(gentle music)
Welcome to "Hadley Presents."
I'm your host, Ricky Enger, inviting you to sit back, relax,
and enjoy a conversation with the experts.
In this episode, we hear from specialists
discussing diagnosis and treatment
of several eye conditions, along with information about
getting the most from your remaining vision.
You know, I've learned so much
during my time as host of "Hadley Presents,"
and I've gotten to chat with some really incredible guests.
We have had topics on vision loss,
ranging from art to technology to marriage,
and pretty much everything in between, I think.
One thing that we heard a lot from our listeners
was that they wanted to know more about vision loss itself.
So they wanted to understand
their own eye conditions better,
and they wanted some idea of what to expect going forward.
Thankfully, we were able to find the guests
who could speak to that really well.
We've had a number of eye doctors and low vision specialists
who were willing to share their time
and their expertise with us, so we figured
why not gather some of that info all in one place,
kind of like a one-stop shopping for low vision information.
So I think one of the most common eye conditions
is glaucoma.
So many people have it,
but it's not actually caused by just one thing.
There's not even a single, definite symptom
that tells you that you have it.
So what exactly is glaucoma, and how does it get diagnosed?
For the answer to that, we approached Dr. Jullia Rosdahl.
So, glaucoma is actually a group of
eye diseases,
and what they have in common is that the optic nerve,
which is the cable that connects the eye to the brain,
it's when that optic nerve becomes thinned out
because of those neurons, those retinal ganglion cells,
of those neurons dying.
So when the nerve dies off like that, people lose vision,
and it usually affects
their peripheral or side vision first in glaucoma.
The most common type of glaucoma in the United States
is primary open-angle glaucoma, and one of the main problems
that we have with glaucoma is that people have it
and they don't know it,
because the vision loss happens really slowly,
and once you lose vision from glaucoma,
we can't get that vision back.
So early detection and diagnosing glaucoma early
is really important for saving sight.
You asked about risk factors.
So they include having a family history of glaucoma.
So, people in your family.
Older age is an important risk factor for glaucoma too,
and, actually, Black race and Hispanic ethnicity
are risk factors,
although a lot of white people can get glaucoma too.
Okay, so how does someone get to the point
where it's clear that they should be screened for glaucoma,
and what is a typical glaucoma exam like?
The scenario that we hope for is that
people are going along in their regular lives,
and they're getting regular complete eye exams
with their local eye doctors.
That local eye doctor recognizes some early sign.
Maybe the eye pressure is a little elevated,
or maybe the optic nerve looks a little suspicious,
a family history is noted, and that savvy local eye doctor
either does some of the glaucoma testing themselves
or refers them to someone like me as a glaucoma specialist,
and then I see them.
We do what we call a glaucoma evaluation,
which is a pretty lengthy visit in-clinic,
where they get a lot of special testing
and an in-depth eye exam,
and we ferret out whether they do have glaucoma
or just some risk factors that need to be followed.
So that's the scenario that we hope for,
where the disease is diagnosed early
before really any vision loss has occurred,
and we can start treatment early and prevent vision loss.
So we also get referrals for help in managing patients
who've already sustained vision loss from glaucoma
or already have advanced glaucoma,
and sometimes the reasons that they come to us are because
they need surgery, or they need some additional treatment
that that local eye doctor is not able to provide.
So there are lots of different ways
that patients come to see a glaucoma specialist,
but we always hope that they're coming early enough
where we can save vision, and that frequently is the case.
Actually, most people who are diagnosed with glaucoma
and treated for glaucoma don't go blind from it.
Okay. That's awesome news.
So then what can someone expect
as far as how glaucoma is treated?
The main treatment for glaucoma is to
lower eye pressure,
and we have a lot of different ways to do it.
Typically, we'll start with eye drop medications
or a laser treatment to the drain of the eye,
and then there are also surgical treatments
that we typically reserve for cases
where we cannot control the glaucoma with the drops or laser
or where those treatments
are just not effective or not possible.
For example, a patient who has a lot of eye drop allergies
cannot tolerate any of the drops.
Then surgery may be considered
for a more mild case as well.
