You may be used to thinking of valence in terms of the chemistry of particles. but the valence we’ll speak of here relates more to brain states – a follow up to consecutive exotropia as a journey to the center of the mind. As noted in Wikipedia, emotional valence is a term used in psychology to denote different states – positive or negative, associated with different events, objects, or situations. In consecutive exotropia the brain’s sensory status still reflects the mindset of esotropia even though the misalignment of the eyes is in the direction of exotropia or excessive outward drifting. This is depicted in John’s case, and as you listen to his description keep in mind that the target he is referring to is one similar to a Worth 4 Dot, viewed red and green glasses. In this instance the upper red target – a rhombus – is seen only the the right eye, the two green targets are seen only by the left eye, and the bottom white circle can either be fused and seen by both eyes, or seen as two independent circles, one red and one green. John reports seeing two when he is looking at the target intently, but in unity when he is looking “softer”. This is normally the mindset that we give a patient with esotropia, and it is a reminder of the emotional valence of strabismus that when John gets into the mindset that is normally associated with moving his eyes outward, his surgically re-arranged eye muscles wind up aligning together better.
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Compelling ideas, great photos. Nice work.
Dr. B
Thanks, Dr. B.
Sounds as if this patient should have had VT in the first place. Surgery should have been supportive, if necessary. Then’ followup VT should have been done.
Ideally, yes. But realistically we know what the referral patterns are like. The goal at this juncture should be to have pediatric ophthalmologist work on guidelines for exactly what you propose – identifying cases that would do best with VT first. We really need to develop the type of synergy that occurs between PT and orthopedic surgery.
The importance of binocularity needs to be emphasized as necessary to maintain any alignment of the eyes.
As binocularity exists on a continuum, so does alignment of the eyes.
Ha! This very strongly resonates with me. I often get in trouble when ‘trying too hard’. I go all in on the converging but my eyes don’t follow and then problems arise with increasing intensity. Tensing up, frustration, … I used to be an esotrope but surgery made me a non-commitant exotrope. I have been trying to make these ‘ends meet’ ever since. Until they do, looking soft it will have to be! The pieces are starting to fall in place. Getting tantalizingly close! 😉
“Slaughter of the muscles”
I wonder how many people have strabismus. I noted down your points Doc. And I will research further to know what this probles leads to when not addressed immediately. And thank you for sharing John’s video. It became clearer to me.