Eyeglasses may assist in near vision, but not necessary.

We have the perfect storm of several facts.

1. I am a firm believer one must own up to one’s words. If you say something, especially something that has a direct effect on someone else’s life, you should be held accountable for your words.
2. David’s mother and I fully agree that David’s caretakers should do everything possible to maximize the potential for his vision.
3. I have a penchant for putting things in writing.
4. Somehow I have learned to listen to what someone says to me, and, if the situation so deserves, simply use their words “against” them.

I am rather perturbed by the optometrist basically telling David’s caretakers that they do not need to put his glasses on, that that is “not mandatory.” They will simply not bother.

So, if you are feeling voyeuristic, and you want to see the full email trail and the thoughts behind it, keep reading. My “conjecture” is that you will find it entertaining.

And, by the way, I still don’t know who my secret admirer is.

(I know you don’t like to click to “read more,” but just this once …)

Brief review … David was brought to an optometrist to have his eyeglasses checked. The non-doctor simple wrote on the report “eyeglasses may assist in near vision, but not necessary” (emphasis his). I wrote him the following email. Note, I start with a simple review of the facts, I attach the report, and I end with a very direct, but simple question. Since this guy is a consultant to the rehab center, I copied both David’s case manager and the medical director of the facility.

Attached is the Vision Consultation form that you appear to have filled out for my son, David, concerning his exam by you on January 24, 2011 of this year. I have a question and some concern about the only note that is written on the form.

It says “Eyeglasses may assist in near vision, but not mandatory” (emphasis as on the original)

The first part of that I understand says that in your opinion you do not know if optical correction with eyeglasses would assist David in his near vision. Am I correct? Obviously they would not help with his neurological issues and his partially compromised optic nerve, but he does have optical issues as well.

More importantly, you appear to say that eyeglasses are “not mandatory.” They are not mandatory for … what? For something to be mandatory it must fulfill a need or be needed to obtain a goal (i.e., meet legal requirements, enable an action, etc.). It seems to me that you are saying his glasses are no longer mandatory for him to reach some goal you have set or you are using for his vision.

SPECIFICALLY, what goal has been set for David, with respect to his vision, for which optical correction is not mandatory?

Thank you for your time and attention.

I received a response, there were no “open” cc’s on it. Of course I do not know if there were any blind cc’s. This is typically done because one knows his response is not satisfactory and does not want his supervisor, or others, to see it. Here is the response, but when reading it, remember that my email to him has one simple question, that is, what was his (the optometrist’s) goal for David’s vision. His response:

The evaluations we conduct at the center are as comprehensive as possible. I try to evaluate form and function. The limitations you stated are correct and there is little we can do to evaluate “function” short of conducting formal electrodiagnostic tests.

He is slightly hyperopic (farsighted) which implies that his eyes are too weak to see anything without engaging his focusing system. Distant objects require a little focusing effort and the closer you try to see, the exponentially more the eyes require use of the focusing mechanism. I’m sure you can see for yourself that with proper distant correction in place, if you try to bring reading material closer, you can feel your eyes straining until it blurs out. We tend to retain maximum focusing ability until our early 20’s and then it slowly fades until our mid 50’s. At that time we will need progressive eyeglasses. David should have maximum flexibility at his age and shoud [sic] effortlessly transition from far to near. All we can do is observe and watch how he functions. We should evaluate his progress through his teachers/ staff to see if he benefitted [sic] from his glasses or not, relative to the care required to maintain his glasses.

I hope this helps. Let me know if you need more clarification or want to persue [sic] another treatment protocol.

Note how he completely ignored the question and just babbled. I learned absolutely nothing from his answer, and he refuses to define, explain, nor take responsibility for his simple statement on David’s report. Hence, I respond and once again, I cc the medical director and David’s case manager. All I do is offer some information showing that I am not totally stupid, I even tell him my answer to the question if it was asked of me (and showing him what I am looking for, by example) and once again I end by emphasizing the one simple question.

I greatly appreciate the information you offer, but it does not answer my question.

We know from previous tests (VEP, preferential looking, etc.) that David has both optical and neurological issues with his sight. We also know that the limiting factor has been his neurological issues, that we can improve the optical issues greatly and that that will increase his potential for useful, or functional, vision.

You state that eyeglasses are not mandatory, emphasizing the “not.” This will cause the staff around David to put a significantly lower priority on his wearing glasses and most likely he will not be wearing them.

David’s parents have the goal that the rehabilitation center should do everything possible to maximize the potential for David’s vision. In order to reach this goal, David needs to wear glasses, even if as you believe he only “may” benefit. In this case, the glasses would in fact be mandatory to reach our goal.

So I ask again, since you strongly emphasize that David’s glasses are not mandatory, what goal are you trying to achieve?

And then he answers, again without any cc’s. First, I will let you read it as received …

First, I did not have any previous records from previous evaluations to base my opinion.

