WEBVTT 1 00:00:00.125 --> 00:00:02.708 (gentle music) 2 00:00:04.080 --> 00:00:06.300 Welcome to "Hadley Presents." 3 00:00:06.300 --> 00:00:10.920 I'm your host, Ricky Enger, inviting you to sit back, relax, 4 00:00:10.920 --> 00:00:13.830 and enjoy a conversation with the experts. 5 00:00:13.830 --> 00:00:15.938 In this episode, we hear from specialists 6 00:00:15.938 --> 00:00:18.270 discussing diagnosis and treatment 7 00:00:18.270 --> 00:00:21.024 of several eye conditions, along with information about 8 00:00:21.024 --> 00:00:23.970 getting the most from your remaining vision. 9 00:00:23.970 --> 00:00:25.610 You know, I've learned so much 10 00:00:25.610 --> 00:00:28.410 during my time as host of "Hadley Presents," 11 00:00:28.410 --> 00:00:32.280 and I've gotten to chat with some really incredible guests. 12 00:00:32.280 --> 00:00:34.764 We have had topics on vision loss, 13 00:00:34.764 --> 00:00:38.411 ranging from art to technology to marriage, 14 00:00:38.411 --> 00:00:41.700 and pretty much everything in between, I think. 15 00:00:41.700 --> 00:00:44.340 One thing that we heard a lot from our listeners 16 00:00:44.340 --> 00:00:48.180 was that they wanted to know more about vision loss itself. 17 00:00:48.180 --> 00:00:49.770 So they wanted to understand 18 00:00:49.770 --> 00:00:51.456 their own eye conditions better, 19 00:00:51.456 --> 00:00:55.496 and they wanted some idea of what to expect going forward. 20 00:00:55.496 --> 00:00:58.440 Thankfully, we were able to find the guests 21 00:00:58.440 --> 00:01:00.600 who could speak to that really well. 22 00:01:00.600 --> 00:01:04.290 We've had a number of eye doctors and low vision specialists 23 00:01:04.290 --> 00:01:06.090 who were willing to share their time 24 00:01:06.090 --> 00:01:09.060 and their expertise with us, so we figured 25 00:01:09.060 --> 00:01:12.097 why not gather some of that info all in one place, 26 00:01:12.097 --> 00:01:15.863 kind of like a one-stop shopping for low vision information. 27 00:01:15.863 --> 00:01:19.020 So I think one of the most common eye conditions 28 00:01:19.020 --> 00:01:20.022 is glaucoma. 29 00:01:20.022 --> 00:01:21.870 So many people have it, 30 00:01:21.870 --> 00:01:25.251 but it's not actually caused by just one thing. 31 00:01:25.251 --> 00:01:27.955 There's not even a single, definite symptom 32 00:01:27.955 --> 00:01:30.060 that tells you that you have it. 33 00:01:30.060 --> 00:01:34.950 So what exactly is glaucoma, and how does it get diagnosed? 34 00:01:34.950 --> 00:01:39.300 For the answer to that, we approached Dr. Jullia Rosdahl. 35 00:01:39.300 --> 00:01:40.133 So, glaucoma is actually a group of 36 00:01:40.133 --> 00:01:40.966 eye diseases, 37 00:01:42.642 --> 00:01:46.452 and what they have in common is that the optic nerve, 38 00:01:46.452 --> 00:01:50.318 which is the cable that connects the eye to the brain, 39 00:01:50.318 --> 00:01:53.430 it's when that optic nerve becomes thinned out 40 00:01:53.430 --> 00:01:56.070 because of those neurons, those retinal ganglion cells, 41 00:01:56.070 --> 00:01:57.540 of those neurons dying. 42 00:01:57.540 --> 00:02:01.170 So when the nerve dies off like that, people lose vision, 43 00:02:01.170 --> 00:02:02.370 and it usually affects 44 00:02:02.370 --> 00:02:06.360 their peripheral or side vision first in glaucoma. 45 00:02:06.360 --> 00:02:09.570 The most common type of glaucoma in the United States 46 00:02:09.570 --> 00:02:14.250 is primary open-angle glaucoma, and one of the main problems 47 00:02:14.250 --> 00:02:17.550 that we have with glaucoma is that people have it 48 00:02:17.550 --> 00:02:19.200 and they don't know it, 49 00:02:19.200 --> 00:02:21.990 because the vision loss happens really slowly, 50 00:02:21.990 --> 00:02:24.750 and once you lose vision from glaucoma, 51 00:02:24.750 --> 00:02:26.850 we can't get that vision back. 52 00:02:26.850 --> 00:02:30.426 So early detection and diagnosing glaucoma early 53 00:02:30.426 --> 00:02:33.626 is really important for saving sight. 54 00:02:33.626 --> 00:02:35.640 You asked about risk factors. 55 00:02:35.640 --> 00:02:39.390 So they include having a family history of glaucoma. 56 00:02:39.390 --> 00:02:41.280 So, people in your family. 