Attributed to Rene Descartes, the Latin phrase de omnibus dubitandum translates as “be doubtful of everything”. You may recall that when the landmark CITT study was published in Archives of Ophthalmology in 2008, it was accompanied by the unprecedented step of having a qualifying editorial embedded front and center on the first page of the article.
It was not surprising at the time that the press release by the NEI/NIH heralding CITT as proof of a better way to manage CI through office-based vision therapy would be disconcerting to ophthalmologic practitioners who, by and large, offered no such treatment. For many years the doubters dissuaded patients from pursuing optometric therapy, citing the lack of efficacious studies and the significant costs involved. “Besides”, they opined, “if it really worked, don’t you think we’d offer it?” Yet here was scientific proof, published in an ophthalmology journal with a high impact factor, that office-based VT not only worked – but was far superior to the conventional wisdom currently being dispensed. When a gold standard research study shakes your paradigm, there are really only two recourses:
- Ignore the study
- Qualify the study (“let’s not jump to conclusions”)
Our colleague, Dr. Dominick Maino quickly pointed out in his editorial for OVD that same year, that the embedded Archives editorial was in essence a veiled attempt to cast doubt on the need for office-based optometric vision therapy. The CITT Executive Committee could have chosen to ignore the embedded editorial but, to their credit, Cotter et al wrote a response detailing why the concerns about the CITT were misplaced. Still, the fact that the original editorial was embedded in the study means that the qualifier (justified or otherwise) would remain stamped on the original paper, a reminder of how unsettling the results of the study were to a small but vocal segment of pediatric ophthalmologists.
It should therefore not be a surprise that history is repeating itself regarding another landmark NEI/NIH funded study on hyperopia and literacy, guided largely by optometry, and accompanied by a press release with unsettling implications supportive of plus lenses related to literacy. These implications have already been grasped within educational circles.
Quite predictably there is an editorial that will appear in the same journal publishing the NEI/NIH study, using a classic straw man argument. The title of the editorial is “Should Glasses Be Prescribed for All Children with Moderate Hyperopia?” The straw man of course is that this study didn’t suggest that glasses be prescribed for all children with moderate hyperopia. Reading through the editorial you’ll recognize familiar arguments:
- Children are self-conscious about wearing glasses, so better be sure that the benefits outweigh the psychosocial costs.
- In many cases the parents of these children struggle to pay for basic necessities. When glasses are prescribed in these cases (in the absence of esotropia and amblyopia), direct costs are the examination, the glasses, and the second opinion examinations when children refuse to wear the glasses.
- Indirect costs to these struggling parents include time missed from work going to doctor appointments, time spent looking for glasses that children hide to avoid wearing them, or at dispensaries having the glasses repaired.
- Prescribing needlessly for hyperopia at a young age may interfere with the emmetropization process.
How does this sit with you?