Asymmetry of Optic Nerve Head Parameters Measured by Confocal Scanning Laser Ophthalmoscopy in Myopic Anisometropic Eyes

Round 1

Reviewer 1 Report

The authors describe the inter-eye asymmetry of optic nerve head parameters measured by confocal scanning laser ophthalmoscopy (HRT) in non-glaucomatous, myopic anisometropic eyes (36 eyes of 18 subjects).

They demonstrated that cup/disc ratios (area, vertical, horizontal) were significantly smaller in more myopic eyes. Larger disc area was independently and significantly associated with larger cup/disc area ratio and vertical CDR.

The difference of spherical equivalent (SE) between both eyes was ≥1.5 diopters.

 

Comments:

Line 56: The SE for 56 both eyes of each subject was ≤0.00D. This means that there was at least 1 subject included with combined myopic and astigmatic refraction (e.g., -2.0 sph # + 4.0 cyl). The mean amount and range of astigmatism isn´t shown in this manuscript. Maybe the authors could add these numbers.

Line 60: … more and less myopic eyes ... seems to be an arbitrary decision. Why did the authors choose these cut-off values mentioned in Results? Any reasons?

Line 97: … range of less (0 to -5.88) and more (-2.50 to -8.00)… why overlapping ranges?

Line 78: …HRT 3…see line 17: HRT II … please select the appropriate one

Line 85: …50mm… please change to …50µm…

Line 98: … The mean inter-eye difference of SE was 2.20D (range: 1.50 to 3.88). This is not a hugh difference. Although, the mean axial length numbers (25.37 versus 24.52 = 0.85 mm, only) were statistically different.

Line 262: … (SE) of more than 1.50D. Please add the range (range: 1.50 - 3.88 D) or: … more than 1.50D but less than 3.88D.

Line 281: …range of refractive error was -8D to 0D. Please add the mean refractive error in brackets.

 

Several typos.

 

In summary the topic – inter-eye difference of quantitative parameters of the disc in anisomyopic eyes - is interesting. As mentioned in the discussion, the sample size is rather small. Additionally, it would have been of interest to compare these results of inter-eye differences with results of isomyopic eys or/and of emmetropic eyes. Only longitudinal studies can prove that small inter-eye differences of the appearance of the disc have definitely an influence concerning the development of glaucoma.

Author Response

Line 56: The SE for 56 both eyes of each subject was ≤0.00D. This means that there was at least 1 subject included with combined myopic and astigmatic refraction (e.g., -2.0 sph # + 4.0 cyl). The mean amount and range of astigmatism isn´t shown in this manuscript. Maybe the authors could add these numbers.

Response: the mean and range of astigmatism was added. See line 99-100.

Line 60: … more and less myopic eyes ... seems to be an arbitrary decision. Why did the authors choose these cut-off values mentioned in Results? Any reasons?

Response: We use minimal difference of 1.50 diopters between eyes (instead of 2.50 diopters) as cut-off values. We believe this refractive status is more common in population.

Line 97: … range of less (0 to -5.88) and more (-2.50 to -8.00)… why overlapping ranges?

Response: These are the range of more myopic eyes and less myopic eyes in the subjects. Each subject has one more myopic eye and one less myopic eye.

Line 78: …HRT 3…see line 17: HRT II … please select the appropriate one

Response: It is HRT II. See line 80-82.

Line 85: …50mm… please change to …50µm…

Response: The error was corrected. See line 88.

 

Line 98: … The mean inter-eye difference of SE was 2.20D (range: 1.50 to 3.88). This is not a hugh difference. Although, the mean axial length numbers (25.37 versus 24.52 = 0.85 mm, only) were statistically different.

Response: We use minimal difference of 1.50 diopters between eyes as cut-off values. As a result, the inter-eye difference was 2.20D.

Line 262: … (SE) of more than 1.50D. Please add the range (range: 1.50 - 3.88 D) or: … more than 1.50D but less than 3.88D.

Response: The range was added. See line 260.

Line 281: …range of refractive error was -8D to 0D. Please add the mean refractive error in brackets.

Response: The mean was added. See line 281.

 

Several typos.

 Response: The manuscript was checked again.

Author Response File: Author Response.pdf

Reviewer 2 Report

The study is novel and with good discussion. One major drawback is the minimal difference between myopia and fellow eye of 3 diopter. A more relevant study is to compare emmetropia in one eye and true unilateral myopia of 10-14 diopter or so. In case we will compare zero power to -12 diopter, then we ned to correct for the machine magnification using the formula (correct for diopter or axial length) such as Mansour AM. Measuring fundus landmarks. Invest Ophthalmol Vis Sci. 1990Jan;31(1):41-2. PMID: 2298541.

 

Author Response

The study is novel and with good discussion. One major drawback is the minimal difference between myopia and fellow eye of 3 diopter. A more relevant study is to compare emmetropia in one eye and true unilateral myopia of 10-14 diopter or so. In case we will compare zero power to -12 diopter, then we ned to correct for the machine magnification using the formula (correct for diopter or axial length) such as Mansour AM. Measuring fundus landmarks. Invest Ophthalmol Vis Sci. 1990Jan;31(1):41-2. PMID: 2298541.

Response: We use minimal difference of 1.50 diopters between eyes (instead of 2.50 diopters) as cut-off values. We believe this refractive status is more common in population.

Author Response File: Author Response.pdf

Reviewer 3 Report

applsci-1651634 Review Report

The authors need to answer the following comments to improve the manuscript to be suitable for publication in Applied Sciences.

1) The journal format should be applied throughout the manuscript (e.g., title, abstract, sub-headers, tables, and references).

2) Delete the section “6. Patent”.

3) Add the ethical approval number.

4) The featured application is not sound and does not contain any possible future applications. You can either improve or delete since it is not a must.

5) No need to divide the abstract into sections (1, 2, 3, and 4)).

6) remove the numbers within the keywords (1, 2, 3, and 4).

7) The introduction section needs improvement and should clearly state the difference between the current and those previously reported.

8) The novelty of the work should be clearly stated.

9) The number of subjects is low.

10) The averages were represented by the mean ± standard deviation. Are the data normally distributed?

11) The results were reported in both the text and the tables (duplication).

Author Response

• The journal format should be applied throughout the manuscript (e.g., title, abstract, sub-headers, tables, and references).

Response: The format of title, sub-headers, and tables was corrected. We also checked the format of references according to the template.

• Delete the section “6. Patent”.

Response: the section “6. Patent” was deleted.

• Add the ethical approval number.

Response: the ethical approval number was added. See line 53.

4) The featured application is not sound and does not contain any possible future applications. You can either improve or delete since it is not a must.

Response: The featured application was deleted.

• No need to divide the abstract into sections (1, 2, 3, and 4)).

Response: The numbers was deleted.

• remove the numbers within the keywords (1, 2, 3, and 4).

Response: The numbers was deleted.

• The introduction section needs improvement and should clearly state the difference between the current and those previously reported.

Response: The introduction was revised.

• The novelty of the work should be clearly stated.

Response: The novelty of the work added in introduction section.

• The number of subjects is low.

Response: we agree that the number of subjects is low. We discussed it in the limitations.

• The averages were represented by the mean ± standard deviation. Are the data normally distributed?

Response: Kolmogorov-Smirnov test was used. All the data is normally distributed.

 

• The results were reported in both the text and the tables (duplication).

Response: the results in the text were removed.

Author Response File: Author Response.docx

Round 2

Reviewer 3 Report

The format of the references is still not suitable for the journal, however, the manuscript is acceptable for publication.