Maino D. Maino D. Mistakes were made (Yes by you!). Optom Vis Dev 2011;42(2):66-69.
EditorialMistakes Were Made (Yes by You!)Dominick M. Maino, OD, MEd, FAAO, FCOVD-AEditor In the last issue of Optometry & Vision and Aronson discuss how certain groups of individualsDevelopment, I reviewed a book titled Mistakes Were (police officers, prosecutors, researchers) can maintainMade (But Not by Me): Why We Justify Foolish Beliefs, this inability to admit mistakes while using a groupBad Decisions, and Hurtful Acts by Carol Tavris, PhD think mentality to bolster an otherwise indefensibleand Elliot Aronson, PhD.1 There are few books that position.have an immediate and long lasting effect upon Several authors of various articles in a recentour view of the world. Mistakes Were Made (But edition of the American Orthoptic Journal, VolumeNot by Me) will forever change the way I see myself 60, 2010; should read the Tavris and Aronson textand others. This particular text explains why some or forever be known as potential knaves fools,individuals do what they do and can justify their villains, or hypocrites. This volume of the journalfoolish beliefs, bad decisions and hurtful acts. When was overwhelmingly dedicated to a symposium titled,these same individuals are clearly shown the error of What We Really Know about Pediatric Ophthalmologytheir ways, they continue to desperately and even and Strabismus: The Application of Evidence-Basedmore strongly hold on to their outdated science, their Medicine and had several editorials and about tenbiased opinions and their articles.mistaken ideology. They … What we cannot and should The first article inremain unshaken bytruth, fact and science. not forgive is the double standard this volume, which was authored by David K.They know what they various medical organizations Wallace, MD, MPhknow. They believe what (Evidence Based Medicinethey believe. The facts be often apply to non-MDs… and Levels of Evidence2)damned. immediately caught my The introduction in this book, Knaves, Fools, attention. I had previously read an editorial3 he hadVillains, and Hypocrites: How do They Live with written to express his concerns regarding the CITTThemselves, noted that somehow those in politics, law, study. His paper was simultaneously published in theresearch, business, medicine, and even religion refuse same edition of the Archives of Ophthalmology as thatto acknowledge the mistakes they have made despite of the CITT study.4 In fact, as remarkable as it maysolid evidence to the contrary. Later in the text, Tavris sound, the editor of the Archives of Ophthalmology decided to place an announcement concerning Dr. Wallace’s editorial rebuttal within the body of theCorrespondence regarding this editorial should be emailed to text on the very front page of the CITT study. Evendmaino@covd.org or sent to Dominick M. Maino, OD, MEd, Illinois though Dr. Wallace has participated in clinical trialsCollege of Optometry, 3241 S. Michigan Ave., Chicago, IL 60616. Allstatements are the author’s personal opinion and may not reflect the opinions in the past and is quite aware that the make-up ofof the College of Optometrists in Vision Development, Optometry & Vision the CITT study included both optometrists andDevelopment or any institution or organization to which the author may ophthalmologists he wrote of several misgivings hebe affiliated. Permission to use reprints of this article must be obtained from had concerning this study.the editor. Copyright 2011 College of Optometrists in Vision Development.OVD is indexed in the Directory of Open Access Journals. Online access is In an editorial5 I had written as a response toavailable at http://www.covd.org. Dr. Wallace’s misgivings, I pointed out that he used phrases such as, “I believe…,” I think…,” and “InMaino D. Maino D. Mistakes were made (Yes by you!). Optom Vis Dev2011;42(2):66-69. my experience…” as a part of his justification for not accepting the evidence based research before66 Optometry & Vision Development
