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.
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.
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.
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.
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.