Transcript

[00:00:00] Today’s episode is brought to you by Dax Co Pilot from Microsoft. Dax Co Pilot is your AI assistant, you know, like a little Jonathan in your pocket for automating clinical documentation and workflows that help you be more efficient and reduce the administrative burden that leads to feeling overwhelmed and just burned out, learn more about how Dax Co Pilot can help improve healthcare experiences for both you and your patients by visiting aka.

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Hello everybody. Welcome to Knock, knock. I with me, your host. Dr. Glockham Flecken, thanks for joining me today. Your one stop shop right here for [00:01:00] all things eyeball related. If you’re watching on YouTube, uh, you’re going to see my dog in here. This is Milo. Uh, he’s, he’s going to join us today. Uh, and, uh, uh, this is, uh, it’s, it’s been a good day.

I’m on my lunch break. And I had an interesting patient come in who had a diagnosis that I’ll get to later. I’m going to do a little case presentation for you. And it was one of those things that. It’s like, it’s an, not a rare disease, but it’s unusual that we, I don’t see it. Maybe I’ll see maybe a few times a year.

One of those things as a physician where you like feel good about yourself because you got the diagnosis, you knew you’re smart enough. To know right away what it is. And so, uh, um, so I, it’s, it’s fun. It’s fun for me. It’s not like, you know, cataract, anybody can diagnose the cataract. Um, but this was like a little bit off the wall and I was like, I used my, my brain, I used all my brain thoughts.

And I came up with the right [00:02:00] answer and I, I feel good about that. And so I was like, let’s go and tell everybody on a podcast, how amazing I am, basically. Anyway, I do, you gotta, you gotta celebrate your wins, I think. And the patient’s going to do great. And it’s, it’s like a, it’s a relatively minor problem, but anyway, we’ll get to it a little bit later.

First, before ophthalmology stuff, uh, I wanted to share. Tweet that I read a couple of days ago that just, I could do a whole segment, you guys on, um, Congress people just saying ridiculous things about health care, clearly not knowing what they’re talking about. And, and so I’m going to read this to you and then we’re going to, we’re going to discuss it.

I’m going to tell you my thoughts about it. So this came on January 28th from a congressman, Greg Murphy. So he is a representative from North [00:03:00] Carolina’s third district. So he says, number one reason for MD shortage in med schools, admitting student is admitting students who aren’t going to practice.

Number one reason for MD shortage is med schools admitting students who aren’t going to practice. Only 60 percent of med students today plan on practicing clinical medicine. Med schools need to focus on admitting students who want to take care of patients, not just get their MD. What must it be like to just Not have the self awareness or the, the, the, I don’t know what you would call it.

Shame. Uh, uh, just the presence of mind to like, to, to feel, uh, I guess shame. It is shame about posting things that are obviously not correct. Like, what is it like to [00:04:00] just feel like you can just say something without any knowledge. Of whether or not what you’re saying is actually true and not seem to care.

Is it, this is, this is crazy. So number one reason for MD shortages, med schools, admitting students who are not going to practice medicine. Yeah. Where do you get that stat? Who knows? Only 60 percent of med students today plan on practicing clinical medicine. He’s saying that. 40 percent of, of med students applying to med school, being admitted to med school, 40 percent have no intention of seeing patients.

There is no way that that is a correct statistic. And it’s not just that, because that alone is like, okay, like, whatever. If it was just like some random person saying things with no evidence to back it up, that’s one thing. But But this is someone in [00:05:00] Congress who, like, we kind of, we kind of need these people to help make health care better.

And so whenever they’re saying things that are clearly not true and are not going to help anything in any way by having that line of thought, it’s, it’s annoying. It’s frustrating. It makes me a little bit angry. So this totally obscures the fact that. That the reason, well, first of all, it just, it’s not the reason that we have an MD shortage.

There are, you cannot point to one specific. Thing. That’s like the reason we have an MD shortage, uh, someone I love following on Twitter, Brian Carmody, he’s done a lot of work on this and laying it out. You should check him out on X. He also has a YouTube channel, but he talks about this, the position shortage, like what is really going on with the position shortage.

