good evening and welcome to doctors on call I'm Dr Peter nalen professor and head of the Department of Family Medicine and biobehavioral health and Associate Dean for Rural medicine at the University of Minnesota Medical School Duluth campus I'm your host for our program tonight on eye problems the success of this program is very dependent on you the viewer so please call in your questions or email them to ask at pbsnorth.org the telephone numbers can be found at the bottom of your screen our panelists this evening include Dr Charlie Ahrens an ophthalmologist with St Luke's Eye Care Miller Creek Medical Clinic Dr Matthew Cossack an ophthalmologist with Essentia Health and Dr Lisa Graham an ophthalmologist with Ralph Eye Care Specialists in Hermantown our medical students answering the phones tonight are Barrett bukowic from War Road Minnesota Kenny Knudsen of Cambridge Minnesota and Katie McLaughlin from Hibbing and now on to tonight's program on eye problems and we already have questions from our callers Dr Aarons what is the pardon me Dr Kasich this one's for you what is the difference between Optometry and Ophthalmology well that's an excellent question there are two different professionals that care for the eye and we work well together the three of us on the panel tonight are ophthalmologists and what that means is that we went to medical school and earned our medical degree in four-year training after college and then we went on to complete an internship in usually in a hospital caring for all sorts of General medical issues we then completed three years of residency in Ophthalmology and that's really the most important part during those three years we did hundreds of surgeries where we were observed by other ophthalmologists and we learned right next to experienced doctors most ophthalmologists will do about 200 cataract surgeries under the supervision of someone else during this period and then after that there's an optional period where you could complete a fellowship training in a certain specialty like glaucoma oculoplastics Pediatrics retina or cornea and so that's the path of an ophthalmologist an optometrist will complete college and go to optometry school for four years they'll learn fitting glasses and contacts and also learn about eye disease but they are they don't have that training of the Ophthalmology residency which is very important for doing any procedures and treatment of advanced disease on the eyes thank you Dr Graham what is the relationship between dry eyes and computer use a strong relationship so dry eye is very common especially in the winter in Minnesota so I'd say a lot of folks suffer from dry eye symptoms with any visual tasks reading crocheting watching TV driving you can have grittiness burning blurring of your vision even watery eyes and computers we spend a lot of time on our devices computers laptops phones and they can definitely cause your eyes to be dry as well you don't blink as often when you're looking at something and so you're not coating your eyes with fresh tears as consistently and your eyes can dry out so a lot of computer syndrome is really just dry eyes thank you Dr Ahrens what is the treatment for a cataract in childhood cataracts in childhood is is a pretty unique disease process it's not the same as when we're older the if a pediatric patient develops cataract it's usually within the first one or two years of life and it can be significantly disabling for that child especially long term as far as developing amblyopia or lazy eye and so you we have to be pretty aggressive with cataracts in childhood usually those are performed by a pediatric basically a pediatric sub-specialist who really likes doing and is really good at doing cataract surgery and so they do have a few of those sub-specialists in the Minnesota area but we also then have to watch long term for things like glaucoma because there's such a high association with glaucoma and pediatric cataracts so these are lifelong patients that we need to be aware of very early on and get them treatment very early on and it's a lot different than the than the older patients who slowly develop cataracts over time because of how disabling the vision can be just having that cataracts or cataract either when they're born or when they develop it really early on Dr Kasich what holds a lens implant in place that's a great question the Cataract which is formed in the eye from cloudiness in your natural lens so that natural lens is formed of cells that are clear when you're younger that becomes a cataract and needs to be removed surgically and so your question asker is asking about the plastic lens that we put in when we remove the cataract and there's a fine layer of cells around the Cataract that are held in place by wires called zonules and it's especially important here in northern Minnesota because many of our patients are northern European or Scandinavian and have a condition which gives them very weak zonules so there's no need for glue there's no need for stitches in the vast majority of cases because we're using the structures that are already in place in the eye to hold the lens in place thank you Dr Graham a caller wants to know After experiencing iritis and uveitis three times in three years with testing not showing Graves disease why might this be occurring well the differential diagnosis or the array of medical problems that can cause uvitis is huge Graves disease is actually not a common one so if a patient