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Tweak, observe, measure, repeat
Ours is a “process driven” profession.
Early in our training we receive the fundamentals by which to examine eyes and then embark upon a career during which these skills are constantly refined.
We tweak, observe, measure and then do it all over again. It is a discipline applied to all aspects of practice – from a pre-exam technician work-up through the final measurement obtained during eye wear selection.
 Michael D. DePaolis |
While some of this is driven by the need to see more patients in less time, it is done primarily to enhance patient care.
Improved efficiencies, better outcomes
Given optometry’s affinity for processes, it should come as no surprise we apply the same methodology to our treatment programs. Whether prescribing a contact lens or managing a glaucoma patient, we constantly strive for improved efficiencies and outcomes. It is for precisely this reason clinical research is so important. Across all health care disciplines, clinical research validates – or refutes – the next generation of treatment. In essence, we tweak, observe, measure and then do it all over again.
While we universally agree clinical research is the genesis for improved treatment programs, we must be cautious in our interpretation of outcomes. By design, clinical research is often inherently narrow – specific patient inclusion criteria, detailed protocol and a well defined outcome metric. This is for good reason, as a robust protocol assures a defensible outcome. The danger lies in how those (of us) in the patient care trenches interpret the results.
Put TVT results in context
A perfect example involves the “Tube vs. Trabeculectomy” study. A liberal interpretation of the TVT study implies that “glaucoma shunt surgery is a better choice than trabeculectomy in the surgical management of medically uncontrolled glaucoma.” While this may be true for certain patients, a closer look might suggest otherwise.
First, the TVT study included only those patients with medically uncontrolled glaucoma who had previously undergone trabeculectomy or cataract/IOL surgery. Second, while the tube surgery group experienced a greater reduction in IOP than the trabeculectomy group, many did so only with the benefit of adjunct medical therapy. Finally, the TVT study provided follow-up for 1 year only – arguably too short of a time frame from which to draw long-term conclusions.
While the clinical pearls gleaned from the TVT study are numerous, they are valuable only when applied in the proper context. Simply put, it is the practitioner who must ultimately determine the right solution for the individual patient at hand. So, we continue to tweak, observe and measure.