Hurricane or SuperStorm Sandy, call it what you will, has knocked out our weekends at the Jersey Shore indefinitely, so I find myself gravitating to the office to do some long neglected “house cleaning”. One of the joys in doing so is coming across articles to be of enough perceived value that we put them in plastic holders for sake-keeping and re-visiting. The world is transitioning to electronic folders instead of plastic holders for paper that we’re printing less and less, but the re-discovery of a highlighted paper can be as serendipitous and pleasurable as bumping into an old friend unexpectedly.
Such was the case last night as I came across this article from Dr. Ruedemann, who established the Kresge Eye Institute at the Wayne State University College of Medicine in Detroit, about whom I blogged earlier this year. Take a look at his background here. The article on Binocular Coordination with the graphic above is from a journal titled Medical Times, April 1963 (vol. 91, no. 4, pp 311-313), and was sent to me awhile back by our colleague, Dr. Curt Baxtrom. “Ruede”, as he was known to his colleagues, makes the following points regarding binocular problems, with specific reference to squint, a term widely used in Europe for strabismus:
a) It is the rare child who is found to have a real defect of the extraocular muscles. Therefore, the ophthalmologist who operates on the extraocular muscles without recourse to other means does not offer the patient the full benefit of his knowledge nor does he present the patient a real chance for function.
b) Barring those conditions which absolutely prevent fusion, there are many others which cause the development of a squint but are not a result of a defect in the extraocular muscles. Since the usual surgical intervention is towards the ocular muscles, the other factors involved must be dealt with first. Training of binocular function is necessary, both before and after surgery.
c) Probably more important, and far more common, but incurring less interest, are the children with fusion of an unstable nature. The means that the child may fuse, in fact have third degree fusion or stereopsis, but under conditions of stress, lose fusion, or develop symptoms relative to the demand to retain fusion.
d) These children will have a measurable heterophoria for distance or near and a brittle fusion range. Under conditions of stress these children have the choice of 1) developing diplopia or blurred vision; 2) symptoms due to their demand for single vision; 3) of if both the above are too difficult they will take some other, or even no visual act.
e) In any case the eye-brain-hand pattern will not be maintained. The child will have poor attention and poor retention. The eye-brain efficiency will be reduced. Such a child will be a poor learner or reader unless other learning means are developed. Some children with poor binocular efficiency learn by rote, develop auditory retention, and utilize abstract cerebral mechanisms.
f) It goes without saying that a child with inadequate binocular function will not gain through remedial reading or rapid reading courses.
g) Binocular coordination is a subject of vital interest to the physician interested in the developing child. As noted above the child with a frank squint is only a small part of the total problem.