ET From Another Planet


Martha is a comparatively young colleague who is wise beyond her years when it comes to many areas of clinical practice.  One of those areas is strabismus, and she seems to have an intuitive feel for how to work with patients of all ages.  This was particularly true for little Johnny, whose mom was in a quandary.  Her husband, a physician, was not nearly as holistically inclined as Johnny’s mom.  So it was with great reluctance that she consented to have Johnny undergo eye muscle surgery for esotropia early last year at age two.

Long Story Short

The surgery didn’t hold.  Johnny’s left eye began to turn in again, and the surgeon prepared his parents for considering a second surgery.  This time his mom insisted on looking into alternatives, which through her holistic network led her to Martha, who wisely Rxed low plus lenses with binasal occlusion.  When the weekly trips for VT became onerous for the family, Martha referred to me.

ABduction

When I first saw Johnny he had very limited abduction of the left eye. We worked considerably on increasing the range of motion of his left eye by, as W.C. Maples is fond of saying, “slappin’ the sockets”.  Johnny was compliant with wearing the Rx full time and although the esotropia was slowly lessening, his father became impatient and battled mom about obtaining another surgical consult.

I gave Johnny’s mom the name of a surgeon with whom I’ve collaborated before, and prepared her for the fact that he can be gruff at times.  We both knew ahead of time that he would recommend surgery, and that he would insist on Johnny being Rxed the -3.00 sph OU that he scoped even though it made his esotropia considerably worse and he was visually interacting with his environment just fine through his low plus with binasals.

 

Long Story Short

I called Johnny’s mom after receiving the obligatory report from the surgeon, and she thanked me for preparing her for Dr. Gruff ahead of time.  Otherwise, she said, she would have been in tears.  He belittled Johnny accomplishments through vision therapy, telling mom “we know that VT only works for convergence insufficiency”.  When Johnny put his low plus binasals back on at the end of the exam, Dr. Gruff waved his hand dismissively and scoffed: “I don’t know why he wears those glasses anyway; they’re useless”.  At which point mom pointed out that when a three year-old prefers to wear his glasses, chances are they’re doing something.  It was the surgical consult that was useless, other than to placate her husband.  Mission accomplished.

ET Planet

Reflecting on my conversation with Johnny’s mom, I was reminded for the umpteenth time that when it comes to management of ET, most surgeons really are on a different planet.  Slappin’ the sockets just isn’t part of their orbit.

4 thoughts on “ET From Another Planet

  1. If the child’s eyes were fairly well aligned after the first surgery, it sounds as if the mind is not ready to accept the aligned information and so misaligns the eyes to avoid having to deal with the situation. Exactly focusing the eyes with lenses will only exacerbate the avoidance of alignment. Anything that makes the child more peripheral is likely to help–binasals certainly working in this direction. If the eyes have been straight in the past it is likely they can be at least that straight in the future. To my knowledge there are no studies showing improved surgical outcomes between age 2 as compared to age 4 or 5. Obviously, as the child matures more options will be available. Over-correcting prism is always one possibility to break down the mind’s avoidance of bifixation. Congratulations to all involved–especially the mom.

  2. Any muscular surgery requires a brain readjustment to the new structural situation. The brain controls the body within it’s structural limits. Through VT, one learns to use it’s residual resources to do a task differently. This becomes the new normal. Voila! Neuro-plasticity!

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