Talk:Vision therapy

Rawstron

Dear Wikipedia mods, I would like to challenge the Rawston citation on your vision therapy page. When you read the entire Rawston paper and not just the abstract, you will note that Rawston states that vision therapy is effective in the treatment of convergence insufficiency. Rawston also cites Birnbaum's trial into the treatment of convergence insufficiency had merit as did the studies of Grisham et al Cooper 1983, North and Henson(1982) and reviews by Griffin and Grisham.

Rawston et al (2004) cite studies by Hoffman (1982) and Weisz (1979) regarding the successful use of vision therapy in the treatment of accommodative dysfunction though the author also advocated the requirement for a further large controlled trial in this area. As regards Rawston’s comments on the use of vision therapy in the treatment of learning disabilities and dyslexia, he cites a review by Keogh and Pelland (1985) which states that optometric and ophthalmological literature seem to have opposing views on the efficacy of vision therapy and states that there are not that many controlled studies in this area though cites a study by Seiderman (1980) which showed a significant improvement in reading assessment in the experimental group when compared to the control group as well as greater improvements in visuomotor and perception measures in all areas except divergence break and recovery at near and distance. Spelling was also found not to have improved. Rawston mentions a study by Maples and Bither (2002) using a quality-of-life checklist though concludes that there were not sufficient controls in this study and that overall more work has to be done in this area.

Rawston is positive as regards the use of vision therapy in treating stereoacuity citing a controlled study by Saladin et al (1988) though recommends further controlled trials in this area. As regards vision therapy as applied to sport, Rawston recommends further studies as regards the use of vision therapy in sports vision training using controlled trials.

Rawston is positive in the use of vision therapy in the training of residual visual functions citing a study by Sabel and Kasten (2000) on treatment of patients with optic nerve or post-chiasmatic brain injuries who had some residual vision and concludes that this treatment would appear to be of significant benefit for patients who have suffered brain or optic nerve injury. He advocates further studies in this area in order to provide further information as regards the effectiveness of vision therapy.

Broadly speaking Rawston seems to be in favor of the use of vision therapy in the treatment of convergence insufficiency, accommodative dysfunction, stereoacuity and patients with residual visual function following brain injury. He cites the study by Seidermann (1980) as being successful in the treatment of learning disabilities and dyslexia though at the same time advocates the requirement for further controlled trials in this area. He also advocates the requirement for further trials as regards proving the efficacy of vision therapy in the treatment of divergence excess, intermittent exotropia, constant exotropias, amblyopia, myopia and sports vision. I welcome your comments. Bear in mind that I teach the subject of binocular vision to which behavioral optometry and vision therapy are related an undergraduate and post-graduate level as well as to the neurorehabilitation teams at Derby and Newcastle Hospitals in the UK. I would not engage in this interaction with yourselves unless I was confident of my material. I am happy to go through each citation in turn and would expect any moderators I interact with to be polite as this is the way I treat people in general. Peace.81.157.57.164 (talk) 19:54, 6 August 2015 (UTC)

References

Thank you for placing the citations thus. You are much better at editing than myself. In Peace 86.139.98.143 (talk) 05:32, 7 August 2015 (UTC)

This is to try and re-examine the material Rawstron et al have and draw a different conclusion. The conclusion of the article states:

There are few applications of eye exercises with convincing studies published to support their efficacy. The treatment of convergence insufficiency is the only major use for eye exercises that has a significant weight of published evidence to validate practice. In the majority of areas reviewed, we found little or no published scientific proof to show that eye exercises are more effective than placebo treatments.

Thus I find that this source is currently represented correctly here. We need to respect the conclusions of secondary sources, and avoid trying to "re-run" the review they embody. Alexbrn (talk) 07:04, 7 August 2015 (UTC)

Dear Alex, From your comments I take it that you have you read the Rawston paper in full as well as the references I have cited as otherwise you would not offer the opinion you have. In which case, what are your thoughts around the Birnbaum, Grisham, Cooper Hoffman, Weisz, Keough and Seidermann and Saladin papers? In my opinion these all deserve citation in the current article as their conclusions stand up as stated and they are well written papers. If you care to look at the body of work of any of these researchers on Google Scholar you will find that their research is much admired. Certainly within Optometry it is standard practice at University level to check the citations used by authors at both undergraduate and post-graduate level. If citations are not as cited this reflects both on the author(s) of the paper, the person who has cited the reference and the supervisor. I have written a number of papers and have had my citations forensically examined by editors of the journals I have written for so I always look for good references and read them thoroughly as I know that the journal editor will as well. It saves time having to cite new and better references if you can get good references in the first place. On this basis, you will note as regards the Rawston paper that his conclusions are not as are stated in your current article. In my initial interaction with Wikipedia I said that I would find citations to put on either side of the discussion. I have raised a number of citations as above and would like you and other moderators to offer your thoughts as regards all the cited papers. My thoughts on Wikipedia have always been that you would want to thoroughly reference any opinion voiced on said pages and I would hope that in the context of good science that you would do the same. I chose the Rawston paper to start with as it is an excellently researched paper though when you have read it you will note that the conclusions as stated by Wikipedia are inaccurate. Perhaps I am expecting too much as I am used to writing for professional journals as well as reviewing papers that are to be submitted to professional journals, as well as advising students on the quality of their undergraduate work. Perhaps standards are different for Wikipedia. I find it ironic that you as moderators ask for citations, I provide them and it seem that you are not willing to read them. I hope that I am being reasonable here. Obviously I can post my opinions on all your citations on both Wikipedia pages as well as the Barrett and Jennings papers. As I have pointed out to Famous Dog in a personal email on Wikipedia after he had contacted me with some questions - I now have much respect for him - Barrett stated in his paper that there are no studies to support the use of Behavioral Optometry in strabismus. I found 17 papers and decided not to cite any more beyond that. I thought that it might be more constructive to cite one citation at a time though I could start on the more esoteric ones such as the ones by Selzer and Warner which when you read them you realise that they are all anecdotal and that a Dr Hunter an ophthalmologist in Boston speaks out in favour of vision therapy though this is glossed over in the citation. Let me know how you all wish to proceed. In peace Peaceful07 (talk) 23:19, 7 August 2015 (UTC)

Peaceful07, Contrary to what you say above, I have not received a response from you in reply to my email (and yes, I have checked the spam folder). Please try replying again. Famous_dog (c) 07:48, 10 August 2015 (UTC)

@Peaceful07: Yes I've read the paper. I have nothing to add to my previous response. You seem to want to carry out an amateur re-review of Rawstron's sources so as to contaminate the clarity of his conclusions. We don't do that. We respect secondary sources and summarize the accepted knowledge they contain. Alexbrn (talk) 08:11, 10 August 2015 (UTC)

Even when they are clearly proven to be wrong in fact and science......Loomis Ideology (talk) 03:41, 31 July 2016 (UTC)

@Alexbrn: Does it seem to matter to anyone that there is a turf war between optometry and ophthalmology? Ophthalmology openly declared a war on optometry and vision therapy not too long ago. The paper's such as Rawstron's all follow a common theme. Ophthalmology reviews vision therapy and unilaterally decides vision therapy is unproven.

