Letter to the Editor
Author's reply
Respuesta de los autores
M. Díaz Llopis
Universidad de Valencia, Hospital La Fe, Valencia, Spain
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Villa-Collar, G. Carracedo, J.M. González-Méijome, D. Piñero-Llorens" "autores" => array:4 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Villa-Collar" ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Carracedo" ] 2 => array:2 [ "nombre" => "J.M." "apellidos" => "González-Méijome" ] 3 => array:2 [ "nombre" => "D." 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Díaz Llopis" "autores" => array:1 [ 0 => array:3 [ "nombre" => "M." "apellidos" => "Díaz Llopis" "email" => array:1 [ 0 => "manuel.diaz@uv.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Universidad de Valencia, Hospital La Fe, Valencia, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta de los autores" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We entirely agree with Villa-Collar <span class="elsevierStyleSmallCaps">C</span> et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> in that the ONLY measures that to date have demonstrated efficiency — without being contaminated by financial and marketing interests — to halt the progression of myopia in children are two: increased number of weekly hours of exposure to natural light and the application of nocturnal supra-diluted atropine eyedrops continuously administrated during many years. The absence of side effects of these measures was personally verified by us in clinic studies and explicitly acknowledged in 2018 by the American Academy of Ophthalmology.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We also agree with the authors of the letter to the editor that NONE of the optical devices (bifocal ophthalmic or progressive lenses, orthokeratology or bifocal hydrophilic contact lenses) have demonstrated any objective efficacy in halting myopia, most of them after decades of use. However, said devices have provided considerable profits for the professionals and opticians who placed them in the market. Obviously, said market is significant and marketing initiatives are easily promoted through nonmedical journals of which Villa-Collar C are editors and in which they publish their own “research”.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Said letter to the editor was published in an ophthalmology scientific journal in which medical university professors and prestigious ophthalmologists with over 245 international published articles in Pubmed in the past 30 years made the effort, from an objective, impartial and untainted perspective, to bring to the attention of ophthalmologists the current professional challenge posed by the “epidemic” of myopia. In addition, said letter warned about the danger posed by the permanent invasion of exclusively medical competencies by groups of professionals who repeatedly incur in professional intrusion their quest to find a way to combine lucrative sales with scientific studies. Similarly, said letter warned about the commercial intoxication by non-medical ophthalmology groups who, by means of twisting scientific evidence to suit their objectives, repeatedly put forth lies in order to create a truth in their endeavor to profit as much as they can from this new and potentially large “market of clients”, confusing it with the “epidemic of patients” mentioned by said letter to the editor.</p><p id="par0020" class="elsevierStylePara elsevierViewall">When they mention common sense, do they mean that it is normal for people to sell products in shops that could involve risk of blindness such as contact lenses, without being responsible or competent to face the severe consequences of the use of said products? Does that make sense? In addition, is it necessary to insult an ophthalmology professor who in good faith warns about this extended practice which is legally and socially tolerated despite its severe consequences in a letter to the editor addressing exclusively the ophthalmological professionals?</p><p id="par0025" class="elsevierStylePara elsevierViewall">When they discuss interprofessional cooperation, do they mean that a segment of opticians should adapt extremely high risk contact lenses in shops, such as nocturnal Ortho-K lenses, even when severe infections arise? And, after collecting over 1000 euros each year for said lenses during 10 consecutive years (the estimated treatment duration), these patients have to visit the Emergencies section of our hospitals for an ophthalmologist to resolve the problem within his/her ethical commitment and as part of his daily work, in this case under the threat of civil and criminal liability if any further problem arises? Is this the interprofessional cooperation they are referring to?</p><p id="par0030" class="elsevierStylePara elsevierViewall">When the authors of said letter, who are NOT doctors OR ophthalmologists, deliberately put forth untruths and profanities against an ophthalmologist who is a university professor, accusing him of lack of scientific rigor and clinical ethics, multiple imprecisions, of taking up an extreme position WITHOUT ANY SPECIFIC ARGUMENT OR EVIDENCE, clearly motivated by profit and making use of manipulated arguments based on their own publications with an irrelevant international scientific impact index as well as on publications in nonmedical journals of which they are co-editors, I believe they should be congratulated due to the skill with which they use the so-called “post-truth”, i.e. the skill of putting forth lies and repeatedly attacking the opponent in order to create a “truth”. By way of example, we SPECIFICALLY refute below some of said comments:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0035" class="elsevierStylePara elsevierViewall">In their letter, they state that the risk of infectious keratitis does not increase with nocturnal Ortho-K contact lenses — nearly 8<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10,000 users — who with daily use — only for 4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10,000 users — i.e., TWICE the amount according to their own data, but they insist in that it is not higher. This statement can only be refuted with a broad smile and an invitation to study mathematics and engage in a serious reading of <span class="elsevierStyleItalic">Pubmed</span>. The FDA of the USA and the American Academy of Ophthalmology have NOT approved Ortho-K lenses for this type of practices in children — only for adults — due to the risk of severe infections with much higher frequency than in adults, additionally stating that the effect is always absolutely REVERSIBLE, and disappears one week after use, which confirms the “temporal refractive cosmetic effect” of the lucrative orthokeratology business.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6–8</span></a> Regardless of the above, the Ortho-K adapted and sold by Villa-Collar C — over 12,000<span class="elsevierStyleHsp" style=""></span>€ per patient for a complete treatment — have a very severe infection complication capable of causing blindness, but as opticians they do not have the therapeutic capacity or knowledge (and apparently, no legal responsibility either) to resolve said complication because there’ll always be a vocational ophthalmologist without financial or commercial interests available at the emergencies ward of a hospital willing to tackle the problem. Is this what Villa-Collar C et al. mean when they talk about broadness of vision, common sense and interprofessional cooperation?</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0040" class="elsevierStylePara elsevierViewall">We were perplexed to read the phrase in which they state that “more time spent outdoors is effective in preventing the development of myopia” because this is absolutely false. What they say is that children should be out in the streets, even during the night, in order to prevent myopia. This is NOT so, its about exposure to sunlight and is not about being outdoors. Again, more Pubmed and less marketing is required here.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0045" class="elsevierStylePara elsevierViewall">They also mention international clinic studies (NCT) with bifocal soft lenses when in fact it is their own “very Spanish” single center studies published in journals that are not particularly ophthalmological or generally medical.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0050" class="elsevierStylePara elsevierViewall">They praise the efficiency of the MiSight<span class="elsevierStyleSup">®</span> lens with the “scientific argument” that it bears the CEE label, when ophthalmologists deal on a daily basis with health products carrying said label (intraocular lenses, silicone, glaucoma valves, etc.) withdrawn from the market due to lack of efficacy or severe adverse effects. In addition, it is a fact that Villa-Collar C et al. are the only authors in the world who have published the “studies” of said multinational company.</p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">In summary, we would like to reiterate our admiration for these polarized geniuses of marketing who have the ability to utilize an ophthalmological journal for their purposes, which is beyond any limits. Apparently, everything is valid in business, although not in medicine generally and ophthalmology particularly. Exactly the opposite of the way things should be.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Díaz Llopis M. Respuesta de los autores. Arch Soc Esp Oftalmol. 2019;94:205–206.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Miopía, el reto de la oftalmología y su «explosiva epidemia» mundial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Villa-Collar" 1 => "G. Carracedo" 2 => "J.M. González-Méijome" 3 => "D. 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