Ockham’s Razor, the idea that a hypothesis with the fewest assumptions should be selected over hypotheses with many assumptions. This is a term I learned for the first time a few years ago in a psychology class, a term I never thought I’d use again. After a recent patient encounter while shadowing Dr. Weinberg the concept re-surfaced and the case was quite interesting to hear.
A young man came to our office not knowing why he was there. He had been to every type of doctor and therapist he could think of. He had been to the neurologist, he had been to ophthalmologists, he had been to the masseur and chiropractor. Not one had been able to “cure” him. He had been admitted into one hospital to rule out Rocky Mountain Spotted Fever. He was released with no signs of RMSF and all accompanying reports had come back negative. CT scans were performed which also returned negative results. The patient presented ongoing symptoms of blurry vision, headaches and neck muscle pain. These symptoms had been occurring for over a year at this point and he had been in and out of hospitals and therapy sessions ever since the onset. He stated the massages helped with the muscle pain. The blurry vision remained constant. His final stop and last hope for an answer was at a Developmental Optometrist.
Dr. Weinberg performed a thorough visual evaluation. The young man had nearly perfect vision at both far and near. A very slight eye turn was discussed, however a simple “in home” exercise was prescribed to alleviate this symptom. Sitting in the exam room and watching the interaction, a prognosis seemed a mystery. After careful study of the young mans near vision the doctor asked the patient what kind of work he did, then how much time he spends in front of the computer. The patient confessed that at one point in the past year there was a stretch where he had to sit and work in front of a computer for more than ten hours a day.
Mulling over the information gathered during the exam, the doctor hypothesized that this mystery ailment the patient suffered from was an extreme case of simple problem…Eye Strain. Dr. Weinberg explained how doing so much near work for so long puts stress on the eye. It takes a lot of energy for the eyes to fixate and stay focused at a near distance. The strain became so much that the body has over compensated to alleviate the eye strain. The overcompensation induced neck pain and headaches. Needless to say the patient was quite shocked to hear that this was the problem. After all he had seen a neurologist, an ophthalmologist, masseur and chiropractor. For all of his troubles, all that was needed was a new Rx for near work to relieve his eye strain. Ockham’s Razor!
Something I would like to point out from this exposé is the relationship that vision has with the brain and body. Just as this young mans eye strain caused neck pain and headaches, a person suffering from an acquired brain injury or other neurological insult may experience a visual midline shift as described by Dr. William Padula, OD, DPNAP, FAAO, FNORA. The patients (spinal) posture changes in accordance to the their visual orientation being off kilter, for example a lean to one side or the other. The case above as well visual midline shift syndrome from an acquired brain injury may seem to be the extremes, however think how a visual problem may affect a child’s behavior who is struggling due to a visual deficit. One problem leads to another then another and so on, causing a much larger problem than what it began as. Remember Ockham’s Razor and the law of parsimony because much of the time there is a much more succinct solution for a large number of problems.