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Hello, again, everyone and welcome to Lakeland Currents where tonight we're going to be talking about something very important to all of us, our eyes.

If there's anything more important, well I suppose there are some of things more important, but the eyes are a vital part of having a healthy life and my guest this evening is Dr Seth Dokken, who is an optometrist from Staples.

He has his own business over there, and I believe we have another doctor with you over there, multiple doctors, and we were just talking about this, 10 or 11 years ago you were on and we both looked like elementary kids and now we look like we're old guys.

I look like an old guy.

More gray hair, for sure.

Yeah.

It's great having you here.

Thank you.

Thanks for inviting me.

There's been a lot of development of new technologies, but there are three basic diseases that affect people that we're going to talk about first.

And should we make the first one cataracts?

Yeah, no, thanks for having me.

It's just awesome to be on.

It has been a few years so it's good to catch up on these things and talk about all the new developments that are happening for sure.

You know in terms of ocular disease, cataracts is a huge, huge disease.

The world's leading cause of blindness is cataracts and I think us as Americans we don't realize how wonderful our healthcare system really is where we can fix a lot of these issues.

Cataracts is a disease where the lens inside the eye starts to get opaque, and there's a a photo that I wanted to show up where there's two boys, and you'll see one is kind of blurry and one is clear, and that's kind of your blurry one is your cataract eye and your clear one is your post-cataract surgery there.

And the surgery, what they do is they go in and they take the lens out and they replace it with a new lens.

It's about a 7 minute outpatient procedure.

99% of the time the surgery goes just like we want it to and you know there's always risk with any surgery but it's a very common surgery, most common surgery in the United States of America and most successful surgery in the United States of America is cataract surgery.

In terms of the new developments is, you know, what's really taken off there is some of the multifocal technology and the toric implants and the laser assisted cataract surgeries where you're taking some of those trickier parts of surgery and taking it out of the surgeon's hands and doing it with a robot.

You know, and I always tell patients, it's like if you wanted to cut a board really straight would you use your saw in your hand or would you use your cnc machine you know.

And I think that's what's really happened there for sure.

So if some of these poor countries that don't have medical help, don't have the finances, if someone were to lose their eyesight from cataracts could that be restored, fixed?

Absolutely, for sure.

You know we run mission trips and things like that where we will run into patients that are just completely blind from cataracts and we take that lens out, put a new lens in and it's definitely fixable.

It's amazing, you know, I mean it's life changing for a lot of.

Can you imagine that living in a house or some place where you're blind and someone comes in and the next day you can see?

Yeah, no vision is very important.

Just like what you were mentioning earlier.

There was a study, actually, I think it was about 20 years ago, where they said what do you fear the most and death was number three, Alzheimer's was number two and blindness was number one exactly.

So people feared death actually less than they fear blindness, you know, so is what the study said back then.

And so I mean I do, I think it's a wonderful gift to go to work every day.

It's a blessing to help people with their vision and accomplish these things, you know.

What does a, and I've had cataract surgery, but from your perspective what is it that starts to happen that people notice?

Usually they'll think they need new glasses.

I would say 90% of our patients that come in that need cataract surgery will come in and say hey Seth, you know, I'm here, I got these glasses a couple years ago, I'm just not seeing very well out of them.

And we'll take a look at all that stuff and we'll just have to sit and have an honest conversation to say well, if you get a new pair of glasses today you're not going to see any better.

If you want to see better you really got to do surgery and so that is the most common complaint.

Night driving, you know, oh I can't night drive any more or I was at my granddaughter's volleyball game and I was having a hard time telling which one she was that is your very, very common cataract complaint.

The other type of cataract complaint is the reading side where patients just say, you know, I can read this Bible or this book, but I need a lot of light on it.

I just can't see it as well as I think I should be able to.

And those are the cataract complaints there.

And some people you hear say they see things yellower, yellowing.

For sure.

Cataracts changes your colors dramatically and it really makes your vision off color-wise.

Every year we do cataract surgery and I have patients that need to repaint their house or get a different car because they had bought a certain color car when they had cataracts and then they had cataract surgery and then they don't like the color anymore, they have to repaint the bathrooms, things like that.

Yeah for sure it does really change your colors, kind of yellowing up your vision and making it dull, for sure so.

Is there any way to prevent the development of cataracts?

Well, you know, sunglass protection is definitely needed.

The other thing is just generally being healthy.

You know I think of the typical diabetic or you know somebody who's not taking care, smokers, they're going to be early cataract surgery you know.

