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Research has shown that the preschool years are a vital time for children to acquire the language skills necessary to succeed in school. In 1965, as part of the “war on poverty” in the United States, the Head Start program was started to help preschool children from low-income families improve their readiness for school. However, by the time a child starts the Head Start program, it may be too late for these children to catch up with children from higher income families. In a landmark study, Hart and Risley1 studied 42 children from diverse socioeconomic and racial backgrounds beginning when they were 7 to 9 months of age until they were 3 years old to better understand how children develop language skills.

We thank Galvis et al for their interest in our paper.1 We agree that a more quantitative estimate of the effect of education on myopia would be very interesting. Unfortunately for this meta-analysis contributing studies from the European Eye Epidemiology (E3) Consortium submitted summary data, this means that an analysis producing estimates for the step change in myopia prevalence per year in education was not possible. Additionally, although some studies have genetic data on their participants, genetic material is not universally available on the E3 studies, and as such we are unable to undertake a similar analysis to the interesting paper by Cueller-Partida et al.

A 50-year-old man with cutaneous T-cell lymphoma (CTCL) complained of painless vision loss in his right eye. He had a large, indurated plaque on his tongue (Fig 1A) whose biopsy showed invasion with neoplastic T-cells (Fig 1B). Vision was count fingers in the right eye, and there was vitritis, retinal vascular sheathing, and a diffuse, white infiltrate in the macula (Fig 1C). Antimicrobials were injected intravitreously without effect. Cultures were negative. Flow cytometry of the vitreous showed monoclonal T cells, consistent with metastatic CTCL.

A 17-year-old boy presented with recurrent headache for several weeks and sudden vision loss on the left eye to light perception. On slit lamp examination partial aniridia with transillumination was identified (Fig 1A). Ophthalmoscopy and angiography of the left eye revealed a central retinal artery occlusion (Fig 1B, D). Computed tomography of the cardiovascular and cerebrovascular system discovered ectasia of all major arterial vessels, including carotid and cerebral arteries (Fig 1C). Genetic analysis revealed a missense mutation of the ACTA2 gene, encoding for a smooth muscle isoform of α-actin.


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