We appreciate the correspondence from Drs Tornambe and Grizzard and their highlighting the results of the Pneumatic Retinopexy Clinical Trial. As is true with all of medicine, results in the real world generally are different from the controlled parameters of a clinical trial, as evidenced in our findings. We agree with the statement of limitations made in our article and the letter about the use of claims data, and we wish to emphasize the limitations noted in our article. To address one of the questions in the letter, we did distinguish the type of second procedure after pneumatic retinopexy (please see Table 3, which shows that after initial pneumatic retinopexy, 10.9% of patients underwent further laser or cryotherapy and 5.8% had another pneumatic retinopexy). With regard to cost effectiveness, we agree with Drs Tornambe and Grizzard’s point that even with higher reoperation rates, pneumatic retinopexy may be a more cost-effective option. In the article, we mentioned Dr Tornambe’s paper that reported that the cost of pneumatic retinopexy was approximately 59% that of scleral buckle (assuming a 82% single-operation success rate for scleral buckle and a 68% single-operation success rate for pneumatic retinopexy), including the cost of all subsequent operations.
Most importantly, we do not make clinical recommendations for the care of specific patients based on our data. We agree that the art of medicine requires that the patient and physician together make a decision as to which surgery option provides the best course for that patient and that the results of specific surgeries may well vary based on the experiences of specific physicians. As noted in the letter and our article, pneumatic retinopexy has the fewest associated complications, and thus remains a reasonable and viable first option for treatment for many patients.