Sometimes you can only do so much about treating
a problem because the patient has to decide what he wants to do about his eyes.
All you can ask is, "They're your eyes, what do you want to do?"
Pat was one of those patients. He wanted to
be like everyone else and get his driver's license when he was 16 years old.
However, due to his condition, only he could control his driving fate.
It was a crisp fall morning the day that the
Wyman family first came to see me. Both parents came with their two children,
Betsy, 8, and Pat, 10. They moved here from Atlanta and their wonderful
southern accent was very different from the St. Louis accent to which most of
us were accustomed.
After a routine examination of Betsy, with
mom sitting in the corner of the room, it was time to examine her older brother.
Pat had congenital nystagmus due to oculo-cutaneous albinism.
Pat had spent his life not feeling normal
because of his condition, so I decided to propose something. The idea of
driving a car would make him feel like other kids, and it would also make him
want to take care of his eyes. I told him that he'd have to invest a lot of
time and effort over the next 6 years if he wanted vision good enough to drive,
but it was possible.
What do you want to do?
These were his eyes, and he had to take
responsibility for them. His mom and dad would help, but he had to do all the
work. And, work it would be to increase his visual acuity to at least 20/60,
the minimum needed in Missouri to obtain a restricted license. So, I asked what
he wanted to do.
After thinking about it, Pat asked,
"Can I really get a driver's license? Could I really drive?"
Pat decided to take on the challenge, so we
embarked on a 2-year plan to increase his acuity. Pat's corrected vision was
poor. He was 20/400 in his neutral position, using either or both eyes. After
about 18 months of using corrective spectacles, his vision was at 20/80.
Suspecting that at least some of his visual loss was due to amblyopia, I also
initiated a vigorous program of visual therapy.
We then used contact lenses with a pinhole
pupil, but Pat was unhappy with the reduction of his peripheral vision. So, we
tried toric contact lenses; his correction was about +2.50-3.75x150 OU. At his
3-month visit, his vision was 20/60 OU, 20/70 OD or OS.
When it came time for his driving test, even
though he was nervous and scared, he passed. At 17, Pat got his driver's
license. It had a daytime restriction, but it was a license. I don't know if he
was more excited about getting his driver's license or just feeling normal.
This year I said goodbye to the Wymans. They
moved back East. Pat had since gone off to an engineering university, and Betsy
is now also in college. As I performed their final eye examinations, their mom
sat with me as she'd done over the last 10 years.
With tears in her eyes, she said, "What
would we have done 10 years ago without you? What would've happened to
I sat next to Mrs. Wyman, now a friend, and
considered what she just said. Offering Pat a chance to improve his vision,
also offered him his freedom to choose a different life than he might have had.
I was overwhelmed that she recognized this.
However, I know someone would've said,
"They're your eyes, what do you want to do?"
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