(upbeat music) And welcome back to Family Health Matters.

I'm Shelley Irwin.

With me today those experts.

Dr. Renee Mika, Director of Vision Services, optometrist at Cherry Health.

Good you are here.

Dr. Gina Lynem-Walker, physician at Blue Cross Blue Shield of Michigan.

And Christina Hedlich, Low Vision Rehabilitation Specialist for the Association of the Blind and Visually Impaired at Mary Free Bed Rehabilitation I think an occupational therapist as well.

- Yes.

- Very nice.

Christina, would you expand upon your role please?

- I definitely help out with our low vision clinics, which we hold here to help individuals who experience vision loss and need a little bit more rehabilitation and looking into other devices that can help them.

And I also do home visits.

After those visits, our low vision optometrist gives orders for occupational therapy to come out to the house.

And we do continue that rehabilitation that has started during our low vision clinic.

- Thank you for that.

Dr. Lynem-Walker, your role is?

- Hi.

Yeah, thanks for having me.

My role was as an internal medicine physician, many years, working with patients with chronic illnesses, diabetes, hypertension.

As part of my role, I do some visual screening for members.

And those with eye infections or other eye problems.

My role at Blue Cross is as a medical director.

So I do some pre-authorization or I look at authorizing certain procedures that might be related to the eye.

So just different roles that I have with both modalities.

- Great.

Dr. Mika, what's an optometrist?

- Oh dear.

(chuckles) Thanks for having me Shelley.

So I'm a doctor of optometry and as an optometrist.

I mostly do pediatric optometry at Cherry Health, but as you know, my field, my specialty by nature is community health.

And so I'm the director here and an optometrist.

And our goal is just to assure that every, you know, our community of patients have equitable resources and distribution of care.

So each day is different for me.

So I wear an administrative hat some days and other days I'm in the clinic, seeing patients across a couple of our sites, including a school linked clinic that we have as well.

- Great taking care of our young eyes.

Thank you for that.

A question for all three of you, let's do a little vision 101.

How important, how precious are our eyes?

Dr. Lynem Walker.

- Well, our eyes are the window to the world.

And we need to practice good health and safety with our eyes.

Very important to get a visual screening.

I know Dr. Mika talked about her work with children and that's where we need to start is childhood, yeah, you know, infant until 18 and beyond.

- Yes.

Dr. Mika, would you follow up on that?

- Yeah, I, you know, I would say that sight is probably the, the sense that we most fear losing that hasn't really been well-documented, but we say it a lot, but there was a, there was a recent UK study that actually surveyed adults and from the general population.

And so we do, we do fear losing our sight.

And globally, we know that 2.2 million people have vision impairment.

And the troubling part of all of that is that, over half of those folks with visual impairment, you know, it's preventable.

Globally with cataracts.

And when I say cataracts, it's not preventable, but we get treatable.

But with glasses, it is preventable.

And so that's the same thing for the United States.

About 80% of those with vision impairment is preventable.

We just need the care.

We need to make sure everyone gets the care they need.

- Thank you for that.

Your answer to that, Christina and a followup from you.

When do you come into play as an occupational therapist?

- I would say to your first question, I, vision is definitely one of the biggest, the most, the senses I agree with Dr. Mika that is most feared to be lost.

Also, it is one of the most invisible senses besides next to hearing loss where people sometimes can't identify that somebody has a vision loss.

And so some of our services help to get people through some of that process of acceptance.

If they do have some vision loss.

Teach them how to be advocates for themselves and how to improve their mobility in society, but also continue to do their daily living activities independently, if possible, with devices or techniques, making sure that they continue to get their eye exams and their further up follow up care as well.

- Great.

We'll get examples as our conversation continues.

Let's talk about some common vision disorders and I'll start with you, Dr. Lynem Walker.

- Well, the most common vision, disorder would be a myopia, which is a refractive error of the eye, where in fact, you can't see distance, so that would be most common.

But as we age, somethings kind of stick out and Dr. Mika mentioned cataracts, which is an age related problem, but there's also a little bit of a hereditary component to that.

