- They say your eyes are the windows to your soul, very small organs of your body in comparison, but also very important ones.

According to the CDC, there are some health conditions that can put you at higher risk for vision loss.

And these conditions, like diabetes and high blood pressure, are more common among Hispanics and Latinos.

Statistics show that Hispanics are about two and a half times more likely to have diabetes and non-Hispanics.

And 68% of Hispanics have poorly controlled high blood pressure, compared to 54% of non-Hispanic whites.

In addition, Latinos are less likely to have had eye exams, participate in daily physical exercise or be able to access health and eye care services, all of which contribute to a higher risk for vision loss.

On this episode, we'll look at maintaining good eye health, talk about eye diseases, and discuss ways you can correct your vision.

Welcome to A Su Salud, Cheers to Good Health.

I'm your host, Genesis Ortega.

We're broadcasting from inside the PPL Public Media Center in Bethlehem, Pennsylvania.

My first guest is Dr Karen Dacey from St Luke's University Health Network.

Thank you, Doctor, for joining us today.

- Thank you for having me.

- Let's get started here.

Let's talk about perfect vision.

What does 20/20 vision actually mean?

- That's a great question.

So 20/20 vision is defined as normal.

It's the first number, the top 20, is the distance the patient sits from the measuring eye chart.

And the second number is the size of the letter that they can view.

So in a 20/20 normal vision eye, that person is seeing what a normal person would see at 20 feet.

As the letters get bigger on the eye chart, the number, the number goes up.

So less than perfect vision is something like 20/30 or 20/40.

So the 20 on top stays the same because that's the fixed working distance from the patient to the eye chart.

But the letters are getting larger.

And so that bottom number changes.

- What are some of the most commonly known conditions that can affect your eyes?

- So that varies depending on the age of the patient, but mostly when we're talking about older adults, cataracts, diabetes, glaucoma and dry eyes are pretty much the top reason somebody would be seeing an ophthalmologist.

- Let's talk about those.

Let's start with cataracts.

What is that?

- So a cataract is a natural change of the lens on the inside of the eye.

Everybody gets him as just the birthdays roll up and it's a clouding of the lens and that can affect vision, causing it to be blurry.

So roadsigns may not be as clear.

Small print may be hard to distinguish.

It may be harder to distinguish colors like dark blue and black.

And then they happen very slowly over time.

They don't cause any pain.

And eventually somebody may come in and say, "I really just can't see the directory on the TV "as well as I'd like", or "I can't distinguish between "a six or an eight on my crossword puzzle."

And we start looking for things like cataract in that kind of patient.

- What about glaucoma?

- Glaucoma is more of a silent disease.

It is a disease of the optic nerve and the optic nerve is in the nerve highway from the eyeball to the brain.

And when we look in the eye, we can examine the optic nerve and kind of describe it in words as to the health of the optic nerve.

And the optic nerve can die in a particular pattern over time and you lose side vision as that happens.

In early or moderate glaucoma, often times a patient has no recognition that there's a problem.

It's only with very advanced glaucoma would a patient recognize that they have some loss of their side vision.

So glaucoma is one of the very important things to be screened for because you may have it and not know it.

- You also mentioned dry eyes.

Is it just like it sounds?

- It is, but it's...

The chief complaint, people would come in, don't necessarily say, "I have dry eyes."

They may say, "I have a gritty sensation in my eyes," or "My eyes burn a lot," even "my eyes tear a lot".

And that really confounds people because they say, "Why am my eyes tearing if they're dry?"

And that's your body's response to being dry, to overproduce tears.

- Can you detect these diseases or conditions in its early stages?

- Absolutely, early detection is key to maintaining good eye health, and that often requires a visit to an eye care provider, ophthalmologist and optometrist, and dilated regular dilated eye exams.

- Research shows, Doctor, that Hispanics and Latinos have high rates of eye disease and impairments.

Why is that?

- Ooh, I don't know if I can answer the why.

I know when we are learning about eye diseases and training in residency, we learn certain patterns of recognition.

And we know that African-Americans, for example, have higher rates of glaucoma.

We also know now that Hispanics and Latinos also have higher rates of glaucoma when compared to Caucasians.

I don't know if I know the answer to why.

- That's OK. You know, a lot with times of science, you just are trying to figure out that why, right?

We don't have all of the answers.

But, you know, let's talk about preventative measures.

And can you take certain preventative measures regarding any of these vision impairments?

- So you mentioned diabetes and high blood pressure.

Controlling blood sugar, blood pressure and cholesterol are very important for protecting the health of the eyes.

