Saturday, November 16, 2013

A Million Diopters

by Specs4ever

This was so unreal. Here I stood in a courtroom in front of a judge. I had no attorney, and the judge had overruled me at every attempt I made to try to defend myself. I was accused of having made fun of a number of girls in grade school that had started to wear glasses when I was in their class. And, now, almost 20 years later, just as I was graduating from the School of Optometry I was being called upon to pay for my misdeeds. Yes, I had laughed at the kids who had gotten glasses, and I had called them 4 eyes and had even joined with the other kids in taking their glasses from their face, and hiding them until they went crying to the teacher, at which point their glasses would mysteriously reappear. I could not deny that I had done all that, and even more. But as I grew older I had developed an interest in vision, and vision care. I was only weeks away from being an Optometrist. Should this not redeem me for my earlier misdeeds?

I guess not, for it appeared I was being convicted. Now the judge told me to stand up straight, while he pronounced his sentence. I was sentenced to what? I had to prescribe a million diopters? I spoke to the prosecutor after I heard my sentence, and he clarified it for me. I had to, in my lifetime, prescribe a million diopters of correction. I got a point for every diopter I prescribed, and I got double points for any overcorrection. Would this even be possible I asked? He told me that I would be allowed to count all the diopters my patient left my office with. Even if a patient came in with –12.50D and left with –13.00D I got to count all 13 diopters, and if the increase from –12.50D to –13.00D was not a necessary increase I got to count the patient as 13.5 points. Maybe, just maybe this would be possible. And what was my reward? I was told that if I got to the million diopters I would be very happy in my retirement, and in the hereafter.

The alarm clock went off, and I sprang out of bed to shut it off. My dream from last night remained exceptionally vivid in my mind. Where had the idea of a million diopters come from? I knew I was tired, because I had been pushing my studies a little too hard. And hopefully today it should pay off. I was writing my final exam, and since I had already completed my apprenticeship I was going to be a fully licensed Optometrist. I had paid all of the first months rent and a deposit for an office. I had all my instruments waiting for my shipping instructions. All I needed was to pass the exam. Sure, that’s all my dream was, just a symptom of too much pressure.

As I drove to the university I heard that darned song by the Bare Naked Ladies again. That’s where it came from! The radio station I usually listened to was having a money give away. And every time it came on I paraphrased it to, “If I had a Million Diopters.” I couldn’t get it out of my mind. You know how it is, you hear a tune and for days all you can think about is that tune. The exam went well, and I was positive I had passed it. Our professor had advised us that we would have our marks within 48 hours. He was putting a team of teacher’s assistants on the marking, because he knew that most of us had plans to start our own practice.
During the next 48 hours I couldn’t get the song out of my mind. A million diopters? How long would it take me to prescribe that? If I saw 2 patients an hour for a 40-hour week, the total would be 80 patients a week. If I worked 50 weeks out of the year during the year I would see 4,000 patients. If each patient had a prescription of around 2 diopters, that would give me 8,000 diopters for the year. I was convinced that I would never be able to prescribe a million diopters in my lifetime at that rate. Even if all my patients had an average prescription of 4 diopters, I could only get to 16,000 diopters a year. I would need to examine 4 patients an hour, and I would need to prescribe 33,333 diopters per year if I worked for 30 years. I could see no way for this to happen. But what the hey, it was just a funny dream anyway.

I passed my exam with a very respectable mark. So, I authorized my banker to wire transfer the funds to my equipment supplier. I paid the rent on my office for the next 2 months, and I went in and painted it myself to save a few bucks. And wouldn't you know it; while I was painting I bet my radio station plugged their money give away at least 3 or 4 times an hour. They were making sure I couldn't stop thinking about a million diopters.

The movers placed my equipment where I had it marked to go, and now the office appeared a lot smaller. I measured the distance that the projector was going to be putting the eye chart on the wall, and I made the necessary adjustments so that I had the proper 20/20 line in focus. Now I was ready to see my patients. I had a receptionist all lined up, but I didn’t have the funds to pay her yet, so I was doing all my own bookings during the first 4 weeks. I had placed my business card in a number of grocery stores, and I had gone to a few optical stores and left my card. Soon I started to get a few appointments booked.