I imagine eye drops aren't at
the top of anyone's list of favorite things.
Still, it's helpful to know how much they can really do
and what to expect
if this is the treatment you'll be working with.
It's really, really important
that patients follow
those eye drop treatment regimens.
I like to say to my patients,
"This eye drop is a very powerful way
to lower eye pressure, but it does not work
if it is sitting in the bottle.
It needs to go into your eye."
There are a lot of different types of eye drops
that we prescribe, and so the regimens can vary quite a bit.
I would say the most simple one would be
a once-a-day eye drop that you might use at bedtime,
but sometimes, we have patients on
three or even four eye drop medications.
Some of them need to be dosed
two or even three times per day, and it's quite a feat,
getting them all in at the right times,
but it's really quite important.
Those eye drops lower eye pressure
for a certain amount of time after they're instilled,
and then that eye pressure will go back up
once that eye drop medication has kinda worn off,
and so that next dose is timed
to really maintain that lower eye pressure,
and we think that maintaining a lower eye pressure
and really keeping it low
without those kind of big fluctuations
can really help protect the optic nerve,
help preserve that sight.
The biggest misapprehension about glaucoma treatment
I would say is about the effects of treatment.
Most people expect that glaucoma eye drops
will make their eyes feel better or help them to see better,
but that really isn't the case.
Eye drops for glaucoma help to lower the eye pressure
to prevent future vision loss,
so they help keep your vision,
but they don't make vision better,
and they can have some side effects.
Most of them are manageable.
People do great on their drops,
but there can be some stinging or redness,
and sometimes we do need to even stop or change drops
because of side effects.
So that misapprehension about the effects of treatment,
that's one that I'd like people to know about too.
Thank you, Dr. Rosdahl, for giving us
such a great overview of not only what glaucoma is
and how it's diagnosed,
but also what to expect when it comes to treatment.
Knowledge is power, right?
So, I guess, when it comes to eye conditions,
there's one part of the eye that gets mentioned quite a bit,
for a number of reasons.
So many eye conditions affect the retina,
so we wanted someone to talk about that.
What is the retina? What does it do?
And what options do you have
when something goes wrong with it?
Well, who better to answer those questions
than a retina specialist,
so we approached Dr. Tim Murray to talk about that.
[Dr. Murray]I think the retina is the key to
the vision that we enjoy,
and for us that are a little bit older,
the retina is much like the film in the camera.
You know that light comes into the eye.
It gets focused through the clear cornea and the lens,
which allows us to focus the image,
but what actually takes that image
and transfers it in an electrical way to our brain
so that we can see is the retina.
So, if the retina doesn't function, you cannot see.
For most retina specialists, we're referral-based,
which means that you've seen an optometrist
or another ophthalmologist that has seen you
and recognized that you have a retina specialty problem
and has referred you, and most of those referrals
are actually quite urgent.
So, they may see a tear in the retina or a detachment,
or tumor, or evidence of a stroke or bleeding from diabetes.
So, most of our patients,
when they're made aware that they need a retina specialist,
need one quickly.
A lot of times, we have conditions that run in families,
and so we know that a family member
may have a parent or a child or sibling
that could have disease, and we'll actually,
as the retina specialist,
ask them to bring their family members in to be seen.
One of the most common diseases
affecting the retina,
especially in older individuals, is macular degeneration,
and people who have been diagnosed
naturally have a lot of questions about it,
like what treatment options are available,
and what's likely to happen once they've been diagnosed.
[Dr. Murray]First of all, the most important thing is
to recognize that most types of macular degeneration,
which is the dry type of macular degeneration,
never need to be injected.
So, it's very important to get the correct diagnosis,
as you might imagine,
and the technology to do that has become incredibly precise.
We have technology now that's called OCT,
or optical coherence tomography.
It takes a laser scan of the retina that is so precise,
it's better than what I used to see in the microscope
when I was in medical school,
and those testing evaluations allow us
to be incredibly precise about how we treat the patient,
and at this point, we really personalize our therapy.
So, it is not one size fits all.
