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—We appreciate Dr Bath's impassioned plea for action regarding the unmet eye care needs of those members of our population living in poor, inner-city neighborhoods. She cites the lack of affordable tertiary eye care services as the obvious reason a large volume of undercorrected refractive error remains in the east Baltimore population. There is a clear difference between the availability and the accessibility of tertiary ophthalmologic services and more basic services such as those required for prescribing and fitting spectacles. The reasons these services are underutilized in particular segments of the population are not clear and may be different for these two types of eye care services. We feel it is important to attempt to identify the specific barriers to appropriate utilization, be they financial, social, educational, or motivational, in order to develop intervention strategies that will have the greatest potential to address these critical problems.Dr Bath's