Shortly before I left the State University of New York’s College of Optometry for the joys of full-time private practice in 1997, I heard from my SUNY colleague Ken Ciuffreda about a book for which he’d served as a consultant. It wasn’t the type of book you’d normally associate with Ken, this being a novel rather than an optometric text. It was a suspense story in the Matthew Hope mystery series, the title being an aural malapropism of an old church hymn, “Gladly the Cross I’d Bear”. I have no idea why I recalled the author’s name, Ed McBain, or that Ken helped him understand how glasses could help align the eyes of young individuals with accommodative esotropia. The book was a good read at the time, though it now resides deep in the recesses of my tupperware storage tins holding books with interesting titles that I may re-read some day with a quieter mind.
Hayley B. McBain is a chartered psychologist at The School of Health Sciences, The City University London. She is the lead author of a new article in the British Journal of Ophthalmology entitled: Factors associated with quality of life and mood in adults with strabismus. The article contains the following statement:
“However, contrary to the expectations of many healthcare providers, these findings suggest that clinical variables alone fail to explain the majority of variance in QoL and mood. This analysis suggests that beliefs, cognitions and social support are more consistent predictors of mood and QoL. Beliefs about illness and treatment are constructed by patients so that they are able to make sense of their condition and associated symptoms. Patients, who feel strabismus has major and serious consequences on their life, are concerned about the possible physical and psychological side effects of having surgery, and have a poor understanding of their condition as a whole, and find the symptoms puzzling, experience poorer QoL and mood.”
Some years ago ophthalmologists began to pay more attention to the psychological costs of strabismus. Their motivation seemed to primarily be the justification of strabismus surgery as more than a cosmetic procedure. It was another SUNY colleague of mine, however, who seemed to put his finger more squarely on the pulse of strabismus:
Groffman S. Psychological aspects of strabismus and amblyopia—a review of the literature. J Am Optom Assoc 1978; 49:995-9.
It is one thing to study the psychosocial factors in strabismus as a researcher or clinician. It is quite another matter to truly appreciate the sense of self in strabismus as a patient, even when one’s eyes have been aligned through surgery. The studies to date, including the work by McBain and her colleagues at City University London, focus on cognitive factors related to appearances. They barely scratch the surface of how an individual with strabismus processes the world in relation to self, and vice-versa, from a behavioral vision standpoint. To begin to grasp this more fully, we need to listen to individuals with strabismus who have undergone strabismus surgery and have subsequently experienced optometric vision therapy.
There is such an individual, and her name is Sue Barry. Much as Ed McBain reached out to Ken Ciuffreda about accommodative esotropia, Hayley McBain and colleagues should be reaching out to Sue Barry and her intimate knowledge of how strabismus influences the sense of self. Sue and I are working on a presentation we’ll be making in England about strabismus and the sense of self. Perhaps we’ll invite Hayley and her colleagues to attend.