Transcript

[00:00:00] Knock, knock. Hi, knock, knock. Hi. Welcome everybody to Knock, knock I with Dr. Glock Flecking. It’s, it’s a little, uh, little pun. Yeah. I, you guys know, I’m not a big pun guy. Uh, knock, knock eye is, is really the only pun you’re really gonna ever get from me on a consistent basis. Uh, this is just a little bonus, just a little extra thing that I, I, cuz every now and then as an ophthalmologist, I just, I gotta talk about eyeballs for a bit.

Usually it’s surrounding some kind of pop culture. News event, something that happened that I get tagged about on social media hundreds of times, and people want to hear to my thoughts about whatever it is. Uh, and it’s, uh, ultimately it’s just an excuse for me to talk about eyeballs, which is a top five ball, I [00:01:00] think, uh, in the world, right?

I, I could probably make that list actually. Top five balls, uh, eyeball in no particular order. Football, uh, basketball, beach ball. What other balls? I don’t just in, in, in general, in all of of history, there’s been a lot of balls. I think eyeballs right up there near the top in the human body. There’s lots of balls too.

Uh, there’s, there’s testicles, uh, ovaries. You could, uh, the pituitary, it’s kind of ball shaped in a way. There’s lot, uh, gallstones, uh, lots of types of stones. I don’t know. Um, but anyway, uh, this is, uh, gonna be a very eye centric episode here. And the reason that I, uh, were, I’m really doing this is because last week there was a big news story about the Apple Vision Pro.

This, the new Apple device. It looks like a, it’s a, it looks like a VR headset. Uh, you put it, and this is just based on the, [00:02:00] um, uh, the, the commercial that was put on social media. Uh, so you put on this, this, this headset with a strap on it. Just go about your day wearing this thing on your face. That’s, uh, basically like you’re, it’s, it’s, uh, your operating system.

You can answer emails, you can text message, you can look up the weather and, and it’s not like a Oculus or something where you’re like playing a game. You’re just like doing your normal life. But you’re doing it wearing a, this giant thing on your face that looks like it would give you horrible neck problems.

I don’t know how much it weighs. Um, but, uh, you know, this, this does seem like the natural progression of things, right? We’re all, everybody knows we’re on our devices all the time. I, myself included, we’re on our phones and, and eventually we were going to take the phone and just attach it to our face.

That seems like what the Apple Vision Pro is trying to do at a price tag of [00:03:00] $3,500. And so the question that was posed to me that I got tagged in a lot is like, what is this? Is this bad for your eyes? Like what’s it doing? And, uh, and first of all, I’ll just say, well, even if it is bad for your eyes at $3,500, if you can afford the Apple Vision Pro, you can probably afford new eyes.

Uh, so, you know, I wouldn’t worry about it too much. Um, uh, I’ll just say that right off the bat. Um, but. The, the biggest concerns, I guess they’re two big concerns. One is people were asking me about blue light. Now I did this, uh, a similar bonus episode with the Mr. Beast Cataract Surgery stuff, and I talked a lot about blue light, and just to recap that, There’s, you know, blue lights in everything.

It’s in the lights that are shining on me right now. It’s in the sun. We’re constantly bombarded with blue light, uh, and so the only time blue light might mess up your life a little bit. [00:04:00] Is at night when you’re trying to go to sleep and you’re, you’re looking at your phone that contains like all the world’s history and information since the beginning of time.

Uh, yeah. If you, you have that right in your face when you’re trying right before you try to go to sleep, it’s probably gonna mess with your circadian rhythm a little bit. There is studies that show the blue light. Can have that effect on your circadian rhythm, but it’s not gonna cause damage to your eyes.

It’s not gonna, it doesn’t really induce eye strain just having blue light. Otherwise we’d all be like in constant eye strain at all times. Uh, so the blue light thing, Yeah, if you’re like, you, you got your, your Apple Vision Pro on your face all day. Uh, you, you, you give your family who’s also wearing Apple Vision Pro headsets, a nice hug and a kiss goodnight, and you go and lay down and, uh, you’re, you’re on, you know, uh, TikTok with your headset on in bed.[00:05:00] 

And then you take it off and immediately try to fall asleep. You might have some problems that, there’s a lot of problems with that scenario, but, uh, um, it’s, that’s probably not great for you. The other thing though is eye strain. I get a lot of questions about eye strain. So what eye strain is, uh, is, uh, whenever you are trying to accommodate your eyes.

