1. Editorial
Mistakes Were Made (Yes by You!)
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
Editor
In the last issue of Optometry & Vision and Aronson discuss how certain groups of individuals
Development, I reviewed a book titled Mistakes Were (police officers, prosecutors, researchers) can maintain
Made (But Not by Me): Why We Justify Foolish Beliefs, this inability to admit mistakes while using a group
Bad Decisions, and Hurtful Acts by Carol Tavris, PhD think mentality to bolster an otherwise indefensible
and 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 recent
our view of the world. Mistakes Were Made (But edition of the American Orthoptic Journal, Volume
Not by Me) will forever change the way I see myself 60, 2010; should read the Tavris and Aronson text
and 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 journal
foolish 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 Ophthalmology
their ways, they continue to desperately and even and Strabismus: The Application of Evidence-Based
more strongly hold on to their outdated science, their Medicine and had several editorials and about ten
biased opinions and their articles.
mistaken ideology. They … What we cannot and should The first article in
remain unshaken by
truth, 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, MPh
know. They believe what (Evidence Based Medicine
they 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 had
Villains, and Hypocrites: How do They Live with written to express his concerns regarding the CITT
Themselves, noted that somehow those in politics, law, study. His paper was simultaneously published in the
research, business, medicine, and even religion refuse same edition of the Archives of Ophthalmology as that
to acknowledge the mistakes they have made despite of the CITT study.4 In fact, as remarkable as it may
solid 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 the
Correspondence regarding this editorial should be emailed to text on the very front page of the CITT study. Even
dmaino@covd.org or sent to Dominick M. Maino, OD, MEd, Illinois though Dr. Wallace has participated in clinical trials
College of Optometry, 3241 S. Michigan Ave., Chicago, IL 60616. All
statements are the author’s personal opinion and may not reflect the opinions in the past and is quite aware that the make-up of
of the College of Optometrists in Vision Development, Optometry & Vision the CITT study included both optometrists and
Development or any institution or organization to which the author may ophthalmologists he wrote of several misgivings he
be 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 to
available at http://www.covd.org. Dr. Wallace’s misgivings, I pointed out that he used
phrases such as, “I believe…,” I think…,” and “In
Maino D. Maino D. Mistakes were made (Yes by you!). Optom Vis Dev
2011;42(2):66-69.
my experience…” as a part of his justification for
not accepting the evidence based research before
66 Optometry & Vision Development

2. him. I also noted that optometry is often criticized patients at any age.8,9 On the downside this article
by ophthalmology for using the very same phrases he still defines amblyopia as a problem with visual acuity
chose to support his CITT study misgivings. When when it has clearly been shown that it is really an
I 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
2
addressed by a randomized clinical trial, the best of vision screenings overwhelming shows that vision
available 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 article
clinical experience enough to disregard the evidenced says that the research evaluating the use and outcomes
based, research based findings of the CITT study? Is of vision screenings are so poor that they couldn’t
it appropriate to write one thing if you support the come to a conclusion as to the value of conducting
outcomes 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 required
is a hierarchy of study methodologies for obtaining to ascertain the degree to which vision screening is
evidence. He then listed these levels from being the effective…”12 Unfortunately, this article goes on to
least to most useful (laboratory research, editorials, state that, “…Evidence based medicine is probably
case reports and case series, case controlled studies, an inferior method of analysis of potential benefits of
cohort studies, and randomized clinical trials). So was vision screening…” Once again it appears that if your
the randomized, double blind, placebo controlled beliefs run contrary to evidence based research, you
CITT study not the highest within his hierarchy? can ignore that which does not coincide with those
Shouldn’t it then be considered the most useful? If beliefs.
the CITT study was at the Another article by
highest evidence level and the …the hypocrite is the last an orthoptist, Vision
most clinically useful, why
did he write the editorial?
one to recognize the hypocrite Therapy and that optom-
acknowledges
Orthoptics,13
How could he justify using in the room…. etric vision therapy is the
his experience and beliefs as a most efficacious treatment
basis for his editorial when a clinical trial has shown for convergence insufficiency and that yoked prisms
otherwise? 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 juvenile
do 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 American
in this edition of the American Orthoptic Journal Academy of Pediatric Ophthalmology and Strabismus
dispel myths and beliefs long held by many within (AAPOS), American Academy of Ophthalmology
the eye care field. For instance, did you know that (AAO), and the American Association of Certified
you can treat amblyopia after the age of six years! This Orthoptists (AACO)14 to support her misguided
article even acknowledges the possibility that adults beliefs. This joint statement has been shown to be
with amblyopia can be treated successfully as well.6 faulty, embraces intellectual dishonesty, and is a
Of course those of us in the field of developmental great disservice for all those individuals who could
optometry have been achieving successful outcomes benefit from what optometry has to offer. Several
for our older amblyopes for years and even publishing responses15,16,17,18 to this erroneous joint statement
papers about this in the optometric literature. have been published and unfortunately ignored by the
Unfortunately it wasn’t until similar case reports and author of this article (Marla Shainberg). The rebuttals
research appeared in the ophthalmologic literature did of the joint statement point out that: “A review of
our colleagues begin to acknowledge the treatment the references in the joint statement as well as other
possibilities for adults.7 It is my hope that all begin references find that the joint statement is misleading
to read the literature in a variety of professions that because of inappropriate citations and selected
support the treatment of this significant disorder for references.”15,16 “The most current joint statement
Volume 42/Number 2/2011 67

