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  1. M S J Blundell1,
  2. L P Hunt2,
  3. E J Mayer1,
  4. A D Dick1,
  5. J M Sparrow3,4
  1. 1
    Academic Unit of Ophthalmology, University of Bristol and Bristol Eye Hospital, Clinical Research Unit, Bristol, UK
  2. 2
    Department of Clinical Sciences South Bristol, University of Bristol, Institute of Child Life & Health, UBHT Education Centre, Bristol, Bristol, UK
  3. 3
    Bristol Eye Hospital, Lower Maudlin Street, Bristol, UK
  4. 4
    International Centre for Eye Health, London School of Hygiene &Tropical Medicine, London, Bristol, UK
  1. Mr M S J Blundell, Academic Unit of Ophthalmology, University of Bristol and Bristol Eye Hospital, Clinical Research Unit, Bristol Eye Hospital, Lower Maudlin Street, Bristol BS1 2LX, UK; msjb1{at}doctors.org.uk

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We acknowledge the points made by Lindfield et al1 and thank them for taking an interest in our article. Their letter highlights that our subanalysis of standardised mortality ratio (SMR) by age group only demonstrates decreased mortality in the older population groups. They hypothesise that within these older age groups, individuals with comorbidity that would affect their mortality may be less likely to have cataract surgery, thus artificially lowering the SMR measured in our study. They go …

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