To the Editor We acknowledge the time and effort of Yousef et al1 in their review of intra-arterial chemotherapy (IAC) for retinoblastoma. We agree with many of their thoughts including the abstract’s conclusion, “Intra-arterial chemotherapy is a promising new treatment associated with high rates of globe salvage,”1 and the article’s final phrase, “the authors recommend that IAC be offered selectively among other options, with fully informed discussion about all possible risks, benefits, and uncertainties.”1 The term selectively cannot be underestimated. The ocular oncologist must understand each therapeutic alternative and expected outcomes, such as when it is best to save the eye or advise enucleation, when it is safer to use intravenous chemotherapy (IVC) rather than IAC, and what the anticipated local and systemic effects are.2