How Can Studies of Overall Development Help Us?
The milieu in which I see strabismus occurring is critical not only for the development of the visual system but also for the global development of the fetus and neonate as well. My goal in this chapter is to enlarge the circle of phenomenology we must carefully examine if we are to place strabismus in its true perspective. It is not a thing apart. It happens in time and to a developing human being. A before and an after and, if I am not mistaken, a “something else” accompany it. I come to this conclusion on at least two grounds. The first is a consideration of the central hypothesis, which postulates a specific time, site, and mechanism by which an insult is delivered to the developing visual system. Synaptogenesis in its decrescendo (dying back) phase is implicated. But synaptogenesis, as has been pointed out, is a systemwide process occurring in all cortical areas on almost the same schedule. Though not intuitively obvious, this simultaneity (of synaptogenesis) does make sense from the standpoint of having much of the central nervous system circuitry and all primary areas of sensory and motor processing ready as early as possible before, during, or slightly after birth. What this means is that we should then look at the other special senses, at the somasthetic and motor behavior and, yes, even early cognition and learning, for evidence of a unique clinical entity, “global synaptic plethora,” that might result in the production or survival of primitive motor and sensory behavior patterns long after they should normally disappear. Or, on the other hand, more advanced and integrated motor, sensory, or even cognitive behaviors might be delayed in appearance as a result of this dysmorphology of synapses.
KeywordsRespiration Peri Tral Strabismus Nipple
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