Firstly, we would like to thank Xiao and associates for their interest in our paper.

Xiao and associates raise the point that in their practice it is very unusual for presbyopic myopic patients to demand a LASIK procedure. It is well known that there are some differences in several countries around the world regarding the interest of the myopic population to correct their refractive error. In fact, it is quite common in our population (Spain) with mild to moderate myopia to demand corneal refractive surgery to correct their refractive defect, even at presbyopic ages, but we recognize that this may not be the case in China.

In addition, Xiao and associates suggest that the increased prevalence of dry eye disease in elderly patients could be a contraindication of refractive surgery. Although we do agree that dry eye disease is a quite common complication of LASIK, especially in older people, we believe that potential complications of cataract surgery or clear lens extraction are not negligible. In fact, we (and many of our patients) prefer to deal with post-LASIK transient dry eye symptoms than to deal with intraocular complications such as cystoid macular edema or endophthalmitis.

Finally, Xiao and associates raise the point that it might be that patients would be comfortable with LASIK-induced monovision, but because presbyopia increases with aging, the patients might be disappointed with the unaided near visual acuity years after the refractive surgical procedure. Again, we do agree with the authors and we should have stated in our paper that the information given to the patients should include this point in order to make patients have realistic expectations regarding the result of the procedure. Nevertheless, we do believe that performing LASIK-induced monovision in mild to moderate myopia may be enough, as we found in our paper, to provide good unaided far and near visual acuity, and that clear lens extraction using monovision or multifocal intraocular lenses may be performed later on, when presbyopia is so pronounced that the patient can no longer have near vision without glasses.