And he says, he talks about how it’s [00:06:00] not. A fact that we need to like admit more, more applicants into med school. We don’t need more med schools creating more of it. We don’t, we might not even really need more residency programs. It’s, it’s, uh, the, the perverse incentives that we have in medicine that pushes the whole population of physicians in certain directions that are not great for a diverse.

Society like the U S we have incentives in healthcare that push people away From primary care away from rural areas away from doing common specialties and toward uncommon specialties where we don’t really need more like left middle right middle lobe lung surgeons who do one thing [00:07:00] like it’s I don’t even know if that exists but you get my point it’s like we’re just we’re physicians are not Going to the places that we need them to go.

Now, I still think like we need probably more residents, more residency positions, more residency programs, but he does have a good point. Like the incentives are not there. And so this guy, Congressman Greg Murphy, talking about how the problem is 40 percent of med students come into med school, not wanting to practice medicine.

On its face, this doesn’t make any sense who on earth would go through all the prerequisites in college, the cost of applying, of interviewing, of really setting up the, the, your, your prime years of your youth, going through your entire twenties, pursuing a degree. That really has like [00:08:00] the only, the most important thing you can do with this degree is see patients like who would do that?

Without the intention of actually seeing patients, it doesn’t make any sense. Maybe one out of a hundred are like thinking I’m going to use this MD to, uh, you know, work in a pharmaceutical, you know, for a pharmaceutical company or be a consultant, but I’ll tell you what, it’s not. It’s not this, there’s not people that are applying that think that it’s people that get into it, that start doing their clinical rotation in the third year, their fourth year internship residency, and realize medicine sucks.

Clinical medicine is terrible. They don’t want to do it anymore, but they’re stuck because they have 300, 000 in student loans. So they have to see it out. They have to get their degree, but then. They’re not going to practice or at least not going to practice very long and start doing other things. That’s a big driver of the physician shortage.

I think people [00:09:00] leaving medicine as well as all the things Dr. McCormody talks about, which is the incentives, not putting physicians in the right place, but there’s a lot of people just leaving medicine, they’re not coming, they’re not applying without the intent of practicing medicine. And if you think that that’s a problem because it takes attention away from what would be a real problem, which is people getting into medicine, realizing it sucks and leaving.

That’s what we don’t want because it is crazy expensive from a time standpoint, monetary standpoint to train a physician. It is expensive. And so it is terrible. We put these highly trained people into job situations. That are awful that are not supported and force them out of the field of medicine [00:10:00] because everyone comes in wanting to take care of patients.

I promise you 99. 9 percent of people who are of undergrads or whatever you are in your in your in life who come in who apply to med school 99. 9 percent of them want to see patients and practice medicine. It’s the health care system. That pushes them away from that. So stop talking about how we’re admitting the wrong people.

That’s nonsense. That’s stupid. There’s no point in talking about that. That’s how would you even like try to figure that out anyway? Like the stat doesn’t make any sense. It’s pointless to talk about that and start talking about the real reason that people are leaving medicine because that’s important.

Like make life better. Stop cutting reimbursement, control the cost of student loans, uh, of medical, the cost of medical education, um, uh, put more ownership into the hands [00:11:00] of physicians, people that actually taking care of patients. All right. Take more power away from PBMs, health insurance companies, limit the corporate practices of medicine.

You can do all of these things. That’s going to keep people in medicine, make people more excited about practice, practicing clinical medicine.

New series. What did Congress say today on social media? I’d say it’s like every week there’s something anyway, I just, I couldn’t believe it, but he goes on in that thread, by the way, this, this congressman, Greg Murphy, Murphy, and then I’m done with it. I’ll move on to something else. Um, he says it should be mandated that unless disabled, each medical school graduate should have to practice medicine full time for 15 years.

