covereyes

I recently examined a beautiful 3 year old girl with an exotropia (an eye turned out).  She had seen another optometrist a year ago and that doctor had recommended surgery to straighten her eyes, but mom didn’t want her daughter to have surgery.  After my exam, I felt that surgery was the best option, for several reasons:  the eye turn has been present since birth; there is no significant refractive error causing the eye turn; the turn is large, constant, unilateral and outward; the associated amblyopia is getting worse.

I was about to launch into a one-sided patient education monologue on “why your daughter needs strabismus surgery,” but for whatever reason, I began instead with a question, “why don’t you want your little girl to have the surgery?”  Mom’s answer surprised me and it opened the door to a conversation, one in which we both learned a great deal.

“From what I’ve read, the surgery would only be cosmetic.  She still wouldn’t know how to use her eyes together and she might need multiple surgeries. I want her to have vision therapy.”

I wanted to jump up and down and scream,”YES!!!  YOU ARE RIGHT!!”  Well, I refrained from jumping and screaming and I began to explain how treating her duaghter’s eye turn had to consider both motor and sensory components.  Once her daughter’s are aligned motorically with surgery, then vision therapy could work on teaching her brain to use both eyes together (the sensory component) to keep them aligned.  We talked for a long time and covered alot of ground.  In the end, she agreed to consult with a surgeon.

I had assumed that mom didn’t want her daughter to have the surgery because she didn’t understand the problem and its sequelae. I will never make that mistake again.  This mom taught me how important it is to reach out to our patients to better understand their values and their perspective.  Now, we both know we are in this for the long-haul; it’s not an easy fix.  But we are definitely both focused on the same goal.

You may now jump up and down and scream.

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