Then we think about glaucoma as another eye problem that can be hereditary and certain ethnic groups are more prone to that problem in particular African-Americans and those of Mediterranean descent.

So it's important that we know our family history and that we look out for signs and symptoms of things that may be going on.

But as far as cataracts and glaucoma often, you might not have symptoms until they're further along in the disease process.

- Thank you for that.

Dr. Mika, would you expand.

There's also, is it macular degeneration?

- Yes.

Yeah.

You know, in the states here besides refractive disorders like myopia, astigmatism, hyperopia, presbyopia, those types of things that require glasses.

You know, along with what Dr. Lynem was saying with glaucoma, macular degeneration for sure, is another one.

And diabetic retinopathy would be another major issue that we see in United States.

So macular degeneration affects that center, most sensitive area in the back of the eye for your central vision, your color vision.

And with Northern European descent, we might see more.

We do see more of that, but that is something that unfortunately we can't cure right now, but it is, it is treatable and manageable and new technology today has enabled us to do much more and catch things much further in advance than we could before.

So it's really important along with what Dr. Lynem was saying, that we have preventative care and that we remember to make sure that we're getting regular eye exams, just like we get regular checkups with our dentist or well-care visits with our doctors, especially as we age, it's very important.

- Yes.

That aging process.

Guess it beats the alternative if we have to go there.

Christina, you want to add to that and perhaps give us a, either a case study or an assistive device that may help with one of these diagnosis, disorders.

- I would say that here at the Association for the Blind, we see a combination of all of these issues, and it is very important to continue to see your eye doctor and catching it early is a really helpful on the way and the rehabilitation and, and adapting.

And so what we work with, people who have maybe have already have glasses and the glasses don't help.

So utilizing hand magnifiers that are stronger than what you can find at the store using electronic magnifiers.

Or even teaching somebody how to utilize the accessibility software in their computer.

So they can still read their emails again.

It's pivotal in today's time using their cell phones.

And the accessibility features there.

A lot of people don't know that exist, but it takes a little bit of instruction.

- Yes.

Let's talk about when one should have their first and or last eye exam.

I'll start with you, Dr. Lynem.

- Well, first eye exam should be as surely after birth, I would say.

You know, your pediatrician can be the first one to look at your eyes and that they do certain maneuvers, such as looking at the red reflex or the, the blink and pupil response very young.

So you can pick up on things at that age, moving down the line as you're approaching school-age you want to make sure you get a visual exam, at least a visual screening done by your healthcare provider.

You know, we do suggest that children get a comprehensive eye exam.

If there's a family history of a congenital eye problem that happened in as a child.

So starting very early can be important then going on as we get older, those 18 and above should have an eye exam every two to three years.

I think is what is recommended.

And I'll let Dr. Mika kind of weigh in on that.

- Yes Dr. Lynem.

Yeah I would absolutely suggest that we don't have a universal recommendation for this.

So I'm going to start there, but I will also agree with Dr. Lynem that it needs to start early.

So your, your pediatrician is a great place to start initially.

However, we see kids here, you know, a few months of age when there are concerns by their pediatricians about their eyes.

And we also start seeing kids here at the age of three.

So it's amazing what you can see objectively.

You don't ask a child, you know, which is better one or two, but objectively, we can look in the eye and we can do a comprehensive eye exam with kids, not necessarily concerned about health issues.

If there isn't a history, but we still do those comprehensive dilated exams.

And we can also look at the light reflex inside the eye and determine if there's a refractive error that could create a problem such as amblyopia.

One of the issues we didn't talk about earlier, 'cause it's not the most common, but it is an issue that affects learning and development with children and that's refractive amblyopia.

And you can also have strabismus amblyopia and other forms.

And amblyopia is just a fancy word for having decreased vision as a result of either needing glasses or having unequal prescription between the eyes or having an eye churn that reduces that input to the brain.

So those, those folks sometimes can't see 2020 even with glasses, but if it's caught early, sometimes we can prevent that visual impairment.

So back to the timing of those exams, I agree with Dr. Lynem, we should have regular comprehensive eye exams, but we recommend every couple of years for kids or sooner, if their doctor recommends, if their eye doctor recommends, they need it sooner.

