In Reply We thank Chang et al, Aggarwal et al, Hoffman, and De Bernardo and Rosa for their thoughtful responses to our article. The ultrasonic measurements of the optic nerve sheath diameter (ONSD) can result in overstated values owing to artifacts. However, such errors might be minimized by striving to ensure correct operation of the device.1 We agree that this aspect is deserving of our attention. Indeed, we have noted these issues previously and tried to avoid them in our research. Figure 2 in our article shows the optic nerve and its surrounding structure without artifacts. Moreover, using a Pearson correlation analysis, we found that the change in ONSD was strongly correlated with the change in intracranial pressure (ICP) (r = 0.702). These findings suggest that ultrasonographic ONSD measurements may be a useful, noninvasive tool for dynamically evaluating ICP, especially in intensive care units or settings in which invasive ICP monitoring or other noninvasive techniques are not available.
Wang L, Chen H, Xing Y. Measuring Optic Nerve Sheath Diameter as a Proxy for Intracranial Pressure—Reply. JAMA Ophthalmol. 2018;136(11):1311–1312. doi:10.1001/jamaophthalmol.2018.3438
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