Functional vs Cosmetic Ophthalmologic Defects

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To the Editor. —Bravo! The editorial by Anderson and Holds1 in the December 1990 Archives is timely and well done. However, they did not mention the importance of defining ptosis. Until a recent study at the University of Oklahoma, Oklahoma City, there was no accurate definition of this entity. We define ptosis as a midpupil to upper lid distance of less than 2 mm. Ninety-seven percent of patients with ptosis so defined will have restriction of the upper field of vision to 30° or less.2 Although this study was not intended for deciding questions of reimbursement, it is used in this part of the country as a guide for Medicare claims evaluation. Another important semantic issue not stressed in the editorial is the proper use of terms in discussing and reporting diagnoses and surgical procedures. For example, one frequently sees the word cosmetic in ophthalmic literature, especially in

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