We read the paper by Steel et al. [1] with great interest and welcome their study demonstrating large macular holes do not behave differently in terms of surgical anatomical closure at the arbitrary “cut-off” value of 400 µm, confirming the findings of our previously study published in 2018 [2]. Whereas we demonstrated that a size of ~630 µm appears to represent a significant inflection point where surgical macular hole closure significantly decreases, the BEAVRS dataset suggests a value of ~500 µm. The authors suggest the difference may be due to the fact that the ROC analysis in our study “shows a fairly low profile covering a number of possible values”, and being a larger series, they suggest that 500 µm is the correct, pragmatic “cut-off”.

Scrutiny of our ROC curve demonstrates a very similar profile to the BEAVRS study, and whilst the AUC value for the BEAVRS study was 77.9%, for our study the value was 76.9% (i.e., virtually identical). Further analysis (unpublished) of our data demonstrates to achieve 70% sensitivity and 69% specificity, the range of values are between 608 and 630 µm (i.e. a relatively narrow range of possible values and less than the quoted range by the BEAVRS dataset study of 464–500 µm). We politely suggest the authors have misinterpreted the perceived “flatness” of our ROC analysis as it purely relates to the scale of the drawn axes.

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