Those of you who have been around for awhile will remember the infamous rubber ducky cover of the March, 1998 issue of Review of Ophthalmology, authored by Harold Koller, in which he posed the question “Is Vision Therapy Quackery?” In his JBO editorial Dr. Irwin Suchoff pointed out the damage done when a question like that is framed irresponsibly. I recall lecturing on the matter subsequently and pointing out to audiences that the use of the duck was was yellow journalism at its best, where the answer to the question would pale in comparison to the sensationalism of the quackery question. I wonder in fact how many people who saw the cover of the Review and glanced at the article remember how Dr. Koller answered the question, or ever considered Dr. Jeffrey Cooper’s scholarly response to the article. Given this background, take another look at the insightful blog post last month our colleague Dr. Fortenbacher regarding an Advanced Amblyopia Treatment Paradigm.
It’s fair to pose the question, based on the paradigm substantiated by vision science research as reviewed by Drs. Fortenbacher, Stull, and Tran, of whether the approach of offering patients nothing more than a pair of glasses and an eye patch for amblyopia therapy is tantamount to quackery. That may seem like a harsh question, and I’m not just posing it as payback for Dr. Koller’s wise-quack about vision therapy 15 years ago.
I’m posing the question to hold a mirror of accountability up to professionals who persist with time-honored minimalistic treatment approaches in the face of mounting evidence that these approaches are ineffective, or fail to acknowledge to patients that there are better options. The long awaited CITT and PEDIG study outcomes should be pointing these professionals toward a broader mindset regarding therapeutic approaches rather than continuing to parade as Emperors Without Clothes. The first step is to pose the right question.