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www.thelancet.com Vol 390 November 11, 2017 2141 group, the conclusion of the study is that PRP alone was associated with a 3-letter vision loss. What was the cause of this loss? If it is diabetic macular oedema—the authors state that “no patients were offered antiVEGF treatment for macular oedema in the PRP group”—many reports show the efficacy of anti-VEGF therapy in improving vision. We are strong advocates for anti-VEGF therapy for diabetic macular oedema and proliferative diabetic retinopathy but we believe there is potentially a role for combining it with PRP, especially in eyes with proliferative diabetic retinopathy.