If I see a typical patient it's probably 70 years old when they're getting into some cataract discussions.

You add a diabetic to that mix and it's 60 to 65.

You get some bad family history there, I mean you get 55 year old cataract surgeries.

The youngest surgery we did last year was 29 and that was trauma, you know.

So sometimes you'll get into trauma situations, motor vehicle accidents, four wheeler accidents, something happened, somebody got hit, and they'll develop a cataract.

It's kind of like a chip in a windshield of a car where if a rock hits it, it can definitely throw it off.

So what are, don't want to scare people, but what are some things that could go wrong when you have that surgery?

Yeah 100%.

I think most of the things that can go wrong are very fixable.

You know obviously there's a mild infection risk, one in 10,000 cataract surgeries does get an infection, then you have to get some antibiotics on board and try to clear that up.

The lens can move, I've seen that happen a few times where you get into a motor vehicle accident or a big fall, airbags are deployed, things like that the lens can move on you, and so then we got to kind of resuture it back in place.

Pressure issues, and that's why you're watched so closely right out of cataract surgery, is sometimes when you're in doing the surgery the drains of the eyes can get clogged and the pressure can go up and you just have to pop some medication on board.

You know but, like I said, 99% of cataract surgeries go very, very well, and I don't think any surgery is 100%, you know, they wouldn't call it surgery if it was easy, it's always complicated.

For sure.

Let's talk about another disease that I think all of us are afraid of, glaucoma.

Yeah, you know, glaucoma is a tough disease.

You know, again, two boys on the picture here, one is a normal eye and one is a glaucomanus eye.

What happens in the glaucomanus eye is where the peripheral vision will start to constrict and so in a normal eye you have good peripheral vision and in a glaucoma eye you start to lose that peripheral vision, usually because of pressure.

If the pressure in the eye is too high, it'll damage the nerve, that's the connection between the eye and the brain.

And if that nerve gets damaged then your peripheral vision goes away.

Again, a lot of new advancements on the glaucoma side.

You know when I first started practicing, 15 years ago, glaucoma treatment was put patients on medication.

Now, actually, the current recommendation is to do some of these surgery things.

You take a laser and you laser out the drain or you put a stent in with your cataract surgery, you know, and most of those patients are not even on medication anymore.

Because medication has side effects, it has cost, you forget to do it.

It's kind of like a heart where it's like, okay, you can take this medication the rest of your life or we can put this stent in and just fix your heart.

Same thing with these stents in the eyes.

What they do is they drain off that pressure and, you know, I would say nobody should go blind from glaucoma anymore.

The patients who do either the practitioner missed something or the patient is not listening.

I think it's such a fixable disease that you do some sort of surgery or some sort of drops and you can really prevent a lot of issues with that.

So glaucoma has been a heavy advancement over the last five years and I'm sure it's going to get better.

So that's just encouraging to hear that you don't see people going blind from that anymore.

It used to be the kiss of death.

Yeah not very often from glaucoma, I mean it certainly can, but somebody's not doing something right.

Yeah it's pretty rare, you know.

it's like a controlled diabetic where you're going to die of something else, you know.

It's like a prostate cancer where this is something where we've got this a, b, and c that we're going to do and this should turn out very, very well.

How about the other big disease, macular degeneration, that's a little more complex, isn't it?

Certainly complex, but again there is a lot of development there.

So for the last 20 years we've had some treatment for wet macular degeneration.

There's two forms of macular degeneration, one is wet macular degeneration, the second one is what's called dry macular degeneration.

So for the last 20 years we've been doing injectables for wet macular degeneration.

That's a macular degeneration where the eye will bleed.

Macular degeneration is a disease where the central vision goes away.

So when you look at those two little boy pictures, you get that center picture there of that one boy where you just lose the middle of their face and in wet macular degeneration what we do is we inject a a drug into the eye and it absorbs that blood and really it is again a little, you know, great where those patients' vision are really holding.

Just this year, the FDA approved a treatment for dry macular degeneration called Syfovre and it is the first treatment that has come on board for dry macular degeneration.

There's a particular form of dry macular degeneration called geographic atrophy, which is a pretty devastating form, and this new treatment that just came online in the last six months or so has really shown some promise there.

So I think that gives our retina specialists some tools for the toolbox that they didn't have before.

So we used to think of wet as treatable.

I do think, you know, over the next 10 years here we're going to also think of dry as treatable.

The last time I was on the show dry macular degeneration was all about prevention, you know, ocuvite and preservision and getting your multivitamins on board to prevent you from getting dry macular degeneration and now there is an injectable.

