neither the el paso medical society its members nor pbs el paso shall be responsible for the views opinions or facts expressed by the panelists on this television program please consult your doctor [Music] in order to prevent the spread of the virus we all need to do our part one of the easiest ways to prevent that is by wearing a mask in order for masks to do its job it needs to cover your nose your mouth and your chin first you should wash your hands with either sanitizer or soap and water before putting on a mask then pick up your mask by one of the ear loops to make sure that there's no tears or stains on the mask if it is dirty throw it away immediately if it's intact take both loops and put it over your ears like this and then press down on the bridge of the nose to make sure that it fits and there are no gaps you are done with the mask please take it off the same way both ear loops pull it away and put it either in a ziploc bag or throw it away if it's a surgical mask if it's a cloth mask make sure to wash it with soap and water and keep it dry for the next use do not put your mask down at your chin or above on your forehead when you're starting to remove it as that just contaminates the mask thank you so much for doing your part to prevent the spread throughout the season thank you so much dr days and again one thing that we didn't have time to talk about during that video is if you have to move your mask if you feel that it's going down under your nose you take the mask in the middle of the mask you stay away from keeping your fingers on your face don't let that happen um kovid this is a time and you may have heard the term covid19 long haulers this refers to people who have been diagnosed with coven 19 had a myriad of different symptoms and technically technically are recovered however there are long lasting and long-term negative effects and different types of health issues one of them is issues with the eyes issues that affect the eyes as we're going to be talking about this evening we have questions and answers for you about ophthalmology about some long-term lasting effects of covet 19 and what we are doing to figure out where we're going from here please understand please understand that this is all still relatively new and that there are new studies coming out every single day so the doctors are going to answer to the best of their ability this evening as you know this is a live program so stay with us and ans and ask some questions of your own give us a call at 881-013 this evening's program is underwritten by southwest eye institute we also want to thank the texas tech paulo foster school of medicine for providing the medical students to man your phones and actually today it's just one we have ryan floresco with us he's the lone wolf and he did a great job last time he was on so ryan thank you so much for being here we appreciate it and we also want to thank the el paso county medical society for bringing the show to you each and every month good evening i'm catherine berg and you're watching the el paso physician [Music] good evening there are long-term effects for covid19 for some people not all obviously um again this is this is a weird virus it's still novice and it's in in many ways there's still a lot of things that we are going to learn and i joke about this all the time although it's not a joke but a decade from now when they write the book about covet 19 we'll we'll know all the answers that we're trying to to find out right now but dr de la torre dr javier de la torre is an ophthalmologist with the southwest eye institute and what i'd like to do we also have dr brent shelby shelley here and he is an optometrist with the southwest eye institute but dr de la torre you've been here a couple of times before and we've talked about all kinds of different issues but what i'd like for you to answer this evening is what what is an ophthalmologist and then dr shelley will talk about what an optometrist is and how complementary both of your jobs are within southwest eye institute sure thank you for having us again and so we are colleagues but in essence the difference is the training and ophthalmologist by training it goes through a college degree usually it's a four-year college degree then goes through med school and does the minimum four years of med school and then goes into an optomology training process that it's minimum of three years and depending on the fellowship that you do can extend past that and so it trains us to treat both medical and surgical diseases of the eye okay and then also issues too that will affect the eye later on which is kind of what we're talking about this evening and dr shelley um optometrist and complementary to southwest eye institute what what is what is your all-day everyday job does that make sense sure as an optometrist we too have a four-year degree and then go on to a four-year graduate degree in optometry the first two years optometry school are biomedical sciences many of the medical schools in uh the country now actually have medical school the first two years an optometry school combined whereas optometry goes ahead and diversifies into the eye rather than doing the standard uh third and fourth year rotations that a medical school does and the residency as an optometrist we are trained in primary eye care okay we do in addition to your standard glasses and contacts which we do not do at southwest institute we are trained in a treatment of eye disease we don't necessarily do the intense surgical procedures that our ophthalmology colleagues do but we do do some minor procedures so it's it's very cooperative it's a great relationship that we have and i i wanted to start off the show um i was telling dr delatore there is a i call her mama breck a woman that i have known since i was 17 and i was riding my bike earlier today went by her house she goes oh you're doing the southwest eye institute show tonight um and she just wants to give her thanks praise and adoration because she's been wearing contacts since she was 16. she had cataract surgery and she said you know what and they were able to fix my eyesight too so it was just so cute but a thank you from her and i'm sure from so many patients that you all have had um i want to talk about how covid has affected your office at least over the last several i mean my gosh we're into it now a year right but we're into it really heavily the last 10 ish massimentos yeah months yeah so the like many of our colleagues we had mandates from national entities that they recommended that we had to stop for a period of time of seeing patients for routine eye care and for elective surgeries we did continue seeing patients through