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—We appreciate Dr Lemp's careful reading of our article. We would like to emphasize two points that were the major thrust of the article. The first is that the soluble tear mucin content and the conjunctival goblet cell content are not related in a linear fashion, so that measurement of the soluble tear mucin does not allow prediction of the goblet cell content. Further, it is entirely possible that the level of adsorbed mucin on the ocular surface epithelium is not related to either the level of soluble tear mucin or the goblet cell content. The unknown relationship of these factors to adsorbed mucin makes it even more difficult to categorize surface disease in terms of "mucus deficiency," since we have no methodology to quantitate deficiencies of adsorbed mucin.The second point is not, as Dr Lemp suggests, "that conjunctival goblet cell densities are an indicator of
Thoft RA, Friend J, Kinoshita S. Ocular Surface Disease-Reply. Arch Ophthalmol. 1984;102(2):194. doi:10.1001/archopht.1984.01040030148009