Monday, April 21, 2008

A Singular View

Back in March after writing the post on prosthetics, I received a package that contained a copy of the book, A Singular View, and a copy of the Journal of Ophthalmic Prosthetics (JOPPro) along with a note. Michael O Hughes, ocularist and senior editor of the JOPPro asked me to submit an article for a "focus" edition on esthetics that they are putting together for next year.

My thought of an article (only four pages needed!!) would be expectations of the patient from the perspective of a plastic surgeon; which is very similar to the restorative work of an ocularist and a oculoplastic surgeon. Please keep in mind; ocular/facial prosthetics is very different from orthotics; which you may be more comfortable/familiar- due to your father.

Facial disfigurements can hit a patient at the core of their security. Then again; some patients are very flip id about the loss. Regardless; the world of ocular prosthetics is surrounded by myths and many misconceptions. Maybe plastic surgery; for the average consumer is also.

Michael Hughes

I have no experience, either in training or in practice with patients who have lost an eye. I do not feel qualified to write such an important article. If there is anyone out there who can (perhaps David Khorram, MD who writes the blog marianaseye), please do so. Thank you.

There is a lot of information at Mr Hughes website. The information covered includes ocular prostheses (photographs, the fabrication, and the history) and patient resources.

As for the book, it is a great source of information on adjusting to monocular vision. It contains practical suggestions such as:

  • Lightly touch the pitcher of water/tea to the rim of the glass before pouring.
  • When choosing a seat at the dinner table, try to sit with your unaffected (remaining eye) side to the person you will be conversing.
  • Learn how to use perspective and relative movement to judge distance.
  • Don't give up the activities you enjoyed prior to your eye loss. Relearn how to do them with monocular vision. The books author was a pilot both before and after his injury left him with one eye.

The book gives a nice explanation of how depth perception works and is changed by the loss of one eye. Depth perception involves 1) retinal disparity, 2) convergence, and 3) accommodation.

Retinal disparity depends on an object being viewed with two eyes separated by several inches so that each eye is looking at the same target from a slightly different location at the same moment.

Convergence has to do with the merging of these two images produced on the retinas. The effort by the eyes to bring the two images into exact correspondence produces a strain on each eye, and the experienced brain knows how to translate this into a measure of distance.

Accommodation is a term for the automatic adjustment each eye makes to bring an object into focus. It is only effective for judging distances up to about six feet; thus it's likely to be the least useful of the three mechanisms. When you've lost an eye, however, it's the only one available to you, and we will cultivate it to its limit.

There are many famous people who have had great careers and only monocular vision. Some examples are:

  • Peter Falk -- an actor well known for the detective Columbo. Surgeons had removed his right eye, along with a malignant tumor, when he was three years
  • Sandy Duncan -- an actress and dancer. In the 1970s, she was treated for a tumor behind her left eye, which damaged the optic nerve. She lost the sight in the eye.
  • Theodore Roosevelt -- 26th president of the United States. He lost his left eye in a boxing match with a naval officer
  • Sammy Davis Jr --singer/entertainer. He lost his left eye in an automobile accident prior to achieving stardom as an entertainer
  • Wiley Post Post, pioneering aviator who made the first solo circumnavigation of the globe with vision in only his right eye
  • Elizabeth Blackwell, the first woman to graduate from an American medical school lost an eye while in postgraduate school in France
  • James Stuckey, MD--not as famous, but did practice Plastic Surgery in Little Rock, Arkansas. He was very well thought of by his patients, his peers, and the nurses. He retired in the early 1990's and died almost 10 years ago. (Couldn't find a link to his obituary)

4 comments:

Dreaming again said...

Not exactly the same ... Aristotle Onasis wore a patch over one eye to compensate for double vision due to myasthenia gravis. Essentially giving him only one with which to function.

Definitely difficult to manuver through life with depth perception being effective.

I think the example that you gave that made me startle was the surgeon! *grin*

rlbates said...

He had learned how to compensate and did really good work.

Marianas Eye said...

Wow, you have a lot more energy than I do to put together such a fine review article! Great posts on the topics!

David

rlbates said...

Thanks, David.