So accommodation is basically just focusing your eyes. So you have little muscles in your eye. They’re called the, the ciliary muscles. That contract, you do have little, little muscles inside your eye. They contract and they change the shape of your lens, and that allows you to focus on things. Closer to you now, um, when we’re.

You know, in our teen teenage years, twenties, thirties, early thirties, in a little bit in late thirties too, uh, we can do that pretty well. All right, we can, we can focus all day. Uh, you know, a 20 [00:06:00] year old can be staring at their phone six inches from their face for 10 hours, and they’re probably gonna be just fine in your forties.

You start to lose it, it starts to go away a little bit. People start holding things a little bit further away from them. The problem with all the screen time we have now, and I see a lot of this in the eye clinic, is people come in with with, you know, a lot of times they’re like in their forties and they’re like, oh, just strain, but things are getting blurry up close, or I’m having headache, a brow ache right here.

It’s because they’re spending so much time right here, right here, and they’re not wearing reading glasses, not wearing any kinda glasses and their eyes. Are aging that a word that I’m not ever supposed to use as a doctor, um, is, uh, is is what aging does, is it, it, it the eyes when they age, they lose the ability to accommodate, to focus up close.

And so that is, is the real main concern really with any device, but certainly one that you’re [00:07:00] gonna be strapping to your face and wearing all day. Is that you’re, the things you’re looking at and you know, there, there’s some kind of, I’m not sure the technology they use, but some, you know, they’re making the image appear that it’s further away.

So that does kind of trick your brain and your eyes to probably not have to focus so close. Cuz it’s like you’re looking at like a, a movie screen. 10 feet away from you, that helps. Uh, but you’re also going to be doing a lot of, of activity kind of close up as well. And so that’s the biggest concern is that like you have this thing on yourself, like eight hours, you’re, you’re probably gonna induce some icer.

The other thing you can get is, uh, is like dry eye too. Cuz when we’re looking at screens all day, like all of a sudden you blink after a while you realize you haven’t blinked in a while and it feels like sandpaper. It’s cuz your eyes are dry. Fairly common. Happens all the time when we’re looking at screens.

And so that’s kind of the effects that this type of device is gonna have on your eyes. But remember, it’s $3,500. [00:08:00] You can afford new eyes. Uh, probably, maybe not, you know, this year or next year. It might take a few years for us to develop the technology to, you know, transplant a 20 year old’s eyes. But when we do, I just know there’s gonna be a lot of people that do it.

So those are my thoughts in the Apple Vision Pro. Biggest things, you know, maybe some eye strain, maybe, uh, a little bit of dry eye. Uh, not a lot of like blue light. I’m not, I’m not worried about that. Uh, we’ll see where it goes. I don’t know. I don’t know what the next generation, where this is gonna go from here, because again, that thing looks like it’d be uncomfortable wearing it for quite a while.

All right, let’s get to some questions now. So I always, I, I like to, to answer some eyeball related questions. People always have questions about their eyeballs. Uh, and these are questions that I got from, uh, my wonderful, uh, patrons on Patreon. And so I’m gonna, uh, go through some of these. All right. The first one, uh, is a great question and one that I don’t get to talk about very often and I apologize to actually, I [00:09:00] don’t apologize.

If you follow me, if you’re still listening, it’s cuz you kind of are interested in eyeballs too. And so, uh, uh, which is very exciting to me. Uh, the, it’s, thank you Glock flock for being here and listening to all. Me talk about eyeballs. I don’t get to do it very often. Um, all right, so Alice Wchu. Alice Wchu says, how common is it to use Botox to help correct strabismus?

So strabismus is when the eyes are misaligned in some way. Up, down, left, right. And, uh, and so this is something that we need to treat. There’s lots of ways to treat it. Uh, Botox is one of them. So this is, uh, this is, uh, something that you’ll, you can, uh, like a piece of trivia that you can use to, uh, to entertain.

