editor's perspective

Clinical Signs in Asymptomatic Patients

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

An interesting dilemma has been playing out for years in the way we care for our patients. It's something that I am sure each of you in practice has faced time and time again. Specifically, what is the appropriate action to take when you have an otherwise asymptomatic patient, but you notice some other clinical sign that could be related to a potential problem?

You have probably faced this issue many times. For example, what do you do when a contact lens wearer is asymptomatic, but you notice papillary changes that might be related to deposition? Do you refit the patient into a different material? Recommend a more frequent replacement? Change the care solution or care regimen? Or do nothing?

Likewise, think about the patient you were recently examining who had no complaints or symptoms, but during your slit lamp examination you noticed some meibomian gland capping and tear film debris. You think about your options—educate the patient, initiate treatment such as lid hygiene or warm compresses, or even consider an artificial tear or prescription therapeutic? Or the alternative option, which again is to do nothing. What do you do?

It is obvious that in considering these scenarios, we have to weigh the pros and cons—which include, among other things, the severity of the potential outcome that might ensue if we fail to intervene. That being said, I would argue that we have a professional and ethical responsibility to always provide optimal care for our patients regardless of the severity of an outcome, the extra time it will take us, or whether or not we get paid. After all, it's been said that "character is doing the right thing when nobody's looking" (J.C. Watts)—as eyecare providers, we should continue to look.