Sir,

We deeply appreciate the comments from Rajendram et al1 regarding our article ‘Intravitreal ranibizumab for choroidal neovascularisation secondary to pathologic myopia: 12 month results’.2 We agree that myopia cannot be assessed accurately only with refraction. In some patients lenticular changes could contribute to a certain amount of myopia. Axial length was not used in this study. However, patients had to have retinal abnormalities consistent with pathological myopia (such as lacquer cracks, peripapillary atrophy, etc).

Regarding the frequency of injections, the main characteristic of myopic choroidal neovascularization in comparison with age-related macular degeneration is the very different dynamics of CNV progression. Myopic CNV is more likely to respond with less injections needed and with improvement in vision. As reported in this study, the loading phase does not seem to be necessary and could represent an overtreatment for many patients. The recurrence is unpredictable; some patients may never have it, while many patients may not have it for several months. This justifies the pro renata regimen. Owing to the potential specific risk of myopic eyes, it seems advisable to reduce the number of injections as possible. We once again thank Rajendram et al for their interest and comments.