This editorial discusses and critiques three articles related to optometry and vision. [1] It argues that an article claiming unnecessary prescriptions for children was biased and did not consider other valid reasons for prescribing glasses. [2] It summarizes a study showing that progressive addition lenses can slow myopia progression in children. [3] It discusses a study finding that vision therapy improved academic performance for children with reading disabilities. The editorial urges readers to carefully consider the evidence presented in these articles.

1. Editorial
Ophthalmology Causes Myopia! Dominick M. Maino, OD, MEd, FAAO
Editor
HEADLINES & HOGWASH already determined by its title, “How often are
spectacles prescribed to ‘normal’ preschool
Mark Twain once said that there were, children?” The conclusion that Donahue
“Lies. Damn lies. And Headlines!” I know reached, that “a significant percentage of chil-
many of you actually believe that he was talk- dren are probably prescribed glasses unneces-
ing about statistics, but this is just not true. I sarily” must be viewed with a great deal of
can understand Mr. Twain’s frustration with skepticism.
the news media and it’s time we took them to It appeared that Donahue believed that
task. only refractive factors that are considered am-
Several months ago when Sean Donahue’s blyogenic should have been prescribed for
article was published1 concerning how often
these children. Are there no other reasons for
“normal” preschoolers were prescribed spec-
prescribing glasses? Did he investigate these
tacles, you’d think optometrists and their as-
other potential reasons? He also noted that
sociated “optical industry partners” were pull-
several children were given corrections for
ing the greatest scam ever attempted on par-
+3.00 to +3.50 even though they had no stra-
ents and their children. At least that was the
bismus. Would you prescribe this amount of
impression you might have received if you just
plus for a child only when strabismus was
read the headlines in the vision and eye care
present? Donahue went on to state that
press.
Unfortunately, few (if any) of the news ar- glasses should be prescribed “if visual acuity
ticles in the press evaluated the validity of the can be improved or if the patient has astheno-
Donahue article nor did they discuss if its con- pia.” All too often you do not know “if visual
clusions were appropriate or not. This article, acuity can be improved” until after the child
which was listed under the “editorial” category has been wearing the glasses and because chil-
by the Journal of the American Association for dren seldom complain of asthenopia, how can
Pediatric Ophthalmology and Strabismus, you use that as a guide for when to prescribe?
should not have been considered anything (He did acknowledge that children seldom
more than an opinion piece. Sadly, it appears complain of eye problems, however.)
only to have been written to “prove” an opinion Donahue goes on to state that, “Experi-
enced” (quotes were placed by Donahue) pedi-
atric ophthalmologists prescribed spectacles
Correspondence regarding this editorial can be for only four children without amblyogenic fac-
emailed or sent to Dominick M. Maino, OD, MEd, JOVD tors. Even though he gives the impression that
Editor, Illinois College of Optometry, 3241 S. Michigan
“experienced pediatric ophthalmologists” were
Ave., Chicago, Il. 60616 (e-mail: dmaino@eyecare.
ico.edu). experts in the area of refraction, we know that
All statements are my personal opinion and may not this is not true. Ophthalmologists spend little
reflect the opinions of any institution or organization to time in their careers studying refraction. Op-
which I may be affiliated. tometrists, on the other hand, spend a great
Maino D. Ophthalmology causes myopia. J Optom Vis deal of time both didactically and clinically
Dev. 2004:35(2):67–69. studying the diagnosis and treatment of re-
Volume 35 / Summer 2004 67

