Thank you for your response1 to the “Five things to know about …” article on acute floaters and flashes in the CMAJ.2 These points are a summary of data from a large meta-analysis published in JAMA in December 2009.3 The 14% incidence of retinal tears in patients with acute floaters and flashers was indeed patients referred to ophthalmology clinics at tertiary hospitals (but not just to retinal specialists). We agree that there is a selection bias and that this may not necessarily represent the same population of patients who present to the general practitioner with similar symptoms. Many such patients may indeed have long-standing or recent floaters that are benign. Like you, we are not aware of a study that looks at this. However, we believe general physicians need to be aware of the importance of the acute onset of floaters and flashes and the appropriate time frames for referral — especially in cases of field loss, vitreous hemorrhage and subsequent resurgence of symptoms.