Peer Review History
Original SubmissionDecember 4, 2020 |
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PONE-D-20-36881 The evaluation of a web-based tool for measuring the uncorrected visual acuity and refractive error in keratoconus eyes: a prospective open-label method comparison study PLOS ONE Dear Dr. Muijzer, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Apr 25 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript:
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Competing interests can arise in relationship to an organization or another person. Please follow this link to our website for more details on competing interests: http://journals.plos.org/plosone/s/competing-interests [Note: HTML markup is below. Please do not edit.] 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: Partly Reviewer #3: Yes ********** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know Reviewer #3: Yes ********** 3. 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 #1: Yes Reviewer #2: Yes Reviewer #3: Yes ********** 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 Reviewer #3: Yes ********** 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: I will focus on methods and reporting. The abstract is clearly written and balanced. Overall, the methods appear appropriate, but more references need to be added about the less standard analyses (vectors etc). Some are already there, but a couple more need to be added where appropriate. the multivariable model is not clear (e.g. how bilaterality modelled, keratoconus severity etc). I am not convinced by the decision to use complete case analysis. How do the authors know the missingness mechanism? did they test for it? Also a complete case analysis tends to be more problematic that multiple imputation even if data are MNAR, see https://pubmed.ncbi.nlm.nih.gov/28068910/ A major concern is that the power calculation was for the whole trial (which is not clearly reported here, besides the formula). This subgroup analysis is very likely underpowered, In non-inferiority trials this is more crucial, since lower power biases the results towards non-inferiority. The authors either need to demonstrate they have enough power or they need to move away from non-inferiority and present exploratory comparisons, with strong caveats. Reviewer #2: 1) You are including keratoconus (KC) patients, but you have no clear definition of the methods of such diagnosis? Did you include overt KC cases only which are diagnosed by signs in the cornea? Who was responsible to diagnose your cases and with which criteria? You did not mention anything about clinical signs of your cases. How many of your patients had clinical signs of KC? 2) Your inclusion criteria omit the patients outside the refractive error +4 to -6 diopters of spherical equivalent( SE). Where those numbers come from? It suggests that based on some kind of primitive analysis you decided to omit higher SE patients because you had found those patients are not responsive to your algorithms. If not, mention the exact cause of such decision. Many KC patients' refractions are outside the SE of +4 to -6 diopters and you can not generalize your data to the majority of KC cases. You may excluded many severe cases and this is a source of bias. In this regard, you can not mention the general term of KC in your topic and you have to say 'KC cases with certain refractive error'. 3)In your exclusion criteria, you only mentioned diabetes as a cause of exclusion. What about other retinal or optic nerve problem? Did you include glaucoma patients , other retinal disorders like RP case and macular hole, cataract, PCO ,media opacity, etc ? As we know all those cases may have some problems in contrast sensitivity and visual acuity. 4) You mentioned 24 patients have a history of previous ocular surgery. Mention the type of surgeries for further clarification. 5) In the last paragraph of your results( line 275), you mentioned that you could not assess the CDVA of more than half of your patients with your web system. In 13 of eyes evaluation did not have an outcome and 19 eyes had a problem because of bad instruction. These cases are a large proportion of your sample size and you cannot overlook this large numbers by saying " missing at random" !!!. You have to separately speak about this data by clearly defining their refractive error, severity, etc in a separate table. Reviewer #3: The authors tested the possibility of a web-based too that measures visual acuity to translate the visual acuity results into refractive correction in patients with various amounts of presbyopia. As the authors present original research that is of interest for the field, especially with the background of field testing of vision, the methods need to be detailed and the data needs some more work regarding the interpretation. Abstract: The authors did not mention that they assessed variability but present data on it – how was it assessed? Line 66: I am not sure about that the content of the statement the authors want to make. For sure, an autorefractor measures refractive errors. But out of that data, it is possible to make an assumption of the uncorrected visual acuity. Also, there might be autorefractors on the market that allow to measure visual acuity (either corrected as well as uncorrected). Line 91: could patient acquisition has been biased by the use of already known patients of the clinic? This could also influence the (subjective) refractive measurements, as the