Author Affiliation: Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin–Madison.
The letter by Gutmann and colleagues provides an opportunity to discuss issues outside the purview of the original report.1
The optic gliomas in question1 (grade I juvenile pilocytic astrocytomas) are indeed congenital in origin and may enlarge postnatally. A handful of early, amalgamated computed tomographic and magnetic resonance imaging studies had commented on initial neuroimaging failing to reveal a glioma that was subsequently detected.2,3 Such initial findings made these early neuroimaging results reportable in their own right. But as the authors of those reports had noted in their discussions, such impressions could simply have been due to the poorer resolution of the computed tomographic and magnetic resonance imaging scanners initially used.2,3 The lack of subsequent reports of supposed de novo tumor emergence in the last 2 decades may be attributed to the greater availability of high-resolution magnetic resonance imaging, which permits detection of the smaller lesions that are present congenitally and enlarge thereafter.
Parsa CF. Visual Function and Optic Pathway Glioma: A Critical Response—Reply. JAMA Ophthalmol. 2013;131(1):120-124. doi:10.1001/2013.jamaophthalmol.519