and that prospective studies of keratoconus progression should be undertaken to appropriately answer this issue. This was perhaps what the authors questioned about our work, and we agree with them on this aspect. ´ ZQUEZ ˜ OR VA PABLO R. RUISEN ´ JONATAN DAVID GALLETTI NATALIA MI´NGUEZ MARIANELLA DELRIVO FERNANDO FUENTES BONTHOUX ´ S PFO ¨ RTNER TOMA ´ ´ JEREMIAS GASTON GALLETTI
Buenos Aires, Argentina CONFLICT OF INTEREST DISCLOSURES: SEE THE ORIGINAL article for any disclosures of the authors.
REFERENCES
1. Ruisen˜or Va´zquez PR, Galletti JD, Minguez N, et al. Pentacam Scheimpflug tomography findings in topographically normal patients and subclinical keratoconus cases. Am J Ophthalmol 2014;158(1):32–40. 2. De Sanctis U, Loiacono C, Richiardi L, Turco D, Mutani B, Grignolo FM. Sensitivity and specificity of posterior corneal elevation measured by Pentacam in discriminating keratoconus/subclinical keratoconus. Ophthalmology 2008;115(9): 1534–1539.
belonging to the African-American and other diverse ethnic groups.2 Another study3 by Phillips and associates also demonstrated similar results and showed that a higher percentage of African-American patients went on to develop multiple sclerosis and neuromyelitis optica. This is of particular interest to us in the Indian subcontinent, since studies from India4 have also shown differences from the pattern reported in the ONTT, with a higher rate of bilaterality, poorer visual outcomes, and a lower rate of multiple sclerosis. We see a large number of patients in the pediatric age group with optic neuritis in our practice and feel that there may be significant differences from the cohort described in this study. Our hitherto unpublished data of 34 children presenting with optic neuritis with a mean age of 12.38 years (range 5–15 years) show that 65% had bilateral involvement, as compared to 41% in the current study; 26.4% had papillitis, as compared to 67% in the current study; and none went on to develop multiple sclerosis, as compared to 39% in the current study. A majority, however, recovered good visual acuity (>20/40) at last followup, though follow-up intervals varied from patient to patient. Also, the authors mention in the initial data that 9 patients (4%) were not treated; it would be interesting to know if visual outcomes varied in these patients and the reason for not treating, and also if these children had any underlying systemic diagnoses. This subset is of particular interest to us, since in our practice a significant proportion of patients may refuse or be unable to receive treatment for socioeconomic reasons.
Visual Outcomes in Pediatric Optic Neuritis
AKSHAY BADAKERE PREETI PATIL CHHABLANI
EDITOR: WE READ WITH GREAT INTEREST THE ARTICLE ENTITLED
‘‘Visual Outcomes in Pediatric Optic Neuritis’’ by Wan and associates,1 which describes visual outcomes and potential risk factors for poor visual recovery after a first episode of optic neuritis in children. There is scanty data regarding optic neuritis in children and this study certainly provides very valuable inputs, especially as the follow-up was carried out at 2 defined time intervals of 3 months and 1 year after the initial attack. This provides us with a timeline for the visual recovery. The authors have mentioned that the only risk factor for poor visual recovery was found to be poor recovery of vision at 3 months and that other variables such as sex, baseline vision, laterality, treatment, or underlying diagnosis did not predict poor visual outcome. However, there is no mention of any racial difference seen in visual outcome. A recent analysis of the ONTT (Optic Neuritis Treatment Trial) data showed that race/ethnicity is associated with long-term contrast sensitivity and visual acuity outcomes after optic neuritis, with a worse outcome in patients 210
RAMESH KEKUNNAYA
Hyderabad, India VIVEK WARKAD
Bhubaneshwar, India VIRENDER SACHDEVA
Vishakhapatinam, India THE AUTHORS HAVE COMPLETED AND SUBMITTED THE ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. The authors indicate no funding support.
REFERENCES
1. Wan MJ, Adebona O, Benson LA, Gorman MP, Heidary G. Visual outcomes in pediatric optic neuritis. Am J Ophthalmol 2014;158(3):503–507.e502. 2. Moss HE, Gao W, Balcer LJ, Joslin CE. Association of race/ ethnicity with visual outcomes following acute optic neuritis: an analysis of the Optic Neuritis Treatment Trial. JAMA Ophthalmol 2014;132(4):421–427.
AMERICAN JOURNAL OF OPHTHALMOLOGY
JANUARY 2015
3. Phillips PH, Newman NJ, Lynn MJ. Optic neuritis in African Americans. Arch Neurol 1998;55(2):186–192. 4. Saxena R, Phuljhele S, Menon V, et al. Clinical profile and short-term outcomes of optic neuritis patients in India. Indian J Ophthalmol 2014;62(3):265–267.
MICHAEL J. WAN OLUMUYIWA ADEBONA LESLIE A. BENSON MARK P. GORMAN GENA HEIDARY
Boston, Massachusetts REPLY WE APPRECIATE THE CORRESPONDENCE AND FEEDBACK
from Badakere and associates, who raise several important issues about this study. In terms of race, the ethnic background of each patient was recorded during the initial data collection. The race breakdown of the 46 patients in the study was as follows: White 70% (n ¼ 32), Black 15% (n ¼ 7), Asian 2% (n ¼ 1), Other 7% (n ¼ 3), and Declined to answer 7% (n ¼ 3). Of the 4 patients with a poor visual outcome at 1 year (visual acuity
Buenos Aires, Argentina CONFLICT OF INTEREST DISCLOSURES: SEE THE ORIGINAL article for any disclosures of the authors.
