The phrase, An Inconvenient Truth, was popularized by Al Gore regarding the environment, but could just as readily apply to new information on the website of the American Academy of Pediatric Ophthalmology and Strabismus (AAPOS). My colleague Dr. Fortenbacher and I have have previously exposed the inadequacies in the eyecare field regarding treatment of convergence insufficiency. One might have been optimistic to think that organized Ophthalmology would catch up with evidence based medicine about this important condition. Apparently this is an inconvenient truth that our medical colleagues are unable to deal with.
The perfect opportunity to do so presented itself last month, when AAPOS updated its website information on Convergence Insufficiency. Suffice it to say that when you read this information it is considerably out of step with the series of research studies published by the CITT. We anticipated that even though the results of the CITT should be presented to patients in terms of office-based therapy giving the greatest chance of success, ophthalmologists would still try to downplay the outcome research because most are not trained or equipped to do office based therapy in the manner in which it was conducted by the CITT.
A review by the Cochrane Data Base, the agency that for years has been used by insurance companies to deny claims for optometric vision therapy, makes it very clear that office-based therapy is the treatment of choice for CI. Evidently AAPOS feels that only Optometry has to answer to a higher authority. But CI is not a frankfurter, and patients who are told to make the best of things when guidance tantamount to placebo therapy is dispensed deserve better. It is time for pediatric ophthalmologists to collectively practice what they preach, and follow the guidelines of evidence-based medicine. Given what controlled studies have proven, this notion of making value judgments based on what patients can likely afford is a blatant double standard bordering on deception when it comes to how CI is to be treated effectively. At the very least, it ignores the inconvenient truth.
- Leonard J. Press, O.D., FCOVD, FAAO