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Please provide your age:
 
25-35
 
36-45
 
46-55
 
56-65
 
65+
 
 
 
Please select the number of years you have been practicing:
 
0-5
 
6-10
 
11-15
 
16-20
 
21-25
 
25+
 
 
 
Please select the mode of practice you in which you work:
 
Private Sector
 
VA Hospital
 
HMO
 
Military Hospital
 
OD/MD Practice
 
 
 
Please select the county where you practice:
 
Wayne
 
Livingston
 
Monroe
 
Oakland
 
Washtenaw
 
 
 
What questions encompass your case history during a diabetic eye examination (check all that apply)?
 
A1c Level
 
Fasting blood glucose
 
Duration of disease
 
Medications
 
Compliance
 
Medical history – Review of systems, such as renal function, neuropathy, weight loss/gain, podiatry, and oral hygiene

 
 
 
What elements are typically included in your diabetic eye examination (check all that apply)?
 
Visual Acuity
 
Intraocular pressures
 
Pupil function
 
Oculomotility
 
Visual field screening
 
Refraction
 
Slit lamp examination
 
Stereo fundus examination
 
Fundus Photography
 
 
 
Which statement below MOST accurately reflects how you value the retinopathy severity scale (based upon the clinical approximations of the ETDRS modified retinopathy severity scale via the Airlie House classification of DR)?
 
The retinopathy severity scale is not of much value as it is long outdated
 
The retinopathy severity scale is most valuable for coding purposes ONLY
 
The retinopathy severity scale is most valuable for coding purposes AND as a practical guideline for clinical diagnoses and management
 
The retinopathy severity scale is most valuable for coding purposes, as a strict guideline for diagnosis/management AND as a description of baseline retinopathy levels and for identifying the risk for progression of DR
 
 
 
Do you routinely use mydriatics?
(If you answer yes, please select the mydriatics you routinely use).
 
Yes
 
No
 
.5% Tropicamide
 
1% Tropicamide
 
2.5% Phenylepherine
 
Other
 

 
 
 
Which statement below MOST accurately reflects your referral patterns for patients with diabetic retinopathy?
 
I routinely refer ALL (or most) patients presenting with ANY retinopathy or ME regardless of severity
 
I routinely refer only the MOST SEVERE cases of NPDR and ALL cases of PDR or ME
 
I routinely refer cases according to the retinopathy severity scales and risk factors for progression
 
 
 
Are there any other referrals that you make for your diabetic patients? (check all that apply)
 
PCP
 
Dentist
 
Podiatry
 
Neurology
 
Endocrinology
 
Other
 
 
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