The Ophthalmologist’s Myopic Daughter

by Specs4ever

I was relieved, and very pleased to have finally graduated. At the young age of 24, I was a doctor of optometry, commonly called an ophthalmologist. I had a job lined up and if things went well, I expected to be asked to buy out the older ophthalmologist within a couple of years. Vision, and eye care had been a passion of mine since I had started high school. Actually, I think it was an attraction for very myopic ladies that fueled my passion for eye care.

The first few months got me settled into a routine, and I was finally drawing in a few patients of my own. But, I was still the doctor with the lightest workload, so I got all of the new patients, and any of the emergency calls. One afternoon our receptionist escorted a gorgeous looking auburn haired girl into my examination room. This young lady had a fabulous figure, and she had everything in all the right places – everything that is except the contact lens in her right eye. Bonnie had gotten one of her contact lenses stuck way up in her right eyeball, and her eye was red from her attempts to bring it back down over her cornea. It only took me a minute to remove the lens, and I cautioned her to not put her lenses back in until the irritation was gone.

I hadn’t looked at her chart, but when she told me that it was impossible for her to go without contacts, I glanced at her file. Her prescription for contacts was –14D for both eyes, and I knew that she was in trouble. And, of course, like most girls in their early 20’s, Bonnie didn’t even have a pair of glasses with her. And, as I found out when I offered to drive her home to her apartment, she didn’t even own a pair of glasses in her current script.

During that drive, I found out that she was single, and currently employed as a receptionist at a nearby insurance agency. So, I asked her out on a date the following evening. I told her that she would probably be able to again put in her contacts in the morning, and I advised her that the purchase of a new pair of glasses would be a very worthwhile expenditure.

I helped Bonnie with her selection of frames when she came into the office to order glasses, and when I saw her wearing her new glasses, the light dancing off the plano fronts of the strong lenses made her look even more appealing to me. It didn’t take too long, before we were married.

Christine was born within a year, and two years later Tara was born. When Tara was 3, I discovered that Tara had a wandering eye, so I prescribed glasses with some prism in one lens, and a plus prescription for a bit of farsightedness. I did hope that Tara would grow out of this, but wearing glasses is not the worst thing in the world. Christy wanted her own glasses to wear as soon as Tara got her glasses, but she didn’t show any symptoms of needing glasses. So Christy didn’t get glasses, and was upset with me for a while.

When Christy started kindergarten she again told me that she wanted glasses. I suppose, as a doctor, I should have taken her to the office for an eye examination, but Christy still hadn’t shown any of the usual symptoms. She didn’t sit too close to the TV, nor did she seem to squint to see anything. Her reading material was usually held at the proper distance from her face, and she seemed to be able to read quite well.

When Christy turned 6 she tried once again to convince me that she needed glasses. I asked her if she had any problems seeing the chalkboard at school, and she told me that she couldn’t see what the teacher had written on it. So, the following Saturday morning Christy came to the office with me.

I turned on the auto refractor, and when it had warmed up long enough I had Christy sit in front of it. The auto refractor did its job, and when it was finished it spit out the printout. When I read what the auto refractor had printed out as a prescription for Christy I almost spit out my mouthful of coffee. Now I felt guilty. Here I was, a respected eye doctor, and according to the reading from the auto refractor my own daughter was running around with –14D of uncorrected myopia. I felt a little like the mechanic who drives around with his own car held together with baling wire. I took Christy into the examination room, and sat her in front of the phoropter. I started with the prescription that the auto refractor had given me, and sure enough Christy could read the 20/20 line very well with a –14D prescription. I felt simply awful.

I placed some lenses into a child’s size trial frame, and placed it on Christy’s face. She seemed to function very well. As I was preparing to place a rush order of lenses for my daughter I got thinking. Why, with such a strong prescription had Christy not shown some of the classical symptoms of high myopia? So, I took off the trial frames, and put Christy back in front of the phoropter. I lowered her prescription by a diopter. She could still see 20/20. The same thing happened at –12D, then at –10D. I was back down to –1.50D before she could not read the 20/20 line. So, I brought the prescription back up to –2.00D, and she could see the 20/20 line perfectly well.

We selected a frame that Christy liked, and I ordered her a pair of glasses. I was relieved. Now I no longer felt as guilty, and I was very happy that Christy had not required such a massive first prescription. But, I was really mystified. I had learned in my studies that children could accommodate around 10D. It was generally considered that a child Christy’s age could put on a pair of glasses with a prescription of between +5D and – 5D, and still be able to see 20/20. Here was a child who could accommodate 12 diopters of correction on the minus side. This went against what I had been taught.

Christy was happy to wear glasses finally, and she never took them off except to shower, and to sleep. Neither Bonnie nor I were really pleased about this, as we felt that Christy would be better off removing her glasses once in a while, especially when reading. A year later, another exam showed that her prescription had remained stable, so we didn’t say anything more about her wearing them all the time.

