The impact of physician subspecialty training, risk calculation, and patient age on treatment recommendations in ocular hypertension

Purpose: To determine whether glaucoma subspecialty training, formal risk estimation, or patient age has an impact on physician treatment recommendations in cases of ocular hypertension. Design: Experimental study. Methods: Members of the American Academy of Ophthalmology (118) and American Glaucoma Society (58) were recruited. Each physician was first asked how many young and old patients with ocular hypertension he or she would treat to prevent someone from progressing to glaucoma (number needed to treat). The physicians then 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 5 years and half were presented without an estimate. The treatment recommendations were analyzed to determine whether subspecialty status or the presence of a risk calculation had any impact on treatment recommendations. Results: Both glaucoma specialists and non-glaucoma specialists were more likely to recommend treatment in cases for which a risk calculation was provided (P =.001). Furthermore, non-glaucoma specialists were more likely to recommend treatment for ocular hypertensive patients than were glaucoma specialists (P <.001). Finally, both groups indicated they were more likely to treat young patients than old. Conclusions: Both provision of a risk estimate and lack of glaucoma subspecialty training were associated with physicians being more likely to treat ocular hypertension. These findings have implications with regard to ways in which the treatment of ocular hypertensive patients could be modified and possibly made more consistent with available evidence.