WEBVTT 1 00:00:00.099 --> 00:00:02.516 (soft music) 2 00:00:03.870 --> 00:00:06.240 Welcome to "Hadley Presents". 3 00:00:06.240 --> 00:00:10.830 I'm your host, Ricky Enger inviting you to sit back, relax, 4 00:00:10.830 --> 00:00:13.710 and enjoy a conversation with the experts. 5 00:00:13.710 --> 00:00:16.860 In this episode, we explore frequently asked questions 6 00:00:16.860 --> 00:00:18.390 regarding glaucoma. 7 00:00:18.390 --> 00:00:22.830 And our guests are glaucoma specialist, Dr. Jullia Rosdahl 8 00:00:22.830 --> 00:00:24.990 of the Duke Eye Center, interviewed 9 00:00:24.990 --> 00:00:27.930 by Hadley Chief Program Officer, Ed Haines. 10 00:00:27.930 --> 00:00:29.820 Welcome to the show, both of you. 11 00:00:29.820 --> 00:00:30.720 Thanks Ricky. 12 00:00:30.720 --> 00:00:33.300 Thanks Ricky, I'm really excited to be here. 13 00:00:33.300 --> 00:00:34.620 I'm excited to have you 14 00:00:34.620 --> 00:00:37.560 because glaucoma is one of those things 15 00:00:37.560 --> 00:00:41.520 that I actually don't know as much about as I should, 16 00:00:41.520 --> 00:00:44.370 even though my fiance has glaucoma 17 00:00:44.370 --> 00:00:46.950 and sometimes I ask him things 18 00:00:46.950 --> 00:00:50.070 and he tells me what he knows. 19 00:00:50.070 --> 00:00:52.170 But I think that I'm going 20 00:00:52.170 --> 00:00:57.170 to learn a lot more from our conversation today. 21 00:00:57.180 --> 00:00:59.575 Before we jump into that though, I want 22 00:00:59.575 --> 00:01:02.880 to know a little about each of you. 23 00:01:02.880 --> 00:01:05.160 Just tell the audience a bit 24 00:01:05.160 --> 00:01:07.350 about who you are and what you do. 25 00:01:07.350 --> 00:01:08.560 Let's start with you, Ed. 26 00:01:08.560 --> 00:01:09.750 Well, I'm Ed Haines. 27 00:01:09.750 --> 00:01:11.820 I'm the Chief program officer at Hadley. 28 00:01:11.820 --> 00:01:14.760 I've been with Hadley about 15 years, 29 00:01:14.760 --> 00:01:15.990 but I've spent the majority 30 00:01:15.990 --> 00:01:18.900 of my career in the field working with older adults 31 00:01:18.900 --> 00:01:21.600 with vision loss, so I've had a lot 32 00:01:21.600 --> 00:01:23.760 of clients over the years with glaucoma, so I'm thrilled 33 00:01:23.760 --> 00:01:26.610 to be able to talk to Dr. Al today. 34 00:01:26.610 --> 00:01:28.890 Fantastic and Dr. Rosdahl, 35 00:01:28.890 --> 00:01:31.140 how about you, tell us a bit about yourself, 36 00:01:31.140 --> 00:01:33.030 and I'm always curious 37 00:01:33.030 --> 00:01:36.660 about how people choose the careers that they do. 38 00:01:36.660 --> 00:01:38.340 So just tell us a bit about you 39 00:01:38.340 --> 00:01:42.750 and what made you decide to become a glaucoma specialist. 40 00:01:42.750 --> 00:01:44.340 Well, thank you. 41 00:01:44.340 --> 00:01:46.980 So as you noted in the intro, 42 00:01:46.980 --> 00:01:49.860 I'm a glaucoma specialist at the Duke Eye Center 43 00:01:49.860 --> 00:01:51.990 in Durham, North Carolina. 44 00:01:51.990 --> 00:01:55.680 And in additions to seeing patients with glaucoma 45 00:01:55.680 --> 00:01:58.380 and prescribing eyedrops and doing lasers 46 00:01:58.380 --> 00:02:01.290 and surgery, I also teach medical students 47 00:02:01.290 --> 00:02:03.690 and ophthalmology residents, 48 00:02:03.690 --> 00:02:06.120 and I'm involved in some research as well. 49 00:02:06.120 --> 00:02:09.210 I lead our wellness program at the Eye Center 50 00:02:09.210 --> 00:02:11.730 and I serve on some national organizations, 51 00:02:11.730 --> 00:02:15.210 including the National Eye Health Education Program, 52 00:02:15.210 --> 00:02:16.950 also called NEHEP, 53 00:02:16.950 --> 00:02:19.320 and that's part of the National Eye Institute. 54 00:02:19.320 --> 00:02:21.600 And that's actually where I learned about Hadley 55 00:02:21.600 --> 00:02:23.580 and the great work that you're doing 56 00:02:23.580 --> 00:02:25.470 for people with vision loss. 57 00:02:25.470 --> 00:02:27.480 So I think that's how I was able to connect 58 00:02:27.480 --> 00:02:29.850 and be a part of this program today. 59 00:02:29.850 --> 00:02:33.630 You also asked about why I chose glaucoma as a specialty, 60 00:02:33.630 --> 00:02:36.990 and I really enjoy telling this story. 61 00:02:36.990 --> 00:02:40.710 When I was in medical school, I did a combined program 62 00:02:40.710 --> 00:02:44.370 where I earned both a PhD and an MD. 63 00:02:44.370 --> 00:02:46.860 And yes, my parents did wonder if I 64 00:02:46.860 --> 00:02:50.253 ever would finish school, but I eventually did. 65 00:02:51.101 --> 00:02:54.780 And in my PhD I studied how the neurons in the eye, 66 00:02:54.780 --> 00:02:57.510 the retinal ganglion cells, how they developed 67 00:02:57.510 --> 00:03:00.240 and made connections in the brain. 68 00:03:00.240 --> 00:03:02.850 And that led me to the specialty of ophthalmology. 69 00:03:02.850 --> 00:03:06.270 And then the choice of glaucoma wasn't a choice at all at 70 00:03:06.270 --> 00:03:10.020 that point because in glaucoma, the neurons that die 71 00:03:10.020 --> 00:03:13.230 and cause vision loss, those are the retinal ganglion cells. 72 00:03:13.230 --> 00:03:17.100 And so now every day as a glaucoma specialist, 73 00:03:17.100 --> 00:03:20.040 my job is really to help people save their vision 74 00:03:20.040 --> 00:03:22.440 by saving those retinal ganglion cells. 