I am probably one of the most boring people in the world. I work with numbers and probabilities. When I was in university I found this a fascinating field, and the more I got into it the more I enjoyed it. After I graduated from university I found employment in the insurance industry, compiling statistics that allowed them to set your life insurance rates, and your car insurance premiums. But, while I could go on for hours about how the numbers tell you the story, I am afraid you would soon be drifting off to sleep.
In mid 1995 my employer downsized, as a result of a merger with another insurance company. So, I was unfortunately one of those left unemployed. The statistics were not good. I was 49 years old, and the probabilities of me finding another job at a similar rate of remuneration were not in my favor. However, my good friend Chip Jamieson, who I had attended university with, came to my rescue with an assignment that was right up my alley. This had been the start of my own company, and now I was quite successful. I had a number of actuarial people working under me.
I hadn’t heard from Chip for a few years, and I was surprised to receive a phone call from him in late 2004. What was even more surprising was having Chip tell me that the project I had completed for him in late ‘95 and early ’96 was way out of whack with the actual numbers. I was shocked. I offered my clients a guarantee that my projections would be within + or – 5%, and in actual fact I usually fell within a 3% margin of error. I immediately offered to pay Chip back every cent I had charged, even though doing so would have really bit into my bottom line. I was relieved when Skip refused my offer, however I insisted I wanted to look into the situation to see where I had gone wrong.
Chip was the president of LESIA. The acronym stood for Laser Eye Surgery Institute of America. The survey I had completed in 1996 had been a survey that projected the numbers of people who would be having laser eye surgery each year for the following 10 years. And, to me, this had been a fairly easy survey to do. To help you understand the concept, take a group of 1,000 people. In 1996, the numbers had been that 60% of the population of the USA wore glasses for some reason or another. This included all the people who only wore reading glasses, and takes every one of all ages into account. Of this 60%, which is 600 people, 40% of these were nearsighted. Out of a total of 240 nearsighted people, 10% were high myopes, which for the purpose of our survey included those people in the range of –6D to –12D. So, 24 people were high myopes. Of these 24 people, 10% were severe myopes, which meant that out of every 1,000 people in the population, 2.4 people were outside the range of laser surgery. From the percentage of nearsighted people it was determined that 27% would elect to have surgery to return their vision without glasses to 20/20
My projections had indicated a very similar set of numbers for the 10-year period. There was a slight increase in the percentage of nearsighted people, with corresponding increases in the high and severe myope figures. By all intents and purposes the future for laser eye surgery was quite rosy. And, I had projected that the cost of $3,500.00 for doing both eyes, with another $500.00 fee for the referring doctor would remain stable, and possibly see a slight increase.
But instead of an increase in the numbers of people having surgery over the past 3 years, there had been a significant decline. The numbers were down over 25%, and this was quite worrying to Chip’s colleagues. Cut rate doctors were now offering Lasik for as low as $900.00 for both eyes just to keep up the payments on their eximer laser machines.
One explanation for the reduced numbers was that while in its infancy in 1996, Lasik had been counting on having people with prescriptions between the range of –2D and –12D as clients. This was the case at the start, but there were a number of problems with the higher prescriptions, and ICL’s had appeared on the scene. ICL stands for implantable contact lenses, and is actually the better method for treating the higher degrees of myopia. So, prescriptions between –8D and –12D were now treated by implanting contact lenses.
I left my employee’s working on projects that would continue to bring income into the firm, and I began a serious investigation into the world of eye surgery. One of the first things that I learned was that in Asian countries over 80% of people between the ages of 5 and 25 were nearsighted. Some of these younger people were very nearsighted, with 1000 degrees of myopia now being a normal number. This corresponds to an American prescription of –10D. When I began to delve deeper into the figures for the USA, I discovered that the percentage of myopia in younger children was fast approaching 75% of the population in the age group between 4 and 25. In checking with a number of one hour optical labs I discovered that while a –10D prescription had been the strongest prescription they could make in an hour 6 or 7 years ago, now a prescription of –14 could be done in an hour. I also found that many 16 year olds had prescriptions of, or exceeding –10D. This was absolutely crazy. If there were so many more nearsighted kids why had the laser surgery business tanked? And, why were there so many more highly myopic schoolchildren?
I was stymied. The end results were nothing like my projections, and this is something that just didn’t jibe. My field is based on entirely predictable numbers.
