Robert is 65 years old and began seeing double about five years ago. A pair of eyeballs never walks into the office in isolation and, as a practice becomes more specialized it will attract certain niche patients. We have met them along the way in these blog posts, and an increasing niche is adult patients with strabismus. One who we revisited yesterday in Part 2 is Greg, and Robert could just as well be his big brother. As you give Robert’s face a closer look you’ll notice that has a mild anatomical left hyper. Not only does his left eye appear to be slightly higher in the orbit, but his left ear appears to be slightly higher than the right as well. We visited postural adaptations and skews last week in terms of visual centers of gravity and Robert tilts his head slightly to the right. Before giving you his key optometric findings, I’ll share a little bit more about his background.
At age 50 Robert faced some serious health challenges and found himself pursuing holistic pathways to healing. Many of the principles that he followed are summarized well in a new book on adaptogens by Donald R. Yance.
At age 60, when he began to experience double vision, it seemed natural for Robert to think of turning toward an optometrist well-versed in nutritional optometry. He did so, but found himself increasingly frustrated by his double vision that seemed to defy the best nutritional counseling and guidance. Robert had been using over-the-counter readers with no need for a distance Rx since undergoing cataract surgery in both eyes in his early 50s. He went to a conventional primary care optometrist who prescribed 1.50^ BD in his left lens, but the improvement in double vision was fleeting. He was having considerable difficulty reading, and even when driving was now finding himself closing one eye to see clearly. Robert sensed that he was unravelling quickly, and the optometrist offered him no other recourse than to consult with a strabismus surgeon who advised that strabismus surgery was imperative.
To shorten an already long story, Robert’s cover test in my office showed that with his head held straight he has a constant left hyper-exotropia with diplopia. Parks 3 step revealed a right superior rectus paresis. His best field of fusion was when looking down and to the left, so Robert’s habitual head position was now with his chin upward and head tilted to the right where he still retained a high degree of sensory fusion including random dot stereopsis.
What do you think Robert’s VO Star and Cheiroscopic Tracings look like? The VO Star is very useful to map out vertical imbalances and central suppression zones, but we often find that cheiroscopic tracing maps out cyclovertical imbalances more dramatically. Such was the case as you can see in Robert’s findings here.
It was very revealing, when I sat down with Robert during our post-evaluation conference to learn that as much as he wanted to improve his vision, he was just as intent on understanding what his eyes were doing.