And for adults, especially adults over the age of 50.

And usually we say between 60 and 65 every single year, because we also know that things like diabetes can rob you blind.

And those, without those regular eye exams, we can't catch the little changes in the blood vessels, inside the eye without dilating the eye, and actually looking inside, inside the eye.

And oftentimes like Dr. Lynem said earlier, those folks might not have symptoms until it's too late or until we, you know, it's a lot harder to slow that process down.

So.

- What is the general course of treatment then if you pick up these type of symptoms in a post 60-year old.

Dr. Mika, I'll start with you.

- I'm sorry, symptoms of.

- Yeah symptoms of say I come in and, and you do note some changes, perhaps some signs of, of diabetes or the correlation there.

Yep.

- Yeah.

Great question.

So sometimes people don't realize it because it's so slow and insidious and other times there's fluctuating vision.

So if the blood sugar is not stable, there might be fluctuating vision as a result of that.

Other times, there can be a defect in, in the field of vision for different reasons.

And other times there's central vision loss due to some fluid leakage in the back of the eyes.

So there are a number of things that folks might complain of, but oftentimes, there are no complaints and we catch changes in the back of the eye or leakage of blood vessels without any symptoms, but we're able to then re-establish them with their primary care doctor to get their blood sugar back under control.

- [Shelley] Nice.

Christina would just spend some time.

ABVI does such a great job with, with the teen who may either be blind or have visual problems that require accessories.

Talk about any programs specifically designed for your teens.

- A lot of the teens come through our clinic, whether their eye doctor sends them, or sometimes they come through because of recommendations through with the school system, because maybe they're already receiving some special help because of their vision that has been identified by parents or learning issues.

And then they get them through the clinic, through a state funded program, the Youth Low Vision Program for the Bureau of Services for blind persons.

Either way they come through and they do get a low vision exam where it's addressing multiple different facets of asking and creating goals around what they're struggling with, whether it's homework, whether it's things that they doing homework at home, sometimes it's different than at school because they have access to different pieces of devices that those devices aren't available necessarily at home all the time.

So it's working through with the teachers, with the parents and the team on discussing that piece, but also the future of, you know, can they drive?

There are some that even with limited vision impairment with special instruction and device possibly could drive in the future, but dealing with getting them connected up with future services as well for employment down the road and what their aspirations are and whether they want to go onto college trade school or have some other ideas.

- Thank you.

We'll get back to more functional lifestyle choices.

Dr. Lynem-Walker.

What about nutrition and our eyes?

Well, I got to start with the carrot thing.

- Well, yeah, vitamin A it's an important vitamin and can be helpful, but I would just say, we just need to eat a healthy diet, have a healthy lifestyle, keeping our eyes hydrated.

You know, dry eye is a very common problem with a lot of people.

A lot of times it's because we're not keeping hydrated or we're drinking caffeinated beverages, which can dry our eyes out and our, our body in general.

But also eating green, leafy vegetables, such as kale and you know, other spinach and things like that have a lot of good vitamins, vitamin C. And we talk about the Omega-3 fatty acids, which help with the oxidative process in our bodies and help keep our eyes healthy.

So those are some things that I would recommend, but I wanted to pick up on something that Dr. Mika said about diabetes.

We need to keep our general diabetic health in check.

You know, we want to have a goal A1C of less than 7% if you're diabetic.

So just keeping that in mind as well.

So just a general overall good health regimen.

- Yes.

Let's bring up the topic of the computer and eye strain.

And I'll start with you, Dr. Lynem-Walker.

Obviously is this an issue, if I'm in front of my computer for eight hours a day?

- Oh yeah.

(laughs) I have that problem (laughs) (indistinct) the computer or 12 hours sometimes, but there is a general rule and I know the others can pick up on it as well, but it's called the 20, 20, 20 rule that you stop what you're doing, you know, every 20 minutes or so look away at a distance of 20 feet for 20 seconds.

You know, do we do that?

Probably not, but it's a good idea to get up from your computer in general, you know, 'cause you don't want to sit at your computer and get the hips spread that all getting here, (laughs) but so just get up, you know, take frequent breaks, blink, you know, lubricate your eyes.

