Sir,

We thank Dr Dadeya for his comments on our paper. We are well aware of the social and climatological difficulties that can be experienced when suggesting the use of contact lenses in children and note his comments on the difficulties of follow-up in certain patient groups. However, we do have significant concerns about intraocular surgery for anisometropia in the paediatric age group because of the potential for serious complications including posterior capsule opacification, glaucoma, marked anterior uveitis with synechiae or membrane formation, and retinal detachment. Unpredictable refractive outcomes and higher reoperation rates are well recognised in paediatric cataract surgery. The issues surrounding paediatric lens implantation have recently been highlighted in an editorial in the Journal of AAPOS.1 It is true that some groups have reported excellent visual results from implant surgery in older children; however, close follow-up is important and posterior capsular opacification is still an issue. Occlusion therapy for amblyopia is still required to gain a visual result after surgery and will require regular attendance at clinic. In the context of a society in which follow-up may be challenging, the amblyogenic effect of capsule opacification is of great concern and certainly may prove to be more amblyogenic than the original presenting anisometropia.