Phylogeny vs. progeny? In other words, is it nurture or nature that incited this particular 5-year-old patient to use my chair and stand as a jungle gym. His mom, on the cell phone, declared, “I tol’ him!”

“I tol’ him,” indeed.

When I was his age, my teacher tol’ my mom that I had ants in my pants. This means that, given the opportunity, I would definitely have climbed a chair and stand if given half the chance. I’ve been informed that I was like that since birth. (So is it “progeny”?)

One reason I did not climb furniture in doctor’s offices is that my parents would have tol’ me and I would have quit—or I would have been smacked a good one up side my fanny. That at least temporarily cured my attention deficit disorder. In this case, I guess that phylogeny rules—“phylogeny” meaning corporal punishment.

Patients often ask questions that refer to this issue of progeny vs. phylogeny. They ask such important questions as:

• Does macular degeneration run in the family?
Answer: Could be and maybe the three packs of cigs per day do, too.

• If I need glasses, is there anything I can do to make sure the kids don’t?
Answer: Have all your prospective lovers come in for eye examination to prequalify them.

• Can I make payments?
Answer: Does insanity run in your family or do you guys just learn it over time.

There are genetic predispositions to many eye conditions. Twin studies, in which they check twins who are separated and raised in different situations, are very instructive when it comes to things such as myopia, astigmatism, amblyopia, and who likes Katie Couric as a news anchor.

But phylogeny has a powerful impact because diet and lifestyle, for example, can drastically alter cardiovascular outcomes and whether one upsizes his or her cheeseburger meal. Of course, we can thank this societal truth for important discoveries like stuffed-crust pizzas and heart transplants.

I like to think that both progeny and phylogeny make the world a better place. I cannot help it that my wife has slowly forced me into behaviors that have altered my genetic makeup so I have steadily moved closer and closer to Jimmy Buffett and further and further from Jimi Hendrix. In many ways, these moves depend upon your drug of choice and, at age 57, my drug of choice is comfortable shoes.

So, genetics has profound effect, although one can adjust it a lot by environment. Take gonioscopy. I have done gonioscopy for 31-plus years and I’m still a little fumble fingered. I, of course, blame the patients. It has to be their twitches and blinks. I know this because no one in my family ever accepts fault for anything. It’s just in our genes.

Another example is buying equipment. I blame my great-grandfather for the fact that the more money I spend on office equipment, the less it works right. This is caused by our genes, which command Vickers men to never read instruction manuals.

Now that I am a grandparent (Ella, age 1, with another on the way), I think about progeny vs. phylogeny and the genetics of my family vs. the occasional butt whuppings that will make her become a wonderful, if slightly loony, member of society. I remember when my own children were growing up and going through that difficult time of feeling weird and wanting so to fit in.

My advice to them was this:

Embrace your neuroses, because that’s the only part of you that’s really you.

(Did I always think that, or has my life as an optometrist taught me this? Who knows?)