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Linda Yang, Chan Nguyen; The Impact of Clinical Experience on Thresholds for Initiation of Treatment for Glaucoma Suspects. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6468.
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© ARVO (1962-2015); The Authors (2016-present)
Early intervention with topical ocular hypotensive therapy can prevent progression of primary open angle glaucoma, but the threshold for initiating treatment for glaucoma suspects largely depends on clinical experience. We performed a retrospective clinical study to evaluate the impact of clinical experience on the thresholds for initiation of treatment for glaucoma suspects.
This is a retrospective chart review of patients seen in the Department of Ophthalmology at Parkland Health and Hospital Systems (PHHS) and the University of Texas Southwestern Medical Center (UTSW) from December 1, 2013 to June 30, 2014. All included patients met the screening criteria of glaucoma suspect diagnosis and had no prior ocular surgery. Data analyzed included demographics, central corneal thickness, baseline intraocular pressure, cup-to-disc ratio and Humphrey visual field pattern standard deviation. The threshold risk score at which ocular hypotensive treatment was initiated by residents and faculty, including glaucoma specialists and non-glaucoma specialists, were calculated with the glaucoma risk calculator. The average threshold risk score of the less experienced residents was compared with that of the faculty using a two-sample t-test. The average threshold risk score of glaucoma specialists was also compared with that of the non-specialists. This study received IRB approval from both PHHS and UTSW.
43 patients at PHHS and 42 patients at UTSW were included in the study. The average threshold risk scores for residents and faculty were found to be significantly different (p<0.05) at 11.81 and 10.40 respectively. The average threshold risk scores for glaucoma specialist and non-specialists were 10.71 and 10, respectively, without demonstrable statistically significant difference.
The results showed that residents had a significantly higher threshold for treatment initiation than faculty. The results also suggested a slightly higher threshold for treatment initiation in faculty who were glaucoma specialists compared to faculty who were not glaucoma specialists. This indicates the importance of clinical experience for determining the optimal time for treatment initiation. Larger sample studies and long-term follow-up for the ultimate clinical outcome would be required to determine the actual impact of clinical experience and the practical application of the risk score calculator.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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