Response to letter to the editor regarding our original article “validating the utility of the Kestenbaum number in various types of optic atrophy”
Year: 2025
Type: letter
Abstract: Dear Editor, We appreciate the author’s thoughtful engagement with our article and their valid observations.[1] Indeed, there is a need to corroborate and replicate the study with a larger study group and assess other variables like extremes of age, to refine the clinical utility and limitations of the parameter under investigation. As highlighted by the author[1] and other studies,[2] pediatric optic atrophy constitutes a significant proportion of optic atrophy cases. Our study focused on correlating a subjective clinical parameter-the Kestenbaum number-with objective tests like visual field analysis and optical coherence tomography (OCT). We excluded pediatric subjects owing to the challenges in using Humphrey field analysis (HFA) and OCT in this group. HFA testing in children is often compounded by limited concentration, lack of understanding,[3] and its indices correlate modestly with OCT findings compared to adults.[4] While OCT is more feasible, it is hindered by a lack of normative data and higher motion artifacts. Our study revealed that the Kestenbaum number is the lowest in glaucomatous optic atrophy. However, the actual mechanisms and pathogenesis of this observed phenomenon will need to be examined. The understanding that a vascular compromise would be contributory to a lower Kestenbaum number is well known. It has therefore been proposed as a mechanism. The assumption that glaucomatous optic atrophy is more severe is subjective and lacks consistent objective evidence, given the diverse mechanisms and progression of various optic neuropathies. Statistically, multivariate analysis would be more informative but would require a larger database, which could be addressed in future studies. The study elegantly demonstrates the role of the Kestenbaum number in evaluating and objectively quantifying a subjective condition, which has sufficiently enhanced the ability to assess and follow a condition limited by descriptive measures and ambiguous assessments. That a forgotten clinical tool could be of use in the overloaded armamentarium of today’s technologically advanced domain of vision care is undoubtedly a paradigm shift, providing a fresh look at bedside and patient-centric assessments. The ambiguity surrounding optic disc pallor assessment can be mitigated by this objective measure, offering clarity in a field marked by heterogeneity and stochastic presentations. The recording of the appearance of the disc, as suggested by the authors of the communique, is at best an approximation, and that is well accepted by practitioners of the art of ocular examination, relegating this, therefore, to a lower relevance. Clinical appearance of the disc, even if recorded digitally, is subject to variables of examination and interpretation. The Kestenbaum number provides a more definable tool for the assessment, which is not subject to examination variations. There appears to be no end to technological advancements and the deployment of nonclinical tools of evaluation. The race for technological acquisition appears to lead clinicians to blur the existential sheet anchor of medical care. Our study emphasizes the enduring value of clinical tools like the Kestenbaum number, especially in resource-limited settings where access to sophisticated imaging is restricted. It provides robust, actionable insights that complement or even substitute for high-end diagnostics. Regards, Data availability statement Not applicable. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Authors: Krishna Vaitheeswaran, Madhurima A. Nayak
Institution: Father Muller Medical College Hospital
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7103148961