What Should We Know About Vision?

Last week, during the middle of what would eventually turn into a 3-hour Zoom meeting, my left eye got bored and started to wander. Actually, not bored; tired. I witnessed it pack up and leave because, for those of you unfamiliar with Zoom, there is a setting which allows you to see the people on the call, including yourself.

And an aside here. I think one of the funniest memes going around compares a Zoom meeting to the opening of the Muppet Show where all the Muppets appear in arches.

Back to my eyes. I was born with what is called Strabismus. Essentially, there is a problem with the eye muscle and surgeons fix the muscle in order to align the eyes and prevent blurry vision. That’s the ophthalmological approach. In fact, ophthalmologists have been doing this since the early 1800s!

English surgeon John Taylor attempted to perform strabismus surgery in the 18th century. The field languished until, in Germany, treatment of strabismus by cutting an extraocular muscle was proposed by Louis Stromeyer in 1838 and performed by Johann Friedrich Dieffenbach in 1839. According to traditional teaching, there has never been any proof that anyone in the United States thought of the idea of strabismus surgery before Stromeyer’s report. In 1841, American surgeon William Gibson wrote that he had cut extraocular muscles to treat strabismus several times beginning in 1818 but never published his cases. Gibson’s former trainee Alexander E Hosack of New York confirmed Gibson’s memory. Interestingly, Hosack’s family had a connection with the family of New York oculist John Scudder Jr (1807-1843), whose reported cure of strabismus by cutting some of the fibers of an extraocular muscle was described in newspapers throughout the United States in 1837. Thus, Scudder’s report preceded that of Stromeyer. Scudder’s claim cannot be verified, but his description could have influenced Stromeyer, and demonstrates that the idea of strabismus surgery did exist in America before 1838.

https://journals.sagepub.com/doi/10.1177/1179172117729367

While I have managed to live with this repair, and some of its consequences, it wasn’t until 2018 that I learned much more about vision and strabismus.

People think we see with our eyes. We actually see with our brains; the eyes are the hunters and gathers of the process which results in what we call seeing. Consequently, if one’s eyes don’t work together as a team, the information going to the brain can become muddled.

Author Wendy Beth Rosen, in her very well-researched book titled: The Hidden Link Between Vision and Learning: Why Millions of Learning-Disabled Children are Misdiagnosed, explains it this way.

Eye Teaming, also called binocularity, consists of the ability for each eye to send information to the brain and for the brain to put the information together so that we can have one clear image. Each eye functions independently and sees the world slightly differently, which is normal. Binocularity is a sensory process that fuses the information and works in concert with vergence [the ability to move our eyes together to focus on a certain point]. The information coming into the brain from the input received through each eye is created into a 3-D image that enables us to judge depth, understand relationships and grasp spatial awareness.

Rosen, The Hidden Link Between Vision and Learning: Why Millions of Learning-Disabled Children Are Misdiagnosed, p. 6

My eyes don’t team. I have no depth perception. I can put on those 3-D glasses in movies and everything stays flat. Over time, I (my eyes, and my brain) have learned to accommodate. But learning about vision has allowed me to understand why I would often fall asleep while reading–especially reading dense texts for graduate school. I now understand why I had headaches as a young person. And, I now understand that quite often, surgery for strabismus is merely a cosmetic fix.

This is why my left eye does it’s own thing. And as I age, the left eye takes more vacations when I don’t get enough sleep.

More often than not, ophthalmologists only pay attention to pathology; as medical doctors, they focus on disease, not function. But optometrists look at eye function knowing that strengthening the eye muscles at an early age, and teaching the eyes how to team, can change the life of a child; can improve the educational path of a student.

I have decided to spend the week writing about vision because as the nation’s schools move to remote learning, it is important to understand what we are, and are not, doing for the eye health of students. And prescribing glasses is only one answer.

Graphic asking How Do We See?
Illustration by: Gustavo Castaneda

2 thoughts on “What Should We Know About Vision?

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