Sir,

We would like to thank Drs Singh and Stewart for their interest and comments on our paper. We agree with them in that screening the whole population over a certain age for AMD would be a time consuming, expensive, and largely fruitless exercise. However, that was not the aim of our study.

We have evaluated the effectiveness of retinal screeners in judging the urgency of referral in patients referred with a suspicious macular lesion. In a population-based scenario, these would be patients referred to the general practitioners (GP) or hospital eye service by optometrists, either following a routine examination or with symptoms. These pictures could then be transmitted to the hospital via a telemedicine link and the urgency of referral determined by trained graders. These pictures would then be graded by ophthalmologists or trained graders as in our model, and not by GP as stated by Singh and Stewart.

It has been clearly established that a delay in treatment adversely affects the clinical outcome.1 We believe this technique offers significant advantages in decreasing the time from referral to treatment especially with the advent of new treatment modalities for AMD.