The recent article about Vision Therapy in the New York Times Magazine has created a good deal of debate and discussion. By Monday afternoon, when comments were no longer being accepted, there were 248 comments! As I read through many of the comments, it occurred to me where the line was being drawn in this debate. On one side are the many patient, parents and behavioral optometrists who see lives changing because vision therapy is an effective treatment for so many patients. On the other side are the skeptics, who have had no experience with vision therapy and can only say, “where is the evidence?”
Evidence-based medicine is defined as the “conscientious explicit and judicious use of current best evidence in making decisions about the care of individual patients.” The process of evidence-based medicine BEGINS with the interpretation of clinically relevant research. It ENDS with the careful consideration of all relevant information for an individual patient. Evidence-based medicine has the potential to improve the clinical outcomes for patients with any diagnosis. However, the impact of evidence-based medicine is limited by the difficulty of getting from the BEGINNING to the END. This is where Clinical Practice Guidelines have become so important in bridging that gap.
Clinical Practice Guidelines, or CPGs, define evidence-based practice for specific diagnoses or clinical entities. After finding and evaluating the research, a panel of experts applies the evidence by developing patient care protocols. These protocols help the doctor determine what diagnostic and therapeutic procedures are most appropriate for an individual patient. CPGs ARE the evidence and much more. They help the doctor put the research into practice.
The American Optometric Association has published 20 CPGs. They “combine the best available current scientific evidence and research with expert clinical opinion to recommend appropriate steps in the diagnosis, management, and treatment of patients with various eye and vision conditions.” They are all available online.
For the skeptics who ask, “where is the evidence?,” here it is: