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Bizarre Science Lesson From A Behavioral Optometrist

Charlene Werner is getting a lot of attention she probably did not anticipate or desire. She is the star of a YouTube video in which she explains the scientific basis of homeopathy. Before you watch it, make sure you are sitting down, relax, and brace yourself for an onslaught of profound scientific illiteracy combined with stunning arrogance. For those with more delicate constitutions I will give you the quick summary:

Einstein taught us that energy equals matter and light, but because matter can be condensed down to a very small space if you remove all the empty space between the elementary particles (I am paraphrasing to make her statements minimally coherent), we can mostly ignore matter. Therefore energy is light, and we are all made of energy – not matter (or at least so little matter, you can ignore it). Stephen Hawking then came up with string theory, which tells us that all matter (which we can ignore) is made of vibrating strings. Therefore we are made of vibrating energy. All diseases are therefore caused by unhealthy vibrational states, and all disease can be treated by returning the body to a previous healthy vibrational state. This can be done with homeopathy, which extracts the vibrational energy out of stuff and places it in a small pill that can be used at any time.

Got it? This is now my favorite example of meaningless pseudobabble from a CAM proponent. Also, I am not picking on some unrepresentative crank – this is as good as homeopathy gets. Werner may be more clumsy and fumbling than more eloquent homeopathy proponents, but when you strip it down, magical vibrations is what you get. But Werner does a fabulous job of exposing the gaping holes is homeopathic nonsense.

Werner is also Dr. Charelene Werner which made me curious of her degree and practice, and this led me to a topic that I do not think we have every covered on SBM – behavioral optometry. Dr. Werner is an optometrist who engages is a host of pseudoscientific practices, homeopathy being just one.

Behavioral or developmental optometry is similar to chiropractic, in that it is a health care profession that is self contained, separate from mainstream medical science, with historical roots survival into modern practice. There is a kernel of legitimacy (perhaps) to some of what they do, but then a vast expanding set of clinical claims for which there is little or not evidence. The big difference is that behavioral optometrists, unlike chiropractors, have largely been flying below the radar.

There also appears to be a spectrum, like with chiropractic, and I’m sure those behavioral optometrists who try to be evidence-based may take exception to being lumped in with the likely of Dr. Werner. But – professions have an identity, and you don’t like what’s happening under the banner of your profession, clean it up from the inside.

A look at Dr. Werner’s website give us a clear picture of her philosophy:

We are a holistic based optometric practice dedicated to the highest quliaty vision care for your entire family. We believe that 70% of how you physically function is through the vision system. Therefore, when the vision system is improved or enhanced it also increases overall physical wellness and performance.

This reflects, in my opinion, the tendency for practitioners who are not science-based to slowly expand their claims and scope of practice.  If anecdotes are all you require (not even minimal biological plausibility) to accept that your interventions work, then before long you will think they work for everything. Dr. Werner likely does not grasp how extraordinary a claim it is to say that 70% of physical function is through the vision system. I wonder how she came up with that figure. The vague claims to “improve or enhance…physical wellness” leaves the door nicely open to treating just about anything.

Behavioral optometry is premised on the belief that eye and visual function can be improved, at any age, through training, exercises, or glasses with special lenses or prisms. There is little support or plausibility for this claim so broadly conceived, although there may be some truth to this concept in specific cases. A thorough review of the claims and literature for the various treatments of behavior optometrists is beyond one article, but I did find some recent reviews. This review from 2008 takes a broad look at behavioral optometry practices and concludes:

There is a continued paucity of controlled trials in the literature to support behavioural optometry approaches. Although there are areas where the available evidence is consistent with claims made by behavioural optometrists (most notably in relation to the treatment of convergence insufficiency, the use of yoked prisms in neurological patients, and in vision rehabilitation after brain disease/injury), a large majority of behavioural management approaches are not evidence-based, and thus cannot be advocated.

That is what I found from a look through the literature. The studies that are being cited by proponents are small, unblinded, pilot studies. There is a distinct lack of large randomized controlled trials.

Some of the claims made run directly contrary to evidence in the neurological literature. For example, using prisms to treat dyslexia (a reading disorder) based upon the premise that dyslexia is largely a visual problem (despite normal standard visual testing). However, the evidence has shown that dyslexia is not a visual problem but a disorder of the language area of the brain – a language and learning disorder. The claims of behavior optometrists regarding dyslexia started out being without evidence, but have increasing run contrary to prevailing evidence, but optomestrists failed to adapt or update their theories and practice.

The one condition that seems the most plausible and is most accepted is called convergence insufficiency – difficulty in properly focusing both eyes on near objects. There is weak evidence to support training exercises to help with this disorder, but other methods that are used to treat it (for example and exercise called pencil push-ups) has not been shown to be effective. While this condition requires more research, it is plausible.

At the other end of the plausibility spectrum is syntonic phototherapy. This is the use of specific colors of light to treat a wide range of symptoms and conditions, and improve performance. A search in pubmed on “syntonic phototherapy” yielded zero results. There is probably some research under different terms, but just using “phototherapy” as a search terms yields too many results to wade through (legitimate phototherapy is used for a range of skin and other conditions).

According to promotional sites, syntonic phototherapy dates back to the 1920’s and one man, Dr. Harry Riley Spitler- always a red flag. They seem to follow the pattern of referencing some legitimate basic science (for example the existence of light pathways in the brain that are not involved in conscious vision) to justify specific clinical claims without referencing quality clinical evidence.

Opthalmologists (MD eye doctors) historically have flirted with some of the claims of behavioral optometry, but a recent survey of practice concluded:

Although visual training has been used for several centuries, it plays a minor and actually decreasing role in eye therapy used by the ophthalmologist. At the beginning of the twenty-first century, most visual training is carried out by non-ophthalmologists and is neither practiced nor endorsed in its broadest sense by ophthalmology.

In short, there is generally low plausibility for many of the claims of behavior optometry, a lack of evidence for most of the methods used, a lack of consistency with the overall scientific literature and practice, and an expanding list of conditions they believe they can treat. These are all symptoms of a profession that lacks an appropriate level of respect for evidence and science-based medicine.

It is therefore no surprise to find a practitioner who also uses other unscientific modalities, such as homeopathy, and can so casually display such profound scientific illiteracy. Dr. Werner therefore managed to be an embarrassment to two professions at the same time.

*This blog post was originally published at Science-Based Medicine*

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