There will be times during games, perhaps between pitches or during pitching changes, that Tommy Pham will give himself an impromptu eye test in the outfield.

He’ll pinch one eye shut and make sure the signs around the ballpark are still as crisp as they were the day before, still as clear as they were a few innings ago. Then he’ll check the other eye. The “Busch Stadium” carved into the wall behind home plate offers a constant to focus on, but any of the advertisements or scoreboards can become a personal, daily eye chart. This past week, against Boston, Pham switched the contact lens in his left eye between innings because he didn’t like what he saw — or, rather, couldn’t see.

To thrive at a game that can change in a blink, this is how vigilant the Cardinals’ resurfacing outfielder must be to avoid being betrayed by his vision, again.

“I look at all of them — ‘Busch Stadium,’ ‘KMOX,’ the scoreboard, all of that,” Pham said. “I’ve got to make sure this is the best lens because the best lens gives me the best opportunity. If my left eye gets any worse, I’m in trouble. If my right eye gets any worse, I’m in trouble.”

Pham, 29, returned to the majors two weeks ago, and before going on a tear with a .304 average and a .587 slugging percentage in his first 12 games, he warned people they were about to hear a familiar tale. After an aggravating spring, his offensive awakening came immediately after he got new contact lenses. Since first being diagnosed in 2008 with a degenerative eye condition, keratoconus, Pham has had a breakthrough surgery to halt the erosion and since cycled through a variety of contact lenses looking for the right fit, even if it’s just fit for right now.

Keratoconus causes structural abnormalities in the cornea, warping it and leaving it similar to the shape of a football’s tip. Instead of light bending toward the retina to be processed as an image, the light scatters, splinters. Halos or double images can appear. Pham said he is legally blind in his left eye due to keratoconus.

“It’s like driving a car with someone who is holding a jar of Vaseline,” said Dr. Brian Boxer Wachler, a Beverly Hills, Calif.-based surgeon and ophthalmologist, “and then they smear it all over your windshield.”

Before Boxer Wachler pioneered a non-invasive treatment, the remedy for the keratoconus was a corneal transplant, and the combination of vanishing vision and that extreme correction has forced athletes from their games. It led one Olympic bobsledder, the late Steven Holcomb, to deep depression and a failed suicide attempt. Boxer Wachler’s treatment allowed Holcomb to race again, for a gold medal. Keratoconus affects one in 500, Boxer Wachler said, and it was Holcomb’s recovery and Winter Olympics success that brought new attention to the disease.

Boxer Wachler said he’s treated several elite athletes, including an NHL player, but few have a career based around striking a small, fast-moving object with a round stick. Pham is one.

“What Tommy Pham sees is different than what we see,” said Dr. Edward S. Bennett, a professor and assistant dean for student services and alumni relations at UMSL’s College of Optometry. He has been Pham’s doctor in St. Louis. “It’s like looking through a window and there might be a smudge, there might be a crack, but there isn’t that crisp clear view. If somebody would tell me an individual could play Major League Baseball with keratoconus, I’d say, ‘Absolutely not.’ Only Tommy Pham. I think Tommy is one in a million.”

Sight, not swing, is issue

Pham was back at Dr. Bennett’s office Friday to get another pair of contact lenses because his “backup just wasn’t right.” Before the Cardinals played recently in Miami, Pham tore two left lenses and had to have a new one flown in from Las Vegas. Most players have “a guy” who gets them bats, or “a guy” who can get them fly shoes, or, like Carlos Martinez, “a guy” they frequent for haircuts. Pham is considering flying home to Las Vegas on Monday, an off day, because he’s got “a guy who can sharpen my lenses.”

His pursuit of better vision hasn’t ended since it began, in Jupiter, Fla.

The Cardinals selected Pham in the 16th round of the 2006 draft, and they billed him as an athletically gifted shortstop with bat speed to create havoc. They saw it only in flashes those early years, but Pham mostly struggled. Teammates described seeing details in the spin of breaking pitches he never could — and never has, he said Friday. He presumed as a young player that his talent, not his eyesight, was outmatched.

“It was new to me,” Pham said. “Everyone was throwing harder. I was facing competition older than me. So, I just felt, man, this is what I have to do to catch up. I just thought I had to adjust.”

