Comment on the possible dose-dependent effect of eplerenone on intraocular pressure

Dear Editor, We read the article titled “Possible dose-dependent effect of eplerenone in intraocular pressure” by Razavi et al.[1] The alternate pathway of aqueous drainage through the retinal pigment epithelium that has been suggested for eplerenone is interesting. Being a mineralocorticoid antagonist, this drug has been found to be of some value in the management of central serous chorioretinopathy by its action mainly on the choroidal vasculature.[2] To extrapolate this to posterior aqueous drainage through RPE would require further evidence. Eplerenone undergoes metabolism via cytochrome P450 3A4 which is a common pathway for the metabolism of multiple drugs.[3] It is, therefore, important to know the other systemic medications prescribed to the participants. Furthermore, there is no mention of the adverse effect profile of eplerenone among these patients.[4] The timing of intraocular pressure (IOP) evaluation after systemic eplerenone therapy was initiated is notably absent. It would be interesting to note the relationship between the IOP-lowering effect of eplerenone and the duration of therapy. Also, the subgroup analysis lacks details regarding the effects of low doses (less than 25 mg/day), a crucial aspect in confirming the dose-dependent nature of IOP reduction. A significant reduction in IOP observed in the subset with baseline IOP less than 15 mm Hg suggests potential applicability in normotensive glaucoma. While the study provides valuable insight into the benefits of eplerenone, addressing these concerns will enhance the applicability of eplerenone and pave the way for guiding further clinical research. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.