57 00:02:41.280 --> 00:02:44.880 Older age is an important risk factor for glaucoma too, 58 00:02:44.880 --> 00:02:48.300 and, actually, Black race and Hispanic ethnicity 59 00:02:48.300 --> 00:02:49.380 are risk factors, 60 00:02:49.380 --> 00:02:52.320 although a lot of white people can get glaucoma too. 61 00:02:52.320 --> 00:02:55.350 Okay, so how does someone get to the point 62 00:02:55.350 --> 00:02:58.183 where it's clear that they should be screened for glaucoma, 63 00:02:58.183 --> 00:03:01.920 and what is a typical glaucoma exam like? 64 00:03:01.920 --> 00:03:04.650 The scenario that we hope for is that 65 00:03:04.650 --> 00:03:08.130 people are going along in their regular lives, 66 00:03:08.130 --> 00:03:11.871 and they're getting regular complete eye exams 67 00:03:11.871 --> 00:03:14.790 with their local eye doctors. 68 00:03:14.790 --> 00:03:18.764 That local eye doctor recognizes some early sign. 69 00:03:18.764 --> 00:03:22.410 Maybe the eye pressure is a little elevated, 70 00:03:22.410 --> 00:03:25.350 or maybe the optic nerve looks a little suspicious, 71 00:03:25.350 --> 00:03:30.350 a family history is noted, and that savvy local eye doctor 72 00:03:30.710 --> 00:03:34.044 either does some of the glaucoma testing themselves 73 00:03:34.044 --> 00:03:39.044 or refers them to someone like me as a glaucoma specialist, 74 00:03:39.209 --> 00:03:41.070 and then I see them. 75 00:03:41.070 --> 00:03:44.435 We do what we call a glaucoma evaluation, 76 00:03:44.435 --> 00:03:47.880 which is a pretty lengthy visit in-clinic, 77 00:03:47.880 --> 00:03:49.766 where they get a lot of special testing 78 00:03:49.766 --> 00:03:52.020 and an in-depth eye exam, 79 00:03:52.020 --> 00:03:54.930 and we ferret out whether they do have glaucoma 80 00:03:54.930 --> 00:03:59.160 or just some risk factors that need to be followed. 81 00:03:59.160 --> 00:04:01.710 So that's the scenario that we hope for, 82 00:04:01.710 --> 00:04:04.551 where the disease is diagnosed early 83 00:04:04.551 --> 00:04:08.280 before really any vision loss has occurred, 84 00:04:08.280 --> 00:04:11.760 and we can start treatment early and prevent vision loss. 85 00:04:11.760 --> 00:04:15.390 So we also get referrals for help in managing patients 86 00:04:15.390 --> 00:04:18.840 who've already sustained vision loss from glaucoma 87 00:04:18.840 --> 00:04:21.720 or already have advanced glaucoma, 88 00:04:21.720 --> 00:04:25.566 and sometimes the reasons that they come to us are because 89 00:04:25.566 --> 00:04:29.830 they need surgery, or they need some additional treatment 90 00:04:29.830 --> 00:04:33.660 that that local eye doctor is not able to provide. 91 00:04:33.660 --> 00:04:34.980 So there are lots of different ways 92 00:04:34.980 --> 00:04:38.700 that patients come to see a glaucoma specialist, 93 00:04:38.700 --> 00:04:41.970 but we always hope that they're coming early enough 94 00:04:41.970 --> 00:04:45.570 where we can save vision, and that frequently is the case. 95 00:04:45.570 --> 00:04:48.926 Actually, most people who are diagnosed with glaucoma 96 00:04:48.926 --> 00:04:52.830 and treated for glaucoma don't go blind from it. 97 00:04:52.830 --> 00:04:54.960 Okay. That's awesome news. 98 00:04:54.960 --> 00:04:57.480 So then what can someone expect 99 00:04:57.480 --> 00:05:00.540 as far as how glaucoma is treated? 100 00:05:00.540 --> 00:05:01.373 The main treatment for glaucoma is to 101 00:05:01.373 --> 00:05:02.206 lower eye pressure, 102 00:05:05.430 --> 00:05:08.070 and we have a lot of different ways to do it. 103 00:05:08.070 --> 00:05:11.481 Typically, we'll start with eye drop medications 104 00:05:11.481 --> 00:05:15.600 or a laser treatment to the drain of the eye, 105 00:05:15.600 --> 00:05:17.889 and then there are also surgical treatments 106 00:05:17.889 --> 00:05:20.790 that we typically reserve for cases 107 00:05:20.790 --> 00:05:25.221 where we cannot control the glaucoma with the drops or laser 108 00:05:25.221 --> 00:05:26.880 or where those treatments 109 00:05:26.880 --> 00:05:29.850 are just not effective or not possible. 110 00:05:29.850 --> 00:05:33.203 For example, a patient who has a lot of eye drop allergies 111 00:05:33.203 --> 00:05:35.190 cannot tolerate any of the drops. 112 00:05:35.190 --> 00:05:37.860 Then surgery may be considered 113 00:05:37.860 --> 00:05:40.380 for a more mild case as well. 114 00:05:40.380 --> 00:05:42.930 I imagine eye drops aren't at 115 00:05:42.930 --> 00:05:45.780 the top of anyone's list of favorite things. 116 00:05:45.780 --> 00:05:49.710 Still, it's helpful to know how much they can really do 117 00:05:49.710 --> 00:05:51.030 and what to expect 118 00:05:51.030 --> 00:05:53.820 if this is the treatment you'll be working with. 119 00:05:53.820 --> 00:05:54.653 It's really, really important 120 00:05:54.653 --> 00:05:55.486 that patients follow 121 00:05:57.630 --> 00:06:00.300 those eye drop treatment regimens. 