Until recently, I followed a simple rule: Never go under the knife unless you have to. Moved by a visceral distrust of the medical-industrial complex and cowboy surgeons, I successfully avoided operating rooms for my entire adult life. That streak ended a couple of months ago, when I had eye surgery at a clean and pleasant medical center in New Jersey. The procedure was to correct a condition known as strabismus from which I’d suffered all my life—though “suffered” may put too fine a point on it.
Strictly speaking, there was no medical necessity for the surgery. My condition posed no immediate health threat. So it seems strange, even to me, that my voluntary surrender to the scalpel involved the eyes, of all body parts.
My friends were universally squeamish at the mere mention of the operation. Luis Buñuel and Salvador Dalí were onto this; it’s impossible to watch the razor-blade-slicing-an-eyeball scene in Un Chien Andalou without flinching. Our eyes, after all, are soft gelatinous orbs shielded from the elements primarily by the conjunctiva, a thin mucous membrane. They’re so vulnerable, it’s no wonder we’re hard-wired to protect them.
That I overcame this circuitry is a tribute to the depth of either my curiosity or vanity. Curiosity, because surgery for strabismus can change the way you see the world. Vanity, because it also changes the way the world sees you.
Strabismus is a misalignment of the six muscles that are attached to each eye and control its movements. Most people are born with these two sets of ocular muscles in perfect or near-perfect alignment, and they stay aligned as both eyes move synchronously left, right, up and down. For the two or three percent of us with strabismus, though, each eye seems to march to its own drummer. This can result in either crossed or wall eyes.
For comic relief, strabismus is a no-brainer: Marty Feldman’s wild-eyed Igor in Young Frankenstein is one extreme example. My own pseudo-affliction wasn’t funny, but I’d hardly call it tragic. My right eye had drifted well to the side, its turn becoming more pronounced, if not quite Feldmanesque, over the years. On a daily basis, my interactions with others were complicated by the constant visual miscues that are inevitable with a wandering eye. I’d be traveling the world first-class right now if I had a dollar for every time I was talking to someone who looked over her shoulder to see what I was looking at—even as my engaged eye was staring straight at her. Or for every time I directed a question at someone in a group but forgot to address him by name—at which point he either ignored me or appeared puzzled, looked around and then asked, sometimes with Travis Bickle menace, “You talkin’ to me?”
I’d be traveling the world first-class right now if I had a dollar for every time I was talking to someone who looked over her shoulder to see what I was looking at—even as my engaged eye was staring straight at her.Less frequently, but often enough, I would encounter unconcealed wonder at my ocular irregularity. “You mean you can actually see out of both eyes?” I was asked many times. “How about that!” In fact, I could see with two eyes, but not the same way my unthinking tormentors could.
When the ocular muscles are aligned, both eyes can converge on a single point, sending one image to the brain’s vision center—the occipital lobe—for processing and interpretation. This phenomenon is known as stereopsis (you do the Latin). It’s such a ubiquitous feature of normal binocular vision that most people haven’t given it a moment’s thought.
But when the muscles are misaligned, normal binocular vision is aspirational at best. A persistent turn of one or both eyes creates visual confusion, with two separate images sent to the brain instead of one. Thus, people with strabismus have to compensate in order to avoid seeing double. We do so from a tender age by means of suppression, a neural adaptation that allows us to see with just one eye at a time.
Here’s how it works: Whenever we focus on anything—a face, an apple, a skyscraper—both eyes can’t be directed at it simultaneously. So instead, we look with just one eye and then, usually within a few seconds, the other. When we switch from one eye to the other, the brain suppresses the image from the one that’s not currently in use. Until that eye swings back into action, it’s rendered effectively blind. This alternating blindness continues, left to right, right to left, hundreds or even thousands of times a day. It’s a process that develops unconsciously in early childhood. Since I never saw the world any other way, I didn’t become truly aware of the constant switching until I was an adult and an optometrist pointed it out to me, almost in passing.
As a coping strategy, suppression is brilliant in its simplicity. It’s the ultimate version of seeing only what you want to see. The downside is that it occurs because the traffic cop in your skull has abandoned all hope of enforcing stereopsis.
While researching the topic prior to my operation, I came across several intriguing but unsatisfying labels for this deficit of dual vision. “Convergence insufficiency,” for example, was descriptive of the eyes’ failure to join forces, but it sounded cold and clinical. “Monocular” denoted seeing the world through one eye at a time but didn’t convey much more. Then, in a paper on depth perception, I found a revelatory term for the disability that I’ve had all my life but never named before. As a bonus, it was the perfect tag for a heavy-metal cover band.
