On the heels of Le Massacres du Muscles Oculaire and Entente Cordiale, let’s call this part three of what the French got right. Javal described eye muscle surgery as a massacre of the eye muscles. He wasn’t just referring to the fact that surgical procedures were comparatively barbaric in the late 1800s. He understood perhaps intuitively that cutting muscle nerve endings and spindles, and the scarring process that is part of healing, is a massacre in which one accepts on good faith that the outcome justifies the intervention. In the comments to my blog piece on Le Massacres, Lynda Rimke wrote something very concise and powerful: “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.”
Gill Roper-Hall, a British-trained orthoptist who is an assistant professor of Ophthalmology at the Saint Louis University School of Medicine, wrote an historical vignette on Javal as the Father of Orthoptics who is strongly associated with the concepts of physiological diplopia, stereoscopes, and fusion training exercises. In this article, published in the American Orthoptic Journal in 2007, Ms. Roper-Hall makes an interesting observation. Javal reportedly did therapy with his younger sister Sophie, who had strabismus, at age 8 enabling her to achieve binocular vision. A couple of years later she reportedly underwent surgery with a colleague of Javal’s, Albrecht von Graefe. One is left to surmise that Sophie had the benefit of a non-surgical binocular foundation paved by Javal, and stability of alignment attained through surgery.
Now here’s the part that fascinates me. When von Graefe visited with Javal at the time of Sophie’s surgery, he expressed interest in Javal’s methods. Javal patiently reviewed the many methods in vogue at the time and upon learning what was involved von Graefe reportedly opined that “people are really not worthy of all that trouble“.
In that regard, it is worth noting what Pigassou wrote about Entente Cordiale in 1977 in the British Journal of Ophthalmology. When functional therapy for strabismus is begun between 1 and 3 years of age, in line with current therapy for all developmental troubles, a cure rate of nearly 100% can be achieved. Pigassou adds that in nearly every case it is the “lack of co-operation of the parents” which is responsible for treatments incorrectly followed, and that a considerable number of parents give up treatment in the initial stages.
Very insightful, isn’t it? Pigassou, a French ophthalmologist, understood over 30 years ago that strabismus is a developmental disorder, and as such deserves the benefit of early intervention services by the eyecare field. I reflected on Pigassou’s comments about parents giving up treatment in the initial stages.
Think about it. You’re the parent of a young child and you look toward your pediatrician for guidance. The pediatrician says I’m not sure, by why don’t you go to Dr. X, who is an eye surgeon, and get a second opinion. Here we are, over 100 years since von Graefe made his comment to Javal that therapy is not worth all the time and trouble involved, and some surgeons are still making the same ill-informed value judgments for and about people.
But patients are becoming too savvy to fall for this. The revolution is upon us.
– Leonard J. Press, O.D., FCOVD, FAAO