Without getting into the politics, would it not be more accurate to change the article to address the conflict between the two professions and the fact that there is research both supporting, and reviews that discredit?

The first sentence of the description is completely misleading based on just the CITT study alone.

I am not suggesting the article be changed to support vision therapy. Just to objectively outline research and opinions on both sides. Snapdginger (talk) 13:35, 19 October 2021 (UTC)

Saw this ping. I'd forgotten about this article. My impression is the wider world had dismissed this stuff as woo and moved on, or are there recent WP:FRIND sources? Bearing in mind past disruption, it's also important that any editor proposing radical changes in POV has any relevant COIs declared, per WP:COI. Alexbrn (talk) 13:48, 19 October 2021 (UTC)

:@Alexbrn:. Thanks for being prompt. I don't believe there needs to be radical changes. The article can be improved to achieve greater neutrality. The current iteration does not meet the wikipedia criteria for neutral point of view. Both the papers criticizing vision therapy and many of the papers of supporting research are from reputable sources. It would do more benefit to the public and scientific community to discuss the disagreeing research with more neutrality.

An example of this is the first sentence : " ...which have not been shown to be effective using scientific studies". Although the article then references the CITT study, which shows in a double blind placebo controlled study that vision therapy was effective for treating convergence insufficiency. The article contradicts itself.

It would be much more neutral to describe vision therapy as supported by optometric research, and criticized by ophthalmological papers and journals. That the research in many areas lacks strength (referencing the papers that decry it as quackery), but in other areas it has been shown to be effective (reference CITT study and others).

My potential COI is the same thing that gives me expertise in the area. I have had my doctorate of optometry for 10+ years, and work in this field. Although when I graduated optometry school I was initially against vision therapy because of ophthalmology's view. Even then, I do not wish to see Vision therapy mis-represented as not having controversy around it, or having ophthalmology most often against it, because that would not be accurate either.

For what it's worth we combat ophthalmology's dissent with a satisfaction based money-back guarantee for our patients, so our clinic would not be open if we didn't have a solid level of success. It's basically where physiotherapy or vestibular rehabilitation used to be.

Thanks for looking into this, and I appreciate your insights. Snapdginger (talk) 17:28, 19 October 2021 (UTC)

There's this[1] 2018 piece from Science-Based Medicine, which is a good, independent source for fringe science. Seems like the mainstream view is that this stuff is pretty much quackery. This source could usefully be used to freshen up the article. Alexbrn (talk) 17:37, 19 October 2021 (UTC)

:@Alexbrn: Isn't that basically just another opinion piece? The opinion itself does not have much rigor. There are decent rebuttals of much of these pieces.

So yes, I believe you're right. The page could be rounded out much better to tell the full story. There is a lot of supporting evidence in areas, but ophthalmology still retains harsh skepticism. Which is fine. There is no way the introduction sentence is accurate where it says 'which have not been shown to be effective using scientific studies````

Science-Based Medicine is a well-established WP:RS for pseudo-medicine, and is independent. Note also this source describes how vision therapists falsely try to frame the narrative as a "turf war", when what's really happening is an attempt to push back against health fraud by legitimate medics. You on the other hand have just linked to a special pleading "in universe" source, which is not WP:FRIND. Basically what I'm seeing here is a type of alternative medicine that is largely dismissed in the reliable literature, and a bunch of WP:SPAs don't like it following some recruiting on FaceBook. Wikipedia is not going to be giving credence to pseudoscience per its policies, and neither WP:ADVOCACYs nor WP:MEAT is allowed. Alexbrn (talk) 05:11, 20 October 2021 (UTC)

:@Alexbrn: I'm starting to understand this process a lot better. I also agree the turf war argument is crap to fall back on. It is actually real, but it distracts from the true issues. I read WP:RS at length. Do you have a specific criteria for how to tell which journals meet the standards? I'm surprised optometric journals are being rebuffed when an opinion piece from SBM is allowed. I am not seeking to create WP:MEAT or WP:SPAs. Snapdginger (talk) 12:57, 20 October 2021 (UTC)

WP:FRINGE offers relevant guidance. There are many journals dedicated to fringe science (e.g. homeopathy) which are not reliable sources for knowledge. Optometric journals likewise appear mostly to be believers talking to themselves. For further input, raise a query at WP:FT/N. Alexbrn (talk) 13:22, 20 October 2021 (UTC)

Thanks. Based on that I don’t believe vision therapy meets the criteria of pseudoscience you tagged either. What do you think? Snapdginger (talk) 14:02, 20 October 2021 (UTC)

Alexbrn, are you open to starting this over and having a discussion based around curiosity with the potential to let your viewpoint deviate from its current position? I’d actually rather see this page be edited and re-written by editors coming from different experiences, but able to find the common neutral ground that aptly describes it.

As it currently stands the current iteration is in violation of https://en.m.wikipedia.org/wiki/Wikipedia:FRINGE. It gives undue weight to people outside the scholarly area. I’m not sure if you’re aware, but ophthalmology is not trained in any sort of vision therapy (several of my best friends are ophthalmologists and readily admit this). The extent they are trained is being told it’s ‘quackery’. We know it’s not all quackery (CITT study and more). Perhaps it should be re-titled optometric vision therapy?

There is a way to neutrally discuss the evidence, areas of lack of evidence and ophthalmology disapproval (except CI).

