We appreciate the interest and positive feedback of Woo and associates. When an iridotomy is placed superiorly, lid coverage is not necessarily protective of visual symptoms, for reasons we discussed in our paper. The superior tear film at the lid margin results in a base-up prism refracting stray light onto the peripheral retina that can result in dysphotopsia. Furthermore, as the lid and tear film is dynamic, visual symptoms may vary considerably.
We agree that linear dysphotopsia is an underreported and potential debilitating complication after laser peripheral iridotomy. Proper informed consent is important for any patient undergoing peripheral iridotomy, and we strongly recommend the iridotomy be placed away from the lid margin to reduce the incidence of dysphotopsia. Thus, we prefer the temporal or nasal location in most cases.