122 00:06:00.300 --> 00:06:01.837 I like to say to my patients, 123 00:06:01.837 --> 00:06:04.530 "This eye drop is a very powerful way 124 00:06:04.530 --> 00:06:06.630 to lower eye pressure, but it does not work 125 00:06:06.630 --> 00:06:08.160 if it is sitting in the bottle. 126 00:06:08.160 --> 00:06:10.440 It needs to go into your eye." 127 00:06:10.440 --> 00:06:12.690 There are a lot of different types of eye drops 128 00:06:12.690 --> 00:06:17.250 that we prescribe, and so the regimens can vary quite a bit. 129 00:06:17.250 --> 00:06:19.110 I would say the most simple one would be 130 00:06:19.110 --> 00:06:22.489 a once-a-day eye drop that you might use at bedtime, 131 00:06:22.489 --> 00:06:24.370 but sometimes, we have patients on 132 00:06:24.370 --> 00:06:27.150 three or even four eye drop medications. 133 00:06:27.150 --> 00:06:28.920 Some of them need to be dosed 134 00:06:28.920 --> 00:06:33.430 two or even three times per day, and it's quite a feat, 135 00:06:33.430 --> 00:06:36.510 getting them all in at the right times, 136 00:06:36.510 --> 00:06:38.100 but it's really quite important. 137 00:06:38.100 --> 00:06:40.740 Those eye drops lower eye pressure 138 00:06:40.740 --> 00:06:44.220 for a certain amount of time after they're instilled, 139 00:06:44.220 --> 00:06:46.760 and then that eye pressure will go back up 140 00:06:46.760 --> 00:06:49.500 once that eye drop medication has kinda worn off, 141 00:06:49.500 --> 00:06:52.050 and so that next dose is timed 142 00:06:52.050 --> 00:06:55.682 to really maintain that lower eye pressure, 143 00:06:55.682 --> 00:06:59.789 and we think that maintaining a lower eye pressure 144 00:06:59.789 --> 00:07:01.920 and really keeping it low 145 00:07:01.920 --> 00:07:04.354 without those kind of big fluctuations 146 00:07:04.354 --> 00:07:06.780 can really help protect the optic nerve, 147 00:07:06.780 --> 00:07:08.670 help preserve that sight. 148 00:07:08.670 --> 00:07:11.977 The biggest misapprehension about glaucoma treatment 149 00:07:11.977 --> 00:07:14.880 I would say is about the effects of treatment. 150 00:07:14.880 --> 00:07:17.610 Most people expect that glaucoma eye drops 151 00:07:17.610 --> 00:07:21.780 will make their eyes feel better or help them to see better, 152 00:07:21.780 --> 00:07:23.640 but that really isn't the case. 153 00:07:23.640 --> 00:07:26.790 Eye drops for glaucoma help to lower the eye pressure 154 00:07:26.790 --> 00:07:29.370 to prevent future vision loss, 155 00:07:29.370 --> 00:07:30.960 so they help keep your vision, 156 00:07:30.960 --> 00:07:32.477 but they don't make vision better, 157 00:07:32.477 --> 00:07:35.170 and they can have some side effects. 158 00:07:35.170 --> 00:07:36.986 Most of them are manageable. 159 00:07:36.986 --> 00:07:39.030 People do great on their drops, 160 00:07:39.030 --> 00:07:42.000 but there can be some stinging or redness, 161 00:07:42.000 --> 00:07:45.630 and sometimes we do need to even stop or change drops 162 00:07:45.630 --> 00:07:47.490 because of side effects. 163 00:07:47.490 --> 00:07:51.360 So that misapprehension about the effects of treatment, 164 00:07:51.360 --> 00:07:54.270 that's one that I'd like people to know about too. 165 00:07:54.270 --> 00:07:56.340 Thank you, Dr. Rosdahl, for giving us 166 00:07:56.340 --> 00:07:59.730 such a great overview of not only what glaucoma is 167 00:07:59.730 --> 00:08:01.320 and how it's diagnosed, 168 00:08:01.320 --> 00:08:04.075 but also what to expect when it comes to treatment. 169 00:08:04.075 --> 00:08:06.300 Knowledge is power, right? 170 00:08:06.300 --> 00:08:09.480 So, I guess, when it comes to eye conditions, 171 00:08:09.480 --> 00:08:12.690 there's one part of the eye that gets mentioned quite a bit, 172 00:08:12.690 --> 00:08:14.430 for a number of reasons. 173 00:08:14.430 --> 00:08:16.860 So many eye conditions affect the retina, 174 00:08:16.860 --> 00:08:19.158 so we wanted someone to talk about that. 175 00:08:19.158 --> 00:08:21.810 What is the retina? What does it do? 176 00:08:21.810 --> 00:08:23.700 And what options do you have 177 00:08:23.700 --> 00:08:25.710 when something goes wrong with it? 178 00:08:25.710 --> 00:08:28.140 Well, who better to answer those questions 179 00:08:28.140 --> 00:08:29.970 than a retina specialist, 180 00:08:29.970 --> 00:08:33.874 so we approached Dr. Tim Murray to talk about that. 181 00:08:33.874 --> 00:08:34.707 [Dr. Murray]I think the retina is the key to 182 00:08:34.707 --> 00:08:35.540 the vision that we enjoy, 183 00:08:39.054 --> 00:08:42.251 and for us that are a little bit older, 184 00:08:42.251 --> 00:08:45.480 the retina is much like the film in the camera. 