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Optometric Care and Undetected Eye Disease: A Case of Berkson's Bias?-Reply

Daniel E. Ford, MD, MPH; Fang Wang, PhD; James M. Tielsch, PhD; Paul K. Whelton, MD, MSc
Arch Intern Med. 1995;155(4):429. doi:10.1001/archinte.1995.00430040103017.
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In reply  We appreciate the careful reading of our article1 by Cutter and colleagues. They focused on one component of our study concerning optometrists and undetected eye disease. We suggest that individuals read our article before accepting their view that our comments were pejorative toward optometrists. Berksonian bias is a concern for any study using a sample receiving medical treatment. It is less of a concern, however, when the study sample originates from a primary care clinic, even if the clinic is located in a hospital. The outpatient clinic in which our study was conducted provides primary care to the surrounding community. Over 90% of the patients whom we studied listed this clinic as their usual source of care and almost none would have been referred having first received care at the Wilmer Eye Clinic (Baltimore, Md).In our analysis, the association between eye care being provided by an

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