Therapeutic decisions involving disparate clinical outcomes - Patient preference survey for treatment of central retinal artery occlusion

Background: Major therapeutic decisions are made by patients with information and guidance provided by their physicians. The values patients place on different outcomes and the risks they are willing to accept are important factors in making these decisions. New beneficial therapies associated with potentially serious complications are now available for some blinding diseases. The authors aim to determine the maximum amount of risk of stroke and death persons would accept to recover vision. Methods: Standardized survey of adults with normal vision. Results: Thirty-nine percent and 37% of surveyed adults would accept some risk of stroke and death, respectively, to triple the chances of recovering 20/100 visual acuity in one eye when binocular. More than 80% of persons would accept these risks if they were monocular. Maximum risk scores were significantly higher in the monocular case scenarios than in binocular case scenarios. Medical students and eye physicians were more likely to accept risk than persons with high school or university educational backgrounds. Conclusions: The value persons place on vision when weighed against the risk of stroke or death varies considerably. More persons are willing to accept life-threatening risks if they are monocular. The reason physicians and medical students are more likely to accept serious risks to improve vision than nonphysicians is unclear. Further studies are needed to determine how physicians' values effect the patient decision-making processes.