In many respects, we live in a world of absolutes. For instance, in the late 1800s, Dr. Henry Pickering Bowditch proclaimed the “all-or-none law” to describe how nerves and muscles respond to stimuli in a very predictable way. Similarly, in 1928, mathematician Andrey Komogorov established “the zero-one law,” proving the probability occurrence of certain events, called “tail events,” is either zero or one.
Behavior psychologists define “all-or-nothing thinking” as a failure of one’s thought process to consider both sides of an issue. Simply put, rather than to assess and analyze, one defaults to a dogmatic decision-making of sorts.
As busy clinicians charged with the huge responsibility of protecting sight, we are not immune to all-or-nothing thinking. Our days are hectic and challenging, and while we strive to provide exceptional patient care, we simply do not have the luxury of waxing philosophically. As a result, our way of thinking about a condition can easily become an all-or-nothing proposition. Perhaps this is no more evident than when considering age-related macular degeneration.
Few conditions are more feared by patients than AMD, and for good reason. The National Eye Institute predicts the number of Americans suffering from AMD will likely double, to more than 5 million, over the next 30 years. The actual prevalence may well be higher, as early AMD can go undiagnosed in primary eye care practices. If nothing more, these statistics serve as a sobering reminder that, as an eye care community, we must take a more aggressive approach to AMD, including taking a more active role in managing risk.
While it’s certainly prudent to counsel all patients on the basic tenets of AMD prophylaxis – no smoking, regular exercise, good cardiovascular health and a carotenoid-rich diet – isn’t it time we take a more personalized approach to AMD risk management? An approach that considers more than age and race, but also personal genetics.
The challenge of considering personal genetics in AMD risk management is that we’re venturing outside our comfort zone. With almost two dozen genes influencing AMD risk and a lack of consensus on the importance of each, we simply do not have all the answers. Genetics is complex, difficult to explain to patients and, as a result, the ideal topic for which to default to an all-or-nothing thinking. But if we’re truly striving for exceptional care, shouldn’t we at least entertain the idea of AMD genetic testing?
As personalized medicine sweeps across so many specialties within medicine, genetic testing for AMD seems logical. In this issue of Primary Care Optometry News, we’ve convened a group of well-respected colleagues to share their expert opinions on the role AMD genetic testing plays in clinical practice (“Genetic testing for AMD first step toward personalized medicine in eye care,”). I’m sure you’ll find their comments valuable, thought provoking and relevant. Perhaps, most importantly, you’ll find a common sentiment: AMD genetic testing is anything but an all-or-nothing proposition.
- National Eye Institute. Age-related macular degeneration. nei.nih.gov/eyedata/amd#5. Accessed Oct. 27, 2017.
- Neely DC, et al. JAMA Ophthalmol. 2017;doi:10.1001/jamaophthalmol.2017.0830.