the pandemic for a period of time just emergencies and also we saw inpatient consultations to continue those patients that really needed acute care but it gave us the chance to to stop put a pause and rethink our operation so we've been blessed that uh through the pandemic we've been able to reorganize and we added a telemedicine that's something that we didn't have before and now we can help patients in a way that it limits the amount of unnecessary visits to the office we were able to hire more doctors and open more facilities to diversify and have a perfect ratio of patients to doctors to limit the wait times to the patients when they get there we see them in an efficient manner uh we also added and and joined forces with one of the one of the practices here in el paso dr louis alpern and dr tafoya and and now we're very proud to have them under our umbrella and and continue the great care that they've had for many decades so it just gave us a chance to stop to reorganize and we've come back stronger along the way unfortunately it was sad also we had a staff that lost family members and and our hearts that goes to them including the father of our founder and and ceo dr mark kellman his father passed away from kobe 19 so it they touched us personally but we're here to er to do it better as as we've come back and uh and we're excited to be here to share what we've learned during the pandemic and how covet 19 has affected the ice my condolences to dr ellman he's he's always been a joy to have on the show and i'm sure we'll have him on again um on that note and i i know dr shelley we kind of covered it a little bit too um but on your end too the office in general what precautions are being taken to prevent the spread i know dr delatoria touched base on that um but on your side sure well the first thing is we do adhere to and follow all cdc guidelines we exceed those guidelines to prepare for the reopening we have increased our staff we actually the doors are attended no one enters the building without having been properly screened i'm sure many people have had the myriad of questions right but no one actually even enters the building now uh without that we provide ppe personal protective gear for uh all employees and patients um every room is sanitized after every single patient that's that's what that's an excellent thing to say okay yes we uh reevaluated our patient flow we reorganized our waiting areas so of course to adhere to social distance standards but allowed us to re-evaluate patient flow so there's fewer patients in the uh building at a time it actually has reduced um patient wait times it's actually made us more efficient right yeah and that makes perfect sense too um like for example with zoomings you were talking about telemedicine i feel like there is an efficiency to we're here for a purpose let's get it down let's get it done um and i think it's wonderful that you guys are doing that so i have not been to your facility is it a one big room waiting room as you walk in describe what your facility looks like as people come in as patients come in actually it so we have at now three facilities in el paso yeah so we the main one in east el paso is a big facility that has our surgery center right next to it and so we've rearranged the waiting area so we have social distancing and the patient flow it's one that really there's not at any moment crowding in the wedding areas we have a central location that we open also this year and we're excited to also say we're going to be opening in the north diesel pass and when we have also an office in las cruces and we're hoping to open a second office in las cruces wow this year so that's all in part of trying to have a perfect ratio of doctors to patients to limit the the the waiting areas and the and the waiting times in in our in our office that's great um the conditions that you've noticed during this time during the pandemic what what conditions are you all treating more or that you're seeing more of right now so you talked about the long haulers and and that's one thing that really surprised us because when we were first informed about kobe 19 they told us it's an upper respiratory disease and there's going to be manifestations that commonly you see like pink eye and so personally we haven't seen a lot of pink eye related to kobe 19 in the office granted that we have a population bias we haven't seen the very sick patients but what we've seen is that there's some infections that are happening around the eye that are related not to kobe 19 but to the use of the mask and so that's something that has really surprised us and so we're going to touch that in in detail but also we've seen in some patients that had kobe 19 that has presented with changes in their vision with double vision with blurry vision with changes in their visual field as well which is very early the information that we've had but we've been surprised and so and we'll also talk about that in detail well let's let's start doing that too because when you're talking about mask is it let's physiologically describe what's happening with the mask is it because you know when you're speaking air goes up it goes right into the tear ducts is that the type of issue that you're talking about correct and it's just just the fact that we're breathing that human air upwards so one fact that a lot of the patients are complaining is that the glasses are getting foggy and so we there's multiple things that can be done to prevent that and so dr shelly can can touch into into that okay dr shelley it's it's you now so we were talking about because i had a question here too about uh foggy glasses when wearing a mask and haven't we all been in that situation um and there are certain times too and i feel like there's a lot of issues or i'm walking into a war zone so to speak i'll put the shield on too and talk about fogginess everywhere so um let's talk a little bit about that sure you know it can certainly be frustrating you're sitting there and you're trying to read or write or something or respond to a text and autocorrect gets it all wrong exactly how many times have we had that right so yeah it does it all the time yeah so there are actually there are commercially available uh sprays that you can uh use to treat current glasses a lot of the optical manufacturers have actually come out with an anti-fog coating and as a little personal uh info on me i've been a scuba diver for 30 years i was just going to say is that the same spray i put on my goggles for scuba diving well i i'm a scuba instructor and a master scuba diver and for years i use a five to one ratio of water to baby shampoo when you're a scuba diver you