When Eye Muscles Go Astray
Last time I talked about eye exercises and the fact that vision therapy is not really about eyeballs and their muscles. It’s really about the brain and its neurological pathways. This time I want to go into a little more detail about the issue of eye muscles as it relates to eye muscle surgery. Eye muscle surgery (strabismus surgery) is often recommended for people who have difficulty using their two eyes in an integrated way. Many of these people are told that there is no alternative to eye muscle surgery if they want to get better. Parents are filled with anxiety by doctors insisting that surgery is not only necessary, but must be done immediately or the child might go blind in that eye. I have heard a number of parents relate this exact story from numerous doctors. Such hurried time frames and dire consequences are rarely if ever true. Also, surgeons know that in almost all cases the eye muscles are completely intact, but they still insist that surgery is the only answer.
Eye muscle surgery is still done routinely on people of all ages, especially infants and children. Sometimes eye muscle surgery is necessary and sometimes it works as planned, but not nearly as often as you might think or wish. In general, eye muscle surgery is nothing more than a cosmetic procedure. It is not intended to make the visual system work better. Actually, there is no scientific proof that eye muscle surgery will result in straight looking eyes, let alone two eyes that work as a coordinated team.
There is however research showing that the best way to maintain the cosmetic results as well as good functional results after eye muscle surgery is to follow up with vision therapy. Vision therapy has almost eighty years of clinical success in non-surgically treating so-called eye muscle problems. It is one thing to modify the mechanics of an eye muscle (strabismus surgery); it is another to get the brain to understand how to properly use this new arrangement (vision therapy). Every other type of surgery demands some sort of follow-up therapy; eye muscle surgery is no different regardless of what most surgeons would have us believe. Of course we are not talking about eye exercises, but brain training. This is something most surgeons refuse to accept as reality.
I have worked with hundreds of people who have had eye muscle surgery over the years (including one of my brothers). These people all came to me complaining of one thing or another. Maybe they were unhappy that their eyes weren’t straight, or that they were seeing double or getting headaches or experiencing eye fatigue or discomfort - or any combination of those things. Some of them had undergone more than one eye muscle surgery. It is very common for people who get strabismus surgery to need more than one operation just to keep the eyes looking straight because the eyes are as likely to lose the “adjustment” as they are to hold it. The best way to keep the eyes straight, with or without eye muscle surgery, is to get the brain to use them more efficiently as a team. That is, as I have mentioned before, because the visual process is a brain process, not an eyeball phenomenon.
The retina, which is the inner surface at the back of the eye, is brain tissue. This is important. Once light gets past the transparent parts at the front of the eye it reaches the retina, which is where the brain begins to turn raw light into useful information. The primary purpose of the visual process is to guide our actions in response to the brain’s ability to derive meaning from visible light. The visual process begins with light entering the eyes. The eyes then send signals directly to many parts of the brain and the body.
Eye muscle surgery changes the orientation the eye and the brain tissue enclosed within. Therefore eye muscle surgery is essentially modifying the structure and function of the brain. This is why I prefer to think of strabismus surgery as inadvertent brain surgery. Most doctors who perform strabismus surgery seem either unaware of or disinterested in the complexity of the visual process and its developmental, behavioral, functional and emotional impact on people. The complexity of the visual process and the depth of its impact on human behavior simply are not taken into account when discussing strabismus surgery. This is probably a big reason the track record of eye muscle surgery is less than stellar in its long term results and consistency. Vision therapy is a safe and very effective alternative (or addition) to eye muscle surgery that takes the whole person, not just how they look, into account every step of the way. Behavioral optometrists are not focused on the mechanical structures except as they relate to the development, function and comfort of the visual process…and the individual using it.
Next time: Step Away From The Computer, And Keep Your Eyes Where I Can See Them