Dr. Cha:
Like, people always say, oh, oh, my doctor told me I had glaucoma. You mean cataracts? Oh yeah. Oh,
Dr. King:
We are a family oriented
Dr. Cha:
Entertainment group.
Dr. King:
Entertainment group. Dang it.
Dr. Cha:
Are you cold?
Dr. King:
It’s cold up here.
Dr. Cha:
Oh man. Yeah. I usually bring my,
Dr. King:
It’s keeping me awake.
Dr. Cha:
I usually get my puffer jacket when I sleep.
Speaker:
Just hang out.
Dr. King:
It’s a little scary around here. So, hi, I’m Dr. King. And
Dr. Cha:
I’m Dr. Cha.
Dr. King:
Welcome to Days of Our Eyes. Today we’re talking about pretty much whatever comes to our minds. So stick around, let’s see what happens in our brain.
Dr. King:
So, so today we just wanna reiterate a point about public safety. There are some drops that have been eyedrops that have been on the market that are unsafe. So-called Death Drops.
Speaker:
Not the death drops.
Dr. King:
Don’t be like Skelly, don’t use drops that can damage your eyes. Stick with, let’s start again. Because. I just like, I, I, I,I.
Speaker:
Oh, so, okay. So I can move.
Dr. King:
You can move. Sit. So don’t be like Skelly.
Speaker:
Maybe let me – Get out for a second. Sometimes if it’s a good deal, it’s too good of a deal. So they’re, if you’re worried about any drops that you have at home, remember to go to eyedropsafety.org and they will, they’ll have a list of, of what’s going on, what to avoid. Most of the major brands that you see, companies, you know, they were not involved in all that eye drop stuff because their facilities are well regulated and well run. So just be aware.
Dr. Cha:
Yes.
Dr. King:
So we’re gonna talk about glaucoma today because there seems to be a little confusion in the general public about what is glaucoma. Because how many times has a patient come to you and said,
Dr. Cha:
Oh yeah, my doctor told me I had glaucoma. And we kind of freak out a little bit.
Dr. King:
But you’re not being treated, you haven’t seen an eye doctor in a few years. Even though you say you have glaucoma. Could it be cataracts?
Dr. Cha:
Oh yeah. That what
Dr. King:
We all, it happens to us every day.
Dr. Cha:
Yes. I mean, probably before, you know, we got into the eye world, we probably thought the same thing. I, I know I did.
Dr. King:
Oh sure.
Dr. King:
And people are always asking, what are the symptoms of glaucoma?
Dr. Cha:
That’s a great question.
Dr. King:
There aren’t any, that’s the sneaky part about it. Glaucoma is a potentially site threatening disease that doesn’t really have symptoms in the early stages. Only in the advanced stages where it’s very difficult to do anything about it does it manifest with vision problems? So the idea is to get checked on a regular basis to avoid that.
Dr. Cha:
When we think about glaucoma, not cataracts, we’ve been talking about a lot of refractive things and how we’re trying to improve vision. Glaucoma
is
Dr. King:
We’re trying to preserve vision.
Dr. Cha:
Yes, exactly. You know, the name of the game for glaucoma is early detection and then early, you know, management and treatment if we can help it. But you know, everybody’s normal is different. And when we think of glaucoma traditionally it’s when we see pressures of 20 plus 30, 40, maybe the pressure in the eye just builds up. And I almost think of it like it’s choking the eye from the inside out as the pressures build and it’s choking the eye, the tissue in the eye that doesn’t regenerate the retinal nerve nervous tissue. The axons and the cables, we could, you could almost think of it. They start dying off. They start becoming thin. That’s where it affects your vision.
Dr. King:
Right. After you lose so many nerve fibers, then you notice vision loss. Exactly. Well let’s catch it before that. Because now you’ve lost over half your nerve. Nerve fibers.
Dr. Cha:
The worst type of glaucoma you could have, you know what we call late or end stage glaucoma. You know, pressures have been high for who knows how long. The nerves are nearly all dead. You could still have 2020 vision. The eye and the brain try to preserve the vision that we need to survive that being, you know, central and that being, you know, our outside, you know, right Where our outside vision is. We want to be able to see if a coyote or a tiger is coming at us from our side.
Dr. King:
I’m worried about the tigers in my neighborhood.
Dr. Cha:
And when we talk about peripheral vision that’s taken away. Our nose is where it take is taken away first because we have an overlap in our vision, it can lose a lot more towards our nose before it starts really affecting our vision.
