[Music] good evening and welcome to doctors on call i'm dr ray christensen faculty member from the department of family medicine and biobehavioral health at the university of minnesota medical school duluth campus and a family medicine physician with gateway family health clinic in moose lake i'm your host for our program tonight on eye problems the success of this program is very dependent on you the viewer so please call in your questions or email them to the station the telephone numbers can be found at the bottom of your screen our panelists for this evening include dr todd britton an ophthalmologist with ralph eye care specialist in hermantown and dr kevin tracy an ophthalmologist with st luke's eye care medical arts building our medical students answering the phone tonight are michael goodman from marshall minnesota tanner nordseth from round lake minnesota and lucas rodemaker from battle lake minnesota and now on to tonight's program on eye problems gentlemen welcome this is our last show of the season it was nice you to come out dr tracy i think we'd like to start with you tell me a little bit about your practice before we jump into what we're doing all right i've been uh practicing ophthalmology in duluth since 1988 and uh practiced primarily at the medical arts building and do surgery at st luke's and two harbors and moose lake are actually a cloquet now so i've enjoyed practicing in the north good for you nice to have you dr britton yourself how long have you been around yeah i'm a comprehensive ophthalmologist i've been practicing in duluth for three years now prior to that i was in michigan for three years as well so what does comprehensive mean comprehensive means a little bit of everything but gp kind of like exactly like gp for the eye so very good dr tracy we're going to start tonight with some anatomy you've got the model sitting there so have at it sure well the eye is an amazing structure it's not very big but it's got all sorts of connections and functions that we think about every day when we're evaluating people that are having trouble with vision the goal is for people to have incoming light go through the front part of the eye and become focused on the back part of the eye the retina and some people can do that without glasses other people need glasses to bring it into focus and then from the retina these electrical signals that are generated are sent back to the brain to be interpreted as the vision that we enjoy and there's about 1.2 million nerve fibers that connect the eye to the brain and our goal is to protect those nerves for a lifetime as well as the other structures in the in the eye dr britton it raises the question to me why do we need glasses so we've got the we've got the the cornea we've got the lens and that focuses back so what why do we use glasses what what's the reason for that um so glasses are used for a number of reasons oftentimes when we are let's say near-sighted so a near-sighted person either their eye is either too strong or it's too long and glasses do the you know essentially you know weaken the eye to some extent to focus light on the back of the eye on the retina patients who are far sided although it sounds like they can see far not necessarily true you know everything's a little bit blurry and uh there their images tend to focus behind the retina and so the glasses act to bring the image on the retina glasses are all about focusing the image on the retina where it should be and then they they're the other reason a lot of us start to wear glasses when we get into our mid 40s is because of what's called presbyopia our lens starts to harden it just doesn't change shape like it used to and that makes it tough to see things up close when we're younger when we're when we're in our 20s the the lens balls up into a ball and that allows us to see up close but we we lose that ability like the rest of our body our lens becomes less flexible as we get older and pres to me means old or aging or whatever so there are several ways that you can fix that vision one is with the lenses uh kevin are there other mechanisms that we can use for improving vision short of having to wear the glasses right yes basically if a person needs help either bringing the light rays farther back or closer in uh different types of lenses can do it glasses have been around for you know centuries contact lenses are a nice way to also correct for refractive air that they sit right on the cornea and they can provide the same function the cornea can be reshaped so tissue can be taken away in a certain pattern that will allow the light rays to fall on the back of the eye so that would be lasik or prk and now with for instance cataract surgery taking out the cataract not only will improve the sharpness of vision but it can also eliminate the refractive air more and more so all of those methods can help and i assume that you gentlemen both do lasik surgery or are involved with the you do they so what do you do with lasik surgery todd yeah our clinic does do lasik surgery so lasik surgery i think the best way to explain it is to explain it in the form of an analogy so um when we when we do lasik surgery you know you want to think of the can about your mom so with lasik surgery it's it's essentially um performing surgery on the cornea which is the clear part of the eye um think of the cornea like a book you know a book with many pages with lasik surgery you're essentially opening up that book or opening up the cornea and you're removing or altering you know pages within that book and then you're closing the book so you create a flap you lift that