One of the great pleasures of reading or watching Sherlock Holmes (in any incarnation, but especially Benedict Cumberbatch’s steely portrayal in the new BBC series) assess a crime scene is his legendary capacity for deductive reasoning. A seemingly innocuous clue—a scratch on a cell phone, for instance, or the position of a chair in the room—reveals previously hidden patterns of cause and effect obvious only to him.

Sherlock’s great skill is his ability to differentiate meaningful facts from humdrum happenstance. He can effortlessly make connections between disparate clues and, in so doing, construct with utter certainty a narrative of events he did not witness. It’s entertaining, inspiring—and obviously fictional.

Doctors who spend their days attempting to pull off similar feats of deductive acumen in the exam room surely know just how tenuous those connections, and how provisional the conclusions, really are. It’s the bane, and I imagine also the joy, of clinical practice. When those flashes of brilliance do happen, they make it all worthwhile.

A Visit to Baker Street
This month, we’re pleased to highlight several articles to help you hone those Sherlockian skills.

In Pathology in Perspective, associate clinical editors Al Kabat, OD, and Chris Sindt, OD, present pairs of similar photos that might lead one to the wrong conclusion based on appearance alone. Take the 20-question self-test to match wits with these clinicians by collecting the clinical evidence, sussing out the red herrings and nailing the diagnosis.

In Tricky Retinal Masqueraders Unmasked!, retina specialists Mohammad Rafieetary, OD, and Eric Sigler, MD, address similar challenges in the posterior segment. Take a look at these retinal masqueraders and see if, as Sherlock said, when you eliminate the impossible, whatever remains, however improbable, must be the truth.

And in our Optometric Study Center, Albert David Woods, MS, OD, and Michelle K. Caputo, OD, offer guidance on when to call in the diagnostic heavy artillery—radiologic testing.

Killer Whales, Eskimo Tales
Those of us in the lower 48 probably think it’s overkill that Eskimos are reputed to have so many different words for snow. Surely some are superfluous, right? Yet optometrists must be familiar with umpteen different types of red eye, along with the appropriate treatment for each.

Greater nuance in classification can be liberating, but also a little maddening. Doctors are already griping about the new obligations that will befall them when the 10th edition of the ICD takes effect this October. The number of diagnostic codes one must contend with will jump from 14,000 to a whopping 70,000—that’s a lotta suspects, even for a master sleuth. So many, in fact, that it’s become a source of parody. A publication called Struck by Orca pokes fun at the more eccentric maladies in ICD-10. (FYI, should you encounter such a patient, the code is W56.22xA, “struck by orca, initial encounter.”)
The new ICD will frustrate and challenge you. So will your next patient who presents with subtle and conflicting findings. But will all your hard work to hone your skills feel worth it, when inspiration comes and you’ve cracked the case?

Why, that’s elementary.

  The Heart of the Matter

This month in our companion publication Review of Cornea & Contact Lenses, which just got a terrific new design courtesy of talented art director Matt Egger, longtime columnist Gary Gerber, OD, discusses how he answers the question, “What do you do?” Instead of defining himself matter-of-factly by his job title, he gets at the essence of what he truly enjoys the most about optometry: “Ten to 20 times per day, I get a chance to change someone’s life for the better, and let them experience the world in ways they never thought they could.” It’s a refreshing way to view your place in the world and recognize that you’re part of something special. Be sure to look for Dr. Gerber’s column in the new and improved RCCL. And tell us what you think of it. Drop me a line at [email protected] with any feedback or suggestions. Because that’s what I do—help doctors share their expertise with each other, for the common good. Thanks for being a part of it.