Neuro-ophthalmology Safer Than MRI?

Overdiagnosis of idiopathic intracranial hypertension

“…Improved clinical skills and determination of a pretest probability for each test ordered are simple ways to avoid cognitive traps along the road of making a diagnosis and deciding on a treatment plan. 18 One of the striking aspects of our results is the fact that a large majority of patients overdiagnosed with IIH were young obese women. The fact that ED providers or primary care physicians would wrongly suspect IIH in many of these patients is not surprising; however, most misdiagnoses were made by optometrists, ophthalmologists, and neurologists (some previously trained as neuro-ophthalmologists), who should be comfortable examining the optic nerve or evaluating a headache patient.…”

“…14,15 Numerous studies and editorials have emphasized the deficiencies in specific clinical skills of modern physicians 10,16,17 and the risk of overdiagnosis and misdiagnosis related to overinvestigations and misinterpretation of ancillary tests. [16][17][18][19][20] In their letter "Neuro-ophthalmology safer than MRI?" Sadun et al 18 emphasized that "ordering the wrong test at the wrong time is not only a waste of resources and a cause of delay to proper diagnosis, it can also lead to the wrong diagnosis path and that can be very dangerous."…”

“…[16][17][18][19][20] In their letter "Neuro-ophthalmology safer than MRI?" Sadun et al 18 emphasized that "ordering the wrong test at the wrong time is not only a waste of resources and a cause of delay to proper diagnosis, it can also lead to the wrong diagnosis path and that can be very dangerous." "Better thinking" is indeed one of the main solutions proposed by Wachter 19 to avoid diagnosis errors and overdiagnosis.…”

“…In addition to improving the clinical skills of our trainees, and increasing awareness about the influence of biases and their effect on clinical reasoning, early referral to the appropriate clinical experts may be the best remedy for diagnostic error. 18 …”

Visual field changes as an early indicator of glioblastoma multiforme progression: two cases of functional vision changes before MRI detection

“…This fundamental concept is well known but often overlooked in the era of increasingly sophisticated imaging techniques. Overreliance on imaging that does not fit with clinical findings may lead to delayed treatment, inappropriate treatment, or unnecessary tests 12. While imaging has played and will continue to play a key role in the monitoring of GBM, the development of accurate tools to assess clinical status should be similarly emphasized.…”