In addition, eye protection from trauma is a great preventative measure to take wearing safety goggles when cutting wood or cutting the grass.

And the other thing is either quit smoking or never even start smoking.

And those are all great ways to maintain some good ocular health.

- Are there any other chronic conditions that can affect general eye health?

- We hit on the top, hypertension, cholesterol, diabetes, there are other chronic conditions, things like sarcoidosis or rheumatoid arthritis, other autoimmune diseases, infectious diseases like Lyme disease or cat-scratch disease.

So when we look at the eye, we're not just thinking this is an isolated organ.

We're thinking, OK, is there something going on in the body that's just kind of showing up in the eyes?

- What about age-related degeneration of the eyes?

- Well, to be a little bit more specific, I think age-related macular degeneration is something we hear a lot about and that the macula is a very special area of the retina.

The retina is in the back of the eye.

It acts like the film in a camera when we used to take pictures with film in them, and it's a degenerative process where the retina deteriorates and we can actually see those changes.

And macular degeneration comes in two varieties.

There's the dry kind and then there's the wet kind and the dry kind typically proceeds slowly and people can lose vision slowly over time.

And the wet kind can rapidly affect somebody's vision.

And if you hear a lot of people talking about, "I get shot shots in my eyes," the wet kind of macular degeneration can be treated and treated quite effectively with injections.

- What are some of the most frequent concerns that you hear from patients coming into your office?

- Um, diabetics are very concerned about their diabetic eye status, whether their diabetes is affecting the tiny little blood vessels in the eyes and if they're losing vision.

Really, a lot of patients ask, "Am I going to go blind?"

And we hear that a lot.

And it's our job to assess the status of their eyes, the health of their eyes, and kind of keep any fears like that at bay and treat any conditions that may, over the long term, cause loss of vision.

- Now, that's really relatable because a lot of the times in the back of my head, when I'm seeing my eye doctor, are am "I going to go blind soon" because my eyes are pretty bad, you know?

So from what I'm hearing from you, it's important to have these conversations with your eye doctor to keep to keep those concerns at bay.

Am I correct?

- Absolutely.

- We're running out of time.

I really appreciate your time with us today.

And I want to close out the segment by asking you what sort of advice do you have for your viewers when maintaining good eye health?

- General, good advice.

Wear eye protection when you're doing something active, wear sunglasses when you're outdoors, don't smoke or quit smoking, and get regular eye exams.

- Wonderful.

Thank you so much, Doctor, for being with us today.

- Thank you for having me.

- My next guests are doctors from Texas, Dr Greg Parkhurst is a refractive surgeon with Parkhurst NuVision in San Antonio, Texas, and is a member of the Refractive Surgery Council Editorial Advisory Board.

Dr Roberto Saenz is an optometrist, also at Parkhurst NuVision.

Thanks for joining us today, doctors.

- Oh, thanks so much for having me.

It's a pleasure to be with you today.

- Dr Saenz, let's start with you.

I want to talk about Hispanics and Latinos and how race plays a role when we're talking about eye vision.

- Yeah, good question.

The Hispanic and Latino population, you know, one of the things we always talk about is just how how the Hispanic and Latino population is actually at risk for visual impairment.

And what we mean by that is if we had to simplify it, when I'm going to use the eye model here, when lights comes into the eye, it hits the cornea, then it hits the lens.

And basically this front of the eye focuses the light in the back of the eye.

Now, there are conditions that can cause visual loss in the back of the eye and the front of the eye.

So, for example, we know the Hispanic and Latino population is at risk for things like diabetes and high blood pressure.

And those can cause damage behind the eye with things like diabetic retinopathy and glaucoma.

But the ones that we kind of focus on in our clinic are the problems that can cause visual impairment in the front of the eye, like, for example, cataracts, which is basically where the lens in the middle part of the eye where it becomes cloudy and that's called the cataract or the dreaded word, which are Hispanic patients and Latino patients call "astigmatismo" or astigmatism, where basically a patient has in the front of the eye, they have two prescriptions per one eye.

And those are the big ones for the Hispanic and Latino population.

We know that uncorrected refractive error, things like nearsightedness, astigmatism or farsightedness and cataracts, there are basically one billion people worldwide who have visual impairment from those two conditions.

And the Latino population and the Hispanic population, we see a lot of astigmatism and we see a lot of cataracts in that population.

- Now, let me ask you this, because when I think about cataracts, I think about older adults.

So should Hispanic youth be equally as concerned about maintaining good eye health as older Hispanic adults?

- Yeah, definitely.

We know that cataracts happen for a variety of reasons, and one of those that start it is to basically be UV damage to the lens.

