To the Editor:

We would like to thank Styles et al. for their response to our comment ‘Consulting the consultants: Avastin in the treatment of wet AMD’ [1]. The authors’ letter raises a number of interesting points, while highlighting the importance of patient understanding and misinformation in the Avastin issue.

The results of the survey of Fife wet AMD patients [2] were of great relevance to our own research in this area, particularly as we had undertaken a similar patient survey canvasing the views of Abergele wet AMD patients and found almost the opposite response. Our study, ‘Consulting the patients: Avastin in the treatment of Wet AMD (Part II)’ [3], showed that 18% of Abergele patients, if offered, would be likely to choose Avastin compared to 77% of Fife patients. 84% of Abergele patients felt an information leaflet would be useful, whereas only 11% of Fife patients wanted more information provided. It is certainly noteworthy to compare how varying patient views are within the different geographical cohorts of Northern Wales and East Scotland.

Styles et al.’s survey was slightly larger than our own. Cultural and/or socio-economic factors may go some way in explaining the differences between Abergele and Fife patient views, but, these small independent research efforts cannot clarify this further. A confounding variable, which should not be underestimated, is the questionnaires themselves, which were different. How written patient information is framed, what details are emphasised, and which terms are included or omitted may influence the responses received. It would be exciting to repeat these two patient surveys using a single questionnaire and to include other centres across Scotland, Wales, England and Northern Ireland. This could provide more robust data, which could inform service delivery planning at both a regional and a national level.