Playing Detective

by Specs4ever

As the younger of two optometrists in a moderate sized town that is located within a 3 hour drive from 3 large metropolitan centers, I generally manage to do most of the vision testing for children that are found to have problems in school. But, this time, John, the father of the 8-year-old girl that had been brought in to see me was one of my childhood school friends.

I greeted John, and his wife Sandy in the reception area, and I invited either John or Sandy to accompany me while I took Mary in to examine her eyes. I explained that I wasn’t able to take them both, as my little examination room really wasn’t big enough to hold 4 people. John decided he would come in with Mary and I.

I checked Mary’s eyes with an auto refractor, and found that according to it, Mary was quite nearsighted for her age. Using the auto refractor numbers as a starting point, I used my phoropter, and my ophthalmoscope to further refine Mary’s prescription. The prescription that Mary chose as the best was very close to the numbers that the auto refractor had given me. She was –3.00D in her right eye, and –2.75D in her left eye. I reduced the strength of the lenses by –0.50D, and discovered that her vision was still quite acceptable, with her being able to see the 20/30 line fairly well. So, I wrote Mary a prescription for OD –2.50D, and OS –2.25D. Mary was one of the few first timers that I had seen that didn’t have any astigmatism.

I explained very carefully to John and Sandy that I had not given Mary as strong a first prescription as the examination had shown she needed. And I made a careful notation to this accord in the file I had started for her. John and Sandy seemed to understand, and accept my reasoning, and I am sure that they were prepared to bring Mary back in to me in 6 months time, as I had requested.

In the interval between the time I first tested Mary’s eyes, and the scheduled second appointment, John’s company had transferred him to their main office in one of the large metropolitan centers nearby. Sandy called to cancel Mary’s appointment, and I saw her briefly when she stopped by the office to pick up a copy of Mary’s chart before they moved.

Business went on as usual, and I gave little thought to John, Sandy and Mary. About 7 years after John had moved away, I received a call from him at my office.

“Larry, John Scott here. How are you doing these days?”

“Fine, just fine John. How are you and Sandy keeping? And how is your daughter Mary doing?” Come on buddy, get to the point, I haven’t got all day to waste I thought to myself.

“Well, that is why I wanted to talk to you. Mary is having real problems with her eyesight, and I sort of wanted a second opinion from someone I could trust. Are you ever open on a weekend?” John asked.

“I could come in for you John, but normally I am closed. I don’t have anything planned this next Saturday, if that would work.” I told John.

So, we agreed to meet at my office at 10 am on Saturday. When John and Sandy got out of their car, I easily recognized them. But, I definitely wouldn’t have recognized their daughter Mary. She was all grown up now, at least in appearance. She had long blond hair that she was wearing tied back in a ponytail. Her blouse was nicely filled out, and the very short skirt she was wearing revealed a pair of long nicely shaped legs. And, of course there were her glasses. It was extremely obvious that Mary was now a high myope. From the thickness of the lenses even in the small oval frame she was wearing, combined with the cut in of her face in the lenses, I would have ventured a guess that Mary was in the neighborhood of a –13D myope. We all went into my office, and I started the coffee.

Sandy had brought copies of Mary’s records from the doctor that they were using in the city. Samuel Silverstone, OD was the doctor’s name on the files. Funny, but I had gone to school with Sam. I glanced at the files, and saw that Mary had needed an increase of between -1.5D, and –2D in her glasses prescription every year for the past 7 years. The most recent notations were from only 3 days ago, and indicated that Mary required –16.50D for her right eye, and –16.25D for her left eye. I had not thought that her lenses appeared that strong. And then I realized that these lenses would have been from Mary’s previous prescription, as she seemed to be scrunching up her eyes and peering at everything that was more than a few feet away from her. Even so, her old prescription was –15.50D and –15.25D, so my educated guess was off by –2.50D.

I gave Mary’s records a careful look, and I could see the pattern of stronger and stronger lenses. I could also see that Sam had tried bifocals, with no great success according to his notations. I also noticed that he had been under correcting Mary by at least –0.50D at each examination. As I looked at the numbers, I felt that there was something familiar about the progression. Then it hit me. I had noticed a posting from Sam on the Sci Med Vision newsgroup a couple of months back, and myself and a number of other OD’s had posted with advice. I excused myself, and booted up the office computer. While it warmed up, I poured us all a cup of coffee. Soon I was into the newsgroup, and I found the discussion. I hit print, and soon the printer was spewing out pages of the discussion.

I explained to John, Sandy and Mary what I had discovered, and I explained that I was printing this out for them to take with them and read. Once the printer had finished it’s task, I brought the sheets over, and I went through the online discussion point by point with the 3 of them.

