Association of Metformin With the Development of Age-related Macular Degeneration in the Diabetes Prevention Program Outcomes Study—Reply

Abstract

In Reply We want to thank Oke et al for their responses to our recently published article 1 that examined the geographic distribution of pediatric ophthalmologists in association with US population demographic characteristics. We agree that it is imperative to interpret our data within the context of the limitations we presented. Professional society memberships are free and accessible ways to estimate the geographic distribution of health care professionals of large areas, such as the US. We modeled our methods on several previously published reports 2,3 that estimated physician distribution solely using professional society membership data. These databases cannot accurately account for nuances inherent to a health care professional's role or practice patterns, such as physicians who practice in multiple locations or general physicians who treat pediatric patients. However, we used both the AAO.org and AAPOS.org websites, as we believe these are reputable sources to which patients would also have access when attempting to locate a health care professional. We hoped to demonstrate the convincing and persistent gap in access to pediatric ophthalmic care that many families experience across the US to inspire conversations around this issue and direct future research.While the different geographic units (metropolitan statistical area vs US counties) used in each report preclude a direct comparison over time, an adjustment to pediatric ophthalmologists per million persons aims to account for this discrepancy and provides insight into generic trends in pediatric ophthalmology density over time. We used a well-defined geographical unit that has been and will be consistent over time and will enable future comparisons.Our hope in publishing this report was to shed light on the growing need for pediatric ophthalmic care in many areas of the country. More granular and in-depth research is required to identify underserved regions and their specific needs to develop innovative plans to reduce the health care professionals gap and improve access to care. We hope that this information also promotes every ophthalmologist to opt in to professional society membership platforms to publish up-to-date geographic data and enable patients to identify health care professionals. We thank you for your time and interest in our work.