It occurred to me, as I said goodbye to my first couple of clients, that I had as good a chance today at “Breaking Even” as ever. This was a game we had devised while studying to become optometrists, where we aimed to break even in terms of what we prescribed, giving out as much plus power as minus power. It was not easy to do, as certain times of year tended to upset the balance. I may have succeeded in the past, but since qualifying a couple of years earlier, I had not given the game much thought. Today, however, I had started well. My first two clients had been and gone, and my score was still zero. Mr. Johnson had required no change at all in his prescription, while his wife had one eye which had remained unchanged, where her right eye had shifted from -2.75 -0.50 to -2.50 -0.75, and as far as the rules of the game we had devised were concerned, this counted as “no change”, as the total prescription was exactly the same. It is also worth pointing out one other rule, and that is that all reading adds were disregarded.
As Mr. and Mrs Johnson were married, I had examined their eyes together, so I used the few spare minutes before my next client to leaf through the notes of the other clients to see what sort of chance I thought I had. There were seven of them in total. Today was Saturday, and I was due a half day, in lieu of the extended hours session I had worked on Thursday evening. I was looking forward to the chance to go and watch United, my local football team that afternoon. The new season had started well, and we had gained seven points from the first three games. My peremptory examination of the notes showed me that I had a slim chance of breaking even, but with two of the clients being totally new, I put all thoughts of my little game to the back of my mind as I read my next client’s notes in greater detail.
Mr. Michael Francis was 62 years old, and had been wearing glasses since before his notes began. His prescription on entering the room was a modest R+2.50 L+2.75, with a +2.25 add. As I discussed general health issues and vision with him, it became clear that a slight increase in plus power was going to be needed, for reading, and possibly also for distance. He was starting to struggle to read when his eyes were tired, and as his job involved a certain amount of reading, this was a bit of an inconvenience. It came as no real surprise to either of us that he now required R+2.75 L+3.00 with a +2.50 add; it made the difference between being able to read the smallest lines on the reading card, and being able to do so in comfort. I then passed him on to our dispensing optician to find a suitable frame for his new prescription. So, three down, and my total was +0.50.
The next client was Leighton Bromswold, one of our two new clients. It was only when I saw him that I twigged that this was United’s new striker. The papers said he had a keen eye for goal, and I was a little nervous when I called him through to the examination room. After all, I was looking forward to watching him play that afternoon, so at first I was a little concerned that we might have a new striker who couldn’t see properly. As we chatted before the examination, he told me how he had first got glasses at the age of 12 because he was short-sighted, and contact lenses a couple of years later to enable him to pursue his dream of becoming a professional footballer. Two years ago, he had had Laser surgery in the close season, and had been given a clean bill of health later on. However, he wanted to make sure that his eyesight was still perfect, so had come in for a second opinion. Neither of us need have worried, as he did not require a prescription. As he left, he thanked me, and asked whether I would like a couple of free tickets for that afternoon’s game. I declined as I already had mine, so he promised to drop by later in the week with a couple of tickets for the Tuesday evening game next week. Four down, five to go, and still at +0.50.
Rachael Larne was my next client. There are times when it is quite difficult to maintain a professional approach, and this was one of them. The notes said that her glasses were R-9.50 -0.75 L -9.25 -1.00. The thick lenses protruding behind her black plastic frame were one distraction; her loose-fitting V-neck tee-shirt over her ample chest was another. It was a couple of years since she last had new glasses; she knew she needed them, and as she was about to spend the year in South America as part of her university degree, this seemed a suitable moment to get them. I could not resist the opportunity to ask her a couple of extra questions about her studies, just to give me a bit more time to look at her in her glasses, before I swapped them for the trial frames. Elsewhere, her bundle of notes told me that her contact lenses were -10 in both eyes, so I knew roughly what to expect. By the time she had decided that the red and green were equally clear, and that there was no difference between number 1 and number 2, the trial frames now held R -10.75 -0.75 L -10.50 -1.25. As I returned her glasses to her I explained how much her eyes had changed. I also told her that her new glasses would need to have flat-fronted lenses, to keep their thickness down, although as the glasses were a back-up to her contact lenses, this was not really a consideration. Five down, four to go, and I was now at -2.25.
