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Combine today’s research, formal training
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As any seasoned clinician can attest, patient care is not an exact science. Individual patient attributes, in conjunction with a multitude of external factors, account for the wide array of clinical responses. It is for this reason that the practice of optometry requires a broad knowledge base, a commitment to ongoing education and sound professional judgment. To illustrate this, consider the following case.
I recently saw a healthy 33-year-old female for an annual ophthalmic examination. She wears silicone hydrogel contact lenses daily, uses a multipurpose lens care solution nightly and is compliant with her replacement schedule. She is asymptomatic, and her examination – which includes a meticulous biomicroscopic evaluation – reveals no compromise of the ocular surface. In essence, she is a happy patient.
However, upon referencing a corneal staining grid, we realized that her contact lens and lens care solution are of “questionable” compatibility. A controversy is born. Do we allow her to continue with her current lens design and care product, given her favorable examination results? Or should we prescribe a different contact lens or lens care product? A compelling argument can be made for either management strategy.
As clinicians, we are driven by the fundamental mandate to care for our patients while avoiding harm. It is for precisely this reason we meld our formal training with contemporary research, all in an effort to better our patient care decision making. While it is imperative that we embrace emerging research, it is equally important that we interpret it for what it is. This is especially evident in the area of solution-induced corneal staining (SICS). Indeed, research involving SICS resulted from our need to better understand the relationship between contact lens materials – especially silicone hydrogels – and the various lens care products in the marketplace today.
The concept of staining grids emerged as a way of providing data sets in an easily conceptualized way. While staining grids have provided us with some insight into this relationship, they have also created a variety of questions, such as: Is corneal staining on some level a naturally occurring phenomenon? At what level does corneal staining become clinically significant with attending risks to patient health? How do we differentiate SICS from other forms of corneal staining? Can we accurately measure SICS in a reproducible manner? While generalized corneal staining may well increase the risk of sterile inflammatory infiltrative keratitis, does SICS do the same? Perhaps most provocatively, does SICS correlate with an increased risk of microbial keratitis?
While the answer to the latter is no, many of the aforementioned questions lack a definitive answer. It is for precisely this reason that ongoing research is so important. Not just any research, but rather, research employing sound scientific methodology, rigorous statistical analyses and defensible conclusions. In the meantime it is essential we exercise good professional judgment in providing our patients with much needed guidance. After all, our patients look to us for answers, not confusion.