Monday, August 13, 2012

Jennifer…The Myopic Progression Continues

by Jennifer

The first part is here
Jennifer loved her glasses. Even with her very high prescription of -37.75 -2.50 X 90 in her right eye and -41.00 -1.50 X 164 in her left, she wore them proudly. She had always felt they set her apart from everyone else.
Jennifer’s myopic progression had slowed significantly to well under a diopter per year. She barely noticed the change, and was very happy with her present glasses. She especially liked the Zeiss Lantal version that was a full field lens. They were nearly 18 millimeters thick at the outer edges and a bit heavy, but Jennifer thought they looked incredibly cool. But out of practicality and comfort, she wore her myodiscs most of the time.
Jennifer still resisted having her eyes checked too often; she was still afraid of another big jump. But after two and a half years went by, she was again having trouble reading anything much farther away than the ends of her arms. Something had begun to change more rapidly. She returned to the optometrist fearing another huge increase.
“Let’s see what’s going on here,” the doctor said.
The preliminary exam again showed no pathology or signs of retinal detachment, so they moved on to the refraction. For the past few years, Jennifer had been examined with her glasses on, because the phoropter couldn’t accommodate her high numbers. But recent technology permitted a computerized device unlimited by old constraints. Jennifer removed her glasses and looked at the doctor but his figure blended into the total blur, she couldn’t make him out from the rest of the room. She placed her chin on the ledge of the machine. The doctor dialed in her present prescription and opened the shutters. “What can you read?” he asked.
Jennifer squinted and started to read: “E G…”
“No squinting,” the doctor said.
“Okay,” Jennifer opened her eyes wide. “None of them,” she said, and a bolt of fear struck her. “Am I finally gonna go blind?” she asked.
“No…no, not at all. And with this phoropter we can get a more accurate prescription than ever before. And there is a new lens available for very high minus use. It’s made of flint glass, and I think we can even get you a wider viewing area than with your old myodiscs.”
“Alright, we’ll begin. You are going to see a little light coming from the machine. It’s a very low wattage laser and it can read the refractive power of your eyes as it changes the prescription. It does sphere and cylinder at the same time, and it does them continuously; no more quarter diopter steps. So the new prescriptions read in hundredths of diopters rather than in quarters. The magic of computers you know.”
Jennifer saw a little glow in both eyes, and then the image of the eye chart grew less fuzzy. The progression was slow, but the letters continued to sharpen.”
“What can you read now?”
“E G N U S”
The light came back on and the image sharpened further.
“A P E O T L”
“That’s good.”
And the image grew even sharper.
“O C D E Z R T.”
One more burst of light, and the chart seemed to jump off the wall.
“Oh my God,” Jennifer said, “that’s the sharpest I’ve been able to see in years. I can read the bottom line. This is great! Don’t change a thing.”
“Okay,” said the doctor, “let’s see what we have here.” He typed a command on the keyboard and a printer reeled out a hard copy of the prescription.
“How long did you say it was since your last exam?” he asked.
“It’s been over two years.”
“Well, you’ve had another big increase…”
“I kinda figured…so, let me have it.”
“Your astigmatism stayed the same…that’s good.”
“You’re up by six point seven five in the right eye, and eight point two five in the left.” He handed her the printout.
It read: OD -44.50, -2.50 X 90
OS -49.25, -1.50 X 164.
“Holy shit!” said Jennifer.
“We can cover this nicely with the new lenses; I think you’ll be pleasantly surprised.”
Jennifer asked if they could also be made in a full field version, like the Lantals. The optician said he would check.
Two weeks later, the new glasses arrived. They were made in her favorite Ray Ban frame; slick black plastic with 50mm lenses. Jennifer slipped them on and the world grew instantly brighter and sharper than ever before. “These are great!” she exclaimed. “I can’t believe it!”
“That’s good,” the optician said. “Because I can’t get this prescription in anything but a myodisc.”
She pulled the glasses off and of course couldn’t see a thing; her far point was only two centimeters from the front of her eyes. She put her old ones on and examined the new lenses. They were myodisc style, but the bowls were at least 26 millimeters. The front surface was entirely concave, not just in the front of the bowls. Out of curiosity Jennifer measured it with a lens clock. It read only minus five. The back part of the carrier measured three. She held them up and looked through them at a distance. The room appeared miniscule and far away through the bowls. Most of the prescription was contained in the central 26 millimeters of the lens.
