Balance between quality data, novel ideas can be fine line

There are many similarities between American ophthalmology and that practiced in other parts of the world. However at the Middle East African Council of Ophthalmology in Dubai it was learned that they report on potentially fascinating ideas supported only by preliminary results in very small series as well as work supported by long experience, large series, or well-designed clinical trials.

Recently, my travels took me to Dubai, where I attended the Middle East African Council of Ophthalmology.

It was a long flight to spend 48 hours someplace, but it was worth it. Dubai is an amazing place, characterized by rapid growth, a booming economy, and massive construction (including the world's tallest building). I left with the impression that the inhabitants of Dubai believe in almost limitless possibilities.

I visited the indoor ski resort and watched skiers and snowboarders bundled up against the cold catching the lift and coming down the mountain. The ski facility is part of a giant shopping mall filled with Gucci, Chanel, and all of the luxury brands (and I emphasize all). It's one thing to read about Dubai in a magazine and another thing actually to see it.

Some of the talks were different from what one might hear at U.S. meetings, reflecting the different spectrum of diseases, but they certainly seemed to be of the same excellent quality as would be typical of our best meetings. Although the United States benefits from National Institutes of Health funding of biomedical research, and many ophthalmic pharmaceutical and device companies are headquartered here, we clearly have no monopoly on high-quality clinical research.

One of my favorite parts of the meeting was a symposium in which I was not a speaker but a member of the audience. Entitled "So new it may not be true," the symposium highlighted topics that were intended to be brand new, exciting, and innovative, albeit not carefully vetted in large clinical trials.

As reflected by the title, the organizers were explicitly acknowledging that at least some of the interesting ideas or approaches presented in the symposium would be proven to be invalid. Nonetheless, the idea was that these were interesting and exciting concepts and, therefore, were worthy of presentation.

Among the topics were riboflavin cross-linkage to prevent or stop post-LASIK ectasia and new ablation algorithms to give better visual quality after LASIK. The sample sizes were small, but the speakers clearly believed in the "truth" of their ideas.

One issue that arises with Ophthalmology Times is where to draw the line between reporting on potentially fascinating ideas supported only by preliminary results in very small series (or even only laboratory studies) versus including only work supported by long experience, large series, or well-designed clinical trials. I acknowledge that my bias is toward the latter, because this publication is aimed primarily at busy clinicians who want reliable, clinically relevant, and valid data that they might wish to incorporate into their practices.

Rightly or wrongly, my preference has been to give more prominence to articles that I see supported by stronger clinical data, accepting the risk of passing on some future Nobel Prize-winning idea that has as of now only been tested in petri dishes, mice, or a couple of patients.

On the other hand, most ophthalmologists I know were near the top of their medical school classes and often are interested in new ideas and discoveries that might change our thinking about diagnosing or treating eye disease, even if that change might not reach clinical practice for a few years.

You have seen a few articles highlighting work in animals in Ophthalmology Times; those were selected because, although the ideas may not pan out in humans, the concepts seemed extremely thought-provoking. I hoped many of you would enjoy reading and thinking about them.

If you have thoughts about how well (or not) we are balancing "reliable and validated" versus "intriguing but preliminary" information, I'd be pleased to hear from you.

Peter J. McDonnell, MD is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times. He can be reached at 727 Maumenee Building, 600 N. Wolfe St., Baltimore, MD 21287-9278 Phone: 443/287-1511 Fax: 443/287-1514 E-mail: pmcdonn1@jhmi.edu