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To the Editor: In their clinical trial of topiramate for treating alcohol dependence, Dr Johnson and colleagues¹ concluded that topiramate is a safe and efficacious medication. However, it is important to note that the use of topiramate has been associated with acute angle-closure glaucoma among patients with no previous history of ocular disease and no predisposition to glaucoma.^2-5 Unless appropriately recognized and treated, the angle closure may result in loss of sight. For those affected, blindness is no less of a problem than alcohol dependence.

Financial Disclosures: None reported.

George L. Spaeth, MD
gspaeth@willseye.org

Anand V. Mantravadi, MD
Wills Eye Institute
Jefferson Medical College
Philadelphia, Pennsylvania

1. Johnson BA, Rosenthal N, Capece JA; et al. Topiramate for treating alcohol dependence: a randomized controlled trial. JAMA. 2007;298(14):1641-1651. FREE FULL TEXT 2. Craig JE, Ong TJ, Louis DL, Wells JM. Mechanism of topiramate-induced acute-onset myopia and angle closure glaucoma. Am J Ophthalmol. 2004;137(1):193-195. FULL TEXT | ISI | PUBMED 3. Fraunfelder FW, Fraunfelder FT, Keates EU. Topiramate-associated acute, bilateral, secondary angle-closure glaucoma. Ophthalmology. 2004;111(1):109-111. FULL TEXT | ISI | PUBMED 4. Rhee DJ, Goldberg MJ, Parrish RK. Bilateral angle-closure glaucoma and ciliary body swelling from topiramate. Arch Ophthalmol. 2001;119(11):1721-1723. FREE FULL TEXT 5. Rhee DJ, Ramos-Esteban JC, Nipper KS. Rapid resolution of topiramate-induced angle-closure glaucoma with methylprednisolone and mannitol. Am J Ophthalmol. 2006;141(6):1133-1134. FULL TEXT | ISI | PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2008;299(4):405.

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