Anomalous Correspondents


Many blog entries can be found on our site regarding the continuum of stereoscopic binocular vision.  I’ve also written a number of times about how eye muscle surgeons (pediatric ophthalmologists) tend to judge the success of their surgeries by how straight the eyes look after surgery.  How comfortable or efficient or binocular the patient is remains an epiphenomenon of sorts.  Jeremy’s mom was talking to a friend of hers whose daughter has an eye turn partially compensated by glasses, and had undertaken vision therapy with us with great results.  Despite the fact that Jeremy had eye muscle surgery, this mom felt she could still tell that all was not as good as it could be.  Sometimes it takes a year or longer to develop good binocular vision, but when Jeremy’s parents brought him to us we felt that we could accomplish our goals within a six month period of time.  We agreed that if additional time were needed, we’d cross that bridge later.  Well today marked Jeremy’s completion of his weekly optometric vision therapy visits, and he did beautifully.  At the outset he lacked any stereopsis, local or global, and demonstrated intermittent suppression with considerable binocular instability.  His surgeon told Jeremy’s mother to stay away from vision therapy because it might cause double vision.  She consulted with two other pediatric ophthalmologists who were also dismissive of any further intervention.  Don’t get me wrong:  pediatric ophthalmologists are superb at what they do well, which is surgical re-positioning.  But to find a pediatric ophthalmologist who understands the role of optometric vision therapy is almost an anomaly.  Yet they exist.  In fact in a new textbook just out, a chapter on multidisciplinary care finds one of its co-authors (an ophthalmologist) noting that vision therapy is typically not part of their training, and a potential benefit that should be left to the professional judgement of the optometrist.

Back to Jeremy, and the beautiful Success Story his mother gave to us today.   Her correspondence is anything but an anomaly.  It’s typical of what patients encounter when they and their parents work hard with our talented staff.  Here’s what Jeremy’s mom wrote:

“So many changes.  Jeremy had surgery to straighten his eyes about 4 months before we began vision therapy here.  His eyes were practically straight but I could see that he was still alternating, using one at a time.  I had that sense, rather.  After a couple of months of vision therapy, I started to see his eyes “locking” on me some of the time, and I realized that I really could tell when he was using them together (eye teaming) and when not.  Most important, I began to notice that his eyes were teaming more and more until now it’s just about all the time.

 

 

About 3 months in to therapy Jeremy went to a 3D movie & reacted just as his twin brother did.  He could not have appreciated 3D before.  Also, Jeremy used to cover one eye when he was tired, and did so more at certain times during vision therapy but I have not seen him do this for 2-3 months – at all!  This is a huge relief because I worried about him having eye strain or double vision. 

So I am absolutely thrilled and grateful to this incredible team of people led by Dr. Press – the surgeon said vision therapy would do nothing but I know she was wrong.  I am so glad that we made the  commitment to this program.  It has take away what could have been a disability for Jeremy.  The team communicates superlatively with one another and with parents.  Everyone is so pleasant & helpful.  Jeremy likes coming.  It has been an incredibly positive experience.”

7 thoughts on “Anomalous Correspondents

  1. Dear Lenny,

    Thank you for sharing this success story. It is ironic that ophthalmologists, who demand research to support the efficacy of vision therapy, have very limited studies in the area of strabismus surgery. It is rare to SEE any gold standard research in any ophthalmology journal on this subject. On occassion, you see an article on strabismus surgery, which was conducted overseas. In other words, the ophthalmologists has found the solution for strabismus through the use of trial and error and flawed thinking.

    It is important to note that strabismus impacts more than a patient’s alignment. The strabismus is one symptom of an overall deficit. We are also dealing with accommodative and ocular motor function. Visual attention is another key component of this dysfunction. For an ophthalmologist to intimidate a parent and/or a patient who is interested in seeking an opinion regarding the value of vision therapy after surgery is another level of their paranoia. In 36 years of practice, I have never seen vision therapy cause intractible diplopia in a post surgical patient. It would be helpful for ophthalmology to share the source of this information. On the other hand, I have seen many, many cases of diplopia after surgery, patients who will decompensate into the same visual pattern later in life or an esotrope become an exotrope later in life. Another important question is HOW many surgeries are required to get this problem resolved in a specific patient.

    The ophthalmological model of viewing that surgery is enough is a ridiculous perspective. The eye and the visual system is one of the most complex within the human body. Would a back surgeon tell a patient that physical therapy after surgery would adversely impact their recovery? How can a surgeon simply reattach a muscle on an eye(s) and assume that all visual functions have been restored without the proper intervention beyond rest?

    The current thinking in the area of strabismus surgery is counter productive. It is time for the medical community to rely on compassion rather than ego in their clinical decision making. There are strabismics, who will benefit from both surgery and vision therapy. There are also some strabismics, who will benefit from only vision therapy. It is time to work together for the benefit of our patients rather than fighting an irresponsible turf battle. The CITT studies on convergence insufficiency have set the stage for this cooperative effort. Thanks again for your insights

    Richard

    • Beautifully stated, Richard. I am often saddened by the large blind spot strabismus surgeons seem to cast over supportive vision therapy (pre- and post- surgery). The best of surgeons understand that vision therapy in tandem with their surgery is the best insurance for their “surgical” success.

      It takes patient feedback such as this to help doctors recognize the quality of life changes which can be gained through optometric vision therapy. We ALL need this feedback– not just the strabismus surgeons, but primary care medical doctors and optometrists, and yes, even those O.D.’s who specialize in vision rehabilitation. Our patients’ experiences inspire us and motivate us every day. Such feedback helps us to continue to “pay it forward.”

      Warm regards,

      Samantha

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