flap and you laser the corny underneath the flap and then when you're done you put that flap back the advantage of doing lasik is almost immediate improvement without a whole lot of discomfort you know after the procedure um there is another person did you want me to talk about any of the other procedures go ahead okay so another procedure we think you're taking too much time on that give me the hook so there's another procedure called prk which um in contrast to lasik does not create a flap uh prk uh what is done is what does that stand for yeah a photorefractive keratectomy okay and so with prk what you're doing is you're removing a layer the most superficial layer of the cornea and then you're lasering them that chlorine the drawbacks of prk is of course you're causing a large abrasion on the surface of the eye which is uncomfortable the healing takes longer the advantage is you're not cutting a flap so you're not cutting through nerves one one thing that some of our lasik patients notice is that dry eye can be more problematic after lasik surgery prk is less likely to cause some of those issues and you also don't have to have as thick of a cornea for prk as you do for lasik because you're not creating that flap thank you so kevin why don't you take us into the lens so let's talk about cataracts a little bit all right um when why and how often should they should they be done together how do you do these things so when do you determine that you should do cataract surgery let's start there sure well i'm going to show this again we should let you guys sit together yeah well we'll keep our distance this model has a clear lens and we start life with a clear lens as we get older that lens becomes cloudy and when it starts to interfere with visual function trouble with reading driving depth reception handiwork whatever it might be then it's reasonable to offer cataract surgery which involves going into the eye taking out the cloudy lens and then replacing putting a clear lens plastic synthetic material in the same place where the cataract was and by doing that again as i mentioned earlier not only can you clear the vision but you can redirect the light rays and hopefully bring them into focus some people want to be left nearsighted so they can read without glasses other people want to do the computer without glasses other people want to do good distance vision and so it's a discussion that the surgeon and the patient have what type lens there are some that give more than one focal point and there's drawbacks and whatnot so it's a it's actually gotten more involved the decision making because we have so many options now let's have a little discussion on that because one of the questions was having the having the cataract surgery and what are the options for lenses and what should they consider and i know that some patients set up for distance in there and all these and then there's pan optics and some other types of things so todd it's your turn if you want to jump in and you guys can talk back and forth if you'd like yeah um we could spend the rest of today's show talking about different lenses and it seems like there's always something new coming out is essentially when you when deciding what lens to select a lot of it comes down to whether you want to be free of glasses for some situations all situations the the lens what we call monofocal lens this is the lens that's um often covered by most insurance uh companies uh allows us to correct the vision for you know essentially one distance you know if we if we take into account that all of us basically have three distances where we you know we kind of go about our day-to-day you know activities there's the the way off in the distance being able to see across the room there's computer distance and then there's reading with a monofocal lens we can correct for one of those distances without glasses and then you wear glasses for the other two there are lenses that give you much more broader range of vision that allow you to see everything from distance to you know to reading without glasses and they they work quite well in most circumstances they don't necessarily free you from glasses all the time but they do give you some spectacle independence for for most situations what is pan optics kevin we consider that to be a trifocal lens where it's basically got distance intermediate and near and the earlier versions were rather problematic because they were notorious for creating glare and halos with nighttime driving and some people that became a real detriment to those implants there's an out-of-pocket cost associated with these implants but again the quality of the multifocals trifocal bifocals have gotten better and there are some that blend vision a little i guess more naturally so basically panoptix is one of many options and once they're in you have to live with them so big choice ahead of time we like you to live with them and they can be removed and replaced but every time you do that you run the risk of complications where dry eyes todd you want to talk about dry eyes a little bit yeah dry eye is something i think a lot of us deal with um i would say you know it's you know roughly of 80 percent of my patients that i see day day in and day out have some symptoms associated with dry eye what's often confusing with dry eyes your eyes often water when they're dry so it's kind of the eyes last stitch effort to try to moisturize itself there are a lot of things that factor into dryness our environment that we live in especially here in duluth the cold dry weather winter is the worst time for dryness different