Entente Cordiale: Lessons from Squint

As I’ve previously mentioned, the term “Squint” is a European designation for strabismus that has been adopted as a moniker by one of our talented cadre of adult strabismus bloggers, Squinty Josh, who continues to illuminate through his illustrations as he goes through vision therapy, such as the one on the left regarding “getting around” his suppression scotomas.  Josh and I just had a nice discussion over my last blog piece title, Le Massacres du Muscles Oculaire.  You don’t have to parle Francais to appreciate the term as meaning the massacre of the eye muscles, and Javal’s use of the term is fitting for someone regarded as the godfather of non-surgical approaches to strabismus.  Here’s another French term that is revealing about the field,  Entente Cordiale.  Once again you don’t have to be a linguist to figure out that means cordial agreement.

I first came across the term used ophthalmically in an article by Renee Pigassou in the British Journal of Ophthalmology in 1977:  ‘Entente Cordiale’ in the early treatment of squint.  Permit me to quote a profound and insightful passage from that article:

Orthoptic treatment has its place in the current therapy of all functional and developmental troubles. The principles are the same as those on which the treatment of the other functions is based, and in particular the troubles of general motricity.  It is virtually possible to transpose the directives of Bobath on the early treatment of cerebral palsy to the early treatment of squint, keeping in mind that in cerebral palsy there are organic lesions and that in squint in normal children the perturbation has a functional origin.  ‘Early treatment is important because of the great adaptability and plasticity of the infantile brain’ (Bobath, 1963). ‘The learning of movements is entirely dependent upon sensory experience, upon sensory output which not only initiates but also guides motor output’ (Bobath, 1967).

The scope of the rest of the article is beyond one blog piece, but suffice it to say that the Entente Cordiale to which Pigassou is referring is the type of agreement needed between the therapist and patient (or family, if the patient is a child) in order to achieve optimal outcomes.  We’ll address that in a part 2.  It also addresses the basis for why there is disagreement in opinion between professionals as to how to go about therapy.

Lastly, Entente Cordiale is a great way to describe the types of discussions going on in Sovoto.com between adult patients with varying degrees of strabismus.  One thread of discussion points out the importance of motor movement in optometric vision therapy.  Pigassou would be pleased to know that developmental optometry has picked up the ball that orthoptics has dropped, and run with it.

– Leonard J. Press, O.D., FCOVD, FAAO




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