185 00:08:45.480 --> 00:08:48.600 You know that light comes into the eye. 186 00:08:48.600 --> 00:08:52.410 It gets focused through the clear cornea and the lens, 187 00:08:52.410 --> 00:08:55.020 which allows us to focus the image, 188 00:08:55.020 --> 00:08:57.270 but what actually takes that image 189 00:08:57.270 --> 00:09:01.043 and transfers it in an electrical way to our brain 190 00:09:01.043 --> 00:09:04.194 so that we can see is the retina. 191 00:09:04.194 --> 00:09:08.970 So, if the retina doesn't function, you cannot see. 192 00:09:08.970 --> 00:09:12.930 For most retina specialists, we're referral-based, 193 00:09:12.930 --> 00:09:16.050 which means that you've seen an optometrist 194 00:09:16.050 --> 00:09:19.481 or another ophthalmologist that has seen you 195 00:09:19.481 --> 00:09:23.524 and recognized that you have a retina specialty problem 196 00:09:23.524 --> 00:09:27.357 and has referred you, and most of those referrals 197 00:09:27.357 --> 00:09:30.270 are actually quite urgent. 198 00:09:30.270 --> 00:09:34.506 So, they may see a tear in the retina or a detachment, 199 00:09:34.506 --> 00:09:39.506 or tumor, or evidence of a stroke or bleeding from diabetes. 200 00:09:40.091 --> 00:09:41.850 So, most of our patients, 201 00:09:41.850 --> 00:09:45.240 when they're made aware that they need a retina specialist, 202 00:09:45.240 --> 00:09:47.130 need one quickly. 203 00:09:47.130 --> 00:09:50.790 A lot of times, we have conditions that run in families, 204 00:09:50.790 --> 00:09:53.130 and so we know that a family member 205 00:09:53.130 --> 00:09:58.080 may have a parent or a child or sibling 206 00:09:58.080 --> 00:10:00.471 that could have disease, and we'll actually, 207 00:10:00.471 --> 00:10:02.310 as the retina specialist, 208 00:10:02.310 --> 00:10:06.060 ask them to bring their family members in to be seen. 209 00:10:06.060 --> 00:10:06.893 One of the most common diseases 210 00:10:06.893 --> 00:10:08.458 affecting the retina, 211 00:10:08.458 --> 00:10:12.771 especially in older individuals, is macular degeneration, 212 00:10:12.771 --> 00:10:15.180 and people who have been diagnosed 213 00:10:15.180 --> 00:10:17.250 naturally have a lot of questions about it, 214 00:10:17.250 --> 00:10:19.740 like what treatment options are available, 215 00:10:19.740 --> 00:10:23.340 and what's likely to happen once they've been diagnosed. 216 00:10:23.340 --> 00:10:25.290 [Dr. Murray]First of all, the most important thing is 217 00:10:25.290 --> 00:10:29.374 to recognize that most types of macular degeneration, 218 00:10:29.374 --> 00:10:32.926 which is the dry type of macular degeneration, 219 00:10:32.926 --> 00:10:35.120 never need to be injected. 220 00:10:35.120 --> 00:10:38.964 So, it's very important to get the correct diagnosis, 221 00:10:38.964 --> 00:10:40.605 as you might imagine, 222 00:10:40.605 --> 00:10:45.240 and the technology to do that has become incredibly precise. 223 00:10:45.240 --> 00:10:48.690 We have technology now that's called OCT, 224 00:10:48.690 --> 00:10:51.510 or optical coherence tomography. 225 00:10:51.510 --> 00:10:54.977 It takes a laser scan of the retina that is so precise, 226 00:10:54.977 --> 00:10:58.830 it's better than what I used to see in the microscope 227 00:10:58.830 --> 00:11:00.480 when I was in medical school, 228 00:11:00.480 --> 00:11:03.540 and those testing evaluations allow us 229 00:11:03.540 --> 00:11:07.170 to be incredibly precise about how we treat the patient, 230 00:11:07.170 --> 00:11:10.620 and at this point, we really personalize our therapy. 231 00:11:10.620 --> 00:11:14.160 So, it is not one size fits all. 232 00:11:14.160 --> 00:11:17.100 Every patient gets personally identified 233 00:11:17.100 --> 00:11:20.610 and targeted treatment based on how they're responding. 234 00:11:20.610 --> 00:11:24.450 Some patients are blessed and may need one injection only 235 00:11:24.450 --> 00:11:27.060 and never need to be injected again, 236 00:11:27.060 --> 00:11:31.200 and some patients need to be injected for their lifetime, 237 00:11:31.200 --> 00:11:34.770 but having said that, it's worth it to do it well, 238 00:11:34.770 --> 00:11:36.930 because before these injections, 239 00:11:36.930 --> 00:11:39.570 and I'm a little bit more mature, 240 00:11:39.570 --> 00:11:41.610 every person that we took care of 241 00:11:41.610 --> 00:11:44.707 with wet macular degeneration went blind. 242 00:11:44.707 --> 00:11:48.990 I almost never see that, and when I do see that, 243 00:11:48.990 --> 00:11:51.664 it's because somebody came late, or for some reason, 244 00:11:51.664 --> 00:11:55.080 they weren't able to continue to be treated. 