To the Editor We read with much interest the article by Pichi et al1 regarding the association of retinal and brain venous malformations. Although the findings are interesting, we believe that the conclusions are probably too strong, and the results should be interpreted with caution.
First, the prevalence of venous malformations in the brain is relatively high in the general population.2 The term vascular malformation encompasses a wide variety of lesions, including developmental venous anomalies, which are reported in 1.3% to 6.4% of patients undergoing clinically indicated contrast-enhanced magnetic resonance imaging.2 Cerebral cavernous malformations are present in 0.1% to 0.5% of the population, brain capillary telangiectasias in 0.4%, and arteriovenous malformations in 0.6%.3 Given the small size of the patient population and the retrospective nature of the study by Pichi et al,1 one should remain cautious when interpreting this association, which we believe might not be meaningful. A conservative approach to the data is especially needed in this study because there are no healthy control participants to serve as a reference.
Lecler A, Duron L, Savatovsky J. Is the Association of Retinal Venous Malformations With Venous Malformations of the Brain Clinically Meaningful? JAMA Ophthalmol. 2018;136(12):1424–1425. doi:10.1001/jamaophthalmol.2018.4050
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