Probably honestly nobody. But, uh, if you do end up in the company of dermatologists or ophthalmologists, all right, they’ll be impressed that you know this. Uh, and this is actually, I. I always like to stick it [00:10:00] to dermatologists a little bit, uh, because there’s this, you know, unsung rivalry I’d say between, uh, um, uh, between dermatologists and ophthalmologists.

Uh, it’s, it’s a rivalry that no one else in the world cares about. Because it, it, it revolves around like who’s got the best work-life balance, uh, which is a disgusting topic for everybody else. So I’m not gonna go into details other than to say, uh, dermatology has had one over on us for quite a while.

You know, they, they have even fewer reasons to come into the hospital than we do as ophthalmologists, uh, as, as few, uh, eye emergencies as there are out there. There are even fewer skin emergencies. That’s my understanding of it. Um, and uh, it’s one of those things where if, if you ever have an a dermatologist and an ophthalmologist both in the hospital at the same time, buy yourself a lottery ticket.

Anyway, I, the one thing I do like to to point out about dermatologists is, you know, we all know, you know, dermatologists, they love Botox, [00:11:00] right? They’re doing a lot of Botox. They use Botox. It’s the skin thing. Uh, but the first doctors to ever use Botox clinically, For ophthalmologists. That’s right. Botox was first used.

By an ophthalmologist to treat strabismus, the misalignment to the eyeballs. Uh, just a little fun fact there. So, uh, it’s only certain times of ocular misalignment, but, uh, the way it works is you just, you take a little needle and it’s gonna gross out a lot of people, but you just, you literally, you put a needle into the muscle, into the physical muscle surrounding the eye, whichever muscle you want to weaken, and you inject it with a little Botox.

And, uh, and, uh, what it does is it does the, the, the neurotransmitter, you know, all the things that Botox does. I’m not gonna get into the details of the pathophysiology, but it weakens the muscle. Uh, it, uh, it limits its ability to fire, to have action potentials, and it, uh, it stops working. [00:12:00] Uh, and it lasts, you know, two to three months.

So it’s, it’s useful for certain types of, um, of strabismus, but not as many as you think. And it’s hard for kids, obviously, because you’d have to like put them to sleep. Adults, you could do this under local anesthetic. You don’t have to do general anesthesia. Sometimes it’s easier for older. Older kids or adults.

Um, so I, I’d say it’s not used as frequently, probably as it once was. And I’m not a specialist in strabismus, so I, I don’t know exactly what they’re doing, uh, now. Uh, but I do know that, um, it’s not as common of a treatment. And, uh, uh, the, the beautiful thing about it though is that it’s something that you can try, see what kind of effect you get and, uh, it’s gonna wear off and then you’re gonna be back at square one for the most part.

Uh, and so, um, uh, that’s why like if you’re doing Botox in the skin, it’s like a great procedure to do, uh, because if, if you do like, screw it up, And by screw it up, I [00:13:00] mean like you put a little bit too much Botox, it causes like the brow to droop or you to look really strange. Um, it wears off after a few months, so the patient will be fine.

That’s a great thing about Botox. It really is a, a, a fascinating, um, uh, treatment and the history of Botox. Maybe we’ll get into it of, nevermind. No one’s gonna care about that. Anyway, that’s Botox for strabismus. Thank you for that. Uh, that. Uh, question Alice. Uh, next let’s go to, um, a topic that I get asked a lot about.

Uh, this is from Gracie. Lou says, can you talk about lasik? I’m trying to do some research to get, see if I’m a candidate, and it’s nice to get some general in information. Um, so here is my quick rundown for lasik. First of all, Lasik’s a great, a great procedure. It, it’s, it’s, um, you know, we, I think we take for granted how.

How. How amazing it is to take someone who’s [00:14:00] severely nearsighted, like minus six or higher, which is really close. That’s like way up here. Uh, and all of a sudden we can do, we can reshape their cornea and then they see like 2020 like perfect. It’s, it’s, it’s unbelievable. I mean, these are people you know that have a, such a strong prescription that.