75 00:03:22.440 --> 00:03:23.610 That is very cool. 76 00:03:23.610 --> 00:03:28.200 I love hearing about how people got to where they are. 77 00:03:28.200 --> 00:03:31.350 It's always fascinating story. 78 00:03:31.350 --> 00:03:32.970 So I'm looking forward 79 00:03:32.970 --> 00:03:36.417 to learning a bit more about glaucoma 80 00:03:36.417 --> 00:03:39.120 and so I'm going to sit back 81 00:03:39.120 --> 00:03:41.790 and just take in the knowledge from both of you. 82 00:03:41.790 --> 00:03:45.060 So with that, I'm going to turn it over to Ed. 83 00:03:45.060 --> 00:03:47.130 I know you have some great questions, Ed. 84 00:03:47.130 --> 00:03:48.120 Well, thanks Ricky. 85 00:03:48.120 --> 00:03:50.580 Dr. Rosdahl, I wonder if we could just start 86 00:03:50.580 --> 00:03:51.679 with the basics. 87 00:03:51.679 --> 00:03:54.900 If you could just tell us what is glaucoma 88 00:03:54.900 --> 00:03:56.130 and what are maybe some 89 00:03:56.130 --> 00:03:59.340 of the common risk factors associated with glaucoma? 90 00:03:59.340 --> 00:04:00.173 So glaucoma is actually 91 00:04:00.173 --> 00:04:01.006 a group of eye diseases. 92 00:04:03.000 --> 00:04:06.840 And what they have in common is that the optic nerve, 93 00:04:06.840 --> 00:04:10.680 which is the cable that connects the eye to the brain, 94 00:04:10.680 --> 00:04:13.440 it's when that optic nerve becomes thinned out 95 00:04:13.440 --> 00:04:16.110 because of those neurons, those retinal ganglion cells 96 00:04:16.110 --> 00:04:19.170 that I mentioned before, of those neurons dying. 97 00:04:19.170 --> 00:04:22.800 So when the nerve dies off like that, people lose vision 98 00:04:22.800 --> 00:04:24.840 and it usually affects their peripheral 99 00:04:24.840 --> 00:04:28.230 or side vision first in glaucoma. 100 00:04:28.230 --> 00:04:31.410 The most common type of glaucoma in the United States 101 00:04:31.410 --> 00:04:34.590 is primary open-angle glaucoma. 102 00:04:34.590 --> 00:04:39.030 And one of the main problems that we have with glaucoma is 103 00:04:39.030 --> 00:04:41.640 that people have it and they don't know it 104 00:04:41.640 --> 00:04:43.980 because the vision loss happens really slowly, 105 00:04:43.980 --> 00:04:46.980 so they don't even notice that it's starting. 106 00:04:46.980 --> 00:04:50.550 And once you lose vision from glaucoma, really any type 107 00:04:50.550 --> 00:04:53.850 of glaucoma, not just primary open-angle glaucoma, 108 00:04:53.850 --> 00:04:55.980 we can't get that vision back. 109 00:04:55.980 --> 00:04:57.450 So early detection 110 00:04:57.450 --> 00:05:01.200 and diagnosing glaucoma early is really important 111 00:05:01.200 --> 00:05:03.180 for saving sight. 112 00:05:03.180 --> 00:05:04.770 You asked about risk factors. 113 00:05:04.770 --> 00:05:08.490 So they include having a family history of glaucoma. 114 00:05:08.490 --> 00:05:12.780 So people in your family, brothers, sisters, aunts, uncles, 115 00:05:12.780 --> 00:05:14.940 grandparents, and parents. 116 00:05:14.940 --> 00:05:18.540 Older age is an important risk factor for glaucoma too. 117 00:05:18.540 --> 00:05:20.130 And actually Black race 118 00:05:20.130 --> 00:05:23.070 and Hispanic ethnicity are risk factors, 119 00:05:23.070 --> 00:05:25.590 although a lot of white people can get glaucoma too. 120 00:05:25.590 --> 00:05:29.130 So don't think that you shouldn't get glaucoma testing 121 00:05:29.130 --> 00:05:31.500 or screening if you are white. 122 00:05:31.500 --> 00:05:33.660 What's the typical journey of a patient 123 00:05:33.660 --> 00:05:35.130 between the time they're diagnosed 124 00:05:35.130 --> 00:05:37.770 and they actually see you as a glaucoma specialist? 125 00:05:37.770 --> 00:05:41.970 What's the average scenario that a patient experiences? 126 00:05:41.970 --> 00:05:42.803 So I would say the scenario that 127 00:05:42.803 --> 00:05:43.636 we hope for is 128 00:05:45.780 --> 00:05:50.010 that people are going along in their regular lives 129 00:05:50.010 --> 00:05:54.480 and they're getting regular complete eye exams 130 00:05:54.480 --> 00:05:56.640 with their local eye doctors. 131 00:05:56.640 --> 00:06:01.640 And that local eye doctor recognizes some early sign, 132 00:06:01.920 --> 00:06:05.100 maybe the eye pressure is a little elevated 133 00:06:05.100 --> 00:06:08.460 or maybe the optic nerve looks a little suspicious, 134 00:06:08.460 --> 00:06:11.520 or family history is noted. 135 00:06:11.520 --> 00:06:15.840 And that savvy local eye doctor either does some 136 00:06:15.840 --> 00:06:18.030 of the glaucoma testing themselves 137 00:06:18.030 --> 00:06:23.030 or refers them to someone like me as a glaucoma specialist. 138 00:06:23.250 --> 00:06:25.860 And then I see them, we do 139 00:06:25.860 --> 00:06:28.470 what we call a glaucoma evaluation, 140 00:06:28.470 --> 00:06:31.530 which is a pretty lengthy visit in clinic 141 00:06:31.530 --> 00:06:33.360 where they get a lot of special testing 142 00:06:33.360 --> 00:06:35.700 and an in-depth eye exam. 143 00:06:35.700 --> 00:06:38.610 And we ferret out whether they do have glaucoma 144 00:06:38.610 --> 00:06:42.840 or just some risk factors that need to be followed. 145 00:06:42.840 --> 00:06:44.940 So that's the scenario that we hope 146 00:06:44.940 --> 00:06:48.720 for where the disease is diagnosed early 147 00:06:48.720 --> 00:06:51.960 before really any vision loss has occurred. 