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Authors
Charles Boulet, BSc, BEd, OD

The ‘20/20/20 Rule’ – When Good Intentions and Axiomatic Habit Displace Best Practices

publication date
December 5, 2016
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Abstract/Introduction

ABSTRACT: 

Optometrists often proffer the ‘20/20/20 Rule’ as advice for clients who experience nearpoint visual strain, or who are subjected to prolonged expo-sure to nearpoint devices. The ‘rule’ is offered in the patient’s best interests: To help alleviate asthenopia and visual stress from nearpoint strain, and to reduce the risk of onset or the progression of myopia and associated ocu-lar disease. Best intentions aside, there is a paucity of clinical and scientific support for the rule.

On the other hand, modern optical tools and methods, and vision rehabilitation practices are known to be helpful in addressing mild to severe binocular vision disorders, to promote comfort, and to slow the progression of myopia. While offering trite advice to address potentially serious concerns might appear to be helpful, its continued use could well be displacing other more appropriate management strategies. This paper addresses some concerns regarding the promulgation of this well-meaning, but misguided, advice.


Conclusion/Results

The 20/20/20 Rule is a popular optometric axiom that has made its way into popular culture partly, perhaps mostly, due to its promotion by the profession of Optometry. It is intended to promote greater comfort while reading, i.e., to reduce the symptoms of CVS, to abate accommodative hysteresis and NITM, and to prevent myopia or to slow myopic progression. While The Rule’s clinical impact for patients can at best be described as marginal, it will have, in the most extreme cases, no more impact than that of aspirin on a bad fever. The clinician’s role is to diagnose and treat the ill patient; in this case, the patient suffering from nearpoint visual strain, mTBI, or myopic progression. These issues may be addressed through optics, optometric vision rehabilitation, or medical intervention. The Rule alone will not satisfy troubled patients. It is not based on any definable clinical science, nor does it offer any preventive value for healthy and strong readers. Therefore, it should not be given as professional advice per se. Because it provides such limited benefit to the patient, the time taken to explain The Rule is a missed opportunity for advancing further diagnostics, or for exploring more elaborate options for treatment and palliation. While best practice would include some instruction to the patient to take occasional breaks from reading, the value of doing so should not be overstated, nor should the clinician include the erroneous suggestion that this could prevent the onset of structural myopia and associated ocular disease. Optometrists and ophthalmologists need to consider the potential problems with public and professional percep-tions when they offer trite and unproven advice to resolve complex issues. A greater concern is that pithy advice such as The Rule detracts from and marginalizes the proven benefits of Optometric Vision Therapy, such as the level one evidence presented in the Convergence Insufficiency Treatment Trial,30 and it also diminishes the clinical value of a more comprehensive assessment of binocular visual function, which would lead to a more nuanced and valuable clinical result for the patient.


Testimonials


I haven't actually used the optometrist side, so my review is limited to the vision therapy offered.  This office was recommended by my occupational therapist for the treatment of my double vision following a stroke.


Claire A.

Love this location. I had a brain injury accident from day one one. All the team make you feel you still important and hope in the horizon after when the medical system fell you miserably. Dr. Ikeda very professional and very understanding about your issue. Two tombs up.


Jim K.

My husband and I were immediately impressed with Dr Ikeda. I was hit by a car while cycling which caused broken bones and three brain injuries. The brain injuries caused double vision. Dr. Ikeda examined my eyes and got me started on vision therapy with his occupational therapist who specializes in vision therapy.  She (Chris) is absolutely great.  I am impressed with the array of tools used to help recover my binocular vision.  I am doing things I never thought were possible (balance boards etc).  Chris pushes me and keeps me motivated. I really enjoy my sessions with her.  The office staff is always friendly and they have a wonderful appointment reminder tool that makes it easy to keep my calendar up to date. I am happy the rehab center at Little Co. of Mary recommended them!!


Teresa S.

The Vision Therapy is handled in a separate office through a different door from the shared waiting room. Chris, the vision therapist, has a wide and varied assortment of tools, equipment and resources to best evaluate and treat most vision issues. After just a few visits, my double vision became easier to control, using exercises developed during the therapy process. It was time well-spent.


Joe M.

I have been coming here since I can remember. I love it here. The staff is so amazing and nice. They explain everything they gonna do and never make you feel rushed. Dr. Ikeda has always been my doctor and I would never want another one. He is the doctor for my whole family and is always asking how everyone is doing. I am also so crazy about picking out my frames and have to try so many and each person who helps me take the time and lets me try them all on. I would never want to go anywhere else! I definitely would recommend this office to anyone looking for a great eye doctor.


Kayla W.

This is not for the eye exam but for the frames selection portion. I brought my prescription from Kaiser here with my VSP insurance. The reception staff was very polite and professional.  Manny helped me to pick out frames and explain my coverage.  Very helpful and patient not like the individual at the other place I rated here on Yelp.  I was running late and he still helped me and was not bothered at all.  I am so glad I came here ..........very pleased.

Very professional staff and pleasant.


Daniel G.
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