Response to the comments on “A Prospective Observational Study on Changes in Intraocular Pressure and Iridocorneal Angle Following the Use of Escitalopram and Amitriptyline”

We thank the reviewers who wrote the letter for taking an interest in our article. ¹ We are grateful that they felt our study was pertinent to the context. We understand that their criticism is in the following aspects. Firstly, the potential for change in intraocular pressure (IOP) has not been adequately considered. Secondly, using slit lamp gonioscopy may lead to inter-rater variability of results. Thirdly, they suggested using other modalities like anterior segment optical coherence tomography (OCT) and ultrasound biomicroscope (UBM) to document iridocorneal changes better. Finally, they argued that reporting the IOP and angle changes at the baseline would have helped ascertain whether angles that were narrower at the baseline showed more significant variations.

Firstly, we agree that IOP is a dynamic variable. We could have considered mean IOP, which would have overcome the diurnal variation in IOP. However, given the patients’ underlying psychiatric condition, multiple IOP measurements across the three timeframes were logistically not feasible. We regret this fact. Secondly, we agree that gonioscopy interpretation has a high inter-observer variability. But there is no alternate test to replace it with less inter-observer variability. The gonioscopy interpretation was done by a competent and experienced glaucoma specialist in dark rooms and reconfirmed by another one independently. In case of any discrepancy in interpretation, we took the opinion of a third glaucoma expert, who was not the author of the manuscript. We also agree that anterior segment OCT and UBM could have been a good complementary modality for studying the iridocorneal changes. However, those facilities were not available and thus were not considered. Finally, we endorse that the baseline IOP and findings of gonioscopy were depicted in Table 2 of the manuscript. However, whether angles that were narrower at the baseline showed more significant variations was out of the scope of this study because the inclusion criteria mandated that the IOP and iridocorneal angles be within the normal limits, to ensure homogeneity in the study group.

To conclude, we found the critical comments from the reviewers very enriching. However, this research was conducted in resource-restricted settings, leading to logistical limitations. Further studies that wish to invest their efforts in this avenue will benefit from the constructive feedback of the reviewers.