I couldn’t just walk into the schools and check out how many kids were wearing glasses. But what I could and did do was hang around some of the malls. I was again surprised. Kids were wearing glasses. I saw a large number of kids ranging in age from 5 to 18 years of age, and the bulk of them were wearing glasses. When my daughter was a girl of 13 she started to bug her mom and me for contact lenses, which we finally bought her for her 15th birthday. But now, unless the few bare eyed girls and boys I saw were wearing contact lenses, the biggest percentage of kids wore glasses. And more than a few of the young folks around the age of 15 wore pretty substantial corrections. These kids would have died before they went out of the house wearing glasses if they had been in my daughter’s age group back then. What caused the change?
I also spent a lot of time on the Internet. I discovered that back in the early 90’s many optometrists were advising other optometrists that they should give a child a lower prescription than the child actually seemed to require. A very slight under correction seemed to help stave off prescription increases. Also, it was advised that bifocals were a good idea for the prevention of the progression of myopia. And, children were being advised to only wear the minus-lensed glasses whenever they actually required them to see something in the distance. Removing the glasses for reading was often suggested. And the use of an auto refractor to determine a child’s prescription was not a recommended practice.
Then, somewhere around the mid 90’s everything changed. Many doctors began to suggest that under correction of a child would only cause the child’s prescription to increase faster. And, it became an accepted practice to have a nurse examine the child’s eyes with the auto refractor, and make up a pair of trial frames with the prescription determined by the auto refractor. The child was supposed to wear the determined prescription for a minimum of 20 minutes while waiting for the doctor to give a proper evaluation with the phoropter. And the idea of giving bifocals to children flew out the window. Also wearing glasses all the time was now the recommended practice, even for very low myopes.
I was wasting my time, so I returned to the daily routine of office work. However when the annual Optical Convention came about I made sure I attended. I had taken notes and had made a list of doctor’s names from my investigations on the Internet, so I signed up for any lectures that were given by these doctors.
I am not totally stupid. However, after attending some of the lectures, I was becoming more and more convinced that these doctors were actually promoting more myopia for children. One statement by a doctor was so ridiculous that I could hardly believe that he had suggested the idea. His suggestion was that many of the children he saw in his practice wanted to be prescribed glasses because their friends wore glasses. So, in cases where he felt that the child wanted to wear glasses he suggested prescribing a child a pair of glasses with between –0.50D and –0.75D lenses. Even I know that wearing a simple low minus lens promotes more myopia.
After this particular lecture was over I headed for the cafeteria. I noticed a lady in line who had been in attendance at the last lecture, but instead of sitting with us, she had been up front with the doctor. I worked my way over to her, read the name on her nametag, and struck up a conversation.
“Did Doctor Barlow actually mean what he said when he suggested prescribing kids low minus glasses so they could look like their friends who actually required glasses?” I asked of Marsha Stone.
“Why, of course he did. There is nothing wrong with helping a child fit in.” Marsha replied.
“Even if it means that the child will then have to wear glasses of increasing powers for the rest of their life?” I asked for my next question.
“There is no proof that that will occur. Anyway there is always eye surgery, although that has unfortunately been on the decline lately.” Marsha said.
I detected something in her voice. “Surgery has been on the decline?” I asked.
“Yes, the numbers have been dropping every year. I put much of my retirement income into laser surgery, as did so many of the other doctors. Now our retirement funds are in danger, because the industry is in so much trouble.” Marsh told me.
“But yet the numbers of myopic children are on the increase, and have climbed sharply over the past 10 years. Why are the surgery numbers down?” I asked.
“I didn’t tell you this, but it is my private theory that all the pushing the doctors have done over the past 10 years to increase the number of myopes has backfired on them. They have gotten so many kids used to wearing glasses that now the kids who don’t need glasses want prescriptions so they can wear glasses like their friends.” Marsha said.
It came to me in a flash. This is why the numbers didn’t work out. When my daughter was 13, she was one of only 2 or 3 kids who wore glasses in her class. By pushing more and more kids into myopia the doctors had reversed the status quo. Now there were only a few kids who didn’t wear glasses. And of course they didn’t want to be different. No wonder 97% of 10-year-old girls now wore glasses. By monkeying with the numbers the doctors had outsmarted themselves.
“Well Marsha, I suggest you get your money out of laser surgery and into the eyeglass industry.” I said.
“I moved some out 2 years ago, and a little more last year. I will have it all moved in another few weeks.” Marsha said with a smug look on her face.
“Let me make a bet with you. I bet the doctors haven’t clued in to what they have done yet.” I replied.
“You don’t have a taker on that bet Mister. You know you are correct.” Marsha replied.
I wanted to tell Chip the whole story. But since Chip probably had lost a fair bit of money because of this I merely gave him a sanitized version, telling him that since so many more kids now wore glasses naturally the desire for laser surgery was just not there anymore.
Since there were now so many attractive young ladies in their mid teens wearing glasses it made me wish that I were 45 years younger again.