Is the presentation of a theory sufficient to justify publication? Would Einstein have been published in ophthalmology?

Abstract

There are between 40 and 50 journals in ophthalmology and eye research listed on international data bases such as PubMed and they publish several thousand articles each year. While these journals differ in many ways: some emphasize clinical work, other basic science, some are general and others focus on specific subspecialties, they have one thing in common – They all demand data. Original articles must include data from experiments or clinical observations. A theoretical paper would have little chance of being published in most of our journals. The data-driven approach to science is very strong in ophthalmology and in medicine in general. However, this is not the case in many other fields of science, such as in physics. To take a famous example in physics: the theory that light is influenced by gravity was first proposed around 1800 on theoretical grounds and further developed by Albert Einstein who in a 1915 publication predicted that light would bend around the sun and calculated how much the deflection would be. Einstein′s work was based on theory alone and would probably have been rejected by any journal of ophthalmology or eye research. Earlier, Cavendish (in an unpublished manuscript in 1784) and von Soldner (1804) had pointed out that Newtonian gravity predicts that starlight will bend around a massive object. In 1911, Einstein calculated the same value as Soldner, based on the equivalence principle. In 1915, while working on general relativity, Einstein noted that his (and thus Soldner’s) 1911-result is only half of the correct value. Einstein became the first to calculate the correct value for light bending in a gravitational field, without any observations or experiments on his part. (Einstein 1915a,b; http://www.wikipedia.org). The theoretical work of Einstein led to the observation made by Dyson, Eddington and Davidson in 1919, which confirmed the theoretical predictions made by Einstein (Dyson et al. 1920). Clearly the observation would not have been made, had it not been for Einstein′s predictions. Albert Einstein was a theoretical physicist and probably would not have been able to produce the data to go along with his theory. The result was considered spectacular news and made Einstein and his theory of general relativity world famous. When asked what his reaction would have been if his theory had not been confirmed by Eddington and associates in 1919, Einstein famously made the quip: ‘Then I would feel sorry for the dear Lord. The theory is correct anyway.’ (http://www.wikipedia.org). This example demonstrates the importance of interaction between theoretical scientists and scientists who perform experiments or observations. We need both to advance science. So why do editors of medical and ophthalmology journals, and perhaps eye researchers as well, not realize the importance of the theoretical work. Why do they not look to the example of theoretical and experimental physics, where this approach has been so successful? There may be an issue with nomenclature. The word ‘theory’ in our mind relates to Newton′s theory of gravity, Einstein′s theory of relativity or Starling′s law of fluid movements within the body. These are theories backed by observations, mathematics and ‘laws of nature’. However, we have noticed that some of our colleagues use the word theory in a different context. They will use this word for example for simple clinical hypothesis. For them, a theory might be for example: ‘If I remove the internal limiting membrane, this will make macular edema better’. In this context ‘theory’ is a four letter word. Just like in theoretical physics, we believe that a theoretical approach to medicine and ophthalmology and publishing of high quality theoretical work would advance science. Theoretical work can direct experimental studies, make experiments and observations more focused and more hypothesis-driven. The best theoretical scientists and thinkers may not be the best experimental scientists or observers, and vice versa. Therefore, it appears useful to have a channel of communication between the two types of scientists. Journal editors in ophthalmology and the entire research community may learn from the experiences in the field of physics. Likewise, authors should be encouraged to submit theoretical and modelling work. We should nurture both a theoretical and empirical approach to eye research to advance scientific knowledge and understanding in our field.