We thank Abtahi and associates for bringing up important points pertaining to our study. The authors state that a dose-response relationship should have been explored in our analysis. Because a positive association was observed only among first-time users, a dose-relation analysis in this subgroup would not have been meaningful mainly because of the small sample size within this group (43 exposed cases). The authors also question the difference in the reported days of onset to glaucoma after topiramate use in our study and previous published case reports. These differences may arise from the manner by which the cases were reported. In our study, we examined the time from the first day of dispensation for a topiramate prescription to the date of diagnosis of glaucoma defined by the first International Classification of Diseases, Ninth Edition, code for the condition. It is difficult to infer from the published case reports the manner by which the time of onset of therapy to time of diagnosis of angle closure was obtained. Case series usually are not suitable to answer questions regarding causality or, in this case, the onset to glaucoma after topiramate use. We believe that future studies may shed light on both the possibility of a dose response or time to onset of glaucoma with topiramate use.
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