Sir,

We would like to thank Mr Ali for his interest in our article ‘Screening for age-related macular degeneration using non stereo digital photographs’.1 We agree with the obvious assertion that prevalence of a disease affects the utility of a screening tool by impacting on the positive predictive value.

However, we did not evaluate this technique as a general screening measure for people over a certain age but only for those with suspicious macular lesions that necessitated a retinal opinion. The ‘contrived’ database he refers to were patients referred to the retinal service by optometrists for exactly the above reason and these form our intended target population for telemedicine. In this selected group, we observed a high sensitivity and specificity of AMD detection.

We believe that this technique can significantly reduce the time between referral and appointment with a retinal specialist in patients with treatable CNV, which was the aim of the study in the first place.