Minimum or have to refund the federal government for the cost of tuition. Oh, I didn’t know. I didn’t know we were being gifted money by the United States government. [00:12:00] To do our med school education, refund the federal government. Yeah. We’re paying back those loans, you know? Yeah. And if you’re not, that means you’re doing a student loan, a forgiveness program where you are paying it back.

You’re doing a serving your community. So I don’t know. It’s dumb. So anyway, let’s focus on the things that matter. Please make life better. Congress will do anything except try to make life better for physicians. You know, it’s, it’s, people ask me a lot, would you be okay with your kids going into medicine and all my career, which is now, you know, I, I graduated med school in 2013.

So, you know, I’m a solid, you know, 10 plus years into practicing. Um, I’ve always said, yes, I would, I would not, I guess my answer is always. I will not push them to [00:13:00] medicine, but if they find that path on their own, I will not deter them from pursuing it. Uh, I will support my kids if they choose medicine.

This is like the first time in my life that I feel myself wavering on that. I feel myself thinking like maybe I would try to have my kids explore any other possible viable career first. And if nothing else, if that’s all they can think about is like, yes, I want to be a doctor and that’s all I’m willing to do.

Okay, go ahead. But man, it’s just harder than ever to be a physician. It is. And it’s, it’s, and it’s not from, I mean, it’s still a good life. Like you can still [00:14:00] make a good living. Obviously. It’s not the money. It’s the, it’s the administrative burden. It’s the micromanaging of, of the, the medical decisions we make of having to, to fight so hard for patients.

To get the care that they need people, not, not, not trusting our medical expertise, health insurance company dictating every single step of the way. Like that’s the stuff that just. It makes us want to quit and, and never come back. So let’s fix that. Let’s take a break.

Hey, Kristen. Yeah. I’ve got some friends. I’d like you to meet. I see that you seem a little too friendly with them. I have to say, aren’t they cute? [00:15:00] Sure. With the little beady eyes and their little, little hands, the hands, the claws, I don’t know, appendages. Okay. How about that? That works. But anyway, they just like, well, they’d like to say hi.

Okay. Okay. Wonderful. They’re not, they, Oh, look, the one sticking around. Sure is right on my mic. These little guys are, uh, Demodex and they live on your eyelashes. Yeah. Uh, and they can cause flaky, red, irritated eyelids. See, that’s not cool. That’s a party foul. You just kind of want to, like, rub them. Mm hmm.

You’re not welcome here if you’re going to do that. And it’s caused sometimes by these little guys. Yep. That’s rude. Uh, demodex blepharitis. But you shouldn’t get grossed out by this. Okay. All right. You got to get checked out. Yes. Get checked out. To find out more, go to eyelidcheck. com. Again, that’s E U I E L I D check.

com for more information about these little guys and Demodex blepharitis.[00:16:00] 

All right, here we go. So I told you I had a patient that came in this morning with an interesting, uh, exam and finding everything. So let me, I’ll just tell you, this was a 35 year old woman, uh, who came in with. About a week of pain in the eyebrow, it’s like a dull aching pain. Couldn’t really localize it very well.

So pain in the brow. First of all, we’re, that’s like the edge of, of, of my domain. Like we’ll go, I’ll go brow. I’ll go brow to, to, to like maxillary sinus. That’s, that’s my, this is, this is it for me right there, that, that zone. Uh, and so brow I’ll, I’ll still, you know, browse something I can do. We see some brow stuff from time to time, brow ache.

If you’re, if you’re 45 and you’re trying to read without reading glasses. And you’re farsighted, [00:17:00] you’re going to get a brow ache. It’s because you’re trying to strain so much, and the stress on the ciliary muscles in your eye that allow you to focus your eyes up close, if they strain, if you strain too much, you’re going to get a brow ache, right there, across the brow.

Ciliary spasm, same thing, you know, severe ache, right, right on the brow. So that’s the first thing I’m thinking, well, this patient was myopic, so she’s not, that’s not, that’s not a problem. All right. Thank you. Bye. 35. Minus two, no problem seeing up close, not having strain, didn’t really seem like a strain because it was one sided, one sided pain.

