PONE-D-23-16349Factors predicting the visual outcome of intracorneal ring segment for keratoconusPLOS ONE

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The reviewers and EBM find your MSS appropriate for publication pending adequate addressing of concerns given below. Thank you for choosing PLOSOne journal.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: I Don't Know

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Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is an interesting and well - written manuscript.

The primary concern here is the violation of the assumption of independence of observations, a principle that is fundamental to many statistical tests. By including both eyes from the same patient, the independence of data points is jeopardised, potentially leading to an increased risk of Type I errors.

I would like to recommend a few potential solutions to address this issue. You may consider:

1) Including data from only one eye per patient (I recommend this option - 230 eyes from 230 patients).

2) If data from both eyes are essential to your analysis, more complex statistical approaches such as Generalised Estimating Equations (GEE) or Mixed Effects Models can account for the correlation between the two eyes.

3) Performing an Intraclass Correlation (ICC) assessment to quantify the degree of similarity between the measurements from the two eyes.

Given these methodological concerns, I strongly recommend seeking the advice of a professional biostatistician. Their expertise will be crucial in ensuring that your analysis appropriately addresses these issues and strengthens the credibility of your findings.

Reviewer #2: The manuscript by Khanthik et al. performs a retrospective analysis of KC patients that received ICRS implants to determine a predictive model for a patient to receive ICRS implantation. Their analysis included various important components including biological factors and various factors to determine diagnose KC including spherical power, astigmatism, keatometry of front and back surface, and thinnest region of eye. Additionally, their discussion included various studies that both agreed and disagreed with their finds. Finally, they included the limitations of their studies including the short term aspect and limited potential in severe KC cases.

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Reviewer #1: No

Reviewer #2: No

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Factors predicting the visual outcome of intracorneal ring segment for keratoconus

PONE-D-23-16349R1

Dear Dr. %Kasetsuwan%,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Rajiv R. Mohan, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear authors,

I am happy to inform that your revisions/changes adequately addressed all concerns. The manuscript is accepted for publication. Congratulations!

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: I Don't Know

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: WELL WRITTEN AND INNOVATIVE TOPIC. GOOD MODEL FOR THE CASE SELECTION AND TIMING FOR THE ICRS implantation. also verification from a expert biostatistician is required in this case.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #3: No

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