245 00:11:55.080 --> 00:11:59.130 So that's an amazing change, even in the last 10 years. 246 00:11:59.130 --> 00:12:02.653 So that's the most important message to get across 247 00:12:02.653 --> 00:12:07.380 is that these conditions that routinely were blinding 248 00:12:07.380 --> 00:12:12.030 in our grandparents' decade are now very treatable, 249 00:12:12.030 --> 00:12:15.090 and the key to that is early diagnosis 250 00:12:15.090 --> 00:12:17.340 and seeing a specialist that's equipped 251 00:12:17.340 --> 00:12:19.890 to take the best care of the patient. 252 00:12:19.890 --> 00:12:20.723 There are actually two types of 253 00:12:20.723 --> 00:12:21.556 macular degeneration, 254 00:12:22.800 --> 00:12:24.780 so what if you've been diagnosed with 255 00:12:24.780 --> 00:12:26.493 dry macular degeneration? 256 00:12:26.493 --> 00:12:30.120 Do you have to still be seen by a retinal specialist, 257 00:12:30.120 --> 00:12:33.390 and if you do, how often does that need to happen? 258 00:12:33.390 --> 00:12:35.430 [Dr. Murray]The reason why you want to be followed 259 00:12:35.430 --> 00:12:37.530 with dry macular degeneration 260 00:12:37.530 --> 00:12:40.410 is because it can convert from dry to wet, 261 00:12:40.410 --> 00:12:43.020 and wet is incredibly treatable, 262 00:12:43.020 --> 00:12:46.680 and wet is typically the type of macular degeneration 263 00:12:46.680 --> 00:12:48.630 that leads to blindness. 264 00:12:48.630 --> 00:12:52.385 Dry macular degeneration usually doesn't have 265 00:12:52.385 --> 00:12:57.385 a significant impact in the visual function of the patient 266 00:12:57.600 --> 00:13:01.320 unless they develop what's called geographic atrophy, 267 00:13:01.320 --> 00:13:06.270 and that's literally where the retinal tissues in the center 268 00:13:06.270 --> 00:13:11.270 just become dysfunctional and they essentially wither away. 269 00:13:11.665 --> 00:13:16.313 Fortunately, that's a very rare component 270 00:13:16.313 --> 00:13:19.230 of macular degeneration. 271 00:13:19.230 --> 00:13:22.666 So, I think the last thing you want to do as a patient, 272 00:13:22.666 --> 00:13:27.060 when you have a condition that we know has long-term issues, 273 00:13:27.060 --> 00:13:30.030 is not to continue to be seen. 274 00:13:30.030 --> 00:13:32.070 It's interesting because a lot of people, 275 00:13:32.070 --> 00:13:35.820 regardless of their eye condition, end up having cataracts. 276 00:13:35.820 --> 00:13:38.841 So, of course, they get cataract surgery to deal with that, 277 00:13:38.841 --> 00:13:42.363 and then the vision should be way better after that, right? 278 00:13:42.363 --> 00:13:45.832 Well, sometimes when a cataract is removed, 279 00:13:45.832 --> 00:13:49.050 a specialist can see more about what's going on in the eye 280 00:13:49.050 --> 00:13:52.080 now that the view isn't blocked by that cataract. 281 00:13:52.080 --> 00:13:54.456 So what happens at that point? 282 00:13:54.456 --> 00:13:55.289 [Dr. Murray]One of the things that we try to 283 00:13:55.289 --> 00:13:56.122 teach our colleagues 284 00:13:58.710 --> 00:14:01.530 that are going to do cataract surgery 285 00:14:01.530 --> 00:14:06.210 is that it really is critical in this day and age 286 00:14:06.210 --> 00:14:11.210 to look at the macula with imaging before cataract surgery, 287 00:14:11.640 --> 00:14:15.270 because if a patient has preexisting macular degeneration 288 00:14:15.270 --> 00:14:18.696 and that is the reason that the vision is being impacted, 289 00:14:18.696 --> 00:14:21.660 taking the cataract out 290 00:14:21.660 --> 00:14:25.649 is only going to unmask the macular degeneration. 291 00:14:25.649 --> 00:14:29.700 So, I think it's fair to counsel patients ahead of time 292 00:14:29.700 --> 00:14:31.777 by looking at the macula to say, 293 00:14:31.777 --> 00:14:33.870 "Look, we're going to take your cataract out, 294 00:14:33.870 --> 00:14:36.480 but you have macular degeneration, 295 00:14:36.480 --> 00:14:38.850 and it may require additional treatment 296 00:14:38.850 --> 00:14:40.800 by a retina specialist." 297 00:14:40.800 --> 00:14:43.350 If you have your cataract removed and for any reason 298 00:14:43.350 --> 00:14:46.501 there is not a really good outcome visually, 299 00:14:46.501 --> 00:14:49.770 I think every one of those patients 300 00:14:49.770 --> 00:14:51.783 should see a retina specialist, 301 00:14:51.783 --> 00:14:55.230 because many of the conditions that limit vision 302 00:14:55.230 --> 00:14:58.680 after cataract surgery are eminently treatable 303 00:14:58.680 --> 00:15:00.219 by a retina specialist. 