him. I also noted that optometry is often criticized patients at any age.8,9 On the downside this articleby ophthalmology for using the very same phrases he still defines amblyopia as a problem with visual acuitychose to support his CITT study misgivings. When when it has clearly been shown that it is really anI invited him to respond to my editorial, he declined anomaly of binocular vision.to do so. He now writes in the American Orthoptic If you have ever visited my blog (MainosMemos10)Journal that “Although every question cannot be you know that the research I post concerning the use 2addressed by a randomized clinical trial, the best of vision screenings overwhelming shows that visionavailable evidence should be sought and used to screenings11 have not been shown to be very effective.guide treatments.” So what is it to be? Is belief and In fact I stated on my blog that at least one articleclinical experience enough to disregard the evidenced says that the research evaluating the use and outcomesbased, research based findings of the CITT study? Is of vision screenings are so poor that they couldn’tit appropriate to write one thing if you support the come to a conclusion as to the value of conductingoutcomes of a clinical trial, but to write another if those screenings.11 An article in the orthoptic journal,you do not? Evidence-Based Medicine: The Value of Vision Screening In this article Dr. Wallace also notes that there also says that “…Additional evidence is requiredis a hierarchy of study methodologies for obtaining to ascertain the degree to which vision screening isevidence. He then listed these levels from being the effective…”12 Unfortunately, this article goes on toleast to most useful (laboratory research, editorials, state that, “…Evidence based medicine is probablycase reports and case series, case controlled studies, an inferior method of analysis of potential benefits ofcohort studies, and randomized clinical trials). So was vision screening…” Once again it appears that if yourthe randomized, double blind, placebo controlled beliefs run contrary to evidence based research, youCITT study not the highest within his hierarchy? can ignore that which does not coincide with thoseShouldn’t it then be considered the most useful? If beliefs.the CITT study was at the Another article byhighest evidence level and the …the hypocrite is the last an orthoptist, Visionmost clinically useful, whydid he write the editorial? one to recognize the hypocrite Therapy and that optom- acknowledges Orthoptics,13How could he justify using in the room…. etric vision therapy is thehis experience and beliefs as a most efficacious treatmentbasis for his editorial when a clinical trial has shown for convergence insufficiency and that yoked prismsotherwise? I wonder if I were to ask him to respond to are effective for those with neurological impairments.this apparent discrepancy if he would also decline to She goes on to state that this is not so for juveniledo so as he has done in the past. delinquents and dyslexia. The author uses the old, It is also interesting that several other articles worn out, and just wrong statement by the Americanin this edition of the American Orthoptic Journal Academy of Pediatric Ophthalmology and Strabismusdispel myths and beliefs long held by many within (AAPOS), American Academy of Ophthalmologythe eye care field. For instance, did you know that (AAO), and the American Association of Certifiedyou can treat amblyopia after the age of six years! This Orthoptists (AACO)14 to support her misguidedarticle even acknowledges the possibility that adults beliefs. This joint statement has been shown to bewith amblyopia can be treated successfully as well.6 faulty, embraces intellectual dishonesty, and is aOf course those of us in the field of developmental great disservice for all those individuals who couldoptometry have been achieving successful outcomes benefit from what optometry has to offer. Severalfor our older amblyopes for years and even publishing responses15,16,17,18 to this erroneous joint statementpapers about this in the optometric literature. have been published and unfortunately ignored by theUnfortunately it wasn’t until similar case reports and author of this article (Marla Shainberg). The rebuttalsresearch appeared in the ophthalmologic literature did of the joint statement point out that: “A review ofour colleagues begin to acknowledge the treatment the references in the joint statement as well as otherpossibilities for adults.7 It is my hope that all begin references find that the joint statement is misleadingto read the literature in a variety of professions that because of inappropriate citations and selectedsupport the treatment of this significant disorder for references.”15,16 “The most current joint statementVolume 42/Number 2/2011 67