You know, a hundred years ago they would not have survived. They would’ve been probably eaten by a bear at a very early age. That’s just how it goes. Uh, and so, um, uh, but we have, uh, you know, it’s, I mean, basically myopia is a disability and it’s, uh, we have, uh, disability accommodations now with glasses, contacts and lasik.

And so, um, it’s a great procedure. And, um, uh, uh, there are risks to any procedure though, right? So I’m gonna preface LASIK and whether or not you should get LASIK and, and all the things that go into it by saying there are risks to any surgical procedure. You’re making an incision, you’re cutting the cornea, you’re cutting nerves.

It can lead to dry eye. And very [00:15:00] rarely, very rarely you can get very severe dry eye that really impacts quality of life. There’s lots of news stories out there about that. Uh, obviously like the really bad cases, they do get a lot of of attention. Um, but for the most part it is extremely safe and we are very good at it at this point.

Uh, and so, um, uh, and, and, and so the other, the other thing I wanna talk about with lasik, Is who should get it? Who should get it. Now part of this is, is like your medical evaluation. You have to have eyes that are healthy enough for lasik. And so that can only be answered by actually going to the eye surgeon and getting the evaluation, having them look at you.

There’s lots of things with your eyes that could disqualify you from having a refractive surgery. Um, but I think one thing I can answer for you is, um, about age and so. There are diminishing returns with LASIK as you get older. And what I mean by that, and this goes back to that [00:16:00] ability to focus when you’re in your twenties and your thirties and your ear, mainly the early thirties, and you can focus all day, get lasik, it’s great because you can get 2020 perfect vision and you can still focus up close and so you can get completely outta glasses when you get into your late thirties and then definitely into your forties.

That focusing up close. Oh, that starts to go away. That starts to leave, leave you. Uh, and uh, it’s really frustrating for everyone, but it’s as certain as death, you will lose that ability to focus your eyes. Uh, and so I’ve seen it before where people get lasik, uh, in they’re, when they’re like 37, 38, 3 years later, they still got great distance vision, but all of a sudden they’re wearing reading glasses.

So you gotta be aware of that. That’s why I say diminishing returns over time. Cuz if your goal is to get outta glasses completely, if you get LASIK when you’re 23, 24, 25, you’ll have [00:17:00] probably 10, 15, maybe even 20 years where you won’t need glasses. But if you get LASIK when you’re 38, you may have like three or four years.

And, uh, and that’s a shame because like Lasik’s expensive and nobody has money for LASIK when they’re like 22, 23. So it would, it would actually be a, a fantastic gift to give somebody. Uh, is LASIK a very generous gift? Uh, so people don’t have the money to spend on refractive surgery until it’s too late, uh, which is, uh, some, a lot of times that’s what happens, uh, whenever you’re.

Over the age of 40, really the only benefit to getting LASIK is if you do what’s called monovision, where you have one eye that sees far away, one eye that sees up close. People do this with contacts and um, uh, and it takes away your death perception, but some people tolerate, really tolerate it really well.

Some people absolutely hate it. Uh, and it’s, it’s personality dependent. You know, does your brain are, do you have a plasticity to your [00:18:00] brain? Does it, can you neuro adapt? And I’m throwing out all these words as if I really know what they mean, but they, it sounds good. It sounds right. I don’t knows. Bottom line is some people can do it, some people can’t.

So monovision is the only way that you could consider it. Uh, uh, really over the age of 40. And then, um, once you’re 60, Like, don’t get LASIK because you have cataracts by the age of 60, and we can do more with cataract surgery than we can with lasik. All right? So, uh, I would just, you know, just not do it by that age.

Um, so that’s my breakdown of lasik. Okay. Diminishing returns with time. Uh, but it is a great procedure and it’s, it’s, you know, sister procedure. Um, uh, um, P r k Photorefractive Keratectomy, where you, uh, basically it’s just a different way of resurfacing the, the eye, um, or, or not resurfacing a different way of [00:19:00] reshaping the cornea.

All right. And the other, this is like refractive day. I’m gonna get the refractive stuff out of the way here. So I had another question from, uh, Martha Simmons. Martha says, can you discuss r l e refractive, uh, lens exchange? I’ve been wearing hard gas permeable lenses for 45 years, and honestly have had very little trouble, but maybe it’s time to consider r l E because I’m minus 12.

