Human factors underestimated in retinal detachment management

The complexities of human psychology play a far more important role in the decision-making process concerning key questions of retinal detachment (RD) management than we might imagine, Bill Aylward FRCS, FRCOphth said in his Kreissig Lecture delivered at the 15th EURETINA Congress in Nice.

In an entertaining and wide-ranging lecture on the topic of “A logical approach to retinal attachment”, Dr Aylward, UK, touched on topics as diverse as mathematics, statistical theory, medicine and psychology to explain why it is so difficult to resolve some of the more intractable questions surrounding retinal detachment.

“I was thinking about the subject of this lecture and reflecting on a number of questions which have interested me over the years, and I thought I would take just one question and try to resolve it. However, I soon realised that, not only have these questions been around since the beginning of EURETINA, but I did not actually know the answer to any of them myself for sure,” he said.

The questions which Dr Aylward referred to included items such as: ‘does laser treatment to lattice degeneration reduce the lifetime risk of retinal detachment?’; ‘what is the best treatment for rhegmatogenous retinal detachment (RRD)?’; and ‘does shaving the vitreous base increase the success rate of vitrectomy for RRD?’

These questions are not resolved for a variety of reasons, including the subject matter, tools and human and psychological factors, said Dr Aylward.

Taking the example of lattice degeneration and whether laser treatment might reduce the lifetime risk of retinal detachment, Dr Aylward said that while this could be resolved with a randomised clinical trial, in reality it is not so easy.

“We know that the annual incidence of RD is 0.01 per cent, and if we assume that the laser works and cuts the detachment rate by 50 per cent, the number of patients required is over 7,000 in each arm of the trial. And because we are treating young people we need to wait until they have had their posterior vitreous detachment, so we would need a 40-year follow-up. Clearly this is never going to happen,” he added.

Psychology also plays an important role in the decisions that physicians make in terms of treatment, said Dr Aylward.

He cited issues such as confirmation bias – the tendency to search for, interpret, favour and recall information in a way that confirms one’s beliefs or hypothesis – as posing a problem for logical decision-making. Similarly, physicians should be aware of the “sunk cost fallacy” by which future decisions are inappropriately influenced by past investment.

·    The Kreissig Award was established in 2003 in recognition of the immense contribution of Prof Ingrid Kreissig to ophthalmic training and research, particularly in the field of retina