“It’s hard to believe they’ve got over forty diopters of curve right there,” said the optometrist.
She put them back on and looked in the mirror.
Her eyes appeared tiny, and the sides of her face seemed to be moved in more than ever before. When she turned the lenses sideways, the power rings in the bowls appeared to be nearly a half inch deep, but they blended nicely with the carrier, and the actual edge thickness of the lens was less than twelve millimeters. But in spite of the incredibly strong lenses, the glasses looked surprisingly good. The four diopter difference between her eyes was noticeable, but not too bad. And most importantly, everything looked better than ever through them.
Jennifer was elated, but wondered what her vision would be in ten more years.
Luckily, that was the last large increase for Jennifer’s prescription for awhile. Five years later, her lenses were: -47.50 right, and -52.25 left. Her astigmatism remained the same, and the high tech lenses accommodated the prescription very well, except that now the bowls were 24 millimeters and contained one third of the prescription on their front surface, the remaining two thirds on the back. The carrier remained a minus ten overall. But Jennifer had to be very careful to wear the glasses close to her eyes because every millimeter of vertex distance changed the effective lens power by almost three diopters.
In fact, when she found a new pair of frames that she loved, but fit a bit further from her face, the lens powers had to be recalculated. The resultant prescription was: Right -52.50, -3.00 X 90, Left -58.50, -2.00 X 164.
The difference between her eyes grew to six diopters because of the vertex distance adjustment of only two millimeters, and was now quite noticeable. At this level, the carriers returned to a plano surface front and back, and the prescription was split evenly between the front and backs of the 22 millimeter bowls. To Jennifer’s delight, the edge thickness of the entire lens was only ten millimeters.
But when she looked in the mirror, her eyes appeared to be less than half their normal size, and the sides of her head visible in the bowls seemed to be squeezed towards her nose. Her head appeared to be less than two inches wide through the lenses. Even though the plano carriers made up the outside portion of the lenses, it looked like the whole world was visible through the little bowls.
Jennifer put on her regular glasses and held the new ones out towards the room. Everything appeared to be a tiny percentage of its normal size; it was like looking through the wrong end of a very powerful pair of binoculars. She held out her shapely, muscular arm and looked through the glasses at it. Even though her upper arm measured over thirteen inches, it looked like a fragile twig through the glasses. She slipped them back on her face and studied her eyes and her gorgeous features. She was still as stunning as ever, and these glasses made her exotic as hell.
“You know,” she said, tossing her head around and flinging her pony tail forward over her broad, tanned shoulders, “I think I’ll wear these all the time.”
Jennifer did wear the glasses all the time, and over time, she found herself pushing them closer and closer to her eyes to keep the image sharp. Finally one day, she couldn’t bring anything into focus. What is happening to me, she wondered. So back to the eye doctor she went; scared shitless.
The doctor again found no pathology, but said, “Okay, here’s what’s happening; you are experiencing a version of adult onset myopia. It’s rare, but it occurs. The problem is that you are already quite myopic…”
“Yeah…no kidding…”
“Anyway, that’s why it came on so quickly and aggressively.”
“So, can it be corrected…or is this it?”

“What do you mean by…it?”
“Well, I mean when I won’t be able to see very well, or at all. I’ve been watching how much lens power it takes to keep up with this, and it’s getting scary…actually it’s been scary for quite a while.”
The doctor led her into the room with the high tech phoropter. “Let’s see how it goes.”
Jennifer removed her glasses and put her head against the machine. The doctor adjusted a positioning pad. “We’re going to watch vertex distance very carefully this time. I have it set at ten millimeters. You’re going to have some very close fitting glasses in any case.”
“Sure,” Jennifer said, while again feeling apprehensive about whether the glasses would work or how they might look.
The examiner opened the shutters; the chart was a blur. He typed her existing prescription and the image cleared, but she still couldn’t read a line.
“Nothing,” she said.
He entered another command. The image grew sharper but smaller; Jennifer had never noticed this before.
“How about now,” he asked.
“Top line; ‘E.’”
More keyboard entries.
“Third one down.”
