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Some patients require innovative care
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As clinicians, it would be arrogant to presume we have all of the answers, to think that our diagnosis and first-line therapy is perfect every time. In doing so we assume patients are predictable and unyieldingly consistent. Of course, we know they are often anything but. It is the complexity and uniqueness of each patient that makes clinical care so humbling. It is for precisely this reason we treat each patient with attention to detail, a tincture of skepticism and an open mind.
This dictum was again made perfectly clear for me through a recent patient encounter. John, a 55-year-old, had a history and symptoms classic for dry eye. John’s physical examination was equally compelling and, as such, I anticipated he would respond favorably to a fairly straightforward therapeutic regimen. Unfortunately, my initial strategy – lifestyle and dietary modification, lid hygiene and lubricating drops – failed to significantly improve John’s status.
Not to be daunted, I prescribed topical steroids, cyclosporine and eventually doxycycline, all with less-than-stellar results. With John growing weary, and me a bit desperate, I suggested an omega-3 supplement. I thought John was lost to follow-up when he returned a few months later. He was thrilled, not only with the omega-3’s impact on his dry eye, but with the fact that his rosacea had dramatically improved as well.
In reality, John’s success should not surprise us, as omega-3 supplements have become an integral part of managing dry eye in recent years. However, this wasn’t always the case.
This dilemma is not unique to omega-3 supplements. This has long been an issue for a variety of nontraditional therapies as well. Whether we’re discussing vitamins, nutritional supplements, homeopathic agents or even acupuncture, traditional medicine has been slow in embracing alternative therapies.
To a certain degree, it’s understandable. Many of these options lack the well-conducted, masked, placebo-controlled, peer-reviewed clinical trials we so fervently covet. The problem lies in the fact that these clinical trials are lengthy, arduous, costly and, therefore, difficult for manufacturers to justify. Despite these challenges, we are witnessing a shift in sentiment regarding nontraditional therapies. We’ve seen it with respect to multivitamins and carotenoids in age-related macular degeneration, for homeopathies in allergies and for omega-3s in dry eye.
While nontraditional therapies provide us with exciting alternatives in treating some of our most vexing clinical cases, we must always remember that our primary responsibility is to protect our patients. It’s also our responsibility to provide patients with the best care possible. That means being innovative and keeping an open mind.