On Saturday’s Christy and sometimes Tara would accompany me to the office. While I did paperwork Christy would play with the kids toys in the waiting room. I thought nothing about this, and was pleased to have my daughters tag along.

When Christy was in grade 3 there was a parent teacher evening. Christy was supposed to accompany us, but she developed an upset stomach at the last minute, so Bonnie and I left Christy and Tara with a sitter while we went. Mrs. Morris, Christy’s teacher had very good things to say about Christy and her work, and as we were shown around the classroom we came across a picture of a group of kids that had one picture blackened out. Mrs. Morris looked at the picture, and was very upset. It was Christy’s picture that had been damaged. She immediately found another copy, and when she handed it to me to look at I looked at the picture of my daughter, and I wondered what glasses she was wearing. They certainly were not the same glasses that I had prescribed for her to wear.

When Bonnie and I arrived home I took the baby sitter home, and when I returned Bonnie picked up Christy’s school bag and dumped it out. I saw the panicked look on Christy’s face when a pair of glasses in a case came out on the floor. They were the glasses Christy had been wearing in the picture. When I got a closer look at the glasses, I recognized them as an old pair of Sheila Martins. Sheila had been one of my early patients, and at the age of 10 had a prescription of around –8.00D. I knew without even asking that Christy had taken these glasses from the Lions Club donation box in my office and had been wearing them to school. I asked why she had done this, and all Christy could tell me was that these glasses made her eyes feel good.

I thought about this for a couple of days. I then took Christy to my office and did a complete refraction – a cycloplegic one, in which I placed atropine drops in her eyes to paralyze her eye muscles. Once Christy had lost her accommodation, I was a little surprised to see that Christy actually required a –10D prescription. I had checked Christy prior to using the eye drops, and I found that she could read the 20/20 line with as high a prescription as –16D, and as low a prescription as –4D. She still had over 12 diopters of minus accommodation. So, I was uncertain as to what I should do. I knew from my training that once a prescription was placed in front of a child’s eyes, they would adapt to that prescription. But, I knew that for Christy to use her excellent accommodation to see clearly with a lower prescription I would be creating a lot of pressure on her eyes, and she would quite likely have headaches. Finally I decided I really had no choice other than to provide Christy with a new pair of glasses with a prescription of –10D.

Christy looked darling wearing her new glasses. I called Bonnie before Christy and I selected a new frame, and Bonnie and Tara came to the office, where as a family we selected Christy’s new frames. To stave off competition for the one-hour optical chains, I had recently been forced to purchase the equipment, and set up a small lens lab. And, as is so often the case, it seemed that whenever I had a technician trained, they would get a better offer from some other optical place, and I was forced to train another lab technician. So, I was familiar enough with the equipment that I was able to complete a pair of –10D lenses for Christy in about an hour. Since she had a child size frame, with small lens sizes, I didn’t use the more expensive hi index lens blanks, but instead used regular old CR39 plastic. Christy looked very nice wearing her new glasses. They did look quite strong, but that was because they actually were strong.

Tara no longer required prism in her one lens, as the eye muscles had seemingly strengthened enough. But, she still needed a little bit of plus – only +1.50D, but in order for her to see clearly she wore her glasses. And, I was pleased about this. Bonnie was very nearsighted, although her prescription had been stable, and had not changed since before we were married. Now Christy also was quite nearsighted, so I was glad that Tara had seemingly escaped the high myopia that her mom, and her sister had.

I watched Christy like a hawk. Every 6 months I made sure that I gave her a complete refraction, using the atropine drops each time. She went a full 2 years without an increase, although I probably could have given her a bit more minus at the end of the first year. By the end of the second year, when Christy was 10 years old, I could no longer avoid it, and had to give her a 2-diopter increase. Now she had a –12D prescription. I didn’t like seeing her with such a strong prescription at this age, as I knew that she would be prone to further increases. And I also knew that Christy liked to wear glasses. I had other girls her age as patients that had been prescribed their first low minus prescription that wanted contact lenses, but Christy seemed more than content to wear glasses.

The next 3 years slid by in a flash. I continued with my twice-yearly examinations of Christy, and there was no change. Just as I was being lulled into complacency, Christy turned 13. Shortly after her birthday Christy complained that she was having trouble seeing things on the board at school so even though it had only been a couple of months since her last exam, I took Christy in for another exam. I had been discussing my myopic daughter’s case with a number of my colleagues, and I was keeping a careful record of her accommodative myopia as well as her cycloplegic myopia. When I had given Christy her prescription for –12D glasses, her accommodative myopia was –22D. I had used the auto refractor first, and I had verified this finding manually with the phoropter. So, I used the auto refractor again. I wasn’t really surprised when the auto refractor showed that Christy’s accommodative myopia had dropped to –20D. Not one of my associates had ever seen a patient with more than –6D of accommodative myopia, so it was not surprising to me that Christy’s accommodative myopia had lessened. When I used the drops, and did a manual examination, this time I found that Christy’s real myopia had increased sharply. She had gone from a –12D prescription up to a –16D prescription in only a couple of months. And I had followed all the proper steps, doing everything the same way, so there was no chance I had made a mistake. I thought about this for a few minutes. Now Christy’s accommodation range was likely from –12D up to –20D, a more normal 8 diopter range, and approximately correct for her age.

