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To the Editor: We appreciate the interest of Kaur and colleagues in our study showing the role of anterior segment optical coherence tomography (AS-OCT) in localizing extraocular muscle insertions. 1 Ngo C.S. Smith D. Kraft S.P. The accuracy of anterior segment optical coherence tomography (AS-OCT) in localizing extraocular rectus muscles insertions. J AAPOS. 2015; 19: 233-236 Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar Kaur and colleagues state that measuring extraocular muscle insertion is not an important variable in primary strabismus surgery and that the overall results are biased as majority of included muscles were previously untouched. We agree that the use of AS-OCT may not yield useful additional information for primary surgery in routine cases. However, we performed this pilot study on regular cases to determine, for the first time, whether the vertical rectus muscles can be imaged on the AS-OCT and also to confirm that the horizontal rectus muscles can be imaged, as reported by Liu and colleagues. 2 Liu X. Wang F. Xiao Y. Ye X. Hou L. Measurement of the limbus-insertion distance in adult strabismus patients with anterior segment optical coherence tomography. Invest Ophthalmol Vis Sci. 2011; 52: 8370-8373 Crossref PubMed Scopus (44) Google Scholar We wish to point out that there are certainly instances of primary cases where it can be helpful, such as in suspected absent muscles and in craniofacial cases where muscles can be aberrant in position and number. The accuracy of anterior segment optical coherence tomography (AS-OCT) in localizing extraocular rectus muscles insertionsJournal of American Association for Pediatric Ophthalmology and Strabismus {JAAPOS}Vol. 19Issue 5PreviewTo the Editor: We read with interest Ngo and colleagues' study of the role of anterior segment optical coherence tomography (AS-OCT) in localizing extraocular muscle insertions.1 The paper describes the use of AS-OCT in 56 untouched muscles and 9 muscles undergoing reoperations. We wish to highlight the fact that measuring extraocular muscle insertion is not an important variable in primary strabismus surgery. It is only of importance where no information on previous surgery is available or in resurgeries, where secondary healing and tissue remodeling is expected to cause an anterior or posterior creep of the muscle insertion by 1–2 mm, altering the desired postoperative result. Full-Text PDF