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A 51-year-old man presented with a 10-year history of a gradually enlarging, asymptomatic, left medial canthus mass (Fig 1). Hematoxylin and eosin stain of the excised lesion revealed hyperplastic sebaceous glands forming irregular-shaped lobules with lumina containing proteinaceous material (asterisks) consistent with sebaceous adenoma (Figs 2 and 3). Although this patient was found to be otherwise healthy, a solitary sebaceous adenoma may be associated with malignancies of the gastrointestinal tract or other viscera (Muir-Torre syndrome).

Dr Odaibo correctly identifies that the relationship between high-dose zinc supplements (as in the Age-Related Eye Disease Study [AREDS] formulation), genotype, and age-related macular degeneration (AMD) progression risk is an important public health issue. He argues that a dense sampling of a population is likely to result in a more accurate representation than a sparse sampling. A more familiar approach to this issue is the concept of statistical significance. How large a sample is needed to reduce the risk of a false representation of the sampled population to an acceptable level? We found the difference in response to zinc-containing treatments in AREDS patients with high-risk CFH/low-risk ARMS2 versus low-risk CFH/high-risk ARMS2 under a Cox model to be significant to P < 0.00099, meaning that the chance that the observed relationship is owing to chance alone is <1 in 1000.

We thank Pautler and Browning for their interest and comments regarding our recent article. The suggestions of Pautler and Browning are interesting, but we do not think that uveal effusion is the underlying cause of the cystoid fluid collections (CFCs) in dominant cystoid macular dystrophy (DCMD). The phenotype is different from the case report of Pautler and Browning1: in DCMD, we observed a very constant, autosomal-dominantly inherited, early-onset phenotype starting with intraretinal CFCs diffusely affecting the posterior pole without persistent serous subretinal fluid, without choroidal folds.

A 60-year-old woman with a subretinal Artificial Silicon Retina microchip (Optobionics, Inc., Glen Ellyn, IL) that had been implanted 10 years previously. No encapsulation, neovascularization, or inflammatory response was noted.

In a perfect world, how would the peer review process work to ensure that the latest, highest quality scientific research is conveyed to busy practitioners who are eager to provide the best care for their patients? Authors would conduct hypothesis-driven investigations on important clinical questions about which they have no conflict of interest. They would describe their findings in clear, concise prose; cite appropriate (but not excessive) references to previous work; and use plagiarism detection software to ensure that their paper does not contain text that previously has been published.