Coleman et al claim the recommendations in our report are unjustified.1 They cite three shortcomings, including clinical inconsistency, low incidence of rhegmatogenous detachments, and methodologic flaws.
Coleman et al argue that the results are clinically inconsistent because women with preeclampsia do not present with similar retinal disorders during pregnancy. Clinical consistency is not a requisite for causality. If this argument were correct, more women with preeclampsia would have cardiovascular disease during pregnancy. Yet the well-established association of preeclampsia with myocardial infarction and ischemic stroke is seen only decades later.2
They further assert that the incidence of retinal breaks should track with rhegmatogenous detachments. Rhegmatogenous detachments occur primarily at older ages.3 In a cohort of young women, detachments will be rare. Breaks commonly precede detachments, and most breaks will not even develop into detachments.3 It is therefore expected that preeclampsia will show stronger associations with breaks in young women.
Coleman et al cite several methodological flaws, including misclassification, confounding, and selection bias.
We agree that it is premature to alter screening recommendations and, as mentioned in our article, remain convinced that “further research is needed to determine whether a history of preeclampsia should also be an indication for screening.