Minus 12. I’m sure a lot of you have probably heard, um, uh, uh, uh, radio ads or maybe even TV ads. For r l e there’s a few big chain, like it is weird to say like refractive surgery chains, but that’s kind of what they are. They’s all they do is refractive surgery, um, that are advertising this. What refractive lens exchange is, it’s basically, it’s cataract surgery without the cataract.

So with cataract [00:20:00] surgery, we talked about this on the Mr. Beast episode, uh, a month or so back, cataract surgery, you’re removing the native lens inside the eye that gets yellow and darker over time as you get older. And, uh, see that’s how, that’s how you gotta say you as you, as you get older, as we all get older, as we get older there, there’s ways you, like you talk about aging as a physician, uh, to make people like not feel bad that they’re aging.

Uh, I don’t know. It’s just like something that kind of comes naturally with time, but like, you know, I can’t ever say you’re old, even though like 99% of what I diagnose on a daily basis is aging. Like that’s the reason it’s happening Anyway. That’s, uh, neither here nor there. What was I talking about? Uh, r l e.

So yeah, it’s, it’s basically cataract surgery without the cataract. So for someone who is. 25 or 30 or even 40. And um, uh, they don’t have a [00:21:00] cataract at that age, but say they have a really high prescription, they’re like a minus 12 that is ex extreme myopia. Um, they are probably not gonna be a candidate for lasik.

Because with lasik, again, it reshapes your cornea, uh, but you can only reshape it so much. So if you have a really, really high prescription, you’re less likely to qualify for lasik. So refractive lens exchange, instead of fixing the vision on the cornea, you’re going inside the eye, you’re removing the lens, and you’re replacing it with an artificial lens.

That artificial lens is going to, is going inside your eye, staying there the rest of your life, and it’s gonna help you see well for distance, uh, and the, the downside Well. Depending on the type of lens you use, we have like lots of lens technology that goes inside the eye. Some lenses only get you seeing at one distance, either distance or near some, uh, [00:22:00] lenses, uh, give you what’s called multifocality, where you see distance and near, uh, lots of different options.

Most of the time, people who are getting r l e are getting those multifocal lenses because they wanna be able to see everything out of, you know, um, and so, It’s the, the biggest downside to R L E number one is the cost. It’s gonna be the most expensive because it’s all out of pocket insurance will not cover r l e because it’s a refractive procedure, not something you have to do, but it can significantly improve your quality of life.

Um, so it, I, I don’t, I don’t know what it’s, I don’t even do R L E I, I don’t, I don’t wanna do it. Um, but probably I would guess five to 10,000 per eye, something like that. And so, um, and the other big downside is the risk to it. Now LASIK has risk, but not as much risk as something like r l e because with r l e, you’re actually going inside the eye.

With lasik, you’re not going inside the eye, right? You’re just going on the surface of the eye. Uh, with r L e, you’re actually [00:23:00] going, making an incision. You’re using instruments, you’re going inside the eye, mucking around in there, removing the lens, and then you’re putting that artificial lens in there.

That artificial lens, by the way, made of plastic folds up. And it just goes right into a little two millimeter incision. And it can be life-changing for people who are, uh, who are like a minus, like Martha here, who’s minus 12, uh, because that’s the only option. And so, The people that I, I have, you know, I refer to other people who do refractive lens exchange occasionally, I probably wouldn’t do it in like a 20 or 30 year old.

Um, just because again, that risk and, um, I, I’m not real convinced that the lens technology will make a 20 year old happy with their vision. Um, but for someone who’s probably over the age of 40, Probably in your forties. I would say that’s a, uh, maybe even in your thirties. It’s probably a, [00:24:00] a, a, someone you could talk to about, you could consider doing r l e.

Um, I’m, I’m just not super high on the procedure just because of a little bit of higher risk involved and where our lens technology is right now. Those, those are my thoughts about r l e. Not a bad procedure, but, uh, you gotta be pretty selective with who you do it with. So those, uh, that’s, that’s two of the big, uh, refractive technologies there.

