With all the recent discussions about prism, I thought I would try my hand at writing a story that is prism related. Right now, I think it may wind up being 3 or 4 parts, but a lot depends on your reactions, pro or con. Your comments would be appreciated.
The Strabismus Institute
Part 1 - The Interview
There were butterflies in my stomach as I approached the entrance to the rather modernistic building. Actually, the butterflies were more in anticipation than apprehension. Maybe, just maybe, my search for a solution to my vision problems was inside that door. Just next to the door, in keeping with the elegantly simple architecture, was a very tasteful, brilliant brass, placard, with the words, The Strabismus Institute.
I had to admit to myself that I was more apprehensive than usual about enduring another bout of extensive eye exams. I had worn glasses since I was 14, but in mid adulthood, I had started developing double vision problems. I had seen many Eye Care Professionals and worn ever more powerful prism glasses to try to keep the images from my two eyes fused. I had very reluctantly had muscle surgery a few years before to try to stop my eyes from turning inward, I had even been warned that it might not work. I probably should not have even taken the risk, but I did. 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.
Usually, the additional prism enabled me to fuse the images, at least for a while. but always at the cost of ever reduced Visual Acuity. Finally, I had
had enough. I really like having excellent vision and my profession as an Electronic Engineer and Problem Solver (Perfectionist?) made it difficult to
accept the frequently offered explanation that high prism automatically means lousy vision with the glasses. In effect, I was given three choices.
One, wear prism glasses and see one somewhat blurry image. Two, see two sharp images with my low prism glasses and let my brain learn to use
which ever image it wanted to. Or three, wear a patch on one eye, I could choose which, and see clearly with one eye. At least choice three would
save my brain the extra work of making a decision about which eye to use.
The receptionist was a rather attractive woman, in her late 20s, who was wearing glasses with a 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 and I believe I have an appointment this morning for an exam and consultation.”
She turned to her computer and said, “Yes, I see you have an appointment with Dr. Simpson and that you have filled out all the information forms we need, on line. If you will just have a seat, I will notify Dr. Simpsonís nurse that you are here and she will call you in a few moments.”
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 arm chairs 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 we start the exams, we need to chat a bit and get to know each other better. I need 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 there, but I need to better understand your situation. You have to look at your vision problems every waking hour and I can only do some tests that are sort of an ‘outside, looking in’ type exam. I need to try to understand what you are experiencing in your words and try to find the best possible solution to your vision problems.”
I was having trouble getting my mind around my experiences, so far, at The Strabismus Institute. I had been in many Eye Doctor’s offices over the years, but never had I been treated like a guest. Sometimes, I felt like an object served up for the benefit of the doctor and it was my job to please him/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 prism glasses because you are somewhat cross-eyed. 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 since I learned to read at a very early age. I think I actually needed glasses a few years earlier, but it turned out that I was significantly more nearsighted in one eye than the other. I read with one eye and used the other for distance.”
“Did you have any problems with double vision?”
“No, not that I remember. One thing, I was never any good at sports like baseball. By the time I figured out where the ball was, it was already in the catcherís mitt.
By the time I got glasses, I was much more interested in electronics and the sciences than sports.
In my early 20s I was working part time fixing radios, TVs, and other things like that and I started having headaches doing close work. I was prescribed ‘functional bifocals’ with a very small amount of Base In prism to help me converge, but I don’t remember any particular double vision. The bifocals really helped with the headaches and I never regretted the bifocals. I continued wearing bifocals, but my next prescription did not have any prism.”
“When did you start having trouble with double vision?”
“Mid 30s if I remember right, but it took several eye exams before I actually was able to get prism in my glasses. I started with about 5/5 BO and it got to where 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 the 15/15 BO glasses made and when it turned out 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.
For about 3 months after the surgery, which was to move my inside eye muscle’s attach points, back on my eyeballs, I was able to wear glasses without any prism correction.
Then, the double vision started again and this time, it increased very fast. 5/5, 7/7, 10/10, 12/12, 15/15, 23/23. Then, I developed an unusual form of cataracts and had
to have my crystalline lenses replaced. Curiously, the cataract surgery seemed to help the double vision, but that didn’t last long. At least the new lenses in my eyes pretty
much fixed my nearsightedness.
I am now wearing 20/20 BO glasses and having a lot of trouble with double vision and also trouble seeing clearly with the glasses. More muscle surgery has been suggested, but after my experience with it before, I am not sure. Part of the problem with getting high prism glasses made is that I think it is almost a lost art. Every optician who knew how to make prism glasses in the old days, is now retired or dead. Because of the prevalence of muscle surgery, there is not much demand for prism glasses except special cases.
“Jack, it sounds like you have the problem nailed. That is why we exist. To help people like yourself see well and we have the knowledge and the tools to make it happen.
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 ranges from low to high. You will have a button that you press whenever you see double images.
The machine is something like a phropter 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 or two to munch on the way. Come with me.”
https://vision-and-spex.com/the-strabismus-institute-part-1-t314.html