Reply
Authors: Jack T. Holladay, Samuel Masket, Walter Stark, Scott MacRae, Flora Lum
Journal: Ophthalmology (2017)

We appreciate Dr Brown's thoughtful comments and thank him for providing 2 additional references for pupil ovalization to our article.1Masket S. Rorer E. Stark W. et al.Special report: The American Academy of Ophthalmology Task Force consensus statement on adverse events with intraocular lenses.Ophthalmology. 2017; 124: 142-144Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Notice, however, that in all 3 references the ratio is measured using the vertical to horizontal ratio (normal from 0.96 to 0.98, a 2% variation), whereas in the consensus document it is the ratio of the major to minor diameter of the ellipse in photopic conditions. The major and minor axis may not necessarily be orthogonal and will not be vertical or horizontal in most of the cases. The major and minor diameters are much more sensitive when the diameters are not vertical and horizontal. For example, if the ellipse is oriented at 45°, the vertical and horizontal diameters will be equal no matter what the major and minor diameters. This measurement is only triggered when the clinician recognizes dyscoria (an irregularly shaped pupil at the biomicroscope) and is recorded photographically on each visit, so there is no question that a change in the shape of the pupil will be well-documented over time. The adverse reaction of ovalization of the pupil primarily occurs with anterior chamber intraocular lens that are either angle or iris supported. Both are exaggerated by constricting the pupil with a bright light (photopic conditions). The ratio of major to minor diameter is simply a quantitative measure and the photographs are the primary documentation. The figure illustrates an example of an adverse event with an oval pupil.2Alió J.L. Abdelrahman A.M. Javaloy J. et al.Angle-supported anterior chamber phakic intraocular lens explantation causes and outcome.Ophthalmology. 2006; 113: 2213-2220Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar The major diameter is 11.5 mm and the minor 3.0 mm, resulting in a major to minor ratio of 3.83 (11.5/3.0). The vertical to horizontal is much closer to 1. We do agree that additional studies should be performed using the ratio of the major and minor axis of the ellipse to provide normative data for pupil ovalization. Re: Masket et al.: Special report: The American Academy of Ophthalmology task force consensus statement on adverse events with intraocular lenses (Ophthalmology. 2017;124:142-144)OphthalmologyVol. 124Issue 8PreviewThe January 2017 issue of Ophthalmology included 6 American Academy of Ophthalmology Task Force special reports related to intraocular lenses (IOLs). Several of these were consensus statements reflecting the collective opinion of internationally respected cataract surgeons. These statements are intended to guide future research and reporting in the evolving field of IOL design and in particular to standardize the nomenclature and establish a uniform optical framework. They are likely to be consulted and cited frequently. Full-Text PDF CorrigendumOphthalmologyVol. 124Issue 12PreviewThe authors of “Reply to Brown” (Ophthalmology. 2017;124:e67) would like to issue the following correction: The reply referred to a figure, which should have noted Figure 5 in the original article titled “Angle-Supported Anterior Chamber Phakic Intraocular Lens Explantation” (Ophthalmology. 2006;113:2213-2220) Full-Text PDF