The Strabismus Institute

Hi, Cactus Jack here.

Recently, one of our members contacted me about a story I wrote back in 2013 about The Strabismus Institute.

It was my first and only attempt to write a fictional story, but not my first attempt at writing.  I have written several technical manuals, but nothing with dialog.

When I started the story, I thought it might have 2 or 3 parts, but as I got into the tale, the characters sort of took over and it wound up being 11 parts with a very unsatisfying ending.  S4E gave me some excellent advice about story telling.  I don’t remember his exact words, but it was something like: ”You need to know the ending before you publish!”

I have done some editing and followed most of the Grammarly suggestions to make it more readable and have written a new ending.

 At present, I am undecided.  Here are a few choices.

1.    Repost the story as individual parts a few days or weeks apart.

2.   Post the complete story near Frequently Requested Explanations.

3.   Post the Original Ending, the new ending, or both

4.   Continue the story as the mood strikes.

5.   Don’t bother with any of the above.

For those who are new here, or don’t feel like searching thru the 2013 files, here is Part 1 or Chapter 1.

The Strabismus Institute Part 1 - The Interview

There were butterflies in my stomach as I approached the entrance to the rather modernistic building.  The butterflies were more in anticipation than apprehension.  Maybe, just maybe, my search for a solution to my vision problems was inside that door.  Next to the door, in keeping with the elegantly simple architecture, was a very tasteful, brilliant brass plaque, with the words, The Strabismus Institute.

I had to admit to myself that I was a bit more apprehensive than usual, about enduring another bout of extensive eye exams.  I had worn glasses since I was 14 and probably had 50 or 60 eye exams of various types, over the years.  I pretty much enjoyed the experience of seeing more and more clearly as the lenses were changed.  I didn’t care for the after-effects of dilated exams, while my pupils and focusing muscles recovered from the effects of the dilating agent.  

In mid-adulthood, I had started developing double vision problems.  I had seen many Eye Care Professionals and worn glasses with ever-increasing prism power, to keep the images fused.   The increased prism worked for a while, but at the cost of reduced Visual Acuity.  It wasn’t long until I was seeing double again.  Finally, I had had enough. 

A few years before, I had very reluctantly agreed to muscle surgery to try to stop my eyes from turning inward.  I had been warned that the surgery might not work.  I decided to take the risk anyway.  The surgery solved the double vision problem for about 3 months, then my strabismus came back with a vengeance and roared past my previous prescription of 15 Prism Diopters, Base Out, in each eye, accompanied by about 20/30 vision or worse.

I really like having 20/20 vision, or better.  My background as an Engineer involved precision and accuracy.  Not having good vision made my work harder and me less productive.   My problem solving, engineering background, also made me a bit skeptical, when I complained that prescription in my new glasses was wrong and was told that “high prism lenses always have distortion that causes Visual Acuity to be less than 20/20”.   I generally kept my “cool” and didn’t say what I was thinking, BULLS**T!

I had heard of The Strabismus Institute and its reputation for being the go-to place if you had difficult-to-correct double vision problems. 

As I reached the door, it opened silently, and I entered a modern, very tastefully appointed lobby.

The receptionist was a rather attractive woman in her late 20s, who was wearing glasses with obvious Base Out prism correction.

“Good morning sir, how may I help you.”  She said with a very nice smile.

“Hi, my name is Jack Charles.  I believe I have an appointment this morning for a consultation and an exam.”

She turned to her computer and said, “Yes, I see you have an appointment with Dr. Simpson.  Also, that you have filled out all the information forms weneed, online.  If you will, just have a seat, I will notify Dr. Simpson’s nurse that you are here.”

I had just barely made myself comfortable when my name was called by another attractive young woman.  As I rose from my chair, she came over and introduced herself.  “Mr. Charles, my name is Natalie Jones, I am Dr. Simpson’s nurse.  If you will follow me, Dr. Simpson will meet you in his reception area in just a moment.”

