The letter by Gutmann and colleagues provides an opportunity to discuss issues outside the purview of the original report.1
The optic gliomas in question1 (grade I juvenile pilocytic astrocytomas) are indeed congenital in origin and may enlarge postnatally. A handful of early, amalgamated computed tomographic and magnetic resonance imaging studies had commented on initial neuroimaging failing to reveal a glioma that was subsequently detected.2,3 Such initial findings made these early neuroimaging results reportable in their own right. But as the authors of those reports had noted in their discussions, such impressions could simply have been due to the poorer resolution of the computed tomographic and magnetic resonance imaging scanners initially used.2,3 The lack of subsequent reports of supposed de novo tumor emergence in the last 2 decades may be attributed to the greater availability of high-resolution magnetic resonance imaging, which permits detection of the smaller lesions that are present congenitally and enlarge thereafter.
Figure 1. A mass developing postnatally within already-formed visual axonal pathways may block all axonal transmission and cause considerable visual morbidity (A); a same-sized lesion in utero (B), however, may cause selective pruning and apoptosis of surplus axons and ganglion cells, allowing remaining ganglion cells and axons to permit normal visual function (C).
Figure 2. A 16-month-old boy without neurofibromatosis with normal visual behavior, growth, and development with a large glioma had only asymmetric nystagmus and trace optic nerve atrophy and no hydrocephalus. Patients without neurofibromatosis type 1 generally present only when symptomatic; such selection bias creates the false impression that non–neurofibromatosis type 1 optic gliomas are more severe than those associated with neurofibromatosis type 1, in which asymptomatic lesions are frequently discovered during routine surveillance scans. R indicates right.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Ophthalmology editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.