We thank Drs Zhang, Yao, Zhang, Zhou, and Zhou for their interest in and comments on our article, titled “Influence of Eyelid Pressure on Fluorescein Staining of Ocular Surface in Dry Eyes.”
We agree with their first comment that we did not provide any evidence on whether a higher eyelid pressure was due to dry eye conditions or whether dry eye conditions were due to a higher eyelid pressure. We cannot explain this difference at this time, and future studies will be designed to resolve this. On the other hand, we believe that the shear stress generated by blinking can influence the fluorescein staining of the ocular surface. In our study, we examined the eyelid pressure as an alternative to shear stress generated by blinking. Thus, we used “influence” in the title.
For analytic approaches in ophthalmic clinical studies, we agree with the comment from Zhou and associates in general. However, we made optimal use of the data and used the data of both eyes because our study was designed to be exploratory. In the future, we plan to perform a randomized controlled study to verify our results using 1 eye, as suggested.
We appreciate the pointing out of the typographical error by Zhou and associates. The description in the Discussion section (page 690), which states, “Our dry eye patients were diagnosed based on the 2006 revised Japanese criteria for dry eye, which include BUT scores ≤5 s and Schirmer I test score ≥5 mm” should be “BUT scores ≤5 s or Schirmer I test score ≤5 mm,” as stated in the Methods section (page 686).
Finally, we appreciate their encouraging comments about future studies on the relationship between body posture and eyelid pressure. We hope other clinicians will take interest in this topic and instrument and will perform studies to confirm or reject our findings.