Guest Editorial

A matter of perspective

By Laura M. Periman, MD

The practice of medicine is the natural union of art and science. No wonder many ophthalmologists are visually driven: we like to see the picture and recognize the pattern of disease. So it is with me. I would rather see a picture, figure or diagram than read a chapter.

This point is especially true with my special interest in ocular surface disease — I deliberate its clinical management from simultaneous perspectives. The subjective and objective information contains multiple, even discordant or conflicting data points, that when pieced together and viewed as a whole, looks…rather like a Cubist painting.

Cubism fuses the past and the present. It is the representation of different views and angles of the subject pictured at the same time. Each dissonant angle appears garish, even confusing in single consideration, but when viewed as a whole, a defined, unified picture emerges. In the case of Cubism, it is also beautiful.

View OSD as you would view a Cubist painting. Examining only details, you’ll consider the components intriguing but perhaps discordant. But seen en masse, a challenging, compelling portrait emerges. Yes, the signs and symptoms do not correlate and that can indeed be frustrating. But frustration dissipates when they are viewed as one.

The Blue Period has long passed for OSD. With each advance in diagnostics and treatments, we can capture the OSD picture with more color and precision.

Nearly everything we do as ophthalmologists depends upon multiple and simultaneous perspectives. For example, before we perform cataract surgery, we collect extensive amounts of data and we process patient expectations to optimize cataract surgery and IOL selection. In glaucoma management, we rely upon examination and special testing in order to guide our treatment recommendations.

OSD is no different. Simultaneously viewing subjective and objective data points, physicians can skillfully process and optimally view the clinical picture.

In the context of neuropathic corneal pain, a subset of OSD known as “pain without stain,” a clearer picture emerges when it is viewed as simultaneous inflammatory, neural feedback, damaged inhibitory pathways, central processing and efferent signaling pathologies.

Similarly, different perspectives in the clinic add to OSD’s whole management picture. In this issue, physicians did not author all OSD-related articles, and for good reason. It takes many skill sets to organize and maintain a dry eye clinic and some are represented here. Think of clinics that have successful dry eye centers: they typically have “champions” — MD, OD, surgical counselor, lead technician or even a practice manager — who see how the patient-benefit and practice-benefit picture emerges.

How lucky are we to be at the crossroads of science and art. The OSD components, when viewed as one, are more beautiful and compelling than they appear up close. It’s a matter of perspective. OM

OM’S GUEST EDITOR FOR AUGUST:
	Laura M. Periman, MD, is a cornea and refractive surgery-trained ophthalmologist in Seattle, Wash. Her interests in immunopathophysiology began in the 1990s when she was a research and development associate at Immunex Corp. Reach her at lauramperimanmd@gmail.com.