Vision was fine, no problems with the eye, there’s no redness, no discharge, no signs of infection, no significant, uh, light sensitivity. So, if we have light sensitivity, then we’re thinking, okay, could it be uveitis? Could there be inflammation inside the eye that causes that pain? So, what could be causing this pain?

You know what else? [00:18:00] Is in that area. Well, it could be shingles. So you have the the first branch of the trigeminal nerve distribution that that shingles can can and herpes can affect. Uh, so usually that’s an upper lid brow forehead. I have seen a few times where patients will come in with pain in the brow.

Or pain in the forehead, but I just don’t see anything and then maybe the pain. It was usually it’s like a day like one day of burning discomfort in the forehead and there’s nothing there. And then a day later, or maybe even hours later, the rash pops up. So I’ve definitely seen patients with shingles who before they get a rash, they start having pain.

Uh, so I’m always thinking herpes is. Zoster or simplex, any kind of herpes at like, it’s always like on the tip of my tongue. It’s always something that’s right there on the surface. [00:19:00] I feel like that could be like a thing that you just do. With every patient. Is it herpes? You just think think is this herpes chances are it’s not but it could be especially when it’s something weird You can’t explain it.

It might be really be herpes. Alright, so I’m always thinking about herpes, but this one it didn’t fit It didn’t fit Uh, not shingles at least, uh, and patient didn’t have any history of, you know, any cold sores or anything. No shingles outbreaks in the past is only 35. So that was, that seemed much less likely.

So I started my exam. I’m not, this is like the first 20 seconds of the encounter. I’m thinking like, well, okay, what could this be? Um, so I do my exam and start, you know, Palpating. I talked a couple episodes ago about how I can like look at the patient and see any obvious diagnoses pretty quickly. Well, there’s no toast.

It’s like everything look normal. You would never think that this person was having a problem with their eyes just by looking at her. So I start to palpate [00:20:00] along the brow. And as soon as I get to the inner corner of the brow. She’s like, that’s where it hurts. So I’m like, Hmm. So I go a little deeper, a little bit under the brow.

Now I’m getting into like the superior orbit. So you feel your brow Ridge right underneath it. That’s the superior rim of your orbital, your frontal bone. Okay. Um, your eye sits in your orbit. And so I’m palpating kind of the upper. Inner aspect of that superior orbit right at the base of the inside part of the brow and I start pressing a little harder.

She’s like, Oh yeah, that hurts. That’s it. So I’m like, I think, I think I know what this is. I think I know what this is. I don’t see this often, but, uh, but I think I know what this is. So it was right. The really, the pain was right. And what we call the supra orbital notch, which is where the super orbital nerve.

Pops up. Do you know what else is in that area of [00:21:00] the orbit? A little thing called the trochlea. So the trochlea is this saddle like cartilaginous structure in the superior and medial part of the orbit. It’s one of those structures in the human body that you’re like, how it almost makes you want to question evolution.

How on earth? Would anything like this develop? We literally have a pulley system in our orbit that that tour that in cyclo torts and x cyclo torts the I must the the I by redirecting the path. Of the, uh, of the superior oblique muscle. We have a pulley in our orbit. That’s crazy. How does that happen? But we have it.

It’s the weirdest thing, but it does help us to, uh, whenever we’re laying [00:22:00] down on our sides or we can maintain our binocular vision because we have, our eye has the ability to twist back and forth. We twist trochlea helps us do that. You get those kind of the weird movements, not the up, down, left, right.

Now we’re doing diagonal, twisting in, twisting out because of this thing, this weird thing called the trochlea. And it’s, uh, um, and there’s a disease that you can get called trochleitis, trochleitis. So you basically just get inflammation. Of the superior oblique tendon sheath, which is the part that’s kind of going right through that, that pulley, that trochlea as far as like what causes it.

Um, it could be just friction. That’s not, I think that’s really what we think it is, is I don’t know if we have a great explanation for why people get trochleitis, but like [00:23:00] chronic micro trauma related to the continuous friction of the tendon through that little trochlea. Maybe someone has a particularly small trochlea.