It turns out that I am, and always have been, “stereoblind.”
Stereoblindness manifests itself in various ways, most of them more annoying than debilitating. Reading can be a chore, as switching from one eye to the other becomes a conscious effort at close range; hence my lifelong status as a slow reader. Moving objects, too, can be difficult to track. I learned that lesson the hard way in Little League. The one time my bat connected with a baseball, I was so surprised, I forgot to run to first base.
There’s also the problem of 3-D movies—not an existential issue but a clear illustration of the limits imposed by stereoblindness. Those disposable red-and-cyan glasses they give out at 3-D screenings do nothing for me. The lenses require a pair of eyes that can merge two overlaid images into one, creating the illusion of depth. But people with strabismus don’t do depth, at least not the binocular kind. Instead, we get by on what ophthalmologists call “monocular clues” to depth and dimensionality: shadows, for instance, or the relative movement of stationary objects viewed from shifting angles. We don’t see in three dimensions the way most people do—the way you probably do.
Sometimes that makes me wonder what I’m missing. Is there a richer, deeper, more textured universe out there, hiding in plain sight? There’s no way of knowing, of course, just as a person who’s been blind since birth can’t grasp the beauty of the Sistine Chapel, or someone who has never heard a sound can’t appreciate the artistry of Thelonius Monk. To paraphrase an immortal American, you perceive the world with the senses you have, not the senses you wish you had.
Dr. C., the ophthalmologist who performed my surgery, says there’s a 50-50 chance that I’ll become stereoacute—the opposite of stereoblind—after I’ve fully healed three or four months down the line. My reading of the medical literature suggests the odds are a lot longer than that. But who am I to second guess the go-to guy for eye-muscle surgery in New York? Dr. C. does about 30 strabismus corrections every month, concentrated into two full days of marathon, assembly-line eyeball straightening. Most of his patients are young children, because strabismus is best addressed early on.
Dr. C. took one look at my out-of-whack peepers and his own eyes lit up. The cowboy surgeon alarm sounded somewhere in the back of my head. I chose to ignore it.In my own childhood, the problem was largely ignored. My parents told me I had “a weak muscle” in my eye, but since my vision was otherwise healthy they decided to leave well enough alone.
My first visit to Dr. C. last year felt like a throwback to those long-ago days. I tried not to look too sheepish sitting in his waiting room, which was cluttered with building blocks and Fisher Price toys. The only other adults around were moms and dads fussing over their four- and five-year-old handfuls. My dignity wasn’t spared in the examination room, either. The diagnostic set-up featured a dancing white bunny flanked by alternating colored lights.
Dr. C. took one look at my out-of-whack peepers and his own eyes lit up. “Here’s a man who relishes a challenge,” I thought. During that initial consultation, the confident, gym-toned specialist told me he considers strabismus correction “a kind of sport.” The cowboy surgeon alarm sounded somewhere in the back of my head. I chose to ignore it and scheduled the surgery before leaving his office.
About six weeks later, on a frigid Tuesday in January, a car service took me to the surgical center in Fort Lee. Everyone there was soft-spoken and kind, even as I endured the standard embarrassments: stripping down to my underwear, stuffing my clothes and other belongings into a clear plastic bag, donning a flimsy hospital gown and, to top it off, a baby blue shower cap.
Events moved quickly once I got into the operating room, or so I’m told. My memory covers only the first five minutes, up to the point when the anesthesiologist switched my IV drip from saline solution to something stronger. “Happy juice,” she called it. I remember asking her how long the stuff would take to knock me out. The next thing I knew, the recovery room nurse was gently nudging me awake.
At this point, my brain was highly confused. For the first time, both eyes were pointing in the same general direction, so suppression was temporarily short-circuited. I looked up at the sweet-faced, middle-aged nurse and saw two of her smiling back at me. Beside her were two IV stands, behind her two bathroom doors, two exit signs, two wall phones. I looked down at my four hands and thought—possibly because I was still under the influence of the happy juice—“How cool is this?”
Within thirty minutes, my nervous system was adjusting, more or less, to my realigned optics. By the time I got dressed and ready to leave, I was mostly seeing one of everything, one eye at a time. Suppression had kicked back in. This was to be expected; Dr. C. had warned me not to bank on stereopsis just yet. Still, I felt a little disappointed. While double vision isn’t sustainable, it is a form of binocular sight. I saw double when I woke up because my brain was processing images from both eyes at once. For that half hour, even though everything looked so excessive, I wasn’t stereoblind anymore.