One of my earliest patients was Marcy Mac Donald and her daughter Karen. Marcy was quite nearsighted, with a –10.50D prescription. She was complaining about things being a little blurred in the distance, so I examined her eyes. I could have probably gotten away with increasing Marcy to –11.00D, but at the last minute I flipped another –0.50D in front of her eyes, and she could still read the 20/20 line quite well. She even felt that everything was much clearer with the extra –0.50D. Then it was time to examine 6-year-old Karen. Marcy had noticed that Karen was bringing everything very close to her eyes all the time, and Karen’s teacher had even sent a note home saying that Karen appeared to be a little nearsighted. Marcy, of course, was not surprised at this because of her own high myopia. What was surprising was that when I suggested that Marcy might want to come in to the office while Karen had her eye exam, Karen was strongly opposed.
I checked Karen first with the auto refractor. It didn't show much myopia – maybe –0.50D or so. This was strange, because usually the auto refractor will give a higher reading than the child really needs. I put Karen in the chair, and using the phoropter I discovered that Karen could almost see all of the 20/20 line with no correction. But there was something really strange here. She kept pulling her head back from the phoropter. And when I gave her the red and green test she always said red, even if I didn't change the lens away from plano. Something was wrong, and I bet I knew what it was.

“Karen, your eyes are pretty good. You don’t need glasses yet.” I said.
“Are you sure Doctor? Most of the time I can’t see very good.” Karen replied. “And I get headaches when I am watching TV.”
“Do you want to wear glasses Karen?” I asked.
“Yes I do.” Karen replied.
“If I give you a prescription for glasses you will have to wear them. And it is possible that your eyes will get worse if you wear glasses. Someday you might not be able to see without glasses.” I said.
“Like Mommy?” Karen said with a tone of excitement in her voice.
“Yes, just like your mother.” I replied.
“I’d like that very much.” Karen said.

So, knowing that Karen would eventually end up wearing glasses anyway I wrote a prescription for –1.25D, no cylinder for Karen, and took her out to tell her mom. I suggested that Marcy get Karen her new glasses, and then bring her back in 3 months time for a free check. It would, according to my policy, be free only if she didn’t need another prescription written out, but I had a sneaking suspicion that Karen was one of those that would need another prescription.

Just for the fun of it I had been keeping a running total of all of my patients diopters. I put down 12 points for Marcy, and added another 2.5 for Karen.

Word travels through the school jungle grapevine like wildfire. During the following 3 months I had 4 little girls that came in for eye examinations. I discovered that none of them really required glasses at the time, and when I told them that, all 4 of them said that Karen M. told them that I would give them glasses if they told me that they wanted them. I felt a few qualms when I prescribed glasses to all of them, but they all seemed pleased with the idea that they would be getting glasses. With the prescription I had given each of them they were easily able to read the 20/20 line through –1.50D lenses. That chalked up another 12 points for me.

When it was time for me to see Karen again I asked Marcy how her vision was with her new glasses, and she told me that they were the best glasses she had ever had. She could see everything very clearly. She stayed in the waiting room again while I took Karen into the office.

“How are your glasses Karen?” I asked.
“I think I probably need stronger ones Doctor.” Karen replied.

I didn't waste my time with the auto refractor. I just went for the phoropter, and I discovered that in 3 months Karen had adapted to the prescription in her glasses. She now really needed the –1.25D I had prescribed her for both eyes. I doubled her prescription, and placed –2.50D lenses in front of her eyes. She could read the 20/20 line quite well. I increased the lenses to –3.00D, and then I moved up to –3.50D. At –4.00D I felt I better stop, even though it appeared that she could have handled a little more. I then dropped back to –3.50D.

“How is that Karen?” I asked.
“It’s really clear Doctor. How much is that?” Karen asked.
“This will give you a –3.50D prescription now Karen.” I replied.

I had wanted to talk to Karen about telling other girls that I was the doctor to use if they wanted to be prescribed glasses. But I hadn't. I figured that she had probably told all of her friends, and I wouldn't hear any more about it. But I was wrong.

Over the next few years I got to hear those dreaded words more times than I ever thought possible. It was like there was an epidemic of young children who wanted to wear glasses out there. And each and every one of them would blindside me with the words “Karen M. told me that you would give me glasses.” I didn't want to do this any more. I knew what would happen. I would prescribe the child their first pair of glasses. I would talk to the parents and tell the parents that little Jack, or Sheila, or whatever their name happened to be had a very small amount of myopia, and they could choose if and when they wanted to wear the glasses. But my caution was obviously to no avail, because each and every one of these boys or girls would come back within 6 months needing at least the prescription I had prescribed, and wanting a new, stronger prescription.