That could be it. And so there’s just more friction of the tendon as it goes through that structure that leads to this self induced localized inflammation because you’re all your all day you’re using all your eye muscles and the movement becomes restricted. It can cause further damage to the tissue and just get in the cycle of inflammation of the trochlea or trochleitis.

And so you classically, you have pain on the inside of the orbit, right where this patient did. Uh, and sometimes there’ll be swollen. Like you can see some swelling of the eyelid in that area. Sometimes not if, especially if it’s a mild case and if the patient looks down and then up again, those movements will actually increase the pain.[00:24:00] 

Uh, because you get this a little bit of restriction and you’re, you’re, you’re activating that muscle. So it’s, it’s causing it to, and that’s, you’re using your superior oblique when you’re, when you’re looking. And down like up and down, several muscles are involved, but the superior oblique is one of them.

So you activating that muscle, you’re causing pain. So I tried to do that with this patient. That wasn’t really what was really helpful was just palpating the area of the trochlea and inducing that pain. And, um, and so as an other, that’s, that’s pretty much, and some people can have, uh, double vision, not all the time.

Um, but, uh, and so what do we do for this? Well, You can do like a CT scan or an MRI, but that’s, that’s kind of overkill with stuff like this. Uh, because this is not like a, a, this is not a typically a, uh, uh, like a kind of vision threatening issue or life threatening issue, unless there’s like, [00:25:00] More diffuse orbital inflammation, you know, so there’s some kind of like orbital inflammatory disorder or even like a lymphoma affecting the orbit where you get inflammation in the back heart behind the eye.

Well, that can also affect the orbital tissue kind of right there at the superior orbit. So, uh, but in this case, it seemed like a pretty slam dunk. trochleitis. So no need for imaging. You start with, uh, with just insets, you know, trying to, and this patient had, had tried that, you know, for several days already without much relief.

And so you give it like a solid a week or so, seven to 10 days, see if they can control it with topical insets, even, um, um, an oral, oral insets and topical insets you could try. I wouldn’t do a topical inset. I, I, I’m not a big fan of those because they can be pretty. Um, uh, toxic to the cornea. [00:26:00] And so topical steroid can be tried.

I ended up putting this patient, having her use oral insets, ibuprofen, and then also gave her a prescription for a topical steroid. And, uh, um, but if that doesn’t work, so people might not respond to that at all, then the next step to control this pain would be a localized injection right into the superior.

The medial superior orbit right where the trochlea is, you just inject a bit of steroid right into that region. I’ve never done that, and if that is what ends up happening for this patient, I will send her to my wonderful partner, who’s our oculoplastics doctor. Who has done a lot of that stuff. I’ve sent him a couple other patients just like this and he’ll take care of it.

But chances are, I think this will probably get better just conservatively and eventually going to quiet down the inflammation. The problem is, you know, could [00:27:00] this, you know, could there be multiple episodes of this over time? And yeah, I guess it’s possible. But 95 percent of these patients have complete.

Improvement and remain pain free for months or years. But occasionally you require like a second or third injection of the steroid to get it to calm down completely. So chances are this isn’t gonna, there’s just a one time thing. She’s not gonna have any other problems. But it was kind of, it’s just a, it was a fun diagnosis to make because it’s always fun to, I don’t want to say fun, it’s, it’s just satisfying.

That’s a good word, right? Because the patient comes in with a problem, it’s always wonderful to be able to have an answer for that problem, which doesn’t always happen in ophthalmology. The vision, the vision. Is a weird thing. You guys, I there, people experience things that are very hard to explain. Like one time a patient came in with, uh, all the [00:28:00] only complaint was like, she sees cracked glass.

That’s it. That’s all I could get nothing else wrong. Cracked glass in her vision. I thought, I was like, it’s probably just a migraine, but this, it doesn’t sound like a migraine. So I’m not quite sure what to do. Ended up giving it, getting an MRI and sure enough, occipital tumor, brain tumor. That, that, that scared me.

