therefore cannot dismiss the possibility that ReNu MultiPlus may contribute to Fusarium keratitis in Asian populations.
As expected, recall bias may lead to a mistaken estimate of risks and is a limitation in all case-control studies. Subjects who were using ReNu with MoistureLoc could have reported using ReNu MultiPlus, but this is more likely to be an exception rather than the rule.
In summary, ReNu MultiPlus contact lens solution significantly increased the risk of contact lens–related Fusarium keratitis in Singapore. While the association was strong, we could not infer that it was causal in nature. We recommend that other studies be conducted elsewhere.
Correspondence: Dr Saw, Department of Community, Occupational, and Family Medicine, National University of Singapore, 16 Medical Dr, Singapore 117597 (cofsawam@nus.edu.sg).
Financial Disclosure: Dr Aung has received travel funding and research grants from Alcon Laboratories, Inc.
Funding/Support: This work was supported by the Singapore Eye Research Institute.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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