I thought about this for a full day before I made the lenses for Christy’s new glasses. As a lover of strong minus glasses I was very tempted to increase her prescription to –18D, a full –2D over what it appeared that Christy really required, but I hesitated to do this. My equipment was not designed to grind anything higher than a –15D lens in regular plastic. So, I took a lens blank with a –2D rear curve and a flat front. I flipped it around and I ground a –14D into the flat side of the lens, creating a biconcave lens. When I checked my 2 new lenses in the lensometer I discovered that I had calculated something wrong. My new lenses had ended up at –16.75D instead of the –16.00 that I had originally been attempting to make. Now I was faced with a dilemma. I knew that Christy would easily tolerate the higher power. As much as I feel that people with strong prescriptions are very special people I really didn’t want to have her prescription increased by even –0.75D. Finally I gave in, and fitted the lenses to her frames.

That evening when I took the new glasses home, and placed them on Christy’s nose, she was ecstatic about how well she could see with them. Bonnie was not pleased to find out that Christy’s new prescription was only –0.50D less than her own –17.25D prescription. Bonnie had now been wearing the same prescription since she turned 21, and in the 15 years we had been married had never shown the slightest need for an increase. I think really that Bonnie was upset that she had passed the genes for her poor eyesight on to Christy. I consoled her as much as I could, and I told her that as long as Christy could see reasonably well, it really didn’t matter how strong her glasses had to be. After all, she could wear contact lenses if she wanted to, and every day there were new advances in the eye care field. Bonnie was quite right about one thing though. Bonnie had reached her high prescription by the age of 21, and most of the changes in her eyesight had happened from the age of 13, through the age of 21. Christy was barely 13. How much stronger a prescription could the poor kid have before the problems of super high myopia restricted her life.

I increased Christy’s eye examinations to a quarterly visit. Every 3 months I thoroughly examined my myopic daughters eyes. I was more worried about her retinas possibly detaching than I was about an increase in her already severe myopia. By the time Christy was 15, I was pleased to see that her retinas were still firmly attached, with no signs of any lattice degeneration. I wasn’t as pleased to have had her myopia creep up to the –20D level. So, having reached –20D, I gave up any thoughts of making her lenses myself, and I ordered Christy a pair of hi index plastic lenses. Her face had filled out a little, and even if I had used the same small eye sized frame that she had been wearing, her regular plastic biconcave lenses would have been terribly thick. And, with a –20D biconcave lens, for me to make it the front curve would have had to have been around –6D, which creates a lot of distortion for the wearer.

Christy was a lot happier with her new glasses. Both Bonnie and I had tried to talk Christy into wearing contact lenses, but Christy simply told us that she liked wearing glasses. She explained that she enjoyed sliding the glasses down her nose, and having the world disappear into a complete blur. We figured this was a bit strange, but since contact lenses have problems of their own we decided that until she requested them, we would be content to let her have her own way.

And over the next few years Christy was content to get stronger and stronger glasses. By the time she was 19, Christy was wearing a prescription of –28D. Her newest lenses were a very high index glass, and were so thin at the optical center that I was afraid if I pushed on her lens too hard with my finger, the lens would shatter. These lenses had come from a supplier in Asia, and definitely would not have passed the regulations here. But, I knew that anyone with such poor uncorrected vision as Christy had would be extremely careful with their glasses. I did make Christy aware of the fact that the lenses in her glasses were extremely breakable when she first got them, and she has had no problem wearing them.

Bonnie had a slight increase recently, and when she saw how thin and attractive Christy’s –28D lenses were, she wanted a pair for herself in her now –18D prescription. So, I ordered Bonnie a pair of the same hi index lenses, and they are so thin they look like a –6D prescription from the side. Both Bonnie and Christy wear their glasses exclusively now. Christy never has wanted to try contact lenses. For some unknown reason Christy seemed to have her increases in her severe progressive myopia stop when she reached the age of 19, and even with all the studying she did in university, her prescription has stabilized at the –28D level that she was at age 19. And her younger sister Tara is still mildly farsighted. But Tara now only wears glasses for reading.

I have had numerous discussions with other ophthalmologists at conferences I attended, and no one has ever been able to tell me of another patient who had experienced the same amount of accommodation as Christy did. It was fortunate that Christy was the daughter of an ophthalmologist. If she had been brought to me as a patient at age 6, I would have tested her eyes, discovered that she required a –14D prescription, and she would have started off wearing this very strong prescription. She easily could have been a –40D myope by age 21, instead of only requiring a prescription of –28D. And, a prescription of –28D is a very strong prescription, but Christy has had no problems with her corrected vision, and she has also never had any trouble finding a boyfriend, so everything seems fine.

Specs4ever

Nov 2005