respecting the fear…

If you took your car to the mechanic at the first sign of trouble, and were told it needed to be completely disassembled and reassembled in order to make it run better, what would you think? You may question what you’re supposed to do in the meantime?  Can the problem really be fixed?  Am I better off just driving a car that runs poorly rather than walking?  What if it gets worse? Can I really trust this person to deliver on what they’ve claimed? Any degree of common sense would need to solve at least some of these issues before you hand over your keys. After all, if it’s a choice between a car that runs poorly and no car at all, most of us would choose the former. Vision Therapy seems to walk a parallel path at times, as some patients become very protective of their poor visual system because alas, change is scary. Much like the car analogy, the idea of allowing someone to tinker with all you’ve ever known can be frightening, even if it’s for the better.

The best example of this I’ve ever come across was a mid 20’s female patient we worked with a few years back.  She had a congenital 40 dipoter alternating esotropia with no suppression in place and was intermittently anomalous.  For those of you “non-optometry” readers, she alternated between her right and left eye and the eye she was not using at any given moment turned in drastically towards her nose.  Her brain still sought images from the turned eye, which is fairly uncommon. She was constantly double, and at times, claimed to see triple with “halos”, which could have meant she was actually seeing quadruple.  It hurts to even think about, doesn’t it?  By the way, she also had a Masters Degree and drove over 40 miles per day.

The one lasting memory from working with this patient is how protective she was of her visual system. She was in VT, but was very resistant to any changes, which blew my mind. My thought was she’d be banging down the door every morning asking, if not begging, for us to make her better.  Didn’t quite happen that way. Instead VT became a war of wills.  She wanted to make it better, but at the same time, became very protective of what she had for fear of losing everything.  The lesson I took away from that experience was pretty simple: When you’re hanging on by a thread, anyone who wants to mess with your string is a threat, and you need to protect yourself.  This patient was resistant to VT because as we say “we need to break the bad skills before building the newer and better ones”. She had to be in fear of it not working, or possibly making things worse.  Regardless of what we said, her visual system made sense to her as it was, no matter how inefficient or painful it may seem. She was not about to let it go without a fight.

Vision Therapy is wonderful, and for those of us who have dedicated our lives to it, the strides we witness our patients making are phenomenal.  At times though, those steps can be scary and our responsibility includes respecting our patient’s feelings and fears, and doing all we can to educate and reassure them. Much like the automotive analogy, taking away the one system that works poorly with the promise of something better is nice, but for those who face walking to work the rest of their days, that clunker doesn’t sound so bad.


Posted on October 17, 2013, in From My Perspective.... Bookmark the permalink. 6 Comments.

  1. I remember this patient very well, Robert. Thanks for sharing your perspective!


  2. Courage is a word that comes to mind regarding the emtional changes that patients (particularly adults) undergo when we ask them to make changes. Although we tend to view the changes as ‘better’, the more diffcicult proposition for the patient is that it is decidedly different – and that is where fear of the unknown comes into play. And in some instances, particualrly when one has had multiple eye surgeries, perhaps a latent fear that is even deeper-rooted than we can ever know. It was through many years of exchanging thoughts and ideas wtih ‘Stereo Sue’ that I finally came to appreciate this, though I still stumble at times. Thanks so much for bringing this up, Robert. Sue and I plan to do a joint presentation about this at ICBO 2014 in England.


    • Robert Nurisio COVT

      Thanks, Dr. Press. Indeed courage is a good word. It’s hard for us to understand why they would not want to improve, but sometimes that fear of the unknown and possibly a worse outcome has to be overwhelming.


  3. Wow – I need help proofreading. Sorry for the typos!


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