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Comment & Response
October 2017

Current Shortcomings of Camera Screening—Reply

Author Affiliations
  • 1Ophthalmology and Eye Health Programs, Los Angeles County Department of Health Services, Los Angeles, California
  • 2Ophthalmology, USC Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles
  • 3Barbara A. Levey MD & Gerald S. Levey MD Endowed Chair; Chief, Division of General Internal Medicine and Health Services Research; Professor of Medicine and Health Policy and Management; David Geffen School of Medicine at UCLA, Los Angeles, California
JAMA Intern Med. 2017;177(10):1539-1540. doi:10.1001/jamainternmed.2017.3836

In Reply Our teleretinal diabetic retinopathy screening (TDRS) program1 was implemented to address the large backlog of persons with diabetes in Los Angeles County waiting for diabetic retinopathy (DR) screening examinations. As stated in our article, our TDRS program is intended solely for DR screening; it is not intended to replace a comprehensive eye examination to rule out the presence of conditions such as glaucoma. However, it is clear that the highest risk of blindness posed to our patient population is from diabetic retinopathy. Although the pre-TDRS mean wait time for screening of 158 days may be acceptable for lower levels of diabetic retinopathy, it is not an acceptable wait time for a screening examination to determine who falls into that category. As evidenced by our historically low screening rate and long wait times for DR screening examinations, many of these patients were not getting adequate eye care, or any eye care at all, prior to the implementation of our TDRS program. This is a major challenge for the US safety net.2

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