Sir,

We read with great interest the article ‘Pain relief during panretinal photocoagulation for diabetic retinopathy: a national survey’ by Richardson and Waterman.1 We have some comments to share with the authors.

First, this is a study assessing the pain during panretinal photocoagulation (PRP) from the doctors’ perspective. It may not be objective and convincing enough for us to draw a conclusion regarding whether PRP is painful and whether use of analgesics is effective in reducing pain based on the data of the present study. In fact, the authors might have added a question in their questionnaire regarding how the doctors knew their patients were in pain during the procedure. Did they actually ask the patients or only judged from the patients’ incompliance? We notice that some patients could not cooperate during the procedure not because they felt painful. They in fact only felt ‘sore’ in the eye that was under PRP, or felt the scattered light to be ‘too shining’ for the contralateral eye. Moreover, different doctors might have different levels of understanding of the likelihood of pain in question 7 described in this study. It would be more objective to assess the pain by asking the patients to fill in the pain-rating scales.

Second, the authors may need to attach the questionnaire in the article, as it is important for us to know how it was designed and what questions exactly were asked. Besides, according to what was described in the article, it seems that there were some missing data, such as the age and gender of those patients who often felt pain during the procedure. In our own clinical practice, we have noticed that young female patients were more sensitive to the pain caused by the laser burns and were less compliant during PRP.