Saturday, January 21, 2012

Improvement or Cure?

I used to work in a ophthalmology clinic. When I first started, part of my duties included talking to patients about their treatment options and what they could expect after treatment. The big word was "improvement" - one we've all heard, but one that means so many different things. In a medical setting, the word "improvement" is not synonymous with the word "cure". In an ophthalmology clinic, improvement could mean better contrast or reading an extra line on an eye chart. It is almost never perfect vision. Improvement, especially in cases of allergy and atopy, can mean a partial or temporary alleviation of symptoms.

The reason why this is important to understand is because thinking about allergies and atopic conditions in these terms can help one cope throughout life. It's optimism tempered with reality. There may one day come a cure (hopefully, soon), but until then, there isn't. So, instead of chasing non-existent cures or expecting miracles from any kind of treatment, what parents and patients should be looking for is the treatment option that leads to the best improvement.

I'll use my atopic dermatitis as an example of improvement. My skin has been visibly affected by over three decades of trauma. At present, I do not have any major flare-ups. Everything is under-control. So, at this moment, it's a question of maintenance. To maintain this level of improvement, I have to ensure that I continue my skin care regimen. It's not romantic or miraculous. I never found a cure and no one thing has lead me to this level that I am at currently.

Still, it's improvement. I don't lay awake itching like I did as a child. I don't have to put socks over my hands, but I do keep my nails short. I don't have to use corticosteroids every day, but I always have some on hand in case I need it.

I like to brag that my immunologist gushes about my skin whenever I see him. Not because it's flawless, but because the texture has improved. It's not something I could have imagined when I was young. I also couldn't have imagined that I would wear t-shirts, despite the areas of depigmentation on my elbows. More importantly, I never guessed that I would genuinely like the way I look when I see myself in a mirror.

All of that is improvement. It's not a cure, but it's pretty spectacular nonetheless.


  1. I just realised u work in ophthalmology clinic! I've lost hope n don't even think of perfect vision long ago! V short sighted :)

  2. I no longer work there, but I still remember everything. :) Some very short-sighted people would have clear lens extraction and get a multifocal lens implant, basically cataract surgery for those without cataract. Expensive and it has risks, but it worked well. We always had to tell them that improvement didn't mean they would definitely be without glasses, just use them less.

  3. Keeping eczema under control is a lot of work on the patient's part and you can't let up. Like so many things, it would be nice to have a single pill you could take to solve the problem, but that's not an option and may never be.

    One really only wants to allieve eczema to the point where it's no more of an inconvenience than any other ordinary health issue the average person deals with. I can imagine that the world will be at that point within two lifetimes from now. Not much consolation, is it?

    1. You're right. It isn't much consolation, but it's the best way to deal with it. As a child and young adult, I went through a lot of alternative treatments which promised cures. I hope other people don't go through the same thing. It's a waste in so many ways.