McNeer et al1 refute the issues raised in my editorial2 regarding their article titled "Botulinum Toxin Management of Infantile Esotropia in Children." They provide us with some new information that addresses some (but not all) of my concerns. For example, they tell us that in fact all patients elected botulinum toxin type A injection over incisional surgery. This information, which was not in their original article, refutes my concern about one type of selection bias in their series. Also, they point out some possible reasons why they achieved better results with botulinum toxin for treating infantile esotropia than other investigators. Some of their reasons are plausible explanations (eg, simultaneous bilateral injections and aggressive follow-up treatment). For some suggested reasons, the relationship between cause and effect is less evident (eg, alternate patching and the patient population).
Burton J. Kushner. Botulinum Toxin Therapy for Essential Infantile Esotropia in Children—Reply. Arch Ophthalmol. 1998;116(5):701–703. doi: