by Tom the Hungarian

The first time I saw Bob in my office, - he was 10 years old - he behaved exactly like innumerable little macho boys I had met in my career who love sports, see themselves as their favorite male movie star and hate the idea of wearing geeky, nerdy glasses. He had been caught by the school nurse's eye test, he was clearly nearsighted, I prescribed about -1.50 lenses and Bob now had spectacles whether he liked the idea or not.

His mother brought him back a year later and, once again in another 12 months, for eye tests and everything was still quite normal. His myopia was slowly getting worse as it usually does for children in their years of puberty. Each time I increased his prescription by about -0.50. Nothing unusual!

On his fourth visit - he was now 13 - I noticed something different. I like to go out into my waiting room and invite the next patient to my office personally. I believe it makes for better personal relationships. I did so on this occasion. It was a busy day. I was fully booked and I had a few drop-ins. I do not like to refuse drop-ins because I am connected with an optician's store and I do not want them to lose the business. So I just fit them in the best I can. In any case, the waiting room was full. Bob was there with his mother, two little girls, both wearing glasses, with their respective mothers, and one or two others. It was just before the school year started which accounted for so many children. Bob was the last of the three children I tested.

When I had Bob sitting in the examination chair, he said to me with curiosity in his voice,
"One of the girls had much thicker glasses than me!"
"Yes," - I answered, - "she has much worse eyes than you."
He, then, started asking questions. He wanted to know why she was more nearsighted, what caused it, was there anything to be done about it, had she done anything that caused it. I answered him the best I could and was curious about his sudden interest.
"Will I need stronger glasses today?" - he wanted to know.
"We will soon know, Bob," - I replied, - "but I wouldn't be surprised. You are at an age when nearsightedness tends to get worse."
"Will I end up needing such thick glasses like that girl?"
"I doubt it, she was born with bad eyes."

His mother spoke up and asked,
"Anything we can do to help? Is there anything he needs to avoid doing, so his eyes don't get worse?"
"Not much you can do," - I replied. - "A lot of it is genetic... most of it comes with his age... Obviously it's better if he does his school work in good lighting."

I examined his eye and found the slight increase in myopia I expected. Then came the subjective test with the eye chart. I told him to sit up close to my instrument with his chin and forehead against the barriers.
"If you distance your eyes away from the lens I will end up prescribing lenses that are too strong," - I explained.

I soon noticed, however, that as soon as I took my eyes off him, he did move away from the eye piece and I also noticed that when I gave him the choice between lenses, he invariably chose the stronger one. "Does he want stronger lenses?" - I wondered. I was not very concerned, however. If the boy ended up with a prescription slightly too high, the accommodating powers of his young eyes would easily take care of it.

A few months later I noticed a young boy, wearing glasses, hanging out near the optician's store, looking in through the shop window and eventually even stepping inside. He looked familiar but it took me a moment to recognize Bob. As time went on, I saw him quite often, always near the optician's store, always looking inside. "Could this young kid be showing signs of a 'glasses fetish'," - I asked myself.

The following year, at the usual time of year, just before the start of the new school year, Bob came with his mother. He complained that his eyes had become much worse and his mother was worried about them. When I looked inside the eye, I found no dramatic increase in myopia. maybe it was -0.75 more rather than -0.50 but all was certainly within the normal range. When the test with the eye chart came up, Bob did everything to get me to prescribe stronger lenses for him. In addition to the tricks he had played the previous year, I was pretty sure he pretended not to see lines which he was perfectly capable of reading. I saw no reason for not going along with his tricks and I figured he probably ended up with a prescription about -1.00 stronger than he actually needed. The following year we played the same scenario but in the end I said to him:

"You know Bob, if you are willing to try, I think you can do better than this! I prescribe lenses even stronger. You will see very well but if your eyes get tired, all you need to do is to move the glasses a little further down your nose, increase the distance between your eyes and the lenses and you'll be ok."

He, of course agreed with alacrity.

The following year, I increased his prescription to -2.00 above what he really required but recommended that he get bifocals because I was concerned about him doing close work with such strength of lenses.

We continued the game for all the years he was in high school. By the time he graduated, his eyes had naturally deteriorated from -1.50 to -5.00 but he was wearing -7.50.

He came to see me before he was off to college.

"Doctor," - he said to me - "You know, of course, that I want to wear stronger, thicker lenses than I need. Would you help me? Can you prescribe for me plus contacts so I can get stronger minus lenses?"
" I am sorry, Bob," - I answered, - "but I can't possibly do that! It would be unethical and I could lose my license. But I tell you this. If you come to see me with contact lenses in your eyes... I have been known to make mistakes and... well, I might not notice them."

Bob is now wearing -20 lenses regularly and just ordered his first myodiscs. It is amazing how fast his myopia increased!

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