editor's perspective

A Different Way to Look at Lens Complications

By Jason J. Nichols, OD, MPH, PHD, FAAO

I have recently been reading Malcolm Gladwell's books. I find them entertaining and thought provoking. His most recent book, What the Dog Saw: and Other Adventures, is a compilation of many of his articles that originally published in The New Yorker, where he is on staff. The book attempts to provide a vision of the world through the eyes of others, including dogs.

In the section called “Million Dollar Murray,” Gladwell tells stories of alcoholism/poverty and police brutality and makes the case that although each of these problems is large in number, they can essentially be boiled down to “a few hard cases.” When fitted mathematically, these “few hard cases” follow a power law distribution (a statistical distribution that looks like a “hockey stick”). Gladwell goes on to say “… and that's good news, because when a problem is that concentrated, you can wrap your arms around it and think about solving it” rather than simply managing it. This got me thinking about contact lenses and associated complications from this perspective—I wonder if this combination of factors would also be best fitted by the power law distribution?

If you stop to think about it, vast clinical experience as well as dozens of studies have shown that many of our contact lens patients are not compliant with some aspect of contact lens wear, for example. Why, then, are not more of our patients stricken with a significant complication such as microbial keratitis? More interestingly, what is it about the few patients who do end up with a significant complication that makes them different? First and foremost, contact lens wear is a safe mode of vision correction, and I also must emphasize that I am in no way arguing that compliance is not important. However, rather than focus on the variables that are the same (or similar), shouldn't we be looking for what may be unique or different? Maybe this would help us solve the problem.

Lately I've been hearing from practitioners about a potential rise in infiltrative keratitis in contact lens wearers. I've had practitioners tell me that they feel that certain contact lenses, care solutions, or combinations of contact lenses and care solutions are the culprit. So where are we on this issue? Is there a true rise or is this also an example of “a few hard cases” and better awareness of the problem? I don't begin to know the answer to this, but we are committed to bringing you more on these issues in the months to come.