Response to comment on: Effect of short-term meditation training in central serous chorioretinopathy

Dear Editor,

We greatly appreciate the authors for their interest and comment on our recently published article titled: “Effect of short-term meditation training in central serous chorioretinopathy” in “Indian Journal of Ophthalmology.”[1,2]

With regard to disease categorization and heterogenicity, the inclusion and exclusion criteria of the study included “Patients more than 18 years of age with central serous chorioretinopathy (CSC) and without any prior treatment [methods section, para 1] and presenting with ocular symptoms for the first time were enrolled in the study.” Hence, categorization as acute or chronic was not considered prior to enrolment into the study. We hoped to address the risk of selection bias and disease heterogenicity by designing a prospective, randomized study. In accordance with this, the cases were randomly divided into two groups—meditation training and routine follow-up (no meditation training)—by simple randomization [methods section, para 1, last sentence]. Although the sample size was small, we assume that the possibility of selection bias and disease heterogenicity was minimized by randomization.

The term acute used in the discussion is an aberration and does seem contrary to our inclusion criteria indicated above. What was meant to be conveyed by the term “acute” in the context of this study was to emphasize that the study results could be applicable to patients who do not have indicators of chronic CSC at presentation and in those who have multifocal leaks [as patients with these clinical and angiographic features were not enrolled into the current study—methods section, para 1]. We appreciate the author for bringing this inconsistency to our notice and giving us an opportunity to clarify.

While we agree that focal retinal photocoagulation does have a role in arresting the duration of an acute episode, it does not alter the risk of further episodes [40% within the 1^st year] and is known to have permanent adverse sequelae over the long term such as poorer contrast, laser run off, and enlarging scotoma. Owing to these effects of conventional laser, efforts are still on to find an intervention that is safer, such as the use of subthreshold micropulse laser.[3,4] In addition, it can be seen that patients in the control group were also showing signs of clinically significant but statistically insignificant [P 0.08] resolution [results section, para 4, sentence 1] during the study duration. In this situation too, guidelines are not clear if we must necessarily intervene at 4 months or continue to extend the follow-up to 6 months. It would have been ideal for us to first undertake an intervention and then recruit only those cases that failed to resolve or showed a recurrence. However, this approach would have been impractical for us as it would have severely extended the study recruitment period and restricted the enrolment. Having said this, our long-term objective with further extensions of this study would be to address the effect of incentivized [to reduce dropout rates] meditation on lowering the risk of recurrence and in enhancing stabilization in those with recurrent and chronic CSC.

As has been indicated in the discussion section [concluding para, last but one sentence], we agree that measurement of serological biomarkers like endogenous cortisol levels would improve our understanding on the biochemical axis, through which the effect is mediated.[5] We thank the author for reiterating this and for introducing us to a few recent publications on this topic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.