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.