Every patient gets personally identified
and targeted treatment based on how they're responding.
Some patients are blessed and may need one injection only
and never need to be injected again,
and some patients need to be injected for their lifetime,
but having said that, it's worth it to do it well,
because before these injections,
and I'm a little bit more mature,
every person that we took care of
with wet macular degeneration went blind.
I almost never see that, and when I do see that,
it's because somebody came late, or for some reason,
they weren't able to continue to be treated.
So that's an amazing change, even in the last 10 years.
So that's the most important message to get across
is that these conditions that routinely were blinding
in our grandparents' decade are now very treatable,
and the key to that is early diagnosis
and seeing a specialist that's equipped
to take the best care of the patient.
There are actually two types of
macular degeneration,
so what if you've been diagnosed with
dry macular degeneration?
Do you have to still be seen by a retinal specialist,
and if you do, how often does that need to happen?
[Dr. Murray]The reason why you want to be followed
with dry macular degeneration
is because it can convert from dry to wet,
and wet is incredibly treatable,
and wet is typically the type of macular degeneration
that leads to blindness.
Dry macular degeneration usually doesn't have
a significant impact in the visual function of the patient
unless they develop what's called geographic atrophy,
and that's literally where the retinal tissues in the center
just become dysfunctional and they essentially wither away.
Fortunately, that's a very rare component
of macular degeneration.
So, I think the last thing you want to do as a patient,
when you have a condition that we know has long-term issues,
is not to continue to be seen.
It's interesting because a lot of people,
regardless of their eye condition, end up having cataracts.
So, of course, they get cataract surgery to deal with that,
and then the vision should be way better after that, right?
Well, sometimes when a cataract is removed,
a specialist can see more about what's going on in the eye
now that the view isn't blocked by that cataract.
So what happens at that point?
[Dr. Murray]One of the things that we try to
teach our colleagues
that are going to do cataract surgery
is that it really is critical in this day and age
to look at the macula with imaging before cataract surgery,
because if a patient has preexisting macular degeneration
and that is the reason that the vision is being impacted,
taking the cataract out
is only going to unmask the macular degeneration.
So, I think it's fair to counsel patients ahead of time
by looking at the macula to say,
"Look, we're going to take your cataract out,
but you have macular degeneration,
and it may require additional treatment
by a retina specialist."
If you have your cataract removed and for any reason
there is not a really good outcome visually,
I think every one of those patients
should see a retina specialist,
because many of the conditions that limit vision
after cataract surgery are eminently treatable
by a retina specialist.
Thank you, Dr. Murray.
That information is so helpful
for anybody with a retinal eye condition,
and especially for those with mac D.
It's great to know what to expect.
Now, we've talked a lot about particular eye diseases
and how they're treated,
but what we haven't really talked about yet
is what happens in addition
to any medical treatment you get.
You still have to figure out things
like glasses, lighting, that kind of thing, and, honestly,
it's hard to even know what's available,
as far as what can really help you
get the most out of your remaining vision,
and that's where a low vision specialist
can really make a difference.
We talked with Dr. Mark Wilkinson
about what you can expect when you walk in
to an appointment with a low vision specialist.
[Dr. Wilkinson]We want to know what the person's
visual history is,
what they've been told about their vision,
their diagnosis, prognosis,
and what types of tools they've tried
or have used in the past,
and what difficulties they're having at this point
accomplishing the visual tasks that they need to do
on a daily basis.
From there, we're going to assess their vision,
both their distance and their reading vision,
oftentimes a little bit different
than might be done by their medical eyecare provider.
We're going to double check their glasses prescription,
which many times has not been done for a number of years,
see if an alternate glasses prescription will help
distance and/or reading vision.
We're gonna review their contrast needs,
because contrast is very, very important
for being able to function better.
The real world is not perfectly black and white,
and so that's one of the things I always tell people,
is the eye exam room is the most unnatural place you can be
because it's perfect lighting, perfect contrast,
and the real world is not like that.
From there, we'll review devices and strategies
that can enhance the remaining visual abilities
and allow them to do the things
they're currently finding difficult or impossible to do.
