optic neuropathy with substantial loss of axons is not likely to be the cause of decreased visual acuity in moderate anisometropic or strabismic amblyopia. We did not observe optic disc pathologic features in our cases, and the OCT findings do not suggest optic nerve pathologic features. However, Dr Lempert is convinced that optic nerve pathologic features (either optic disc dysplasia or optic nerve hypoplasia) play an important role in amblyopia. 1,2 He suggests that there are parameters of the optic disc, other than peripapillary RNFL thickness, that can be measured with OCT. We are unaware of such measures possible with OCT. Dr Lempert suggests that our study may be biased in that the fellow eyes of amblyopic children may not be normal. We believe this to be unlikely because, as noted in the Discussion section, the global fellow-eye RNFL thickness in the current study (109.6 m) was similar to normative data reported for similarly aged children. 3–5 Dr Lempert raises the issue of differential magnification when eyes have differing refractive errors, which would result in amblyopic eyes having artificially high thickness measures. As noted in the article, we did not find an association between RNFL thickness and hyperopic refrac- tive error. We also addressed this consideration in noting that the average refractive error difference (1.02 diopters) seen in our study would have an inconsequential effect on RNFL thickness of less than 2 m. Multiple centers were used by the Pediatric Eye Disease Investigator Group to complete this study. Quality control measures (signal strength and image centration) were part of the protocol, and all images were reviewed for quality with feedback to the centers. As we noted, replicate OCT testing demonstrated a high degree of reproducibility of the measurements. Last, Dr Lempert misrepresents the statement regarding sample size, which is from an article about clinical trials. Our sample size was sufficiently large to result in a 95% confidence interval with half-width of only 2.5 m that effectively ruled out a meaningful difference between amblyopic and fellow eyes. MICHAEL X. REPKA Baltimore, Maryland RAYMOND T. KRAKER Tampa, Florida SUSANNA M. TAMKINS Miami, Florida DONNY W. SUH West Des Moines, Iowa NICHOLAS A. SALA Erie, Pennsylvania ROY W. BECK Tampa, Florida ON BEHALF OF THE PEDIATRIC EYE DISEASE INVESTIGATOR GROUP REFERENCES 1. Lempert P. Optic nerve hypoplasia and small eyes in presumed amblyopia. J AAPOS 2000;4:258 –266. 2. Lempert P. Retinal area and optic disc rim area in amblyopic, fellow, and normal hyperopic eyes: a hypothesis for decreased acuity in amblyopia. Ophthalmology 2008;115:2259 –2261. 3. Huynh SC, Wang XY, Rochtchina E, Mitchell P. Peripapillary retinal nerve fiber layer thickness in a population of 6-year-old children: findings by optical coherence tomography. Ophthal- mology 2006;113:1583–1592. 4. Salchow DJ, Oleynikov YS, Chiang MF, et al. Retinal nerve fiber layer thickness in normal children measured with optical coherence tomography. Ophthalmology 2006;113:786 –791. 5. El-Dairi MA, Asrani SG, Enyedi LB, Freedman SF. Optical coherence tomography in the eyes of normal children. Arch Ophthalmol 2009;127:50 –58. Uveitis as a Presenting Feature of Autoimmune Hepatitis EDITOR: WE READ WITH GREAT INTEREST THE ARTICLE BY LIM AND associates regarding uveitis in patients with autoimmune hepatitis (AIH). 1 This confirms our original observation published previously, and quoted in the article by Lim and associates. 1,2 Interestingly, in 3 patients studied by Lim and associ- ates, onset of uveitis preceded AIH (age range, 5 to 18 years), as in our case report. 1,2 The patient we presented reported photophobia and blurred vision in both eyes on more than one occasion; that is, 6 years before admission, the patient showed conjunctival hyperemia without sys- temic diseases usually associated with anterior uveitis. 2 Two years before admission, conjunctival hyperemia reap- peared and diagnosis of bilateral iridocyclitis was made by 2 different hospital staffs. Subsequently, the patient was treated on both occasions with systemic and topical corticosteroids and his symptoms resolved. Two years later, the patient at admission to our department had conjunc- tival hyperemia in both eyes, together with abnormal liver function test results, even though biomicroscopy of the anterior segment of the eye showed negative results for iridocyclitis: AIH was diagnosed. 2 Two years later, photo- phobia and blurred vision recurred in both eyes and an ophthalmologic examination revealed the presence of inflammatory cells and proteinaceous flare-up in the ante- rior chamber of left eye (Tyndall +--), together with a corneal stromal lesion. 2 Even if an infective form of uveitis could not be excluded this time, as suggested by Lim and associates, the overall clinical and anamnestic patient features resembled chronic recurrent uveitis. 1,2 The association of uveitis, a rare autoimmune condition, has been well described in association with systemic autoimmune diseases. AIH has been observed together with extrahepatic immune-medi- AMERICAN JOURNAL OF OPHTHALMOLOGY 318 AUGUST 2009