don't get a rinse your mask out right that is what i use personally on my glasses and examination lens is a little spurt of a five to one ratio of baby shampoo to water and uh you're good to go and you clean your glasses at the same time i love that i'm going to start using that okay so i'll use that a couple of times too there's other patients that have used a very simple trick of just applying a piece of tape at the tip of their mask and that will avoid the air flowing upwards and in some patients have benefit that when we do surgeries like the patient that you talked about where we do cataract surgery where we do lasik surgery we're able to decrease the dependency of the glasses and therefore get rid of the bingo of the fogginess of the glasses with surgery so there's patients that actually have come to us asking for lasik surgery for cataract surgery because they just want to get rid of the fogginess of the glasses wow very eggs this has not gone away for quite some time dr shelley um styles styes i was like man almost sound like an italian dish i wasn't quite sure so let's talk about so i know that my kids had sties before um but chileseons i i don't know what are the difference between the two okay so a stye is um an active infection of an oil gland in the eyelid i like to explain to my patients it's kind of like a pimple in your eyelids okay and when the hairs come out is that what yes yes in that general area yes ma'am and um it's an active acute inflammation okay whereas a stye is where the inflammation has more died off the bacteria aren't necessarily growing and reproducing a stye is very tender to the touch it's sore you don't like to touch and rub it like it hurts yes a chilisian is less tender to the touch okay and uh is more of a long-term necrotic dead bacteria issue oh wow okay so describe what that might look like uh some people will complain that you know i've had this bump on my eyelid for two or three months or people will say you know my i had a sty a few weeks ago and i tried some over-the-counter uh style remover and you know it feels better but i still have this bump so it went from being a stye to being a chillasian okay so a chilesian to continue with that is there a way to does that go away on its own does that require treatment you know there are treatments and i'll yield that to dr delathori okay great before i do that just my natural question pinkeye because that's something you get pink eye in school it's like everybody's got to stay home it's like lice whatever it is so i know it's not on here i get it uh but talk about pink eye really quick just because that's another common issue sure pink eye is a generic term for a condition called conjunctivitis there are a variety of different causes and it depends whether it's a bacterial cause or it's a viral cause that in and of itself is the real determinant on how contagious you are okay yeah you can actually have the common cold and then get a flaring pink eye thereafter okay and you can also have a bacterial infection that clears up within a day or two with just antibiotics viral pink eye conjunctivitis due to the cold you know it takes a week or two to resolve whereas a bacterial conjunctivitis will clear up very quickly okay so it's kind of still like the so you can't definitely see it i definitely see an eye care professional to differentiate the diagnosis okay and if i could because we're on this subject too when a parent is looking at a child with pink guys i remember with my poor kid we were on vacation we had to find a doctor describe what pink eye looks like versus a stye ah yes so pink eye will cause the white of the eye to be red and the child will generally complain that they've got crusting on their eyelashes the eye tends to burn it feels irritated they've got a lot of mattering whereas a stye it's more to the eyelid itself being red swollen and tender to the touch okay yeah perfectly described and i know dr de la torre i just stole that away from you uh the treating of the styles no but i i want to touch on something that dr shelly mentioned he made a great uh point in uh explaining how a style is like a pimple in my eyelid and and i was talking to some of my colleagues that are dermatologists here in el paso dr guevara dr osanic and they've noticed the same issue with the mask use and they're they're calling it actually masked knee so acne created by the mask and so it's a general problem perfect sense to me so it's it in general it is a oil gland that gets blocked and when an oil gland gets blocked bacteria will try to invade it and cause an infection same thing in the skin same thing in the eyelid and so sty's as dr shelley explained it's an infection in the eyelid and we tend to treat it with antibiotics a combination of oral and topical antibiotics we tend to prefer ointments rather than eye drops eye drops are mainly for pink eye versus when it's an eyelid infection we try to treat it with ointments because it penetrates to the skin the eye drop will penetrate through the eyeball itself so ointment you're talking about ointment that's kind of got the consistency of vaseline i'm just trying but it's designed but it's designed to be used around the eye so if it gets in the eye doesn't sting gotcha and then and then antibiotic peels and we like to use warm compresses to massage that area and the warm massages attracts a vasodilation and healing power of your body to that area to get rid of that infection we've seen a dramatic increase in the frequency of size insulation since the pandemic started interesting so this has become like the second pandemic we're seeing about three to five new patients with size insulations daily and there's been an increase also in the frequency of how many surgeries we do for the chileasians because the styes we tend to treat with medical treatment and they tend to get better but the actual the style that never drains becomes a chelation as doctor shall explain and those we tend to do more surgical procedure when the patients develop at scalaceon we bring them to the clinic we numb the eyelid and we do a procedure where we drain the chelation from the inside of the eyelid so there's no visible scar outside and they wear a patch for a day and they go home and use the antibiotic ointment to help them heal and tends within a week to get better but this we've seen a dramatic increase we've seen compared to 20 18 28 more cases oh my goodness that we did in 2020 and 22 more compared to 2019 so there's definitely our correlation and again we're not anti-masters we we do believe yeah yeah so that's when we ask you prevention we have to use the map but there are ways to be able to safely use the mask