What should I have done? Should I have refused to give these children glasses? I was very surprised when the first few boys showed up wanting to wear glasses. I had thought that this was mostly a girl thing, but it had turned out that out of the 300 kids I had overcorrected during my first 15 years as an Optometrist there were about 80 boys, and 220 girls that had left my office over corrected. I knew at the time that I had no excuse to continue doing this. All I can say in my defense is that I was worried that if I turned the kids requests down, somehow it would get back to people that I had been overcorrecting the kids.

Marcy Mac Donald was still a loyal and faithful customer. I had only added a little bit to her prescription the first time I saw her – only about –0.50D. She had been thrilled with her slightly over corrected vision, but since she was already a fairly high myope I decided that all I would do for Marcy was to just give her the most correction that my phoropter showed that she required. If my phoropter showed that her best vision was with an additional –0.37D I would move her up to the next full quarter, so that she got a full –0.50D, rather than the –0.25D I could have given her. But, even so Marcy was now right around –16.50D. She couldn't wear contact lenses, and she always spent as much money as she needed to in order to buy herself the nicest looking thinnest possible lenses, and even with her –16.50D prescription her new glasses were thinner than her original –10.50D regular plastic lenses had been when I first met Marcy 15 years ago.

Karen, now an absolutely gorgeous 20-year-old brunette with a killer body had come in with Marcy for her annual eye exam. I escorted her into the examination room, and took her –22D myodiscs from her face.

“Well, do you feel you need a slight increase Karen?” I asked.
“I always need a slight increase Doctor.” Karen said with a grin on her face.

I checked her prescription with the phoropter. The prescription she was wearing was still perfectly satisfactory for her, and I told her so.

"But Doctor, I want to have things a little clearer.” Karen said, obviously trying to push me into giving her yet another –0.50D increase.
“Karen, you are going into your second year at university. You already have an extremely strong prescription, and I am worried that it will increase a lot more naturally over the following 3 years because of all the studying and other close work you will be doing. Your eyes have to last you for another 50 or 60 years, and if you end up with too strong a prescription now they just might not last.” I replied
“Are you sure you can’t give me just a little bit more?” Karen pushed.
“Karen, my mind is made up. I should have talked to you over 15 years ago, when you started sending all your friends that wanted to wear glasses without needing them. I did you a favor, and you have repaid me ever since then by all these kids threatening to blackmail me if I didn't give them the same overcorrection I gave you. But I don't care now. You can tell on me if you like, but I am not going to give you any more correction that you don’t need. I will not stand by and watch you go blind.” I replied.

Karen could tell I was a little angry. Angry with myself for what I had done, and angry with her for putting me in that position.

“Does that mean that you won’t help anyone else?” Karen asked.
“That is what I said Karen. I don’t want to be blackmailed any more.” I replied.
“No one ever blackmailed you.” Karen said.
“Well, you could have fooled me. It sure felt like I was going to be in deep trouble if I didn't continue helping all your friends become myopic like they wanted. And how did so many kids get your name to use anyway?” I asked.
“I only told a few kids that if they wanted to get glasses all they had to do was mention my name.” Karen replied.
“A few? It was more like over 20 a year. I bet I have overcorrected about 300 kids in 15 years.” I said.
“No, that isn't possible. I only told 5 or 6 others.” Karen said.
“Then each of these 5 or 6 others told someone else, who told someone else. Why do so many kids want to wear glasses? And why are so many kids like you, and want to wear very strong lenses in their glasses. I have only given 300 kids glasses to start their ride up the myopia staircase, but I bet I have seen another 300 kids who already wore glasses, and wanted stronger lenses than they needed. And, by the way, they all mentioned your name as well.” I said.
“I don’t know why the other’s wish to wear strong glasses Doctor. I can only speak for myself and tell you that I love the fact that when I take my strong glasses off everything disappears into a blur. I become totally helpless, and I can’t see to walk anywhere, not even around my own bedroom. I can’t even see to put makeup on my face, because I have to bring my eyes so close to the mirror that there isn't enough room between my eye and the mirror to put my hand in there to put eye liner on. And then when I slide my glasses up onto my nose, and push them tight to the bridge of my nose everything bursts into focus, and I can see clearly again. I love this feeling. It is almost an erotic feeling.” Karen told me.
“Well, tell your friends that this doctor is finished. I am through giving out prescriptions for glasses that kids don’t need.” I replied.