ignores the results of evidence based research.” the leaders and membership of these organizations“Ophthalmology should not allow professional will read, Mistakes Were Made (But Not by Me) andrivalry to cloud its judgment regarding optometry’s realize that Mistakes were Made (Yes by You!)involvement in the diagnosis and treatment oflearning-related vision problems.”15,16 The references Keywords: cognitive dissonance, convergenceinclude outdated research literature, and are padded insufficiency, evidenced based medicine, hypocrite,with 23 references to the Irlen lens concept. None of learning related vision problems.the positive studies on vision therapy from optometricliterature is included.”15,16 Although it would have Referencesonly taken a moment or two to find articles that 1. Maino D. Mistakes were made. [Review of the book Mistakes Were Made (but not by me): Why We Justify Foolish Beliefs, Bad Decisions, andsupport optometric vision therapy19,20,21,22,23 for a Hurtful Acts by Carol Tavris, PhD and Elliot Aronson, PhD. Marinerhost of disorders including learning related vision Books; Reprint edition (March 2008)] Opt Vis Dev 2011. 42(1):39-40.disorders, Ms. Shainberg chose the easy way out 2. Wallace DK. Evidence Based Medicine and Levels of Evidence. Amer Orthop J 2010;60:2-5.and only regurgitated the falsities noted in the joint 3. Wallace D. Treatment options for symptomatic convergence insufficiency.statement. 1. Arch Ophthalmol. 2008;126 (10):1455-56. David Hunter, MD, PhD, in his article, Do 4. Convergence Insufficiency Treatment Trial Study Group. RandomizedWe Need Evidence for Everything?,24 brings to our clinical trial of treatments for symptomatic convergence insufficiency in children. Arch Ophthalmol. 2008:126(10);1336-49.attention that “There is no randomized, controlled 5. Maino D. An Open Letter to David K Wallace, MD, MPH (and othertrial supporting the contention that evidence-based disbelievers and holders of outdated and biased opinions and beliefs).research is beneficial … Systemic reviews have severe Optom Vis Dev 2008;39(4):178-180.limitations of scope and reach … real patients bring 6. Matta N, Singman EL, Silbert DL. Evidence-based medicine: Treatment for amblyopia. American Orthop J 2010;60:17-22.with them an abundance of messy heterogeneity … 7. Fronius M, Cirina L, Cordey A, Ohrloff C. Graefe’s Arch Clin Exp[and] … Medical training is as much an apprenticeship Ophthalmol. 2005; 243:278–280as it is an education and medicine as much a craft as 8. Wick B, Wingard M, Cotter S, Scheiman M. Anisometropic Amblyopia: Isit is an art.” the Patient Ever Too Old to Treat? Optom Vis Sci. 1992;69 (11):866-878. I suppose we can at times forgive medicine for 9. Levi D, Li R. Perceptual learning as a potential treatment for amblyopia: Aexhibiting their bipolar characteristics when it comes mini-review. Vision Research 2009;49(21):2535-2549to evidence based research and its clinical applications. 10. MainosMemos http://www.MainosMemos.blogspot.comWe all typically find ourselves in similar situations, no 11. Schmucker C, Grosselfinger R, Riemsma R, Antes G, Lange S, Lagrèze W, Kleijnen J. Effectiveness of screening preschool children for amblyopia: amatter if you are an ophthalmologist, orthoptist, or a systematic review. BMC Ophthalmology 2009, 9:3doi:10.1186/1471-developmental optometrist. We sometimes prescribe 2415-9-3 available from http://www.biomedcentral.com/1471-2415/9/3“off-label” treatments for our patients because it 12. Beauchamp GR, Ellepola C, Beauchamp CL. Evidence-Based Medicine: The Value of Vision Screening. American Orthop J 2010;60:23-27.appears to be the best option available. We use 13. Shainberg MJ. Vision Therapy and Orthoptics. American Orthop Japproaches to patient care that have not been verified 2010;60:28-32.by randomized, placebo controlled, double blind 14. Joint Statement: Learning Disabilities, Dyslexia, And Vision available fromclinical trials because if we wait for that clinical trial http://one.aao.org/CE/PracticeGuidelines/ClinicalStatements_Content. aspx?cid=8aa39ca4-039a-4329-beec-42e5a3007329to be completed, our patients would suffer. 15. Lack D. Another joint statement regarding learning disabilities, dyslexia, What we cannot and should not forgive is the and vision--a rebuttal. Optometry. 2010 Oct;81(10):533-43. Epub 2010double standard various medical organizations often Aug 21.apply to non-MDs. As Tavris and Aronson tell us in 16. A flawed statement on vision therapy, learning and dyslexia is reissued available from http://newsfromaoa.org/2009/07/29/a-flawed-statement-Mistakes Were Made (But Not by Me),1 “…we come to on-vision-therapy-learning-and-dyslexia-is-reissued/believe our own lies … [and that] … the hypocrite is 17. Facts and Fallacies The Snake Oil Myth available from http://www.the last one to recognize the hypocrite in the room.” visionfactsandfallacies.com/ Lord Molson (a British politician 1903-91) said: 18. Researchers: Pediatrics/ Ophthalmology statement on vision therapy