Of course Sam had just indicated that he had a 15-year-old girl as a patient, with no family history of myopia. This young lady had come to him as a patient at the age of 9, wearing a prescription of –2.50D, and –2.25D. Her chart indicated that the prescribing doctor had lowered the prescription by –0.50D less than she should have been given for optimum correction. The next few years were, for the young lady, a nightmare of needing stronger and stronger lenses. Sam had asked the group if any other doctors had any suggestions to help save what remaining eyesight this young girl had. The general consensus of opinion by the posting doctors, myself included, was that he bring the young lady up to her full prescription, because recent studies have shown that a high myope who is given less than the required correction is straining their eyes to see, and this can in fact increase the myopia. Another point was that the young lady should definitely be given bifocals. And, a strong case was made for the young lady to be fitted with RGP contact lenses, with a low powered pair of drugstore readers to be worn when she was doing near point work. Every professional that had posted was in agreement with this course of treatment. And then of course there were the usual crazies who suggested that we had ruined this young ladies eyesight by giving her minus lenses for her glasses in the first case. “Vision training, and plus lenses would have most certainly prevented this child’s myopia, and it was criminal that so many eye doctors were ruining peoples vision.”

I almost hated to include these rantings with the printouts that I gave to John and Sandy. I knew that they really couldn’t be sure that maybe I might have made a mistake in giving Mary her first pair of glasses. I advised them that there was a faction of untrained people that had some weird theories, but the facts did not support them. They seemed to believe me, at least I hope they did, as John and I went back a long way.

I took Mary into the examination room, and gave her a very thorough vision exam. Sam had given her the full prescription this last time, and although she did not have her new glasses yet, I hoped that the bifocals that Sam had prescribed would help.

“I have a feeling that you are quite worried about your eyesight Mary.” I stated.

“I just don’t want to go blind Doctor. I don’t know if I could stand that.” Mary told me.

“Well, I can’t make any promises, but your vision is correctable to 20/20 with the proper lenses. And there is really nothing that I can see that would indicate any problems. Your eyes are healthy, and your retina’s are great. Just try your best to use the bifocals the Sam has prescribed. Are you going to get contacts?” I asked.

“Mom and Dad want me to try them, so I probably will.” Mary told me.

I finished the exam, and Mary and I went back to the waiting room. I told John and Sandy that Mary’s eyes were actually in very good health, except for her severe myopia.

As they were preparing to leave, John asked me what he owed me, and I had to threaten to boot him out the door for mentioning money. John had given willingly of his time when I built my own house a few years ago. I was supposed to help him build his own house, but we both knew that that wasn’t likely to happen now, so I was pleased that I could do something to help him out.

Mary’s steadily worsening vision occupied a lot of my thoughts over the next few weeks.

I wasn’t sure if there might actually have been something that I could have tried when she first needed glasses. But, in reality I knew that I was just beating myself up without just cause. When I first became an optometrist, I am sure that I prescribed minus glasses for a number of children that might have been helped by vision training, rather than glasses. But in the past few years, we have been less inclined to prescribe glasses for a small amount of beginning myopia. Only after all other avenues are explored will I give a child glasses now.

I was tossing and turning in bed one night when I awoke suddenly. Dawson Longwood came to my mind. Dawson had gone through school with John and myself, and Dawson had experienced the same vision problems that seemed to plague Mary. And, although Dawson’s children, Janey and the twins all went to Doc. Seabright for their vision care, I was sure that the three children had the same problems that their dad had while they were growing up.

The next morning I gave Doc. Seabright a call. I explained that I was looking into some cases of high myopia, and I asked him if I could see the records on Dawson, and his 3 children. Doc. told me he would have his girls copy the records, and I could buy him lunch. So I agreed. We had a pleasant meal, with most of our discussion centered around the Longwood family myopia. I hadn’t remembered until he brought it up, but Dawson’s mother had very high myopia as well.

Back at my office I went over the records for the Longwood girls. Janey was 3 years older than my daughter, and had been a tutor for Kim in high school. Barbara and Carol were a year younger than Kim, and had been close friends with my son Jeff, who was in the same grade, but was a bit younger. So this made Janey 7 years older than Mary. I looked closely at Janey’s record, and I compared her progression with Mary’s chart. Similar, very similar. Also, Barb, and Carol had numbers and a progression that was very close. Janey’s progression had slowed down when she reached 18, and at aged 22, she was just a bit over –20D in both eyes. Barb and Carol were both 18, and they were both around –18.50D. I felt a bit better about Mary’s chances of having her myopic progression slow down a bit over the next few years.

The next few days I procrastinated over calling John and Sandy, to tell them what I had discovered about the Longwood girls. After all, this was just a similar case, and there was no telling what could happen with Mary in the long run. That evening I was dozing in my recliner. Something was bugging me. I recalled something John had said; about being lucky that there was at least one strong swimmer, or they never would have been able to have Mary. Was it possible that John had a very low sperm count? Even more so, was it at all possible that John wasn’t even Mary’s real father? And, as far-fetched as it might seem, could it be possible that Sandy had an affair with Dawson Longwood? I resolved to discuss this with Sandy.

