The Effect of IOP on Clinicians’ Perceptions of Glaucomatous Optic Neuropathy

Leon Nehmad, MSW, OD, FAAO 
Richard J. Madonna, MA, OD, FAAO


Background: Clinicians’ determination of glaucomatous optic neuropathy may be biased by other aspects of the case, including patient intraocular pressure (IOP). 

Methods: Optic disc photos rated as glaucoma, normal or uncertain along with an IOP reading were shown to clinicians with various levels of experience. The clinicians were asked to label the photos as glaucomatous or normal. One month later, they were asked to re-evaluate the photos using the same or different IOP. 

Results: Reclassification was extensive across all levels of clinician experience. Reclassification based on IOP change was greater for less experienced clinicians, who were also more likely to reclassify when IOP was decreased. 

Conclusions: Less experienced clinicians may be more likely than those with more experience to change perceptions of glaucomatous optic neuropathy based on IOP. Training should be aimed at evaluating the optic nerve independent of other variables. 

Key Words: glaucoma, optic nerve assessment, clinical education

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