editor's perspective
New
Clinical Entities
BY
JOSEPH T. BARR, OD, MS, FAAO, EDITOR
I'm
sure that when Sattler saw his first veil, he was startled and made sure that he
was confident of what he saw before he wrote his first article about corneal edema.
Likewise, the first time clinicians saw central corneal clouding from PMMA contact
lens wear, they were amazed and at first hesitated to comment on it. And when Korb
first saw an edematous corneal formation, he worked repeatedly with others to make
sure he knew what he was seeing, even if he wasn't 100 percent sure of the etiology,
before he made his observation public. When Spring first reported GPC with contact
lens wear, was there controversy? No question. Imagine how astounded Zantos and
Holden must have felt when they first saw corneal endothelial bleb formation, how
unsure we were when we first observed corneal thinning in contact lens wear, and
how unsure clinicians were when they first observed superior limbic keratoconjunctivitis.
I know we were really perplexed when Schoessler and others first saw endothelial
polymegethism from contact lens wear. Other events that weren't reported include
such things as epithelial microcysts, superior epithelial arcuate lesions and lens
binding with GP lenses. In the early days of soft contact lenses, some practitioners
even denied that they acquired deposits. Of course, skepticism is common when we
see new clinical findings because of the old adage and common comment "but we've
never seen this before," which reminds me of the common slit lamp recording WNL
— short for "we never looked."
I
typically don't write about topics that appear in a feature article or column in
our publication. I usually write about anything else but the topics at hand. This
month Tom Løfstrøm, OD, MScOptom, and Allan Kruse, OD, from Denmark report
a new entity. Clearly this is controversial, if not critical. We also have another
report this month on the same topic by some experienced and well-known researchers.
We have no desire to sensationalize or diminish this new finding. The exact meaning
and prevalence of this finding remain uncertain. It reminds me of the earliest discussions
from about 10 to 12 years ago concerning edge staining and edge chips in disposable
contact lens wearers. I wouldn't under or over estimate this new finding. Certainly,
we'll see more reports and better analyses as time goes by, and surely we'll find
new entities to describe as we use better instrumentation and new products.
Contact Lens Spectrum, Issue: September 2005