The April 2011 issue of the Journal of the American Association for Pediatric Ophthalmology and Strabismus is a gold mine for readers to see how ophthalmologists (MDs who are not Doctors of Optometry) are still slow on the uptake of information that we’ve been visiting in our blogs. The first item is an editorial of sorts from Dr. David Granet. His name may be familiar to you from a blog discussion that we had awhile back. This piece is basically a shill for the tired and recycled party line of organized ophthalmology that vision has little if anything to do with reading, and/or parents are being duped by optometric vision therapy and should spend their money on “proven” therapies. The fallacies inherent in this perspective have been addressed many times, and you can re-visit this in our call for voices of reason regarding1) myths and misconceptions about optometric vision therapy and dyslexia 2) the illusion of objectivity 3) how we effect real change.
Dr. Granet ends his opinion piece on a promising note: “However science does not stand still and so it is up to us to alter our recommendations as new clinical trials and improved scientific evidence become available.” So how well has Ophthalmology altered their recommendations based on new clinical trials and new scientific evidence? That brings us to the second item of the JAAPOS trifecta in the April 2011 issue.
It would be very convenient if ophthalmologists could prove that office-based vision therapy wasn’t necessary to achieve success. That would lend substance to the way most practice – not dedicating any significant staff or resources required to achieve the type of success that patients experience through optometric vision therapy. This was the intent of the article entitled: Treatment of symptomatic convergence insufficiency with a home-based computer orthoptic exercise program by Serna et al. In the discussion segment of the article, the authors write: “Many clinicians, including our group, use home-based therapy for convergence insuffciency“.
Of course, therein lies the problem. As we’ve pointed out in our blog before, despite the fact that research doesn’t support home-based therapy being any more effective than placebo therapy, ophthalmologists keep practicing this way. It’s a blatant double standard. The saving grace of item #2 in this JAAPOS trifecta is that the editors gave a Doctor of Optometry the opportunity to point out how ophthalmology still gets it wrong! In his editorial perspective Dr. Mitchell Scheiman, Principal Investigator of the CITT study writes:
“Despite these findings and the conclusion from the recent Cochrane systematic review for convergence insufficiency that “current research suggests that office-based vision therapy/orthoptics is more effective than home-based pencil push-ups or home-based computer vision therapy/orthoptics,” some eye-care providers still prescribe home-based treatments as the primary treatment option, presumably because they do not offer office-based vision therapy/orthoptics in their offices or on account of the low cost and ease of use of home-based therapy.”
Here’s my challenge to Ophthalmology: Either do your homework and get it right, or stop giving patients “VT Lite” in the guise of real therapy. Patients can tell when they’re being patronized.
Now for the grand finale of the JAAPOS trifecta: Development of motor fusion in patients with a history of strabismic amblyopia who are treated part-time with Bangerter foils. Here’s the key conclusion of the paper: “A child’s motor fusion status is generally believed to be established during an early formative period of visual development. The development of motor fusion in many of our patients during the course of part-time Bangerter foil treatment suggests that improvements in motor fusion status can occur at a later age than previously believed.”
Hello? Is anybody home? Somebody should break the news to the authors that motor fusion can be developed beyond the early formative period of visual development. It’s called neuroplasticity, and its been plastered all over the place in optometric literature. We’ve been doing it for years, despite the artificial limits that MDs have placed on what patients can accomplish through therapy beyond patching, drugs, or surgery in early childhood. You can read about it here, there, and everywhere.
– Leonard J. Press, O.D., FCOVD, FAAO