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Ophthalmic Examination in Diabetes Mellitus FREE

Stanley P. Griffith, MD; William L. Freeman, MD, MPH; Carla J. Shaw, MPH
JAMA. 1994;271(22):1745-1745. doi:10.1001/jama.1994.03510460037027
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To the Editor.  —Dr Brechner and colleagues1 point out in their recent article that "about half of adults with diabetes in the United States are not receiving timely and recommended eye care to detect and treat retinopathy." Screening for retinopathy can identify early disease and prevent major vision loss. However, we have still not determined the most cost-effective screening method.Numerous articles have been published evaluating the accuracy and cost-effectiveness of various strategies of screening for diabetic retinopathy. Most have defined "accuracy" as diagnosing specific grades of diabetic retinopathy. For example, Singer et al2 reviewed a previous study by Moss et al3 and calculated that ophthalmoscopy had a sensitivity of 79% and a specificity of 99% for the detection of proliferative retinopathy. Of the patients known to have proliferative retinopathy by the criterion standard examination in the study by Moss et al,3 screening identified proliferative retinopathy

REFERENCES

Brechner RJ, Cowie CC, Howie LJ, Herman WH, Will JC, Harris MI.  Ophthalmic examination among adults with diagnosed diabetes mellitus. JAMA . 1993;;270:1714-1718.
Singer DE, Nathan DM, Fogel HA, Schachat AP.  Screening for diabetic retinopathy. Ann Intern Med . 1992;;116:660-671.
Moss SE, Klein R, Kessler SD, Richie KA.  Comparison between ophthalmoscopy and fundus photography in determining severity of diabetic retinopathy. Ophthalmology . 1985;;92:62-67.
Peters AL, Davidson MB, Ziel FH.  Cost-effective screening for diabetic retinopathy using a nonmydriatic retinal camera in a prepaid health-care setting. Diabetes Care . 1993;;16:1193-1195.
Lairson DR, Pugh JA, Kapadia AS, Lorimor RJ, Jacobson J, Velez R.  Cost-effectiveness of alternative methods for diabetic retinopathy screening. Diabetes Care . 1992;;15:1369-1377.

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Brechner RJ, Cowie CC, Howie LJ, Herman WH, Will JC, Harris MI.  Ophthalmic examination among adults with diagnosed diabetes mellitus. JAMA . 1993;;270:1714-1718.
Singer DE, Nathan DM, Fogel HA, Schachat AP.  Screening for diabetic retinopathy. Ann Intern Med . 1992;;116:660-671.
Moss SE, Klein R, Kessler SD, Richie KA.  Comparison between ophthalmoscopy and fundus photography in determining severity of diabetic retinopathy. Ophthalmology . 1985;;92:62-67.
Peters AL, Davidson MB, Ziel FH.  Cost-effective screening for diabetic retinopathy using a nonmydriatic retinal camera in a prepaid health-care setting. Diabetes Care . 1993;;16:1193-1195.
Lairson DR, Pugh JA, Kapadia AS, Lorimor RJ, Jacobson J, Velez R.  Cost-effectiveness of alternative methods for diabetic retinopathy screening. Diabetes Care . 1992;;15:1369-1377.
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