Patients' risk attitudes should factor into treatment decision-making
NICE, France — In making decisions concerning glaucoma treatment and target IOP, patients’ risk attitudes should play a role, according to a specialist here.
“Risk attitudes and risk assessments are highly individual, and the same risk is not the same for everybody,” Norbert Pfeiffer, MD, said at the 2014 European Glaucoma Society meeting. “A risk that, to us, is small may be large for some patients, and vice versa.”
Pfeiffer presented the example of a teacher who had surgery with very good results; however, she developed a bleb on the nasal side that heavily affected her self-confidence at work.
“She said that whenever she entered the classroom pupils stared at her. She was in tears, and I could not persuade her to have the second eye operated,” Pfeiffer said.
Treatment should be aimed not only at maintaining vision, but also at improving quality of life, he said. Some high-risk behaviors, such as drinking alcohol, driving fast or not using eye drops as directed, may be strictly related to the quality of life of the individual, he said.
According to Pfeiffer, the amount of time needed for treatment or the cost of medications might be areas of concern for some patients, whereas for others, treatment simply has a negative stigma.
“In my practice, I explain to my patients the concept of mean risk. I try to understand their personality and often make compromises between my idea of a treatment and their views,” Pfeiffer said. “I frequently assess their quality of life and take into consideration their risk acceptance. If it is very low, than I aim for lower target IOP; if it is very high, I aim for higher target IOP and delayed treatment, or less treatment.”
Disclosure: Pfeiffer has no relevant financial disclosures.