In Reply We thank Ashraf and colleagues for their attention to our article. We agree that other interpretations of the clinical findings among our patients are possible, but in our opinion, these interpretations are not very likely for the following reasons.
First, it is known that ischemic insults in watershed areas of the brain can be located far away from the actual blood stream blockage site.1 Thus, the single observation that the earliest finding in acute macular neuroretinopathy occurs at the level of the outer plexiform layer–the watershed zone of the retina—does not prove a cause and effect relationship with ischemia of the deep capillary plexus. Instead, it may represent the distal area of infarction from an ischemic insult affecting the choroid.
Thanos A, Faia LJ, Randhawa S. Optical Coherence Tomography Angiography Artifacts and Potential for False Negative—Reply. JAMA Ophthalmol. 2017;135(6):676. doi:10.1001/jamaophthalmol.2017.0921
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