To the Editor.
—We quite agree with Dr. Foos, Dr. Okun, and other authors1-8 who state that retinal detachment can be caused by an outer-layer break of retinoschisis alone, even though some authors state that the presence of breaks in both outer and inner layers is essential for retinal detachment to occur.9-11We also concur with Dr. Foos' observation that the breaks in the outer layer of retinoschisis are probably due to "trophic change (related to local nutritional factors)" and certainly are not due to "the traction by vitreous or zonule," since there is no direct connection of the outer layer with the vitreous or the zonule. The outer-layer breaks that we have observed were often round, with no flaps or opercula. We think that in these cases, the outer layer becomes so atrophic that the tissue disappears, leaving a round hole. However, we also have seen
Hirose T, Schepens CL. Retinal Detachment. Arch Ophthalmol. 1973;89(3):259-260. doi:10.1001/archopht.1973.01000040261021