Sir,

Thank you for giving me an opportunity to respond to the comments made by Mr Deane on the results of retinal detachment surgery performed by general ophthalmologists in a district general hospital. The author's point on the risk of macula-on detachment becoming macula-off before they are dealt with at the tertiary centre is a valid one, and to my knowledge has not been studied. I agree with the author in that if there is significant delay in patients with macula-on detachment reaching the regional centres, there may be a role for the ophthalmologists in the referring centres in their surgical management. However, I am not sure of the number of general ophthalmologists available with sufficient training and competence to take on retinal detachment surgery. Certainly, the newer generation of ophthalmologists without additional subspecialty training are unlikely to be able to perform such surgery.

The situation in our region is such that referral of patients with macula-on detachment is treated on an urgent basis and hence the risk of macula-on detachment becoming macula-off detachment before surgery is likely to be minimal. Any future college audit on retinal detachment surgery should be able to look at this aspect and provide us with an answer for this question and appropriate guidelines.