but also prevent styles and challenges okay and that's where you come in prevention man uh so we talked a little bit about so is the cleaning of the mask and that's something too like i'm wearing a cloth mask i've got several of these exact same masks but um is it is it right to say you have to treat your mask like you're cleaning you know like you treat your underwear you clean your underwear every day right if you only have one pair you're going to clean your underwear every day same thing with the mask if you guys have a cloth mask or permanent mask that you have around it's different with you all if you've got disposable masks but um i just wanted to say that just in general because we're going to be in mask mode for a good year you know around the globe um so other prevention that you might be able to think of well certainly uh cleaning your mask like your mom would say i don't want you having an auto accident in dirty underwear [Laughter] make sure you uh definitely are washing your mask hot water every day have two or three masks as a matter of fact you know like we said the data is always changing what i say today may be different next week but even just yesterday they uh came out saying that maybe two masks is the way to go so definitely a clean mask on a constant basis yeah and when the faces and when the pieces have been using the mask and again we we see with the foggy glasses that air is coming upwards we believe that that air is bringing bacteria to the eyelids after a day where you've been using the mask water and soap we recommend baby shampoo that doesn't sting and we can clean the lash as well they also sell commercially available lid scrubs that have a shampoo that doesn't sting and we can just scrub our lashes well to remove the bacterias that have accumulated throughout the day and prevent the size and the solutions in that way interesting okay um i think we covered most of that i'd like to talk about and i just thought this question was interesting this is a question that you all provided which i thought was kind of cool dr della torre um the types of problems that you're finding uh postcovid people firefighters who have had kovid now they're technically again recovered like we talked about beginning the show fire fire specifically you were talking about what what's yeah so so it's a very interesting story talking about the long hauler so we we i have a doctor that has worked with uh our office dr nance and a trusted doctor he already retired and he put us in contact with doctors ago goodness gracious yes a great guy and so he put us in contact with an oculo occupational therapist that has been helping firefighters here in el paso recovered from kobe and she noticed a pattern of these firefighters complaining to her about vision changes and it was really interesting so we invited these firefighters to come to our office and we did a full examination dr shelley was the leader there and we had a protocol on how to examine them and how to test their eyes and we started to notice a pattern of these patients having blurry vision having double vision having also changes in their peripheral vision and we found it very curious we're not saying that it's only isolated to firefighters that's all our experience in in how these patients came to us from these occupational therapies that that uh noticed this trend and so we are in the early stages of collecting collecting data and we're sending this firefighters to get more testing to see what correlations we we can find and where the problem is but dr shelley has taken the lead so he has more details about that so i'm going to ask you about that and again what this book 10 years from now will reveal that's interesting to me um question here objectively verifiable right and and that's one of the questions too the complaints and again we're looking at firefighters now and and thoughts of who might come up with these issues in the future i don't know absolutely so um first let me say it's been a thrill if i if thrill is the proper appropriate word i've been honored to work with these firefighters and uh it's we've got some really interesting data um some of the tests we can do involve measuring eye alignment measuring peripheral vision uh measuring visual acuity these are all objectively verifiable conditions whereas pain is always a subjective thing we take people with their word we have grading skills but it's very subjective but the verifiable objective information that we've obtained is very interesting and what i know it's just a guessing process right now why might you think is it firefighters i mean is it oh it's just curious to know firefighters are the subjects of the study they were directed to us okay so they are there right it's not it's not every post-code patient that comes in the office okay it is this subset of patients that are in the office that were corroborating with other providers on i get you yeah okay because in my head i'm thinking would they have had to been in the fire of smoke i mean what's this oh no it's not that type of thing i get it just happens to be that that study group that you're looking at um the results of the finding dr shelley were just talking about that too and so i have i've got a lot of the questions that we burn through really quick but here's a great question from the audience that i want to ask uh from uh ryan thank you ryan for sending this away i'm reading this cold have you seen a trend in diabetic in diabetics or those with macular degeneration being more affected by long-term eye symptoms after cobit 19. question from the audience and again i will stress this too this is all new i mean we've been in this for 10 real months and so a lot of this stuff is brand new so i just want to give both you guys a disclaimer even though we have that beginning the show so we're going to do the best we can to answer this question would you like me to read it again no no okay i got it okay so i can tell you that diabetes being a pre-existing condition and patients with diabetic retinopathy which is a manifestation of diabetes in the eyes it would make sense for those patients to be at higher risk of having a complications we personally we don't treat a diabetic retinopathy to the level that's more of a retina specialist so we haven't seen a lot of patients with of that subset of population to really be able to gather that data and answer that question accurately but there are retina specialists in town that just that's their bread and butter they dedicate themselves to diabetes and diabetes in the eyes okay um on that same note and i'm just thinking cataracts and and i know we're we're deviating from here now but the idea of