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Giant cell arteritis in a Hispanic population
Letters to the Editor Giant Cell Arteritis in a Hispanic Population
Occlusion Therapy in Amblyopia
Dear Editor: The article by Dr. Liu and colleagues regarding the incidence of giant cell arteritis in a Hispanic population in Southern California (Ophthalmology, 2001;108:1145–9), is a retrospective review of 121 consecutive cases of patients who underwent temporal artery biopsy from 1986 to 1998. Forty patients were Hispanic, and none was found to have a positive biopsy result. Hispanics, therefore, may have genetic factors that protect them from this disease, and I totally agree that further studies are needed to confirm this possible genetic predisposition. During my 6 years of ophthalmology training at the University of Illinois Eye & Ear Infirmary (1977–1983) and 4 years of private practice in the suburbs of Chicago, I observed ophthalmology diseases in the American midwest. This contrasted with my experience at an ongoing ophthalmology practice that I undertook in Cordoba City, Argentina (South America) in 1988. Together with my team of ophthalmologists, we see an average of 3000 to 3500 patients a month, and over the past 13 years we have never encountered a genuine biopsyproven case of giant cell arteritis. Let me add that on only two occasions was it deemed necessary to perform temporal artery biopsy after the clinicians’ suspicions were raised by the elevated erythrocyte sedimentation rate levels. Likewise, we have not observed a single typical case of presumed ocular histoplasmosis, even though histoplasmosis is quite abundant in the nearby riverside areas. Similarly, for the past 13 years not a single occurrence of a map-dot (fingerprint) corneal dystrophy was detected by our anterior segment specialists. These findings may bring about some more inquiries on diseases that may not be prevalent in Hispanic populations compared with the white American population.
Dear Editor: The data presented in the report by Leiba et al1 does not support the conclusion “that occlusion therapy for amblyopia is effective.” A statistically significant shift in visual acuity in children normally occurs with increased age.2 Varying rates of intellectual development characteristically lead to a lack of uniform responses of preschool children to visual acuity testing (Robinson BE, Visual acuity assessment in preschool children [ARVO abstract]. Invest Ophthalmol Vis Sci 2000;41:S931. Abstract no. 4955). The authors correctly acknowledge that this “ongoing process of maturation”1 could affect their study, but no effort was made to compensate for this variable. Moreover, visual acuity in occluded fellow eyes and presumably amblyopic eyes has been shown to improve in parallel with intensive patching.3 This phenomenon is the likely result of reinforced recognition related to repeated testing with the same set of test objects. Leiba et al’s report lacked both a control group and any information describing vision changes in the fellow eye. Therefore, there was no comparative basis for assessing the effects of maturation and training on the vision in the amblyopic eyes. The article offered no data distinguishing improved performance caused by increasing familiarity with the test procedure and improved literacy from the presumed effect of occlusion therapy. The authors stated that patients with organic visual disorders were excluded. This determination was apparently based on subjective assessment of ocular structures. However, in previous studies, when quantitative criteria for normal eye size, optic disc area, and optic disc topography were used, most seemingly amblyopic eyes were found to be abnormal (Lempert P. To assess the anatomy of eyes presumed to be amblyopic and their fellow eyes. Presented at the Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida.4,5 The authors apparently did not apply any of these objective techniques to identify these physically impaired eyes. The patients who failed to improve their visual acuity may have been limited by more severe defects in ocular anatomy, such as optic nerve hypoplasia or dysplasia. Those subjects who did improve were likely to have been demonstrating the usual progression of visual acuity that ordinarily takes place as they learned to take the test and/or read the optotypes. This article does not contradict the conclusions of Snowdon and Stewart-Brown.6
NATALIA M. ARTAL, MD MABEL RODRIGUEZ, MD JOSE´ D. LUNA, MD VICTOR E. REVIGLIO, MD OSVALDO CUELLO, MD JUAN CARLOS MUIN˜ O, MD CLAUDIO P. JUAREZ, MD Co´rdoba, Argentina Author reply Dear Editor: The clinical impression of Dr. Juarez is similar to our reported findings on temporal arteritis. However, they provide their experience on such ocular diseases as histoplasmosis and map-dot corneal dystrophy. Because our report does not address these two diseases, we do not wish to comment on their observations. NARSING A. RAO, MD Los Angeles, California
References 1. Leiba H, Shimshoni M, Oliver M, et al. Long-term follow-up of occlusion therapy in amblyopia. Ophthalmology 2001;108: 1552–5. 2. Holmes JM, Beck RW, Repka MX, et al. The amblyopia treatment study visual acuity testing protocol. Arch Ophthalmol 2001;119:1345–53.
