Firstly, we would like to thank Huang and associates for their interest in our article. It is well known that ocular characteristics of children vary with ethnicity. As noted in their letter, previous studies implicate that factors including age, race, and axial length may have significant impact on optical coherence tomography (OCT) findings. We failed to establish any significant correlation between the average retinal nerve fiber layer (RNFL) thickness and axial length (AL) in our study of normative values of the peripapillary retinal nerve fiber layer and macular thickness in healthy children obtained by the spectral-domain optical coherence tomography (SD-OCT). As noted in the discussion section of our above-mentioned study, many possible factors may account for this. Firstly, the inclusion criteria, including spherical equivalent value, AL value, and cup-to-disc ratio, in our study were narrower when compared to those studies reporting significant correlations between AL and RNFL thickness. So, the reference indicated in Huang and associates’ letter in favor of the existence of significant correlation includes adult cases as well as having a wider range of refractive error and AL range. Also, the main initial aim of our study was not to establish any possible impact of AL or refractive error on RNFL thickness. We attempted to investigate SD-OCT findings of an otherwise healthy pediatric group with a limited range of refractive defect. Because of the close relation of refraction and AL, the AL range of our study population was small compared to those studies cited in Huang and associates’ letter indicating direct correlation between refractive error and AL values. Thus, we did not determine any significant correlation between AL and RNFL thickness in our study population, but we did not attempt to deny such possible relation. In relation to this, in our discussion section we also stated that “these results could be attributable to the small case number or age distribution or the narrow range of AL (21.2–26.0 mm) of our study group.” Yet, there are also OCT studies involving pediatric populations reporting parallel findings with us. Among those, Leung and associates determined that the RNFL thickness among pediatric patients shows no significant correlation with age. El-Dairi and associates also noted that the axial length value has no significant effect on the RNFL thickness.
The suggestions and comments about methodologies of further similar studies are confirmed, and finally we want to express thanks to Huang and associates for their interest in our study.