I have long been wary of subjective rating based research. Asking a patient how they feel in a certain type of contact lens or how they rate the vision through a particular spectacle lens seemed to me fraught with potential pitfalls. The question itself will introduce bias ('is this more comfortable?' 'can you see better now?') and may mask external influences such as a free supply of the new lens/product. I assumed that objectivity had to be the key. Though not a Damascene conversion, I have had to think long and hard about my initial viewpoint having listened recently to an interview on the radio 4 series 'The Life Scientific.' This is a sort of a scientific Desert Island Discs without the music where a key figure in the scientific world talks through their background and how they have arrived at their current eminent position. Sir Ian ChaImers is an obstetritian who spent some time working in the Middle East. Here he noticed that much of what he had been taught and what had been learned from apparently evidence-based research did not seem to be borne out by his real-life experiences. He noticed, for example, inconsistencies in the way that Caesarian section births were assumed by many to be the best method of delivering children. He noted how many of the methods 'proved' by research to be the best way of offering analgesia during birth were contradicted by statements of the women actually giving birth. He noticed, in fact, a lack of input from patients and their views in general when researchers were looking at specific therapeutic interventions and that the outcomes were rarely measured in terms of patient satisfaction. He was thus inspired to become a champion of better designed research, based upon the ideal of randomised controlled studies and including all aspects of potential outcome including that of patient inference.
In 1992, Chalmers was appointed director of the UK Cochrane Centre. Subsequently, he became founding editor of the James Lind Library, which documents the history and evolution of fair trials of treatments, and helped to establish the James Lind Alliance, a non-profit organization that "aims to identify the most important gaps in knowledge about the effects of treatments". The aim is to make sure there is ready access for professionals and patients alike to well designed research about any particular specific topic. The online Cochrane resource publishes regular reviews and meta-analyses about a wealth of topics and allow you to view the summated evidence based on well-designed research. There are many that apply to optometry. I will be reviewing the site in the next Contact Lens Monthly but suggest you have a look at www.cochrane.org and register yourself.
Many subjective studies would not make such a review as they would be seen to be inherently biased. However, forgetting the view of the patient, for example the person having to wear a contact lens, might similarly be viewed as significant error!