The Footballer, the Postman Pat Girl, and the Film-Maker

As things currently stand, we do our patients a disservice by working at a polarised end of the Cartesian split. We choose not to see what is in front of us. It is us, the eye professionals, who turn a blind eye.

I shall start with Billy, a robust outgoing 9-year-old, fond of football, who was referred to the Eye Department, complaining of blurred and deteriorating vision.

His period of attendance at the Eye Clinic ran concurrently with my participation at the Tavistock Eye seminars.

He was seen firstly by an orthoptic colleague in March. Billy was found to have 6/18 vision in both eyes, somewhat less than the desired standard of 6/6. The consultant ophthalmologist had found: no refractive error, white and quiet eyes, and healthy discs. When I saw Billy, I found his vision to be initially 6/18 6/12. His convergence was slightly reduced. I had a feeling his vision was higher than 6/18 6/12. With further testing, with a variety of different very weak lenses used to correct long-sightedness, short-sightedness, or astigmatism, his vision came up indiscriminately to 6/5 6/5, suggesting that optically at least his vision was sound.

Standard Orthoptic case-history taking involves making enquiries about ocular history, signs and symptoms, a possible family history of squint, refractive error and other eye disorders; establishing if there are any general-health problems, and finding out details about the birth history. In Billy's case, however, I felt it prudent to make a few sensitive enquiries about his school and family lives. He came with both his parents, although they were divorced. Both parents had remarried, and Billy now had a little step-brother. On their way out of the door, his mother volunteered the information that Billy's grandmother had a brain-tumour.

I brought Billy's case to the Tavistock Eye group. I pointed out that at the hospital his divorced parents were together. I wondered if there was anxiety about the divorce and the grandmother's b