Cocaine-Associated Abnormalities May Not Be Causally Related-Reply

In Reply.—We thank Dr Neuspiel for his interest in our article and agree that the effects of cocaine on the fetus should be estimated with well-designed studies. Our study was designed to show that vasoactive drugs may cause cerebral malformations throughout pregnancy and that ocular abnormalities are a common associated finding. Ours was not simply a case study since we made reference to two important comparison groups. Of 200 infants with strabismus, only eight had extropia, and four of the eight had both cerebral malformations and prenatal drug exposure. We concluded that infants with extropia have an incidence of cerebral malformations and prenatal drug exposure that is far higher than the incidence of either in the general population. For our second comparison group, we cited the scores in the study by Skarf and Hoyt¹ of 41 patients with bilateral optic nerve hypoplasia. Since in their series three of