Novel Instrument for Clinical Evaluations of Active Extraocular Muscle Tension

Round 1

Reviewer 1 Report

Please add a video to the presentation or a series of images to show a real-time example of hoe to use the device.

Then revise the entire text accordingly.

Thank you.

Please add a video to the presentation or a series of images to show a real-time example of hoe to use the device.

Then revise the entire text accordingly.

Thank you.

Author Response

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Reviewer 2 Report

Dear Authors,
Thank you for your article.I appreciate your hard work.
  I particularly appreciate the discussion of the difficult issue of strabismus and its surgery.   Particularly noteworthy are the very careful photos.   I consider the article as contributing a lot to strabismus surgery.Just a minor punctuation error please.  

Author Response

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Reviewer 3 Report

Though usually strabismus operations are being planned by measuring the amount of squint in prism diopters and not by figuring out what the muscle tension is, this article presents a fresh approach and the idea to measure muscle tension and building such a measuring device is really to be appreciated.

I do not know if this will be useful for practical daily clinical use but it is definitely worthy for publication.

 

Author Response

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Reviewer 4 Report

In this paper, the authors present a compact device for non-invasive measurement of the active extraocular muscle (EOM) tension. This is an innovative development, with a relevant goal, whose context is well presented. The paper is well-written, the methodology is correct, and the conclusions are supported by the results present. The paper deserves to be published. I have only a few minor comments, which, in my opinion, may improve the paper.

1 – In section 2.1, when presenting the control unit, it would be useful to specify the used sampling rate and the resolution of the ADC. This would also ease the readability of the horizontal scale of the graphs presented in Figure 4.

2 – When presenting the results of the calibration of the device, the authors provide the value of the correlation coefficient. From the point of view of assessing the device’s performance it would be better to provide the non-linearity value (linearity error).

3 – This work concerns a proof-of-concept study, performed on 3 subjects, and, as the authors state, repeatability assessment will be addressed in a future larger study. Nonetheless the authors could provide an initial estimative of the repeatability of the device. This value can be estimated from Figure 8(a) but, in my opinion, it could be included in the text.

4 – What is the reason for the larger values of standard deviation when measuring the active EOM tensions for the superior rectus? If relevant, please consider include a brief explanation in the manuscript.

Author Response

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Reviewer 5 Report

This study demonstrated the use of a novel device for measuring active EOM tension objectively with wireless recording capabilities and possible real-time surgical applications. The use of this device is particularly interesting because the current approach with FDT and FGT tend to be very subjective and heavily reliant on the surgeon’s skills. Given that this novel device can potentially improve future surgical outcomes, the authors should provide some additional background on the current surgical outcomes and explore how this device can possibly be used. While implying that abnormal EOM tension is the cause of strabismus, the authors should also briefly explain the pathophysiology covering the sensory aspects in order to give a balanced background to the readers. In the results section, it is not clear how many subjects were included in this present study, and it is not clear why only males were recruited. How many measurements were taken on each subject? How repeatable are those measurements? Lines 189-194 should belong in the methods section rather than the results section. While this is meant to be a commentary article, the manuscript seems to be short of a discussion section as the authors should provide a comparison of this novel device with current instruments even if it is restricted to research. This can be presented as a table for the ease of comparison.

Author Response

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