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Editor,—I read with interest the article by Heyworth and associates on the natural history of recurrent corneal erosion syndrome,1 published in the January 1998 issue ofBJO.
However, this article raises certain issues of concern. Firstly, the title “A 4 year review of 117 patients” is misleading, since 94 patients were studied. Furthermore, the authors also state in the first sentence that epithelial basement membrane dystrophy (EBMD) is an anterior stromal dystrophy. The two are distinct clinical and pathological entities.
A further point of concern is that none of these patients was examined as to the cause of the early morning irritation, so it is not certain that their symptoms were caused by recurrence of epithelial erosions. Indeed, such symptoms could well be due to blepharitis or a multitude of other ocular disorders. There is also an inaccuracy in Table 1, which lists the percentage of symptomatic EBMD patients as 78%, when it should be 75% (21 out of 28 patients).
The authors finally state that these symptoms couldbe attributed to recurrent corneal erosion syndrome, which does not really prove anything at all.
Editor,—We thank Dr Menon for his comments on our paper on the natural history of recurrent erosion syndrome.
The paper sets out to review the symptomatology of a group of 117 patients who were originally recruited for Hykin’s studycomparing two treatments for recurrent erosion syndrome. We contacted 94 (80%) of the original 117 that were studied. Since the original cohort was of 117 patients we do not feel that this is misleading.
We accept that the term anterior stromal might better be termed anterior dystrophy when discussing the most common causes of recurrent erosion syndrome; however, dystrophies extending to the anterior stroma such as lattice, granular, and macular may also cause a recurrent erosion syndrome—this particular group having been excluded from our study.
We accept the limitations of a telephone questionnaire in confusing symptomatology with coexisting and related disease such as blepharitis; however, the episodic and acute nature of the pain in this condition is generally characteristic. The fact that 91% of symptomatic patients complained of symptoms upon waking in the morning rather than throughout the day suggests that these symptoms were of recurrent erosion syndrome rather than blepharitis or other ocular disorders. We nevertheless accept that there may be some crossover in symptomatology among a small number of patients when there is coexisting disease.
There are no other natural history studies available on this condition which is known to be chronic and recurrent. The authors hope that other readers will find the data useful despite what we believe are minor deficiencies in the study.
There is an inaccuracy in Table 1. The percentage of symptomatic EBMD patients is 75% (21 out of 28 patients); this error was made at the proof reading stage and we thank Dr Menon for pointing this out.
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