Researchers: Pediatrics/ Ophthalmology Statement on Vision Therapy Outdated, Flawed

Reprinted from News from the American Optometric Association, July 29, 2010

A “Joint Policy Statement” published online in the Journal Pediatrics on July 27 appears to cobble together outdated research and vision science, such as the controversial Irlen lens, in an attempt to discredit optometric vision therapy, according to prominent optometrists.

The policy statement, developed by the American Academy of Pediatrics, Section on Ophthalmology; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; and American Association of Certified Orthoptists, sheds doubt on the claim that vision therapy treats dyslexia – a claim that vision researchers and clinicians have not made for decades.

It also ignores the evidence of the proven benefits of vision therapy, such as in well-designed studies, most notably the Convergence Insufficiency Treatment Trial (CITT), which was funded by the National Eye Institute. This study showed that vision therapy administered in an eye care provider’s office is the best course of treatment for that condition.

“This publication pretends to be a review of the literature, but instead is a straw man argument,” noted Leonard Press, O.D., chair of the AOA’s Pediatrics and Binocular Vision Committee and prominent member of the College of Optometrists in Vision Development (COVD). “The references at the end, for example, include outdated research literature, and are padded with 23 references to the Irlen lens concept. None of the positive studies on vision therapy from optometric literature is included.”

The timing of the “joint policy statement” seems curious as well, noted Dr. Press, with recent studies showing positive results from vision therapy and with prominent individuals from the academic and scientific communities supporting vision therapy.

In May, Susan R. Barry, Ph.D., professor of neurobiology in the Department of Biological Sciences at Mount Holyoke College, published a book, Fixing My Gaze, about her long struggle with vision problems and the ultimate success of vision therapy treatment.

More currently, there is the well-publicized success of former vision therapy patient Larry Fitzgerald as a wide receiver for the Super Bowl-contending Arizona Cardinals earlier this year. Fitzgerald credits his grandfather’s vision therapy treatments as a key to his success in catching the football. Just last month, Fitzgerald started working with COVD as a spokesperson.

And now, as children and parents ready for the school year, and the AOA is engaged in a media campaign to raise awareness of the importance of having vision examinations before school, there appears to be a campaign to discredit vision therapy.

Dr. Press said there has been a regular pattern of such publications.
“What the policy statements have consistently done is link vision therapy treatment to unrelated conditions and then show the treatment is not successful,” he noted.

He prepared a detailed refutation of the “joint policy paper” and told AOA News that he was grateful, in a way, for its publication because the paper provides another opportunity to cite relevant research, recount the success stories and raise awareness of the role of optometric vision therapy in treating vision conditions that inhibit learning.

Other prominent optometrists and educators also took issue with the “joint policy paper.”

“It should also be noted that every school and college of optometry teach courses in and provides clinical experiences for students in the area of vision therapy and that the procedures used in vision therapy have been codified within text books published by major publishers throughout the United States and the international community,” said Dominick M. Maino, O.D., M.Ed., professor of Pediatrics/Binocular Vision at the Illinois College of Optometry and editor of Optometry & Vision Development.

“Optometric vision therapy is a scientifically sound series of therapeutic procedures used successfully for a number of vision disorders from amblyopia to learning-related vision problems,” Dr. Maino said.

“In this era of evidence-based medicine it is disheartening to read this panel of ‘experts’ purposefully misleading the reader by disregarding recently published randomized clinical trials and the only quality research about the effectiveness of treatments for convergence insufficiency,” said Mitchell Scheiman, O.D., chief of the Pediatric/Binocular Vision Service and a professor at Salus University. Dr. Scheiman was the study chair for the year-long CITT study, which had clinic sites in nine states and included 208 children.
The authors of the joint policy statement falsely note that “symptomatic convergence insufficiency can be treated with near-point exercises, prism convergence exercises, or computer-based convergence exercises. Most of these exercises can be performed at home, and extensive in-office vision therapy is usually not required. Alternatively, for other patients, reading glasses with base-in prism or minus lenses can be used as treatment,” Dr. Scheiman said.

“The references they use to support these statements are not research studies, but are editorial responses to the CITT studies published in Archives of Ophthalmology. The authors of these editorials base their opinions about the effectiveness of home-based therapy on their ‘clinical experience’ and fail to present any quality data from randomized clinical trials. The authors also conveniently chose not to reference the only randomized clinical trial of base-in prism for the treatment of convergence insufficiency. That study, in fact, found that base-in prism was no more effective than placebo reading glasses.”