Authors response comments on: Evaluating the impact of polycythemia vera on retinal and optic nerve head microvascularity: An OCTA study

Dear Editor, We appreciate the interest and thoughtful comments regarding our article, “Evaluating the impact of polycythemia vera (PV) on retinal and optic nerve head microvascularity: An OCTA study.” We welcome the opportunity to address the queries and suggestions posed. Firstly, we would like to point out a critical issue regarding the citation style used by the authors of the letter. In academic writing, it is a well-established convention that author names should be cited in the format of “surname followed by initials.” Thus, “Feyza CM et al.” is incorrect and should instead be written as “Cicek MF et al.” This is a fundamental aspect of scholarly publishing, and adherence to these conventions ensures clarity and professional integrity in academic discourse. It is essential to clarify that our study primarily aimed to identify subclinical changes associated with PV, as explicitly stated in the manuscript. As widely recognized in the scientific community, clinical manifestations often represent the culmination of underlying pathological processes, which may result in irreversible damage. The primary objective of preclinical or subclinical investigations, such as ours, is to detect early changes before overt clinical symptoms develop. It is neither necessary nor expected for the findings of such studies to have immediate clinical implications. Dismissing subclinical results based on their lack of direct clinical relevance undermines the very foundation of preventive medicine and early diagnostics. This approach, if universally adopted, would preclude the advancement of preclinical research and hinder efforts to detect pathological changes before the onset of clinical sequelae. The mean follow-up period for our patients was 20 ± 5.4 months. Furthermore, it is important to emphasize that our study was designed as a cross-sectional investigation, not an observational longitudinal study. This inherently limits our ability to analyze changes over time or to assess baseline values for each participant. Without knowing the individual baseline retinal parameters before the onset of disease or treatment, any correlation analysis based on disease duration would be speculative and potentially misleading. Performing such an analysis in a cross-sectional study could result in erroneous conclusions, as the observed changes might reflect individual variability rather than disease progression. To avoid providing data that could mislead readers or misrepresent the nature of PV’s impact, we refrained from conducting time-based correlation analyses in our study. It is well established that retinal and optic nerve parameters are influenced by a multitude of factors, including genetic predisposition, environmental conditions, and the characteristics of the study population, in addition to the underlying disease. The absence of a significant correlation does not imply the absence of disease-related changes. Instead, it highlights the complex interplay of factors influencing ocular microvascular and structural parameters. It merely underscores the complexity of isolating the impact of PV from other contributing factors. Additionally, considering that patients with PV may have an asymptomatic phase both ophthalmologically and systemically, it is technically challenging to determine a specific time point that could serve as a reliable cut-off for such analyses. Given this uncertainty, it becomes evident that any time-based correlation analysis would be unlikely to yield meaningful or actionable results. The critique that “the decrease in various retinal parameters may be statistically significant, but they still lie within the normal range for the patient’s age” lacks a rigorous scientific basis. The assertion of what constitutes a “normal range” is subjective unless supported by specific, peer-reviewed data. The authors of the letter did not provide any references or criteria to substantiate their claim of normalcy. As clearly stated in our study, only patients with spherical and cylindrical refractive errors ≤1.00 D were included to eliminate potential confounding effects of refractive status on retinal parameters.[1] Even slight variations in refractive error can significantly influence these measurements. Moreover, as emphasized, genetic, environmental, and population-specific factors can profoundly affect retinal and optic nerve parameters, rendering the concept of a universal “normal range” scientifically untenable. In line with best practices in the literature, we have taken careful measures to minimize potential confounding factors. However, it is crucial to recognize that any normative comparison must account for the inherent variability introduced by the study population and external influences. Interestingly, the letter states, “the authors have rightly mentioned that further studies are needed. Future studies should try to evaluate whether medical treatment in cases of PV brings about a change in the vascular indices.” Unfortunately, this suggests that the author(s) of the letter to the editor have not thoroughly reviewed our article. In our manuscript, we explicitly addressed this point by stating, “also, new research could incorporate functional parameters, such as contrast sensitivity, visual fields, or microperimetry, to provide a more holistic view of the impact of PV on ocular health.” This demonstrates that we have already acknowledged the need for further studies and expanded the scope of future research in a more detailed form than what the letter to the editor of the author(s) already suggested. In conclusion, we respectfully observe that the letter lacks a strong scientific foundation and relies heavily on subjective assessments rather than evidence-based critique. Despite this, we appreciate the engagement with our work and remain confident in the scientific rigor and originality of our study, which uniquely evaluates both structural and vascular parameters of the optic nerve head and retina in patients with the rare condition of PV. We thank you once again for publishing our work and trust that it will make a meaningful contribution to the literature. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.