3. 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) and
rivalry to cloud its judgment regarding optometry’s realize that Mistakes were Made (Yes by You!)
involvement in the diagnosis and treatment of
learning-related vision problems.”15,16 The references Keywords: cognitive dissonance, convergence
include 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 optometric
literature is included.”15,16 Although it would have References
only 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, and
support optometric vision therapy19,20,21,22,23 for a Hurtful Acts by Carol Tavris, PhD and Elliot Aronson, PhD. Mariner
host 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. Randomized
We 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 other
trial 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; 243:278–280
as it is an education and medicine as much a craft as 8. Wick B, Wingard M, Cotter S, Scheiman M. Anisometropic Amblyopia: Is
it 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: A
exhibiting their bipolar characteristics when it comes mini-review. Vision Research 2009;49(21):2535-2549
to evidence based research and its clinical applications. 10. MainosMemos http://www.MainosMemos.blogspot.com
We 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: a
matter 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 J
approaches 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 from
clinical trials because if we wait for that clinical trial http://one.aao.org/CE/PracticeGuidelines/ClinicalStatements_Content.
aspx?cid=8aa39ca4-039a-4329-beec-42e5a3007329
to 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 2010
double 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 masked
appears 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. Binocular
approach 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

4. 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 J
22. 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.
Acknowledgements
Welcome 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 the
newest addition to the OVD editorial staff and latest, scientifically sound optometric resource in
Journal Review Board: Li Deng, PhD. She has been the areas of pediatrics, binocular vision, optometric
kind enough to volunteer her many talents to OVD vision therapy, rehabilitative optometry and special
as our statistician. Dr. Deng’s background includes populations. Dr. Deng will help us make this happen
receiving her PhD and MA in statistics from Rice with every issue. Please congratulate her on becoming
University, 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 Corrections
Professor of Biostatistics at the New England College
of Optometry in Boston, MA. She has already been OVD 42-1 Article Correction
recognized as someone with special talents as an Optometry & Vision Development Volume
Outstanding Graduate Student at the University of 42, Number 1, contained an article named
Texas (El Paso) and by receiving a pre-doctoral trainee Accommodative Response in Children with
Fellowship from the W.M. Keck Foundation to the Visual Impairment. The author was cited as
Gulf 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 profoundly
journals. 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, FCOVD
school year and summer” Optometry and Vision Southern California College of Optometry
Science 86(4): 403-41.
Catherine Johnson, Barry Kran, Luisa Mayer and Eric Borsting, OD, MS, FAAO, FCOVD
Li Deng (2009), “Comparison of the Cardiff and Southern California College of Optometry
the Teller Acuity Tests in a Deafblind Population.” Karissa Paul, OD
Optometry and Vision Science, 86(3): 188-195.
Brittany Reimers, OD
Ruth Manny, Li Deng, Connie Crossnoe and
Jane Gwiazda (2008), “IOP, Myopic Progression and
OVD 42-1 Article Correction
Axial Length in a COMET Subgroup.” Optometry
Optometry & Vision Development Volume
and 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 published
associated with Experimentally-Induced Myopia or
in Volume 41, Number 4. Our apologies
Hyperopia in Chickens,” Investigative Ophthalmology
to Dr. David Goss, author of our Current
and Visual Science, 49: 858-867.
Literature Review section and to our readers.
Aurora Denial, Li Deng (2008), “Predicting
Clinical Performance,” Optometry Education, Spring
33(2): 70-74.
The editorial staff and the Journal Review Dominick M. Maino, OD, MEd, FAAO, FCOVD-A; Editor
Board always strive to make Optometry & Vision
Volume 42/Number 2/2011 69