Dr. King:
Correct. They overlap. So one eye will compensate for the other. And that’s something about glaucoma is it usually starts in one eye, but it’ll show up in the other one. Just one eye leads, the way I think of glaucoma as a nerve disease, the nerve is dying. It atrophies. And there are cases of glaucoma that are called normal tension glaucoma where the pressure is in that 10 to 21, 6 to 21 range. But it’s still not healthy for the nerve. The nerve is still dying. That’s it. That’s why we’re always looking in the back of the eye. People are like, I don’t wanna be dilated. I don’t want all these bright lights in my eyes. Too bad. That’s how we’re gonna see it. That’s how we’re gonna find this stuff. One of the things that I always tell patients is there’s no one single glaucoma test because they’re all, I always will have people say, well I had the glaucoma test that puff thing. By the way, I agree with you. I hate the puff. Yes, okay. It’s horrible. I won’t let people do it on me. I do. I do. Other ones. You know, there’s more to checking for glaucoma than just the puff test. Yeah. So that’s what Dr. Cha’s been talking about is we have to look at the nerve layer. We have to look at the structure of the nerve and the function of the nerve. Even if it looks okay, is it functioning normally? And that’s where we get into things like the peripheral vision test. The visual field test that everybody hates. Although these days,
Dr. Cha:
Oh yeah,
Dr. King:
Technology’s changing. It’s getting a little more fun. Now we have, you know,
Dr. Cha:
VR headset
Dr. King:
VR headsets to do visual field. Sorry, I can’t ever think of VR, I don’t know why I wanna say VF headsets. Visual field.
Dr. Cha:
Right, right,right
Speaker:
But that there’s literally a quote from the father of glaucoma that says it’s the law we don’t know about glaucoma, but what we do know are warning signs.
Dr. King:
So yeah. Like she said.
Dr. Cha:
Yes, exactly.
Dr. King:
We can’t restore sites that’s been lost. All we can try and do is preserve what we have. So the sooner we detect something, the better off we are. And sometimes it involves asking you a lot of questions too. We’re gonna ask you about medications, we’re gonna ask you about family history.
We’re gonna ask you about your sleep habits. ‘Cause believe it or not, that all has to do with glaucoma. The eyes are not isolated by themselves in these little sockets in our head. They’re connected to the rest of the body. And sometimes it’ll feel a little like, why does my eye doctor need to ask me that stuff? There really is a reason for it. Did you know sleep apnea, if it’s untreated, can raise the risk of glaucoma by 30%? Because the optic nerve leaves the eye goes through the middle of the brain to the vision cortex in the back. And what happens in sleep apnea? What does that mean? We stop breathing during sleep. Oxygen levels in the brain suffer. Where did I just say that optic nerve is, it goes right through the middle of the brain. So guess what? You’re starving your optic nerve for oxygen as well. So that’s gonna damage the nerve. That’s gonna look like glaucoma. But we can treat the eye all we want. The damage is happening behind it. So that’s why we ask you some of these questions. It’s not to be nosy and it’s not to just make us sound important. It is really related to what’s going on with your vision. So if your doctor starts asking you stuff, it’s okay to be honest, what’s said in that room stays in that room. Hipaa. hipaa. hipaa.
Dr. Cha:
Yep. If you get a routine eye exam, you know, this is something we routinely check. You know, your pressures are always checked, your vision’s always checked, your pressure’s always checked. And then we try to take a peek inside, at least to give us, see if we see any red flags. And glaucoma is a slow acting disease. Yes. You know, it takes years and years for it to finally show up in, you know, in our, you know, in the exam room, in testing and then years and years longer for you to even realize it’s affecting your vision. We don’t wanna wait that long. Of course.
Dr. King:
Right. But that’s the whole point. If we catch it years early, we’ve got time.
Speaker:
And that doesn’t mean you get to choose to not take your drops if you haven’t.
Dr. King:
That’s true. Yeah. Then let’s say you’ve been diagnosed, your doctor puts you on an eye drop to lower the pressure to try and treat glaucoma. Let’s say that’s a pretty common place to start because we have pharmacological stuff we can do, we have laser stuff we can do, we have surgical intervention. We can do, just depends on the patient, the case, the type, the structure of the eye, all that. You’re gonna take that drop and you’re like, I don’t feel any different. And this costs money. Yep. But if it’s saving your sight, it’s worth it.
Dr. Cha:
Things like nutrition and you know, things like taking care of the rest of your body. You know, conditions like low blood pressure or diabetes, they’re associated with glaucoma as well. Just because they affect our blood flow, the oxygen to the rest of our body.
Dr. King:
People always are asking me, what can I do myself to help my glaucoma? And I’ll say, you know, the optic nerve needs a ton of circulation. It needs good blood flow. Get off the couch and start moving. People that are active, they’re, they respond better to treatment than couch potatoes. A sedentary lifestyle can damage the vision too. So, and I say this because I need to practice that myself. Especially, it’s the middle of winter right now. So I’m just curled up in blankets constantly on the couch. You know, it’s, it’s just the hardest. I am hibernating
Dr. Cha:
Trying to stay alive.