outdated, flawed available from http://newsfromaoa.org/2009/07/29/“I will look at any additional evidence to confirm the researchers-paper-on-vision-therapy-outdated-flawed/opinion to which I have already come.”1 This quote 19. Atzmon D, Nemet P, Ishay A, Karni E. A randomized prospective maskedappears to explain the AAO, AAPOS and AACO’s and matched comparative study of orthoptic treatment versus conventional reading tutoring treatment for reading disabilities in 62 Children. Binocularapproach to assessing optometric vision therapy Vision and Eye Muscle Surgery Quarterly 1993;8 (2): 91-106.as a treatment modality for learning related vision 20. Fischer B, Hartnegg K. Instability of fixation in dyslexia: development–problems. It is my sincere hope that in the near future deficits – training. Optom Vis Dev 2009;40(4):221-228.68 Optometry & Vision Development
21. Okumura T., Laukkanen H., Tamai H. Computerized Saccadic Eye 23. Fischer B, Hartnegg K. Saccade control in dyslexia: Development, deficits, Movement Therapy to Improve Oculomotor Control during Reading and training and transfer to reading. Optom Vis Dev 2008:39(4):181-190. Reading Rate in Adult Japanese Readers. Opt Vis Dev 2008: 39(4):191-197 24. Hunter D. Do We Need Evidence for Everything? American Orthop J22. Fischer B, Köngeter A, Hartnegg K. Effects of Daily Practice on 2010;60;59-62. Subitizing, Visual Counting, and Basic Arithmetic Skills. Optom Vis Dev 2008:39(1):30-34.AcknowledgementsWelcome Dr. Li Deng Development not only the very best journal possible, Optometry & Vision Development welcomes our but also the first journal clinicians go to for thenewest addition to the OVD editorial staff and latest, scientifically sound optometric resource inJournal Review Board: Li Deng, PhD. She has been the areas of pediatrics, binocular vision, optometrickind enough to volunteer her many talents to OVD vision therapy, rehabilitative optometry and specialas our statistician. Dr. Deng’s background includes populations. Dr. Deng will help us make this happenreceiving her PhD and MA in statistics from Rice with every issue. Please congratulate her on becomingUniversity, Houston, TX and her BS in mathematics OVD’s statistician.from Zhejiang University, Hangzhou, Zhejiang, P.R.China. Dr. Deng currently serves as an Associate CorrectionsProfessor of Biostatistics at the New England Collegeof Optometry in Boston, MA. She has already been OVD 42-1 Article Correctionrecognized as someone with special talents as an Optometry & Vision Development VolumeOutstanding Graduate Student at the University of 42, Number 1, contained an article namedTexas (El Paso) and by receiving a pre-doctoral trainee Accommodative Response in Children withFellowship from the W.M. Keck Foundation to the Visual Impairment. The author was cited asGulf Coast Consortia through the Keck Center for Catherine L. Heyman, OD, FAAO, FCOVD.Computational Biology at Rice University. We were remiss in reporting ALL the co- She has had multiple articles published in major authors for this article and we profoundlyjournals. Some (but not all) of these articles include: apologize for the omission. The co-authors for Li Deng, Jane Gwiazda and Frank Thorn (2010). this article are:“Children’s refractions and visual activities in the Catherine L. Heyman, OD, FAAO, FCOVDschool year and summer” Optometry and Vision Southern California College of OptometryScience 86(4): 403-41. Catherine Johnson, Barry Kran, Luisa Mayer and Eric Borsting, OD, MS, FAAO, FCOVDLi Deng (2009), “Comparison of the Cardiff and Southern California College of Optometrythe Teller Acuity Tests in a Deafblind Population.” Karissa Paul, ODOptometry and Vision Science, 86(3): 188-195. Brittany Reimers, OD Ruth Manny, Li Deng, Connie Crossnoe andJane Gwiazda (2008), “IOP, Myopic Progression and OVD 42-1 Article CorrectionAxial Length in a COMET Subgroup.” Optometry Optometry & Vision Development Volumeand Vision Science, 85(2): 97-105. 42, Number 1, contained a portion of a litera- Chea-su Kee and Li Deng (2008), “Astigmatism ture review that had previously been publishedassociated with Experimentally-Induced Myopia or in Volume 41, Number 4. Our apologiesHyperopia in Chickens,” Investigative Ophthalmology to Dr. David Goss, author of our Currentand Visual Science, 49: 858-867. Literature Review section and to our readers. Aurora Denial, Li Deng (2008), “PredictingClinical Performance,” Optometry Education, Spring33(2): 70-74. The editorial staff and the Journal Review Dominick M. Maino, OD, MEd, FAAO, FCOVD-A; EditorBoard always strive to make Optometry & VisionVolume 42/Number 2/2011 69