Parachutes, Optometric Vision Therapy and Randomized, Clinical Trials

Martínez PC, Muñoz AG, Ruiz-Cantero MT.Treatment of accommodative and nonstrabismic binocular dysfunctions: A systematic review.Optometry. 2009 Dec;80(12):702-16.

CONCLUSION: Scientific evidence exists for the efficacy of vision therapy for convergence insufficiency. Insufficient scientific evidence exists on the best therapeutic options for treatment of the other nonstrabismic binocular anomalies and accommodative disorders.

Comments: Are these authors really this naive? Do they really think you cannot treat patients’ problems unless the treatment has had randomized, clinical trials conducted? Do they practice in an ivory-tower bubble? Medicine has NEVER waited for the clinical trials before treating. Should optometry be held to a different standard? There is enough research at various levels (Observational Studies, Case-control Study, Cross-sectional Studies, Integrative Studies and Case Series studies) to support optometric vision therapy as a viable treatment. If these authors bothered to look at this research they would have known better than to come up with this erroneous conclusion! Go to http://www.covd.org for a listing of these papers.

Please see the paper below. It illustrates just how “obsessed” some folks can become with “evidence based medicine”. We need good science to support clinical care. Good clinical care usually occurs while the science tries to catch up. DM

Smith GCS, Pell JP. (2003). Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ, 327(7429), 1459-1461. DOI: 10.1136/bmj.327.7429.1459

Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials

Gordon C S Smith, professor1, Jill P Pell, consultant2

Abstract

Objectives To determine whether parachutes are effective in preventing major trauma related to gravitational challenge.
Design Systematic review of randomised controlled trials.
Data sources: Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists.
Study selection: Studies showing the effects of using a parachute during free fall.
Main outcome measure Death or major trauma, defined as an injury severity score > 15.
Results We were unable to identify any randomised controlled trials of parachute intervention.
Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute

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