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The authors thank Dr Dasari's suggestion of 18 March 2011 that the
title of our manuscript should be changed to a fundus picture under
investigation. We acknowledge this but wanted to get across that he was
referred to us as having diabetic retinopathy from a local screening
service and that keeping an open mind about referral diagnoses forms part
of good clinical diagnostic thinking. We wanted to convey through this
quiz the importance of considering differential diagnoses in patients with
"atypical" retinal changes. We were hoping that the fundus photo would
lead the reader to question the title (as Dr Dosari has correctly done)
and that reading on through the quiz would either vindicate the discerning
reader's scepticism or educate the reader who at first may have accepted
that this was diabetic retinopathy. In addition, the title may well have
drawn in those with an interest in diabetic retinopathy for whom
recognising atypical patterns is essential. We acknowledge that it could
have been entitled "Unusual fundus appearance referred as diabetic
retinopathy" although we feel it would not have had as much impact.
Perhaps inverted commas around the words 'diabetic retinopathy' would have
been a possibility to make it easier.
Competing interests:
No competing interests
04 April 2011
Hon Shing Ong
Specialist Registrar
Areeb Moosavi, Susanne Althauser
Department of Ophthalmology, Royal Free Hospital, Hampstead NHS Trust
May I suggest that the title of "atypical diabetic retinopathy" is
perhaps a bit misleading even though he has been referred from the
diabetic screening service. Diabetes and hypertension are part of
geriatric medicine and are almosts like adjuncts after the age of 50.
A picture with Roth spots points to some other disease other than diabetes
as also mentioned in your differential diagnosis.
Perhaps using the term fundus picture under investigation may immediately
steer one to think in terms of number of other diseases, other than
diabetes or hypertension.
Re:title- atypical diabetic retinopathy
The authors thank Dr Dasari's suggestion of 18 March 2011 that the
title of our manuscript should be changed to a fundus picture under
investigation. We acknowledge this but wanted to get across that he was
referred to us as having diabetic retinopathy from a local screening
service and that keeping an open mind about referral diagnoses forms part
of good clinical diagnostic thinking. We wanted to convey through this
quiz the importance of considering differential diagnoses in patients with
"atypical" retinal changes. We were hoping that the fundus photo would
lead the reader to question the title (as Dr Dosari has correctly done)
and that reading on through the quiz would either vindicate the discerning
reader's scepticism or educate the reader who at first may have accepted
that this was diabetic retinopathy. In addition, the title may well have
drawn in those with an interest in diabetic retinopathy for whom
recognising atypical patterns is essential. We acknowledge that it could
have been entitled "Unusual fundus appearance referred as diabetic
retinopathy" although we feel it would not have had as much impact.
Perhaps inverted commas around the words 'diabetic retinopathy' would have
been a possibility to make it easier.
Competing interests: No competing interests