JAN 24, 2012
The ability of physicians to estimate clinical risk and to incorporate it into their decisions is a complex task that is based on a number of factors, some of which are intrinsic to the physician and some of which may depend upon characteristics of the individual patient. This study sought to assess factors that impact physician treatment recommendations in cases of ocular hypertension.
The authors asked ophthalmologists, both glaucoma specialists and non-glaucoma specialists, how many young and old patients with ocular hypertension they would treat to prevent someone from progressing to glaucoma (number needed to treat). Then they reviewed 100 simulated cases of patients with ocular hypertension and reported their likelihood to treat each case. Half of these cases were presented with an estimated risk of conversion to glaucoma within five years.
Both glaucoma specialists and nonglaucoma specialists were more likely to recommend treatment in cases for which a risk calculation was provided (P = 0.001). Indices measuring both confidence in their decisions and consistency of those decisions with underlying patient risk improved when a risk estimate was provided. However, asking physicians how likely they are to treat ocular hypertension, as their number needed to treat, did not reflect their behavior when making actual treatment recommendations. Both groups also indicated that they were more likely to treat young than old patients. However, nonglaucoma specialists were more likely to recommend treatment for ocular hypertensive patients than were glaucoma specialists (P < 0.001).
The authors say the study's findings have implications for improving the treatment of ocular hypertensive patients by modifying treatment protocols and making them more consistent with available evidence. The results also indicate that physicians in the study underestimated the risk of developing glaucoma in the simulated ocular hypertension cases they reviewed. The authors conclude that differences between ophthalmologists with and without glaucoma training may be important when crafting practice guidelines or communicating concepts of glaucoma risk to the two groups.