- Yes, yes.

Dr. Mika, expand on that.

And of course, if you have any nutritional options as well.

- Yeah.

I, you know, I would say on the, on the computer just ergonomics only helps so much, but it helps.

So making sure that we're positioned in a way that's comfortable, not just for the body, but also for the eyes that we're looking straight ahead or slightly down from, from direct gaze.

You know, anti-reflective lenses do only so much, but they do help cut down on reflections and making sure that we're controlling the light on our screen, the font size on the screen.

There are some of us (coughs) like myself (laughs) that are of that age, where we have dry eyes.

And as a woman, there are hormonal impacts as well on dryness of our eyes.

And so lubricating the eyes is important too making sure we have artificial tears or plenty of really good artificial tears over the counter that are available or ask your eye doctor about that if they have recommendations.

And the other thing with computers is that we're seeing parents ask me this all the time.

"Oh, is my child on the screen too much?"

Yeah, we all are.

Nevermind.

Yes.

We're all on the screen far more than we ever expected to be.

But also with kids, what we're seeing is there is a correlation with progression of myopia, with the amount of near work that we're doing.

And screenwork, and so we definitely want to follow as Dr. Lynem said that 20, 20, 20 rule.

And sometimes the kids forget that.

No we can share just look three times an hour, just make sure you're taking that break every 20 minutes, make sure that you're going grabbing a glass of water, you know, grabbing a snack, looking out the window and play outdoors.

We also know that that contributes to healthier eyes and vision.

So play outdoors as much as possible.

And then along, you know, the lines of the diet and nutrition, I think Dr. Lynem nailed it.

And we do have special formulations for certain conditions like macular degeneration.

And you'd leave it to your doctor to work with you on that because it's not for everybody, but definitely those green leafy vegetables and antioxidants, that's really important that the Omega-3 fatty acids that's important too.

So if you like your salmon, eat it.

And if you don't eat fish or eat, eat those green leafy vegetables, that's real important.

- Wonderful.

one, two, three, let's all look away from the screen.

Boom.

Boom.

There we go.

(laughs) Christina, back to function with you, anything to add with this.

And then I'd like to also talk about if we're going to be outside playing and we want to wear the proper sunglasses.

Christina, what do you have with this conversation?

- Definitely.

I was going to even mention that.

Protective eyewear whether I mean, not everybody gets to work behind the screen.

So those individuals who work in higher risk or type of work where things are flying around, whether you're in construction or other things, welding whatever, wear the protective eyewear to protect those eyes.

Also, I would add going outside, wearing your sunglasses, wearing a brimmed hat that is all important for us to protect our eyes.

A lot of people who we're seeing now with a macular degeneration didn't have that benefit when they were younger.

And that is one of the triggers.

If you have, if you have the genetic makeup that has macular degeneration, that can, that's something that those individuals weren't knowing when they were younger back in the mid 1900s or even the late 19OOs and sunglasses weren't a thing.

So it makes a difference to protect them now, especially the younger ones for what's coming later to keep your eyes healthy.

- Wonderful.

Dr. Lynem you mentioned touched on this earlier.

Maybe a certain segment may be more susceptible to eye issues.

What about the, the light skin blue eyed person?

Should we, or, or they be concerned about sun affecting our eyes significantly?

- Well.

I can't speak too much on it.

I'm not really sure, but I would guess it's the same thing as just protecting yourself from the sun.

People would love fair skin, lighter skin, or are more apt to cancers of the skin.

So that being the case, just like Chris was saying, you want to wear your sunglasses to protect your eyes.

And if you have a lighter eyes, you're probably more at risk for problems.

So making sure that you have a sunglass that's 99 to a 100% protection, protection against those UVA and UVB rays is very important.

- I imagine just getting a good sleep, staying with you, Dr. Lynem is essential.

Not only for our health, but maybe for our eyes.

Closing our eyes if applicable.

- Yeah.

Closing the eyes and just getting the proper rest for general overall health is good.

You know, we recommend at least seven to eight hours of sleep for an adult.

More than that for a teenager who's growing sometimes 10 hours is what they need.

