The impact of risk calculation on treatment recommendations made by glaucoma specialists in cases of ocular hypertension

PURPOSE: To determine whether a risk calculator changes treatment recommendations made by glaucoma specialists in cases of ocular hypertension. METHODS: Two groups of case scenarios were created using the results of the Ocular Hypertension Treatment Study (OHTS) such that pairs of scenarios had the same risk of developing glaucoma. Glaucoma specialists were asked to review the cases and to make treatment recommendations. Only the second group included the estimated risk of glaucoma. The recommendations of the specialists were analyzed using ordinal regression and 2 measures termed confidence and inconsistency. The relative weighting of risk factors derived from physician recommendations was also compared with the weighting of those factors in the OHTS. The main outcome measure was quantitative change in recommendations when physicians were provided with an estimate of glaucoma risk. RESULTS: Inclusion of the calculator changed recommendations, increasing the measure of confidence and decreasing the measure of inconsistency. The relative weighting of risk factors by physicians in cases in which they did not have a risk calculation were different from the weights of those same risk factors in the OHTS. Even with the risk calculation, physicians tended to weight intraocular pressure and cup-disc ratio more heavily than the OHTS would suggest. CONCLUSIONS: Use of a risk calculator in cases of ocular hypertension changed treatment recommendations. Furthermore, the relative weighting of risk factors was more consistent with the published results from the OHTS when a risk calculation was available.