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Dr Margo is correct in concluding that findings from clinical trials with rigid selection criteria are not universally applicable to all patients and physicians but only to patients who meet the enrollment criteria established for those trials and to physicians with comparable diagnostic and treatment skills. It also is true that certain types of data from community-based outcomes studies have the potential of being more broadly applicable to the universe of patients with a particular condition. However, because of limitations inherent in the outcomes approach (eg, lack of uniform case definitions and lack of appropriate controls), results from carefully controlled clinical trials will continue to serve as guidelines to practice management for the foreseeable future.The COMS misdiagnosis rate, taken in the context of the results of the study by Dr Margo, illustrates the potential for minimizing misdiagnoses in clinical practice. The quality-control mechanisms in the COMS to
Fine SL. The Accuracy of Diagnosis of Posterior Uveal Melanoma-Reply. Arch Ophthalmol. 1997;115(3):433-434. doi:10.1001/archopht.1997.01100150434029