I would like to thank Dr dell’Omo and Dr Costagliola for their interest in my article. To clarify the scanning protocol, this study was performed using serial spectral-domain optical coherence tomography (SD-OCT) images with the Topcon 3D OCT 1000 (Tokyo, Japan). The 3D macula protocol was used for all scans, which generate 5 to 6 μm of longitudinal resolution and 20 μm of horizontal resolutions at 18 000 A-scans per second in a 6 mm by 6 mm grid (512 × 128 pixels resolution). These were all horizontal in orientation and no fold was along the scanning plane, and therefore there was enough detail to distinguish between types of folds without having the scans perpendicular to the fold as suggested.

Furthermore, the first OCTs were performed 6 to 8 weeks following the surgery when all gas had dissipated. The following OCTs were taken on each follow-up, which occurred at least 6 months and 12 months after the initial operation. The objective of this study was to illustrate the natural history of different types of folds by OCT. Therefore, Figures 1 and 4 clearly describe the times at which these folds were scanned. Identification of types of folds was done at the 6- to 8-week postoperative visit and not any later, which makes it unlikely that the ripple fold patients were patients who had resolved taco folds.

I hypothesize that a taco fold occurs only at the junction of attached and detached retina where the weight of the subretinal fluid almost causes the retina to hang over the attached retina. These folds are thus more prominent, and large outer segment lesions are formed. This effect is so severe that it can cause a rosette configuration, as seen in Figure 5 of the manuscript. Ripple folds are more common and can occur throughout the area of detachment. These occur as the retina has initially stretched because of the detachment, but folds have been created because of redundancy. Therefore, ripple and taco folds have a different configuration and etiology.

Drs dell’Omo and Costagliola do not agree with the name “displacement fold” because displacement is seen in many retinal detachments, as described first by Shiragami and associates in their study using autofluorescence. I have no doubt that it occurs in taco folds as more retinal tissue is involved, and therefore one can postulate that more displacement occurs in tacos compared to ripples.

However, displacement measured by autofluorescence is also not an exact science, and the theory of why the images occur is hypothetical. My colleagues at St. Thomas’ Hospital have looked at over 80 consecutive cases of retinal detachments with postoperative autofluorescence (Edward Lee, personal communication, 20 May 2012). Not all macula-off retinal detachments showed evidence of translocation on autofluorescence, and even some macula-on patients had displacement of the autofluorescent shadows corresponding to blood vessels. My definition of a “displacement fold” describes usually an inferior retinal taco fold where there is a clear shift of the fovea noticeable without the use of autofluorescence, giving patients intractable binocular diplopia, which is not seen in either taco or ripple folds. This has nothing to do with the fact that the fold causes the displacement or the displacement causes the fold, but rather that both the displacement and fold are present.

Finally, in the methods section, 5 patients were excluded because they had received further surgical intervention. Two patients had displacement folds that were re-detached and allowed to reattach, but there was no resolution of their diplopia. Therefore, the suggestion of the degree of translocation and resulting diplopia being amenable to surgical intervention is premature. Perhaps extraocular muscle transposition is a means for improving the patients’ symptoms, but sensory factors such as aniseikonia may hinder the ability to fuse the images. Unlike retinal translocation surgery for wet age-related macular degeneration, most patients have good vision in the contralateral eye, and therefore diplopia may persist despite extraocular muscle surgery.