It is important for eyecare providers to have a basic awareness of some of the more common scams and misinformation about eyecare, past and present. Our patients commonly ask us about certain “questionable” products or services they’ve heard about or seen advertised. It is our role to provide a thorough explanation to patients and debunk any scams or misleading services that seem too good to be true. Unfortunately, there are a wide range of controversial products and services in eyecare that make claims which are not backed by definitive science. In this article we’ll address some of the misinformation patients may inquire about and dive into some of the scams they could fall victim to.
1) Does eating carrots really improve your night vision?
We’ve all heard patients ask “should I be eating more carrots for my eyes, doc”? Advising patients to consume a plethora of brightly colored vegetables for general ocular health is a great idea and should be promoted. Increased consumption of vegetables, thanks to their beta-carotene and antioxidant properties, can help maintain ocular health while staving off ocular disease.
Those who are vitamin A deficient may have visual improvement by adding vitamin A rich foods, such as carrots, to their diet. However, this is an entirely different claim than that held by the old adage that says carrots will specifically improve one’s night vision. This was not the information that was marketed to the British population during World War II which popularized the widespread myth that carrots improve night vision.
To set the scene: in 1940, German aircraft were bombing Britain (and other countries). To make it more difficult for the German air force to hit their targets, Britain had issued city wide blackouts. Britain had also developed radar capabilities that allowed them to know before approaching planes reached the British Channel. To keep their radar technology under wraps, they needed to promote another idea why they were capable of this: super-human night vision due to carrot consumption.
Fig 1. Left image, one of the many advertisements that appeared during WWII, encouraging consumption of carrots for help seeing during blackouts. Right image courtesy of World Carrot Museum.
The hype around increased carrot consumption was further popularized by British propaganda, encouraging not only their air force, but also average citizens to eat more carrots as well. During a time when rations were strict for many items, carrots were in surplus and people were encouraged to eat them in creative ways. Creative cartoons were created to encourage people to eat more surplus crops and prepare them in unique ways. For example, since sugar was rationed, carrots could be a satisfactory replacement in desserts as a sweetener.
Fig 2. “Dr. Carrot” and “Potato Pete” were introduced in 1941 to help promote the consumption of surplus crops in the United Kingdom during WWII.
2) Can you really improve your vision naturally, without glasses?
Many companies have marketed the “Bates” Method to improve vision without the need of prescription glasses. Established in the early 1900s by Dr. William Bates, companies selling this service promise to provide a series of exercises that are used to “relax your eye muscles” to fix the problem of refractive error and reverse the need to ever wear corrective lenses again. They warn that optometrists are trying to scam consumers into buying glasses and contact lenses, which inevitably will make vision worse and increase consumers’ dependency on corrective lenses.
Companies like Quantum Vision System claim they’ll teach you the secrets to unlocking good natural vision for life. Consumers are told that for the cost of several hundred (or even several THOUSAND dollars, depending on the system), they’ll never have to wear glasses again. Desperate to sell more of their services, these companies have even been caught hiring undisclosed actors to impersonate board certified optometrists, a direct violation of the Federal Trade Commission.
Both the American Academy of Ophthalmology and the American Association of Pediatric Ophthalmology have looked into the claims and techniques like those promoted in the Bates Method, and found no conclusive scientific evidence that natural vision correction nor vision therapy can reverse preexisting refractive error.
Carrot Neurotechnology was also among the numerous companies trying to promote online apps that promise to correct vision naturally. Their specific app, Ultimeyes, claimed to “Turn Back The Clock On Your Vision” and provide “Comprehensive Vision Improvement” for just $5.99. The company was then heavily fined by the FTC for making the misleading claim that their simple-to-use interactive game was “scientifically shown to improve vision”.
3) Can I just get an eye exam online?
A growing number of online companies and smartphone apps are offering refractions and “eye exams”, all from the convenience of the consumer’s home. In some cases, these services may cost more than the insurance copay for a complete in-person eye exam. Regardless, these companies continue to push the boundaries with their marketing claims, while dodging legal trouble with the FDA and FTC.
