Sir,

We thank Pyott1 for his interest in our article.2 He rightly echoes concerns regarding the immoral exploitation of workers associated with manufacturing practices in the developing world.3 Although this concern and subsequent fair-trade comments are worthy of consideration, it should be remembered that the original article specifically documented our practical problems with inadequate instrument processing.4 In this context, the commonly voiced criticism of single-use instruments being more expensive than reusables is inaccurate if the sterilisation process leads to damaged, unreliable and non-functioning equipment. Guaranteed reliability of high-quality microinstruments is invaluable in the emergency setting. If this reliability cannot be guaranteed through the current sterilisation practices, or delays patient care, it is unsurprising that there is growth in the single-use market.

Dr Pyott's interesting comments regarding outsourcing of the sterilisation process may provoke further discussion, particularly regarding the cost effectiveness of such an approach. Creating a platform for such original independent debate was the intention of our controversy article regarding Green Issues and Ophthalmology.2, 5 We hope that the various issues raised will lead to clarity of thought and position among ophthalmologists, and promote open and honest debate regarding the way forward in these uncertain financial times. Both patients and doctors need to engage management to influence a long-term perspective on the investment/disinvestment agenda to safeguard clinical care.