Abstract
It is my pleasure to have discussion with Dr Demer regarding our article. What we revealed in the study 1 Uchiyama E. Matsuo T. Imai S. Itoshima E. Paretic side/normal side ratios of cross-sectional areas of the superior oblique muscle vary largely in idiopathic superior oblique palsy. Am J Ophthalmol. 2010; 149: 508-512 Abstract Full Text Full Text PDF Scopus (17) Google Scholar was (1) that paretic side/normal side ratios of the cross-sectional areas of the superior oblique (SO) muscle in patients with idiopathic SO palsy showed a wide range of variation; (2) that left side/right side ratios of the cross-sectional areas of the SO in control subjects did not show any variation; and (3) that left side/right side ratios of the cross-sectional areas of the 4 rectus muscles in both SO palsy patients and control subjects did not show any variation. We did not state in our article that the 95% confidence interval of the paretic side-to-normal side ratios of the cross-sectional areas of the SO in the SO palsy patients should be used for diagnostic purpose of the SO muscle atrophy. Rather, we stated in the Conclusions of the Abstract that “the muscle hypoplasia could be defined as such when the paretic side/contralateral side ratios of cross sectional areas of the SO muscle on magnetic resonance images fall outside the 95% confidence interval of the ratios in normal controls.” We also suggested in the Discussion of the article that “another way of defining the muscle hypoplasia is to use the paretic side/contralateral side ratios which are located outside the range of the left side/right side ratios of cross sectional areas of the SO muscle in normal controls.” Paretic Side/Normal Side Ratios of Cross-Sectional Areas of the Superior Oblique Muscle Vary Largely in Idiopathic Superior Oblique PalsyAmerican Journal of OphthalmologyVol. 150Issue 3PreviewI read with interest the recent report by Uchiyama and associates of their magnetic resonance imaging study of superior oblique (SO) muscle cross-section in patients with unilateral SO palsy.1 These authors compared coronal plane magnetic resonance imaging (MRI) in 50 cases, and in 45 control subjects. The authors calculated the ratio of SO cross-section between the paretic and normal sides. The figure provided by these authors shows a very impressive scatter of data for SO palsy, yet very small 95% confidence intervals are superimposed on the data. Full-Text PDF
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