For example, 1-800 CONTACTS’s website offers an ExpressExam that has used past marketing phrases like “No dilation or puffs of air required – Skip the trip to the doctor’s office.” Patients are asked to send a close-up video of their eyes while wearing their contacts to ensure the lenses fit properly. This is essentially telehealth and is actually a benefit to patients during the current pandemic; however, it may not be a viable long-term solution. Their panel of board-certified ophthalmologists review patients’ exam findings and authorize updated prescriptions for glasses or contacts.
Despite the American Optometric Association’s appeals to the Federal Trade Commission regarding 1-800 CONTACTS’s marketing practices, the company continues to use ambiguous phrases that may mislead patients, and undermine standard-of-care.
While it may seem obvious to the general public that we’re not comparing apples to apples (online vs. in-person eye exam), an online health care terminology survey was conducted to assess consumer perception. Of the 1000 subjects who were shown these advertisements, 56% thought an ExpressExam provided the same quality of care they’d receive at an in-person office visit, in less time. The survey results also showed 49% of people thought they’d have the opportunity to discuss their eye issues with a doctor, communication that does not exist through the ExpressExam.
Towards the end of 2018, the online refraction giant Opternative changed their name to Visibly in an attempt to salvage its reputation after receiving warning from the FDA for misbranding their services as a mobile “eye examination.” Patients who were at risk for various ocular diseases like glaucoma were being missed, while some refractive errors were also not correctly identified.
Thanks to the AOA’s repeated efforts to collaborate with the FDA and fight against online eye exams and refraction technology, Visibly was later shut down in the summer of 2019. They have not gone away completely, however, and have been waiting for the prime opportunity to exploit situations such as the coronavirus pandemic in order to leap back into the market. On their website, they state they are now able to operate due to the recent update (loophole) in telehealth for eyecare - FDA Enforcement Policy for remote ophthalmic testing.
Unfortunately many online eye exams and optical retailers are attempting to bypass the eye doctor altogether. Optometrists are made out to be a significant barrier to obtaining fast and affordable corrective lenses. While everyone likes convenience and automation, patients must be educated on the long-term, potentially harmful effects of online eye care. While this may initially sound amazing to consumers, it is not in the best interest for our patients’ long term ocular and systemic health. The doctor-patient relationship is also jeopardized with this technology.
It is our role to thoroughly educate our patients on the various aspects of an in-person comprehensive eye exam. When they hear about companies offering online “eye exams,” they will have a better understanding and know that what we do cannot possibly be replicated on a smartphone at this time.
Patients may also ask their eye doctor if they have heard of or would recommend trying iridology, a diagnostic tool commonly used in naturopathic medicine. Iridology?! Established in the late 1800s by Ignatz Von Peczely, iridology practitioners claim to assess changes in iris pigmentation to diagnose and monitor a broad range of systemic conditions. Trained iridologists can examine the patient in person with a penlight and loupe magnifiers, or assess enlarged photos or video of patients’ irides.2 Numerous national and international iridology associations exist.
Proponents of iridology claim that information about each organ within the body is transmitted to the iris via CN3, the ocular motor nerve. Much like the face of a clock, the iris is broken up into 60 different sectors, each corresponding to a specific internal organ or bodily function. Changes in iris color were thought to occur from a broad range of causes. For example, rust colored spots were thought to be from an injected chemical from vaccines, while yellow spots may have indicated a sulphur deposit from the ingestion of a sulfa drug.
While various scientific studies have been conducted looking at the efficacy of iridology, no definitive evidence exists showing its clinical utility. Unfortunately, this practice is potentially damaging, as patients may be led to believe they have a clean bill of health when in fact they have a potentially serious medical condition. On the contrary, patients could also be led to believe they have a serious condition when in fact they do not, creating unnecessary anxiety and fear about their health prognosis.
Fig 3. The Jenson iridology eye chart commonly used among iridologists.
In conclusion, it is important for eye care practitioners to have a general awareness of the many scams and misinformation that are targeted towards our patients. It is our role as primary eye care providers to explain to patients what evidence-based medicine is and the importance of avoiding products or services that are not based on science or seem too good to be true. Next time you’re asked if you’d recommend iridology to assess systemic health or eye exercises to reverse astigmatism, you’ll have a better understanding on how to respond.