It was in a most unlikely source that I read something yesterday that crystallized the public health and education crisis we have about CI. Essilor, the world’s largest ophthalmic lens manufacturer, publishes a bi-annual international review of ophthalmic optics, Points de Vue or Point of View. The magazine is published in English, Spanish, French, German, and Mandarin. It is distributed by Essilor’s global subisdiaries to Optometrists, Opticians, and Ophthamologists around the world.
Turning the pages of the Spring 2010 issue, I was expecting to find various articles about lenses, and I did. Unexpectedly I came across an article on the early diagnosis of glaucoma. Its author, an ophthalmologist, underscored an important point crucial in early identification and treatment of the disease:
It is certain that about half of all patients diagnosed as having glaucoma and treated by professional ophthalmologists are not actually suffering from this disease.
I did a double take. Was the author saying that ophthalmologists were treating patients as if they had a disease, when in reality they didn’t? To dispel any doubt that this was exactly what he was saying the author repeated his premise in the next paragraph. He reiterated:
To improve the prognosis for glaucoma, it is important to focus on the at-risk population, and training for ophthalmologists must be improved. They would then be in a position to identify true glaucoma to avoid unnecessary treatments. It is estimated that about 50% of patients diagnosed after screening campaigns are subjected to treatments that are unnecessary.
It was refreshing in a way to read what Professor Sanchez had to say in this article. Chronic open angle glaucoma (COAG) is one of the most vexing problems in eye care. Even though for years we really had few ideas on how to treat it, we did whatever we could. This largely consisted of lowering eye pressure as much as possible, and doing anything that appeared to be protective of the optic nerve and its connections within the eye and to the brain.
Yet the conundrum remains. As Professor Sanchez admonishes, we treat a large number of patients for presumed glaucoma who don’t need to be treated, and we don’t identify true COAG patients early enough who could benefit from treatment – if we could only find what those effective treatments were for individual patients.
How does the situation in glaucoma compare to our current circumstances in treating convergence insufficiency (CI)? Essentially we have the opposite problem. In CI we have a very well defined condition, and one that is easy to identify clinically in its earliest stages. We now have definitive studies and guidelines, as reviewed extensively throughout these blog pages, on exactly how to treat the condition and normalize the patient’s visual function.
In part 1 of this series, Dr. Fortenbacher posed some serious questions about why some doctors overlook the patient with CI. The first possibility he posed was:
- Could it be lack of training?
That’s a distinct possibility. When I was studying to be a Doctor of Optometry, one of our College’s influential clinicians would dismiss the condition by stating that no one ever went blind or died from convergence insufficiency. That would be a very unfair value judgment for someone left to struggle for years with functional vision problems due to undetected or untreated convergence insufficiency, wouldn’t it?
Leonard J. Press, O.D., FCOVD, FAAO