—We appreciate the comments of Hedges et al regarding our article entitled" 'Outbreak' of Optic and Peripheral Neuropathy in Cuba?" We agree with Sadun1 and Hedges et al that it can be difficult to distinguish the Cuban optic neuropathy from functional vision loss; in fact, some of the Cuban "cases" might be functional. In our study, we used the following features to diagnose optic neuropathy: central or centrocecal scotoma and at least two of the following three criteria: (1) loss of visual acuity (corrected to 20/40 or worse); (2) loss of color vision (missed two or more of six American Optical Hardy-Hand-Ritter plates); and (3) temporal pallor of the optic disc. Hedges et al concur with Sadun that the critical finding in Cubans affected with optic neuropathy is "presence of nerve fiber layer (NFL) dropout in the maculopapillary bundle of the retina."The NFL is composed of
Hirano M, Odel JG, Lincoff NS. Optic and Peripheral Neuropathy in Cuba-Reply. JAMA. 1994;271(9):663. doi:10.1001/jama.1994.03510330040028
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