Brian Collins will have no guarantees next Monday, when he removes his thick bifocals and a living cornea is sewn across his right eyeball.
Collins, 22, hopes for the best. But his has been a difficult life of blurred and double images since birth, and he does not want to be let down again.
He fought his way through East Long Beach schools, where he sometimes took minutes to read a single paragraph and where some teachers made few allowances for his legal blindness.
Now, as the second beneficiary of a year-old Gift of Sight surgery program at Pacific Hospital of Long Beach, Collins' life may be dramatically altered.
But he's not counting on it.
"I really don't know what to expect," Collins said cautiously as he sat on a stool at his parents' small Cherry Avenue decal company, where he works. "I haven't heard much about the operation. The proof is in the pudding, I think."
Surgery Performed Free
Others, however, are nearly certain the $8,000 surgery, performed without charge by Long Beach ophthalmologist Henry Hirschman and the hospital, will significantly improve the young man's vision.
"With this new cornea--a permanent living contact lens--his visual performance should be much better," said Hirschman, Collins' doctor for 20 years.
"At the very least, he'll certainly never have to wear those cataract glasses again. At best, he will improve several lines on the eye chart. Now he can read only the E (at the top of the chart)."
To Collins, permanent removal of the bifocals would be progress enough.
"These glasses hurt and people notice them too much," he said. "They ask questions because they think there's something wrong with me. People can't understand how I can see some things and not other things.
Eyes Appear Large
"And," he added, "when I'm wearing my glasses, the little kids always ask why my eyes are so big."
It was Hirschman who nominated Collins for the Pacific Hospital Foundation's surgery program for visually impaired children and young adults from families with little money or medical insurance. In a December operation, the sight of a 17-year-old Mexican girl, blinded by an exploding soda bottle, was restored. The foundation eventually hopes to do three or four of the free operations a year, spokesmen said.
"I have a special feeling for the Collins family," said Hirschman. "This is a case where, with all the money and medical care we have in this country, this hard-working family that owns its own business just kind of fell through the gratings. They don't have insurance, and Brian just didn't fit into any of the programs.
He Doesn't Complain
"And, you know, somehow you just don't hear any griping from Brian," Hirschman said. "He just does what he can do. And you've got to love a kid like that."
Brian was born with congenital cataracts and nystagmus, an unusual disorder that causes his eyes to move rapidly from side to side.
By themselves, the cataracts gave him 20-200 vision--he could see at 20 feet what the average person can see at 200. He could read a book only if he held it within three or four inches of his face. The rapid eye movements made things even worse, since focusing on a single word or object required extraordinary concentration.
"I have to move the page around to find the optic point," he explained. "For some reason, I can hold my eyes still better in some positions. But I still have trouble keeping my eyes on the letters themselves."
Contact Lenses Helped
Things improved a little a couple of years ago when Brian was fitted with special contact lenses. But the lenses made his eyes very sore and they would lag behind his pupils because of the eye movements. "It sure made for a blurred world," Hirschman said.
Still, Brian used the lenses as much as he could because they increased his peripheral vision, stopped questions about why a blind man would wear glasses, and eliminated the "Jack-in-the-box" images that throughout Brian's youth would jump suddenly into his vision.
Now, attachment of a live cornea promises to implant the advantages of the lens without the soreness or lag. It will also serve as a small weight to slightly slow down the eye movement. But Hirschman said advances could be greater.
May Get Much Better
"He may get much better," said the surgeon. "20-100 is quite conceivable. If so, his ability to function normally is really going to improve."
Brian brightened when told of Hirschman's optimism. "He never told me that," he said. "That would be nice."
Already, in a pre-operation procedure, there has been improvement, said both doctor and patient. Brian's pupils are cocked upward, so a laser cut was made by Hirschman July 2 to extend the opening of the right pupil downward to the center of his eye.
"That improved his vision immediately, so we know he is capable of improvement," said Hirschman.
Brian smiled when he told of returning home after the laser cut, drawing a newspaper close to his eyes and finding everything out of focus.
Reads at a Distance
"I threw it on the floor," he said. But a few moments later he noticed that he could read the newspaper on the floor.
He demonstrated his new-found reading ability by holding a card a foot, not the usual three inches, from his face and quickly reading four consecutive words. But when he shifted to another paragraph, he could not decipher a word. "Today, I can't keep my eyes still long enough," he said after perhaps 30 seconds of effort.
Come Monday, Brian's right eye muscles will be paralyzed by injection and a specially "carved and shaped" living cornea will be sewn onto his, Hirschman said. He probably will remain awake throughout the 45-minute operation and will go home the same day.
Within a day or two a patch will be removed from the eye, but it will take a couple of weeks before Brian will know how well the operation worked, the doctor said.
Hopes for Recording Job
Regardless of the results, Brian hopes to pursue a career as a sound technician at a recording studio. The job requires little sight, only a feel and love for music, he said. Four-track recording equipment, a mixer and two synthesizers occupy much of his bedroom in the family's university-area home, he said.
But for now, he works with his parents and two sisters at the family's Calray Decal Co. A 1981 graduate of Wilson High School, he dropped out of Long Beach City College because the special large-lettered books and tape-recorded texts often provided in high school were not available in college, Brian said. Their absence made a degree in music impossible, he explained.
He is also considering the study of Braille, a skill he and his parents wish he had mastered long ago.
"The schools did not want him to learn Braille," said Lorraine Collins, Brian's mother. "Their attitude was he should use the vision he had."
Jerry Collins said many teachers simply never responded to his son's inability to see. "They said, 'If he wears glasses, then he can see.' But he couldn't."
That is history, said Brian, who seems adjusted to life without sight. "I've been so long without it. I don't think the operation can make much difference. But I'm hoping for improvement. The more the better."