We thank Dr Gonser for his appreciation of our systematic review and his support of the hypothesis that the commonality between uterine artery and ophthalmic artery Doppler waveforms is attributed to the fact that both indices reflect maternal cardiovascular function. There are now considerable new data which support the cardiovascular origin of pre-eclampsia1,2. Although we agree that ophthalmic artery Doppler assessment may prove superior to uterine artery waveform analysis in screening and diagnosis of pre-eclampsia, data are currently lacking to support this assertion3. We believe it is important to explore the potential use of other arterial waveform analysis methods and, indeed, maternal echocardiography1–3.