Entry 324: I Can’t See Clearly Now

I’ve worn glasses since I was four years old, and here’s what I don’t understand: When you think about all the technological advances that have been made in the last 56 years, how is it possible that my eyeglass prescription is still determined by reading lines on a chart and saying “better” or “worse” while an ophthalmologist switches lenses in and out of a contraption that looks like a medieval torture device?

And why do we trust our vision to people called ophthalmologists anyway? Can’t they see that there are too many “h’s” in that word? What are they, blind?Eyedoc[1]

So I go for my eye test, and they put me in the big chair and lower the torture mask over my head. This is the phoropter, which sounds like the name of a dinosaur because it should be extinct by now. I don’t think this apparatus has changed much in half a century.

“What’s the lowest line you can read?” I am asked.  Well, I don’t care how much he tortures me with his evil-looking mask, I am not going to reveal to him what’s on the lowest line. He could threaten my family, and I would not tell him what it says. Mostly, because I have no idea what it says.

“Third from the bottom,” I say. I find that it helps to give up some information.

“Go ahead.”

Oh. I thought he’d take my word for it. I didn’t know I’d actually have to read it out loud. I concentrate, and I wonder briefly if the letters might be Hebrew. Finally I venture a guess: “D, P, N, Something, something, something?”

There’s a brief pause while the doctor perhaps wonders if I might be illiterate rather than somewhat vision-impaired. Then he clicks in a new lens. “Is that better or worse?”  There is no difference whatsoever, but I don’t want to disappoint him. “Slightly better?” I say.

Another click. “How about now?”  Oooh. The P has turned into an F, and the last three letters are clearly P, T, and H. Or maybe A. “Better,” I say confidently.

“Can you read the line below that?”

“There’s a line below that?”

A few more clicks and I’m reading the second from the last line, but that’s evidently as good as it’s going to get, because the bottom line still looks something like a series of punctuation marks, and I’m not going to sit there saying “Comma, comma, comma” as if I’m doing a William Shatner talk-singing version of “Breaking Up Is Hard to Do.*”

chart“Okay,” says the doctor, “read the second to last line.”

“P, H, U, N, T, D, Z.” Click. “Better or worse?” “Better.” “Read it now.” “P, H, U, N, T, D, Z.”  Click. “Better or worse?”

I wish he’d give some indication of whether he thinks it should be better or worse. Shouldn’t he know whether it’s better or worse?

“Better.” “Read it.” “P, H, U, N, T, D, Z.”  Click. “Better or worse?”

I’m really not sure by now. I have a suspicion that he’s already determined how poor my vision is, and now he’s just trying to find out how stupid I am by clicking in the same lens and seeing if I claim there’s a difference. “Better.” “Read it.”

I am tempted to just say “funtidzuh” to move things along. I’m bored. Can’t they at least give you something different to read? I already know how this line ends. Also, while my memory may not be as sharp as it once was, after the third time saying “P, H, U, N, T, D, Z” I’ve pretty much got it down. I would challenge myself by saying the letters with my eyes closed, but I understand that we’re on the honor system here, and that it’s not in my best interest to recite the letters by rote. Otherwise, I could have looked the damn chart up online last night and memorized it. Except that I am currently looking at the chart on my computer screen and I still can’t read the friggin’ bottom line.

Then he pulls out his little flashlight. “Look up. Look to the left. Look to the right. Look down. Look up to the left. Look down to the right.” I don’t know if he’s evaluating my vision or my response time. Did he think there was too long a pause while I was deciding which way was left?

Finally he writes me a prescription and sends me out into the world to buy progressively-bifocalled, transitionally-shaded, scratch-resistant, anti-glare glasses. But then, as an experiment, I went for a second eye test with another eye doctor (an optometrist this time), and the second person told me I needed a different prescription. And also that my insurance wouldn’t cover another eye test.

Look, I’m not implying that one eye doctor was better than the other. But I am asking how confident we can be in any doctor who depends on that much input from the patient. I don’t want doctors depending on information I give them in order to make a diagnosis; that’s what all the tests are for. Hell, if an internist asks me how my prostate is, I’ll say “Just fine, thank you. No need for that glove.”

By now, optic technology should have progressed to the point where you can go to the opthalmologist (a major advancement would have convinced them to drop the extra “h”), look into a machine for three seconds and have a computer print out your eyeglass prescription automatically.

I can tell you definitively that would be “better.”shatner

See you soon (unless you’re on the bottom line).

*I don’t know if Shatner’s ever actually done “Breaking Up is Hard to Do,” but you’ve got to check out his version of “Rocket Man.” You will LOL.

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One Response to Entry 324: I Can’t See Clearly Now

  1. Marc G. Rubinstein, M.D. says:

    Very hcute. We hhave an exphression inh Ophthalmolgy (no need to add any “h”s here): you cant refract a 20/200 hbrain. FYI there are manyh fields in medicine where we dehpend on the patient’s input Psychiatry (try treating the patient without his help). Even some formhs of Neurosurgery, as another example. Ever go to the Internest and he asks, “does this hurt when I press here?” Does this confuse you as well? When we refract a patient, we are confiming information gathered from a piece of technology called an autorefractor. When I get a patient with a 20/200 brain, I don’t pay attention to their input (I’m sure you are aware of this because this is how I arrived at your latest eyeglass perscription, Mark). I hope this has cleared up your bluriness of my professionhhhhh!

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