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The Future of Diabetic Retinopathy Detection 

In October’s Opinion (“The Boomers Are Coming: Will We Be Ready?”), Dr. Mills points out that the one-to-16,000 ratio of ophthalmologists to patients has been fairly steady over time, and that the rate of residency program matriculation is not expected to increase. What was not addressed is the flip side of the coin: As Baby Boomer ophthalmologists retire, there will be a net loss of active practitioners. Thus, even without additional demographic shifts, demand for eye care services will exceed the supply of ophthalmologists.

However, along with the increasing need for age-related ophthalmological interventions, there are 22 million diabetics and an additional 43 million Americans who have prediabetes. Few of the latter will become normoglycemic; hence, a tsunami is fast approaching.

Today, only about 11 million screening examinations for diabetic retinopathy are performed annually. What are we prepared to do when the number of diabetic patients in the United States reaches more than 60 million, all of whom will require annual dilated retinal examinations?

Given these facts, I was disappointed to note that this publication failed to mention—even in passing—the role of digital retinopathy detection as a means of bridging the significant gap between current screening rates and unmet need.

Hundreds of peer-reviewed papers on the use of imaging to provide accurate screening of diabetic fundi—including those of the Academy’s own Ophthalmic Technology Assessment Committee—indicate that this approach is both scientifically valid and cost-effective. Use of the severity scales to communicate screening results to primary care physicians creates an integrated health care delivery model and can provide the type of feedback that general physicians require to triage their patients effectively.

It all comes down to two incontrovertible facts: As the number of practicing ophthalmologists decreases through attrition, the need for retinopathy screening will skyrocket. The only means of bridging the gap is to use a proven technological intervention to extend screening to the millions who need it and then to shepherd those found to have sight-threatening retinopathy to ophthalmologists for treatment.

The number of Americans at risk for diabetic blindness is about to increase exponentially. Doing nothing today to prepare for this calamity should not be an option.

Lawrence M. Merin, FOPS
Nashville, Tenn.

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The Rich and the Poor

I am appalled that our specialty is pitting the rich against the poor. Nowhere else in medicine is there such a discrepancy. I am not referring to plastic surgery or refractive surgery, but to basic cataract and lens implant surgery.

Rather than our Academy taking a stand against the lens manufacturers to reduce the costs of multifocal lens implants, we have allowed our specialty to offer the rich the opportunity to avail themselves of this advanced technology, while ignoring the poor.

Medicare covers bifocal eyeglasses after cataract surgery, so the rationale that these implants are refractive in nature and not reimbursable is ludicrous. Is our specialty yielding to the stockholders of the lens companies rather than to our own patients?

The public will soon look upon us as money-seeking eye doctors. Let’s not set a precedent in medicine and surgery for separating the “haves” from the “have nots” with advanced technology for basic health needs.

Kenneth Cohn, MD
South Gate, Calif.

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Free the Prisoners!

In May’s Opinion (“Sustainable Growth Rate: Medieval Torture?”), Dr. Mills correctly notes that we Medicare physicians remain on the torture rack voluntarily because it pays well. However, with inflation and a reduction in revenue, our salaries will look like those of any other low-level white-collar job.

OphthPAC should help release us from this rack by promoting a system that allows physicians to charge whatever they want and health insurance to assist patients in paying bills, and not to artificially set prices.

Donald J. Mirate, MD
Valdosta, Ga.

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