—Skalka's criticism of our optic nerve measurements is based on the assumption that "optic nerve thickness" refers to dura-to-dura diameter. In our report, we measured the thickness of the optic nerve per se without its sheaths. Such a measurement enabled us to compare the values obtained with tables from L. McNutt, MD, based on a comparable method of measurement (oral communication, May 1, 1980).Skalka then questions our statement, "enlarged optic nerves are not always present in early stages of Graves' disease" and in the following paragraph contradicts himself by stating that "the diameter of the optic nerve itself remains normal in uncomplicated cases." In McNutt's study,1 the two eyes (2.3%) that demonstrated enlarged optic nerves (larger than the 95th percentile) had a class IV involvement. We agree there is good evidence both by ultrasound and computerized tomographic scanning that the orbital optic nerve sheath expands in some
Shammas HJF, Minckler DS, Ogden C. Ultrasound in Orbitopathy-Reply. Arch Ophthalmol. 1980;98(12):2245. doi:10.1001/archopht.1980.01020041096026
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