304 00:15:00.219 --> 00:15:02.280 Thank you, Dr. Murray. 305 00:15:02.280 --> 00:15:04.140 That information is so helpful 306 00:15:04.140 --> 00:15:06.360 for anybody with a retinal eye condition, 307 00:15:06.360 --> 00:15:08.820 and especially for those with mac D. 308 00:15:08.820 --> 00:15:11.430 It's great to know what to expect. 309 00:15:11.430 --> 00:15:15.000 Now, we've talked a lot about particular eye diseases 310 00:15:15.000 --> 00:15:16.230 and how they're treated, 311 00:15:16.230 --> 00:15:18.660 but what we haven't really talked about yet 312 00:15:18.660 --> 00:15:20.850 is what happens in addition 313 00:15:20.850 --> 00:15:22.923 to any medical treatment you get. 314 00:15:22.923 --> 00:15:25.170 You still have to figure out things 315 00:15:25.170 --> 00:15:29.310 like glasses, lighting, that kind of thing, and, honestly, 316 00:15:29.310 --> 00:15:31.620 it's hard to even know what's available, 317 00:15:31.620 --> 00:15:33.510 as far as what can really help you 318 00:15:33.510 --> 00:15:35.940 get the most out of your remaining vision, 319 00:15:35.940 --> 00:15:38.400 and that's where a low vision specialist 320 00:15:38.400 --> 00:15:40.320 can really make a difference. 321 00:15:40.320 --> 00:15:42.930 We talked with Dr. Mark Wilkinson 322 00:15:42.930 --> 00:15:45.090 about what you can expect when you walk in 323 00:15:45.090 --> 00:15:48.180 to an appointment with a low vision specialist. 324 00:15:48.180 --> 00:15:49.013 [Dr. Wilkinson]We want to know what the person's 325 00:15:49.013 --> 00:15:49.846 visual history is, 326 00:15:50.966 --> 00:15:53.250 what they've been told about their vision, 327 00:15:53.250 --> 00:15:55.226 their diagnosis, prognosis, 328 00:15:55.226 --> 00:15:57.720 and what types of tools they've tried 329 00:15:57.720 --> 00:15:59.040 or have used in the past, 330 00:15:59.040 --> 00:16:01.230 and what difficulties they're having at this point 331 00:16:01.230 --> 00:16:03.690 accomplishing the visual tasks that they need to do 332 00:16:03.690 --> 00:16:05.460 on a daily basis. 333 00:16:05.460 --> 00:16:07.110 From there, we're going to assess their vision, 334 00:16:07.110 --> 00:16:09.990 both their distance and their reading vision, 335 00:16:09.990 --> 00:16:11.370 oftentimes a little bit different 336 00:16:11.370 --> 00:16:14.754 than might be done by their medical eyecare provider. 337 00:16:14.754 --> 00:16:17.100 We're going to double check their glasses prescription, 338 00:16:17.100 --> 00:16:20.070 which many times has not been done for a number of years, 339 00:16:20.070 --> 00:16:22.590 see if an alternate glasses prescription will help 340 00:16:22.590 --> 00:16:25.140 distance and/or reading vision. 341 00:16:25.140 --> 00:16:26.730 We're gonna review their contrast needs, 342 00:16:26.730 --> 00:16:29.040 because contrast is very, very important 343 00:16:29.040 --> 00:16:31.110 for being able to function better. 344 00:16:31.110 --> 00:16:33.300 The real world is not perfectly black and white, 345 00:16:33.300 --> 00:16:35.970 and so that's one of the things I always tell people, 346 00:16:35.970 --> 00:16:39.390 is the eye exam room is the most unnatural place you can be 347 00:16:39.390 --> 00:16:41.790 because it's perfect lighting, perfect contrast, 348 00:16:41.790 --> 00:16:44.160 and the real world is not like that. 349 00:16:44.160 --> 00:16:46.650 From there, we'll review devices and strategies 350 00:16:46.650 --> 00:16:49.134 that can enhance the remaining visual abilities 351 00:16:49.134 --> 00:16:50.820 and allow them to do the things 352 00:16:50.820 --> 00:16:54.480 they're currently finding difficult or impossible to do. 353 00:16:54.480 --> 00:16:57.840 I think that care is always ongoing, but that said, 354 00:16:57.840 --> 00:16:59.850 you know, not everybody needs to be seen 355 00:16:59.850 --> 00:17:02.041 every few months or even every year, 356 00:17:02.041 --> 00:17:04.920 and I tell my patients, if you don't have to see me, 357 00:17:04.920 --> 00:17:07.620 that's a good thing because it means your vision is stable 358 00:17:07.620 --> 00:17:10.110 and you're doing well with the devices you have, 359 00:17:10.110 --> 00:17:12.360 but with that in mind, I have a plan, you know, 360 00:17:12.360 --> 00:17:14.055 that I set up with each patient 361 00:17:14.055 --> 00:17:16.800 so that we know when we're gonna see them again 362 00:17:16.800 --> 00:17:18.930 based on their individual needs and situations, 363 00:17:18.930 --> 00:17:20.880 and we always tell them you can come back 364 00:17:20.880 --> 00:17:22.200 and see me sooner if needed. 