Another change and the image grew sharper. Jennifer could read the top three lines, but below that, the letters were too small to make out.
“Still the top three,” she said, a little shakily.
The doctor reached over and turned something on the machine, and with a click, two more lines popped into focus.
“I can read the top five now, but everything below that is too small…”
“Okay, that’s the twenty/one hundred line, and I think that’s as far as we can go.”
“So, that’s it…I’ve finally gone blind?”
“There are some options still available, but we’ll address them next.”
Jennifer realized tears were running down her cheeks; she felt defeated. “I’m afraid to ask what my prescription is now.”
“Well, it’s very high,” the doctor said, looking at the printout. “But we’ve reduced the vertex distance and that will help…”
“What is it Doc?”
“Okay: you went up twelve diopters in your right eye, and fourteen in your left. The astigmatism is the same. So: -64.50 -3.00 X 90 in the right, and -70.50 -2.00 X 164 in the left. That gets you a little better than 20/100…”
Jennifer put her head down and began to cry. “I want to be able to see…”
“I said there are other options.”
She looked up.
“First, we’ll order glasses in the Zeiss design you’ve been wearing, and see how they work. You can always see better with the finished prescription than through the machine. Then I’m going to order you some telescopic glasses. Those will allow you to see much smaller print—maybe twenty/thirty or even twenty/twenty. We’ll have to see.”
“What will those look like?”
“Like regular glasses with little scopes attached to the lenses…like surgeons wear for close work, only yours will be for distance. The scopes are only about a half inch long and now, they’re nearly three quarters inch in diameter, so the vision is pretty good. But there’s no peripheral to speak of.”
Jennifer put her head in her hands and tears started to fall again. She knew she had just entered the dark world of the partially sighted.
“So, is that it?” she asked.
“No, the other option is surgery; we can eliminate between thirty and forty-five diopters with lens implants, and we could get rid of the difference between your eyes.”
Jennifer was greatly relieved, but said, “Let’s see how the glasses and the telescopes work; then we’ll talk.”
For the next two weeks, Jennifer got around by wearing two pairs of old glasses at the same time. When the frames kept falling off, she glued the lenses from one pair to the other with crazy glue. Her vision was still not very good, but she could get around.

When the call came from the opticians, Jennifer was scared, excited, and confused. She had never been so worried about her eyes or what may happen in the future. She prayed the glasses would allow her to see better than 20/100. She didn’t want to be seen wearing the little telescopes if possible. And she still wanted to be able to drive. She knew she couldn’t possibly pass the eye test which required 20/40, but she had driven without a license for some time.
The optician pulled out the Zeiss glasses first. Jennifer examined them closely while wearing her old glasses and holding the new ones about four inches away. She estimated the myodisc bowls to be only 16 mm in diameter, both front and back. It looked like the prescription was evenly split between them. The front carrier surface was plano and the back was sharply beveled from the edge of the lens to the circumference of the bowl. There was a slight blending of the edge. It appeared this part of the lens would fit completely into her eye socket, touching her nose. She held them up to the room and looked through them. The image was tiny, miniscule even. The edges of the bowls presented a tunnel effect and the beveled portion of the lens created a prismatic view of things to the side. She slipped them on. When they were firmly against her face, the surroundings popped into focus. Everything was sharp, but unlike in the phoropter, appeared to be closer normal size. She could read the signboard across the street. She looked at a magazine on the table; she could read all the print. “This isn’t bad at all,” she said.
“Let’s try an eye chart,” the optician said, indicating a chart on the wall behind him.
Jennifer looked up; she could see all but the bottom four lines.
“That’s twenty/forty,” the optician said. “Not bad for these numbers.”
She looked in the mirror. Her right eye appeared to be the size of a pea, and her left eye was so small it was nearly invisible. Her head looked to be maybe an inch wide through the bowls. These glasses were beyond exotic, they were downright weird. But they seemed to work pretty well, and it was all she could hope for.
She picked up the telescopic glasses and put them on. With these, images were bigger and she could read the 20/30 line on the chart, but her peripheral vision was completely gone—that was the tradeoff.
She put the Zeiss glasses back on and walked around the room. After a while she felt confident enough to head home. “I guess these will have to do for a while,” she said, and stepped out the door.
