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We read with interest the meta-analysis of population-based, cross-sectional studies from the European Eye Epidemiology (E3) Consortium by Williams et al on the impact of educational level on myopia prevalence.1

Esotropia with a high accommodative convergence-to-accommodation (AC/A) ratio is a relatively common type of strabismus in children. Typically, it presents in early childhood as esotropia greater at near than distance fixation; however, not all of these cases are considered high AC/A. If the near deviation reduces significantly when the child looks through +3.00-diopter (D) lenses, then the deviation is established as accommodative rather than the result of an excess of convergence driven by near proximity.

A 30-year-old man with a 14-year history of a prior penetrating keratoplasty (PKP) presented with an open globe following a motor vehicle collision (Fig 1). Complete dehiscence of his corneal graft at the graft host junction was observed with uveal tissue protrusion. Computed tomography imaging (Fig 2, arrow) demonstrated the absence of the corneal graft. An attempt to close the globe was followed by an enucleation (Fig 3). Histopathology (H&E) confirmed the absence of the corneal graft and revealed suture material (Fig 4, arrow) in the host cornea and prolapsed uveal tissue.

In an analysis from the second year of the Comparison of Age-related Macular Degeneration Treatments Trials (CATT), Sharma et al (p. 865) described the association between visual acuity (VA) and morphologic features on fundus photography (FP), fluorescein angiography (FA), and optical coherence tomography (OCT). They found that the associations between VA and morphologic features that were identified during year 1 of this prospective, randomized study were maintained or strengthened during year 2.

We thank Drs Takkar and Azad for their interest in our work.1 They propose a novel concept, that choroidal detachment resulting from retinal detachment could itself damage the ciliary nerves, and that this may be a frequent occurrence. According to most series, however, including the one Takkar and Azad refer to (citation 2 in their letter), choroidal detachment, noted generally to occur in approximately 4% of patients, is a rather infrequent finding, secondary to very low intraocular pressures that may be associated with chronic retinal detachments, the majority of those aphakic.