148 00:06:51.960 --> 00:06:55.440 And we can start treatment early and prevent vision loss. 149 00:06:55.440 --> 00:06:57.270 So we also get referrals 150 00:06:57.270 --> 00:06:59.070 for help in managing patients 151 00:06:59.070 --> 00:07:02.520 who've already sustained vision loss from glaucoma 152 00:07:02.520 --> 00:07:05.400 or already have advanced glaucoma. 153 00:07:05.400 --> 00:07:08.640 And sometimes the reasons that they come to us are 154 00:07:08.640 --> 00:07:10.830 because they need surgery 155 00:07:10.830 --> 00:07:14.017 or they need some additional treatment that 156 00:07:14.017 --> 00:07:17.550 that local eye doctor is not able to provide. 157 00:07:17.550 --> 00:07:20.640 So there are lots of different ways that patients come 158 00:07:20.640 --> 00:07:22.590 to see a glaucoma specialist, 159 00:07:22.590 --> 00:07:25.860 but we always hope that they're coming early enough 160 00:07:25.860 --> 00:07:27.960 where we can save vision. 161 00:07:27.960 --> 00:07:29.760 And that frequently is the case. 162 00:07:29.760 --> 00:07:33.480 Actually, most people who are diagnosed with glaucoma 163 00:07:33.480 --> 00:07:36.990 and treated for glaucoma don't go blind from it. 164 00:07:36.990 --> 00:07:39.210 And that actually was gonna be my next question. 165 00:07:39.210 --> 00:07:40.350 I was just gonna ask, 166 00:07:40.350 --> 00:07:42.720 does you know glaucoma always result 167 00:07:42.720 --> 00:07:44.850 in some vision loss or blindness? 168 00:07:44.850 --> 00:07:46.950 Can people with the right kind 169 00:07:46.950 --> 00:07:50.820 of treatment prevent having any vision loss at all? 170 00:07:50.820 --> 00:07:53.100 Oh, that's a great question. 171 00:07:53.100 --> 00:07:57.180 So it is possible for someone to have glaucoma 172 00:07:57.180 --> 00:08:00.000 and not lose any vision from it. 173 00:08:00.000 --> 00:08:04.020 The earliest stage of glaucoma is when there is just changes 174 00:08:04.020 --> 00:08:05.430 to their optic nerve, 175 00:08:05.430 --> 00:08:08.400 but we're not able to pick up any losses 176 00:08:08.400 --> 00:08:09.630 in their peripheral vision 177 00:08:09.630 --> 00:08:13.800 even with automated computerized visual field testing, 178 00:08:13.800 --> 00:08:17.190 that would be mild glaucoma based on the American Academy 179 00:08:17.190 --> 00:08:19.950 of Ophthalmology Preferred Practice Patterns, 180 00:08:19.950 --> 00:08:23.490 but often people, even with mild to moderate glaucoma, 181 00:08:23.490 --> 00:08:28.490 where we can identify peripheral field defects 182 00:08:28.500 --> 00:08:30.660 with the computerized automated 183 00:08:30.660 --> 00:08:33.120 visual field testing, even in those patients, 184 00:08:33.120 --> 00:08:35.730 often we can pick up those areas 185 00:08:35.730 --> 00:08:38.700 of vision loss, but they are not noticing it. 186 00:08:38.700 --> 00:08:42.420 And so those patients too, with treatments started, 187 00:08:42.420 --> 00:08:46.680 they can really not have vision loss 188 00:08:46.680 --> 00:08:48.810 that's affecting their quality of life. 189 00:08:48.810 --> 00:08:52.470 And before we talk about treatments, is it possible 190 00:08:52.470 --> 00:08:55.020 that the vision loss resulting from glaucoma 191 00:08:55.020 --> 00:08:56.910 can ever be reversed? 192 00:08:56.910 --> 00:08:59.520 Or is it a permanent loss of vision? 193 00:08:59.520 --> 00:09:00.353 So it is a permanent loss of vision 194 00:09:00.353 --> 00:09:01.186 with the treatments 195 00:09:03.720 --> 00:09:07.650 that we have at this point, I am very hopeful 196 00:09:07.650 --> 00:09:09.870 that we will have treatments in the future 197 00:09:09.870 --> 00:09:12.990 that reverse vision loss from glaucoma, 198 00:09:12.990 --> 00:09:17.160 but at this point, that vision loss occurs from the death 199 00:09:17.160 --> 00:09:18.960 of those retinal ganglion cells. 200 00:09:18.960 --> 00:09:22.650 And we don't have ways yet to renew 201 00:09:22.650 --> 00:09:26.940 or replace or really recharge 202 00:09:26.940 --> 00:09:29.400 or regenerate those nerves at this time. 203 00:09:29.400 --> 00:09:33.150 So it is unfortunately a permanent loss of vision. 204 00:09:33.150 --> 00:09:36.240 And what are normally the kinds of treatments 205 00:09:36.240 --> 00:09:38.850 that you prescribe for folks with glaucoma? 206 00:09:38.850 --> 00:09:42.720 So the main treatment for glaucoma is 207 00:09:42.720 --> 00:09:44.490 to lower eye pressure. 208 00:09:44.490 --> 00:09:47.130 And we have a lot of different ways to do it. 209 00:09:47.130 --> 00:09:50.910 Typically we'll start with eye drop medications 210 00:09:50.910 --> 00:09:54.660 or a laser treatment to the drain of the eye. 211 00:09:54.660 --> 00:09:57.390 And then there are also surgical treatments 212 00:09:57.390 --> 00:09:59.880 that we typically reserve for cases 213 00:09:59.880 --> 00:10:04.880 where we cannot control the glaucoma with the drops or laser 214 00:10:04.890 --> 00:10:07.860 or where those treatments are just not effective 215 00:10:07.860 --> 00:10:08.940 or not possible. 216 00:10:08.940 --> 00:10:10.560 For example, a patient who has a lot 217 00:10:10.560 --> 00:10:14.280 of eye drop allergies cannot tolerate any of the drops, 218 00:10:14.280 --> 00:10:16.920 then surgery might be considered 219 00:10:16.920 --> 00:10:19.320 for a more mild case as well. 220 00:10:19.320 --> 00:10:21.480 And I know with eyedrops, I've worked with people 221 00:10:21.480 --> 00:10:25.710 that are not necessarily as conscientious about compliances, 222 00:10:25.710 --> 00:10:26.760 maybe they should be. 223 00:10:26.760 --> 00:10:29.790 So how important is it that the person follow through 224 00:10:29.790 --> 00:10:31.800 with your exact prescription 225 00:10:31.800 --> 00:10:34.290 and your instructions for medication? 