Believing is Seeing

I’ve been fortunate to have very talented staff work with me through these many years in vision therapy, perhaps none more so than our current core of optometric vision therapists.  One of our therapists, Danielle, who has been in the field for 18 years, brought a book to my attention last week that was critiqued very favorably in The New York Times Book Review.

The cover itself is interesting for its visual blandness, given that the book is about the mysteries of photography.  The title of the review, Limited Vision, is equally intriguing.  In what way does the book’s author, or his subject matter, have limited vision?  Kathryn Schulz, the reviewer, begins:  “One of the first things we learn in Believing is Seeing is that its author, the film-maker Errol Morris has limited sight in one eye and lacks stereoscopic vision – ‘My fault’, he writes, for refusing to wear an eye patch after being treated for strabismus in childhood.  It’s hard to think of another writer who so neatly embodies the theme of his own book. Believing is Seeing is about the limitations of vision, and about the inevitable idiosyncrasies and distortions involved in the act of looking – in particular, looking at photographs.”

As you can see, Morris has a constant esotropia (inward turn) of his right eye.  Danielle was intrigued enough to buy a copy of the book based on the Review, and a flip to its preface puts his strabismus in context.  We learn that Morris was just short of his third birthday when his father died from a massive heart attack.

“Just after my father’s death, my eyes were operated on.  I had strabismus, a condition in which one of the eyes is misaligned.  I was wall-eyed, like Jean-Paul Sartre.  With strabismus there is nothing functionally wrong with the eye, just with its alignment.  Once the eye has been put back into the correct position, the brain can then integrate the output of the two eyes into a single stereoscopic image, that is, it can produce normal vision.  In order to promote the development of the ‘lazy eye’, a patch is placed over the good eye.  This treatment doesn’t always work, and I reduced whatever chances I had for normal vision, by repeatedly tearing the patch off.”

Wait a moment.  If Morris was indeed wall-eyed, or had exotropia prior to his surgery, how did he wind up with a large esotropia as an adult?  It’s entirely reasonable that his refusal to wear an eye patch had little bearing on his lack of stereovision as an adult, and more to do with the significant risk factor of patients with exotropia being converted into esotropia through unintended surgical overcorrection.

Ironically, the surgeon who operated on Errol Morris’ eyes was Ben Esterman, who married Cinnabelle Morris 20 years later, becoming Errol’s stepfather.  Errol’s wife, Julia, calls it a new version of the Oedipus story:  “Future stepfather blinds boy and marries his mother”.

“If I share anything with Oedipus”, Morris continues, “it is asking one too many questions.  Why do I see things the way I do?  I suppose it must have something to do with my skepticism about vision.  Did this influence the way I look at still photographs or my skeptical approach to documentary filmmaking?  I wish I could pin it down more precisely.  Maybe that’s what I’m trying to do here.”

Errol Morris is no stranger to controversy, and his book jacket notes that he was the recipient of the MacArthur “genius” award.  I don’t doubt his genius, but when it comes to a full appreciation of strabismus, his view is more limited than even he imagines.  Were he to join in the discussion on the SOVOTO Adult Strabismus Forum, he might widen his view in all its Oedipal complexity.


– Leonard J. Press, O.D., FCOVD, FAAO

2 thoughts on “Believing is Seeing

  1. I’m sure that’s a rhetorical question, Floyd. I’ve come to accept that for a variety of reasons, MDs don’t want to refer to Optometry because it seems like a “comedown” of sorts to them in their pecking order. They don’t want to give us credence because they perceive it would lesson their self-proclaimed dominion over all things visual. The legislative successes of Optometry have resulted in ophthalmologists digging in heir heels more, and we know that Medicine is still largely a “club” of sorts that thrives on referrals within. There are some very unique exceptions, such as MDs who will refer for neuro-optometry consults. I’ve even seen MDs refer to ODs in very select cases, but these are quite the exception to the rule.

    More commonly, when an OD essentially works as a tech in an MDs practice, they’re happy to have the OD do all kinds of things independently under their roof that they would never refer for if that same OD were practicing outside of the MDs office and control.

    Let me give you are recent example. Last week my staff gave me their intake info from a parent who said an ophthalmologist referred them for CI are related to a learning problem. Something smelled fishy so I looked up the practice online and found that there were two ODs in there. My office manager called to confirm who actually saw the patient and when they checked the record it was the OD. My office manager spoke with the OD who was very concerned that it “not get back to the MD that she suggested the patient look into VT”. My office manager offered to send her patient education literature, and they agreed that it was best to send it to her home address.

    I give the OD credit for the “stealth referral”, but isn’t that a sad commentary?

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