Ophthalmology Volume 101, Number 1, January 1994

patient than would a nasal mucosa biopsy. Perhaps the authors could further describe their decision-making pro­cess in the diagnostic evaluation of this most instructive case.

BRIAN S. BIESMAN, MD Chicago, Illinois

References

1. Crystal RG. Sarcoidosis. In: Braunwald, .I~selbacher, eta!, eds. Harrison's Principles ofInternal Medzczne lith ed. New York: McGraw Hill, 1987;1445-50.

2. Ohara K, Okubo A, Kamata K, et a!. Transbronchiallung biopsy in the diagnosis of suspected ocular sarcoidosis. Arch Ophthalmol 1993;111:642-4.

Authors' reply

Dear Editor: We appreciate Dr. Biesman's comments on our article.

When reviewing our patient's initial computed tomo­graphic scan, we believed that the thickening of the nas~l mucosa was technically oflittle consequence because this finding is seen in a large percentage of individuals. The high incidence of pulmonary involvement in sarcoidosis prompted consultation with the pulmonologists who be­lieved that the patient's chest radiograph was abnormal, and proceeded to do a transbronchiallung biopsy.

VICTOR M. ELNER, MD, PhD WAYNE T. CORNBLATH, MD Ann Arbor, Michigan

Ab.. and Ad .. vs En .. and Ex ..duction Dear Editor: The letters "B" and "D," as every dyslectic child knows, are similar in appearance. "B" and "D" are also difficult to differentiate by sound alone. Listeners aid differentia­tion by lip reading. Speech is composed of energy peaks called speech formants. There are generally two formants for each sound. With the sounds for "B" and "D," the first formant is similar. In addition, presbycusis (hearing loss associated with aging) results in high-frequency hear­ing loss with difficulty differentiating the second forma~t. Amplification also causes distortion and reduces the dif­ferences between sounds.

Adduction (movement toward the mid-line) and ab­duction (movement away from the mid-line), terms com­monly used in ocular motility, have the disadvantage of sounding and looking alike. The substitution of "B" for "D" changes the meaning of the eye movement by 180°. Lecturers, to aid audience differentiation, often use the clumsy term a-Boy-duction or a-B-duction to sep­arate the word from a-Dog-duction or a-D-duction.

I suggest the terms be changed to enduction and exduc­tion. The prefix en is a preposition meaning in; the prefix ex denotes out. Both are derived from Latin and Greek. 1

Enduction and exduction are euphonious, have no other meaning and have the advantage of ease in both written and spoken differentiation. If widely adopted, the new terms should reduce confusion.

MARTIN E. LEDERMAN, MD New York, New York

Reference

1. Webster's Ninth New Collegiate Dictionary. Springfield, MA: Merriam Webster, Inc, 1985.

2