My next clients were a pair of brothers, aged 11 and 10, Simon and Arthur King. Their mother was with them, and I had all three of them in the examining room at the same time. Neither of the boys wore glasses, although my initial conversation with Mrs. King confirmed what the notes told me; Simon had been told a year ago that he would probably need glasses this time around, and his mother was keen for him to start the new school year able to see clearly, so they had come back 11 months after their previous appointment, rather than wait for the full year. As Simon read the letters out I could see that he was starting to squint when he reached the 20/30 line. He managed several of the letters correctly on the 20/25 line, but I stopped him there, and put the -0.25 and -0.50 lenses into the trial frame for him, which is what he had required 11 months earlier. I then showed him the 20/20 line, and again he managed some of the letters, but also made several mistakes. An extra -0.50 in each eye, and he was able to read the line clearly, so I tried him with the 20/15 line. He said it was better with another -0.25, but I decided I would prefer to under-correct him at this stage. After checking the health of his eyes, I explained to him and to his mother that he would need to wear glasses for reading the board and watching the television, and wrote out the prescription of R -0.75 L -1.00. He then went outside to look at the frames we had in stock, while I turned to his younger brother.
Arthur King had good eyesight. He managed to read the whole of the 20/20 line with both eyes, but the slight hesitation he made over some of the letters made me wonder whether he was not following his brother’s path. A glance at his notes showed me that he was 14 months younger than Simon, so this indeed seemed to be a possibility. I put the trial frame on his face, and slipped a -0.25 lens into each side. With his left eye, he managed to read the 20/20 line with a little more confidence. I removed the lens, and put a +0.25 in its place. This was a bit worse, so I then put a -0.50 lens in as well. Again, he was able to see the line clearly, so I took the +0.25 lens out. This made little difference, so I removed the -0.50 lens, and put the -0.25 lens back in. We then went through an identical process with his right eye. I then checked the general health of his eyes, which was fine. Mrs. King had been watching the process intently.
“Two pairs of glasses, then?” she asked as I turned to her.
“Not at this stage,” I said. I then went on to explain that although Arthur could get glasses, they would be the weakest we could possibly make. I filled in the form to show R -0.25 L -0.25, then ticked the “No prescription required” box. I said that they could come back within the year if they felt it necessary, but that if Arthur’s eyes were like Simon’s, he would probably need glasses next year, or it might be in two years’ time. Mrs. King thanked me for taking the time with her sons, and went out to help Simon with choosing his first pair of glasses. In the meantime, I did a bit of totting up; Simon was an extra -1.00, Arthur -0.50, so that gave me -3.25, and two patients to go.
I picked up the next set of notes, which belonged to a Shaunnagh Galway, a young lady of Irish origin, if the name was anything to go by, and rather short-sighted. Her most recent prescription was only 6 months old: R – 4.75 L -6.00; 12 months before that, it had been R –2.50 and L -3.50, so she had clearly been told to come back sooner, rather than struggle on for a year. My chances of breaking even seemed to be disappearing rather rapidly. I was also slightly puzzled by the fact that there was no older prescription.
As I went out to the waiting area, I knew immediately who my next client was.
“Shaunnagh Galway?” I enquired of a teenager with slightly longer than shoulder-length strawberry blond hair and gold metal-rimmed glasses.
The young lady rose.
“Would you like to come through, too, Mrs. Galway?” I asked of the lady who was sitting next to her, gently wheeling a buggy backwards and forwards. The moment I had said the words, I knew I had got her name wrong, and I also realised exactly why there were no prescriptions for Shaunnagh from more than 18 months ago. I had examined her mother several months ago, when she was in the latter stages of pregnancy, and she had told me then how she and her daughter had moved to England a couple of years earlier to start a new life, following the death of her husband and son in a road traffic accident.
“If you don’t mind, I’ll stay here until you’ve done the sight test,” she replied. “It’s easier to keep Connor distracted out here, without disturbing you.”
“Okay, that’s fine by me. I’ll speak to you once we’re done.”
Shaunnagh was already sitting in the big, black chair when I returned to the examining room. I asked after her general health, which was good, and her vision, which was not so good. Without her glasses, she told me that she thought the big letter at the top of the chart was probably an E, but that she was doing that more from memory, rather than based on what she could really see. She told me that she really wanted to get contact lenses as her glasses were getting rather thick. However, with the new baby, her mum and new husband could not afford to get them for her, and she had to make do with ordinary plastic lenses because the thinner, higher index ones were also too expensive, especially as she had to get new glasses every six months at the moment.