In 2008, he hit .203 for the season but also slugged 18 home runs in 394 at-bats. He returned to Florida to pick up the car he left behind, and was greeted there by then-farm director Jeff Luhnow. Pham explained his average was the result of his swing. Luhnow suggested it was his sight. After a flight to St. Louis and a checkup there, Pham was diagnosed with keratoconus. Now he had an explanation.

To save his career, he needed a solution.

“Vision is the most important thing (in baseball). You’ve got to see it to hit it. Simple as that,” said Dr. Don Tieg, a consultant for the New York Yankees who oversees a sports vision institute. “I’ve worked with (multiple) major-league teams and there was usually one player with some vision issue that you’d think would not let them get to the top, and they won a Cy Young Award or are in the Hall of Fame. Athletes compensate. The question becomes how do you do that if you’re impaired by keratoconus? More power to him.”

During the 2011 offseason, Pham visited Boxer Wachler and had the treatment now named Holcomb C3-R Cross Linking System. The procedure uses a vitamin application and ultraviolet light to strengthen the cornea. Boxer Wachler said he’s performed about 6,000 of the procedures, which gained FDA approval last year, and the success rate is 99.3 percent. In a video filmed shortly after he had Holcomb C3-R, Pham describes how he’s had other surgeries that brought him to tears.

This one put something else in his eyes: relief.

“If I never had it, who knows where I would be right now,” Pham said.

Since LASIK was never an option, Pham had a set of contact lenses that improved his eyesight, from 2009 until he landed 52 games in the majors in 2015. He once experimented with a new type of lenses only to have them slide and shift and blot out his vision when he tracked fly balls. He experienced similar issues last season, even as he hit nine home runs. During the All-Star break, he, Dr. Bennett, and Pham’s handful of self-improvement books drove to Iowa to meet with a specialist for assistance. Another set of contacts came. The issues continued into the spring and undermined his bid for the opening-day roster. Nine years after he learned it wasn’t his swing, it was his sight, he had the same lesson. Experimenting with new contacts had “backfired on me.”

With the help of his optometrist in Vegas and Dr. Bennett in St. Louis, Pham concluded that he needed to use a brand of contacts that uses a corneal topographer — literally a map-maker for the eye — to create curvatures that allow for a snugger fit on irregular corneas. One flaw can throw his vision off. This is why Pham does his daily check of the advertisements.

K-M-O-X spells clear.

Clear means his career.

“With Tommy Pham a mild change can turn a home run into a strike out,” said Dr. Bennett, who had Pham’s permission to speak with the Post-Dispatch. “He is just so totally dedicated. He is consumed. That’s why he’s been successful.”

A ‘bigger purpose’

When Boxer Wachler first met Steven Holcomb, the U.S. bobsled driver had already been to the brink. As he recounted in his book, “But Now I See,” and elsewhere, Holcomb washed down 73 sleeping pills with whiskey in an attempt to escape the blindness swallowing his eyes. Keratoconus was about to force him from his beloved sport, until Boxer Wachler told him about his procedure.

“He was still skeptical,” Boxer Wachler recalled this past week. “All he had heard was this kind of prison sentence of corneal transplant.”

What became known as Holcomb C3-R offered more than parole. It improved his vision from 20/1,000 to 20/20, according to reports, and he led the U.S. bobsledders to gold in Vancouver and won two Bronze Medals in Sochi 2014. Earlier this month, Holcomb was found dead in his room at the Olympic training facility in Lake Placid, N.Y. Boxer Wachler became close friends with Holcomb and relayed what the bobsledder often said about the role he came to play for others with keratoconus, now his legacy.

He saw it as a “bigger purpose.”

“Gives them hope,” Boxer Wachler said. “Gives them hope that they can be helped. You don’t have to just wait and wait and lose and then get a corneal transplant. Others see him succeed and know it’s possible. Tommy’s story, in that bigger purpose, can give hope, too.”

Pham, who has hit his way into a larger role with the Cardinals, acknowledged that he’s been asked to embrace a larger role as “spokesperson.” He noted it’s something he must consider. In the clubhouse Friday, Pham recounted details of his latest apportionment and during his answers he would close an eye, squint, and open it wide. He was trying to read the nameplate on his locker — from the other side of the room. Asked what kept him chasing the game through all this, Pham opens both eyes wide.

Even as his vision failed, his focus remained.

“I would regret quitting on my ability before I made it to the major leagues,” Pham said. “I saw other guys make it to the majors, and there were times I think I was better, that I was good enough.”

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