medications that we take a lot of the side effects of those medications are our dry eye and then just getting older you know our bodies don't work quite as well as they as it used to what are some remedies that you guys prescribed kevin probably the most common is recommending over-the-counter lubricating drops and those for mild dry eyes seem to be adequate for many people we've learned that it's not always a decrease in tear production but there can be an increased evaporation so helping the glands secrete oils onto the tear film to reduce evaporation is another approach that is often discussed with patients if they show signs of needing that and now there are prescription medications to suppress inflammation and also stimulate tear production and even novel techniques of stimulating nerves within the nose to increase production of tears in the eye so a lot of research going in because as dr brenton mentioned it's a it's a common problem we forget that the great american desert is the northern latitudes in the wintertime and the humidity is usually very low macular degeneration dr tracy you have the equipment over there do you want to address macular degeneration a little bit for us yeah and i think for this i'll take the model off and show the picture because again light comes in the front goes through the cornea goes to the lens in the back of the eye and then just off the optic nerve is called the macula and that's where the cones and the density of the nerve fibers are greatest and that allows for the fine detail that we need for reading small print and other items well as we get older that area of the retina is prone to degeneration and accumulation of material that can cause worsening vision most of it is dry meaning there's no new blood vessels occasionally part of the response of the eye to this degeneration is to develop new blood vessels and that can lead to severe vision loss due to scar tissue so there are nutritional recommendations dietary supplements that can help slow down the degeneration trying to prevent severe vision loss and if people do show new blood vessels then injecting medicine in the eye can also help maintain good vision so the difference between dry and wet is the blood vessels so do you you brought up one of the questions is what should i take are there vitamins or are there things i should take to protect my eyes well i think everyone there's many good reasons to maintain a well-balanced diet lots of fruits and vegetables green leafy vegetables in particular may reduce macular degeneration if people develop what we would consider intermediate or advanced changes on their eye exam even though they're not aware that they have a problem then we do recommend some over-the-counter nutritional supplements that have a combination of vitamins and minerals todd there's been a couple questions on eye health we're addressing a little bit here but someone's got normal vision never had any problems why should they see an ophthalmologist yeah yeah a lot of a lot of the or an optometrist i guess for that yeah yeah absolutely um yeah a lot of unfortunately a lot of eye conditions um they have a very insidious onset and uh you know we think of things like glaucoma what is glaucoma yeah glaucoma is damage to the nerve in the back of the eye and uh has you know many factors that play a role in terms of increasing your risk of developing glaucoma age is certainly a risk factor family history eye pressure the the thing is that a lot of a lot of the changes that happen with glaucoma are they go unnoticed until the glaucoma is very bad [Music] glaucoma is something where you're not going to notice the the changes in your vision without specific testing which we can do in the office dr tracy diabetic eye exams how often should they come in and what are you looking for well generally we recommend type one the younger onset within five years of the diagnosis type two the older onset probably should get an eye exam shortly after the diagnosis the idea is to establish a baseline exam and then monitor to detect changes that need treatment and it can be a slow process before diabetic changes occur in the back of the eye so annual exams is still the current recommendation and if we start to see leaky blood vessels new blood vessels then the frequency may go anywhere from three to six months eight months i think we've learned a lot here in just the last few minutes about you can have very normal eyes but you don't know about glaucoma and there's insidious changes that can take place in vision macular degeneration some of the other things that you may not notice so i think it's a really good idea to go in and get checked floaters dr britton it's your turn there's some questions on floaters what are they and how can i get rid of them yeah so floaters um just a general term that we often use but when we're when we're referring to the typical floaters that most people deal with what we're referring to is the vitreous in the eye or the jelly that's in the iron uh it starts to liquefy and pull away from the back of the eye this can happen for a number of reasons trauma you know um i'd say the most common is again you know not to not to keep bringing this up as an excuse for things but getting older um as we get older that jelly starts to start to shrink and liquefy and pull away from the back of the eye floaters are a nuisance for the most part uh but we do like to uh you know do an in an exam when you first develop a floater because there is a small risk of developing a retinal tear retinal detachment with a new floater uh dr tracy a wrinkle in the retina what's that