Responding to comments on "Astigmatism in Duane Retraction syndrome".

This response addresses readers' comments on our study published in BMC Ophthalmology, which analyzed astigmatic variations among Duane Retraction Syndrome (DRS) subtypes. We clarified that our retrospective study relied on clinical data rather than advanced imaging due to practical limitations. Differences in DRS subtype prevalence were attributed to our focus on patients requiring surgical intervention rather than general epidemiological patterns. Age-related refractive variations across different DRS subtypes were found to be statistically insignificant, confirming that age differences did not influence the observed refractive patterns. The potential paradoxical effects of co-contraction and palpebral fissure narrowing on corneal curvature are notable, as both factors can simultaneously influence corneal changes. However, co-contraction may have a more prominent effect on corneal curvature than palpebral fissure narrowing, leading to a tendency toward against-the-rule astigmatism. Data inconsistencies in Table 3 were corrected, and the omission of key symbols in formulas was acknowledged. The insights provided by readers underscore the need for future studies incorporating advanced diagnostics and corneal topographic data to achieve a deeper understanding of astigmatism in DRS.