On the cab ride home along the New Jersey Turnpike, I shut my eyes to rest. The afternoon sun was low on the petrochemical horizon. Its rays dappled the car, setting off random fireworks behind my closed lids. The cutting was over. Now I felt surprisingly anxious to show my new normal to the world.
Which brings me back to the question of vanity. But that may be too harsh a word for the natural human impulse to fit in, based on the most superficial and yet influential social standard of all—appearance.
It has to be said: This talk of stereoblindness may be a diversion. True, my eye turn had become more distracting in recent years. Reading, especially, was increasingly arduous. There was also the remote but real danger of amblyopia, a strabismus-related condition in which one eye becomes so dominant that the other weakens or shuts down altogether. And yet, apart from its effect on my vision, strabismus saddled me with another burden—a psychic one. Strange as it sounds, my eye problem gave me a skittish sense of invisibility.
Maybe that’s really why I finally decided to put my faith, and 50 percent of my sight, in Dr. C.’s hands.
No doubt this was partially a product of my own insecurities, but not completely. All of us are biased to some degree against anyone who looks “different.” Some of this bias may even be biologically based. Research shows that human beings and many other species are deeply attracted to symmetry. The evolutionary dynamic seems to be that symmetrical features connote health and survivability, and are perceived as genetically advantageous. A lack of symmetry, particularly facial symmetry in humans, is perceived unfavorably.
People with obvious disabilities or deformities are aware of the shunning and stigma that can result from such perceptions. My woes were nothing compared to theirs. But strabismus is a type of facial asymmetry, and it can generate discomfort and suspicion in the beholder. Even the vernacular for this condition, “lazy eye” (which technically refers to amblyopia, but never mind), carries a whiff of value judgment.
There were times when I caught the scent of that judgment. It’s hard to pinpoint how, exactly: I just had a general sense of being dismissed or disregarded a little more often than my intellect and personality warranted, even with their obvious limitations. Eventually, I began to avoid looking strangers or casual acquaintances in the eye. Even with friends, at times, I would self-consciously avert my gaze. If the eyes are the window to the soul, my blinds were half-drawn for too long.
For a week or so after the operation, the muscles of my right eye felt tight. They stung when I moved the eye from side to side—which I tried not to do too abruptly, for fear of rupturing the tiny dissolvable stitches that secured its newly forward-looking angle.
If stereoblindness is my worst affliction, I’m a lucky man.The white, or sclera, of the eye was almost entirely suffused with blood during that first post-op week. It looked as if I’d been violently poked, and I took a few days off from work to let the bloodshot redness fade. When my recovery is complete, according to Dr. C., no outward evidence of surgical trauma will remain. Until then, it may be too soon to detect any new pattern in the reception I get from the ocular “straights” whose ranks I’ve now joined. What I can report so far is a definite increase in the number of times each day when I lock eyes with someone who’s looking right back at me, double-barreled. It’s an alien sensation, and I’m usually tempted to turn away.
Apparently, learning to trust and live with that new normal will take a while, even though the evidence in the mirror is clear. So much for vanity.
Meanwhile, I’m still curious about what it might be like, one day, to see through two eyes at a time. First, however, my brain will have to blaze some new synaptic trails. On follow-up visits in the coming months, Dr. C. will test me for stereopsis using—among other diagnostics—an oversized image of a housefly. Viewed through the ophthalmologic equivalent of 3-D glasses, the fly will appear to stretch its wings wide if and when I’m able to merge two images into one.
I realize now that I won’t be devastated if that bug never takes flight. I’m glad I had the surgery, proud to have taken a shot at something more, especially at a time in life when I might be expected to settle for less. But with or without stereopsis, I’ve seen a lot already. I’ve seen the sun rise in a smoky sky on the edge of the Sahara, and plunge like a giant meteor in the hurried dusk of the tropical Pacific. I’ve seen one life brought into the world in the fluorescent glow of a hospital delivery room, and another snuffed out by a stranger with a knife in a dim city stairwell. I’ve seen my children grow up, and my parents grow old. In half a century of seeing, I’ve seen heartbreaking beauty and nauseating ugliness and everything in between. And every image, fleeting or fixed, has been as vivid as I could ever imagine.
If stereoblindness is my worst affliction, I’m a lucky man. If there’s even more to see, all I can do is look the world in the eye and say: Bring it on.