2. fractive problems. Optometrists are the true dergone a program of optometric vision
experts in this area. therapy (VT) that not only improved these pa-
Donahue continues with the statement tient’s visual abilities, but concurrently im-
that . . . pediatric ophthalmologists were much proved their academic performance as well.
less likely to prescribe spectacles. . . . Shame Over the years, we’ve collected many anec-
on them! The ophthalmologist, in general, and dotal success stories from our patients and
the pediatric ophthalmologist in particular, their families about how wonderful their child
may be doing a great disservice for our chil- is now doing in school after a few weeks of VT.
dren. Now there’s a headline that should be The problem was that the research connecting
printed. improved vision performance to improved aca-
demic performance seemed less than convinc-
OPHTHALMOLOGY CAUSES MYOPIA! ing to our critics. Harold Solan et al.3 have
Here’s a potential headline that also does now published the first of probably many pa-
not tell the whole story. The headline should pers to come that establishes one or more sig-
read, Progressive Myopia can be Stopped nificant links between vision therapy and aca-
(or at least slowed)! A paper by Jane Gwi- demic improvement. Our colleagues in other
azada et al.2 was a National Eye Institute sup- professions should certainly welcome this re-
ported, multi-site, well-designed research search.
study that included both ophthalmologists Dr. Solan and his associates noted that the
and optometrists as researchers. It clearly vision therapy used stressed various aspects of
showed the relationship between the progres- arousal, activation and vigilance and that at
sion of myopia, esophoria and a high lag of the completion of attention therapy, the mean
accommodation in 469 ethnically diverse chil- standard attention and reading comprehen-
dren aged 6–11 years. This study noted that in sion scores of the experimental group improved
those children with larger lags of accommoda- significantly while the control group showed
tion and/or esophoria, shorter reading dis- no such improvement. All of this was accom-
tances and a lower baseline of beginning myo- plished in just 12 weeks of therapy for the
pia, PALs (progressive addition lenses) were child with mild to moderate reading disability!
effective in significantly slowing down myopic We should also note that vision therapy tech-
progression at the children’s 1-year evaluation niques and procedures that we have used for
and even more so at the 3-year follow-up. This decades (i.e., tachtistoscope, oculomotor
significance was both statistical and clinical. therapy, and the Computerized Perceptual
Because few ophthalmologist or optom- Therapy Program by Dr. Sid Groffman) were
etrists not associated with the College of Op- utilized during this study as well. (Because of
tometrists in Vision Development or the Opto- its importance and since few of you may have
metric Extension Program prescribe multifo- access to the original journal in which this pa-
cals for children, the headline could indeed per was published, the Journal of Optometric
read that those practitioners cause myopia to Vision Development is reprinting it in its en-
increase over time by ignoring near point per- tirety in this issue.)
formance. Evidence based medicine now man- VT Improves Reading is one of those few
dates that we seriously consider prescribing news headlines that require no alteration to
bifocals for all children who are myopes with tell the true story. This headline may not be as
high lags of accommodation (and/or any of the sensational as those prompted by Donahue’s
additional factors listed above). Because those paper, but for professionals seriously inter-
children with a low baseline of myopia benefit ested in the welfare of children, it warrants
the most, it may be particularly important to earnest consideration. Those who ignore op-
consider a multifocal when prescribing for tometry’s many contributions in the areas of
even relatively small amounts of myopia. refractive error diagnosis and treatment, as
well as in vision and learning, demonstrate a
VT IMPROVES READING! professional myopia of the highest degree.
Now that’s a headline that we’ve believed All COVD members should carefully read
in for decades. Clinically, optometrists have the 3 articles discussed in this editorial.
worked with numerous patients who have un- Please send comments and other feedback on
68 Journal of Optometric Vision Development

3. this and any other related topic to dmaino@ Tootle W, Manny R, Wang Y. Everett D (COMET Group).
Accommodation and related risk factors associated with
eyecare.ico.edu. myopia progression and their interaction with treatment in
COMET children. Invest Ophthal Vis Sci 2004;45(7):2143–
REFERENCES 2151.
1. Donahue SP. How often are spectacles prescribed to “nor- 3. Solan HA, Shelly-Tremblay J, Ficarra A, Silverman M, Lar-
mal” preschool children? JAAPOS 2004;8(3):224–229. son S. Effect of attention therapy on reading comprehen-
2. Gwiazda JE, Hyman L, Norton TT, Hussein MEH, Marsh- sion. J Learn Disabil 2003;36(6):556–563.
Volume 35 / Summer 2004 69