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May 1987

Lancaster Test With Tensilon for Myasthenia-Reply

Author Affiliations

Department of Neurology University Hospitals of Cleveland Cleveland, OH 44106

Arch Neurol. 1987;44(5):473. doi:10.1001/archneur.1987.00520170005006

In Reply.  —The major points of my article1 were the following: (1) in the office setting, the only way to be certain of a truly unequivocally positive response to a Tensilon test in a patient with suspected ocular myasthenia is to observe directly a weak muscle become stronger, and (2) to argue against the use of indirect measures such as a muscle light and prisms, red glass, Maddox rod, and Lancaster red-green torches. I loosely called these latter procedures "subjective" measures of "diplopia." Younge and Bartley correctly state that the Lancaster test is not a measure of "diplopia." Whether the test is "subjective" is open to semantic dispute.I was distinctly aware that my discourse ran contrary to the accepted practice of many highly competent neuro-ophthalmologists. Nevertheless, for the reasons stated,1 I remain convinced that direct observation, rather than dependence on optical devices, is the only reliable way to avoid

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