Anicularum Lucubrationes – Old Wives’ Tales. Here’s one for you: The cause of strabismus is weak eye muscles. Well certainly weak eye muscles can be one cause of strabismus, but it would be highly misleading to think that all forms of strabismus are caused by weak eye muscles, and that surgery is therefore the only intervention to be considered.
Bela Julesz posed this problem in his book, Dialogues on Perception, in which he asked (p.107): “When does binocular neural disfunction cause strabismus?” We’ve also alluded to the limitations of strabismus surgery in isolation as a satisfactory treatment for strabismus by voices within ophthalmology that have been overshadowed, and you’ve read directly about the explorations of patients seeking binocularity beyond surgery.
Let’s be clear about something: surgery can be a very useful tool in helping to re-align the eyes. But when misalignment of the eyes is caused by faulty signals to the muscles from the brain, realigning the eyes is a back-door approach to convince the brain that the eyes should be working in unison.
It should not be that difficult to perceive that strabismus is the tip of the iceberg in binocular neural disfunction. When indicated, surgery can be very useful in mechanically re-aligning the eyes so that binocular perceptual learning can take place more readily. When used in isolation as a panacea, it perpetuates an old wives’ tale.