We are glad that our study raised interesting comments and we would like to thank de Ortueta and Arba-Mosquera for their constructive letter. However, we want to emphasize that their concern of possible peripheral effects as a result of a small optical zone was actually not an issue in our study.

We would like to disclose here additional information on our study and its design, unfortunately not included in the original manuscript, that will address that concern.

All the surgical procedures were performed with a wide 6.5-mm optical zone (OZ) together with a 1.25-mm transition zone (TZ). In addition, only 1 surgeon performed all the treatments.

The raised concern of a possible crescent-type peripheral area inducing additional coma because of a small optical zone could actually be plausible, but not under the conditions of our study. We measured the aberrations for a 6-mm pupil and used a complete optical zone of 7.75 mm. This gives a range of around 0.87 mm for a relative decentration, much larger than the actual values in our study. We were more inclined to see the differences related to the particular aberration structure in hyperopic eyes and the coupling effect with LASIK hyperopic treatments.

We agree with the fact that using coaxial light reflex is subjective, but to eliminate this bias, only 1 surgeon operated on the patients and we found that the coaxial light reflex coordinates under the laser microscope concurred with the preoperative topographic Cartesian coordinates of the corneal vertex. Moreover, we highlight the fact that the surgeon did not know the topographic decentration coordinates when reporting the preoperative coordinates.

As we discussed in our paper, we agree that the main inconvenience of centering on the pupil is the pupil modification depending on the illumination conditions. It would actually be possible to use an additional fixed reference, such as the limbus, to avoid these issues. Although that is technically possible, we did not have that capability at the time of the study.

We would like to finally mention that our study was based on a relatively small population with moderate hyperopia. Further studies should be performed treating more patients with higher hyperopia and also analyzing controlled changes in the induced corneal asphericity. We firmly believe that a better understanding of the optical implications of the corrections will result in improved visual quality for the patients.