There’s A Beautiful Baby In That Bathwater!

This year’s online COVD meeting has been wonderful in terms of continuing education, and one of the presentations I was looking forward to was by Dr. Mitch Scheiman regarding CITT-ART. You may recall that we blogged about the study when it was first released in 2019. While all of us miss the camaraderie engendered by in-person meetings, one of the nice features of this year’s virtual meeting has been the Zoom chat room. During the chat following Dr. Scheiman’s presentation, Dr. David Cook reiterated his comments to my blog regarding “placebo therapy” in CITT-ART. What he wrote is so important and insightful that I’d like you to read it again:

With the benefit of hindsight (or perhaps more appropriately in hindvision) it is easy to appreciate that the placebo group in the CITT-ART was actually a non-orthoptic arm of full-scope optometric vision therapy. Dr. Scheiman essentially acknowledged this during the chat session following his course, and I reiterated the point that what the CITT-ART really showed, was that the OBVAT(Office-Based Vergence Accommodative Therapy) group made impressive gains in reading that were essentially equal to the OB non-VAT group. The fixation, attention, and relatively low-level vision information processing tasks mastered by the “placebo group” were placebo only with regard to the orthoptic nature of vergence-accommodative therapy as designed by the trial. This is far from being the same as a remedial reading teacher giving giving a child attention through supplemental help. CITT-ART actually underscores the power of full-scope optometric vision therapy with regard to reading!

(Another paper remains to be done [though Dr. Scheiman related that after 25 years it was time for him to move on from this] in which this study is repeated with a no-treatment group that continues to receive their usual reading interventions, and a treatment group that incorporates the full scope of optometric vision therapy. A placebo group might receive language/phonics based instruction done through optical instruments or “special lenses/filters” that were relatively inert.)

It was interesting to hear Dr. Scheiman refer to controversy surrounding use of the CISS (Convergence Insufficiency Symptom Survey). If you’re not familiar with this, take a look at the critique from Horwood, Toor and Riddell titled: Screening for convergence insufficiency using the CISS is not indicated in young adults. (Click on that link and let me know what you think about the article’s concluding paragraph.) Another article in that genre is by Horan et al titled: Is The Convergence Insufficiency Symptom Survey Specific for Convergence Insufficiency? A Prospective, Randomized Study. Dr. Scheiman commented that it was time to update the CISS because it was constructed well before the ubiquity of digital devices. In doing so, the challenge again will to spare the baby while replenishing the bathwater.

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