So proper rest in general, healthy diets, staying lubricated, exercising.

All those things that we hear about are so important for our eye health as well.

- Wonderful.

Dr. Mika, how do I get fit for glasses?

- Well, (Shelley laughs) there are so many places that you can get fit for glasses.

So you need an eye exam first from a licensed eyecare provider, whether it's an optometrist or an ophthalmologist, that's the first start.

So there are plenty of people in the area that you can rely on if you're uninsured or under-insured.

There are places like Cherry Health.

So as a community health center, we take care of folks regardless of their ability to pay, because we can do that on a sliding fee so that it's based on your income.

And we also accept Medicaid and other insurances.

So there are most doctors are online, so you know what insurances they take.

And then once you have that prescription, you can take that prescription anywhere to get eyeglasses that's yeah, there are lots of places to get glasses.

- Yes, yes.

Are we still wearing contacts?

Or is it okay to wear my contact lens until you know.

- Well, I'm not, my eyes are too dry.

(laughs) I wish I could still wear my contacts, but yes, contact lenses are definitely an option for folks and same thing.

Again, most, most practices have their services online and all of the features, all the things that they offer and most offer both contact lenses and glasses.

- Wonderful.

We touched on this Christina.

Injury to the eye, not only in a work setting, but a baseball hits me in the eye.

What are some, I guess, immediate needs if there is an acute eye injury?

- Immediately, I would say seek out an eye professional if it's during their work hours or go to the emergency room or immediate care to get assessed, especially if there's some changes in vision or anything like that, but there are some undetectable changes that can occur from an injury.

And so that needs to be looked at as soon as possible.

Glaucoma can be caused by a traumatic event.

If it's in the right place of the eye, any additional swelling to that area is not great for your vision.

So it is a, an emergency and they should get looked at if, if they've been, if they've injured their eye.

- Dr. Lynem, let's go back to a little anatomy one-on-one, tell me more about this optic nerve.

How important is this in my world?

- Optic nerve is very important that is the nerve that transmits the signals from your retina, which is the lining of the back lining of the eye, which has light-sensitive cells on it, which picks up the focus or the vision.

And then that nerve transmits that to the brain.

So very important.

And one of the diseases that we were talking about earlier, glaucoma can damage the optic nerve.

There's a buildup of pressure.

The fluid is not being drained properly, and that can damage the optic nerve.

So that's a very important nerve in our body.

And if it's damaged, it's a high chance of blindness.

- Yes.

Speaking of glaucoma, Dr. Mika, is it true I used to have those glaucoma tests where you shoot something in my eye and I'd have to jump back.

Are you still doing that?

- Everyone loves that class.

Why would we get rid of that?

(laughs) We don't do that here, (laughs) but yeah, there's still that they call it a non-contact tonometry.

Otherwise there are other forms of checking the pressure in the eyes, how they're a little bit friendlier, more patient friendly, but that's not the only thing.

You know, we, we sometimes call that a glaucoma screening to check the pressure in the eyes, but pressure is not the only indicator of glaucoma.

And sometimes there's lack of appropriate or enough vascular perfusion to that optic nerve, which is causing that glaucoma.

And you can have low pressure and still have glaucoma, which is why you still need those preventative eye exams to make sure you're getting all of that checked out.

So you can catch things early and try to slow down the progression.

- Wonderful.

Christina, again, back to your teens, I know a teen that is just wild with her technology.

She is blind, and yet she can respond to me through her phone just as you and I can.

How is this happening?

- There's software adaptations and phones that they can, that people can use the sense of touch and they memorize what apps are on the screen and using special gestures, which is the way you move your fingers across the screen.

You can advance across the apps and tell the phone what to do.

So they're using the phone with just the sense of touch and using their sense of hearing to motor through things.

And then they're able to input like you or I do, whether they might use voice, sometimes they can type.

And there are some options on there where if they know Braille, they're able to use the Braille keyboard to enter things to through their, the screen of their phone.

- Kind of jumping all over.

But Dr. Lynem can one, one can assess blindness at birth.

Is this true?

I don't know.

- Not really sure, but.

I know that your pediatrician will do some maneuvers that may indicate damage.