Uh, and sometimes you, and that was just like a couple of years ago in practice, just a cracked glass. And the vision vision looked like cracked glass. Wasn’t sure what to do with that. Well, now I do. If I hear that again, sometimes you have those types of experiences of physician where, you know, it’s not quite what you learned in school.

Um, there’s a reason why myself and many other people have been in practice say that you learn more in their first year or two in practice than you [00:29:00] do throughout the rest of your medical education and training, because. The human body does not read the textbook and the human body is not a computer and wild things can happen with the body.

People can experience disease in ways you never thought they would, and it can manifest in ways you never thought you would. You just, you hope you can just put your thinking cap on and do what you think is best based on your wealth of knowledge that you have. But it takes that kind of experience to like have enough of those types of situations where you know what I saw a patient five years ago who had this exact thing and this is what ended up happening.

That is so valuable, which to bring it full circle, why it sucks that people are leaving medicine, people with 10, 15, 20 years of practice experience leaving medicine. [00:30:00] We’re losing that wealth of information and knowledge that can only come sometimes with practicing medicine, with seeing patients. We’re losing that, that sucks.

All right, we’ll come back. I have a couple of questions that I’m going to hit up.

All right. So, uh, last episode, I teased this a bit. I ran out of time, so I’m going to try to do a little bit more justice now. Uh, this comes from, uh, by the way, all these comments. I know you guys, if you watch all these episodes, you know, I hear the say is all the time, check out the YouTube channel at Glockham Fleckens.

All the podcast episodes, knock, knock, knock, knock, knock high. Are going to be there. Um, check it out, leave a comment. I always read the comments on the knock, knock guy, really on all the episodes, but specifically on knock, knock I episodes, leave a comment on the YouTube channel, and I always address at least one, sometimes do a whole episode where I’m just answering [00:31:00] questions from you guys.

I love seeing those. So, um, these come from, uh, the YouTube channel. All right. At Jen Lee 4, 2, 1, 2 said, have you ever commented on the social media trend where people cut off their eyelashes? I was concerned about this. I had not seen this. I’m on Tik TOK, not frequently. I don’t typically scroll a lot on Tik TOK.

Uh, but. Certainly trends come up that are alarming to me. Uh, this seems like one of, maybe one of the more benign ones. So I went to check it out and sure enough, yes, there are people that are taking clippers that you would get at the barber shop that just give you like a buzz cut. And they’re just taking them to their eyelashes.

First off, those of you who are young, don’t. Like if you’re in your like twenties and thirties, you won’t understand this. You want to understand this. And I am in my thirties, but I take care of a lot of people in their seventies, [00:32:00] sixties, seventies, eighties. Do you have any idea how much people would be willing to pay for natural long Eyelashes.

What are you doing? Why are you doing that? Not only are they are long eyelashes there. They’re very pretty to look at. They’re coveted. They’re highly coveted by many people in society. What are you doing trimming them? You don’t need to do that. And second of all, From like an evolutionary standpoint, we kind of need those things, especially if you do any kind of work in a dusty, dirty environment, you sweep up dirt, or you work in a hair salon, you sweep up hair, or you’re doing woodworking or metalworking or anything, you’re in a factory, I don’t know, something where there’s just a lot of stuff in the air, you do landscaping, any of this stuff, Your eyelashes are actually quite important.

All right. They, they do keep things out of your eyes. Ask [00:33:00] people with alopecia who don’t have eyelashes, uh, don’t have eyebrows, like they are more likely to get foreign bodies. It’s just, it’s not as just hold on to your eyelashes. They’re wonderful things. We have them for a reason. We have lots of things in our body.

We have for a reason, except for the spleen, we don’t need the spleen. I’m sure it does some things, but come on, really? We need, how about a second liver? I keep, I keep saying it anyway. All right. So. All right, she goes on, uh, Jen Lee 4212 on this comment, uh, says, I came across this recently, this trend of people cutting off their eyelashes and would be interested in your take.