I had no appointments on the first Wednesday of every month. So that morning I told my wife that I had to go to the city to look at a new phoropter. I asked her if she wanted to come, but I wasn’t surprised when she declined. I gave Sandy a call from my cell phone, and mentioned that I would like to see her to discuss Mary’s vision. She asked if I wanted John to be there, and was surprised when I told her that this was something that the two of us should discuss first. So, we agreed to meet for lunch.

I didn’t want to ruin my lunch, so I waited until we were having coffee.

“John is impotent isn’t he Sandy.” Rather blunt, but I had to get the ball rolling.

“Why, why would you even suggest that?” Sandy tried to bluster.

“He told me that he had a very low sperm count, and it was a miracle that you became pregnant with Mary.” I told her. “ I don’t think it was a miracle. I think someone else fathered Mary, and I think that I know who this someone else is. I just would like to have you confirm this.”

“What are you going to tell John?” Sandy asked with a worried expression in her voice.

“If you tell me what I think you are going to, then I will tell both of you that it is quite likely that Mary will stop having further massive deterioration in her vision by the time she is 18, and that by the time she is 21, her eyesight will remain stable for most of the rest of her life.” I told her.

“I can’t, I can’t tell you.” Sandy cried.

“I will write the name on a piece of paper. I need to know for Mary’s sake.” I said.

I wrote the name on a piece of paper: Dawson Longwood. I slid the paper over to Sandy, and she turned it over. My suspicions were confirmed by the look on her face.

“How, how could you know?” She asked.

“Just a guess, based on the genetics of high myopia, and the similarities between Mary’s myopic deterioration, and that of the three Longwood girls. I also know that Dawson’s vision stabilized after he turned 21, so I am presuming that the same will be true for the girls” I told her.

“What are you going to tell John?” Sandy asked.

Not a darned thing more than what I just told you about the probabilities of Mary’s vision settling down at 18, and stabilizing by the time she turns 21. John loves Mary, and Mary loves her dad, so I see no reason to destroy this relationship. And, I won’t ask you why you were unfaithful to John, as I know that you love him very much, and I don’t think this was a regular habit of yours.” I said.

“I have to explain Larry. As you know I am from Lancaster, and I spent some time here in the summers with my Aunt and Uncle. Dawson and I went together for a while the summer I turned 16, and I ended up going home to my parents carrying Dawson’s child. I ended up having the baby, but my parent’s and I placed her for adoption before she was born. So, when I discovered that John couldn’t give me a child, I persuaded Dawson to sleep with me again. I will be very grateful if you do not tell John all this.” Sandy told me.

And true to my word to Sandy, I told John what I had discovered about the probabilities of Mary’s myopia slowing its progression, and stabilizing by the time she turned 21. John was grateful that I had shown such concern.

I don’t think Sandy was too happy a few months later when John was returned to our city as general manager of the branch of the company he worked for. She realized that with John back here, he and I would become close friends again, and she worried about me letting something slip. However, the day that I helped them move into their new house, I made a point to reassure Sandy that her secret was safe with me, so she lightened up a little.

That evening Lisa, my wife, and I had John, Sandy and Mary over for supper. Kim wasn’t home, but Jeff arrived home in time for supper. I think when Mary spotted Jeff; she wished that she had taken the time to change her glasses for her contacts. But, even with her strong prescription, Mary’s glasses looked very nice on her. I am pretty sure that John had spent a lot of money on them, as they were a lot thinner than the prescription normally would have been, even taking the small oval frame into account.

Jeff didn’t let a pair of glasses slow him down. Mary is very attractive, maybe even beautiful, and Jeff was making more moves than a star basketball player. Mary had just turned 16, and Jeff was just over 18, and I could tell he was smitten. After supper was finished Jeff asked to borrow the car, to take Mary to the movies. John and Sandy approved, so I gave Jeff the keys, and off they went.

That evening I was thinking about it, and I started to wonder if maybe for Mary it had been a good thing that she had worn her glasses instead of contact lenses that evening. Jeff, although he had been almost a year younger than the Longwood twins, had spent a lot of time with them, and he had even dated Carol – no, wait, maybe it was Barb. Or maybe he had dated both of them, separately of course, for a while. And I seemed to recall a couple of his other girlfriends had worn glasses. Could my own son be an optic obsessive?

Jeff and Mary were still going together when Mary turned 21. Since Mary turned 16, her prescription increases had indeed slowed down, but she was still right around –20D by the time her 21st birthday arrived. And, on Mary’s birthday, she received an engagement ring from Jeff. So sometime over the next year there is going to be a wedding to attend. Fortunately as father of the groom, I will not be required to do anything more than give a speech, and propose a few toasts. And, with Mary as my daughter in law, I can guarantee that the truth about her conception will never be revealed. It will be unfortunate that my granddaughter will inherit the Longwood family’s high myopia, but that is a fact that can’t be helped. And even with her high myopia causing her to wear strong, thick glasses, Mary is a great girl. I am glad that Jeff turned out to be a lover of girls wearing high minus glasses.

Specs4ever,

written in August 2004

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