We thank Dr Ayata for the thoughtful comments of our article. He
had three questions that we would like to answer as follows:
1) Figure 1 was quite important for the paper because it shows the exact location of the macular pigment in monkeys (courtesy of Francois Delori, PhD). We are sorry for the lack of the image in the on-line paper version but it was probably due to the PDF saving process.
2) We do not think there is any inconsistency between results and conclusion because that was exactly what we expected. If a pseudohole is a macular lesion where there is no loss of foveal tissue, the presence of foveal AF indicates the absence of macular pigment in the fovea. Being the pigment located in the outer plexiform layer and outer nuclear layer in the fovea (fig 1), that means we were dealing with lamellar rather than pseudo macular holes. Our paper just underlined the finding that OCT alone is inadequate to differentiate pseudo from lamellar holes. As to this respect AF imaging may be useful because reveals a loss of foveal tissue.
3) We are aware of the different aspects of AF-imaging after dark and light adaptation. As Dr Ayata properly pointed out, the visible changes in AF imaging in light and dark adapted eyes are minimal in the fovea and the lack of macular pigment in lamellar macular hole is in the fovea. The AF ratio was used to correlate AF intensities with residual retinal thickness at the bottom of the defect. The reason why we did not use raw images for AF quantitative measurements was related to the great difficulties in visualizing foveal defect in non normalized images. The ratio could have affected the results of these correlations but not the presence of foveal AF itself.
We thank again Dr Ayata for his interest in our article.
Ferdinando Bottoni ,MD