Evidence-Biased Medicine: Part 1


Lauden_RichardA trend in healthcare has been to cite so-called evidence-based medicine for decisions in treatment, as well as reimbursement guidelines by third party carriers.  The challenge of course is agreeing on what constitutes “evidence”.  In this regard our colleague from the New England College of Optometry Dr. Richard Laudon has coined a nice turn-of-the-phrase, “evidence-biased medicine”.  This came to the forefront in a discussion about a review article just published in Pediatric Clinics of North America.

Let us be very clear about something that we’ve reviewed a number of times before:  the evidence base for convergence insufficiency (CI) is crystal clear that office-based therapy combined with supportive home therapy is far superior to home therapy alone, and should be the first treatment option proposed to parents.  Don’t take my word for it.  This evidence-based medicine for CI was reviewed by the principal authors of the gold-standard CI Treatment Trial published in Archives of Ophthalmology as cited in their review article in Optometry and Vision Science in 2009.  Dr. Scheiman and colleagues emphasize that the evidence requires pediatric ophthalmologists to either offer the patient office-based therapy, or to refer them to a colleague who does.  After all, only 3% of ophthalmologists at best offer office-based therapy.  But how many of you, if you are a parent, were referred to an optometrist for vision therapy by a pediatric ophthalmologist?  And if you are an optometrist, what percentage of your vision therapy patients with convergence insufficiency were referred to you by a pediatric ophthalmologist?  Given that the answer to the question is close to zero, why has pediatric ophthalmology continued to ignore the evidence-based medicine of the gold standard CITT in favor of an evidence-bias against referring to optometric colleagues for office-based therapy?

eye-on-investments-01-1-e1394648645581Something you may not know about our colleague, Dr. Laudon, is that in addition to being savvy about CI he is also very savvy about investments.  It has been on my radar to get to Dr. Laudon’s podcasts, and perhaps just writing about this will be the impetus to do it!  In addition to lauding Richard’s thoughts and ideas, I commend to you an individual outside of eye care, Gerd Gigerenzer who can provide us with some insight to the questions above.  Professor Gigerenzer is currently the director of the Max Planck Institute for Human Development in Berlin, and lectures internationally on the importance of risk education for everyone, from school-aged children to prominent doctors.

Consider Professor Gigerenzer’s opening to the TedX Zurich presentation above:

“I assume all of you can read and write.  We have the fortune to be literate.  We Internet users blog, chat, and surf, and the next truth is just a click away.  But knowing how to read and write isn’t enough in our high tech society.  What we also need is risk literacy.  Without it, we jeopardize our health and our money.  And as we will see, without it our emotions can be easily manipulated and remote controlled.  In fact, they already are.”

Certainly there are select pediatric ophthalmologists who give parents unbiased information about optometric vision therapy without trying to manipulate and control the situation.  But why so few?  Stay tuned for Part 2.

5 thoughts on “Evidence-Biased Medicine: Part 1

  1. Dear Lenny,

    THANK YOU for the acknowledgment. It is an honor to be recognized by you on your blog. It is very important to communicate the double standard that currently exists in our health care system. Behavioral optometry/optometrists play an important role in improving the quality of life for our patients every day. Patients deserve a choice. The medical
    communities’ position on vision therapy is ridiculous. As I have stated on many occasions, it is about ego, control and money. It is time to put the patient FIRST. Thanks you again for your kind comments.

    Richard

  2. Very pertinent stuff Len. For years the excuse from pediatric ophthalmology was there were no evidence based studies for in-office optometric vision therapy in relation to convergence insufficiency. Now we have studies that are wildly supportive. What does ophthalmology do? They go against the studies and prescribe home based pencil push-ups! The exact treatment that the studies indicate is not as effective as in-office optometric vision therapy! Yikes!!!

    Can’t wait for Part 2 but realize the flowers must come first on this beautiful Memorial Day! Best to Miriam and the family!

  3. As usual, Len, you did a great job and you once again, raise the important questions. We all see parents & patients feeling greater empowerment in this current national movement toward patient-centered, not disease-centered, care. I suspect that no one will question that patient experience and perceived positive outcomes as reported by our patients, is our best friend. One thing that all studies continuously show is that people like the care received by “the eye doctors” who specialize in office vision therapy and our people-centric, relationship-centered, hands-on approach.

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