has more than one episode of uveitis or commonly called iritis as well they should be tested for sort of a myriad of things blood tests perhaps a chest x-ray tuberculosis like a skin test it's it's a vast differential diagnosis a lot of times unfortunately all those tests come back negative and we just end up treating the the recurrences of uveitis as they come up but that patient should at least be tested for a Cause okay thank you Dr Kasich what would be a reason to operate on the muscles of the eye the muscles of the eye move the eye around and so this often comes up in Pediatrics because a child may have an eye that's turned in or turned out and in order to change the positioning of the eye you operate on the muscles by either tightening them or relaxing them and these are the main reasons to operate there in thyroid eye disease for example you may also have involvement of the eye muscles to relax them and align them thank you Dr Ahrens what causes intermittent double vision and what could be a treatment that's a that's a complex question as well just like Dr Graham was saying there's a large spectrum of things that can cause double vision particularly if it's intermittent as a specialist when we see these patients that walk in and and the patient is having double vision we generally will kind of start to try and break it down into is it only in one eye is it in both eyes depending on if it's in one eye generally we get to take a step back because there's only a couple of places that that could be either tear film cornea lens there's not going to be a lot of other things that it can be so it could be as simple as dry eye which Dr Grandma talked about earlier particularly if it's intermittent in nature we see that quite frequently especially in the last couple months because of all the Long Winter that we're having now if it's in both eyes um we all generally have a little bit of a misalignment like Dr Kasich had mentioned and and our brains are able to fuse our two eyes together but sometimes if we're getting really tired or anything like that it'll start to break down a little bit and we can get double vision we focus back in and get it back to single uh as long as it's not problematic and not affecting our activities of daily living most of the time we can just watch it if it's problematic affecting our daily living or there's other neurologic signs or symptoms those need to be worked up and you should be seeing an ophthalmologist like us to do that thank you Dr Graham what could be the association between hyperpigmentation and macular degeneration I'm not sure exactly what you mean by hyperpigmentation um in well Mac let's start with macular degeneration macular degeneration is a disease that is quite common about 25 percent of the people as they age over the age of 50 or 60 develop some macular degeneration some of it is visually dis visually debilitating and some people lead a very normal life when we are looking for macular degeneration signs we see sort of a hyperpigmentation of the retina that indicates scarring um and progression towards vision loss so thank you for that we have a question on Fuchs dystrophy what can be a cause or treatment um sure so this is a condition uh given that it's a dystrophy it's uh genetic and inherited although it is possible that one of your parents may not have known that They Carried this condition so you may be the first to know about it and that uh what it is is it's a problem with the water pumps of the cornea the cornea is the front windshield of the eye and because the inside of the cornea is against water what we call the aqueous humor it has to pump that water back out so that it does not become swollen up and in this dystrophy those pumps fail to work and that can be worsened by surgeries inside the eye because it puts stresses on those cells that pump the water out the other thing that will cause this condition to worsen is just simply aging um we have thought in the past that using a salt water drop called Miro can help to dry out the cornea and help these pumps along but some more recent Studies have said that it may not do very much and I think many of our patients would agree that it often doesn't do much so most the patients are most symptomatic early in the morning because their eyelids have been closed and their corneas have not been able to dry out and they have blurry vision that can clear up through the day and if it's very bad it may go on to require cornea transplant thank you Dr Ahrens how do ophthalmic beta blockers help glaucoma so to not get too into the nitty-gritty of the biomechanics of all the drops basically when we're using when we're talking about glaucoma which is a specific damage to the optic nerve um there's a large variety of different risk factors that are associated with it one of them and the most the only modifiable risk factor is the pressure inside the eye and so that's how we treat it is we lower the pressure any of these processes like beta blockers or the the most common ones that we use would be like prostagland analogs they're all geared towards either decreasing the amount of fluid that's pumped into the eye like Dr Kasich was saying the aqueous humor or increasing the outflow of the fluid when it drains because it's constantly being recycled and and put back into our circulatory system so between the beta blockers the Latana process and all of our different medicines that we're using we're basically trying to turn