CATS WHO SUCCEED – Part 3

As a three-time table tennis champion, two-time Olympian, and graduate of Oxford University, Matthew Syed is what some might call the consummate scholar-athlete.  His recently published book on the science of success makes some excellent points pertinent to our discussion.  If you liked Malcolm Gladwell’s book, Outliers, you will love this book.  (And if you haven’t read Gladwell’s book, what are you waiting for?)

The basic premise is that success stems from many hours of repeated, purposeful practice.  Elite performers are able to extract more information and detect appropriate visual clues.  Their ability to chunk perceptual information into meaningful wholes and patterns speeds up their visual and motor processing.  Syed spends several chapters getting to the heart of purposeful practice:  what it means, what it take, and how it should be designed and structured.

A couple of years ago I wrote a guest editorial about the role of the placebo effect in the landmark Convergence Insufficiency Treatment Trial (CITT) study.

PRESS – EDITORIAL – CITT PLACEBO – JBO

Designing a good placebo treatment group in research isn’t easy.  The better one does it, the closer the study will come to attaining the full power of the placebo effect, and such was the case for CITT.  The power of the placebo stems from something that Syed and Gladwell write about, which is one’s  internal motivation to improve.

On the surface, the CITT study may appear to be somewhat of an embarrassment to Ophthalmologists who have disputed the basis for Optometric success in vision therapy.  Many years ago, when I was Chief of VT Services at the SUNY College of Optometry, our house pediatric ophthalmologist claimed that he could achieve just as good success as VT by putting patients on what he termed “schmooze control”.  In other words, the basis for success was in the patient’s head, and what they needed was talk therapy.  In essence we supplied them with a sympathetic ear when few others would listen.

Well pediatric ophthalmologists aren’t entirely wrong.  It does turn out that the basis for improvement begins with the patient’s internal motivation to achieve.  The mistake, however, is that while motivation is necessary to succeed it is not sufficient.  To be successful with optometric vision therapy, conditions must be set to have the patient engage in purposeful learning and practice.

The irony is, most critics of vision therapy persist in treating patients with either “schmooze control”, or these days will hand out a computerized program with little if any orientation, and tell the patients to do it and come back if they are having any difficulty.  This hands-off approach is at best a placebo effect.  When we have such good evidence in the field now that a more structured approach to therapy involving in-office visits complemented by home therapy is considerably more effective, isn’t it troubling that professionals would  continue to offer their patients treatment that amounts to nothing more than placebo therapy?