cataracts and it may be or maybe not related to covid um but because we have you guys on the air and because we have people in the audience that they're going to have cataracts whether or not kovid's around or not i would like to talk about what what cataracts are like what physiologically is happening to the lenses in your eye when someone starts to develop cataracts and then i like with you on that answer talk about the stages like some people don't know that their eyes are cataract-y until it's a good point right so yeah so um we have a natural lens that got placed inside the eye and that lens over time starts to go through the natural aging changes that at first makes it not to be as flexible and that usually starts around age 45 to 55 where we start to develop the need for reading glasses and then later on in life that lens starts to also opacify and get cloudy and that starts to uh not allow the light to go through the eye and be able to focus properly in the retina the back of the eye so that's what we call a cataract so when the lens gets cloudy and gets stiff and doesn't help us focus well okay and so we have a grading system goes through one through four and so four is a mature cataract that in theory the patient has significant loss of vision one would be a cataract that is in the early stages that the patients still with glasses or contacts can see well and function well and so we want to emphasize that in terms of cataract surgery no longer with the modern surgery that we do nowadays there's reason to wait until a cataract gets to a four to do cataract surgery okay and so now we've noticed that with the covet pandemic a lot of the patients that are in the cataract age they wanted to postpone their routine eye care that includes a regular exams for cataracts and cataract surgery and so we want to encourage those patients to come back and to have their eyes examined that we have taken all the precautions to ensure their safety in the office because you don't want to wait on a cataract to continue to ripen right to then do the surgery and so we're hoping that in 2021 we can capture those patients that decided to postpone their care during 2020 uh and and and make them feel welcome and and and safe in our facilities so here here's my question to sometimes people you were talking about right that was one of my favorite questions from way back when what does it mean when a cataract is ripe you have to have it right before removing but you're talking about it doesn't have to be right but when a patient because sometimes your vision can start getting worse but because it's happening so gradually you don't know it when when do you think hmm how's this question when one might know when it's time to go should i talk to shelly about that so dr shelly um again and and this and i remember this this happened with my grandmother which is why she we were talking before the show my grandmother was uh 80 when she had a new lens put in her eye it was back in germany but it was 30 years ago so i'm thinking gosh the the surgeries from now versus then um but she says she waited too long she didn't want to have the surgery and we were bringing her to america to live with us here so she wanted to have everything done there but in general how do you know when it's time how do you know when you think you have cataracts does somebody need to tell you your eyes look cloudy do you see that you are having a hard time seeing it and i'm talking about people who are not getting the yearly eye exams which they should is something we should say on this show too definitely they should be getting their annual exams but the the complaint that someone will notice that they're developing cataracts is they'll have glare at night when driving or they'll have a ring around headlights or street lights or like last night was a beautiful full moon people will see two moons superimposed over one another reading the um the ticker on the news at the bottom of the tv or subtitles they'll notice problems with that inverting letters difficulty of doing tasks around the house without having bright light you know they have to put a really bright light on to be able to read and stuff like that basically they'll they'll uh be going along they'll start noticing their vision changing and then so they do seek out care and that's when they find out oh i have cataracts i don't need just a new pair of glasses because it is it's so slow and inciduous it really is like you mentioned and one way that patients can know that it's the cataract affecting their vision is that when they go for that annual exam with their optometrist and they're giving you glasses and then they put the new glasses and they don't see a wow effect of that new glass that helped them see better right that's the catter because the problem is inside the eye so it doesn't matter how new and fancy are the glasses outside the problem is inside the eye so that's a way that the patients can also know new glasses don't make a big change in their vision right so here's my my science question um that i want to ask you so what exactly are you doing physiologically to the eye during a cataract surgery because we were talking about this a little bit before the show when god gives you that lens and we take that lens away we got to give it the lens back could you kind of describe to our audience who might be in that world of oh should i have cataract surgery should i not uh describe how the surgery is so character is an outpatient procedure that is done under a local anesthesia and sedation and in our facility we have mastered the cataract surgery to a level that patient's satisfaction is really high typically we place a pill under their tongue that melts and that gives them enough sedation we don't have to start any iv and we do eye drops that numb the eye the patient is taken to the operating room and we just have a cover just for the area of the eye but they can they're breathing and they're interacting with the surgeon they're talking to the surgeon we do very small incisions over the cornea and we enter the eye and we open the sac that holds the cataract think about it as a grape and we're going to remove the skin of the grape and that gives us access to the inside contents okay we're going to use a machine that's called an ultrasound machine and we're going to eat up the inside contents but we're going to leave that sack like the skin of the grape is left behind and in that same skin we're going to place the new lens that goes inside the eye there's multiple lenses in the us market that can be used and we customize the lens to the patient so now it's not cookie cutter everybody gets the same we have a ways