226 00:10:34.290 --> 00:10:35.123 Oh, I'm so glad that you brought 227 00:10:35.123 --> 00:10:35.956 up the topic of adherence 228 00:10:37.977 --> 00:10:39.990 to treatment regimens. 229 00:10:39.990 --> 00:10:41.820 It's really, really important 230 00:10:41.820 --> 00:10:46.470 that patients follow those eye drop treatment regimens. 231 00:10:46.470 --> 00:10:48.067 I like to say to my patient, 232 00:10:48.067 --> 00:10:51.780 "This eye drop is a very powerful way to lower eye pressure, 233 00:10:51.780 --> 00:10:54.360 but it does not work if it is sitting in the bottle, 234 00:10:54.360 --> 00:10:56.610 it needs to go into your eye." 235 00:10:56.610 --> 00:10:58.890 There are a lot of different types of eye drops 236 00:10:58.890 --> 00:11:00.120 that we prescribe. 237 00:11:00.120 --> 00:11:03.390 And so the regimens can vary quite a bit 238 00:11:03.390 --> 00:11:05.850 and they also can be quite complex. 239 00:11:05.850 --> 00:11:09.570 And so I certainly understand when patients have trouble 240 00:11:09.570 --> 00:11:11.340 adhering to these regimens. 241 00:11:11.340 --> 00:11:13.380 I would say the most simple one would be a 242 00:11:13.380 --> 00:11:16.920 once a day eye drop that you might use at bedtime. 243 00:11:16.920 --> 00:11:19.260 But sometimes we have patients on three 244 00:11:19.260 --> 00:11:21.210 or even four eye drop medications. 245 00:11:21.210 --> 00:11:23.310 Some of them need to be dosed two 246 00:11:23.310 --> 00:11:25.440 or even three times per day. 247 00:11:25.440 --> 00:11:29.220 And it's quite a feat getting them all in 248 00:11:29.220 --> 00:11:30.570 at the right times. 249 00:11:30.570 --> 00:11:33.630 But it's really quite, important those eye drops 250 00:11:33.630 --> 00:11:36.690 lower eye pressure for a certain amount of time 251 00:11:36.690 --> 00:11:38.310 after they're instilled, 252 00:11:38.310 --> 00:11:41.490 and then that eye pressure will go back up once 253 00:11:41.490 --> 00:11:43.590 that eye drop medication has kind of worn off. 254 00:11:43.590 --> 00:11:47.970 And so that next dose is timed to really maintain 255 00:11:47.970 --> 00:11:50.160 that lower eye pressure. 256 00:11:50.160 --> 00:11:54.300 And we think that maintaining a lower eye pressure 257 00:11:54.300 --> 00:11:57.180 and really keeping it low without those kind 258 00:11:57.180 --> 00:12:00.870 of big fluctuations can really help protect the optic nerve, 259 00:12:00.870 --> 00:12:02.850 help preserve that site. 260 00:12:02.850 --> 00:12:03.683 Are there any kind of, 261 00:12:03.683 --> 00:12:04.516 I think I've had someone tell me 262 00:12:05.550 --> 00:12:07.080 that there's some lifestyle changes 263 00:12:07.080 --> 00:12:08.970 that maybe people need to be aware of too. 264 00:12:08.970 --> 00:12:12.210 Like I think someone told me inverted yoga positions 265 00:12:12.210 --> 00:12:15.030 for instance, people are advised against those 266 00:12:15.030 --> 00:12:16.140 kinds of activities. 267 00:12:16.140 --> 00:12:19.320 Do you recommend lifestyle changes to go with medication 268 00:12:19.320 --> 00:12:21.600 or is that dependent on the individual? 269 00:12:21.600 --> 00:12:24.566 I would say that most patients probably don't 270 00:12:24.566 --> 00:12:29.280 need any particularly extreme lifestyle modifications. 271 00:12:29.280 --> 00:12:31.620 However, if I do have a patient 272 00:12:31.620 --> 00:12:34.950 who is progressing despite a regimen 273 00:12:34.950 --> 00:12:37.140 that we think really should be adequate, 274 00:12:37.140 --> 00:12:39.570 or a patient who's really motivated 275 00:12:39.570 --> 00:12:43.140 to do every single possible thing they can think of 276 00:12:43.140 --> 00:12:44.250 to prevent their disease, 277 00:12:44.250 --> 00:12:47.370 then we do talk about lifestyle modifications. 278 00:12:47.370 --> 00:12:50.310 And the things that I talk about with patients include 279 00:12:50.310 --> 00:12:53.010 that yoga concern that you brought up. 280 00:12:53.010 --> 00:12:54.180 We do think 281 00:12:54.180 --> 00:12:58.980 that prolonged head down postures like doing headstands, 282 00:12:58.980 --> 00:13:03.270 that that can increase the pressure in the eye just 283 00:13:03.270 --> 00:13:08.270 from that elevated venous pressure, tight neck ties as well. 284 00:13:08.550 --> 00:13:13.110 And interestingly, prolonged wind instrument playing 285 00:13:13.110 --> 00:13:15.780 where you're blowing against a reed 286 00:13:15.780 --> 00:13:18.450 and again, kind of increased pressure in your head 287 00:13:18.450 --> 00:13:22.410 from those prolonged periods of kind of holding your breath 288 00:13:22.410 --> 00:13:24.600 and breathing against that wind instrument. 289 00:13:24.600 --> 00:13:28.890 We think that those might potentially result 290 00:13:28.890 --> 00:13:32.460 in some potential progression of glaucoma. 291 00:13:32.460 --> 00:13:36.180 I would say that I don't like to tell people not to do yoga, 292 00:13:36.180 --> 00:13:39.840 however, because I think that it's a really good way 293 00:13:39.840 --> 00:13:44.760 to relax, recharge, and good for your health. 294 00:13:44.760 --> 00:13:47.490 So it's really those prolonged head down postures. 