editor's perspective

Let Evidence Guide Your Medical Decisions

BY JASON J. NICHOLS, OD, MPH, PHD, FAAO

You've probably heard at least some of the terms floating around these days that are being used to describe and qualify the practice of medicine. These terms include descriptors such as "evidence-based medicine," "gender-based medicine," "alternative medicine," and "value-based medicine." Some of this may be related to the current national debate on health care and the ways in which it is funded. However, much of it may simply relate to the evolution of clinical medicine.

Of these terms, one that I think deserves some attention is the idea of evidence-based medicine. It is thought that this term first appeared in the medical literature in the early 1990s. Evidence-based medicine is the practice of using evidence obtained from scientific studies to make medical decisions. It's the idea that clinicians use research to optimize clinical practice patterns so that they predict the most desirable outcomes for their patients. I have witnessed (and am witnessing) a significant shift in ophthalmic curricula that no doubt has followed the changes occurring within medical curricula at academic institutions in general. In some instances, this transition has been one of changing a culture, which is no easy feat.

Some question why evidence-based clinical practice is necessary. For instance, I often hear comments such as "why do we need a study to tell us something we already know from clinical practice?" The simple fact is that individuals typically have biases that influence their actions, and these biases may be wrong and may lead down a wayward path. For example, many practitioners used alignment-fitted GP lenses for myopia control for years. Yet, two controlled clinical trials have now shown that alignment-fitted GP lenses do not slow the progression of myopia (Katz et al, 2004; Walline et al, 2004). The scientific process, while not necessarily completely unbiased in and of itself, helps reduce the potential for these biases and inappropriate decisions.

I feel it is important that we as contact lens practitioners base our practice patterns on evidence as much as we possibly can. We try very hard at Contact Lens Spectrum to make sure that we incorporate supporting references for materials that should be referenced, or we try to make it otherwise clear that authors are stating an opinion or their belief. CLS will always be a place where colleagues in the eyecare industry can share their opinions — we recognize that research topics often come from practitioners who notice a trend in their practices and that good research is often based on clinical observation. At the same time, we hope that you join us in embracing evidence-based contact lens practice.

For references, please visit www.clspectrum.com/references.asp and click on document #169.