Absolutes in Medicine

I recently got in a "twitter war" with some UK keratoconus support groups over some false things they were tweeting. I probably shouldn't have bothered and nobody wins those things, but I have a problem with "fear-mongering". These people fevently believe, and repeatedly tweet to their hundreds of followers, that "eye rubbing" CAUSES keratoconus. It doesn't. Keratoconus is a poorly understood GENETIC/inherited corneal degenrative condition. People who have keratoconus can make their condition worse and progress faster by rubbing their eyes, but they did not initially acquire keratoconus solely by rubbing their eyes. That is false, no matter how many times those 2 support groups tweet it. You have to have a "susceptible cornea", AKA already have a weakened cornea from inheriting the gene for keratoconus, in order for "eye rubbing" to be a factor. So blasting out to everyone worldwide that "EYE RUBBING CAUSES KERATOCONUS! DO NOT EVER RUB YOUR EYE! ALL EYE RUBBING IS BAD!" is just irresponsible, even if you fervently believe it to be true (it's not). I call this "fear mogering". Someone somewhere will read that and get all scared that one time they saw their 4 year old rub their eyes when they were sleepy and NOW THEIR SON WILL DEVELOP KERATOCONUS! This stuff really happens. I get patients like this all the time. "DOCTOR! LAST NIGHT I SLEPT IN MY CONTACTS AND MY LAST EYE DOCTOR TOLD ME TO NEVER EVER EVER SLEEP IN THEM! SO I AM HERE BEFORE YOUR OFFICE OPENS JUST TO CHECK AND SEE IF EVERYTHING IS OKAY!" Well, yes. You're probably okay. Use some common sense here. As I tweeted to these people: "most of the time for most people, 'eye rubbing' does not cause anything, certainly not keratoconus". Well the piling-on began and I got multiple tweets with lay-person's definitions of what keratoconus is. Uh, yes thanks I fully understand keratoconus. I just disagree with fear-mongering EVERYONE EVERYWHERE with the false statement that if they EVER rub their eye they will get it, which is what these support groups repeatedly tweeted. Of course when I chime in to correct them I was attacked. I was even called "rude" for arguing the point, because if all health care providers worldwide don't agree with the 1100 followers of those 2 support groups, they must of course be rude people. When I jokingly asked the moderator/tweeter/blogger if they felt remorse for "causing" their own keratoconus by "eye rubbing", (since they argue that eye rubbing causes keratoconus and it is also NOT genetic/inherited) they responded with "it's not about whose fault it is! I don't know why I got keratoconus because neither of my parents had it!!!". Well unfortunatley that is a statement from a person who does not understand genetics. There is a lot of bad info out there on the internet: GPC is misdiagnosed as "dry eye", myopia progression is OFTEN blamed on "too much reading/computer use", and eye rubbing "causes" keratoconus...those are just a few examples of wrong/incorrect statements about eye care on the net. There is even a group out there who I have mentioned before that claims optometrists are literally "to blame" for worldwide myopia. Just because someone out there tweets/blogs something about health care does not make it true. Heck even health care professionals disagree, as I've blogged about before. In short: use common sense. Does common sense say that sleeping in your contacts ONE TIME will cause a corneal ulcer? Does common sense say that reading too much causes you to need glasses? And does common sense say that rubbing your eyes, in and of itself in the absense of any genetic predisposition, CAUSES keratoconus? Be careful about thinking in "absolutes".


  1. I understand the need for support communities and patients sticking together. And I probably shouldn't have argued with these people. They stick together, like communities should. Arguing on the net rarely goes anywhere. I just don't like wrong/bad info on the net, and I when I get ganged up on, sometimes I argue back. That does not make me rude or a bad person...it also, however, does not make me "wrong".

  2. Is there a reason one of my eyes would be blurry and one would be clear wearing the contact lenses? I wear the same brand for almost two years...one is a little stronger, but same BC, etc. No pain, but when trying to see anything up close...maybe from 1-2 feet, one is blurry and one is clear...just started noticing it...can BC make a difference?
    I switched from 2x month to daily because of the same conjunctivitis situation in your earlier posts...it did help dramatically...

  3. Nice read! I always find your blog to be the most helpful eye care blog out there! I have a(not really related) question:

    Recently I went to my annual eye exam/contact fitting section. My doctor gave me Blink Tears(does not says specificly for contact on the packaging), along with a few trial lens of TruEye(nara A version). I used to wear TruEye nara B version for a year.

    Without much thought, I put the Blink Tear drops after putting my contacts on. For few days, I would have this major grinding/bruning on my eyes 1-2 hours after insertion. Initially, I just thought I was having bad compatilibility with this new contact lens material. BUt after a few days, I concluded that the major discomfort only happens if I put the Blink Tear drops in while wearing the contacts. I tried wearing the lens without using any Blink Tear for a day, and my eyes felt fine. My eyes still feels weird after those initial days of major discomfort.

    So my question is, did my doctor screw up by giving me the Blink Tear(not officially approved for contact use, but packaging does not say avoid using with contacts either), instead of the Blink Tears specific approved for contact use? Will using Blink Tear while having contacts damage my eyes? I heard to Blink Tear is too thick to use while wearing contacts.

    My doctor gave me this:
    I think I should be getting this instead:


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