As physicians, we pride ourselves in our use of the scientific method to give the best care to our patients. Yet many of our daily treatment decisions reveal us more as apprentices than scientists. We choose a particular treatment not because a clinical trial determined that it worked better but because that is the way our mentors’ mentors did it. The problem is practical: randomized controlled trials, while scientifically powerful, are difficult and expensive to carry out effectively. Consider amblyopia, a well-recognized cause of vision loss in millions of our patients. Do we occlude the eye with a patch or blur with atropine? If we use atropine, do we use it daily or just on weekends? If we patch, how many hours work best? When do we stop treating? When is it too late to start?
Hunter DG. Treatment of Amblyopia in Older Children. Arch Ophthalmol. 2005;123(4):557-558. doi:10.1001/archopht.123.4.557