We clinicians tend to think of a good clinical “save” as a case in which the doctor recognizes an atypical condition based on limited evidence, potentially early in the natural history, so that treatment can be initiated before complications lead to irreversible damage. Although our medical training teaches us to think about horses before zebras, the cases in which we find a rare disease tend to stick longer in our memories.
As the cases in this article highlight, however, a good clinical “save” does not need to be associated with a rare clinical entity. While the routine nature of recognizing ocular surface disease (OSD) based on a hunch, or incidentally identifying neurotrophic keratitis (NK) because of corneal anesthesia, may make it seem like these diagnoses are not special cases, they are, indeed, very meaningful for patients. The expanding array of dry eye and ocular surface disease treatments, as well as broadening options for NK (e.g., cenegermin-bkbj ophthalmic solution 0.002% [20 mcg/mL]; Oxervate; Dompé), means that early diagnosis and prompt initiation of treatment does not just resolve the disease, and it does not just stop progression or aid in disease control, it also impacts positively on patients’ quality of life and potentially saves vision. The market availability of OSD and NK treatments has the effect of sharpening our focus in the clinic: they get us thinking about when to use them, over time we hone criteria for patient selection, and in the end, we become more proficient at recognizing subtle disease features.
In this article, we are pleased to present a series of cases from ophthalmologists and optometrists in the categories of OSD and NK. They are remarkable cases not because of their rarity, but rather because of how relatable the findings are to everyday clinical practice. Each case demonstrates a good “save,” not only in the sense of saving vision, but in some cases aiding in the diagnosis of underlying systemic issues that required specialty care.
Eye care providers don’t typically think about “saves” when they diagnose common clinical entities. Perhaps they should recognize the lifetime of suffering they are saving the patient from when they do recognize and treat OSD or NK before the disease results in permanent vision loss.