Finally, where was it decided that ophthalmology is mainstream and optometry is not? The scopes have overlap in areas, but can also differ substantially. Snapdginger (talk) 14:18, 20 October 2021 (UTC)

I don't have a "viewpoint" except that we follow the WP:PAGs. If reputable sources are saying this stuff is quackery/pseudoscience, then Wikipedia follows and policy especially requires that we make its dubious nature clear, and avoid "both-siding" it with legitimate science. I'm sorry to say your contributions pretty much follow the play book of every alt-med practitioner who comes to Wikipedia advocating for their particular offering. As I say, if you think this is really not a fringe topic, raise a query at WP:FT/N where myriad editors familiar with policy will be able to respond. But as it is, from what I see the good sources we have (i.e. those that are secondary and independent) paint this as fringe and so it must be treated as such. Alexbrn (talk) 14:33, 20 October 2021 (UTC)

@Alexbrn: Thank you. I realize you probably get inundated with quacks or SPA's who just want wiki to reflect their own perspective. My contributions probably seem exactly like that, mostly because this is the first time I've wanted to get involved. Seeing how this process works, and the potential pitfalls makes me want to get involved in more areas. I also have made a few blunders as I learn all the wiki rules. Thank goodness equal weight isn't given to every viewpoint, the flat earth entry would be comical to read. I'll do some more diligence and bring this up in other places to discuss how we discern which is reputable and which is not. Thanks for your time Snapdginger (talk) 17:14, 20 October 2021 (UTC)

@Alexbrn: Your most recent edit to the introduction is not accurate. Vision therapy is based ono the premise of changing neurological control of the eyes and processing of visual information. Not simply that learning disabilities are due to vision problems. Most are not. The only cross-over is if someone's eyes can't track properly, then understandably reading would be difficult, and there is testing to separate that condition.

From the source: "The core claim of vision therapists, or behavioral optometrists, is that many children are misdiagnosed with learning and behavior disorders when in fact they have a subtle problem with vision". Alexbrn (talk) 17:43, 20 October 2021 (UTC)

That's only in the context of evaluating vision therapy with respect to learning/behaviour disorders. It's also something that deserves to be slammed. That claim is outrageous and does a disservice the public. However you are missing part of your quoted SBM piece " 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"

So it is not accurate to say that it's based on learning disabilities. That is only in the context of the article discussing that, and that particular area of treatment. It is more true to say that 'vision therapy is based on re-training the learned components of vision (eg: saccades, pursuits, muscle control, depth perception etc)'. This is applied to various areas (hence the quote on learning disabilities).

The introduction also needs to acknowledge the aforementioned evidence in visual rehabilitation after brain injury.Snapdginger (talk) 18:15, 20 October 2021 (UTC)

The lede is where we should describe the "core claims" of vision therapists. Finer-grained detail belongs in the body, if there are appropriate sources. For the brain injury aspect, we would need good WP:MEDRS. Alexbrn (talk) 18:34, 20 October 2021 (UTC)

The brain injury source is the same source you cited in the lede from SBM [2]. It's where I took the quoote from. ```` — Preceding unsigned comment added by Snapdginger (talk • contribs) 19:16, 20 October 2021 (UTC)

The SBM source is excellent for pseudoscience/quackery/false claims/health fraud etc. But for non-trivial biomedical assertions a WP:MEDRS source is required. Since this is a fringe topic, WP:PARITY applies. Alexbrn (talk) 19:45, 20 October 2021 (UTC)

To be clear. The SBM is an excellent source when they are saying something does not work, but an unreliable source when saying something does work? Snapdginger (talk) 21:28, 20 October 2021 (UTC)

Not so crude, but since the default assumption in evidence-based medicine is no effect, claims which deviate from that require stronger sourcing: e.g. you don't need a strong source to say squirting coffee up your bum doesn't cures cancer, but would need multiple strong sources for the WP:EXCEPTIONAL claim to the contrary. In any case the brain injury content is in another source (The Barrett 2008 review) that SBM quotes. Alexbrn (talk) 04:45, 21 October 2021 (UTC)

I have finally read this thread. That's a good summary. Adding a question: Does the 2019 {{fringe theories}} tag still apply with the current article revision? —PaleoNeonate – 20:12, 23 October 2021 (UTC)

References

Article Bias, Fringe theories, insufficient citations of papers

Dear wiki moderators,

Collapse WP:MWOT.