I think that care is always ongoing, but that said,
you know, not everybody needs to be seen
every few months or even every year,
and I tell my patients, if you don't have to see me,
that's a good thing because it means your vision is stable
and you're doing well with the devices you have,
but with that in mind, I have a plan, you know,
that I set up with each patient
so that we know when we're gonna see them again
based on their individual needs and situations,
and we always tell them you can come back
and see me sooner if needed.
So, I don't necessarily have to see somebody
on a regular basis, but certainly, we're available.
For instance, if they're having issues
with driving or something,
we'll have to see them on a more regular basis for that,
or if they have some progressive condition.
It also depends on their age.
So, lots of variables,
but, definitely, it's not a one-shot deal.
It sounds like one of the key things
that a low vision specialist does is to develop a plan
for how to approach things in a successful way,
just by helping to figure out
what tools are gonna work best in a person's daily life.
So how can you prepare for a discussion like that?
[Dr. Wilkinson]I oftentimes have to tell people,
you know,
your vision has been compromised,
and because of that compromise,
we're gonna have to do things in a little bit different way,
and so there isn't sort of a magic pair of glasses
that's gonna restore your vision
back to the level that it was in the past.
We're gonna have to do things differently,
which might mean holding things closer
with a stronger pair of reading glasses.
It might be holding a device.
It might be using reverse contrast,
the dark mode on your smartphone,
or using some sort of video magnification device
or increasing the magnification on your Kindle or your iPad.
So, we're gonna have to do things
in a little bit different way, but when we do that,
most often, we can accomplish
the goals and the tasks that you're still wanting to do.
I think that it's very important that
they bring the devices they've been using
so we can see what they've worked with,
see what has worked for them, maybe worked well in the past,
and then from there, determine what's gonna be
the best options for them.
Oftentimes, people are buying things online
that are mislabeled, and so they'll say,
"Well, I'm using a 6X," and, actually, it's a six diopter,
which is 1.5X,
and so seeing the devices that they've been using,
what they've been successful with
and what has not worked for them is very important.
I always remember my grandmother
who had diabetic retinopathy,
somebody would send her a new magnifier, you know,
for Mother's Day and Easter and stuff,
and she just looked at it and put it in a drawer
and never used them.
So, there's a lot of things
that sound good by the advertising, but don't work
because they're not really prescription devices.
I think that description of this drawer
full of magnification devices sounds pretty relatable,
pretty familiar to a lot of people.
So, what should you expect a magnification device
to be able to do?
Do you have to get a different device
for each task you're doing,
or is it possible to get a lot of general functionality
just with one thing?
[Dr. Wilkinson]Many people can do well with one device.
If they have mild vision loss,
they may just need some stronger reading glasses.
Other people who need electronic magnification
may have a full-size video magnifier.
They may have a portable one that they take with them
when they're away from home.
Now, we have different apps that you can use
and make your smartphone work like a video magnifier.
You can have your smartphone
read materials to you with text to speech,
and so you have lots of options that are available,
and it just really depends on
what the person's having difficulty with.
They might want to read, do hand work,
but they also might want to play the piano,
and so they would need different devices
for those different things.
So, it really comes down to what the person wants to do,
and then the different tools that will help them to do that.
Thank you, Dr. Wilkinson, for sharing
just how important a low vision specialist can be
for helping you to figure out
how to get back to doing the things you love
just by learning about some devices and tools
that can help you use your remaining vision effectively.
We really do appreciate all the experts
who have shared their time
and their valuable knowledge with us.
If you want to learn more about
anything we've shared in today's episode,
including the full interviews
with each of our guests from today,
you can check out the show notes
for links to lots of great resources.
Also, Hadley is available to answer questions
and help you find information,
so, yeah, you can give us a call.
That's 800-323-4238,
and it can help to just have a conversation
about some of this stuff,
like what to expect at the eye doctor
or how do I find a low vision specialist?
You know, what magnification devices are out there?
All those things, we're happy to talk through with you.
Thanks again to our guests for spending a little time
and sharing their knowledge with us,
and thank you so much for listening.
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Thanks for listening.
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