Giving the Public A Headache: Part 3 – CISS My Ask


In Part 1 we pointed out the press release from the AAO which passes off a poster presented at its annual meeting as the basis for its spin that most headaches are unrelated to vision problems, and that eyeglasses are unlikely to have any impact on resolving headaches.  In Part 2 we pointed out the questionable science behind the poster, including its motives.  The not-so-well-hidden agenda of the press release is to perpetuate the bias that eye examinations of children are unnecessary unless a pediatrician feels, on the basis of a perfunctory screening, that evaluation by an eyecare practitioner is warranted.  Lest you think I’m exaggerating, take a close look at these comments by the Chairman of the AAPOS Vision Screening Committee.

Vision screening works when the principle of KISS works, which is Keep It Simple, Stupid.  It fails miserably when applied to an area that is as complex as headaches, and tries to oversimplify it.  Essentially the spin by eye surgeons on this issue violates a more important principle that applies to science, attributed to Albert Einstein:

Everything should be made as simple as possible, but not simpler“.

Unlike the AAO press release in question, there is a more pertinent and more scientific source for the relevance of headaches to children’s vision that is free of examiner bias.  In this instance, CISS (Convergence Insufficiency Symptom Survey)  trumps KISS.  All one has to do to determine if visual demands are related to headaches is ask, and the CISS proved this reliably.  You can download the CISS here, and note how many items relate to visual discomfort:

Q1: Do your yes feel tired when reading or doing close work?

Q2: Do your eyes feel uncomfortable when reading or doing close work?

Q3: Do you have headaches when reading or doing close work?

Whoa – hold on there for a moment!  Why would the best standardized questionnaire in the history of joint Optometry/Ophthalmology scientific study, a prospective multicenter randomized, masked, gold standard study funded by the the NEI, ask directly about headaches associated with visual tasks, when eye surgeons “know” that it’s a very low yield question?

Einstein’s principle comes to mind here, so let’s dispense with the simplistic notions of the latest AAO press release, and set the record straight:

1) Headaches can be associated with vision problems.  Unless you ask the question, you can’t derive the answer.

2) The pediatrician’s screening does not substitute for an eye examination by an eyecare practitioner.  A child noting headaches associated with nearpoint tasks has one of the important symptom factors associated with convergence insufficiency.

3) A change in glasses may not address the visual cause of headaches.  Rather than assuming that when a change in glasses doesn’t help the headache vision has been ruled out as a cause, the proper conclusion is that a non-glasses visual factor should be ruled out as the cause of headache.

4) If the underlying cause of a headache associated with near visual tasks is convergence insufficiency, the treatment of choice according to scientifically proven studies is office-based optometric vision therapy.

Who’s looking out for these kids?

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