by Tom the Hungarian
This happened many years ago - far more than I care to recall or admit to - in the very first year I started my practice. Patients were still far and few. Brenda was nine years old, tall an well developed for her age when she was brought to my office by her mother for an eye examination. She had a dense forest of long, curly black hair, pale skin with very red cheeks, thick red lips and burning, angry black eyes. And it was not just her eyes that were angry!
After introducing herself and her daughter, Mrs.B. announced that she wanted Brenda's vision tested because she thought she needed glasses. Brenda's response was loud and clear:
"There's nothing wrong with my eyes, I don't want them tested and I don't want glasses!"
"Yes, you do need glasses, you squint all the time!"
"It's just a bad habit!"
"Your teacher thinks you need them!"
"She is a stupid old witch who knows nothing from nothing!"
"Let the doctor test them and then we'll see who is right."
"I don't want them tested! And it's no use anyway because I'm not going to wear specs anyway no matter what this doctor says. They're ugly!"
I tried to lower the temperature. I made all kind of suggestions. Said that if her eyesight was alright, that would be the end of the argument and if not, we can still discuss the pros and cons of wearing glasses. Brenda did not give in easily but after a while she sat down in the examination chair which she had previously called the "electric chair". As soon as I looked inside her eyes, I saw that she was quite nearsighted, her left eye significantly worse, but said nothing. After I finished the examination I announced that I had found nothing seriously wrong and that we now will test her vision with the eyechart. She put up an other fight.
"If you found nothing wrong then what's the use doing this?
"If there's nothing wrong with your eyes," - I replied, - "then why are you so afraid of this test?"
She found no counterargument. I lit up the eye chart and told her to read. She could read only the three top lines, the third one with a little hesitation and then she was stuck.
"Heavens, child!" - her mother exclaimed. - "You are practically blind! Am I happy I brought you here!"
Brenda's face turned bright red, she bit her lower lip but said nothing. I had her look through the instrument I used for the testing refraction, turned lenses of the appropriate strength in front of her eyes and asked he to read. She gasped when she looked through those lenses. It must have been quite a revelation to her being able to see so well! To cut a long story short, after this I did a thorough test, each eye individually and I came up with a prescription as follows
OD -2.25 -0.25 @125
OS -4.25 -1.00 @75
"I don't care what prescription you give me, I won't wear glasses!" - Brenda announced angrier than ever.
"You really are quite nearsighted, Brenda," - I replied. - "It must have been quite a struggle for you to make it without glasses. I don't even know how you managed in class let alone in the movies. Why don't you see how much these glasses will help and then decide."
Sensible as my words were, she did not listen. She just repeated, "I will not wear glasses!"
This was before one could get glasses made in 24 hours and I asked them to return for a quick check-up once she had her glasses. They did but I found Brenda just as angry and stubborn as before and her mother equally stubborn in her insistence that she WILL indeed wear them. I was wondering how this will end and did not think I will ever see them again even though I told them that I wanted to see the child in a years time. But, to my surprise, twelve months later they appeared. Brenda was just as angry and negative as on the first occasion. She had grown and started filling in, a young girl now rather than a child.
"Well, how are things going? Did you get used to wearing glasses?" - I asked.
"NO! I did not!!! I am not wearing them and never shall!"
In conversation I found out that this was not the whole truth. She did use them occasionally in class and always to watch TV or at the movies. The results of the examination concerned me because her eyes had deteriorated considerably in a year. Her new prescription was:
OD -3.00 -0.50
OS -5.25 -1.25
When I told them about the significant increase in her prescription, her mother exclaimed,
"She didn't want to come for the check-up but I knew it was happening! I could see how she squinted even when she had her glasses on and the way she fiddled with them, tilted them and pushed them close to her eyes! I knew she'd need stronger glasses! Brenda's face was red and angry but she said nothing except by restating her position that glasses were ugly and she did not want them.
I did not expect them back for a year but they reappeared about six months later. Brenda's mother told me that she was worried because, once again, she had observed her daughter squinting and wanted me to look at her after only half a year. I did so with Brenda sulking and furious. The result was upsetting and I encouraged them to visit me again in another six months time. By the end of that year, Brenda's prescription had increased at an astonishing rate to:
OD -4.25 -0.75
OS -6.75 -1.50
Since Brenda's hostility seemed unchanged, I asked Mrs. M. to let me talk to her daughter privately to which she agreed and left the room. I said to the girl i a tone as gentle and friendly as I was capable of.
"Look, Brenda, let's face the facts: whether you like it or not, you ARE very nearsighted. I know what your eyesight is like from personal experience because I am nearsighted, too and have lenses with strengths not very different from yours. You can't possibly function well without wearing them."