And so that's why you see people recommending things like sunglasses outside.

And so we know that as we get wiser in age, that lens can become cloudy.

So I think doing things like wearing sunglasses in the young population is definitely beneficial.

But the easy thing now with with basically the treatments that we have for cataract surgery, sometimes people get excited to get cataracts because you actually can correct your vision at the time of cataract surgery and basically correct your near vision, your far vision, up close and astigmatism at the time.

So it's very common now.

I think there's like four million cataract procedures done every year.

My mom has had it and she now loves life after getting that corrected.

- So let's talk about refractive surgeries.

There's things like LASIK and PRK.

Dr Parkhurst, what are the options?

Tell us about those.

- Yeah, great question.

You know, I grew up with really bad vision myself.

I was in third grade when I got my first pair of glasses and I was looking for the day when I could find a solution, where I could just wake up and see and not actually have to wear my glasses anymore.

And I had a laser vision correction procedure almost 20 years ago now, and it's called PRK, which stands for photorefractive keratectomy and PRK was one of the first laser vision correction techniques that first came out about 25 years ago.

Nowadays, we still do some PRK and there's several other procedures.

A lot of people have heard of LASIK eye surgery.

That's one of the most common ones we do.

There's another one called SMILE LASIK, which is another treatment that can correct vision.

Those are all done with laser treatments to the front part of the eye, the cornea.

In addition to that, we can sometimes treat the lens on the inside of the eye.

And that's typically related to people that are getting a little bit older, like in the 40s and 50s, people...

I'm in my 40s now and pretty soon I'm going to have to start stretching my reading material out so that I can see it closer.

That's due to the lens inside of the eye.

And there's there's actually ways to treat that.

- So how does that discussion with your patients happen?

Do you present these surgery options, or do you as a doctor actually choose what's best for the patient?

- Typically, it's upon my recommendation in terms of which of the different procedures that we're going to do, you know, everybody's eyes are different.

Dr Saenz already mentioned a lot of people in the Hispanic community have things like astigmatism or high nearsightedness.

So it really depends on the prescription of the eye and it depends on the anatomy of the eye.

So, for example, if somebody has really thick glasses and the cornea of the eye where we do laser surgery is on the thin side, sometimes we'll recommend doing a lens treatment.

On the other hand, if someone has a smaller prescription and really good, thick, healthy corneas, that's often the time where we'll recommend laser vision correction.

So there are some instances where a patient could choose between a couple of different procedures, but most of the time it's based on a consultation with one of us.

So we look at all the scans, we find out what the goals are, if it's depending on age, and we take all that information and then we make a recommendation in terms of what's going to be the best way to actually correct your vision.

Now, when I look at a surgery procedure like LASIK, I know the immediate benefit is I won't have to wear glasses or contacts anymore.

But what about the cons?

Are there any cons to having surgery done?

- You know, with modern technology, if somebody actually qualifies for laser eye surgery, there are very few cons these days.

Biggest one might be it can take a couple of days off work.

And, you know, during the pandemic, we've been talking to a lot of patients that, you know, their glasses are fogging and they just don't really want to have to put their finger in their eye to put their contact lenses in.

And they're concerned about the risks in this in this world that we live in today.

With modern laser vision, correction in good candidates, the risks are extremely small and patients do very, very well.

- Dr Saenz, I want to talk about cataract surgery, but first of all, how does somebody get cataracts?

- Well, that's a great question.

Here in our office, we like to just talk about basically the three milestones that everybody goes through with your eyes.

The first milestone is your're born with either nearsighted, farsighted, or mixture of both with astigmatism.

And that's usually let's take, for example, Dr Parkhurst.

Dr Parkhurst was born and he was born nearsighted so he could see up close, but not far away.

And he basically had a procedure, PRK, to fix his vision.

And then what will happen is we get into our 40s and 50s where we lose the ability to zoom in up close.

The lens in the middle part of your eye is made out of things like skin cells.

Skin cells can slop off but in your eye, they're basically held in a capsule.

And so that lens gets harder and harder and harder and you lose the ability to zoom in up close.

And this is why everybody goes to the drugstore to buy the over-the-counter reading glasses.

They hold things further away.

And so as that lens starts to stiffen, what eventually happens over time is that lens also starts to become like yellow.

And it's a slow change.

So most people actually don't even know they have cataracts and oftentimes are going to the doctor, like, "These glasses don't work," or they'll start to see halos on the lights at night.

Many different reasons but basically, just as we get wiser in age, that lens, it gets harder first and then it starts to become opaque.

Now, thankfully, here in the US, we have access to this technology where somebody can come in, they can go to their eye doctor and they can get referred for a consultation.

