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I was not questioning the efficacy of Visudyne in relation to certain cases of macular degeneration, merely observing that given the published cost of the treatment, it would be beyond the financial reach of most patients, hence its impact on controlling the disease would be limited. A similar situation arose some years ago when CCTVs first appeared in the country. All of us working with low vision cases knew and appreciated their value. However, the then cost of a CCTV, at approximately &\#163;6,000, restricted this sale to many patients. Competition has changed all that and now many more people enjoy the pleasure of continuing to read with one of these appliances. However, there can be no competition over Visudyne in that Ciba Vision holds an exclusive patent on this product. Edward Watts Shenfield, Essex