all about that typically refers to a condition called epiretinal membrane and that often results again related to vitreous changes as we get older the jelly becomes more liquid it can shift around it can actually separate from where it used to be attached to the back of the eye and as it separates it can cause little breaks in the inner surface of the retina that allows cells to grow out and spread across the macula which we talked about for macular degeneration it doesn't cause new blood vessels but it can distort the blood vessels and this and the retinal photoreceptors so people can notice a straight line appearing wavy or distorted and surgery can be done but many times that's not necessary fuchs syndrome fuch i don't know that one what is that yeah so folks uh involves the cornea which is the the clear part of the eye like the you know the cornea is like the glass on the watch uh with fuchs the the cells that are responsible for pumping fluid out of that cornea and keeping it absolutely clear they don't they don't work quite as well as they as they should um patients with folks they can they can have a couple symptoms um i'd say a lot of patients will have more increased trouble with glare when we look at a patient with folks under the microscope we actually see these bumps on the back side of their cornea and those those bumps tend to catch the light and cause issues with with glare we we worry about our focus patients more when we're planning for cataract surgery because it is a an increased risk for complications uh with cataract surgery one other symptom that that foods patients may notice is blurry vision when they wake up in the morning when that cornea is uh more endemicus or more swollen and this blurry vision tends to improve as they go on throughout the day treatment for folks can involve things like salt water solution drops or ointments or in the event that it should worsen the corneal transplant which is has come a long way over the years in terms of correcting the condition there's another whole subject but i don't think we have time for that glaucoma and treatment kevin sure we touched on it earlier but again 1.2 million nerve fibers bringing both your central vision and your peripheral side vision to the back to the brain and it's called the silent thief because you can start to lose those fibers develop subtle loss of peripheral vision and ultimately can progress to take away not only your side vision but your central vision so the one thing we have to treat it is to lower the pressure and there are people with normal pressures that need low normal pressures so it really depends on how a given eye is responding to a given pressure there are people with high pressure that never develop glaucoma so that's where the eye exam looking at the nerve helps us decide when to treat this lady both she and her husband have family histories of cataracts and macular degeneration what are the chances that the children will have these conditions is there something genetic here or not i don't know so either one of you yes yeah certainly there is a genetic relationship to macular degeneration but there are a lot of factors that that come into play with macular degeneration uh things such as smoking which is something we can't counsel all our patients on you know if you can stop smoking it's definitely uh in your in your best interest um other things such as you know again age you know macular degeneration and cataracts are more prevalent as we age and things like sun exposure you know these are things you know you think about you know what are things that i can alter um in terms of lowering my my risk of going on to developing these conditions uh protecting yourself from the sun with sunglasses is something that you can do but to answer the question there's not a you know there's not a definite risk to your to your children that they will develop these conditions there are a lot of factors that come into play shingles herpes zoster in the eye we don't have a lot of time but i think we need to talk about a little bit and it's one of the reasons to get the shingrix shot very much so it's unfortunate that so many people that do develop shingles which can involve the face typically there's a line right down the middle of the forehead the eyelids and it can lead to scarring of the cornea inflammation inside the eye so certainly prevention is better than treatment because frankly the treatments don't always work and the shingrix vaccine i recommend everyone that is eligible receive it it's a it's like a terribly bad pine needle tear on your eye that just doesn't go away for a while blue light todd does blue eyed affect your eyes and should i have light filters on my glasses so blue light um you know i think it's it's gained a lot of attention um as far as its uh damaging effects on the eye it does not have any damaging effects on the eye i think at best it can disrupt your night's sleep but thank you gentlemen thank you very much a great discussion tonight we could go on and on i want to thank our panelists dr todd britton and dr kevin tracy and our medical students volunteers michael goodman tanner nordseth and lucas radermacher this is our final show of the season our thanks to all of the doctors and phone volunteers who have been with us with us throughout the season for doctors on call i hope you have enjoyed these programs and thank you for watching i want to thank the staff here at wdse and i also want to take a shout out to linda liskowitz who has put together the panels made sure we had all the help that we need for this thank you so much [Music] you