Psychosocial Issues Surrounding Strabismus Surgery

“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.

3 thoughts on “Psychosocial Issues Surrounding Strabismus Surgery

  1. “The shock therapy of realignment”–nicely put. I have a seven-year-old patient who walks around with eyes turned 35 diopters, but it it takes 80 diopters of prism to get near alignment. The child, or the child’s brain, simply does not like the “shock therapy of realignment.” While surgery will likely be part of the child’s treatment, the goal is to allow the patient to come to grips with sensory alignment first. Otherwise, I can’t imagine how much destruction of muscle function would be necessary to overcome the aversion to fusion. This will not be an easy case for either the pediatric ophthalmologist or the developmental optometrist. It behooves all who treat patients with the difficult condition of strabismus to know the surgical and nonsurgical options available to them. And to acknowledge that even a full understanding of all options may sometimes not be enough until the condition is better understood.

  2. Remember we talked about pre-surgery counsel to place the patient in a happy mood.
    Results post op seem to be better with those patients whose attitude is up not down.
    Life is better with a better attitude.
    Kids come to see me and they say. I quote. ” I am a terrible reader”. Or, “I am terrible in math”.
    I say to the kid. Don’t say that. If you say it enough u will believe it.
    Dr. James. New Testament. Said, what comes out of ur mouth will come true.

  3. Um, no. Stereoblindness is in our heads, but saying or acting like it isn’t there is something we are pressured to do all our lives. In fact, I have to kill that voice and advocate for others to do the same. I couldn’t find anything like your verse in James, having just read the whole book. James writes that the tongue is a ruler, but saying something can’t change circumstances. Here’s a better idea “She openeth her mouth with wisdom; and in her tongue is the law of kindness.” (Proverbs 31:26) Kindly read the blogs of the stereo blind before casting judgement. Advocate for vision therapy to be supported by insurance plans and ophthalmologists as an alternative to surgery, just as every other physical therapy option is.

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