Unexpectedly, she started crying. I tried to console her obvious grief and, after a while she stopped. She admitted to me, with little sobs occasionally interrupting her speech, that she was pretty desperate because, just as I had said, she had increasing trouble functioning without them. She, finally agreed, that she would wear them except when going out with friends. Her mother returned and was very pleased with what we agreed upon.
"I think," - she said - "That your eyes were getting worse because you did not wear your glasses and you will find now that it's going to be better."
I did not want to let this misinformation to pass and explained that wearing or not wearing her glasses will not affect her myopia although it might help the headaches which she had been complaining about. I did not think Mrs. M. really believed me. We agreed that they would return in 6 months time.
As far as the progression of her myopia was concerned the next year was not a good one for poor Brenda. From every other point of view, however, she had been doing well. The headaches were gone, her grades greatly improved since she wore her glasses to class more consistently and she had grown physically to an amazing degree. She was 12 going on 15, her body had filled out, her breasts almost burst through the T-shirt she wore and she was almost as tall as her mother.
"Gosh, Brenda," - I said to her, - "you have sure grown up! You are a young lady now, no longer a child!"
She gave me a big smile and was obviously delighted with my words. She was, however, anything but delighted with the results of the eye examination. The results was pretty disastrous:
OD -6.00 -1.00
OS -8.00 -2.00
I had to admit that the rate of increase was troubling and I, therefore, suggested that we try bifocals. This brought about another burst of opposition on Brenda's part but, once she understood that this may slow down the progress of her myopia, she agreed and I prescribed her an add of +1.00 which I increased 6 months later to +1.50. Unfortunately the hoped for results were not forthcoming. her myopia continued its rapid increase. At the next examination she asked me about contacts and I said those were quite feasible but her mother immediately nixed this idea.
"I am sorry, Doctor," - she said in a very serious and severe tone, - "I already discussed this with Brenda. I am a single mother, having a hard time making ends meet and as long as her eyes change as rapidly as now, I cannot possibly consider this. I would have to pay for new contacts every 6 months."
I understood this but also understood Brenda's concerns, the vanity of a teenage girl and suggested that maybe they get lenses from high index plastic. Mrs. M.'s answer was, however, the same: she could not afford the extra cost which would be incurred twice a year.
The following 2 years Brenda's myopia continued increasing rapidly but the next year the rate of increase was less. I had given up on the bifocals since they obviously did not help. Brenda was no longer as anxious about the thickness of her glasses as before. The examination came up with the following results:
OD -10.00 -1.50
OS -13.00 -2.50
"You are not going to see me for a while," - Brenda announced at the end of the visit to my great surprise. She then explained that her she was going to live with her father who had remarried and was doing very well financially and was able to send her to an outstanding private school for the last 3 years of high school. I was sorry to lose this customer but was delighted for her sake.
Three years passed when a gorgeous young women, tall, slim but with very full breasts, dressed in a smart and expensive looking very short dress and high heels emphasizing her already considerable height, appeared. She wore a large frame with very thick lenses - as far as I could tell not made of high index material - with a plano front. I did not recognize her until she introduced herself with a big laugh. She had graduated from high school, was spending her summer before going to college with her mother and decided, for old times sake, to have the eye examination that was due with me. Needless to say that I was delighted indeed!
Brenda's eyesight continued worsening during the three years I had not seen her and she was now wearing
OD -12.00 -1.75
OS -15.50 -2.50
I examined her eyes and found that she needed an increase of -0.50 in each eye.
"I am sorry to say, your myopia is still increasing!"
"O, I'm not surprised," - she answered with deep depression in her voice. - "I know there is nothing I can do about it. I can't even wear contacts, my eyes are reacting to them with almost instant inflammation."
I felt sorry for her.
Four more years passed before I saw her next. She arrived wearing myodiscs so I immediately concluded that her eyes had got much worse and were up in the -20s now. When I examined, however, I was surprised to find that her myopia had increased by -1.50 only and that she needed no further increase. I thought she would be delighted when I told her that but she surprised me again.
"O, shoot!" - she exclaimed. - "No increase? Are you sure? It's disappointing!"
"Disappointing?" - I responded. - "I thought you'd be delighted? And in any case why are you wearing myodiscs? You don't really need them! Your lenses are strong but not strong enough for you to need myodiscs!"
"Well, Doctor," - she said, - "things have changed. I am getting married in a couple of weeks and - by the way - here is the invitation for my wedding for you and your wife. And you know what? Andy, my fiancé, loves girls who wear glasses especially with thick lenses. I had a hard time persuading the optician to give me myodiscs. It was my engagement present for him and he was so excited and delighted! I met him on the Internet, by the way, we were, both of us, fans of a Website called 'Eyescene" and started e-mailing, met personally and now... here we are getting married!"