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Dispatches from ARVO 2014, Day 1: Can "good enough" actually be better?

A picture of all the people at the conference.

The line to get in to the conference rivals that of any nearby theme park.

Hello once again from ARVO! I’m writing to you from the Orange County Convention Center in Orlando, having just completed the first day of the 2014 Annual Meeting.

As I worked my way through the hundreds of concurrent posters and talks, homing in on the topics that are relevant to my own research as well as those I thought would be of interest to our readers, the thought that seemed to tie all the various bits of research together was “Don’t settle for ‘good enough’”. This theme actually started to bounce around in my head before I even arrived here, thanks my choice of in-flight reading. Makers: the new industrial revolution by Chris Anderson is a wonderfully written and informative book about innovation. It deals almost exclusively with entrepreneurial endeavors in the internet age, but presents numerous real-world examples of thinking beyond ‘good enough’ and pursuing innovative solutions to current challenges.

This book was still on my mind when I entered the meeting this morning, prepared to learn all the novel advances in vision research that have taken place over the past year, and musing on the mantra ‘don’t settle’. The Opening Keynote talk was delivered by Nobel laureate Barry Marshall, whose work linking the bacteria H. pylori to peptic ulcers and gastric cancers has made an immense impact on human health.

Dr. Marshall’s talk extolled the benefits of research driven by passion and curiosity. Researching within the paradigm of a scientific consensus is what most of us do, appropriately enough, but as I’ve often said, you never known where the next great idea is going to come from. Allowing, even encouraging, people to think beyond the paradigm is a good thing for advancement of knowledge, although unfortunately it isn’t something that’s particularly encouraged by our current research funding system. “Please give me three years worth of support so I can think beyond the normal framework” isn’t a proposal that’s likely to get much attention from the NIH. Nevertheless, there is great value in spending time conceiving of better ways to do science, if your budget and intellectual capabilities allow.

I kept this in mind throughout the day, contemplating what a careful balance one must strike to conduct research founded in established scientific principles while also striving to make it novel and innovative. I saw a lot of wonderful exciting work, but one poster presentation that will probably be of interest to Usher Coalition blog readers stood out in particular as a unique example of ‘not settling’:

Clinical researchers in the lab of Dr. Anne Fulton, an ophthalmologist at Boston Children’s Hospital, conducted a study comparing the sensitivity of standard ERG testing to Dark Adaptation Testing (DAT) in children with Usher syndrome Types 1B and 2A.

Without exception, every ophthalmologist I’ve ever spoken to at these meetings has expressed a great desire for better diagnostic tools to apply to their Usher patients. They want more information on the decline in vision, more definitive data on which to base predictions on the rate of loss, or to correlate the physical changes that are happening in the eye with the various visual function tests. These are great goals, and of course have contributed invaluably to our knowledge of the disease and our most tractable approaches to treating it. However, I probably don’t have to point out to our readership that these precise testing methods can be pretty drawn out and unpleasant, especially for pediatric patients who don’t understand the point of it all. The researchers working with Dr. Fulton found that ERG responses, which measure electrophysiological cellular output in specific retinal cells, give a more exact readout of visual function than DAT, a simpler, less invasive test where the patient indicates whether he or she can perceive progressively dimming spots of light in a darkened room. However, they also showed that careful analysis of the DAT responses can provide an accurate, trackable readout of a patient’s visual response.

Wait, what? Didn’t I just spend a page and a half talking about “not settling”? If the ERG is clearly the superior test for detecting visual response, why am I continuing to describe the virtues of the DAT? Well, it goes back to the point about the patient experience. To obtain those valuable, information-laden ERGs, pediatric patients under the age of 9 or so usually have to be under general anesthesia, otherwise they’d never sit still for it. Even for those old enough to tolerate it while conscious, the test is long, invasive, and unanimously unpopular. And, although the data obtained are very sensitive and precise, if a less precise but also less arduous method could provide adequate clinical information, wouldn’t that be worth considering? This is a case where settling for “good enough” in terms of the specificity of the results must be balanced against not settling for “good enough” with regard to patient comfort and tolerance of the procedure. If the DAT information allows clinicians to monitor vision loss with enough accuracy to be clinically useful, it could reduce the frequency of ERG testing for pediatric patients.

More highlights from Day Two of ARVO coming tomorrow.

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