“WITHOUT DEVIATION FROM THE NORM, PROGRESS IS NOT POSSIBLE.” —FRANK ZAPPA

By Andrew S. Morgenstern, OD, FAAO

Once every few months, those silly editors from Bryn Mawr Communications and Advanced Ocular Care let me have the mic at the virtual podium in the form of this column. For some insane reason, they also leave me to choose my own topic to discuss with my fellow eye care providers from around the globe.

You may have noticed that I really like to embrace quotes of those that I consider the best in their respective fields. Clearly, these folks have something to offer and significant wisdom to impart. This time around, I decided I was either going with one of the masters of the one liner (shout out to Uncle Milty and Henny Youngman), Norm Peterson, played by George Wendt, from the TV show Cheers!—or one of my favorite musicians of all time, Frank Zappa. I found a way to combine two of them in one quote.

We all know that it is incredibly challenging for any health care provider to change his or her routine once in clinical practice for a few years. During our training, we learn to perform exams and develop a skill set for our full range of procedures. We strive to perfect our skills and become as proficient as possible for the benefit of our patients. We know that repetition and practice bring us closer to clinical perfection. Although we continue to strive for expertise in our skills, we sometimes forget to continue to embrace new and improved devices and procedures. As medical technology rapidly improves at a rate of which we have never before seen, we need to keep our eyes open to new and improved options that may best help our patients. At the same time, we must be vigilant for those interventions that can do harm. Once we find a new great technology, we need to learn it and then apply it in practice. If we don’t, the ship will set sail without us. This could lead to our practices becoming outdated and irrelevant.

Take corneal collagen crosslinking (CXL), for example. The eye care community has fully embraced this great new technology and treatment method with open arms, yet many of our fellow providers still do not understand (1) the real prevalence of keratoconus and ectatic disease; (2) the importance of the posterior aspect of the cornea; (3) the importance of obtaining and utilizing equipment that can evaluate the entire cornea—including the posterior surface and limbus-to-limbus pachymetry measurement; and (4) the importance of treating progressive disease at the earliest stage possible.

That same group of eye care providers that has likely not kept up with the rapidly evolving methods of identifying and treating progressive keratoconus may still rely on anterior corneal surface-based Placido disc imaging as the “gold-standard” in the evaluation of keratoconus and the family of the ectasias. The reason? Because “that is how I was taught when I was in training.” That is not an acceptable excuse anymore. Access to information in the form of evidence-based research has never been easier. It is the responsibility of the doctor (with the help and support of industry) to keep up with all of these changes in clinical practice. A perfect example as it relates to CXL is specifically outlined in one particular study, “Global Consensus on Keratoconus and Ectatic Diseases” by Gomes, et al (Cornea April 2015). This study has literally spelled out for us, among other things, the mandatory findings to diagnose keratoconus. Great academic work like this needs to be recognized and circulated, discussed and taught to the masses in clinical practice and academic environments to best serve our patients.

Sometimes it is uncomfortable to change and practice outside of our secure zones, but change in optometry, ophthalmology, and all of medicine is inevitable, especially in 2016 and beyond. The one thing we know is that we all must be adaptable and be open to changing our ways to fit into the new world of medicine. We need to embrace new technology to provide complete and comprehensive eye exams while at the same time making sure to eliminate new technology that is destructive to our professions and harmful to patients. There is so much brilliant technology that has arrived in the ophthalmic marketplace and more continues to arrive. So deviate from the “Norm” and start making some clinical progress!

As Frank Zappa once said, “Be a civic hellraiser!”

BTW: If you screamed “Norm!” in your head every time you read it in this article, you are old… n

Cheers!

Andy

Andrew S. Morgenstern, OD, FAAO

Chief Medical Editor