295 00:13:47.490 --> 00:13:50.250 There are a couple other lifestyle modifications 296 00:13:50.250 --> 00:13:51.990 too to consider. 297 00:13:51.990 --> 00:13:55.260 One of them is to eat a diet with a lot 298 00:13:55.260 --> 00:13:58.620 of leafy green vegetables with antioxidants. 299 00:13:58.620 --> 00:14:01.980 We think that might help the optic nerve in glaucoma. 300 00:14:01.980 --> 00:14:03.900 Healthy lifestyle in general 301 00:14:03.900 --> 00:14:06.330 with a heart healthy diet 302 00:14:06.330 --> 00:14:10.110 with lots of vegetables, fruits, whole grains, 303 00:14:10.110 --> 00:14:13.140 and lean proteins, getting some exercise, 304 00:14:13.140 --> 00:14:16.350 getting enough sleep, having healthy relationships 305 00:14:16.350 --> 00:14:17.850 with loved ones, 306 00:14:17.850 --> 00:14:20.070 those are things that are good for your overall health 307 00:14:20.070 --> 00:14:22.590 and so they're gonna be good for your eyes. 308 00:14:22.590 --> 00:14:25.020 And then there's one that's kind of interesting 309 00:14:25.020 --> 00:14:29.490 around sleeping with a wedge type pillow, 310 00:14:29.490 --> 00:14:33.330 having your head elevated around 30 degrees. 311 00:14:33.330 --> 00:14:34.830 That's something that's been shown 312 00:14:34.830 --> 00:14:38.010 to decrease progression in really advanced glaucoma 313 00:14:38.010 --> 00:14:39.447 in some studies as well. 314 00:14:39.447 --> 00:14:41.370 And so that's something else that I'll bring up 315 00:14:41.370 --> 00:14:44.910 with a patient who might be progressing despite 316 00:14:44.910 --> 00:14:47.940 what we think is adequate pressure control. 317 00:14:47.940 --> 00:14:51.630 Now if people are adhering to their treatment 318 00:14:51.630 --> 00:14:54.780 and they're taking all their drops the way they should, 319 00:14:54.780 --> 00:14:57.180 does glaucoma ever just stop? 320 00:14:57.180 --> 00:14:58.013 Does it go away? 321 00:14:58.013 --> 00:14:59.040 Or do they have to get treated 322 00:14:59.040 --> 00:15:01.650 for this condition for the rest of their lives? 323 00:15:01.650 --> 00:15:03.990 That is a really common question, Ed. 324 00:15:03.990 --> 00:15:05.640 I'm glad that you asked that. 325 00:15:05.640 --> 00:15:09.840 Glaucoma is a lifelong condition, once you have it, 326 00:15:09.840 --> 00:15:11.610 we have lots of good treatments, 327 00:15:11.610 --> 00:15:13.650 but we really don't have a cure. 328 00:15:13.650 --> 00:15:15.780 And so typically patients do have it 329 00:15:15.780 --> 00:15:17.680 for the rest of their lives. 330 00:15:17.680 --> 00:15:21.090 However, treatments change, responses 331 00:15:21.090 --> 00:15:22.920 to treatments change as well. 332 00:15:22.920 --> 00:15:26.040 And so it is something that has to be monitored 333 00:15:26.040 --> 00:15:27.870 for the patient's life. 334 00:15:27.870 --> 00:15:32.870 Often though it is controlled and people do not go blind. 335 00:15:33.142 --> 00:15:36.060 If I'm diagnosed with glaucoma, do I have 336 00:15:36.060 --> 00:15:38.430 to start being concerned about my kids 337 00:15:38.430 --> 00:15:40.722 or potential grandkids? 338 00:15:40.722 --> 00:15:43.620 Is genetic counseling involved with this? 339 00:15:43.620 --> 00:15:45.090 When would my children, for instance, 340 00:15:45.090 --> 00:15:47.400 need to start being tested for glaucoma 341 00:15:47.400 --> 00:15:48.930 if I've been diagnosed? 342 00:15:48.930 --> 00:15:51.510 Well, glaucoma does run in families, 343 00:15:51.510 --> 00:15:54.330 and so it's a really good idea if you are diagnosed 344 00:15:54.330 --> 00:15:56.970 with glaucoma that you let blood relatives know 345 00:15:56.970 --> 00:15:58.770 about that diagnosis. 346 00:15:58.770 --> 00:16:01.050 And they don't necessarily need to run out 347 00:16:01.050 --> 00:16:03.510 and see a glaucoma specialist right away. 348 00:16:03.510 --> 00:16:07.320 But they should have complete eye exams on a regular basis. 349 00:16:07.320 --> 00:16:09.840 And when they see their eye doctor, 350 00:16:09.840 --> 00:16:13.500 they should tell them about that family history of glaucoma. 351 00:16:13.500 --> 00:16:16.050 And if the doctor sees anything of concern, 352 00:16:16.050 --> 00:16:18.960 more testings needed, like a visual field test 353 00:16:18.960 --> 00:16:21.750 or a computerized picture of the optic nerve, 354 00:16:21.750 --> 00:16:24.690 then they might need to see a glaucoma specialist. 355 00:16:24.690 --> 00:16:26.610 So I would say if you had children 356 00:16:26.610 --> 00:16:29.820 and you were diagnosed with glaucoma, then I'd recommend 357 00:16:29.820 --> 00:16:33.120 that they have a complete dilated eye exam 358 00:16:33.120 --> 00:16:36.900 with a local eye doctor if they haven't had one recently 359 00:16:36.900 --> 00:16:41.250 and to let the doctor know about your diagnosis. 360 00:16:41.250 --> 00:16:44.760 Are there any kinds of just sort of misapprehensions 361 00:16:44.760 --> 00:16:47.370 and false knowledge out there about glaucoma 362 00:16:47.370 --> 00:16:50.310 and treatment that you see that patients come to you with 363 00:16:50.310 --> 00:16:51.990 that you'd like to dispel? 364 00:16:51.990 --> 00:16:54.600 Well, the most important one, I think is one 365 00:16:54.600 --> 00:16:58.590 that we've touched on already, that fear of blindness. 366 00:16:58.590 --> 00:17:01.470 When people first get the diagnosis, they think that, 367 00:17:01.470 --> 00:17:05.100 oh my gosh, I will be going blind. 