“It should be remembered that strabismus surgery can realign the eyes but does not always realign the damaged psyche of a patient who has undergone long-term negative evaluation because of their strabismus.” This quote, from the discussion section of a recently published paper in JAAPOS sounds like a revelatory breakthrough for surgeons. And then one reads the sentence that follows: “It may be that strabismus surgeons should consider preoperative psychosocial interventions for patients who appear to have unrealistic expectations of surgery and poor psychosocial well-being in order to improve outcomes postoperative outcomes.”
The paper is authored by McBain and colleagues, presented as the Philip Knapp Lecture at the 40th Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus, Palm Springs, California, April 2-6, 2014. It is part of a theme that the group has been exploring for the past few years, but one that includes considerations of therapy only in the form of prisms for diplopia or botulinum therapy to wedge muscles when surgery fails (see here). The gist of it is that at least some patients undergoing surgery for strabismus should undergo psychologic or psychiatric evaluation pre-surgically to temper their post-surgical expectations. No mention of pre-surgical assessment of the brain’s preparedness to deal with the shock therapy of realignment, yet alone pre-surgical therapy to deal with the sensory-motor sequelae.
It is a theme that Sue Barry has called attention to extensively since 2006. And most recently Susanna Zayarsky, whose newly published book I have been reading and re-reading to gain deeper insights from the patient’s perspective. I wonder if McBain and colleagues have read either Fixing My Gaze, or would be interested in reading One-Eye Princess? What I do know is that there isn’t a single reference to anything optometric in their article. And that, my friends, is as big an issue as the issue itself.
ADDENDUM October 21, 2016: This newspaper article in The Mercury News regarding Susanna and her book.