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Response to Robert Rutstein’s Letter to Editor
We agree that non-foveal fixation determined by visuoscopy is a feature of microtropia with identity along with other features including reduced stereo-acuity and central suppression using the four dioptre prism test. Our study was retrospective and visuoscopy had not been carried out in the majority of cases. Our paper is a transcript of a clinical presentation that was originally given to a predominantly orthoptic audience where central suppression using a four dioptre prism test is accepted as diagnostic for the presence of microtropia with identity when visuoscopy is unavailable, hence our use of this term. The finer points of microtropia differentiation, diagnosis and terminology were beyond the remit of our paper. Whether central suppression is present due to microtropia with identity or some other foveal abnormality the implications remain the same. In the absence of a suppression response our cohort did not require occlusion treatment and this fact enables us to avoid rushing into unnecessary occlusion treatment which is beneficial for both the patient and departmental patch budgets.
Debbie Lysons & Jane Tapley 9th September 2018