368 00:17:05.100 --> 00:17:07.380 But like we discussed, most people who are treated 369 00:17:07.380 --> 00:17:09.030 for glaucoma don't go blind. 370 00:17:09.030 --> 00:17:12.000 So the message should really be one of hope. 371 00:17:12.000 --> 00:17:15.630 The biggest misapprehension about glaucoma treatment, 372 00:17:15.630 --> 00:17:18.210 I would say, is about the effects of treatment. 373 00:17:18.210 --> 00:17:19.620 Most people expect 374 00:17:19.620 --> 00:17:23.100 that glaucoma eyedrops will make their eyes feel better 375 00:17:23.100 --> 00:17:26.970 or help them to see better, but that really isn't the case. 376 00:17:26.970 --> 00:17:30.120 Eyedrops for glaucoma help to lower the eye pressure 377 00:17:30.120 --> 00:17:32.700 to prevent future vision loss. 378 00:17:32.700 --> 00:17:34.290 So they help keep your vision, 379 00:17:34.290 --> 00:17:36.150 but they don't make vision better. 380 00:17:36.150 --> 00:17:38.850 And they can have some side effects. 381 00:17:38.850 --> 00:17:42.360 Most of them are manageable, people do great on their drops, 382 00:17:42.360 --> 00:17:45.330 but there can be some stinging or redness. 383 00:17:45.330 --> 00:17:48.930 And sometimes we do need to even stop or change drops 384 00:17:48.930 --> 00:17:50.820 because of side effects. 385 00:17:50.820 --> 00:17:54.690 So that misapprehension about the effects of treatment, 386 00:17:54.690 --> 00:17:57.660 that's one that I'd like people to know about too. 387 00:17:57.660 --> 00:18:00.090 And once folks start seeing you 388 00:18:00.090 --> 00:18:02.760 as their glaucoma specialist, do they still need 389 00:18:02.760 --> 00:18:04.950 to see their local optometrist 390 00:18:04.950 --> 00:18:07.440 or their local ophthalmologist as well? 391 00:18:07.440 --> 00:18:09.720 Or do you kind of handle their care, 392 00:18:09.720 --> 00:18:12.570 their primary eye care from that point forward? 393 00:18:12.570 --> 00:18:13.403 So optometrists and the 394 00:18:13.403 --> 00:18:14.236 comprehensive ophthalmologists 395 00:18:16.590 --> 00:18:19.080 are really important partners for us. 396 00:18:19.080 --> 00:18:21.780 I would say some of my patients do just see me 397 00:18:21.780 --> 00:18:25.830 for their eye care and kind of transfer things over to me. 398 00:18:25.830 --> 00:18:29.640 Many of them have other eye problems like dry eye 399 00:18:29.640 --> 00:18:32.370 or glasses, a need for contacts, 400 00:18:32.370 --> 00:18:34.500 and those are things that the optometrist 401 00:18:34.500 --> 00:18:36.900 or that comprehensive doctor is helping with. 402 00:18:36.900 --> 00:18:41.900 And so they'll still see them for those reasons. 403 00:18:41.910 --> 00:18:45.630 And some patients have to travel quite a distance to see me. 404 00:18:45.630 --> 00:18:47.220 And so we will partner with 405 00:18:47.220 --> 00:18:49.980 that local eye doctor, for example, 406 00:18:49.980 --> 00:18:52.650 they'll get their eye pressure checks every three 407 00:18:52.650 --> 00:18:54.030 or four months locally 408 00:18:54.030 --> 00:18:56.370 and then come to see me once a year 409 00:18:56.370 --> 00:18:59.400 for the visual field testing, the optic nerve imaging 410 00:18:59.400 --> 00:19:01.560 and the dilated exam as long 411 00:19:01.560 --> 00:19:04.440 as everything's been stable at those interim visits 412 00:19:04.440 --> 00:19:06.060 with their local doctor. 413 00:19:06.060 --> 00:19:07.260 Oh, that makes perfect sense. 414 00:19:07.260 --> 00:19:11.430 And this is a question I was interested in asking you. 415 00:19:11.430 --> 00:19:13.800 I've worked in the past with a lot of people 416 00:19:13.800 --> 00:19:16.740 with age-related macular degeneration 417 00:19:16.740 --> 00:19:19.950 and the dry type, particularly now that they've been told, 418 00:19:19.950 --> 00:19:22.170 well, there's just really nothing that can be done. 419 00:19:22.170 --> 00:19:23.790 And I'll visit them. 420 00:19:23.790 --> 00:19:25.500 I'll notice for instance, on their chart 421 00:19:25.500 --> 00:19:27.330 that they also have glaucoma. 422 00:19:27.330 --> 00:19:30.090 And I'll say, "Have you seen a glaucoma specialist?" 423 00:19:30.090 --> 00:19:32.040 And they commonly tell me, "Well, 424 00:19:32.040 --> 00:19:34.650 I know nothing can be done about my vision, 425 00:19:34.650 --> 00:19:36.090 so why should I bother?" 426 00:19:36.090 --> 00:19:39.270 What would you say to to patients like that? 427 00:19:39.270 --> 00:19:41.670 So I often have patients 428 00:19:41.670 --> 00:19:45.690 who have both macular degeneration and glaucoma, 429 00:19:45.690 --> 00:19:48.240 and I partner with my retina colleagues 430 00:19:48.240 --> 00:19:49.920 to care for those patients. 431 00:19:49.920 --> 00:19:51.990 And I think these are some of the patients 432 00:19:51.990 --> 00:19:56.160 where glaucoma care is really so important. 433 00:19:56.160 --> 00:19:59.550 Patients with macular degeneration typically have losses 434 00:19:59.550 --> 00:20:01.200 in their central vision, 435 00:20:01.200 --> 00:20:03.870 but their peripheral vision might still be intact 436 00:20:03.870 --> 00:20:06.930 and be helping them with mobility 437 00:20:06.930 --> 00:20:09.810 and seeing to do a lot of the things that they need 438 00:20:09.810 --> 00:20:12.000 to do to live their lives. 