Comment on: Donate eyes, not patients!

Dear Sir,

The article “Donate eyes, not patients!” by Naik MN made an interesting read.[1] The author has rightly stated that we ophthalmologists repose more faith in our colleagues of different specialties rather than our own collective wisdom.

Let us take the case of suspected ocular tuberculosis (TB). Physicians are known to take extreme positions in such scenarios. While a few declare a patient free of TB because of healthy respiratory sounds on auscultation in consonance with a normal chest radiograph completely ignoring the possibility of extrapulmonary TB, some others prefer to treat their patients based on a positive interferon-gamma release assay (IGRA) test. As IGRAs do not differentiate between latent and active TB, there is a risk of patients being subjected to unnecessary therapy with its attendant risks if the patients were to be treated solely on the basis of IGRA. A systematic review studying the efficacy of IGRAs to detect active TB in low- to middle-income countries found the sensitivity to be around 69–83% and specificity to be around 52–61%.[2] Moreover, there was no evidence to suggest that IGRAs were more sensitive than Mantoux test for the diagnosis of active TB. It was found that when IGRA was performed in culture-proven active TB cases, one in four (25%) cases showed a negative IGRA test. Babu et al. have found that QuantiFERON® TB gold test had a sensitivity of 58% and specificity of 77% to detect active systemic TB and a sensitivity of 82% and specificity of 76% in cases of intraocular TB. They thus inferred that QuantiFERON® TB gold test by itself may not be of much value in cases of presumed ocular TB.[3]

Similarly, a request for physician clearance prior to anti-vascular endothelial growth factor injections is met with opinions which reveal their lack of depth in this particular aspect of clinical medicine. Hence, we ophthalmologists are better of making our judgments based on the available data rather than seek opinion from physicians who find the queries esoteric![4]

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