As I mentioned before, the red reflex that you should see, like when you're taking a picture in a camera, you might notice a red reflex in the eye.

And so they can assess for that.

They can assess for just the motion of the eye and how your eye responds to light.

And those could be indicators of low vision or blindness.

- And can you expand more on how Blue Cross Blue Shield works in this field in general?

- Well.

What we do and, and what I do is a pre-authorization predetermination.

So we get a lot, a lot of ophthalmologists or other eyecare professionals who will reach out to us to look at how we can cover certain procedures, such as with macular degeneration, they're new modalities out there that use growth factors and other things like that to help treat a wet macular degeneration.

So we look at those and there are certain criteria that we use to approve or not approve certain procedures.

We do medical policy and, you know, things like that to, to help our members.

- Wonderful.

Are we still using Braille.

Christina, start with you.

- For sure.

There's still being, that's being taught to individuals.

Generally it's taught to people who are younger and blind.

It is a language and it takes a lot of work to learn it.

But generally I see it more in individuals who have a long-term vision problem, but it's not to say we do have some older folks that decide they would like to learn it, but we, we try to figure out what the best and more sufficient avenue is for somebody if they have some vision remaining, there's some pretty neat magnification options out there that they allow them to still use their vision if they have it.

But otherwise, you know, that sky's the limit.

There's definitely some teaching out there that we can direct them to.

- Wonderful.

Ready for closing comments.

I'm going to begin with you, Dr. Mika, if you would start with maybe a plug for the, for the Lions Clubs throughout our US of A and internationally doing great things for, for this field.

- Yeah, I sure can.

We are so proud to be affiliated with our local Lions Clubs, specifically our Grand Rapids Lion's Club.

We've named our vision clinic in downtown Grand Rapids after them for all of the wonderful support and collaboration and funding efforts that helped us enter this building 10 years ago.

So we are, we are so happy and honored to be a part of this community and to be able to serve those that might not otherwise have access to eyecare.

I did want to just add a couple of things.

Some of the questions you asked, I don't know if they came from viewers, but one of the questions about sports vision, we do recommend sports goggles.

So part of that whole safety and trauma, we want to make sure that kids have the eye protection.

They need adults too, not just kids and they're not wearing their dress glasses with their, with their sporting events.

You asked a question about young ones and being able to tell whether they can see electrophysiology is amazing.

And we do all sorts of things with electrophysiology to be able to, to monitor waves between the eye and the brain and also the retina itself.

So ask your doctor about those things.

If you would have concerns about your infant.

- Wonderful.

How do we find out more about your services, Renee.

- [Renee] Ah, well, you can join us on cherryhealth.org.

If anyone is interested in donating to our nonprofit, just add donate to that line and you will find that online and you can learn more about our services that way we take care of infants through adults.

So zero to, well now we should say 120.

- Good.

That's the goal.

Dr. Lynem, your best website to find out more information.

- Ahealthiermichigan.org.

You can find out about any medical condition, including eye health on that site.

So I would suggest that, but I just want to reiterate that the free health care with Lions Club International, there are sorts of free eye health care sites out.

Look on the internet.

There's the Eye Care Institute for America.

That's often a problem.

People are not able to afford healthcare.

So looking look out there for resources.

- Nice.

Thank you for you.

Your closing comments, Christina.

- Yeah.

So, and I reiterate the Lions Club are wonderful.

We've worked with several of them and are beneficiaries of their work as well.

And we truly appreciate what they do in, in our community.

You can reach some more information on eye health actually @abvimichigan.org click on the education tab and select podcasts.

And we have some podcasts out about eye health and protection and prevention and some good recipes for eye health already out there.

- Wonderful.

So for lunch, we'll have our leafy greens and throw on some carrots with a good glass of water in bed tonight at 10, O'clock sleeping those eight hours.

That's what I've learned from you today.

In addition to seeing you all on a regular basis.

Thank you again for your expertise in each of your field, whether it's a medical director, of course, optometrist or occupational therapist.

So thank you all.

And good eyes to you.

Take care.

- [Renee] Thank you.

- [Gina] Thank you.

- Thank you for watching.

Yes.

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