We wish to thank Franks for her insightful contribution to the debate on the indications and evidence for the use of bevacizumab in the eye.

One of the prerequisites for an ethical randomised controlled trial is the state of clinical equipoise—the researchers should not be biased strongly in favour of one treatment option or the other.1 This implies a degree of uncertainty regarding the outcome for both treatment options.

Unfortunately there is little doubt about the natural history of rubeotic glaucoma unresponsive to laser. It is a dire condition with devastating consequences for the quality of the patient's life and their family. It is only natural to wish to do everything one can under such conditions. There is a good theoretical basis for the use of bevacizumab in this condition and so far the safety profile seems good.

We agree with Franks therefore that ranibizumab or bevacizumab in rubeotic glaucoma would be justified in the context of a carefully documented observational study. The wholesale use of this drug in a raft of conditions where other options exist remains a cause for comment. Bevacizumab might well be a very effective and cost-effective drug for much vascular eye pathology—let's just prove it!