Sir,

We thank Professor Azad and colleagues for their interest in our case report.

At the time of examinations the baby was between 32 and 34 weeks gestation, with no suggestion of abnormalities of retinal vascularisation.

We concur with their view that this is a rare occurrence that we noted during an audit of RetCam screening against conventional indirect ophthalmoscopy. At the time of these events, the manufacturers considered that some 1 million RetCam examinations had taken place with no other similar report. They were not aware of any other Unit undertaking a similar audit process, and we are therefore interested to know that Professor Azad and colleagues have not demonstrated a similar occurrence in their study.

We agree with Professor Azad and colleagues that care must be taken not to apply excessive pressure on the eye when using the RetCam. We advise that all neonatal screening should use the lighter ROP screening head and not the heavier standard paediatric head which would produce a greater load on the ocular surface.

We agree that our case report is extremely rare but it does emphasise the fragile nature of the immature retinal vascular system.