I followed her into a small, but very comfortably arranged area with 4 armchairs and a coffee table.  “Please have a seat and I will tell Dr. Simpson you are here.  Would you care for coffee, tea, or other beverage?”

“Tea will be fine, thank you.”

As I was turning to sit down, a smiling man of about 40, dressed in a white smock approached and held out his hand.  “Mr. Charles, I am Jim Simpson.  Welcome to The Strabismus Institute.  Please call me Jim.  May I call you Jack?”

We shook hands and he invited me to sit down.  As I sat down, Miss Jones placed a tray with coffee, tea, and some small pastries on the table.

“Dr. Simpson, I don’t believe I have ever been to a doctor’s office where I was served tea and pastries before an exam.”

“Jim please, Jack.  Before starting the exams, I like for us to chat a bit and get better acquainted.  I would like to ask a few more questions about your visual symptoms and we might as well be comfortable and relaxed.”

“I thought I had answered most everything you asked, on the forms.”

“Yes, there are a lot of questions on the forms, but I need to better understand your situation.  You have to look at your vision problems every waking hour, but I can only do some tests that are sort of an ‘outside, looking in’ type exam.  I want to understand what you are experiencing, in your own words, and try to find the best possible solution to your vision problems.”

I was having trouble getting my mind around my experiences, up to now, at The Strabismus Institute.  I had been in many Eye Doctor’s offices over the years, but I had never been treated like a Guest.  Sometimes, I felt like an object, that was there for the benefit of the doctor.  It was my job to accommodate him or her, rather than vice versa.

“Jack, it is obvious that you have some strabismus problems.  First, you are here at The Strabismus Institute and you are wearing moderately high, Base Out, prism in your glasses.  Tell me more about your visual history.”

“I have worn glasses since I was 14 because I was nearsighted.  I have been an avid reader ever since I learned to read, at a very early age.  Around 4, I think.   I believe my mother got tired of reading to me and taught me phonics so I could read for myself.  That may have been a factor in my becoming nearsighted.

I think I needed glasses for a few years before I got them.  My first exam revealed that I was significantly more nearsighted in one eye than in the other.  It turned out that I was reading with one eye and using the other for distance.”

“Did you have any problems with double vision?”

“No, not that I remember.  One thing though, I was never any good at sports like baseball.  I couldn’t hit or catch the ball.  By the time I figured out where the ball was, it was already in the catcher’s mitt or laying on the ground.  By the time I got glasses, at 14, I was much more interested in the sciences, particularly physics and electronics, than in sports.

By the time I was about 20, I needed a few more diopters of minus in my glasses.  I was studying Engineering at the university.  I also had a part-time job fixing radios, TVs, and stereos.  

I started having headaches when I was reading, studying, or doing my job.  Anything that involved focusing close.  I went to an Optometrist and was prescribed low +1.00 ‘functional bifocals’ with a very small amount of Base In prism to reduce the convergence effort.  I don’t remember any particular double vision issues.  

The doctor, who reluctantly prescribed bifocals at 20, thought that I needed focusing help because of my years of “natural Mono Vision” before I got glasses.  My eyes had never learned to work together.  

The bifocals really helped with the headaches and while there were a few questions about why I was wearing bifocals at 20, I just said that they kept me from having headaches when I was studying.  I continued wearing bifocals, but my next prescription did not have any prism.”

My bifocal Add gradually increased until I was around 30.  By then, I my Add was up to +1.75, if I remember right 

At that time, my job involved reading large engineering drawings and I was having trouble reading the text and instructions at the top of the drawings.  I got trifocals, which I wore for a couple of years.  Later, I got a different job that didn’t involve reading the large drawings and I went back to bifocals until I was around 37.  I then changed back to trifocals, to help with intermediate distances, which I have worn ever since.

“When did you start having trouble with double vision?”

“Mid to late 30s, if I remember right.  It started with occasional slight double vision, mostly when I was tired.  It occurred more and more frequently over the next few years and began to show up during eye exams, but the examiners were reluctant to prescribe prism correction.  A very scary, late-night driving incident made me insist on a solution.”