It's pretty rare where I've seen it done at this point just because it's so new.

I think the doctors are trying to figure out how do we do this, which patients are going to do well with it, where do we get it, insurance companies.

There's all sorts of variables there.

Is that where they inject directly into the eye?

They do.

Yep.

Well that sounds pretty freaky.

It's not that bad.

No?

You know it is the best way to treat an eye.

You know if you have an eyelid problem or, you know, other body parts but for an eye you really have to target it, that's a very isolated tissue.

So most of the time eye doctors are using drops or surgeries or injectables going, you know, into the eye.

We do so many and the safety protocols are so high that you're not gonna have a lot of issues.

So let's just talk generally a little bit about eye care.

I mean, I think most people think well, you're going to have safety glasses and that's eye care, but there's a lot of things that we can do to take care of our eyes, aren't there?

Absolutely.

General health matters.

You know the diabetic issues, the high blood pressure issues, you know those types of things matter.

If you're going to have health issues, you're going to have eye issues.

Your eyes are going to follow that continuum there.

So for sure early taking care of yourself, exercising on a daily basis.

Those types of things are going to matter, your systemic health.

Second thing is safety, you know.

Dermatologists, I think, are smarter than eye doctors probably because whenever you go outside you're always putting on sunscreen.

And they've really said hey, we want to prevent you from getting melanoma, we want to, you know , protect your skin.

Well same exact thing falls for your eyes, you know.

When you go outside you need to put on good protective sunglasses every time.

Your eye is the only structure in your body that lets light in and we know how damaging light is to your body.

One third of all melanomas are here.

You know one third of all melanomas are either around an eye or within an eye.

I see patients every week that have said hey, you know, I got a little bump going on right here, you know, what do you think that is.

And I'll be like well, you need to go talk to Dermatology, that looks a little suspicious.

I didn't realize that.

And so, you know, I do think anytime you go outside you've got to put your sunglasses on.

That's kind of one of the main causes of cataracts and macular degeneration is sun damage inside the eye.

I know you told me one time that the worst patients sometimes you see are farmers who are out in the field all day without sunglasses.

Yeah you know and I mean that is true.

I mean if you're outside all the time you really got to protect those eyes, you just can't let light get in all the time, it's going to be damaging to the structures.

What are some of the new technologies that you're dealing with, because I know a lot of progress is being made, but before you answer that, where does most of this research occur, at universities?

Universities, yeah.

Yeah, you know, you've got the big research institutions like where I went to school in Chicago, you know, those are where a lot of the research, it'll disseminate out to this central Minnesota.

You know like that new drug that was approved this year.

There are retina specialists in St Cloud that are using that drug, you know, but it's not where the research is happening, that's usually either like the U of M or the universities is where the research is happening.

Technology wise what it's made is it's just made it a lot easier to track things.

Like, for instance, in a glaucoma situation I can take a picture of a nerve and tell the nerve integrity right away.

I can say okay this nerve has 93% integrity and I can pull another picture in six months and if that 93 drops to a 91 I know that, okay, I lost 2% of nerve in that last six months I need to get more aggressive on their glaucoma.

On the macular degeneration side, you know, I think 10,15 years ago, you were always guessing is this dry or is this wet, and again with a quick little picture you can tell instantly, this is a patient that's going to need an injection or this is a patient that I'm going to just continue to watch.

On the optos side that technology is searching for melanomas.

So an optos is a machine that takes a photo of your eye that way you don't have to dilate as much, to look for, you know, lesions inside an eye.

They did a study, with an optos you were 80% more likely to catch a melanoma in the eye with the optos technology on board.

So our patients, we're doing that technology all the time.

I mean you save lives doing this stuff, you know, so that's the new technology on the ocular disease side.

On the multifocal implants, that's the cataract surgeries where patients I think 10 years ago, you told patients well you're probably going to wear glasses after cataract surgery.

Now I think there's a discussion there where it's said where a lot of patients you say do you want to wear glasses after cataract surgery.

If you do, awesome, if you don't there's some things that we can do to make that a possibility.

I would say still the vast majority of our patients are going back to glasses after cataract surgery, but at least there's options on board.

And on the glaucoma side, with the stents, it's been amazing where you can just put a stent in instead of taking a drop every day.

It lowers your pressure automatically without you thinking about it or doing anything about it.

For sure.

So do you still dilate once in a while?

Oh for sure, yeah.