Um, hopefully that was helpful and those of you who have questions about that, um, and, uh, those, I gotta do it. Maybe I’ll talk another time. Yeah. It’s so, it’s so great talking about eyeballs. I. Even though I’m just looking into a camera, I’m basically looking at myself, talking to myself about eyeballs.

It’s really is a lot of fun. Uh, this is a, a good reminder actually. Send me questions that you guys have about eyeballs. Like whatever you wanna talk about, uh, whatever eye conditions you wanna talk about. Pink Eye. You wanna talk about sty, you want, you wanna talk about, uh, the GCal conjunctivitis. If [00:25:00] you want, uh, it’s not my favorite topic.

Uh, I’m happy to talk about anything. Uh, I am a board certified ophthalmologist. I know you can’t tell because I, um, dress up. As I have portraits of myself behind me, I dress up as so many different specialties in medicine. It’s hard to know exactly what kind of doctor I am. Some people are actually very surprised to find out that I am indeed an ophthalmologist, uh, one that passed a bunch of tests and did a lot of training to get to where I am.

Uh, and so I, I do relish the opportunity to. Educate at times about ophthalmology among other things and everything else. I gotta like do a lot of research. Like, I don’t know anything about cardiology, but sometimes I like play a cardiologist and so I gotta look like I know what I’m talking about. Uh, but I actually do know a lot about eyeballs, so send me your eyeball, eyeball, ophthalmology related questions.

Um, I’m happy to answer anything that’s on you guys’ minds. Uh oh. Oh, well, lastly, one thing I was gonna say. So on the, on the topic of these [00:26:00] artificial lenses, they’re super cool. They’re, they’re pliable. They’re bendable. You fold them up into a little tiny taco. Basically you put a taco inside the eye essentially.

Um, but the way that we know that plastic lenses we’re able to go inside the eye is, I think it was during World War ii. Uh, they had a pilot and I, the details in this are me are a little hazy, but the gist of it is, Um, there was a pilot, there may be a British pilot that, uh, had like shrapnel and, um, busted up the windshield of the plane.

Do you call it a windshield? I don’t know. Probably. Uh, and some of the, the glass, which was, it wasn’t true glass. It was, it was P M M A, it was like a type of plastic. Um, some of that actually was embedded in the pilot’s eye and. The, the eye did fine, like the patient recovered vision was [00:27:00] okay. That glass, it was inert, that plastic, it just sat in the eye, didn’t cause infection or inflammation or anything, and that was the first time we thought, Hey, We can actually put a plastic lens inside somebody’s eye to help them see better.

And that, uh, was kind of the, the, the, the first kinda eureka moment, like, oh, you know, maybe, you know, cataract surgery down the road. Eventually we started just mass producing these plastic lenses and, and now cataract surgery is the most commonly performed, the most, one of the most successful surgeries performed today.

Uh, that, uh, changes people’s lives. That’s why I like to do it so much, and that’s why. Even though I do all this social media stuff, like I’m, I don’t wanna give up ophthalmology because I love doing cataract surgery. I love helping people see, um, it still brings joy to my life, uh, as does dressing up as a scribe and nodding to all of you.

I love doing that too. Um, but, um, not ready to give up my [00:28:00] day job just yet. Uh, it’s too much fun. So, That’s a lot about lenses and LASIK and refractive lens exchange and Botox. Uh, and uh, yeah, so I guess that’s it for, uh, this edition of Knock, knock Eye. Uh, and thank you for being here and listening all the way through A whole thing about eyeballs.

It’s not the sexiest topic, but uh, as. It is to me. And that’s weird. Anyway, uh, I hope you have a, uh, thank you for being here. Thank you for listening. Uh, I’m gonna just, uh, normally I like have a, like a, a like an outro thing. I’ll just say thank you to, for our producers, uh, and, um, uh, uh, and to human contents.

Uh, check us out. Uh, I, I, I get a lot of the questions I like to answer off of, uh, Patreon, so you can check out our Patreon. Uh, lots of cool perks there. And um, yeah. We’ll see you next time. Take care everyone.[00:29:00]