439 00:20:12.000 --> 00:20:15.150 And so the glaucoma care is really essential 440 00:20:15.150 --> 00:20:19.080 to help them preserve that functional peripheral vision 441 00:20:19.080 --> 00:20:22.410 that's allowing them to live the lives that they want 442 00:20:22.410 --> 00:20:24.720 to live like they are. 443 00:20:24.720 --> 00:20:27.900 And so that glaucoma care is really essential. 444 00:20:27.900 --> 00:20:28.980 Okay, great advice. 445 00:20:28.980 --> 00:20:32.340 I know it's scary how common I've that is 446 00:20:32.340 --> 00:20:34.440 and how much I've heard that though. 447 00:20:34.440 --> 00:20:38.100 Are there any treatments on the horizon for glaucoma 448 00:20:38.100 --> 00:20:40.560 that show promise that might be more effective than 449 00:20:40.560 --> 00:20:42.090 what you're using now? 450 00:20:42.090 --> 00:20:44.070 Well, there is a lot happening 451 00:20:44.070 --> 00:20:45.960 in glaucoma treatment right now. 452 00:20:45.960 --> 00:20:48.990 It's been a really exciting time for us. 453 00:20:48.990 --> 00:20:50.370 In the last couple of years, 454 00:20:50.370 --> 00:20:55.370 we had two new medications approved for glaucoma treatment, 455 00:20:55.560 --> 00:20:59.430 and the two mechanisms of action are new as well. 456 00:20:59.430 --> 00:21:02.970 So they're quite additive to the eye drops 457 00:21:02.970 --> 00:21:04.590 that we currently have. 458 00:21:04.590 --> 00:21:07.080 They are considered second line, 459 00:21:07.080 --> 00:21:10.230 however, so they're not necessarily better than 460 00:21:10.230 --> 00:21:14.190 what we have, but they can be added in a really powerful way 461 00:21:14.190 --> 00:21:16.260 to help us with our patients. 462 00:21:16.260 --> 00:21:20.370 And in 2020, just in this past year, a new way 463 00:21:20.370 --> 00:21:25.290 of delivering glaucoma medications was approved by the FDA, 464 00:21:25.290 --> 00:21:26.670 and it's an implant 465 00:21:26.670 --> 00:21:30.210 that we can inject right into the front part of the eye. 466 00:21:30.210 --> 00:21:34.530 It's tiny tinier than the letter I on a dime. 467 00:21:34.530 --> 00:21:38.160 And then that medication sits in the front of the eye 468 00:21:38.160 --> 00:21:40.530 and elutes over a period of four 469 00:21:40.530 --> 00:21:42.330 to six months before wearing off. 470 00:21:42.330 --> 00:21:46.950 So that's a really exciting development in medications. 471 00:21:46.950 --> 00:21:48.840 And then there has also been a lot 472 00:21:48.840 --> 00:21:52.950 of focus on developing safer surgeries for glaucoma 473 00:21:52.950 --> 00:21:54.240 and advances in what are 474 00:21:54.240 --> 00:21:58.590 called minimally invasive glaucoma surgeries or MIGS. 475 00:21:58.590 --> 00:22:01.530 However, they really do seem best for people with mild 476 00:22:01.530 --> 00:22:05.250 to moderate glaucoma who also have a cataract that's ready 477 00:22:05.250 --> 00:22:09.000 for cataract surgery and want to be on fewer eyedrops. 478 00:22:09.000 --> 00:22:13.560 So we still really need safer alternatives for our patients 479 00:22:13.560 --> 00:22:15.240 with more advanced glaucoma 480 00:22:15.240 --> 00:22:17.550 who really need those lower pressures. 481 00:22:17.550 --> 00:22:20.820 The MIGS surgeries aren't quite there for us 482 00:22:20.820 --> 00:22:22.290 for those patients yet. 483 00:22:22.290 --> 00:22:25.560 And we still need those nerve regenerative therapies 484 00:22:25.560 --> 00:22:28.710 to bring vision back for our patients. 485 00:22:28.710 --> 00:22:30.990 But we have a lot of scientists 486 00:22:30.990 --> 00:22:34.380 and researchers around the world who are working hard 487 00:22:34.380 --> 00:22:36.420 to develop those treatments for our patients. 488 00:22:36.420 --> 00:22:39.150 But unfortunately, we're still waiting for those. 489 00:22:39.150 --> 00:22:41.370 Well Dr. Rosdahl, you've talked about treatments 490 00:22:41.370 --> 00:22:43.680 and I just wanted to ask you one quick question 491 00:22:43.680 --> 00:22:46.230 that's come up with folks that I've worked with in the past, 492 00:22:46.230 --> 00:22:49.440 particularly folks who may not have the insurance 493 00:22:49.440 --> 00:22:52.230 or the money to pay for eyedrops, et cetera, 494 00:22:52.230 --> 00:22:54.090 and that's medical marijuana 495 00:22:54.090 --> 00:22:57.270 and how efficacious is medical marijuana 496 00:22:57.270 --> 00:22:58.950 in treating glaucoma 497 00:22:58.950 --> 00:23:01.590 and should people depend on that as opposed 498 00:23:01.590 --> 00:23:03.540 to actually seeking out treatments 499 00:23:03.540 --> 00:23:05.460 from a glaucoma specialist? 500 00:23:05.460 --> 00:23:06.930 You know Ed, I'm glad you asked that 501 00:23:06.930 --> 00:23:10.230 because I think a lot of patients might be afraid 502 00:23:10.230 --> 00:23:11.640 to ask that question. 503 00:23:11.640 --> 00:23:14.040 But it is a really important question 504 00:23:14.040 --> 00:23:17.280 because I really would ask 505 00:23:17.280 --> 00:23:21.720 that patients not use marijuana for treatment of glaucoma 506 00:23:21.720 --> 00:23:24.450 because it has not been shown to be effective 507 00:23:24.450 --> 00:23:29.070 or safe for treating glaucoma and preventing vision loss. 508 00:23:29.070 --> 00:23:33.720 There's certainly anecdotal accounts of pressure lowering 509 00:23:33.720 --> 00:23:37.080 and potentially different parts of marijuana, 510 00:23:37.080 --> 00:23:41.010 different components that might eventually be part 511 00:23:41.010 --> 00:23:45.690 of an approved treatment for glaucoma, but not at this time. 512 00:23:45.690 --> 00:23:49.530 And so it really isn't a good way to prevent vision loss. 513 00:23:49.530 --> 00:23:50.940 I hope, though, 514 00:23:50.940 --> 00:23:55.290 that we will have marijuana based eye drops in the future 515 00:23:55.290 --> 00:23:58.980 because I think that that is going to really boost adherence 516 00:23:58.980 --> 00:24:03.030 for glaucoma treatment in the future. 