SURVEY OF OPHTHALMOLOGY

VOLUME 53  NUMBER 2  MARCHAPRIL 2008

EDITORIAL

Proverbs, Authoritative Sources, Eponyms, and the Survey of Ophthalmology

Believe not all that you see nor half what you hear.8 This admonition certainly applies to the Internet. If you search on this proverb and its variants, you will nd similar statements attributed to Benjamin Franklin, Edgar Allen Poe, and others. The accuracy of many of these attributions is suspect. We live in an age of information, and the question increasingly becomes what do we access and accept? Even usually authoritative sources have their limitations. Ophthalmology residents use the Academys Basic and Clinical Science Course (BCSC) to study for the Ophthalmic Knowledge Assessment Program (OKAP) and Written Qualifying Examination (WQE)--as well they should, since the multiplechoice questions found on these tests are primarily derived from this remarkable series. At Boston University Medical Center we have an ongoing seminar where each resident in turn abstracts an assigned section and questions the other residents on the subject matter. Whenever I contradict something found in the BCSC, my residents are dismayed. They seek a single right answera, b, c, or d. Consider the statement in recent editions that An increased prevalence of keratoconus has been reported in . Leber congenital hereditary optic neuropathy..3 First of all, there is no such disease. There is Leber congenital amaurosis, and there is Leber hereditary optic neuropathy. Leber congenital amaurosis is a congenital retinal dystrophy that is associated with an increased incidence of keratoconus in later life.7 Leber hereditary optic neuropathy is a mitochondrially-inherited disorder that classically has its onset in young men, but the availability of specic genetic testing has expanded the clinical spectrum to many cases previously thought to
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represent idiopathic or other forms of heredofamilial optic neuropathy, some in children, but none congenital.2 It has no known relation to keratoconus. Theodor Leber was a prolic observer, and his name is also attached to Leber miliary aneurysms which he distinguished from the retinal telangiectasia of Coats disease--and to Leber stellate neuroretinitis.4 Neuroretinititis is the association of optic disk swelling and a macular star gure, a variant of optic neuritis rarely if ever caused by demyelination. Compounding the potential for nosological confusion, Leber stellate neuroretinitis is referred to as Lebers idiopathic neuroretinitis in Walsh and Hoyts Clinical Neuro-ophthalmology,10 as Lebers idiopathic stellate neuroretinitis in Albert and Jakobiecs Principles and Practice of Ophthalmology6 (although many cases turn out to have denable infectious causes, especially cat scratch disease), and as Lebers stellate optic neuropathy in Yanoff and Dukers Ophthalmology.5 In a discussion of neuroretinitis in another chapter in Yanoff and Duker, the eponym isnt even mentioned.1 Will the real Leber disease please stand up? How is all this relevant to the Survey? This journal serves the ophthalmic community by reviewing current knowledge in our specialty. Does this mean that everything published here is authoritative? No, there will certainly be errors and divergent opinions. The former is a seemingly inevitable part of all human endeavors, and the latter is one of the characteristics of scientic medicine. What the Surveys bimonthly format allows, however, is for its editors, reviewers, authors, and correspondents to establish a dialogue that allows readers to appreciate the explosion of medical knowledge without being blown away.

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Surv Ophthalmol 53 (2) March--April 2008

EDITORIAL
2. Barboni P, Savini G, Valentino ML, et al: Lebers hereditary optic neuropathy with childhood onset. Invest Ophthalmol Vis Sci 47:5303--9, 2006 3. Basic and Clinical Science Course; External Disease and Cornea, Section 8 2007-2008, American Academy of Ophthalmology, p. 330 4. Blum M, Kykin PG, Sanders M, Vo lcker HE: Theodor Leber: A founder of ophthalmic research. Surv Ophthalmol 37: 63--8, 1992 5. Brown GC, Brown MM: Coexistent optic nerve and macular abnormalities, in Yanoff M, Duker JS (eds), Ophthalmology. St. Louis: Mosby, 2004. p. 9638 6. Guyer DR, DAmico DJ: Lebers idiopathic stellate neuroretinitis, in Albert DM, Jakobiec FA (eds), Principles and Practice of Ophthalmology, Volume 2. Philadelphia: WB Saunders, 1994. pp. 809--13 7. Koenekoop RK: An overview of Leber congenital amaurosis: A model to understand human retinal development. Surv Ophthalmol 49:379--8, 2004 8. Oxford Dictionary of Proverbs. Oxford,Clarendon Press, 1970. p. 43 9. Schwartz B: The evolution of a journal. Surv Ophthalmol 13: 1--2, 1968 10. Smith CH: Optic neuritis, in Miller NR, Newman NJ, Biousee V, Kerrison JB (eds): Walsh and Hoyts Clinical Neuro-Ophthalmology. Philadelphia: Lippincott Williams & Wilkins, 2005. p. 336

When the late Bernard Schwartz assumed the editorship of this journal 40 years ago, its format immediately evolved, justifying his designation, the new [his italics] Survey of Ophthalmology.9 His vision led the Survey to its current status as a premier review journal, and I hope to continue in the tradition he established. The Survey will of course change, but the changes will respect his legacy. One difference is that, while Dr. Schwartz used his editorials primarily to acknowledge transitions, I shall also offer my perspective on the search for knowledge and how it is communicated. I look forward to participating in the dialogue. John W. Gittinger, Jr., MD Editor-in-Chief

References
1. Balcer LJ, Beck RW: Inammatory optic neuropathies and neuroretinitis, in Yanoff M, Duker JS (eds): Ophthalmology. St. Louis: Mosby, 2004. pp. 1263--7

doi:10.1016/j.survophthal.2008.02.001