Atlantic ‘Eye Exam Scam’ article – some things worth considering before further engaging the author and the public

Yascha Mounk provides some clarifications on Twitter to his original article 'The Great American Eye Exam Scam' and in addressing the AOA's letter in response.

https://twitter.com/Yascha_Mounk/status/1201913559745253376

The replies I'm reading by ODs in the twitter thread where the author has doubled down on his thesis aren't particularly convincing in their method of communication, insults are being thrown and there doesn't seem to be a great job at refuting some of the points raised by the author.

https://twitter.com/Yascha_Mounk/status/1201913403142529026

…there are plenty of medical exams that are not mandatory even though they often help to uncover dangerous diseases. Do you need to see a dermatologist to buy a simple skin cream? No. Do you need to get a prostate exam to buy drugs against incontinence? No.

Here, we could quite easily make an analogy for CLs to a medical device managed by an MD, as CLs present a very real risk for permanent blindness if ocular health is not monitored regularly, which easily refutes this argument. However, I don't think it's quite so simple for spectacles (except for those with unaided VA that does not meet driving standards).

Also, what are your thoughts on the brief discussion here (not raised by the original Atlantic article's author):

https://twitter.com/JHorrn/status/1202395452655706112

Look I’m done here. It’s telling that you can’t cite a single prospective randomized study nor even a comparative study to European countries that do not have the same requirements. You fall back on arguments like ‘if even one life is saved’ and frankly it’s embarrassing for you

Yascha Mounk:

When deciding how to feel about trade-offs, facts matter. Is there evidence that Americans die from relevant diseases at significantly lower rates than, say, Germans? If so, how do those benefits compare to the cost of stopping some Americans from having adequate vision care?

While we often find studies in support of things we perceive to be 'common sense', we are also often surprised by unexpected findings. If we are to hold high standards in research, nothing in science is ever 'self-evident' until properly scrutinised, with RCTs often being the gold standard in medicine. However, this seems to be a problem where it is basically self-evident that preventative medicine would justify mandatory eye examinsations every 1-2 years. Therefore, it seems that there is not really an impetus to fund an expensive RCT on the merits of eye exams as prevention. This is far as I've come in thinking about this so I'm not sure how else to expand on this line of thought to fully address the quote above.

One comment was particularly interesting:

Show me a prospective, randomized study that predefines a primary endpoint and demonstrates a clear, significant health benefit vs control group and makes an attempt to measure the total cost of that benefit. Burden of proof of benefit is on you not me

I am unsure if the burden of proof lies with ODs to prove that the benefit of mandatory eye exams outweights the costs, or on those who claim that the costs outweight the benefits.

Look I’m done here. It’s telling that you can’t cite a single prospective randomized study nor even a comparative study to European countries that do not have the same requirements. You fall back on arguments like ‘if even one life is saved’ and frankly it’s embarrassing for you

Obviously the profound ignorance of the author and general public is apparent (in regards to the importance of eye exams, and the risks associated with CL wear), and this is clear to anyone with an optometric background. However, from my reading of his twitter thread it would be premature to assume he is making these arguments entirely in bad faith, even if he is ignorant about ocular health.

I'm curious what /r/optometry ODs think – I think some of the points raised are actually worth putting effort into refuting in earnest.

submitted by /u/StoicOptom
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