I'd like to apologize for not initially understanding the appropriate ways to edit articles and ensure that the wiki page is representative of the data and studies. Sorry for any headaches I caused in that process. There are 2 key things moderators need to be aware of. 1. The war between professions Here is the issue: Optometry and Ophthalmology largely disagree about vision therapy, with the exception of the CITT study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779032/). Much of this comes from a large political battle between the two professions. Much of this originated from the La Guardia meeting (https://aoafoundation.org/ohs/hindsight/the-meeting-that-changed-the-profession/) where optometry decided to pursue scope of practice that encroached into ophthalmology's scope of practice. Since that happened, the two professions have been at war (https://floridapolitics.com/archives/225274-optometrists-going-back-eyeball-war-truce/), and ophthalmology is out to discredit anything that is optometry specific. 2. Many of the 'reviews' and opinion pieces that 'debunk' vision therapy are not well done, but are published because it fits the political narrative. Most of the 'reviews' cite a very selected works and often mis represent the findings of other works in order to further support the agenda. Wiki does not need to have a Vision Therapy page that is in support of vision therapy, as this would be bias and incorrect. It also stands to reason that having a page citing only literature and opinion pieces against vision therapy is also biased and incorrect. I turn to you to help create a more truthful page that acknowledges the shortcomings of some areas of research about VT, the battle between the two professions, and the areas where research is strong. At the end of this you will find only a very small sample of the literature and I could fill pages and pages more. Evidence Review Effect of treatment of symptomatic convergence insufficiency on reading in children: a pilot study. Scheiman M1, Chase C2, Borsting E3, Lynn Mitchell G4, Kulp MT4, Cotter SA3; CITT-RS Study Group. Clin Exp Optom. 2018 Mar 25 Conclusion: ‘After treatment for convergence insufficiency, statistically significant improvements were found for reading comprehension (mean = 4.2, p = 0.009) and the reading composite score (mean = 2.4, p = 0.016) as measured by the Wechsler Individual Achievement Test at the 24-week visit. These improvements were related to the clinical treatment outcome measures (p = 0.011) with the largest improvements occurring in those who were early responders to treatment. Reading speed (words per minute) increased significantly on the Gray Oral Reading Test (p < 0.0001).’ Improvement in academic behaviors after successful treatment of convergence insufficiency. Borsting E1, Mitchell GL, Kulp MT, Scheiman M, Amster DM, Cotter S, Coulter RA, Fecho G, Gallaway MF, Granet D, Hertle R, Rodena J, Yamada T; CITT Study Group. Optom Vis Sci. 2012 Jan;89(1):12-8. doi: 10.1097/OPX.0b013e318238ffc3. Conclusion: ‘A successful or improved outcome after CI treatment was associated with a reduction in the frequency of adverse academic behaviors and parental concern associated with reading and school work as reported by parents.’ Improvement of Vergence Movements by Vision Therapy Decreases K-ARS Scores of Symptomatic ADHD Children. Lee SH1, Moon BY2, Cho HG2. J Phys Ther Sci. 2014 Feb;26(2):223-7. doi: 10.1589/jpts.26.223. Epub 2014 Feb 28. Conclusion: Convergence insufficiency symptoms are closely related to symptoms screened for ADHD, and vision therapy to improve vergence movements is an effective method of decreasing the K-ARS scores. Behavioral and Emotional Problems Associated With Convergence Insufficiency in Children: An Open Trial. Borsting E1, Mitchell GL2, Arnold LE2, Scheiman M3, Chase C4, Kulp M2, Cotter S5; CITT-RS Group. J Atten Disord. 2016 Oct;20(10):836-44. doi: 10.1177/1087054713511528. Epub 2013 Nov 22 Conclusion: ‘In an open trial, attention and internalizing problems improved significantly following treatment for CI (Convergence Insufficiency).’ Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Convergence Insufficiency Treatment Trial Study Group1. Arch Ophthalmol. 2008 Oct;126(10):1336-49. doi: 10.1001/archopht.126.10.1336. Conclusion: ‘Twelve weeks of OBVAT (office based vergence accommodative therapy) results in a significantly greater improvement in symptoms and clinical measures of near point of convergence and positive fusional vergence and a greater percentage of patients reaching the predetermined criteria of success compared with HBPP(home based pencil pushups), HBCVAT+ (home based computer vergence and accommodative vergence therapy), and OBPT (office based placebo therapy). Application to Clinical Practice Office-based vergence accommodative therapy is an effective treatment for children with symptomatic convergence insufficiency.’ Efficacy of vision therapy in children with learning disability and associated binocular vision anomalies. Hussaindeen JR1, Shah P2, Ramani KK3, Ramanujan L4. J Optom. 2018 Jan - Mar;11(1):40-48. doi: 10.1016/j.optom.2017.02.002. Epub 2017 Jun 7. Conclusion: ‘Children with specific learning disorders have a high frequency of binocular vision disorders and vision therapy plays a significant role in improving the BV parameters. Children with SLD should be screened for BV anomalies as it could potentially be an added hindrance to the reading difficulty in this special population.’ Differences in eye movements and reading problems in dyslexic and normal children. Eden GF1, Stein JF, Wood HM, Wood FB. Vision Res. 1994 May;34(10):1345-58. Conclusion: ‘... A qualitative assessment of saccadic eye movements revealed that dyslexics exhibit fixation instability at the end of saccades... Sex, handedness, IQ or the presence of attention deficit disorder (ADD) did not appear to influence the children's performances on any of the eye movement tasks. The presence of oculomotor abnormalities in a non-reading task strongly suggests that the underlying deficit in the control of eye movements seen in dyslexics is not caused by language problems alone.’ Association between reading speed, cycloplegic refractive error, and oculomotor function in reading disabled children versus controls. Quaid P1, Simpson T. 2013 Jan;251(1):169-87. doi: 10.1007/s00417-012-2135-0. Epub 2012 Aug 29. Conclusion: ‘This research indicates there are significant associations between reading speed, refractive error, and in particular vergence facility. It appears sensible that students being considered for reading specific IEP status should have a full eye examination (including cycloplegia), in addition to a comprehensive binocular vision evaluation.’ Optometric Vision Therapy: Evidence Based Treatment for Head Injury The new standards of care have recognized the importance of identifying and treating vision disorders after head injury. In his position statement on Vision Therapy and Traumatic Brain Injury, Dr. Eric Singman MD, PHD, Milton and Muriel Shurr Director of Johns Hopkins Hospital says: ‘Among the critical members of this (rehab) team, there should be vision specialists dedicated to working with patients who demonstrate deficiencies in eye teaming, loss of visual acuity and/or visual field as well as uncoupling of ‘visuospatial awareness’. For the most part, optometric and neuropsychological communities have embraced visual rehabilitation efforts; notably, these providers have documented successes in helping brain injury patients improve their quality of life’. Evidence Review Vision Therapy for Binocular Dysfunction Post Brain Injury Conrad, Joseph Samuel; Mitchell, G. Lynn; Kulp, Marjean Taylor. Optometry and Vision Science: January 2017 - Volume 94 - Issue 1 - p 101–107 Conclusion: ‘In this case series, post-concussion vision problems were prevalent and CI and AI were the most common diagnoses. Vision therapy had a successful or improved outcome in the vast majority of cases that completed treatment. Evaluation of patients with a history of concussion should include testing of vergence, accommodative, and eye movement function.’ Vision Therapy for Post-Concussion Vision Disorders Gallaway, Michael; Scheiman, Mitchell; Mitchell, G. Lynn. Optometry and Vision Science: January 2017 - Volume 94 - Issue 1 - p 68–73 Conclusion: ‘In this case series, post-concussion vision problems were prevalent and CI and AI were the most common diagnoses. Vision therapy had a successful or improved outcome in the vast majority of cases that completed treatment. Evaluation of patients with a history of concussion should include testing of vergence, accommodative, and eye movement function.’ Vision Diagnoses Are Common After Concussion in Adolescents Christina L. Master, MD, CAQSM, Mitchell Scheiman, OD, Michael Gallaway, OD, Arlene Goodman, MD, CAQSM, Roni L. Robinson, RN, MSN, CRNP, Stephen R. Master, MD, PhD, Matthew F. Grady, MD, CAQSM Clinical Pediatrics Vol 55, Issue 3, pp. 260 – 267 First Published July 7, 2015 Conclusion: ‘Vision diagnoses are prevalent in adolescents with concussion and include convergence insufficiency, accommodative disorders and saccadic dysfunction. Symptoms of these problems may include double vision, blurry vision, headache, difficulty with reading or other visual work, such as the use of a tablet, smartphone, or computer monitor in the school setting. This likely represents a significant morbidity for adolescents whose primary work is school, which is heavily visually oriented. Recognition of these deficits is essential for clinicians who care for patients with concussion and the CISS may prove to be a useful screening tool for use in the future. Identification of these vision diagnoses will help physicians design necessary academic accommodations for patients who have visual deficits and are attempting to reintegrate into school and learning while recovering from concussion.’ Vision rehabilitation interventions following mild traumatic brain injury: a scoping review. Simpson-Jones ME1, Hunt AW1,2. Disabil Rehabil. 2018 Apr 10:1-17. doi: 10.1080/09638288.2018.1460407. Conclusion: ‘There are promising interventions for vision deficits following mild traumatic brain injury. However, there are multiple gaps in the literature that should be addressed by future research. Implications for Rehabilitation Mild traumatic brain injury may result in visual deficits that can contribute to poor concentration, headaches, fatigue, problems reading, difficulties engaging in meaningful daily activities, and overall reduced quality of life. Promising interventions for vision rehabilitation following mild traumatic brain injury include the use of optical devices (e.g., prism glasses), vision or oculomotor therapy (e.g., targeted exercises to train eye movements), and a combination of optical devices and vision therapy. Rehabilitation Professionals (e.g., optometrists, occupational therapists, physiotherapists) have an important role in screening for vision impairments, recommending referrals appropriately to vision specialists, and/or assessing and treating functional vision deficits in individuals with mild traumatic brain injury.’ Visual dysfunction is underestimated in patients with acquired brain injury. Berthold-Lindstedt M1, Ygge J, Borg K.J Rehabil Med. 2017 Apr 6;49(4):327-332. doi: 10.2340/16501977-2218. Conclusion: ‘Visual impairments are common after acquired brain injury, but some patients do not define their problems as vision-related. A structured questionnaire, covering the most common visual symptoms, is helpful for the rehabilitation team to facilitate assessment of visual changes.’ Consequences of traumatic brain injury for human vergence dynamics. Tyler CW1, Likova LT2, Mineff KN2, Elsaid AM2, Nicholas SC2. Front Neurol. 2015 Feb 3;5:282. doi: 10.3389/fneur.2014.00282. eCollection 2014. Conclusion: ‘The results support the hypothesis that occult injury to the oculomotor control system is a common residual outcome of mTBI.’ Effect of oculomotor rehabilitation on vergence responsivity in mild traumatic brain injury. Thiagarajan P1, Ciuffreda KJ. J Rehabil Res Dev. 2013;50(9):1223-40. doi: 10.1682/JRRD.2012.12.0235. Conclusion: ‘Vergence-based OR was effective in individuals with mTBI who reported nearwork-related symptoms. Overall improvement in nearly all of the critical, abnormal measures of vergence was observed both objectively and clinically. Improved vergence motor control was attributed to residual neural visual system plasticity and oculomotor learning effects in these individuals. Concurrently, nearwork-related symptoms reduced, and visual attention improved.’ Impaired eye movements in post-concussion syndrome indicate suboptimal brain function beyond the influence of depression, malingering or intellectual ability Heitger MH1, Jones RD, Macleod AD, Snell DL, Frampton CM, Anderson TJ. Brain. 2009 Oct;132(Pt 10):2850-70. doi: 10.1093/brain/awp181. Epub 2009 Jul 16 Conclusion: ‘Our results indicate that eye movement function is impaired in PCS, the deficits being unrelated to the influence of depression or estimated intellectual ability, which affected some of the neuropsychological tests. The majority of eye movement deficits in the PCS group were found on measures relating to motor functions executed under both conscious and semi-conscious control (directional errors; poorer visuospatial accuracy; more saccades and marginally poorer timing and rhythm keeping in memory-guided sequences; smaller number of self-paced saccades; deficits in OSP). Importantly, the PCS group also had poorer performance on several eye movement functions that are beyond conscious control and indicative of subcortical brain function (slowed velocity of self-paced saccades and indications of longer saccade durations of self-paced saccades, anti-saccades and larger amplitude memory-guided saccades). Cognitive functions likely affected in the PCS group based on the eye movement deficits include decision making, response inhibition, short-term spatial memory, motor-sequence programming and execution, visuospatial information processing and integration and visual attention (Pierrot-Deseilligny et al., 2004; Leigh and Zee, 2006). These results indicate that brain function in the PCS group had not returned to normal and contrasted that seen in patients with good recovery.’ Vision therapy for oculomotor dysfunctions in acquired brain injury: a retrospective analysis Ciuffreda KJ1, Rutner D, Kapoor N, Suchoff IB, Craig S, Han ME. Optometry. 2008 Jan;79(1):18-22. Conclusion: ‘Nearly all patients in the current clinic sample exhibited either complete or marked reduction in their oculomotor-based symptoms and improvement in related clinical signs, with maintenance of the symptom reduction and sign improvements at the 2- to 3-month follow-up. These findings show the efficacy of optometric vision therapy for a range of oculomotor abnormalities in the primarily adult, mild brain-injured population. Furthermore, it shows considerable residual neural plasticity despite the presence of documented brain injury.’ Snapdginger (talk) 22:00, 4 September 2021 (UTC) I’m waiting on some replies to this by the editors and moderators. If I edit the article it seems to get reversed immediately (within a day), but I haven’t yet received a response when I follow the proper guidelines. How does this normally work? What are the expectations?