operator might not have been blind to the medical history of each patient. The authors should also add some details on the question if operator was blind for the measurements of the refractive errors and if the same operator did all the measurements? Line 102: why was the testing not randomized between subjects? What a about a possible learning effect in visual acuity testing? Line 120: I guess that correction was inserted in a trial frame and trial lenses were used? Was refractive correction standardized for the same back vertex distance. Line 129: if subjects were normally wearing contact lenses, how long was the wash-out time before participants could participate in the study? Line 156: due to the mirrorsymmetrie of both eyes, only one should be analyzed. Is the use of the multivariable generalized estimates equation a method to reduce potential bias? Line 164: this statement should not be parts of the Material / Methods section Line 174: the web-based tool also measured myopia in several patients with hyperopic refractive errors. Is this a typical behavior also in subjects without any ocular diseases? What would be the implication for a screening? Line 183: is this a typical of measurements that are missing? Line 190: what was the ICC for the autorefractor vs. web based measurement and autorefractor vs. manifest refraction? Line 202: the definition of the low and high visual acuity group should be done in the methods section. Line 225: what was the significance value? Line 233: is this because the level of keratoconus is smaller in this group? ********** 6. 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 #1: No Reviewer #2: No Reviewer #3: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. |
Revision 1 |
PONE-D-20-36881R1 The evaluation of a web-based tool for measuring the uncorrected visual acuity and refractive error in keratoconus eyes: a prospective open-label method comparison study PLOS ONE Dear Dr. Muijzer, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. There are some additional minor comments from Reviewer #3 which shall be considered. Please submit your revised manuscript by Jul 25 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript:
If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Timo Eppig Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] 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 #2: All comments have been addressed Reviewer #3: All comments have been addressed ********** 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: Line 36 306: visual acuity measurement is not objective. What is the typical intra-individual variation of the web-based test in this patients? (0.1logMAR as with standard acuity test)? As you discuss this in line 306 for VA measurements in subjects with no ocular diseases, do you have data on subjects with keratoconus? Line 38 and following: statement biased by the sponsor? I doubt that algorithm is trainable with this data. General: when you only measure VA, how easy is it to diagnose for keratoconus, especially in early stages? Its not, or? In case of “telemedicine” any drop in VA is most likely related to a refractive error and no diagnosis can be made w/o corneal topography. Is the last section of the introduction still valid having that in mind? Line 284: please change the order and put the limitation on the number of available measurements first. This makes it easier to the reader to classify the results. Please also put the number of cases in brackets for available measurements. Line 318, please add: as such with keratoconus of different stages. Line 361: is this statement true for patients without diseases? Please be specific Line 364: results did not only resulted in poor visual performance (as in terms of VA), but also in a correction that would not be acceptable (in terms of diopters). Line 368: Again: VA is subjective, not objective. [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. |
Revision 2 |
The evaluation of a web-based tool for measuring the uncorrected visual acuity and refractive error in keratoconus eyes: a method comparison study PONE-D-20-36881R2 Dear Dr. Muijzer, 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. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Timo Eppig Academic Editor PLOS ONE Additional Editor Comments (optional): 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 #2: All comments have been addressed Reviewer #3: All comments have been addressed ********** 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 #2: Yes Reviewer #3: Yes ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Reviewer #3: Yes ********** 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 #2: Yes Reviewer #3: Yes ********** 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 #2: Yes Reviewer #3: Yes ********** 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 #2: The manuscript is well written. Although it would be better to do further research in this area with larger sample size,I personally agree that it should be published because of Novelty. Reviewer #3: (No Response) ********** 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 #2: No Reviewer #3: No |
Formally Accepted |
PONE-D-20-36881R2 The evaluation of a web-based tool for measuring the uncorrected visual acuity and refractive error in keratoconus eyes: a method comparison study Dear Dr. Muijzer: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Timo Eppig Academic Editor PLOS ONE |
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