517 00:24:03.030 --> 00:24:04.830 But at this point, 518 00:24:04.830 --> 00:24:09.830 medical marijuana is not an approved treatment for glaucoma. 519 00:24:09.960 --> 00:24:12.180 Eyedrops, laser surgery, 520 00:24:12.180 --> 00:24:14.280 those are the things that we know work. 521 00:24:14.280 --> 00:24:17.040 If patients are struggling with the cost 522 00:24:17.040 --> 00:24:20.160 of their glaucoma care, there are actually a lot 523 00:24:20.160 --> 00:24:23.850 of great programs that a lot of the drug companies offer 524 00:24:23.850 --> 00:24:27.480 to help patients get the medications that they need. 525 00:24:27.480 --> 00:24:29.220 And so I'd encourage those folks 526 00:24:29.220 --> 00:24:32.220 to ask their doctor about different programs 527 00:24:32.220 --> 00:24:34.980 that these pharmaceutical companies have available 528 00:24:34.980 --> 00:24:37.620 for patients who can't afford them. 529 00:24:37.620 --> 00:24:38.970 Well, that's terrific information 530 00:24:38.970 --> 00:24:40.350 'cause I know that is a concern. 531 00:24:40.350 --> 00:24:42.960 So thanks very much and I'm glad I asked the question. 532 00:24:42.960 --> 00:24:43.793 Yeah, that's a great knowledge to 533 00:24:43.793 --> 00:24:44.626 have as is all of this. 534 00:24:46.800 --> 00:24:49.980 I've actually learned quite a bit, 535 00:24:49.980 --> 00:24:54.330 even with some limited knowledge of glaucoma, 536 00:24:54.330 --> 00:24:56.220 I've certainly added to that today. 537 00:24:56.220 --> 00:25:00.210 So I certainly appreciate the opportunity to sit back 538 00:25:00.210 --> 00:25:03.810 and listen as you all discussed this. 539 00:25:03.810 --> 00:25:07.590 As we're wrapping up here, just wanna ask, 540 00:25:07.590 --> 00:25:11.670 are there places that you would recommend either of you, 541 00:25:11.670 --> 00:25:13.140 either Ed or Dr. Rosdahl, 542 00:25:13.140 --> 00:25:16.680 places that patients can go if they want 543 00:25:16.680 --> 00:25:21.510 to read a bit more about glaucoma, whether it's treatment 544 00:25:21.510 --> 00:25:24.598 or perhaps if they're looking for a glaucoma specialist, 545 00:25:24.598 --> 00:25:26.700 places that they can go just 546 00:25:26.700 --> 00:25:29.340 to do some of their own research? 547 00:25:29.340 --> 00:25:31.920 So the websites that I recommend 548 00:25:31.920 --> 00:25:36.300 for learning about glaucoma include the American Academy 549 00:25:36.300 --> 00:25:39.720 of Ophthalmology Patient Education website. 550 00:25:39.720 --> 00:25:43.050 That is called eyesmart.org, 551 00:25:43.050 --> 00:25:46.620 E-Y-E-S-M-A-R-T.org. 552 00:25:46.620 --> 00:25:49.350 It is a great resource for patients. 553 00:25:49.350 --> 00:25:52.650 The National Eye Institute also has a lot 554 00:25:52.650 --> 00:25:54.990 of great information about glaucoma 555 00:25:54.990 --> 00:25:58.770 and some of the more scientific advancements 556 00:25:58.770 --> 00:26:00.600 that are going on right now. 557 00:26:00.600 --> 00:26:03.090 And if you're looking for a glaucoma specialist, 558 00:26:03.090 --> 00:26:05.190 of course the best way is gonna be 559 00:26:05.190 --> 00:26:08.280 to ask your local eye doctor for a recommendation 560 00:26:08.280 --> 00:26:11.700 for someone that they work well with and that they know. 561 00:26:11.700 --> 00:26:12.810 But if you're online 562 00:26:12.810 --> 00:26:14.610 and you're looking for someone, 563 00:26:14.610 --> 00:26:17.310 the American Glaucoma Society, 564 00:26:17.310 --> 00:26:20.850 or AGS, we maintain a list 565 00:26:20.850 --> 00:26:23.640 of fellowship trained glaucoma specialists 566 00:26:23.640 --> 00:26:27.390 in the United States and patients can go on that site 567 00:26:27.390 --> 00:26:29.820 and search by zip code to look 568 00:26:29.820 --> 00:26:33.120 for a fellowship trained glaucoma specialists. 569 00:26:33.120 --> 00:26:35.670 Fantastic and we'll have all 570 00:26:35.670 --> 00:26:38.700 of those resources in our show notes. 571 00:26:38.700 --> 00:26:40.290 I wanna thank you both so much 572 00:26:40.290 --> 00:26:42.240 for spending a little time with us today. 573 00:26:42.240 --> 00:26:44.880 I'm so glad and I am very appreciative 574 00:26:44.880 --> 00:26:46.740 of the information that you've shared. 575 00:26:46.740 --> 00:26:48.150 Oh, you're welcome, it was a pleasure. 576 00:26:48.150 --> 00:26:48.983 It's been my pleasure, 577 00:26:48.983 --> 00:26:49.816 Ricky and Ed, thank you so much. 578 00:26:51.780 --> 00:26:52.613 Thank you. 579 00:26:53.700 --> 00:26:55.380 Got something to say? 580 00:26:55.380 --> 00:26:59.130 Share your thoughts about this episode of "Hadley Presents", 581 00:26:59.130 --> 00:27:01.950 or make suggestions for future episodes. 582 00:27:01.950 --> 00:27:03.720 We'd love to hear from you. 583 00:27:03.720 --> 00:27:08.130 Send us an email at podcast@hadley.edu. 584 00:27:08.130 --> 00:27:13.130 That's P-O-D-C-A-S-T@hadley.edu. 585 00:27:13.230 --> 00:27:17.523 Or leave us a message at 847-784-2870. 586 00:27:20.010 --> 00:27:21.885 Thanks for listening. 587 00:27:21.885 --> 00:27:24.385 (warm music)