In Reply We thank Moshfeghi and colleagues for their comments on the article by de Paula Freitas et al and our Invited Commentary on the ocular finding of babies born with microcephaly presumed secondary to maternal ZIKV infection. Moshfeghi et al suggest that the ocular findings described by de Paula Freitas et al may be a result of the microcephaly itself rather than ZIKV involvement of the eye. Microcephaly is not a disease. It is a physical finding that results from neurodegeneration of the brain. The causes of this neurodegeneration are diverse, including genetic, metabolic, infectious, traumatic, and others. Although microcephaly from other causes, especially genetic, has been reported to be associated with retinal abnormalities, it is highly unlikely that the microcephaly itself causes the retinal abnormalities. Rather, it seems likely that each of these diseases damages the brain and some of them also damage the eye. Until ZIKV is isolated from the eye, as was done with Ebola virus, we will not be certain that the virus has actually invaded the eye. However, we doubt that the physical finding of microcephaly itself was the cause of the observed ocular abnormalities.
Jampol LM, Goldstein DA. Zika Virus, Microcephaly, and Ocular Findings—Reply. JAMA Ophthalmol. 2016;134(8):946. doi:10.1001/jamaophthalmol.2016.1307