Dr. King:
So packed on the pounds, I’m all ready for a long winter sleep. But just good movement. Yes. Makes a difference.
Speaker:
And I have one myth buster.
Dr. Cha:
Okay.
Dr. King:
Myth buster’s bust that myth.
Speaker:
So say there’s people who had clear vision their whole life. Never worn glasses, never worn contacts. Are they as at risk as the folks that wear glasses contacts or any vision correction?
Dr. Cha:
Good question.
Dr. King:
I mean, there’s a small association with my myopia nearsighted people. You know, you have a larger eye. So there’s a bigger structure for your body to kind of maintain, so to speak. So there’s a small association with nearsighted, you know, people in glaucoma. Right. But not like, not a strong, you know, that’s not something that we really like screen for. It’s like, are they, what kind of prescription do they have? And am I more worried about glaucoma? We look at everyone from glaucoma because again, it can happen when your pressures are normal. So it’s like, you know, there’s, there’s no point of like kind of cherry picking, oh, who we should be more careful with this patient. And I think like for these like congenital, like, you know, the babies being born with glaucoma, I think they’re very, they’re extremely hyperopic. You know, they have very big farsighted vision of prescriptions. So there’s no one size fits all for that kind of.
Dr. King:
No
Speaker:
They’re just the ones getting checked.
Dr. Cha:
Yes, that’s true.
Dr. King:
That’s true. That’s true. People who need vision correction are in the eye doctor more than people who don’t. So they’re more likely to get caught early than someone who doesn’t wear vision correction because they don’t have a reason they’re, they’re not thinking of going to the eye doctor. I mean, you know, when I think of just the patients I see every day, and we’re not a primary care practice, but you know, majority of our patients wear vision correction, that’s what got them into the doctor in the first place. So I think, you know, any statistics we try to draw could be kind of skewed. A very strong family
Dr. Cha:
Association.
Dr. King:
Association. Thank you.
Dr. Cha:
That’s okay.
Dr. King:
I didn’t have that big word.
Speaker:
My dad came in ’cause he was a glaucoma suspect, but the verdict was just that he had large cables. And then I got checked and that was the verdict for me too. So
Dr. Cha:
The, the more closely a person’s related to you that has glaucoma, the more likely you’ll have it.
Dr. King:
Correct.
Dr. Cha:
So it’s usually, you know, like siblings and then
Dr. King:
And then parents.
Dr. Cha:
Parents and then
Dr. King:
Then grandparents,
Dr. Cha:
Then like cousins and uncles and stuff.
Dr. King:
Yeah, but the thing is, big optic nerves run in families too. So you know, I’ve, I’ve seen families where, you know, I can tell you got your dad’s optic nerves. You got your mom’s optic nerves. Yep. You know, ’cause one of the parents is always a glaucoma suspect because they have funny looking nerves. I call them ‘fln’ Funny looking nerves.
Dr. Cha:
‘Fln’ funny looking never
Dr. King:
That doesn’t mean that person has glaucoma, but they don’t fit in the normal. So we at least we need to have a baseline and look for changes in their baseline.
Speaker:
Even if you don’t get checked for vision correction, but you had a blow to the eye that you had to go to the doctor for, you’re always at risk for glaucoma.
Dr. King:
That’s true.
Speaker:
So just go get your annual exam.
Dr. King:
Yes. Yeah. Any injuries to the eyes can 20 years later, glaucoma can show up.
Speaker:
Oh, you guys gotta check my boomerang angle one that,
Dr. Cha:
Oh,
Dr. King:
Speaking of injuries to the eyes, Dr. Crow. That’s why she’s an eye doctor.
Dr. Cha:
There you go.
Dr. King:
We all have a story of why we’re eye doctors, chronic corneal ulcers. You know,
Dr. Cha:
That would be good one.
Dr. King:
Oh, that would be a good topic. That would be a good one. Why are we eye doctors? Yeah. What the heck makes you do this?
Dr. Cha:
Say hot and cold glaucoma. Why do we wanna be eye doctors?
Dr. King:
Yeah. Let’s talk about ourselves next time.
Speaker:
I’ll join that one.
Dr. King:
Well we hope you found some nugget of information that you can use today. And if you have any questions, feel free to put ’em in the Dropbox. If you like what you saw, please like it, subscribe. Until next time, I’m Dr. King.
Dr. Cha:
And I’m Dr. Cha.
Dr. King:
Take care.