Snapdginger (talk) 01:07, 18 September 2021 (UTC)

My guess is that your edits are entirely fair and reasonable, but you're having to fight one to three people who've taken it upon themselves to Keep Wikipedia From Advocating Psuedoscience, without actually following Wikipedia's own rules. Basically, you need to call in a moderator. -Horatio Von Becker 180.148.123.68 (talk) 21:26, 23 January 2022 (UTC)

WP:FRINGE is a guideline. It's not "three people", it's the law. --Hob Gadling (talk) 12:30, 9 December 2023 (UTC)

Autism, Retained Primitive Reflexes, and Neurology

Speaking as an Autistic who has recently been referred to a Developmental Optometrist (who diagnosed retained primitive reflexes), it behooves us to focus on the neurological angle, both theory and practice. Does any professional organization track referrals? Have they risen over the decades? Abnormal primitive reflexes are an early indicator of autism. Etc. (I can't speak to the pedagogical aspect.) kencf0618 (talk) 03:15, 26 July 2023 (UTC)

Do you have any sources for this? And that indicate that it's relevant to this article. Brunton (talk) 18:23, 27 July 2023 (UTC)

Issue with identification of behavioral optometry and vision therapy

A major issue with this page is that it identifies behavioral optometry and vision therapy. It is true that at least two major sources for the article make this identification: Novella, whose article is an essentially an op-ed, and https://doi.org/10.1017%2F9781316798096.007. But behavioral optometry is a subfield of optometry, whereas vision therapy is a practice consisting in a set of procedures (vision exercises) designed to treat specific visual disorders, and is prescribed by neuro-optometrists, behavioral optometrists, and orthoptic specialists. This is a semantic distinction and recourse to an identification between two pragmatically and semantically distinct terms in an academic text or an op-ed is not sufficient evidence to disclaim such a distinction.

