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To the Editor.—
The recent article on the diagnosis of diabetic eye disease by Sussman et al showed an alarming percentage of incorrect diagnoses made by ophthalmologists and retina specialists. The reason for this poor showing may be found in the protocol used for this study. The methods disclosed that the ophthalmologists used only indirect ophthalmoscopy for their examination.In my training program, it was stressed that the best way to examine a patient for proliferative diabetic retinopathy was with the use of a Hruby lens, contact lens, and direct ophthalmoscopy as well as indirect ophthalmoscopy. I find that I cannot adequately examine a patient for this problem without the use of some, if not all of these modalities. I do, however, agree with the major thrust of the article, which concluded that the primary care physician should make more use of their ophthalmologic referrals to prevent missing diabetic eye
Fier RH. Diagnosis of Diabetic Eye Disease. JAMA. 1982;248(22):2973. doi:10.1001/jama.1982.03330220019024