365 00:17:22.200 --> 00:17:24.810 So, I don't necessarily have to see somebody 366 00:17:24.810 --> 00:17:28.140 on a regular basis, but certainly, we're available. 367 00:17:28.140 --> 00:17:29.610 For instance, if they're having issues 368 00:17:29.610 --> 00:17:30.570 with driving or something, 369 00:17:30.570 --> 00:17:32.910 we'll have to see them on a more regular basis for that, 370 00:17:32.910 --> 00:17:34.650 or if they have some progressive condition. 371 00:17:34.650 --> 00:17:36.120 It also depends on their age. 372 00:17:36.120 --> 00:17:38.250 So, lots of variables, 373 00:17:38.250 --> 00:17:40.920 but, definitely, it's not a one-shot deal. 374 00:17:40.920 --> 00:17:43.170 It sounds like one of the key things 375 00:17:43.170 --> 00:17:46.800 that a low vision specialist does is to develop a plan 376 00:17:46.800 --> 00:17:49.530 for how to approach things in a successful way, 377 00:17:49.530 --> 00:17:51.330 just by helping to figure out 378 00:17:51.330 --> 00:17:55.110 what tools are gonna work best in a person's daily life. 379 00:17:55.110 --> 00:17:58.320 So how can you prepare for a discussion like that? 380 00:17:58.320 --> 00:17:59.153 [Dr. Wilkinson]I oftentimes have to tell people, 381 00:17:59.153 --> 00:17:59.986 you know, 382 00:18:00.840 --> 00:18:02.601 your vision has been compromised, 383 00:18:02.601 --> 00:18:04.650 and because of that compromise, 384 00:18:04.650 --> 00:18:07.359 we're gonna have to do things in a little bit different way, 385 00:18:07.359 --> 00:18:10.920 and so there isn't sort of a magic pair of glasses 386 00:18:10.920 --> 00:18:12.180 that's gonna restore your vision 387 00:18:12.180 --> 00:18:14.940 back to the level that it was in the past. 388 00:18:14.940 --> 00:18:16.380 We're gonna have to do things differently, 389 00:18:16.380 --> 00:18:18.480 which might mean holding things closer 390 00:18:18.480 --> 00:18:20.130 with a stronger pair of reading glasses. 391 00:18:20.130 --> 00:18:21.900 It might be holding a device. 392 00:18:21.900 --> 00:18:24.690 It might be using reverse contrast, 393 00:18:24.690 --> 00:18:27.000 the dark mode on your smartphone, 394 00:18:27.000 --> 00:18:29.730 or using some sort of video magnification device 395 00:18:29.730 --> 00:18:33.030 or increasing the magnification on your Kindle or your iPad. 396 00:18:33.030 --> 00:18:34.800 So, we're gonna have to do things 397 00:18:34.800 --> 00:18:37.200 in a little bit different way, but when we do that, 398 00:18:37.200 --> 00:18:38.760 most often, we can accomplish 399 00:18:38.760 --> 00:18:42.300 the goals and the tasks that you're still wanting to do. 400 00:18:42.300 --> 00:18:43.860 I think that it's very important that 401 00:18:43.860 --> 00:18:45.690 they bring the devices they've been using 402 00:18:45.690 --> 00:18:48.090 so we can see what they've worked with, 403 00:18:48.090 --> 00:18:51.781 see what has worked for them, maybe worked well in the past, 404 00:18:51.781 --> 00:18:54.150 and then from there, determine what's gonna be 405 00:18:54.150 --> 00:18:56.010 the best options for them. 406 00:18:56.010 --> 00:18:58.500 Oftentimes, people are buying things online 407 00:18:58.500 --> 00:19:00.397 that are mislabeled, and so they'll say, 408 00:19:00.397 --> 00:19:03.420 "Well, I'm using a 6X," and, actually, it's a six diopter, 409 00:19:03.420 --> 00:19:05.141 which is 1.5X, 410 00:19:05.141 --> 00:19:08.130 and so seeing the devices that they've been using, 411 00:19:08.130 --> 00:19:09.540 what they've been successful with 412 00:19:09.540 --> 00:19:13.950 and what has not worked for them is very important. 413 00:19:13.950 --> 00:19:15.420 I always remember my grandmother 414 00:19:15.420 --> 00:19:16.920 who had diabetic retinopathy, 415 00:19:16.920 --> 00:19:19.200 somebody would send her a new magnifier, you know, 416 00:19:19.200 --> 00:19:21.420 for Mother's Day and Easter and stuff, 417 00:19:21.420 --> 00:19:23.400 and she just looked at it and put it in a drawer 418 00:19:23.400 --> 00:19:24.240 and never used them. 419 00:19:24.240 --> 00:19:25.800 So, there's a lot of things 420 00:19:25.800 --> 00:19:28.941 that sound good by the advertising, but don't work 421 00:19:28.941 --> 00:19:32.666 because they're not really prescription devices. 422 00:19:32.666 --> 00:19:35.970 I think that description of this drawer 423 00:19:35.970 --> 00:19:39.450 full of magnification devices sounds pretty relatable, 424 00:19:39.450 --> 00:19:41.640 pretty familiar to a lot of people. 