The next part of the sight test went rather as Shaunnagh had feared. The circles were clearer on the red a couple of times in her right eye, and three times in her left. When we moved on to the white circles, she stopped me, and asked what that test was showing. I explained to her that I was testing for astigmatism, which led me to explain all about the shape of her eyeballs. When I returned to the red/green test again, I was able to reduce the power in her left eye by one step, but the right remained unchanged. I checked the health of the rest of her eyes, and then wrote out her new prescription: R -5.25 -0.25 x 175 L -6.50 -0.50 x 10. I called her mother into the room to explain the new prescription, and that Shaunnagh would have to have new glasses, but I also told them both that her eyes seemed to be changing slightly more slowly, and offered the hope that her next check-up might be the last 6 month one. I ushered them out of the room, and left her notes with one of our dispensing opticians, while mother and daughter went to look at the selection of frames.
There were two people still in the waiting area, a mother and her daughter. I knew one of the two would be my next client, and suspected it would be the daughter, but I went back to the examining room to make sure I called out the right name. This was my second new client of the day, and when I called “Melanie Anderson” out, the young girl rose, followed by her mother.
Once Melanie was seated in the black chair, I started to take some notes.
“My mum thinks I need glasses, because the doctor said I probably did,” she complained, “but I can see perfectly.”
“Melanie, he said we needed to get your eyes checked as they were the most likely cause of the headaches you’ve been getting.”
Before this turned into a heated argument between mother and daughter, I felt we had better get started on the sight test. Besides, I had a football match to get to, and would rather like to go home and get changed, rather than go straight there in my suit.
Melanie had been right about what she could see, as she reached the 20/20 line without difficulty, but as I examined her eyes more closely, I could immediately tell that the doctor had been right in sending her to me.
“See, Mum,” she said. “Nothing wrong with my eyes.”
I placed the trial frame on her face. I already knew that this was a very longsighted young lady that I was dealing with, and was quite surprised she had not come in a few years earlier. However, I knew I should not prejudge these things, so I started with her left eye, which seemed slightly worse, and introduced a +1.00 lens into the frame. By the time I was satisfied that I had gone as far as I could or should go, Melanie had +2.50 in her left eye, and +2.25 in her right. When I showed her both eyes together, she felt she could see slightly better with her left eye, so I reduced the power in her right eye to +2.00. By this point, I could tell that her confidence had sagged; I think she had probably realised that the lenses I had been giving her had been getting stronger, and the fact that she could still see through them was not a good sign. She brightened a little when I asked her to compare her distance vision with and without the lenses, but then slumped when I showed her how much clearer her close vision was with the lenses than it had been without.
“Well, Mrs. Anderson. It seems that both Melanie and the doctor were right. She can see very well at the moment without glasses, but the cause of her headaches is that she needs to be wearing them.”
“For reading only?”
“All the time, I’m afraid. She needs to get glasses as soon as possible and wear them all of the time. She is quite long-sighted, and as she gets older, her headaches will only worsen if she does not get glasses. And this is only the beginning. I’d like her to come back again in 4 months’ time, when we’ll do a fully dilated exam, which will give us a better idea of how long-sighted she is.”
Melanie had gone green at the gills. I was not saying what she wanted to hear, but I knew that I was doing it for her own good. Again, I left them in the capable hands of one of our dispensing opticians to choose a frame, before completing the last few items of paperwork before heading for home. I was just about to turn the lights out, when I realised I had forgotten the “Breaking Even” game. A quick calculation showed that I had just missed out. My final total was a paltry -0.50. If only I had solved the problem of the imbalance in Melanie’s eyes by increasing her left eye to +2.75, rather than reducing the power in the right to +2.00. After all, I knew full well that she would be wearing something quite a lot stronger than +2.50 in 4 months’ time.
I was just settling into the car for the drive home, when suddenly I realised that I had, indeed, broken even. When I had tested young Arthur’s eyes, he had -0.25 in each eye, but I had said that no prescription was required. I hadn’t prescribed him glasses, so his -0.50 did not count. Just for once, I had done it; I had conquered the “Breaking Even” game. What was more, United did better than break even in the football; a thrilling hat-trick from Leighton Bromswold saw us win the game 3-0. He truly had an eye for goal!