But basically, cataracts is still the leading cause of visual impairment worldwide.

There are many places, Dr Parkhurst and myself, we both go on mission trips to Mexico.

And a lot of these patients don't have access to this care or technology.

And so you basically can become completely blind from cataracts, that lens can become completely opaque.

But thankfully, we have a surgical procedure that can help restore the vision.

- So, Dr Parkhurst, talk us through that cataract surgery.

What does that look like?

- Yeah, so Dr Saenz mentioned that we do mission work in Mexico and the type of cataract surgery that we do in those parts of the world is a little bit different than we do in the United States.

Both are very, very successful.

I'm actually operating today, and when we do laser eye surgery, we can actually do laser cataract surgery these days.

And so it involves a two-step process.

The first step is we use a laser to soften the cataract and basically put the cataract into tiny particles that can just be washed out of the eye.

So we use a laser to soften the cataract and also treat things like astigmatism and the need to see far and near.

And then and then we we are ultimately implanting a new lens to restore the clarity of the old lens that had gotten cloudy.

The procedure itself typically takes somewhere between five and ten minutes, it does not hurt.

You know, we give patients a mild sedative.

So they're kind of in a twilight zone state of mind.

And most people are able to return back to work, or pretty normal activities typically the day after surgery.

- Now, I love to hear that you guys are doing mission work in Mexico.

So, Dr Saenz, let me ask you, what are you hearing from people when you go to Mexico?

Are they grateful that you guys are down there?

- Yeah, that's a great question.

I love going to Mexico on these trips.

I mean, it's like you really get to use the ability to... your Spanish-speaking abilities and be able just to help these patients.

Typically on these mission trips, like you're seeing patients who have walked ten hours, who have driven 12 hours, just at this opportunity to come to this clinic.

We see just the first 120 patients who get there.

So you can imagine you're just a clinic with just the lines of people and they come in, open the doors, first 120 people, and then we start seeing patients.

And we're basically, however early you can wake up and however long you can work, we're basically just seeing all these patients to see who would benefit from cataract surgery.

And, you know, typically you have to have 2200 vision or worse in both eyes which here in the US, that would be legally blind.

You basically have to be legally blind for us to basically allow you to have cataract surgery in one of these clinics.

So you can imagine taking your mother or father or brother or sister to this clinic, being visually impaired, legally blind, and then the next day being able to wake up and see your grandchildren, being able to see to help out around the house.

It's just it's a really joyful experience.

And all this training that you went through, like, pays off being able to help contribute back to the community who helped bring you up.

- It's great work.

- A lot of the people that we see down there have often been blind from cataracts for sometimes many years, ten, 15, 20 years.

You know, there's such an unmet need there.

And they'll often come with their families to travel to get their cataracts taken care of.

And one of the most rewarding experiences of the day after cataract surgery, when we take the patches off, we'll often get to experience a grandparent laying eyes on their grandchild for the first time.

And it's just such an emotional moment to be able to cure blindness like that and reconnect families.

It's just super cool.

- That just gives me goose bumps, actually!

I'm sure you guys find a lot of fulfillment in the work that you do.

And Dr Parkhurst, I mean, you're pretty busy yourself.

You also do some work with the American Refractive Surgery Council.

Talk to us about that.

- Yes, so the American Refractive Surgery Council is basically a research institution that puts a lot of publications together and looks at the peer reviewed literature, there's recently been a lot of talk about, you know, what what does the medical literature say about laser eye surgery?

Is it safe?

Is it effective?

Are there side effects?

Things like that.

And it's interesting when you look at it, LASIK is actually one of the single most studied and published upon medical procedures in all of medicine.

There's been over 7,000 peer reviewed publications looking at the safety and outcomes of modern laser eye surgery.

And the Refractive Surgery Council is really looking at the science to see, you know, is this a procedure that's going to be helpful and beneficial to the large population that we treat?

- Thank you both for your time today, for the work that you do as well.

We really appreciate it.

I'm sure our viewers would appreciate the mission work that you're doing in Mexico as well.

So keep it up.

Good luck.

Best of luck to the both of you.

My next guest is Dr Theresa Radtke.

She's an optometrist and we'll discuss the dangers of too much screen time on the eyes.

Thanks for joining us today, Doctor.

- Thanks for having me.

- Let's set a baseline here.

What exactly defines screen time?

- So screen time is anything pretty much any time you're in front of a screen.

So computers, tablets, phones, even television is considered screen time.

- So when people talk about screen time, normally they say in a detrimental way, in a negative way.

So what is it about screen time that is detrimental to the eyes?

