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Peer Review | Oct/Nov '13

Beyond Peer Review

Coming out of a training program, I, like many of you, held up peer-reviewed literature as the paragon of learning and truth. The deep emphasis on evidence-based medicine in all aspects of modern medical education permeates ophthalmic training in many ways. “Journal Clubs” often dissect only the peer-reviewed journals, and those who are considered well read and well versed in journal lingo are commonly regarded as being more competent in their respective fields. Throughout my training, I subconsciously marginalized the value of trade journals by putting them aside in favor of the “blue” journal.

What I’ve learned beyond training, here in the real world, is that there is an art and a science to medicine. This applies to our daily clinical practice as well as to the published literature. The fact is that the art of interpretation and bias can influence any part of a manuscript, from the author who is responsible for the article to the editor who has chosen to publish it. Various areas of medicine have demonstrated that data can potentially be massaged to substantiate any drawn conclusion and may be blatantly contradictory or incorrect, as evidenced by the swinging opinions on breastfeeding versus infant formula, the “overlooked” cardiotoxic effects of Vioxx (rofecoxib; Merck & Co., Inc.), and the dangers of the once ambitiously supported drug-eluting cardiovascular stents, to name a few examples.

Both peer-reviewed and trade journals have merit and serve important roles in our constant learning. Peer-reviewed literature is the major source of true statistically significant data as an objective validation. As my colleague Damien Goldberg, MD, points out, “There are many truths out there in what we each think we see in our surgical and clinical outcomes, but only statistically significant data found in our established peer-reviewed journals show us the real facts.” The importance of trade journals should not be overlooked though, as they provide a forum to communicate clinical trends and technology in eye care at a faster pace. Trade journals serve a vital role in the rapid dissemination of information for those situations that demand more urgent attention, such as with toxic anterior segment syndrome or TASS of the recent past. Trade publications also provide great insight into valuable new treatments such as femtosecond cataract surgery, corneal collagen cross-linking, and presbyopia-correcting corneal inlays well in advance of their peer-reviewed counterparts. Aside from the time investment required to formulate and complete a study, the submission process alone can be rather lengthy with the revisions (and re-revisions) of the peer-review process.

At the end of the day, the take-home message is that published literature, both peer-reviewed and trade alike, serve to educate us. There can be just as much value or bias in either, and accordingly, all manuscripts should be read with a critical eye. But, it doesn’t hurt to be open-minded and utilize all the available published resources for the benefit of our profession, especially early on in our careers. With digital platforms today, such as e-journals, apps, and video-based libraries like Eyetube.net, information is dynamic, instantaneous, and totally accessible.

Elizabeth Yeu, MD

Elizabeth Yeu, MD, is an Assistant Professor of Ophthalmology at Eastern Virginia Medical Schooland a Partner specializing in cornea, cataract, and refractive surgery at Virginia Eye Consultants in Norfolk, Virginia. She may be reached at eyeu@vec2020.com.