425 00:19:41.640 --> 00:19:44.417 So, what should you expect a magnification device 426 00:19:44.417 --> 00:19:45.921 to be able to do? 427 00:19:45.921 --> 00:19:48.030 Do you have to get a different device 428 00:19:48.030 --> 00:19:49.650 for each task you're doing, 429 00:19:49.650 --> 00:19:54.210 or is it possible to get a lot of general functionality 430 00:19:54.210 --> 00:19:55.980 just with one thing? 431 00:19:55.980 --> 00:19:58.500 [Dr. Wilkinson]Many people can do well with one device. 432 00:19:58.500 --> 00:20:00.000 If they have mild vision loss, 433 00:20:00.000 --> 00:20:02.529 they may just need some stronger reading glasses. 434 00:20:02.529 --> 00:20:05.460 Other people who need electronic magnification 435 00:20:05.460 --> 00:20:07.590 may have a full-size video magnifier. 436 00:20:07.590 --> 00:20:09.930 They may have a portable one that they take with them 437 00:20:09.930 --> 00:20:11.850 when they're away from home. 438 00:20:11.850 --> 00:20:14.340 Now, we have different apps that you can use 439 00:20:14.340 --> 00:20:16.890 and make your smartphone work like a video magnifier. 440 00:20:16.890 --> 00:20:18.060 You can have your smartphone 441 00:20:18.060 --> 00:20:21.510 read materials to you with text to speech, 442 00:20:21.510 --> 00:20:24.360 and so you have lots of options that are available, 443 00:20:24.360 --> 00:20:25.980 and it just really depends on 444 00:20:25.980 --> 00:20:28.187 what the person's having difficulty with. 445 00:20:28.187 --> 00:20:30.840 They might want to read, do hand work, 446 00:20:30.840 --> 00:20:32.550 but they also might want to play the piano, 447 00:20:32.550 --> 00:20:34.440 and so they would need different devices 448 00:20:34.440 --> 00:20:35.610 for those different things. 449 00:20:35.610 --> 00:20:39.439 So, it really comes down to what the person wants to do, 450 00:20:39.439 --> 00:20:42.810 and then the different tools that will help them to do that. 451 00:20:42.810 --> 00:20:45.630 Thank you, Dr. Wilkinson, for sharing 452 00:20:45.630 --> 00:20:48.270 just how important a low vision specialist can be 453 00:20:48.270 --> 00:20:50.130 for helping you to figure out 454 00:20:50.130 --> 00:20:52.920 how to get back to doing the things you love 455 00:20:52.920 --> 00:20:55.800 just by learning about some devices and tools 456 00:20:55.800 --> 00:20:58.830 that can help you use your remaining vision effectively. 457 00:20:58.830 --> 00:21:01.470 We really do appreciate all the experts 458 00:21:01.470 --> 00:21:02.760 who have shared their time 459 00:21:02.760 --> 00:21:05.100 and their valuable knowledge with us. 460 00:21:05.100 --> 00:21:06.600 If you want to learn more about 461 00:21:06.600 --> 00:21:09.270 anything we've shared in today's episode, 462 00:21:09.270 --> 00:21:10.920 including the full interviews 463 00:21:10.920 --> 00:21:13.020 with each of our guests from today, 464 00:21:13.020 --> 00:21:14.670 you can check out the show notes 465 00:21:14.670 --> 00:21:17.520 for links to lots of great resources. 466 00:21:17.520 --> 00:21:20.610 Also, Hadley is available to answer questions 467 00:21:20.610 --> 00:21:22.050 and help you find information, 468 00:21:22.050 --> 00:21:24.090 so, yeah, you can give us a call. 469 00:21:24.090 --> 00:21:28.920 That's 800-323-4238, 470 00:21:29.850 --> 00:21:32.280 and it can help to just have a conversation 471 00:21:32.280 --> 00:21:33.390 about some of this stuff, 472 00:21:33.390 --> 00:21:35.725 like what to expect at the eye doctor 473 00:21:35.725 --> 00:21:38.963 or how do I find a low vision specialist? 474 00:21:38.963 --> 00:21:42.330 You know, what magnification devices are out there? 475 00:21:42.330 --> 00:21:45.622 All those things, we're happy to talk through with you. 476 00:21:45.622 --> 00:21:50.070 Thanks again to our guests for spending a little time 477 00:21:50.070 --> 00:21:51.990 and sharing their knowledge with us, 478 00:21:51.990 --> 00:21:54.964 and thank you so much for listening. 479 00:21:54.964 --> 00:21:56.940 Got something to say? 480 00:21:56.940 --> 00:22:00.030 Share your thoughts about this episode of "Hadley Presents" 481 00:22:00.030 --> 00:22:02.610 or make suggestions for future episodes. 482 00:22:02.610 --> 00:22:04.230 We'd love to hear from you. 483 00:22:04.230 --> 00:22:08.520 Send us an email at Podcast@Hadley.edu. 484 00:22:08.520 --> 00:22:13.520 That's P-O-D-C-A-S-T at Hadley.edu, 485 00:22:13.830 --> 00:22:18.830 or leave us a message at 847-784-2870. 486 00:22:19.781 --> 00:22:21.703 Thanks for listening. 487 00:22:21.703 --> 00:22:24.286 (gentle music)