Karen left my office without a prescription for stronger lenses. Marcy was surprised. She had expected to have to buy Karen new glasses again as well as a new pair for herself.

My resolve was strong. I wasn't going to be forced into any more unnecessary prescriptions. I felt good about my decision. It was the end of my 15th year as an Optometrist, and I had been keeping a running total of all the diopters I had prescribed. The judge and the prosecutor in my dream had been a little vague about how I was to count the diopters, so I made up my own rules. The first time a patient came to me I took credit for all their diopters. I got double points for over prescribing, but I had kept this to a minimum, and other than the first time with Marcy, along with the kids that mentioned Karen’s name my points were all honestly earned. I gave myself points then for every diopter that a patient’s prescription increased over and above their initial prescription, which I had only counted the first time. I figured there was no way I would have hit 500,000 diopters in the first 15 years. But, when I added the totals, I was pleasantly surprised. The numbers were 533, 478 diopters. How had I managed to get it that high?

The following week after I had told Karen I was finished with over correcting, my first patient was a darling little blond girl. Her mother had noticed that she squinted a lot, and couldn't read things off in the distance. I took her in and placed her in front of the phoropter. It was going to be a stretch to give this young lady a prescription of –0.50D for both eyes. She really should have waited another year. 
When I told her that she looked at me with her blue eyes wide open, and said those magic words: “Karen M. said you would give me glasses”.
“No”, my mind screamed. I said I wasn’t going to do this anymore. But my fingers clicked the lenses higher and higher, until she could just barely read the 20/20 line. I looked, and the lenses were –3.50D. She had a lot of accommodation. I backed it off to –3.00D.

“Do you really want to wear glasses?” I asked.
“Yes, I do,” she said in a soft voice.

So, I wrote out a prescription, and mother and daughter headed off to the mall to get her new glasses. Myself, I just stayed in my office, kicking myself in the butt for being so weak. And then the floodgates opened. Over the next 10 years, with the advent of the internet, more and more young kids came to me to prescribe them glasses. Now there wasn't a day that went by without me finding a young child who really didn't require glasses that asked me for a pair of glasses like Karen M. got. These kids were e-mailing each other, and they were getting their parents to bring them to me from all over the city, because the word was out there that I would give them a pair of glasses when they really didn't require them that badly at the time. And what was amazing as well was the number of kids who already wore glasses, but wanted to increase their prescriptions even higher. Of the initial group of kids that had been in grade school with Karen, all of them wore prescriptions in excess of –20D. And none of them ever asked me if they could wear contact lenses. The kids who wanted stronger prescriptions had absolutely no interest in contact lenses, not even for their weddings.

When I had been an optometrist for over 25 years. I found myself sitting down at least once a month to total up all my figures. It was then I discovered that I was going to reach my million diopters in only 3 more years if the pace kept up. But I kept asking myself why I had done this. It was only a dream. I really didn't have any reason to have taken these kids, and allowed them to become so nearsighted. And every time one of my over corrected kids came in for an eye exam I always asked them if they were happy wearing glasses. The answer was always that they were. And if they expressed a desire for more over correction I always asked them if they were sure they wanted stronger glasses. The answer was usually yes. Once in a while one of them would decide that they had gone as far as they wanted to go. But, quite often, even if they had decided they didn't want a stronger prescription, nature made the decision for them, and they ended up with a few diopters more anyway.

You are going to say that I am crazy. I had not totaled my figures for over 2 months. I knew I was getting close to the million diopters. And then one day, after seeing yet another patient who wanted to wear glasses that she did not need, I felt a weight being lifted from my shoulders. It was then that I knew, without adding a thing that I had reached my million diopters. From that day on my life really was wonderful. I became a much happier man. And when my 30 years of practice was up, I decided that I would not fully retire, but I would specialize in children’s vision, and would limit my practice to kids under 18, 2 days per week, by appointment only. I am still getting a few kids that mention Karen M’s name, and I make sure I take special care of them.
And, just last week Karen brought her 4-year-old daughter in for her first pair of glasses. Yes, she really needed the first –1.75D, but at Karen’s insistence I added –0.75D to give her –2.50D.

August 2007
Please realize that this story is FICTION, and no doctor would ever do anything like I wrote about in this story.

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