By conflating the two terms the article conflates systematic doubts about the claims of behavioral optometry as a field (more specifically, the inferences some behavioral optometrists draw from the scientifically uncontroversial fact that some vision exercises are effective at treating convergence insufficiency to larger claims about the role of visual issues in learning disorders) with the efficacy of a subset of these treatments. This is unacceptable and should be addressed in a revison. AtavisticPillow (talk) 01:50, 10 October 2023 (UTC)

Let's keep following the independent sources. Bon courage (talk) 06:29, 10 October 2023 (UTC)

Even if the sources are not reflective of a) the general usage of of the key terms in question, and b) the self-understanding of the discipline being analyzed? Both concern me: a quick look at this info page for for the Australian College for Behavioral Optometrists, for instance, shows that vision therapy and behavioural optometry are not identified (vision therapy is there mentioned as a possible treatment for certain eye issues). It also shows a considerably more modest mission statement than is attributed to behavioral optometry by the two sources just mentioned. This is just one website, to be sure, but these discrepancies continue to concern me. AtavisticPillow (talk) 12:59, 10 October 2023 (UTC)

The point is to use independent WP:FRIND sources, rather than the in-universe thinking peculiar to the believers. Bon courage (talk) 13:25, 10 October 2023 (UTC)

Sure, but don't we have to differentiate between two levels of claims here? On the one hand there is the question of the validity of the field of medicine in question – here the claims of the practitioners in a suspect field should not be taken at face value, because demonstrating the validity of a scientific claim requires that certain institutional and methodological criteria be met for the knowledge to be verified and enter general acceptance. On the other hand, there is the empirical question of what is actually practiced and believed by these practitioners. Here the evidentiary standard is obviously different since all we need is the empirical details of the practice, which will have to rely on publicly available information from both practitioners and observers. If there is a discrepancy between the public statements about practitioners and the self-description of practitioners (independent of the question of validity) – and I strongly believe this to be the case here – then the source of this discrepancy has to be placed into a larger context that takes into account this difference and the potential source of the discrepancy.

In other words, we have to accurately characterize the "in-universe" thinking in order to accurately evaluate it, and this cannot be done without direct reference to this "universe" itself. AtavisticPillow (talk) 14:17, 10 October 2023 (UTC)

For many types of woo the terminology is (sometimes deliberately) obfuscated and/or confused, and woo-practitioners are often coy about what they do. If there are more independent sources, or sources which discuss the confusion by all means produce them as they would be useful. Bon courage (talk) 14:33, 10 October 2023 (UTC)

Fair enough. I'll have to look through the relevant sources and literature. AtavisticPillow (talk) 14:35, 10 October 2023 (UTC)

Review of Sources and Proposal for Revision

I spent some time looking over the some of the sources for this article, as well as additional sources for added context. To that end I would like to propose a few revisions. Novella (2018) and LaBrot Z, Dufrene B (2019) are cited for the claim that vision therapy is quackery and pseudoscience. Both of these sources are primarily relying on Barrett (2008), although LaBrot Z, Dufrene B (2019) also rely on Handler SM, Fierson WM (2011). Given this, I would argue we should take Barrett (2008) as a more neutral source: nowhere does he describe vision therapy as quackery or pseudoscience, but he does emphasize that a majority of vision therapy practices are “not evidence based,” and at multiple points suggests that more control-tested clinical trials are needed to verify such practices. The need for further clinical trials is a recurring theme in recent neurology and ophthalmology literature (most strongly emphasized here) – a literature that is highly skeptical of the claims of behavioral optometry/vision therapy/neuro-optometry.

I would also suggest we follow Barrett (2008) when he says: “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.” There is relatively substantial medical literature which recommends neuro-optometric rehabilitation, a variety of vision therapy, after a concussion (1, 2, 3); I think the article should reflect this.

Finally, as others have argued I think the article should make explicit the mutual mistrust between mainstream ophthalmology and optometry. Optometry sources continually insist that there is available evidence for the efficacy of vision therapy. Non-optometry sources disagree because of the quality of the data. But both of the sources just listed insist that better studies are needed. So the basic lay of the land is this: many of the claims about the efficacy of vision therapy have not been proven with the best possible data, but unlike chiropractic (which has been definitively disproven), there is large agreement that more data is needed to verify the practice and efficacy of vision therapy. This could be better demonstrated in the article itself; it is certainly true that behavioral optometrists do not operate with the best scientific practices, but the current characterization that vision therapy is quackery pure and simple (aside from incidentally treating convergence insufficiency) is not accurate or reflective of the state of knowledge in the medical field at large. AtavisticPillow (talk) 15:39, 11 October 2023 (UTC)

Are you editing logged-out? Bon courage (talk) 15:41, 11 October 2023 (UTC)

Apologies didn't realize I was logged out. Yes I made this post. AtavisticPillow (talk) 16:03, 11 October 2023 (UTC)

Seems to privilege the most outdated source, so I think that's a bad idea. Chiropractic has not been 'definitively disproven'. Any stuff about 'mutual mistrust' would need good sourcing on exactly that; as I recall this is just a story used by the quacks to elevate themselves into the respectability of an apparent realm of debate. We don't say VT is 'quackery pure and simple' (far from it). I think from this point it would be advisable in future for you to make very specific edit requests detailing the textual change desired with associated sources. Bon courage (talk) 18:01, 11 October 2023 (UTC)

Two points, then an edit request.

1) The newer sources – the ones used to characterize vision therapy as pseudoscience – use Barrett (2008) to directly substantiate their claims. But Barrett doesn't claim that vision therapy is pseudoscience, just that many of the treatment methods remain unproven. Hence thinking we should be more cautious about that characterization of vision therapy as a whole, especially since it's in the first sentence.

2) The remainder of the article is more balanced than I have given credit. It's really the opening that I feel needs revision, since it makes a categorical claim that is not substantiated by the rest of the article (that vision therapy as a whole is based around a pseudo-scientific claim; the various qualifications the larger article offers refutes this, in my eyes).

So the specific edit request would be to rewrite the opening paragraph as follows:

Vision therapy (VT), or behavioral optometry, is an umbrella term for a variety of alternative medicine treatments using eye exercises. Unlike orthoptics, with which it shares some treatment methods, vision therapy has not been shown to be effective using scientific studies, except for helping with convergence insufficiency. Most claims—for example that the therapy can address educational and spatial difficulties—lack supporting evidence. In recent years, vision therapy has been increasingly employed for the treatment of concussion, although the practice remains controversial. Neither the American Academy of Pediatrics nor the American Academy of Ophthalmology support the use of vision therapy.

And a note about sources:

I think this would be a great source here, since it directly addresses the terminological confusion surrounding vision therapy. Barrett (2008) directly makes the claim made in the second sentence (that VT shares treatment methods with orthoptics). I would use the sources cited in my previous post to support the claim that vision therapy is increasingly used as a treatment for concussion – the literature there is substantial, and recent. AtavisticPillow (talk) 21:13, 11 October 2023 (UTC)

Sources specialising in fringe topics are apt to make the pseudoscience/quackery call. Per policy we need to be very explicit when. something's pseudoscience, so I don't think your lede works. I can't see that the "Kitra Gray" source has any the hallmarks of quality Wikipedia looks for, so would be way of using it. Bon courage (talk) 05:08, 12 October 2023 (UTC)

Not wedded to the Kitra Gray source, just thought it broke down the terminological confusion well and was on a similar level of quality as the Novella source.