“Oh, please tell me about it.”

“I was driving on a rural highway, through a forest, that had just been re-paved.  The pavement was jet black, with no center line markings, and grass shoulders.  There was no moon and no lights of habitation.  Suddenly, I was seeing two, hard to distinguish roads.  I had had enough experience with double vision to close one eye and slow down.    I continued slowly for a few miles, carefully using the slightly more visible grass shoulder as a guide.  Fortunately, there was no other traffic.  Eventually, I came to a section of road that had not been repaved. The older part of the highway had gray pavement and lane markings.  I was able to fuse the images and continue home.  The next day, I got a prescription for Base Out prism in my glasses.

I started with about 5/5 BO, I think.  After that, each eye exam revealed more tendency for my eyes to cross.  Within a few years, I was wearing 15/15 BO and still having double vision problems.”

“You said on your forms that you have had eye muscle surgery.”

“Yes, I had had a lot of trouble getting 10/10 or 15/15 BO glasses made with acceptable Visual Acuity.   When an exam indicated  that I needed even more prism, it was strongly suggested that I consider muscle surgery.  I finally agreed, but I was warned that it might not completely solve the problem.  They were right!

I had Medial Rectus Muscle surgery, where the eye surgeon moved the inside eye-muscle attach point back about 5 mm on each eyeball.  It seemed to work.  For about 3 months, I was able to wear glasses without any prism correction.  Then, I started having double vision problems again.  This time, it increased very fast.  5/5, 7/7, 10/10, 12/12, 15/15, and up to 23/23 Base Out.

Fortunately, I have Esophoria rather than Esotropia and often,I  could wear glasses with less than 23/23 BO, except when I was tired.  Most of the time, I wore glasses with 15/15 of Base Out prism.

Later on, in my early 60s, I developed an unusual form of Cataracts and had to have my crystalline lenses replaced.  Curiously, the Cataract surgery seemed to help my double vision issues, but that didn’t last long.  

The surgeon who did the Cataract operation strongly suggested, that because of my Engineering background, I should not consider the multi-focal IOLs.  Instead, he suggested Mono Vision, with one eye set for distance and the other for moderately close and continue to wear trifocals for the best possible Acuity.  With that arrangement, I probably would be able to function without my glasses, if I needed to get up at the night.  I could wear trifocals for my daily activities, with excellent vision.  It was a little ironic that I had gone from “Natural Mono Vision” in my youth, to “Intentional Mono Vision” in adulthood.

I am now wearing 20/20 BO trifocals, full time.  I am having more than occasional double vision.  I am also having trouble seeing clearly with these glasses.  More muscle surgery has been suggested, but after my experience with it before, I am not sure I want to risk it. 

Part of the problem with getting high prism glasses made is that I think it is almost a lost art.  Opticians and Lens Makers, who knew how to make and fit prism glasses, in the old days, are now retired or dead.  Because of the prevalence of muscle surgery, there is just not much demand for prism glasses, except in special cases.”

“Jack, it sounds like you have amazing understanding of your problems.  You also seem to have quite a bit of knowledge about optics and vision.  I think it is going to be a real pleasure to work with you.

You have done amazingly well on your own.  I think we can take your vision to the next level.   Fortunately, we have the knowledge, tools, and resources that have not yet reached most Eye Care Professionals.  Hopefully, we can significantly reduce your frustration and increase your visual comfort.

I would like to have you do a test that will explore your strabismus which is either Esophoria or Esotropia.  The test is a rather pleasant one.  We want you to watch a movie while the amount of prism correction changes from minimum to maximum.  You will have control with a button that you press whenever you see double images and the machine will compensate by either decreasing or increasing the amount of prism correction.

The machine is something like a phoropter and you watch a movie while sitting in a comfortable theater-like seat.  The only thing we can’t offer is popcorn, but you might want to grab a pastry to munch on.  Come with me.”

End of Part 1.

I would appreciate your comments and suggestions.

Cactus

https://vision-and-spex.com/the-strabismus-institute-t1936.html