The following letters were accepted after Hirano et al had responded to Hedges et al.—Ed.
To the Editor.
—We read with great interest the Letter From Havana by Lincoff et al.1 By invitation from the Cuban Ministry of Health, we visited Cuba in May 1993, the week after the visit by Lincoff et al, and again in September 1993.By the end of May 1993, the Cuban government was frantically trying to address a crisis that affected 42 653 people. In our systematic neuro-ophthalmological examinations, certain clinical features were regularly noted. Remarkably, about half of the conditions that we identified in May were misdiagnosed. We, as representatives of ORBIS International and the Pan American Health Organization, proposed that the Cuban Ministry of Health adopt a strict case definition (Table).2With this strict case definition and a smaller but more reliable database, many risk factors appeared more
Sadun AA, Martone JF, Reyes L, DuBois L, Roman GC, Caballero B. Optic and Peripheral Neuropathy in Cuba. JAMA. 1994;271(9):663-664. doi:10.1001/jama.1994.03510330040029