down the faucet or turn up the drain to to get things to drain out to lower the pressure inside the eye Dr Graham this question is what are a few uses for a donated eye after death um donor eyes are very useful one of the first organs ever transplanted was the cornea of the Clear Window in the front of the eye and it can be damaged by an infection or trauma or Fuchs dystrophy so corneal transplants they're not common but they happen fairly regularly and they can restore sight to somebody who's blind in an eye so that's a very critical use over the years we've also used the tendons of the eye muscles we've used the wall of the eye the white of the eye which is called the sclera so various uses for those tissues and then we're all familiar with using banked eyes that aren't suitable for other uses on on patients to for training so we learn how to operate by starting with donated eyes so they're pretty they're critical very important yeah Dr Kasich what is the post-operative advice regarding mask wearing after eye surgery sure that's a very timely and interesting question I think the most informative data on this subject came from the British Journal of Ophthalmology in the fall of last year and in Japan they did a a review where they looked at 30 000 cataract surgeries and half of them were completed before covid and half of the surgeries were completed after covet and what they found was the rate of infection in the eye was about one in a thousand and this was before covid in the after covert period the rate of infection was two in a thousand so a doubling of the infection rate and what's more interesting is that of the strains of the bacteria that they were able to culture The increased cases were accounted for by Streptococcus bacteria which is found in your mouth and so this is not a bacteria we typically find in the eyes and so this study would suggest that because of the masking in patients who have recently had eye surgery they may be exposed to bacteria from their mouth and it could get into the eyes so it's worth talking with your doctor about the risks and benefits of wearing a mask especially when you've had a recent surgery and your eye still has a wound that has yet to heal thank you Dr Ahrens are there any exercises that can be done to promote Eye Health as we age eye exercise is kind of an interesting question sometimes because it gets tossed around as far as like there's there's uh programs called vision therapy and things like that which can sometimes be beneficial in their own way the only eye exercises that we really see that we have we have evidence peer-reviewed evidence-based mess and that that really works is in an entity called The Comedy of insufficiency and what that is is where when we look up close we do a couple of things our natural reflexes we turn our eyes in to see things we accommodate or kind of crank in power to see up close and our pupils constrict and so that turning in as we age particularly can sometimes slow down and we can get double vision when we're reading we see it more commonly in in patients with say like Parkinson's and things like that so there are pencil push-up exercises and things like that where we slowly will bring you know the tip of a pencil or the tip of a finger in slowly while we're trying to to pull our eyes in that can help it's kind of a rigorous thing to do and and gets kind of annoying doing it but that that has shown benefit to be beneficial thank you Dr Graham this caller wants to know about vein occlusion what causes impending vein occlusion of the eye well folks who have vein occlusions tend to have significant cardiovascular risk factors like diabetes high blood pressure um high cholesterol sometimes they've had previous Strokes um the changes in the arteries tend to compress the veins the adjacent veins which causes turbulent blood flow within the veins and then a clot and blocks the venous drainage from the eye um when blood blacks up in the eye it can do a lot of damage depending on how extensive the vein occlusion is it can actually cause blindness and just a series of compounding problems going forward a small vein occlusion might go unnoticed by a patient and could heal just fine very good thank you Dr Kasich a caller asks about a type of Mayo Clinic custom cataract lenses requiring no glasses afterward is that familiar sure yep there are lenses which we put in the eye following cataract surgery that are covered as part of the cataract surgery and these offer some of the crispest best quality Vision you can have they're very simple lenses and they only focus light from one distance but there are lenses available which are referred to as premium intraocular lenses that can focus light in different ways these are available to anyone across the country including patients here in Duluth it's not particular to the Mayo Clinic there's a couple reasons why patients might want these lenses the first is if they have astigmatism which is an irregular shape to their cornea the lenses to correct that will not fix the cornea but they can cancel it out in the same way that your glasses might cancel out the astigmatism those are called toric lenses then there are lenses that are becoming more popular which can focus multiple distances at once near far and intermediate um and these lenses are great for patients who want to be independent of glasses but we do know that they have slight decreases in contrast sensitivity and more glare because the lens themselves