Our goal as ophthalmologists is to preserve and improve the vision of our patients. As part of this mission, we counsel our patients regarding the risks and benefits of various therapies. New treatments that have limited or unproven therapeutic value create an awkward position for ophthalmologists.
In the treatment of posterior segment diseases, randomized prospective multicenter clinical trials using treatment such as argon laser photocoagulation or pars plana vitrectomy have established the standard of care for patients with retinal vascular diseases. In the first major clinical trial in ophthalmology, the Diabetic Retinopathy Study1 showed clear evidence that panretinal photocoagulation reduced rates of severe visual loss in treated eyes compared with an untreated control group. Additional randomized prospective clinical trials on photocoagulation include the Early Treatment Diabetic Retinopathy Study,2 the Branch Vein Occlusion Study,3 and the Central Vein Occlusion Study.4 These carefully conducted and very important randomized clinical trials reported the risks and benefits of treatment compared with the natural history in untreated control groups.
Flynn HW, Scott IU. Intravitreal Triamcinolone Acetonide for Macular Edema Associated With Diabetic Retinopathy and Venous Occlusive DiseaseIt’s Time for Clinical Trials. Arch Ophthalmol. 2005;123(2):258-259. doi:10.1001/archopht.123.2.258