Over time, Jennifer adapted quite well to the high power Zeiss lenses, it even seemed she was seeing better than when she first got them. But if they slipped even a millimeter down her nose, everything became a blur. She bought a sports strap to hold them in place.
After months of wear, the back of the lens was digging uncomfortably into Jennifer’s eye sockets and the image was beginning to blur. She returned to the optician’s and they were able to grind the back of the lens to make it thinner. After polishing the surface, the lenses were only nine millimeters thick, but the back of the bowl was reduced to a mere twelve millimeters in diameter. But now, Jennifer could keep the glasses even closer to her eyes by nearly two millimeters which helped immensely with image sharpness. Jennifer didn’t know it, but that two millimeters closer had gained her nearly ten diopters of power in each eye. Her prescription had risen well into the seventies in a very short time.
But the flatter surface on the back side improved their appearance, and she felt much better about wearing them. But more time passed, her vision continued to deteriorate further until she could no longer get a sharp image by pushing the glasses closer. Jennifer reluctantly pulled out the telescopic glasses and put them on. The image was better, but still not completely sharp, but she had no other choice.
In spite of their appearance, and total lack of peripheral vision, Jennifer found she was wearing the telescopic specs constantly. For the first time in her life, her glasses attracted attention in restaurants and shopping malls. Comments like, “Oh, that poor girl, so beautiful except for the glasses, she must be almost blind,” and “Did you see those glasses? I’ve never seen anything like those before.”
For years, even her strongest myodiscs had gotten only positive comments, but now she thought, perhaps only out of pity.

Blind; the word hung over her. She considered the narrow image through the telescopic spectacles, her nearly non-existent peripheral vision, the fact that without her glasses she really was blind. She pulled off the specs and held her hand in front of her face and couldn’t begin to see it. Only blotches of light and dark tinged with indistinct colors remained. Jennifer moved her finger closer and closer to her left eye, by the time it came into focus, it was almost in contact with her cornea.

This was the it she had worried about. For years Jennifer had never really been concerned about her vision, always knowing it could be fully corrected. She was never bothered by the higher and higher powered lenses, and actually felt proud of them because they set her apart from everyone else. Until recently, she really enjoyed wearing unusual glasses and always thought of them as undeniably cool. That was when she had been able to see clearly; but now, she was at the outer limits of myopic progression and yet still feared surgery. What if that didn’t work either? What if her myopia kept progressing after surgery; how far could it go…how far would it go?
She made another visit to the eye doctor.
“The good thing about these,” he said, indicating the spectacles, is that we can update them by changing an internal lens, so let’s have a look.”
On the eye chart, Jennifer could read only the top line. The doctor unscrewed the front of both telescopes and changed a lens element. “How’s that?” he asked.
“Getting better; all but the bottom five.”
He made another change and she could see one more line.
“That’s about it,” he said.
“So that’s all the correction that’s available?”
“I’m afraid so, you’re pushing eighty diopters in your left eye; your far point is only one and a quarter centimeters. That’s why the single vision glasses don’t work any more. You can’t get them close enough to your eyes.”
“So I’m stuck with the telescopes?”
“I’m afraid so.”
“What if I put in some contacts too?” Jennifer asked, feeling a momentary rush of excitement. “I’ve heard they go up to minus twenty, would that help? I know I’ve never been too good with them, but now I’m getting desperate.” She picked up her Zeiss glasses. “You think I could get back to using these if I also had contacts?”
“We could try,” the optometrist replied.
He ordered two sets of minus twenty RGP contact lenses.
When the lenses came in, Jennifer thought she might have a reprieve from the telescopes, and from complete loss of sight. She still feared the surgery.
To her pleasant surprise, the new contact lenses were much more comfortable than the ones she had tried in high school. She put them in and slipped her regular glasses on. The room actually popped into view…she could see again. In fact, the combination actually overcorrected her vision and she saw a crisp image for the first time in over a year. “I can live with this,” she said, not mentioning that they were actually too strong. Maybe this combination would last longer.
But as more time went by, she again found herself wearing the telescopic lenses…with the contacts. The single vision lenses had completely lost their effectiveness, and the contacts were growing uncomfortable.
And when the telescopic glasses combined with the contacts started to lose focus, Jennifer finally considered having the implants; no other options remained.