Second, his eyeglass prescription is considered “mild”, giving a commensurate “mild” help. There are studies that show that post traumatic brain injuries “may” benefit from seemingly insignificant prescriptions. I disagree that eyeglasses would benefit him “greatly”. That’s where the “may” comment came from. I would like to see if there is any appreciable/ noticeable difference with or without eyeglass correction. The staff should be aware of his day to day behavior and aptitude.

Third, I agree that we should try to maximize vision, but the actual benefit needs to be weighed against the logistics of eyeglasses. Many times the eyeglasses are physically on the face, but head posture inhibits the actual use as they peer over the frames. That’s why I would like to test the waters for a period of time to evaluate.

Fourth, I agree that the optical component is overshadowed by the neurologic.

I would throw all of the above away if you want to continue with eyeglasses, as all is based on conjecture. Let me know what you would like to do.

That is actually a pretty amazing response. Let’s look carefully at what this puke gentlemen just told me.

First, I did not have any previous records from previous evaluations to base my opinion.

Wow. “I am offering a medical opinion on how to treat your son’s vision, with looking at, or even inquiring about other records.” Records from real doctor’s by the way. (Not to mention his poor wording.)

Second, his eyeglass prescription is considered “mild”, giving a commensurate “mild” help. There are studies that show that post traumatic brain injuries “may” benefit from seemingly insignificant prescriptions. I disagree that eyeglasses would benefit him “greatly”. That’s where the “may” comment came from. I would like to see if there is any appreciable/ noticeable difference with or without eyeglass correction. The staff should be aware of his day to day behavior and aptitude.

“Oh, come on, Single Dad, his eyeglasses are only “mild,” they won’t help much anyway. And I’ll babble about post traumatic brain injuries even though that has absolutely nothing to do with David, but how would I know that? And now that you are trying to nail me down on what I think, I’ll throw in that I’d like feedback from the staff with and without eyeglasses. But then, if I said that originally, the glasses would have to be mandatory at times.”

Third, I agree that we should try to maximize vision, but the actual benefit needs to be weighed against the logistics of eyeglasses. Many times the eyeglasses are physically on the face, but head posture inhibits the actual use as they peer over the frames. That’s why I would like to test the waters for a period of time to evaluate.

“Let’s evaluate! That’s a new smoke screen I am offering you to further obfuscate the whole matter.”

Fourth, I agree that the optical component is overshadowed by the neurologic.

“I’ll throw you a bone. You are right about something.”

I would throw all of the above away if you want to continue with eyeglasses, as all is based on conjecture. Let me know what you would like to do.

WOW. WOW. Look what he just wrote! “conjecture” … “all is based on conjecture.” Go look it up .. Conjecture = SPECULATION, GUESS. He admits he is pulling all of this out of his ass.

There are records on file with David’s facility of many vision tests by medical doctors. Many tests and opinions. And this idiot purely gives a medical recommendation that will completely effect how David’s vision is dealt with, “Eyeglasses may assist in near vision, but not necessary” simply based on “conjecture” … speculation.

And, not only that, HE NEVER ANSWERS THE QUESTION.

He is not worth dealing with anymore. I will make sure David never deals with him again, either. I wrote what may be the final email on this to David’s case manager …

I am very concerned with how David’s vision issues will be handled both by the fact that you have lost your vision specialist (note, I did NOT say you have lost your “vision”!) and I have issues with Mr. Optometrist’s second response (included below).

Note that he starts by saying that he has no idea about previous evaluations and these include fairly extensive eye and vision testing, and I would guess he is not familiar with David’s diagnosis and it’s influence on nerve fibers. I would NOT expect an optometrist to be familiar with all that history, and if in fact the appointment was purely to check David’s glasses as David’s mother and I were led to believe, that would be fine. The fact that he is making treatment recommendations (i.e., eyeglasses are not mandatory) to the staff without any knowledge of David’s condition or history of tests is troubling.

His second point appears to contradict the ophthalmology team at the children’s hospital we use and completely misses the point of optimizing David’s “optical vision” because the limiting factor is the neurological issue. And, David’s issues are different than “post traumatic brain injuries” due to his decrease in the specific amino acid activity, hence the formation of his brain and “neuro-optical” structures is the case in point.

His third and fourth items are not of note.

Finally, he concludes with an evaluation of all he just said, and I quote, “all is based on conjecture.” Conjecture?

Not once in two wordy emails did he answer my simple question.

Until we have our next appointment with the ophthalmologists at the children’s hospital, can we continue with their facts and their recommendations that David indeed wear his glasses as much as reasonably possible?

I have not cc’d Mr. Ophthalmologist on this email, you can feel free to share it with him if you like. Maybe he will tell you the answer to my question.

Have a great weekend and thanks for all you do for David. Honestly, it is very much appreciated and noted.

And as for my secret admirer? Just conjecture, but I think she (?) reads the blog.