to customize the vision for the patient so they can achieve the best vision possible and they're less dependent on glasses after cataract surgery that's fascinating to me so here's another question to stay awake during the surgery the sedation you said that they have is that a necessity is that so that there can be communication with the doctor as a surgery is going on or is that more of a comfort level it's for comfort and so there are patients that request no anesthesia we oh my god yeah yeah so we we encourage patients to have the anesthesia so they're more comfortable during their procedure i would say that most of the patients they do like the anesthesia we provide right and uh for the second i they they request the same okay um but do you have people that ask to be put out completely we we have patients that have requests that we don't provide those services because we feel that the risk of doing that outweigh the benefits cataract surgery in our surgeon's hands is about eight to ten minute procedure so it's really not worth the risk of putting somebody on the anesthesia for such a small period of time uh but there are some patients that because they have disabilities that they cannot cooperate with the surgeon that they do have to be put under anesthesia and we refer those patients to other colleagues that we have in el paso that do a great job with sedation so when i need to have this done many many years from now you need to make me super loopy that's all i'm asking i need to be super super loopy um dr shelly i have a question here about focusing and eye alignment cetera et cetera so i know that's part of your specialty too so if we could talk about um just eye alignments and focusings i know it's we're kind of deviating from cataracts here but it's a question that that was interesting me here uh before the show okay so what this question uh deals with is some of the findings we're having with our uh coveted firefighters okay and uh the results have been really interesting as i alluded to earlier 91 of the uh of their patients in the uh coveted study i'm going to refrain from saying firefighter studies so we don't okay yeah that helps because i keep thinking it's because of their occupation but yeah 91 of our patients in that study complain of eye pain by pain eye pain okay and 66 have a verifiable change in their peripheral vision interesting that's a big percentage it is it was an astounding percentage when i was crunching the numbers and doing the test okay and then for the eye alignment and focusing 54 percent have problems focusing all but this is all post covid yeah this is they had coveted they're recovered from covet this is now some of the exactly all issues okay their distance vision is still perfect they all have perfect distance vision what happens is when we read our eyes converge that means our eyes point in okay so we look at something up close right 54 of our patients and there's actually only one of them that's different have had an eye that points out we have one patient where his eye crossed in interesting yes so uh i have theoretical reasons on what that is but i'm not even going to put those out there because it's all in theory and in theory communism works we have a disclaimer at the beginning at the end of the show because they're in really there's everything's almost theory right now when it comes to again long haulers it's a terrible word to use but that's what they're using and that's what people know about it um but uh would you feel comfortable throwing out a theory and and disclaiming it as a theory as to why that might be a case and if not i completely respect that honestly yeah i do okay let's do i do okay and it all ties in with the visual field okay so as i mentioned 66 percent of our patients have a verifiable visual field of that 66 percent two-thirds have a visual field loss at the top of their vision one-third at the bottom of your vision why does that matter because the neurons or the nerves that run from the eye to the vision cortex of the brain run a very distinct pattern through various parts of the brain superior visual field stuff we see up here is processed in our temporal lobe which is where memory functions are at bottom visual field is our parietal lobe where proprioception sense touch knowing where i am in three dimensions is that okay also by the parietal lobe at the brain stem is an area called the copora quadrigeminide this is where vision and hearing interconnect to allow us 3d when you hear something you know where it's at that's processed in the kapoor quadro gemini and i hypothesize that somewhere in that area where there's been something neurological but it's only in theory yes so we're talking about the eyes but really in essence the theory and i and i respect that is kind of a brain issue oh absolutely the visual field communication between the ocular yes the visual field is actually a wonderful neurological test it's used for migraines it's used for strokes it's used for myriad issues other than just like glaucoma which a lot of people think of peripheral vision and glaucoma so what we've done is send these patients to get mris to see if we can identify those areas that dr shelley have mentioned in the brain and see if we can point at where the issue has been and and see if we can make the correlation of the eye findings that we're finding with the mri findings and if there's any pathology that was created postcode but again this is all theoretical right now no i mean this is great so how how long have you been sort of kind of studying this was this brought to you several months ago yeah several months ago we were approached by dr nansen by his uh friend occupational therapist and and so we got dr schell involved and so we've been it for about a couple of months now and and it's very interesting we're still in the very early stages but this is the things like you say that in the future we'll look back and and try to put the pieces of the puzzle together right now this is just too early you have to make sure to get a recording of this program okay okay so that eight and a half years from now when we write the book that's kind of what we thought it was and it turned out to be the case so i i think that's fascinating in fact it'd be interesting um if people see the show if there's another occupation i don't know when i say occupation because it's an occupational therapist that brought this to you right the whole idea of it but it just the interestingness of itself are there other people that have different visual issues you said earlier that there was complaint of the eyes hurting now to me when i think my eyes hurt that's when i feel like i'm getting a