“Is it even worth testing?” she asked the surgeon.
“Not really, but I feel we can get you back into the range where you can be corrected to twenty-twenty or even better with glasses.”
The surgery took only thirty minutes and was completely painless. As Jennifer lay in the blur and darkness of the recovery room, the surgeon said, “We were able to even out the difference between your eyes and eliminate most of the astigmatism. It went very well, and tomorrow we’ll check you out. Oh, and one other good thing; the new IOL’s are multi-focal, you should be able to read without changing glasses.”
The next day, Jennifer was led into the exam room and she placed her head in the now all too familiar machine. The examiner set the vertex distance at 13.5 millimeters, a more common figure.
“Here we go,” he said.
Jennifer did not reply; she was scared but excited.
The highly automated phoropter arrived at a very sharp image more quickly than ever before. When it stabilized, Jennifer was able to read every line on the chart.
“This is wonderful,” she exclaimed. “I sure hope this holds for a while.”
Her surgeon entered and the examiner handed him a copy of the prescription. He studied it and smiled. “It looks like we were able to get rid of more than forty diopters of your myopia and nearly all of the astigmatism. The difference between your eyes is just over a diopter now.” He looked up at her, “It’s still pretty strong, though.” He handed her the readout: OD -27.00 -.50 X 90, OS -28.50 -.50 X 160.
But Jennifer was elated; her prescription hadn’t been this low since just after college. “This is great!” she shrieked, surprising everyone, since most patients would be horrified at these numbers.
The surgeon beamed proudly, “We were able to eliminate forty-seven and a half diopters in your left eye and over forty in your right. Your left was the limiting factor; you had actually exceeded a minus eighty in that eye. So, I think we’ve done really well.”
“Should I have done this sooner?” Jennifer asked sheepishly.
“No. I think that with your rate of progression, we would have had to repeat the surgery to keep up with it. I think you were right to stick with the glasses as long as you could.
“Do you think this will finally stop?” Jennifer asked with her usual trepidation.
“I hope so,” replied the surgeon, “because we’re pretty much maxed out on the IOL’s; but glasses could carry you another twenty diopters or so if necessary.”
“I hope so too,” Jennifer said, she didn’t relish the prospect of returning to sixty diopter glasses again.
Waiting for the new glasses, Jennifer dug out the glasses that had long been her favorites. They were the -37.75, -41.00 glasses. The astigmatism correction was too strong, and the difference between the right and left was too great, but overall she could see well enough to get along.
Her new glasses arrived in two weeks. She kept the 50mm ray Ban black plastic frames and the lenses were made with the same ultra-high index glass she had grown used to in the higher powered version. To Jennifer’s sheer delight, her vision was better than it had been in many years. She was able to read the 20/15 line with ease.
And the lenses were pretty good looking, she thought. One pair was a myodisc design with 28 mm bowls and only a slight negative curve on the front; probably less than two diopters. The back surface of the carrier nearly matched the front curve, resulting in only a slight plus lens effect. At their thickest point, the lenses were only six millimeters, and just four at the outer edge. Her eyes appeared small, but they were both the same size. And the sides of her head weren’t squeezed into her nose so much anymore, although if one were to measure the apparent width of her head in the bowls, it would have been well under three inches.
The other pair was the Zeiss Lantal full field version. She opted to avoid the sharply angled bevel, which made the outer edges nearly sixteen millimeters thick with a slight safety bevel, but she didn’t care one bit. The edges were highly polished, and the glasses sparkled like jewels.
For the first time in years, her eyes were clearly visible through the lenses, with both pairs—still small—but visible, and both appearing to be the same size for a change. For a brief moment, she actually missed the exotic look of the mismatched eyes, but really, this was better. The aquamarine beauty of her eyes shone brightly. Her vision was clear, and she loved the way the glasses looked on her. She had long, long ago grown used seeing the world through powerful lenses, and she really wouldn’t have it any other way. These kinds of glasses were simply part of her, and she was comfortable with it. Jennifer was elated. Gone were the extreme double myodiscs, the contacts, and, thank God, the telescopic lenses too.
She felt like a kid again, ordered another two pair for back up, thanked the surgical team, and headed out the door; seeing the world brightly again, looking as gorgeous as ever, and praying her myopic progression had finally ended.


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