More to the point, what policy are you referring to? WP:FRINGE/QS definitively says that we should be cautious about the characterization "if a reasonable amount of academic debate still exists." I think I have shown that there is considerable academic debate about the use of vision therapy, with optometry literature as well as much mainstream concussion literature endorsing, while others remain skeptical. All I have done is remove the broad characterization of vision therapy as pseudoscience in the opening sentence as a result, virtually all other doubts and claims remain. I think I have more than met you half way; if there is a policy that I am unaware of please share it. AtavisticPillow (talk) 12:49, 12 October 2023 (UTC)

WP:PSCI and WP:GEVAL are germane. Bon courage (talk) 12:55, 12 October 2023 (UTC)

I fail to see how my proposed revision gives undue weight to fringe sources or fails to maintain a neutral point of view. The primary thing I have done is remove a claim that all vision therapy is based around a pseudo-scientific claim, something which is not borne out by the sources as a whole, the remainder of the article, or the current academic literature. I have left the view that it has been described as pseudoscience and quackery fully intact in the second paragraph, this is fine, I am simply trying to give a more accurate summary of the varieties of opinion in the literature.

I have cited academic literature on the treatment of concussion, as well as mainstream optometry journals. You earlier argued that you saw no evidence of there being a split between optometry and ophthalmology, and that any evidence of this would have to be sourced. That's fine, but in that case on what grounds are you dismissing the optometry journals as sources? AtavisticPillow (talk) 13:09, 12 October 2023 (UTC)

RS says it is pseudoscience, so Wikipedia must prominently do so too. I don't think there is "no evidence of there being a split between optometry and ophthalmology" it is, rather, the nature of that split which is misrepresented as a respectable disagreement rather than a repudiation of unscientific ways, Bon courage (talk) 13:24, 12 October 2023 (UTC)

I see. In that case I am going to add the claim that vision therapy is increasingly used in the treatment of concussion (as in my proposed edit). I am also going to change the source of the pseudoscience claim to LaBrot Z, Dufrene B (2019) rather than Novella, as that is the RS. And I am going to remove the word "neurological" in the third sentence, because even the harshest critics acknowledge that vision therapy has shown promise in the treatment of concussion (see Novella, for instance), and this is in direct contradiction to the claim made there. AtavisticPillow (talk) 13:40, 12 October 2023 (UTC)

The Novella source is strong RS, but not for biomedical claims. The lede summarizes the body so it's not particularly important which sources are (optionally) cited there. Bon courage (talk) 13:43, 12 October 2023 (UTC)

Went ahead and executed my final edit proposal, and added sources for the concussion claim. AtavisticPillow (talk) 17:10, 30 October 2023 (UTC)

Please don't bomb the lede. Also that source looks like it's from Vision therapists, so not WP:FRIND. Bon courage (talk) 17:37, 30 October 2023 (UTC)

I can add further information from the Acquired Brain Injury source to the body of the article in a relevant spot to avoid bombing the lede. It's from an academic textbook about treatment for brain injury, and the source was used as evidence for the claim that vision therapy was being employed as a treatment for traumatic brain injury (not any statements about demonstrated efficacy). The institutional context in which something is employed seem relevant enough to be stated in the lede.

I had thought based on your previous (Oct 12, 13:43) comment you were OK with these revisions. But perhaps I was mistaken? AtavisticPillow (talk) 18:03, 30 October 2023 (UTC)

I'd not seen any revisions at that point, but was commenting on the Novella source. I'm uncomfortable with mentioning something is "used" devoid of knowledge about efficacy, because it implies it works. Bon courage (talk) 18:14, 30 October 2023 (UTC)

Well initially I was only going for the weaker "it is used" claim about brain injury, but Barrett (2008) actually does make the efficacy claim when he says the following: "Although there are areas where the available evidence is consistent with behavioural optometry approaches (most notably in relation to the treatment of convergence insufficiency, the use of yoked prisms in neurological patients, and in vision rehabilitation after brain injury), a large majority of behavioural management approaches do not possess a solid evidence base, and thus they cannot be advocated." This is repeated on the Vision Therapy page in the "Techniques" section. But the claim here directly contradicts the claim in the lede that vision therapy is only effective for treating convergence insufficiency.

So I think we need to edit the lede to reflect that mainstream medical literature acknowledges as valid the use of vision therapy after brain injury (the yoked prism issue is more complicated and need not be addressed here). Given issues with my initial edit how would you feel if I simply added the brain injury claim to the second sentence of the lede?

It would then read: " Vision therapy has not been shown to be effective using scientific studies, except in the treatment of convergence insufficiency and in vision rehabilitation after brain injury." AtavisticPillow (talk) 18:50, 30 October 2023 (UTC)

It hasn't been "shown to be effective" after brain injury. Bon courage (talk) 19:00, 30 October 2023 (UTC)

Well then how about I change the sentence to more accurately reflect the claim by Barrett, who is the citation here. How about: "Vision therapy has not been shown to be effective using scientific studies, although some evidence supports its use in the treatment of convergence insufficiency and in vision rehabilitation after brain injury." AtavisticPillow (talk) 19:07, 30 October 2023 (UTC)

Barret just said the evidence, such as it was, was at least consistent (in 2009). But per PMID:32542907 the current state of knowledge is that VT is no good post brain injury - mirroring Novella. So we need to update that. Bon courage (talk) 19:10, 30 October 2023 (UTC)

Good source. But it doesn't say that VT is "no good" –rather, it says: "Visual complaints occur after mTBI. Some can be linked convincingly to problems such as convergence or accommodative insufficiency, and the best candidate for treatment efficacy may be therapy for post-traumatic vergence dysfunction, and possibly for accommodative insufficiency, but randomized trials are needed to establish that there is benefit beyond natural recovery."

Perhaps a short paragraph summarizing these results can be added to the efficacy section? AtavisticPillow (talk) 19:29, 30 October 2023 (UTC)

It can be summarized as "no good evidence". Bon courage (talk) 19:43, 30 October 2023 (UTC)

Proposal to Remove Portions of the "Treatment Types" Section

Apologies for long post but the "Treatment Types" section is long and messy and has issues with sourcing. I would like to propose a number of removals to clean it up. These proposals are:

1) Remove the "Eye Exercises" sub-section, because the sourcing issues are most serious there and the relevant information can be better presented in other sections (particularly "Techniques").

2) Remove the claim that vision therapy is practiced by unlicensed professionals, because this lacks a source and isn't borne out by the sources we do have, generally sources claim it is practiced by optometrists.

3) Remove "Conceptual basis and effectiveness" sub-section, because it repeats information already stated in the "Efficacy" section above.

