Cognitive Biases in Ophthalmology: A Systematic Review

Authors:Trisha Kandiah, Yannick MacMillan, Danah Albreiki. 

Author Disclosure Block:T. Kandiah: None. Y. MacMillan: None. D. Albreiki: None.

Abstract Body:

Purpose: Diagnostic errors are common in medicine and account for up to 17% of adverse hospital events. Compared to other types of medical errors, these errors are proportionally associated with higher morbidity. Despite cognitive biases being increasingly recognized as one of the causes of diagnostic errors, the relationship between them is under investigated in the literature. This is especially true in the clinical context of ophthalmology. Therefore, the purpose of this systematic review is to outline the common cognitive biases that have been reported in the ophthalmology literature.
Study Design: Systematic Review
Methods: A systematic literature search was conducted using the MEDLINE and Embase databases. The search strategy targeted the topic of cognitive biases in ophthalmology, and articles were screened based on predefined inclusion and exclusion criteria. The search generated 432 results, of which 23 were retained for full text review. Ten articles met inclusion criteria and were included in the final analysis. The quality of the studies was assessed using the Newcastle-Ottawa scale.
Results: Across the included studies, 73 instances of cognitive biases in patient encounters were disclosed, involving over 55 distinct ophthalmologists. Inheritance bias (12.1%) and the framing effect (12.1%) were the most common cognitive biases in the literature. Vertical line failure and search satisfying each accounted for 9.7% of the cognitive biases. The majority of studies were associated with diagnostic error rather than therapeutic error. Overall, there was only a limited number of studies that examined cognitive biases in the field of ophthalmology using clinical scenarios, either real or simulated. Hence, examples of cognitive biases that are common in other medical fields (i.e. anchoring bias, overconfidence, availability bias) were not reported in the included studies.
Conclusions: Cognitive biases affect decisions in medicine and have a significant impact on patient care. Inheritance bias and the framing effect were the most common cognitive biases found in the clinical ophthalmology literature, followed by vertical line failure and search satisfying. That said, the number of studies in this field is limited and more research is needed on cognitive biases with regards to decision making of ophthalmologists, using real clinical cases.