headache behind my eyes and i don't know if it's so much my eyes or it's one of those ocular i call it an awkward headache it's not what it is but what what was that complaint like how were their eyes hurting does that mean yeah it sure does pain behind the eyes and i specifically asked them when they complain of eye pain are you talking about the front of the eye the eyelid i do try to localize it and invariably it's pain behind the eyes like a pressurey pain i don't know why i'm so curious about this yeah a dull constant eight yes ma'am okay yes we wanna use this as a a chance to open it to the public to help bingo that's why i wanna bring it if there's more patients out there that are having the same issues to please call our office and make an appointment so we can help them figure this out and they will help us also with gathering more data so we can then be able to make informed decisions and and conclusions that we can then learn from but right now it's very early we have just a very small sample of patients but i'm pretty sure that there's people out there that are hearing us that are relating to this and we want to welcome them to come to our office and and call our office to to make an appointment okay and i just again love the idea that it's like a case study so to speak and or even a clinical trial if you get to a point of trying to treat what these things might be at that point dr shelly right now you're just studying what it is but there's really not a a way of treating it that we know of yet again it's too early in the stages that's correct we're trying to put it all to that point so again if you've got some of those issues if you're post-covered in recovery and or recovered and you're having some of these issues again southwest eye institute call them and just kind of let them know what's going on and this could be something that they can study you too that number is 2 6 7 20 20. um again since i have you guys here we got another question here from the audience give me just a second i'm reading this cold uh question from the audience a 67 year old female who is overall healthy but every now and again we'll see stars in twinkling in my peripheral vision we were talking about this dr shelley was talking about that i go i don't get dizzy but i want to know if there's some kind of concern about this uh actually i don't know which one of us we were talking about what the signs of cataracts could be would this be no this is something different so when the patients see lights in their vision there's two things that come in mind number one the retina which is the the film of our camera if it's stimulated by pulling and tugging on it it will trigger flashes of light in especially in the peripheral division so when a patient sees new flashes of light we always want to have them come in so we can examine the retina make sure that the retina has not been pulled right to the point where it breaks and tears the other thing that can in a healthy patient cause those changes in the peripheral vision it's actually a retinal migraines there are some patients that have because the retina is made out of neurons and actions they can have like a migraine but in the retina and the way that the migraine will manifest would be with changes of light and in the peripheral vision so that's something that it could be one or the other we would have to examine the patient or know but those are the two most common reasons why a patient would see lights in their vision so here's just a katherine bird question um and yes i have blue eyes people are like you're so sensitive to light because your eyes are blue like yeah i don't buy it really why is it that some people are so photo sensitive in other people's art i mean i remember my daughter you know i used to call her the vampire because of sunshine in her eyes she's like what is that condition why does that happen i'm just asking whichever one of you wants to take it dr shelly yeah it's your turn so you answered your own question with the blue eyes oh it really is so i mean so what happens is the uh there is a pigment inside the eye called the melanin or called melanin and it's the level of melanin that dictates light sensitivity i have green eyes you have blue dr delatorre has brown believe it or not all three of us have black pigment on our iris and it's the level of pigment that actually gives us the light color that we reflect back to people when looking at our eyes so it's the short answer is the amount of pigment in the eye but also the the pupil size that you have so there are some patients that they tend to have larger pupils yes therefore they're allow more light into the eye and so that can trigger the light sensitivity so the amount of pigment like dr shelly said and the pupil size will determine the light sensitivity how interesting pupil size makes sense to me as well so my daughter has blue eyes my son has brown eyes he's never complained a day in his life but my daughter has big ol honking pupils and we've always kind of made fun of her eyes she's got huge eyes anyway but she really really had a problem when she was i mean from infant until three or four who were like we're just gonna put sunglasses on you um fascinating a question here from the audience um since october it doesn't give me an age or or any information other than that but the question from the audience is since october i've had mucus in my left eye putting eye drops helps dissolve it but it comes back who should i see for this so we were talking about all the different the styes and the binkai etc who wants to take that one dr shelley so mucus in the eye in one eye but since october goodness you know off the cuff i would guess that this patient has a plugged drain duct of the eye our tears run from our eyebrow across our eye and down into our sinuses there's a little duct at the corner from the eye to the nose and that's why our nose runs when we cry because the increased tears going down there i suspect that this person has a blocked tear duct drain duct and that's what's causing this and could they come to your office absolutely they could get them cleared up okay um question here from the audience what is macular edema and is it reversible question from the audience yeah so microedema is when so the the area of the retina which is the the back of that the film of the camera that that god designed to see the sharpest is called the macula and the macula uh when it absorbs water that's called macular edema the two most common reasons for that to happen is diabetes and macular degeneration and so those are the two most common reasons why the immaculate would develop swelling and that swelling would limit