I think if you are making surgical decisions or if you're really kind of questioning what's going on, the best way to do it is to dilate, you know, but there's a lot of patients that you can really not torture nearly as much with the new technology and get a lot of data, you know, and I think medicine has went that way as a whole.

You know if you ask somebody you know about it, you know, do you do this or that, there's a lot less torture and they're getting a lot more information other ways for sure.

So what are, as doctors in your field, what are some of the frustrating things you deal with, with patients.

Yeah.

I mean I think the frustrating thing that I deal with with patients is where you do tell them that this is a serious disease, this is fixable, we got to do this or that, and then they show up three years later and you say well, what's been happening over these last three years, and they say well, you know, I didn't think it was that serious or things like that.

The eye is a nervous tissue, so just like a spinal cord injury or you know traumatic brain injury, I mean if you start to damage nervous tissue it is kind of that Holy Grail where we're not that good at fixing it.

Are we better than we were 20 years ago, absolutely.

If you have a spinal cord injury now, you know, you might walk again.

But if you start to damage an eye, a nervous tissue, it is very, very difficult to get that eye back.

So prevention is the absolute way to go there for sure.

So getting people to take you seriously when you're giving out the warnings, and I don't mean you individually but the doctors, pay attention to what they're saying because they know what they're talking about.

Yeah, for sure.

I mean I think that's the thing with healthcare is that you have to be your own advocate.

You have to go in and say hey, you know, consistently my eyes feel fine, I'm seeing fine.

Well guess what, they're looking at other things.

They can catch that early macular degeneration, they can catch that early glaucoma.

If your vision is perfect, awesome, and if your eye exam comes out perfect, awesome, but I do think, you know, an ounce of prevention goes a long way there for sure.

I know, I think, the cataract surgery started in the Vietnam era, is that right?

Yep for sure there.

And tell us how they were originally replacing lenses in that era?

Well, so, in that technology it was glass lenses right, and glass doesn't bend and so you had to make large incisions in order to put this glass lens in the eye.

So they were working on blind eyes at that time and they actually took the surgeon's, they took his license away because it was such radical surgery.

At the time they said like this guy should never be allowed to operate on anybody.

And then, you know, as he got older, they put him in the Hall of Fame, you know.

Or they said like, wow, this guy revolutionized this.

But glass lenses back then, and that's what some of our patients will remember where well, I don't know, Mom had these sandbags on her head and she couldn't move for a week and they were putting these lenses in.

With the new foldable technology, what happens there is that they put this lens inside your eye and once it's in then they'll unfold it, they'll, you know, play a little origami inside your eye and they'll put that lens in place.

And patients who have surgery will tell you that they'll say, well, they were doing something and then all of a sudden I could kind of see better, you know, a lot of lights going off, and yeah so that's what happened with the original cataract surgery there.

How often do you recommend, I'm sure different age groups have different requirements, but how often do you recommend a patient seeing you, a doctor, like you.

Every year.

Yeah it's a huge program of our association, you know, Check Yearly, See Clearly.

Every year and then even the little ones, we really like to see them right around one years old, and even younger if there is, you know, the primary care physicians notice something or mom notices something or dad notices something is off with this one-year-old's eye or this six-month old's eye.

I mean you can get some great data off of little, little, little kids.

And then every year thereafter we say once a year, even if you feel like you're seeing great.

The vast majority of insurances consider it wellness, so it's covered, you just have to make the time in your schedule to go in and get them checked you know.

In about 30 seconds tell us about ocular migraines.

Ocular migraines are common, you know.

I suffer from them myself where you'll get this aura flashing of light, it's going to be there for 10 minutes or so, and then it goes away.

If you get a flashing of light that persists, that's when you really do want to get in, you know.

So everybody will suffer from some ocular migraines, that's where you get this, you know, aura and a flash, but if it persists longer than 10 minutes or so, you really do want to get that investigated pretty quickly.

Because it could be a tumor.

It could be a tumor, it could be a retinal detachment, it could be macular issues, it could be all of those things.

So any sort of flashing that's persisting you got to get that checked out exactly for sure.

So how do people get a hold of you?

You can call the clinic.

Our phone number is 218-894-1331.

Email us, Facebook, Staples Eye Clinic.

Exactly.

Myself and Dr Fenst would just love to see you so.

Well you do a great job and you're very, very good at interviewing and presenting these diseases as we know them today and it's really encouraging to hear the progress that's being made in solving some of these problems.

Seth, thank you very much for jumping on board with us, appreciate it very much.

Thank you, thank you.

You've been watching Lakeland Currents.

I'm Ray Gildow, so long until next time.