REFERENCES
1. Ruisen˜or Va´zquez PR, Galletti JD, Minguez N, et al. Pentacam Scheimpflug tomography findings in topographically normal patients and subclinical keratoconus cases. Am J Ophthalmol 2014;158(1):32–40. 2. De Sanctis U, Loiacono C, Richiardi L, Turco D, Mutani B, Grignolo FM. Sensitivity and specificity of posterior corneal elevation measured by Pentacam in discriminating keratoconus/subclinical keratoconus. Ophthalmology 2008;115(9): 1534–1539.
belonging to the African-American and other diverse ethnic groups.2 Another study3 by Phillips and associates also demonstrated similar results and showed that a higher percentage of African-American patients went on to develop multiple sclerosis and neuromyelitis optica. This is of particular interest to us in the Indian subcontinent, since studies from India4 have also shown differences from the pattern reported in the ONTT, with a higher rate of bilaterality, poorer visual outcomes, and a lower rate of multiple sclerosis. We see a large number of patients in the pediatric age group with optic neuritis in our practice and feel that there may be significant differences from the cohort described in this study. Our hitherto unpublished data of 34 children presenting with optic neuritis with a mean age of 12.38 years (range 5–15 years) show that 65% had bilateral involvement, as compared to 41% in the current study; 26.4% had papillitis, as compared to 67% in the current study; and none went on to develop multiple sclerosis, as compared to 39% in the current study. A majority, however, recovered good visual acuity (>20/40) at last followup, though follow-up intervals varied from patient to patient. Also, the authors mention in the initial data that 9 patients (4%) were not treated; it would be interesting to know if visual outcomes varied in these patients and the reason for not treating, and also if these children had any underlying systemic diagnoses. This subset is of particular interest to us, since in our practice a significant proportion of patients may refuse or be unable to receive treatment for socioeconomic reasons.
Visual Outcomes in Pediatric Optic Neuritis
AKSHAY BADAKERE PREETI PATIL CHHABLANI
EDITOR: WE READ WITH GREAT INTEREST THE ARTICLE ENTITLED
‘‘Visual Outcomes in Pediatric Optic Neuritis’’ by Wan and associates,1 which describes visual outcomes and potential risk factors for poor visual recovery after a first episode of optic neuritis in children. There is scanty data regarding optic neuritis in children and this study certainly provides very valuable inputs, especially as the follow-up was carried out at 2 defined time intervals of 3 months and 1 year after the initial attack. This provides us with a timeline for the visual recovery. The authors have mentioned that the only risk factor for poor visual recovery was found to be poor recovery of vision at 3 months and that other variables such as sex, baseline vision, laterality, treatment, or underlying diagnosis did not predict poor visual outcome. However, there is no mention of any racial difference seen in visual outcome. A recent analysis of the ONTT (Optic Neuritis Treatment Trial) data showed that race/ethnicity is associated with long-term contrast sensitivity and visual acuity outcomes after optic neuritis, with a worse outcome in patients 210
RAMESH KEKUNNAYA
Hyderabad, India VIVEK WARKAD
Bhubaneshwar, India VIRENDER SACHDEVA
Vishakhapatinam, India THE AUTHORS HAVE COMPLETED AND SUBMITTED THE ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. The authors indicate no funding support.
REFERENCES
1. Wan MJ, Adebona O, Benson LA, Gorman MP, Heidary G. Visual outcomes in pediatric optic neuritis. Am J Ophthalmol 2014;158(3):503–507.e502. 2. Moss HE, Gao W, Balcer LJ, Joslin CE. Association of race/ ethnicity with visual outcomes following acute optic neuritis: an analysis of the Optic Neuritis Treatment Trial. JAMA Ophthalmol 2014;132(4):421–427.
AMERICAN JOURNAL OF OPHTHALMOLOGY
JANUARY 2015
3. Phillips PH, Newman NJ, Lynn MJ. Optic neuritis in African Americans. Arch Neurol 1998;55(2):186–192. 4. Saxena R, Phuljhele S, Menon V, et al. Clinical profile and short-term outcomes of optic neuritis patients in India. Indian J Ophthalmol 2014;62(3):265–267.
MICHAEL J. WAN OLUMUYIWA ADEBONA LESLIE A. BENSON MARK P. GORMAN GENA HEIDARY
Boston, Massachusetts REPLY WE APPRECIATE THE CORRESPONDENCE AND FEEDBACK
from Badakere and associates, who raise several important issues about this study. In terms of race, the ethnic background of each patient was recorded during the initial data collection. The race breakdown of the 46 patients in the study was as follows: White 70% (n ¼ 32), Black 15% (n ¼ 7), Asian 2% (n ¼ 1), Other 7% (n ¼ 3), and Declined to answer 7% (n ¼ 3). Of the 4 patients with a poor visual outcome at 1 year (visual acuity
