November 2016
Volume 57, Issue 14
Open Access
Letters to the Editor  |   November 2016
Author Response: A Meta-Analysis of Glaucoma Risk in Hyperlipidemic Individuals: A Critical Problem in Design
Author Affiliations & Notes
  • Paul McCann
    Queen's University Belfast, Centre for Public Health, Institute of Clinical Sciences, Belfast, United Kingdom.
  • Ruth E. Hogg
    Queen's University Belfast, Centre for Public Health, Institute of Clinical Sciences, Belfast, United Kingdom.
  • Augusto Azuara-Blanco
    Queen's University Belfast, Centre for Public Health, Institute of Clinical Sciences, Belfast, United Kingdom.
Investigative Ophthalmology & Visual Science November 2016, Vol.57, 6341. doi:10.1167/iovs.16-20233
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      Paul McCann, Ruth E. Hogg, Augusto Azuara-Blanco; Author Response: A Meta-Analysis of Glaucoma Risk in Hyperlipidemic Individuals: A Critical Problem in Design. Invest. Ophthalmol. Vis. Sci. 2016;57(14):6341. doi: 10.1167/iovs.16-20233.

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      © 2017 Association for Research in Vision and Ophthalmology.

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  • Supplements
We read with interest the letter by Hwang et al.,1 titled “A meta-analysis of glaucoma risk in hyperlipidemic individuals: a critical problem in design,” which was written in reply to our recent publication.2 We would like to thank the authors for their response and the additional information it provides. 
We agree with Hwang et al.1 that a potential flaw in our study was that we could not fully ascertain if it was statins or hyperlipidemia that reduced the risk of glaucoma or if the effects of hyperlipidemia reduced the observed effect of statins (confounding by indication). Hwang et al.1 have attempted to answer if hyperlipidemia affects the risk of glaucoma. However the included studies in their analysis “…did not refine the effects of hyperlipidemia from those of lipid-lowering drugs.” This is a similar limitation to the one faced in our study. We therefore agree that the effect sizes in both our meta-analyses potentially could be underestimated. 
References
Hwang IC, Lee YJ, Bae JH. A meta-analysis of glaucoma risk in hyperlipidemic individuals: a critical problem in design. Invest Ophthalmol Vis Sci. 2016; 57: 6234–6235.
McCann P, Hogg RE, Fallis R, Azuara-Blanco A. The effect of statins on intraocular pressure and on the incidence and progression of glaucoma: a systematic review and meta-analysis. Invest Ophthalmol Vis Sci. 2016; 57: 2729–2748.
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