Vision Impairment by Choice: Why Do Patients Decline Macular Hole Surgery?
Bibliographic record
Abstract
Introduction: Vision care providers generally assume that patients who are affected with treatable vision impairment are interested in appropriate medical options. It has been our clinical experience, however, that approximately 10% of macular hole (MH) patients opt to decline surgery, even though its beneficial effects have been well established. They, thereby, choose to remain visually impaired in the affected eye. The present study investigated visual acuity in the unaffected eye, living distance from the hospital, and the presence of other age-related medical conditions as possible factors in the decision-making process of seniors affected with MH. Method: Thirty patients (aged 59–81 years) who declined treatment between 1998 and 2003 were matched on age and gender with a group of patients who chose the surgical intervention during the same time period. Information from their medical files was used for statistical comparison. Results: The groups did not differ statistically with regard to acuity in the other eye, living distance from the clinic, or the number of other medical conditions. Conclusion: The results indicate that these three variables do not seem to play an important role in the patients' decision-making process. The required 24-hour face-down positioning for approximately three weeks after surgery, as well as possible aspects of each patient's personality and social environment, may carry heavier weight. In addition, patient education and patient-vision care provider interaction are discussed. No patient has declined surgery since a research psychologist in the clinic started supplying potential surgical candidates with additional information and an opportunity to ask individual questions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".