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Occlusion Therapy in Amblyopia
Dear Editor: The article by Dr. Liu and colleagues regarding the incidence of giant cell arteritis in a Hispanic population in Southern California (Ophthalmology, 2001;108:1145–9), is a retrospective review of 121 consecutive cases of patients who underwent temporal artery biopsy from 1986 to 1998. Forty patients were Hispanic, and none was found to have a positive biopsy result. Hispanics, therefore, may have genetic factors that protect them from this disease, and I totally agree that further studies are needed to confirm this possible genetic predisposition. During my 6 years of ophthalmology training at the University of Illinois Eye & Ear Infirmary (1977–1983) and 4 years of private practice in the suburbs of Chicago, I observed ophthalmology diseases in the American midwest. This contrasted with my experience at an ongoing ophthalmology practice that I undertook in Cordoba City, Argentina (South America) in 1988. Together with my team of ophthalmologists, we see an average of 3000 to 3500 patients a month, and over the past 13 years we have never encountered a genuine biopsyproven case of giant cell arteritis. Let me add that on only two occasions was it deemed necessary to perform temporal artery biopsy after the clinicians’ suspicions were raised by the elevated erythrocyte sedimentation rate levels. Likewise, we have not observed a single typical case of presumed ocular histoplasmosis, even though histoplasmosis is quite abundant in the nearby riverside areas. Similarly, for the past 13 years not a single occurrence of a map-dot (fingerprint) corneal dystrophy was detected by our anterior segment specialists. These findings may bring about some more inquiries on diseases that may not be prevalent in Hispanic populations compared with the white American population.
Dear Editor: The data presented in the report by Leiba et al1 does not support the conclusion “that occlusion therapy for amblyopia is effective.” A statistically significant shift in visual acuity in children normally occurs with increased age.2 Varying rates of intellectual development characteristically lead to a lack of uniform responses of preschool children to visual acuity testing (Robinson BE, Visual acuity assessment in preschool children [ARVO abstract]. Invest Ophthalmol Vis Sci 2000;41:S931. Abstract no. 4955). The authors correctly acknowledge that this “ongoing process of maturation”1 could affect their study, but no effort was made to compensate for this variable. Moreover, visual acuity in occluded fellow eyes and presumably amblyopic eyes has been shown to improve in parallel with intensive patching.3 This phenomenon is the likely result of reinforced recognition related to repeated testing with the same set of test objects. Leiba et al’s report lacked both a control group and any information describing vision changes in the fellow eye. Therefore, there was no comparative basis for assessing the effects of maturation and training on the vision in the amblyopic eyes. The article offered no data distinguishing improved performance caused by increasing familiarity with the test procedure and improved literacy from the presumed effect of occlusion therapy. The authors stated that patients with organic visual disorders were excluded. This determination was apparently based on subjective assessment of ocular structures. However, in previous studies, when quantitative criteria for normal eye size, optic disc area, and optic disc topography were used, most seemingly amblyopic eyes were found to be abnormal (Lempert P. To assess the anatomy of eyes presumed to be amblyopic and their fellow eyes. Presented at the Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida.4,5 The authors apparently did not apply any of these objective techniques to identify these physically impaired eyes. The patients who failed to improve their visual acuity may have been limited by more severe defects in ocular anatomy, such as optic nerve hypoplasia or dysplasia. Those subjects who did improve were likely to have been demonstrating the usual progression of visual acuity that ordinarily takes place as they learned to take the test and/or read the optotypes. This article does not contradict the conclusions of Snowdon and Stewart-Brown.6
NATALIA M. ARTAL, MD MABEL RODRIGUEZ, MD JOSE´ D. LUNA, MD VICTOR E. REVIGLIO, MD OSVALDO CUELLO, MD JUAN CARLOS MUIN˜ O, MD CLAUDIO P. JUAREZ, MD Co´rdoba, Argentina Author reply Dear Editor: The clinical impression of Dr. Juarez is similar to our reported findings on temporal arteritis. However, they provide their experience on such ocular diseases as histoplasmosis and map-dot corneal dystrophy. Because our report does not address these two diseases, we do not wish to comment on their observations. NARSING A. RAO, MD Los Angeles, California
References 1. Leiba H, Shimshoni M, Oliver M, et al. Long-term follow-up of occlusion therapy in amblyopia. Ophthalmology 2001;108: 1552–5. 2. Holmes JM, Beck RW, Repka MX, et al. The amblyopia treatment study visual acuity testing protocol. Arch Ophthalmol 2001;119:1345–53.
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