How do you know?
- J T Rosenbaum1,2,3,
- A Deodhar2,
- E B Suhler1,
- J R Smith1
- 1Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
- 2Department of Medicine, Oregon Health and Science University, Portland, OR, USA
- 3Department of Cell and Developmental Biology, Oregon Health and Science University, Portland, OR, USA
- Correspondence to: James T Rosenbaum Casey Eye Institute, Oregon Health and Science University, 3375 SW Terwilliger Blvd, Portland, OR 97239–4197, USA; rosenbajohsu.edu
- Revised 27 January 2004
Some thoughts on judging efficacy in treating patients with uveitis
How do you know if your patient improves with any particular therapy? In the treatment of patients with vision threatening uveitis, the primary goal of therapy is far from universally accepted. Should the end point be improvement in visual acuity? An obvious choice but flawed since many patients benefit without a discernable change in acuity measurements. Cataract and macular scars can limit the improvement in acuity even as inflammation is controlled. In addition, acuity measurements do not reflect lighting, effort, or the sporadic variability that some patients observe with uveitis. Should the goal be reduced inflammation as judged by examination? How about improved visual function as judged by patient questionnaire or by physician assessment? Can a drug be deemed efficacious if it results solely in the reduction in a potentially toxic medication such as corticosteroid? Is stabilisation of acuity an adequate goal? If judging benefit is so complex, is there a way to use a single instrument to accommodate multiple potential end points? As we enter an era of trying to base medical decision making on evidence, we …