- Well, it's kind of an unnatural state for us to be in because screen time is a relatively new concept and we get way too much of it.

Our lives revolve around screen time, unfortunately.

So it's really unclear what the long-term side effects of screen time are, because it's still relatively new, especially being close to screens like computers and cell phones and tablets.

- Now, like you said, the pandemic, I would say, kind of like brought us into this digital world and kind of just like got us into this avalanche of screen time.

So, I want to ask you this.

Let's start with prior to the pandemic, what was the recommended amount of time that kids should be in front of a screen?

- So, it really hasn't changed much.

It's still recommended that kids under under one years old should not have any screen time, if possible.

Kids 1-2 can have like an hour, 3-5 should really have no more than an hour and a half.

And that's really because development wise, they need to be interacting with their environment and with people.

And I know like we're interacting now, you know, you interact with people via screens, too.

So it's a little better than just staring at the screen, staring at like a computer game or something like that.

But it's still not the right type of interaction that that age group should be having for positive development.

- Now, with digital learning for older kids, would you say that has increased because of, you know, they're learning on a screen, on a computer?

- I think it's been kind of become a necessary evil in a lot of ways.

It's allowed kids to continue to learn without having to be physically with other people, which is safer.

But I think it still will turn out to be kind of detrimental, unfortunately.

And it's still the same recommendations from the American Academy of Pediatrics.

- Let's talk about eyestrain.

Is there such a thing as just regular eyestrain versus a digital eyestrain?

- Yeah, so digital eyestrain is a little bit more you know, there are more specific symptoms, so digital eyestrain is not just fatigue, it's also dryness, eye irritation, itchiness.

Those are kind of some of the common symptoms of digital eyestrain.

And that's because when we are on screens, especially computers and phones, we tend to blink less when we're focused on them.

So our eyes tend to dry out and become irritated at the end of that day.

- Now we talk about a lot of discussion about limiting screen time for kids.

But what about adults?

Should adults be concerned about limiting that time in front of the screen, whether it's a TV or a computer?

- Yes, for sure.

For that same reason, for the digital eyestrain reason.

Adults, I mean, I hear it from my patients so much because everyone's working in front of a computer now.

So everyone's eyes are killing them by the end of the day.

And that's from being on screens, you know, when people were outside working, I mean, obviously there's other factors that go into that.

But, you know, having to be focused on a screen, on a meeting, on small, small print on the computer screen, it really can make the eyes very tired.

And adults should be careful to limit their time as well.

- I want to talk about tips that adults and kids can use to deal with increased screen time but let me ask you this.

I had a friend who recently bought glasses to limit that blue ray from the computer.

Is that helpful?

- There's very limited research on blue light effectiveness, blue light-blocking effectiveness.

So, all screens...

Anything computerized hasemits blue light.

Blue light is part of this part of the spectrum, but it doesn't really seem to show that it's as damaging as people are saying.

The one thing we know for sure is that it can affect circadian rhythms.

So it's especially important to reduce screen time before you're going to sleep to to help improve your sleep.

But as far as actually damaging the eyes, UV rays are much more damaging than blue light.

- So how long before you go to sleep should you stop looking at a screen?

- The recommendation is at least an hour.

You know, the TV isn't as bad as the screens that are closer to our face when with regard to blue light affecting sleep.

But it still can stimulate our brains with that light because with how we've evolved the when we have any light, it can affect how we sleep and our ability to fall asleep.

But as far as other digital device use, I tell my patients all day, every day, there's a rule that we recommend called the 20, 20, 20 rule.

So every 20 minutes you should look at something 20 feet away for 20 seconds just to give your eyes a break and allow them to refocus and end up at a different distance.

- How has the pandemic affected your practice?

- So overall, you know, we closed for a little bit, but overall we've been OK. You know, everyone's been very respectful of mask wearing.

We limit the amount of people who are here at a time, but it's really been OK. You know, we've been getting through it and it's kind of the new normal now.

- Well, I appreciate your time.

Thank you for sharing your insight with us on screen time.

- Absolutely, my pleasure.

- I want to thank our St Luke's University Health Network expert, Dr Karen Dacey, our other guests, Dr Parkhurst, Saenz and Radtke for joining us today.

And thank you for tuning in.

We look forward to seeing you again soon.

If there's a medical subject, you'd like for us to cover, send me a message on social media.

You can find me on Facebook and on Instagram.

Plus, you can tune in to hear more of my reporting on 91.3 FM WLVR News, your local NPR News source all day, every day.

I'm Genesis Ortega and from all of us here at Lehigh Valley Public Media, stay safe, be healthy, and cheers to your health.