Editor—Kelly et al point out that we did not discuss the importance of smoking as a risk factor. Our article was intended to provide a broad yet brief perspective on age related macular degeneration, and with the constraints on space we were unable to provide specific and extensive details of the various epidemiological risk factors. Several major epidemiological reviews emphasise that smoking is the most consistent risk factor for choroidal neovascularisation in age related macular degeneration. We also emphasise the importance of stopping smoking as a preventive strategy on page 487 of our article.
Wong et al believe that we have omitted to emphasise the importance of macular relocation surgery in the management of choroidal neovascularisation. It not only entails complex retinal surgery but also alignment of extraocular muscles.1,2 None of the available therapeutic options, whether already tested or currently undergoing evaluation in randomised trials, while minimising the severity of visual impairment that accompanies choroidal neovascularisation will restore normal vision.
Therefore we indicated that newer treatments do help by preventing moderate and severe vision loss, but we also speculate on the potential for restoration of vision through more novel approaches that bypass the neural retinal circuitry and directly interphase with the brain.
One of us (DV) has participated in continued research to improve the results of a simpler procedure of limited macular translocation, but the data from that study have yet to be published.3 We have no doubt that when the success rate increases this may become a possible treatment for a selected group of patients with age related macular degeneration.
Competing interests: None declared.
References
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