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Comment & Response |

Vulnerable Populations in the Underuse of the US Health Care System by Persons With Diabetes Mellitus and Diabetic Macular Edema

Grayson W. Armstrong, BS1; Imran Mahmud, MD1; Michael E. Migliori, MD2
[+] Author Affiliations
1Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
2Division of Ophthalmology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence
JAMA Ophthalmol. 2014;132(8):1030. doi:10.1001/jamaophthalmol.2014.1759.
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To the Editor We read with great interest the recent article by Bressler et al1 describing the current state of diabetic eye care in the United States. The lack of clinical eye care being provided to patients with diabetes mellitus is both alarming and concerning, especially in light of advances in vision-preserving treatment for diabetic macular edema (DME).

Diabetes, among other chronic diseases, is increasing at an alarming rate in the United States. Ample evidence demonstrates that within the United States and internationally, more than 40% of cases (sometimes as many as 70%) may go undiagnosed.2 The problem of underdiagnosis is greater within socioeconomically deprived and ethnic minority groups.3 Given the case definition in this article (self-reported diabetes from the National Health and Nutrition Examination Survey sample), it is likely that a substantial number of cases in the sample have been overlooked. The scale of underscreening and undertreatment of DME may be even greater than we think.


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August 1, 2014
Neil M. Bressler, MD; Rohit Varma, MD; Quan Doan, PharmD
1Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, Maryland2JAMA Ophthalmology, Chicago, Illinois
3Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago4currently at Department of Ophthalmology, University of Southern California, Los Angeles
5Outcomes Insight, Inc, Westlake Village, California
JAMA Ophthalmol. 2014;132(8):1030-1031. doi:10.1001/jamaophthalmol.2014.2445.
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