The Deliberate Deception


aapos-logoLast year our colleague, Dr. Dan Fortenbacher and I blogged about the egregious treatment of convergence insufficiency and optometric vision therapy on the website of the American Association for Pediatric Ophthalmology and Strabismus.  You’d figure that by now, one  year hence, these physicians would have taken the time to get it right.  After all, this website is ostensibly used as a portal to deliver credible information to the public.  If you go to the public information section (“Info for Patients”) and click on Vision Therapy, you’ll find that the aapos double standard regarding binocular vision still persists.  Could this merely be an oversight, or is it a deliberate attempt to deceive the public?  After all, as influential as our blogs may be, perhaps not enough ophthalmologists who have influence in aapos are taking the facts to heart.  You decide.

From the aapos website:

1. On the topic of What is Vision Therapy

“Orthoptic eye exercises are used by pediatric ophthalmologists and orthoptists, while optometrists call it orthoptic vision therapy. When pediatric ophthalmologists and orthoptists prescribe orthoptic eye exercises the exercises are taught in the office and carried out at home.”

2. Does Behavioral Vision Therapy Work?  “Behavioral vision therapy is considered to be scientifically unproven.”

3. On the topic of Why Might a Teacher Recommend Vision Therapy

“Children with dyslexia often lose their place while reading because they struggle to decode a letter or word combination and/or because of lack of comprehension, not because of a ‘tracking abnormality’.”

4. On the topic of What Should I Do if Vision Therapy Has Been Prescribed

“Seek a second opinion from an ophthalmologist who has the experience in the care of children recommended by your pediatrician or primary care provider.”

5. Where Can I Learn More About Learning and Reading Disabilities?  “Your best source is your pediatrician or primary care provider.”

After you digest this (or get indigestion), scroll down to compare your thoughts on these 5 points with mine:

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1. Stating in the year 2013 that pediatric ophthalmologists prescribe orthoptic eye exercises taught in the office and carried out at home is a deliberate deception.  I don’t know of a single pediatric ophthalmologist in the country who conducts in-office vision therapy the way in which it was done in the gold standard CITT.  The weight of scientific evidence is therefore that what pediatric ophthalmologists pass off as vision therapy is tantamount to placebo therapy.  Not to say that placebo therapy doesn’t have its place in medicine, but be honest with the public.

2. Behavioral vision therapy is scientifically unproven?  See #1.

3. Is “dyslexia” the major reason why a teacher would suspect a child has a vision problem that can benefit from vision therapy?  Unlikely.  That’s merely the dead horse that aapos has beaten for the past 40 years with recycled Joint Policy Statements that have been thoroughly discredited.  A teacher may be concerned that a child is fatiguing with sustained visual tasks, losing concentration, or any of the 15 signs in the CI Symptom Survey, for example.  They may be on the front lines of noting signs and symptoms of convergence insufficiency.  Why should a teacher or school nurse suggest a child visit a pediatric ophthalmologist whose opinion can be given over the phone irrespective of what the examination shows?  After all, according to aapos and most of its members, vision has nothing to do with learning unless blur is sufficient due to the need for glasses, or the child is seeing double from CI and placebo therapy will be prescribed.

4. Should you seek a second opinion about optometric vision therapy from a pediatric ophthalmologist not trained in our field?  See #3.

5. The best source to learn more about learning and reading disabilities is your pediatrician or primary care provider?  Really?  I would have thought a knowledgable educator, OT, or SLP might be the best source.  Why would MDs position themselves as authorities on learning and reading disabilities, superior to developmental optometrists yet alone other professionals who interact with these ODs?  The answer in part comes from “the halo effect”, and in this case is a deliberate deception served up with the side salad illusion.

Side Salad Illusion

Here’s how it works.  Which meal seems healthier, the one with the fast-food hamburger alone, or the one with the hamburger and the side salad?  Many people will say the one with the side salad, because the salad confers a halo effect on the burger.  But the burger is still unhealthy, and the salad won’t undo the damage from the burger.  Yet somehow you feel better about swallowing it.  The burger is the aapos spin on VT, and the side salad is the pediatrician or primary care provider.

Should you happen to be a pediatric ophthalmologist reading this, we would welcome your partnership in setting the record straight.  If you’re a pediatrician or primary care provider, we would welcome your input about being positioned as an authority on these issues. If you are an allied professional or patient reading the aapos website information about VT, caveat emptor.

11 thoughts on “The Deliberate Deception

  1. Dr. Press, Thank you for sharing this information. I am already a believer in vision therapy and have been skeptical about the information and negativity provided to my clients by pediatric ophthalmologists. They are especially brutal when the parents relay that an Occupational Therapist has recommended a vision assessment by a developmental optometrist. However, my greatest challenge is your Point No. 2. Could you please give us more information on the scientific evidence that we can put into parent/teacher-friendly terms to help us to keep them informed? Thanks!

  2. Came across this site while researching for a recent paper on visual impediments to learning (VIL). The site, as you say, is deliberately misleading. It seems to be based on the public assumption that ‘if it sounds official, and it comes from a ‘doctor’, it must be truth – even if the truth changes later.’

    As the public becomes more aware of the limitations of contrived and quasi-scientific approaches of allopathic care for learning disabilities versus common sense approaches provided by VTODs, for example, orgs like AAPOS will have to continue to rely on untruths and misleading statements to support the ‘industry’.

    Wish there were more out there like you, Len, who are not afraid of challenging these assertions publicly. National, state, and provincial optometric authorities have been cowed by the intimidating tactics of medical interest and ‘professional’ groups such as the AAPOS.

  3. Dr. Press – Thanks for posting this. Interesting how the writers seem to sidestep the truth and at times, contradict themselves, and even actively omit facts in an effort to take advantage of the general public’s ignorance.

    A quick example of my point is their reference to “tracking abnormality.” – Realistically most of the general public will not understand the role of saccades, vergence and accommodation in reading; nor will they understand that “tracking” is, in large part, not one of the primary reasons their child struggles with reading. Unfortunately, the uneducated public does have the foundation to formulate an intellectual line of questioning to fully understand skills needed to efficiently move one’s eyes across a line of print. This website infers pursuits are the only mechanism in play, which is a willful suppression of the facts for the benefit of their profession

    I suppose on one hand they are correct. By definition, tracking involves following moving target…not many kids I’ve met can read any size print when it’s flying across the room. Funny how that part is never mentioned…

    • You’re welcome, Robert. The good news is that there are members of the public who can see well enough to see through their shallow analysis. On the other hand, if a parent is looking for support to feel vindicated about a decision not to consider these factors, the aapos website is comforting. My hunch is that it runs about 50-50; half the people reading what aapos writes about VT believe they are reading fact rather selective information flavored with speculative opinion.

  4. Pingback: A.D.D. this… « VT Works

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