4) The "techniques" section is little more than a lengthy summary of Barrett (2008) – perhaps this should be edited for concision, a more recent source should be added such as Barton and Ranalli (2020), and the section moved from a sub-section of "Treatment Types" to its own section.

5) Combine the "behavioral vision therapy" and "behavioral optometry" sub-sections because our best sources identify the two.

6) The sources are also pretty weak on the sports sub-section, and if we want to talk about this at all we should probably merge it with the "behavioral optometry" sub-section.

7) Finally, I think a section on neuro-optometric rehabilitation describing the way that vision therapy is employed for treatment of brain injury. This obviously would have put front and center the Barton and Ranalli (2020) source that claims this use currently lacks supporting evidence.

Executing this altogether would leave three major sections under Treatment Types: orthoptics, behavioral optometry, and neuro-optometric rehabilitation. So far as I can tell this better reflects the sources and the actually existing institutional layout of vision therapy. AtavisticPillow (talk) 00:55, 31 October 2023 (UTC)

@Bon courage: sorry to keep bothering you but I'd like to see your thoughts before I execute this. not trying to change any substantive claims, just trying to clean up the page and add a few sentences about the existence of neuro-optometric rehabilitation so perhaps we'll see eye to eye here? AtavisticPillow (talk) 00:39, 3 November 2023 (UTC)

Off-topic chatroom stuff

Hi, Happy New Year. I am not sure who I am meant to talk to here. I have already messaged Bon Courage so I am now messaging you AtavasticPillow. Previously I talked to someone called Doc James a Canadian ER doctor as regards this page and Cochrane reviews and peer reviewed scientific literature. Bon Courage says that that person is not contributing much to Wikipedia. Can I still contact them? Ideally I would like to talk to someone with a knowledge of systematic reviews, narrative reviews and peer reviewed scientific literature. Doc James was very much to speed on that. Can I speak to him or somebody equivalent? I have already left some notes on the Teahouse page and someone called Hoary suggested talking to a Wikipedia editor who might be collegial or might not respond at all. How do I contact a Wikipedia editor? I also messaged a moderator called Lou Sander on his personal email. He was someone else I liased with previously and he hasn't replied....yet Warm regards Peaceful07 (talk) 11:31, 13 January 2024 (UTC) Any pointers welcome.... Peaceful07 (talk) 11:32, 13 January 2024 (UTC) I’m not sure what you’re asking. You spoke to someone in real life and want them to edit a Wikipedia page? Anyone is free to edit Wikipedia, but edits have to be made following Wikipedia guidelines and respected sources. I got interested in vision therapy after it benefited a family member, and I think this page could be improved in various ways by more carefully distinguishing between certain quack claims, unproven uses of VT, and proven areas of VT (orthoptics and methods it shares with other VT). But any such changes have to be be backed up by respectable secondary sources. AtavisticPillow (talk) 13:58, 13 January 2024 (UTC) I am asking the question do you and other moderators on Wikipedia know the difference between a peer reviewed scientific paper, a narrative review in a peer reviewed scientific paper and a systematic review in a peer reviewed scientific paper? Warm regards Peaceful07 (talk) 17:05, 13 January 2024 (UTC) I will pick up on this tomorrow. Have a good evening. Warm regards Peaceful07 (talk) 17:05, 13 January 2024 (UTC) Yes, these are basic distinctions any editor familiar with WP:MEDRS knows. Bon courage (talk) 17:06, 13 January 2024 (UTC) So someone has deleted my last comment 'Bon courage', that the answer to my question is that you and other Wikipedia moderators do not know the answer. This happened the last time I was on this forum. I made some really salient scientifically validated points and they were deleted. Collapse personal bio I came back this morning to say that since working with brain injured patients since 2010 it has changed my attitude to life. I have seen so many people whose lives have been changed in an irreversable way due to someone else's actions, someone not holding the ladder they were standing on when they were reaching for something in a warehouse, someone walking past a pub and someone hearing their accent, not liking it and hitting them, their head hitting the floor and they will never work again, a teenage boyfriend wanting to impress his teenage girlfriend and wrapping his car away around a tree. He walked away completely unscathed. She has a permanent slur to her speech (though can still swear like a trooper - I think that I might probably do the same in her circumstances - and a permanent limp and limited use of her one arm. As soon as anybody shows any kind of aggression towards me I walk away hence my username. When I run into anybody who exhibits traits of anger and aggression I can only think that these people have never met someone with a brain injury or been involved in their rehabilitation. If Wikipedia wants to reach out to someone I recommend Associate Professor Curt Baxstrom at Pacific University Oregon who reached out to me to contact Wikipedia again. Curt can also be contacted at his practice in Seattle. Some other colleagues called Amy Thomas and Rob Fox in the US are also interested. For my part I am now committed to the mTBI PREDICT project at QEH Birmingham an 8 year project looking into biomarkers associated with acquired brain injury. I have been seconded to support the optometric side of the project as the neuro-opthalmologists involved in the project also work in the military so are too busy saving the vision of UK military personnel in combat zones around the world to read through thousands of scientific papers. I have promised to put in the hard yards to do this starting tomorrow (Tuesday) in order to get some top quality research done that will be a guide for my colleagues in neuro-ophthalmology as to how to care for and rehabilitate their patients. The project is funded by the Ministry of Defence and my point of contact are military personnel which really keeps you on your toes. I wish all the people involved on this page, past and present and all Wikipedia moderators the best for the future whatever that might bring. I would like to say that it has been a pleasure, though it really hasn't. This may all get deleted, however.....someone would have read it. Take care, keep away from aggressive people, be kind, be humble and....don't worry.... just pray. Peaceful07 (talk) 06:08, 15 January 2024 (UTC) Nobody deleted any of your comments. The only comment removed was a troll-like one from an anonymous Scotland-based IP user.[3] When I say "Yes" I mean "yes", not "no". To be absolutely clear, established editors working in this area ARE THOROUGHLY FAMILIAR WITH the basic distinction between types of article you mention. Your diary-like writings are not appropriate to this Talk page, which shold be focussed on concrete proposals to improve the article. Bon courage (talk) 06:18, 15 January 2024 (UTC) Dear Bon Courage, First of all the comments that were deleted date back to 2015. Secondly, please explain the distinction as regards the difference between a scientific peer reviewed paper, a narrative review and a systematic review? If it is not appropriate to place to place your answer here, please indicate where on Wikipedia you would like to place your answer. Warmest regards Peaceful07 (talk) 03:31, 19 January 2024 (UTC) Don't ask impertinent questions; you just need to believe me, and this is WP:NOTAFORUM. I have no idea which "comments" from 2015 you are referring to, Bon courage (talk) 03:36, 19 January 2024 (UTC)