We thank Dr Federici for his thoughtful letter referring to our recent article titled “Bilateral Orbital Infarction Syndrome After Bifrontal Craniotomy.”1 Herein, we would like to take the opportunity to reply to his points of criticism.
First, Dr Federici stated that “ophthalmic artery occlusion produces profound vision loss (light perception or no light perception) due to the simultaneous ischemia of the choroid and retina.” Our patient had profound and permanent visual loss from a visual acuity of 20/20 OU prior to the infarction to recognition of hand motion in both eyes. Although there is a significant difference between hand motion and light perception,2 the visual loss from a visual acuity of 20/20 to hand motion or to light perception is comparable (20/20 to hand motion is 23 logarithmic lines; 20/20 to light perception is 27 logarithmic lines). There is no proof that visual acuity better than light perception excludes an orbital infarction syndrome, and it would be wrong to do so.
Maier P, Feltgen N, Lagrèze W. Bilateral Orbital Infarction, Ophthalmic Artery Occlusion, and Cherry-red Spot—Reply. Arch Ophthalmol. 2007;125(10):1441-1442. doi:10.1001/archopht.125.10.1441-b