The French Got It Right: La Partie Trois

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




8 thoughts on “The French Got It Right: La Partie Trois

  1. “People are really not worthy of all that trouble” really speaks volumes, doesn’t it?

    I just got done reading historical vignette of Javal that you mentioned, and now I’m wondering where I can get a copy of his “Manuel du strabisme.” I bet it would be an interesting read!

    • Josh, please direct me to a copy when you find one. Also, could you or Dr. Press let me know if the vignette is online?

      Josh, I just typed volumes, reacting to the “people are not really worthy of all that trouble.” It’s posted even though it’s long …

      At this point I can’t find any way to cut down my verbiage!

      Dr. Press, I’m honored that you quoted me. I had to look up “unconscionable” … the shoe fits.

      • I agree, Josh. It would be an interesting read. I don’t know where to obtain one, as it is quite old (over 100 years). Lynda, here is the link to the Roper-Hall’s historical vignette on Javal:

  2. I am impressed by the comment that a strabismus is related to a “lack of co-operation of the parents.” This can be interpreted in two ways. Parents do not care or the child’s perception of lack of parental integration. I like the second one as well, since this correlates with the integrated vision therapy approach I have been advocating for years. Thank you for this fabulous posting.

    • The comment is not that strabismus is related to lack of parental cooperation. The comment is that lack of parental cooperation is responsible for treatments incorrectly followed. I think that’s an important distinction.

  3. I would certainly invite all vision therapy optometrists to consider that a strabismus in a child or young person can be connected to their perceptions of their parents.I share this from my personal journey in dealing with my strabismus. I have documented these findings in my books ‘The Power Behind Your Eyes‘, and ‘Conscious Seeing‘.

    • Okay, Roberto. Shoot. Tell me how I’m causing harm to the daughter I love. You want to blame parents? Go for it. Spell it out for me.

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