I agree with Scott and Kirkby that current opinion among UK ophthalmologists favours emergency surgery for macula-on detachments. However, there is little, if any, scientific evidence to support this widely held ‘mantra’. Published studies overwhelmingly support the view that there is no detrimental effect in delaying re-attachment surgery for a few days of presentation of a macula-on detachment, even if the macula does detach for a short while before surgery is undertaken.

Scott and Kirkby contend that I have misread my references.1, 2 If they read beyond the title of the article I supposedly misquoted,2 it would become clear that this report specifically addresses macula-off detachments where the macula was determined to have come off within the last 7 days. This is exactly what we are trying to address here. In other words, if the macula does come off for a day or two while awaiting surgery for a detachment that presented with the macula-on, does this lead to a worse outcome? Ross and Kozy2 conclude that if surgery takes place within seven days of the macula coming off, there is no adverse effect on visual outcome. Scott and Kirby subsequently quote Salicone et al's3 publication purporting that this supports the need for emergency surgery. This report actually concludes that emergency surgery does not influence visual outcome. The concluding paragraph of their report states that ‘This study reaffirms the prognostic importance of macular detachment on final visual acuity, but supports the hypothesis that a few days’ margin until repair has no impact on visual acuity.’

It is possible to operate out of hours, but it is arguable whether the quality of surgery in this setting would be as good as that performed as an urgent but scheduled event, for reasons I have stated before. In the absence of credible evidence, Scott and Kirkby marshal opinion and the threat of litigation as reasons to advocate emergency surgery. Surely scientific evidence must take precedence over opinion and threat of litigation in guiding clinical practice, especially where evidence clearly contradicts opinion.