Letter

Authors’ Reply

Kaveh Abri Aghdam, MD, PhD; Amin Zand, MD; Mostafa Soltan Sanjari, MD

Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

J Ophthalmic Vis Res 2021; 16 (3): 526–526

Dear Editor,
We sincerely thank Dr Guzzi for the interest in our

case report[1] and would like to take this opportunity
to make some clarifications as follows:

The main concern raised by Dr Guzzi was
that serum lead level alone does not adequately
reflect the total body burden of the lead and
the whole-blood lead level in conjugation with
its urinary levels is a primary measure of lead
exposure in humans.[2–4] We fully agree with
Dr Guzzi based on the available literature on
this subject. However, one month before the
referral, our patient had been diagnosed with
lead poisoning just based on serum lead level
and had undergone chelation therapy in another
tertiary center by a neurologist. Shortly after
the completion of treatment, he came to our
neuro–ophthalmology clinic for the evaluation of
persistent blurred vision in both eyes. Therefore,
we could only rely on his previous clinical and
paraclinical documents.

In the letter written by Dr Guzzi, the term
“papilledema” was used for the description of

Correspondence to:

Amin Zand, MD. Eye Research Center, Rassoul Akram
Hospital, Sattarkhan-Niaiesh St., Tehran 1445613131,
Iran.
E-mail: sandpost3@gmail.com
Received: 01-04-2021 Accepted: 01-05-2021

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Website: https://knepublishing.com/index.php/JOVR

DOI: 10.18502/jovr.v16i3.9451

our patient’s ocular condition. However, as we
mentioned in our article, papilledema is defined
as optic disc edema due to increased intracranial
pressure (ICP) and should be differentiated from
papillitis. The lumbar puncture in this patient
showed that ICP was within normal limits,
which ruled out papilledema. Therefore, we
considered the condition of the patient as bilateral
hemorrhagic optic disc swelling.[1]

REFERENCES

1. Abri Aghdam K, Zand A, Soltan Sanjari M. Bilateral optic
disc edema in a patient with lead poisoning. J Ophthalmic
Vis Res 2019;14:513–517.

2. Guzzi G, Spadari F, Bombeccari GP, Pigatto PD.
Maxillofacial gunshot wounds and diagnostic tests for
lead in the blood. Br J Oral Maxillofac Surg 2017;55:105.

3. Pigatto PD, Ronchi A, Guzzi G. Iron overload, G6PD
deficiency, and lead levels on blood smears. Int J Hematol
2016;103:724.

4. Casarett LJ, Doull J, Klaassen CD. Casarett and doull’s
toxicology: the basic science of poisons. 6th ed. New York:
McGraw-Hill Medical Pub. Division; 2001.

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How to cite this article: Aghdam KA, Zand A, Sanjari MS. Authors’ Reply. J
Ophthalmic Vis Res 2021;16:526–526.

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