Sir,
We appreciate the authors’ interest in our article. We’re pleased to hear that a disposable ruler could be a possible alternative to depth measurers made of PMMA. It would be useful to see validation of the measurements taken with this disposable ruler, by interobserver and intraobserver reliability data. Confirming repeatability and reproducibility of the measurements with each device is essential, before recommending the device as an accurate alternative.
One advantage of PMMA fornix depth measurers1, 2 is that they are rigid, therefore reproducibility and repeatability are high. With a flexible plastic ruler, reliably measuring upper fornix depth may be less easy, as one wonders if the ruler may bend to a variable degree over the globe and under the eyelid, potentially giving slightly different measurements depending on the technique and the user.
References
Jutley G, Carpenter D, Hau S, Booth D, Jasim HA, Tay E et al. Upper and lower conjunctival fornix depth in healthy white caucasian eyes: a method of objective assessment. Eye 2016; 30: 1351–1358.
Khan IJ, Ghauri AJ, Hodson J, Edmunds MR, Cottrell P, Evans S et al. Defining the limits of normal conjunctival fornix anatomy in a healthy South Asian population. Ophthalmology 2014; 121: 492–497.
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Jutley, G., Saw, V. Response to: 'An alternative method for upper and lower conjunctival fornix measurement'. Eye 31, 1380–1381 (2017). https://doi.org/10.1038/eye.2017.102
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DOI: https://doi.org/10.1038/eye.2017.102