PRK and Amblyopia: Author Reply

Abstract

We thank Dr Kushner for his interest in our article. He correctly has pointed out that there was a mistake in Figure 3. The legend of this figure should read “achieved correction,” as explained in “Results.” We apologize for this. Concerning the other criticisms made by Dr Kushner, we remind him that this was a retrospective study, so the patients were not enrolled to prove or disprove the improvement in visual acuity (VA) but simply underwent a refractive treatment. According to our routine when we treat patients, we use the decimal fraction to measure acuity, and we could not change it. We do not agree that this method cannot be used to show a possible difference in VA. Although in prospective studies with protocol visions more definite claims could be made, we believe we demonstrated a different in vision. With regard to the other criticisms, we think that most of the answers to Dr Kushner’s questions are already present in the article. Dr Kushner writes that in each of the 10 figures the readers are never told if the best-corrected VA (BCVA) difference refers to the difference between right and left eyes or within the same eye before and after photorefractive keratectomy (PRK). The figures are explained in “Results,” and in this section, we believe it was clear that all the results relate to the operated eyes, so if not otherwise specified, we hope readers would not have believed that the figures were related to the fellow eye. The letter writer also asked how many patients crossed the threshold of amblyopia to nonamblyopia. This can be found in our Figure 4, where we plotted the distribution of the improved lines in correlation with the best spectacle-corrected VA before treatment. Concerning the purpose of the surgery, again this was a retrospective study, so in my mind it should be clear that the purpose was to eliminate the glasses, and whenever there was a need, the fellow eye also was operated on. Our conclusion was that our study does not imply that refractive surgery should or may be performed in young children or that refractive surgery can be considered a cure for amblyopia, but rather that adults wishing to undergo refractive surgery may undertake such procedures despite having an amblyopic eye. In fact, in most cases, patients after PRK enjoy better VA and, possibly, better binocular function even in amblyopic eyes previously thought to be refractory to visual rehabilitation by conventional methods, such as spectacles and contact lenses. We used, as correctly stated by Dr Kushner, the word possibly, which, according to the Shorter Oxford English Dictionary,1Shorter Oxford English Dictionary. Vol. 2. Guild Publications, New York1990: 1636Google Scholar means “perhaps.” In this way, we wanted to show that this might be a possibility, even if we were unable to show supporting data. We are not native English speakers, so we apologize if this means something different to a native English speaker such as Dr Kushner. We thank Dr Kushner for his comments and hope that we have been able to clarify aspects of our work that may not have been as clear as we had hoped. PRK and AmblyopiaOphthalmologyVol. 113Issue 6PreviewThe issue of refractive surgery in eyes with amblyopia has the potential for substantial abuse. Consequently, any articles on this subject should be viewed (and reviewed) with great care. Full-Text PDF