Sir,

This article has highlighted and quantified another important risk factor for posterior capsular rupture (PCR) that was not analysed as a part of our series of 55 567 cases as ACD is not currently a part of the Cataract National Dataset. Adding this variable to the risk stratification model would undoubtedly improve its predictive value and we will therefore include it in the future rounds of multi-centre data collection. I also intend to incorporate the risk stratification model within the Medisoft electronic medical record so that clinicians can have access to an accurate estimate of the risk of PCR when planning surgery.

Conflict of interest

The author is the Medical Director of Medisoft Limited.