An adult patient who completed a vision therapy program in our office last year for strabismus made an interesting observation on Sovoto – the vision therapy advocacy network. Greg wrote:
“I had my final vision therapy progress evaluation on March 5th. VT was a great ride I’ll not soon forget… I’m in stereo very often and can put myself in when I’m not with simple exercises… but this isn’t about that final eval. The next day I began taking a prescription for Naproxen to treat inflammation caused by some possible nerve damage in my left arm. Since taking the Naproxen I’ve been in 3-D constantly. My periphery is so tack sharp that it’s been nearly disorienting and so crisp that many times I’ve found myself checking to make sure I have the right glasses on. Could there have been some inflammation around my eyes that the Naproxen has minimized that has caused this increase in stereopsis? I’ve always described my eyes as hard to move and mentioned often to my therapists that I can feel them when they do move during my VT appointments – I feel them itch when they move. This by no means a call for all VT people to start taking Naproxen. I’m just trying to connect the dots.”
I advised Greg this wasn’t surprising, given the concept that the eyes can be viewed as specialized joints adapted for seeing, and are therefore prime hot spots for inflammatory responses. This dovetails nicely with the work of Dr. Richard Horowitz, who I introduced in Part 1. As a brief overview, Dr. Horowitz is an integrative/holistic M.D. who specializes in Lyme and other chronic diseases. Dr. Horowitz characterizes Lyme as a disease that has been ignored or trivialized by the medical professional, and that many patients who see him have seen numerous physicians without relief. He writes: “Their suffering is made worse as they repeatedly face difficulty in obtaining appropriate care from often skeptical medical and insurance communities, as they unknowingly enter one of the more virulent wars between two medical camps that we have seen in our country’s history.” Sound familiar? Dr. Horowitz notes that modern medicine is excellent at providing care for acute diseases, but lacks an understanding of and treatment for a myriad of chronic diseases.
Dr. Horowitz opines that the patients he treats are best described as having multiple systemic infectious disease syndrome, or MSIDS. The roots of their underlying pathologies can often be traced to counterproductive inflammatory processes and oxidative stress. In providing a new paradigm for diagnosing and treating chronic illness, he aims to adopt a middle ground. “My model presumes that everybody who is involved in this controvery is partially correct. Instead of positing another divisive and confrontational position, I am trying to open another door, to move forward.”
There is a list-serve of behavioral and developmental optometrists, and one of its participants frequently offers the opinion when a challenging case is presented that the doctor should “do labs”. By this she means that the doctor should be ordering a litany of specialized blood tests for a variety of potential diseases such as Lyme and PANDAS. As I read Why Can’t I Get Better, some of her dots connected. In the book, Dr. Horowitz presents a 16-Point Differential Diagnostic Map for MSIDS addressing overlapping factors contributing to chronic illness. The 16 potential co-factors are:
Lyme disease and co-infections, immune dysfunction, inflammation, environmental toxins, functional medicine abnormalities with nutritional deficiencies, mitochondrial dysfunction, endocrine abnormalities, neurodegenerative disorders, neuropsychiatric disorders, sleep disorders, autonomic nervous system dysfunction and POTS (postural orthostatic tachycardia syndrome), allergies, gastrointestinal disorders, liver dysfunction, pain disorders/addiction, and lack of exercise/deconditioning.
Among the symptoms and associated conditions on the 16-Point MSIDS map, Dr. Horowitz includes double and blurred vision, and under Possible Related Medical Conditions he lists Lyme disease, co-infections (especially Bartonella), inflammation, environmental toxins, and functional medicine abnormalities.
The combination antibiotic regimens for treating intracellular bacterial infections in MSIDS include plaquenil, doxycycline, Zithromax, rifampin, Septra, nystatin, and Factive. Dr. Horowitz includes indications for herbal treatment, vitamin supplementation and nutritional modifications depending on the blood chemistry profile, and makes this eye-opening statement: “There are other instances when diet and nutrition have been shown to impact the epigenetics of the developing human fetus. It is well-known that maternal metabolic conditions during pregnancy, such as diabetes, hypertension, and obesity, are associated with children who have an increased incidence of autism spectrum disorder, developmental delays, or impairments in specific domains of development, but the specific epigenetic effects are not as well known.” While few of us may be comfortable in ordering and analyzing all of the laboratory tests that Dr. Horowitz describes, their interpretation should be on our radar screen. Many of us have learned that our clinical concerns and populations overlap increasingly more with developmental pediatricians and holistic practitioners than with what Dr. Horowitz categorizes as rigid Western medical thinking.
Although a pair of eyeballs never walk into your office, these ball-in-socket joints are subject to inflammatory processes and their kinematic consequences. Thinking holistically, chronic inflammatory processes have a predilection for eyes precisely because they are specialized joints adapted for sight and vision.