Le Massacres du Muscles Oculaire

By Leonard J. Press, O.D., FAAO, FCOVD

Some might find this image disturbing.  Others might appreciate it as a work of art.  What is the symbolism here?  It’s from the web magazine artnet.com by picture post card artist, Scott Roberts,  entitled  “Any Sufficiently Advanced Technology is Indistinguishable from Magic” and was on display at a gallery in Chicago in 2003.  Louis Emile Javal was a French ophthalmologist who once referred to eye muscle surgery as Le Massacres du Muscles Oculaire as compared to therapy procedures, which is the phrase that came to mind when I stumbled across this picture.

The association occurred to me this evening when a colleague emailed about the case of a teenage patient who had post-surgical intermittent exotropia.  His mother took him back to the surgeon, expressing concern about his continued drift.  When she inquired about doing vision therapy he told her that it would be  “a waste of time and money”.  All he offered in the form of treatment was another surgery.

His mother pursued vision therapy anyway, and the child became fully aligned and asymptomatic.  They went back to the surgeon to see what he would say, without telling him they had done vision therapy.  He said it was nice to see that the condition had stabilized, and no further surgery would be necessary.  I was ambivalent when I read the email.  I no longer view such experiences as moral victories of any kind.  In fact I find them  disturbing.  The  appropriate response would have been for the mother to return to the surgeon and take him to task for having dissuaded her from considering VT.   Can this become the routine rather than the exception?  Absolutely.  It has already begun in the form of mothers blogging actively.  It is mushrooming with adult strabismics having their own sites and forums.  What role will you play in this revolution?
– Leonard J. Press, O.D., FCOVD, FAAO

7 thoughts on “Le Massacres du Muscles Oculaire”

  1. I remember reading the phrase “Le Massacres du Muscles Oculaire” in ‘Fixing My Gaze.’ It has quite a ring to it, and stuck in my memory as well.

    Among the strabismics I’ve talked to online, I know that several of us (my self included) often dream about the day in which we can go back to our eye surgeon’s office and show off our new stereo vision. I’m particularly frustrated, as I had double vision for months after my last surgery – meaning that I had not yet developed a new system of suppression. What a perfect time to start vision therapy! But I was offered no such advice, and any mention of double vision merely resulted in a head nod or a “yes, that happens.” Now I have to spend months and months in vision therapy trying to break through the suppression that I didn’t need to have in the first place.

  2. You couldn’t have hit the nail any more squarely on the head, Josh. In a perfect world patients with strabismus would first be given the opportunity to see what they could accomplish with non-surgical methods. At the very least, non-surgical interventions would better position the patient for success at being able to “get up off the table” with the brain having pathways to use the new aligned position of the eyes well. The natural course of events should also lead the surgeon to have a non-surgical specialist (i.e. developmental/rehab optometrist) work with you post-surgically to make sure you have good binocular efficiency rather than rely on cosmetically reasonable motor alignment which can and does result in a false sense of security.

    I first cited Javal’s term “Le Massacres du Muscles Oculaire” in 1986 in a chapter on the history of VT in a monograph produced by the SUNY College of Optometry. If the term has a ring to it and stuck in your memory, I’ll suggest another term en Francais that you may enjoy: Entente Cordiale. In fact, you just gave me an idea for my next blog piece!

    When you do ultimately go back to your eye surgeon’s office, you should give him (or her) an earful. Given what you know now already, wouldn’t you say that your surgeon fell short of giving you “informed consent”? Don’t you feel, as an adult, that you should have been prepared for the possibility of experiencing double vision, and that if this occurred for several months that it may have factored into your decision to have surgery? Or, at the very least, have been apprised that there is a course of action such as what you are undertaking now.

    Lynda, Sally and you are at the vanguard of public education that will put back-pressure on eyecare practitioners to act more responsibly in this field, and come down from their high horses. It is the finest application of social media-driven revolutions.

  3. Check out this youtube video about 4 minutes in for a surgeon’s matter-of-fact explanation, complete with drawing of “Le Massacres du Muscles Oculaire”

    Shudder, shudder …

    I’m all about greater public awareness of non-surgical solutions that enhance the eye-brain connection.
    Surgeons routinely recommend trying physical therapy for every other muscle in the body … I find eye surgeons’ silence on the eye-brain connection beyond patching and glasses unconscionable.

    • Lynda,
      What is surprising to me is that the fundamental clinical information presented here is incorrect. Specifically, the definition used to define a tropia and phoria is wrong. Now, some might say well the public won’t know that the presenter differentiates a phoria from a tropia incorrectly. But what troubles me is that if a student doctor was to see this video they would be misinformed.

      For example, just for the record, a tropia (strabismus) is eye teaming failure which can present constant or intermitently (the video said a tropia is constant and a phoria is intermittant). A phoria is an eye wandering tendency. Nearly all patients have a mild phoria either eso or exo and it can be perfectly normal. A phoria is measurable on both the unilateral cover test as well as the alternating cover test. (the video incorrectly stated that a phoria was not detectable on a the unilateral cover uncover) If a phoria becomes excessive it is referred to as non-strabismic binocular dysfunction because of the excessive amount of fusional effort it takes to compensate. Vision therapy and correct lens application is the treatment of choice for non-strabismic binocular dysfunction. Prisms glasses alone for the treatment for some conditions such as convergence insufficiency has been proven in double blind clinical studies to be no more effective than a placebo. Yes, Lynda I agree the misinformation and silence about this from the eye surgeon in this video is unconscionable.

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