or lens itself is more complicated so there are certain patients that may not be good candidates to have those lenses put in and additionally they cost more thank you Dr Ahrens a patient a caller anticipates cataract surgery on Monday do they anticipate being put to sleep for the operation uh it it's not me so I know because I don't operate on Monday so um and it's none of us but generally no we're not we're not putting patients to sleep but what most of us are doing is very very minimal light sedation if if any at all we do have occasionally patients who need general anesthesia although I would suspect most of us are going to be talking with those specific patients that hey we're we need to do general anesthesia for you in those certain situations the large majority of the patients I would say 99 Plus or percent are are going to be with just minimal light sedation and going home very soon after the surgery sounds encouraging Dr Graham could you say a bit about a rosacea's effect on the eyes sure so rosacea is a skin condition that's quite common it affects the oil glands primarily on the face and the eyelids rosacea patients get a rosy red Hue to their skin across their cheeks and in the eyelids their oil glands can get clogged and scarred down and this can contribute to dry eye I'm the dry eye doctor of the day so can contribute to dry eye because those oils need to get out onto the surface of the eye to stabilize the tear film prevent it from evaporating from prevent it from just sort of breaking down and not making a nice sheet over the surface of the eye so there are a lot of different ways to treat the oil glands to help with that problem thank you Dr kossek after cataract surgery a caller developed floaters interfering with reading what could be done about it sure that's a great question um so first a note about the floaters these are likely within What's called the vitreous jelly of the eye and they can happen with or without cataract surgery so the jelly breaks down as we age and bits can start to freely float around it's often noted after cataract surgery possibly because the vision is more clear just like you might notice a crack or a dent in your windshield the day after you have your car washed once your your cataract is out of the picture you may notice other smaller visual problems like floaters but it's also possible that the the stress of surgery contributed to the breakdown of the jelly and so this is generally a normal process but it is worth talking to your doctor about and being seen because that jelly of the eye is sticky and when it pulls away from the retina there is a small chance it could pull or tear the retina um I would be more concerned if the caller noted flashing lights because the mechanical stimulation of the jelly pulling on the retina will cause flashing lights even in the dark or with the lights off it's worth following up with their doctor about for sure thank you Dr Graham what is migraine of the eye migraine of the eye we often call it an ophthalmic migraine or an ocular migraine it is a visual aura we call it a scintillating scotoma because it has movement to it sometimes it's colorful sometimes it's black and white and Jagged but it has motion it has a progression it tends to last about 20 minutes classically um some people it really interferes with their vision and some people it's minor it can precede a migraine headache so the ophthalmic migraine really doesn't have any pain associated with it but some folks will have a headache afterward if they're happening really frequently and interfering with your life you can treat it with typical migraine medicines thank you Dr Kasich what is special about a new type of lens in cataract surgery that can be adjusted for its visual outcome afterward sure this is this is very new technology it goes back to that discussion of Premium lenses and there is a new premium lens which we can adjust with a laser afterward to my knowledge I don't know of anyone in Duluth that has access to this oh you do all right there we go yes we do the light adjustable lens that's great yeah a patient will go through a series of light treatments to adjust the power of the lens in the first few weeks after cataract surgery it gives a more custom result can treat astigmatism so it's kind of a nice option for folks who can't have some of the other premium lenses or folks who have a very sort of distorted cornea where it's hard to predict what lens implant power is proper some interesting technology it is yeah Dr Aaron's a brief question we have time for any recommendations for the best vitamins or dietary conditions or considerations for Eye Health generally what I talk to patients when they ask this question is you know if you if you're young healthy you know just a good healthy diet is the best thing you can do eat all your green leafy vegetables things like that if you're going to do a vitamin just a regular multivitamin if you smoke quit if you don't smoke don't start and that's just for General Eye Health very good well I want to thank our panelists Dr Charlie Ahrens Dr Matthew Cossack and Dr Lisa Graham and our medical student volunteers Barrett bukowic Kenny Knutson and Katie McLaughlin this is our final program of the Season our thanks to all the doctors Mental Health Specialists and phone volunteers who've been with us throughout this season of doctors on call we hope you have enjoyed the programs thank you for watching good night thank you foreign