the amount of vision of the eye that area is not designed to have water so it will distort the vision and so macular degeneration it not only there's edema but there's bleeding in the macula and again this is a disease that tends to be treated by a retina specialist and diabetic retinopathy in again early stages same thing you prevent it by just keeping your sugars under control but when it gets to the point where you develop macular edema you need help and we refer the patients to our retina specialists okay so it's not reversible but it is treatable it is treatable okay but it can be reversible it can it can be with with appropriate and timely treatment so if the patient has macroedema for years very difficult to remove that but if it's something that's treated over a fairly promptly we can reverse it okay we have about six minutes left in the show i didn't stop as early as i thought it would because things were just going so well so dr shelly is there anything that we have not covered this evening that you'd like to talk about uh and dr de la torre i'll ask you the same thing in a moment well definitely the importance of annual comprehensive ophthalmic examinations cannot be understated or i should say cannot be overstated overstated i apologize the i and vision is our universal sense it is the most valued uh sense that we have and the changes in the eye can be very slow and insiduous and here in el paso with our large hispanic population there is an eye disease called glaucoma okay people don't know they have glaucoma it can only be detected during a comprehensive ophthalmic examination and uh left untreated glaucoma can cause severe vision loss leading to blindness so definitely this is pressure in the eyes right the eye pressure right it's generally thought of pressure but it's actually more broad than that but yeah okay yeah i just thought i'd throw that out there really quickly because when they're checking that in the office that's what they're checking for dr della torre just because we're running out of time anything that you'd like to bring across that we haven't i just want to emphasize that we're open for business that we've taken all the precautions for patients feel safe and that we've implemented telemedicine a lot of these patients that that we've been seeing with the styes and the insulation related to the mask the initial visit we're doing over the phone and we're helping them we're trying to guide treatment without actually having the patient come into the office and initiate treatment over the phone and then bring the patients that really need to come in a lot of these mass related infections that we've encountered we've been able to treat over the phone and and save time and and money to the patient so we want to let them know that we're open for the business that it be a telemedicine or in the clinic we can help them out and that will make sure that they're safe once they're visiting our facilities yeah at the end of the day don't delay your medical care um because again there are very few safer places than being in a medical type of a situation at your office and in the hospital believe it or not you know some people are like oh i don't want to do that but if you've got an issue take care of it we've had cardiologists on that people did not take care of their heart issues and unfortunately uh succumbed to that i wanted to say a couple of websites and telephone numbers really quick if you have not yet registered for the covid vaccine it doesn't matter what phase you're in i just registered two days ago i'm phase four i'm like the last of the last of the last that's allowed to get it i'm 53 i have no underlining conditions but at least i know i'm registered e p think of el paso ep covid vaccine dot com is where to go on that opening page you will see pre-register on that very top right hand corner do that so that when your turn comes you're already registered and you're you're ready to get uh your vaccine so let me repeat that ep the word covid c-o-v-i-d the word vaccine v-a-c-c-i-n-e dot com go there to pre-register and i have to give a huge high-five to el paso el paso county uh you know texas as well but el paso has been doing very very good at the distribution of the vaccines i know that there's you know every night on the news you hear all this um and it's true i mean we've got a lot of issues globally as far as disseminating the vaccine but el paso had a plan in place months ago on of all of the areas el paso is doing really well in that area if you are not a web person or a website person telephone number to call 915-212-1032 again 915-212-1032 and the website again covidvacine.com is what it is i wanna say thank you so much and now i feel like i have too much time i'm gonna tap dance for a little bit we have two minutes oh we have two more minutes what do you want to say well i want to thank all our staff that there you go perfect that has been so compliant with wearing their ppe and and and helping us keep the facilities clean and uh sacrificing themselves uh going to work and so uh we we want to truly thank them uh for for that sacrifice and most of them already fortunately has gotten the vaccine so you're right el paso county has provided that and so we were very proud of all of them so we want to thank them nice and and keep wearing your masks i know that help is on the way it is uh but we still have to be very cognizant of keeping the mass on social distancing i know everybody's tired of it this is a medical show so if you're watching this and you're rolling your eyes because you're tired of people telling you just keep doing it for a while and do register for the vaccine that's us as a medical entity saying that it matters so register for the vaccine once you get the vaccine that's when we can start getting our herd immunity in the place i know that's a whole other topic for another 15 000 shows but for the most part right now there are two vaccines that are approved that you will have two doses for they're looking at another vaccine that we'll only have one dose for but ep coveted vaccine dot com hey ryan our first year student i want to say again to ryan floresca who has been really oh look at you you're all smiley and happy he's done a great job so what he does is send me all the questions via my text but high five to you my friend you're doing a great job and we appreciate that very much and also a big thank you to the el paso county medical society for bringing the show to every every month and actually often times more than that in the southwest eye institute you've been watching the el paso position i'm catherine berg stay safe keep your mask on good night [Music] [Music] you