Well, I just gave my take like, what are you doing? It’s not going to be, it’s not dangerous. I mean, it might be dangerous if you get something in your eye. Um, also if this is the case, how do you recommend dealing with not having eyelashes for patients? That can’t [00:34:00] help having no eyelashes such as for people who have alopecia or going through chemotherapy so, um, you can live without eyelashes uh, just because Like I said, you’re going to have the most trouble when you’re out and about and you’re, you’re in, uh, you know, if there’s lots of pollen in the air, just you’re in places where you could get something in your eye.

Um, wearing eye protection is always a good idea. It just like sunglasses or glass, even if you don’t have a pair of glasses, uh, or if you don’t have a prescription, just get some glasses anyway. Like it honestly does act as a really good barrier, um, uh, for the eye. And so that’s one thing that I would recommend.

And then. Also, uh, artificial tears, I would use them even if you don’t feel like you have dry eye, the ability to use tears to just rinse the eye. You don’t like pour a bunch of artificial tears, refresh or sustain in the eye, but just give yourself a drop [00:35:00] or two. Um, you know, a couple of times a day and it does help flush.

Specs of dirt things that can can accumulate in the eye. So I protection artificial tears the best you can out avoid makeup. Um, because that stuff can get in the eye. If you don’t have eyelashes kind of protecting you. Um, so anyway, that’s a, that’s a great question though. And just don’t, don’t cut off your eye.

That’s Don’t don’t do that. Oh, keep them. They’re wonderful things. So people will, they, they do pay a lot of money. They take medication to make their eyelashes longer. People love long eyelashes and you will too. Eventually Tik TOK people who follow this trend, who happened to be listening to this podcast.

All right. A couple more questions at.

EmbersAssembling939 says, If everyone has cataracts by age 60, why don’t we all just get cataract surgery when we turn 60 and get it over with? [00:36:00] That’s a great question. A lot of people feel like that is what they want to do. And there is actually a thing that you’ll hear on the radio. Um, I’ve honestly, I’ve only ever heard these ads on the radio, which is interesting.

Never heard them on TV, but they’re for a clear lens exchange, which is cataract surgery. Before you develop a cataract, you pay out of pocket for it. 5, 000 per eye, typically five to 10, 000, depending on what part of the country you’re in. Texas go, Michael, do it for free. And, uh, it’s just taking the lens out and replacing it with an artificial lens.

And, uh, people pay a lot of money for it. Usually the people that do that have a very strong prescription. They’re highly myopic and they want to finally get out of glasses for the first time in their life, but they don’t qualify for LASIK. Well, clear lens exchange is another option. Um, so why don’t, why doesn’t everybody do this?

Well, the cost is one thing because it would be expensive to do that [00:37:00] because most physicians rely on insurance payments to make their money because most patients have health insurance and they obviously have their own guidelines where you have to, to, um, to show to the health insurance company that.

that they have the disease that you are trying to do the surgery for. And if you can’t show that through testing, and it’s actually, it’s usually very simple to show that someone has cataracts, but if you don’t have cataracts, then we can’t do cataract surgery for you. Even though you have cataracts, if they don’t, if they’re not severe enough, you’ll hear the term, which I hate.

It’s like nails on a chalkboard. People saying the cataracts not ripe yet. The word ripe does not terrible connotation when it comes to the medical field, when you hear the term ripe, but anyway, so if they’re not severe enough, then insurance won’t cover it. And it’s too expensive for most people to get cataract surgery.

Also [00:38:00] there’s risk involved as opposed to LASIK, which has its own risk cataract surgery. has different risks because we’re actually going inside the eye. Now, this is the most common surgery performed in the US. So the chances of a complication are extremely low, but, um, not zero. And so what you’re doing is you’re taking someone who’s 60 years old, who barely has a cataract or maybe doesn’t even have a cataract.

No, I, I actually, I did say that everybody by 60 has cataracts. So yeah, they have a cataract, but they’re not severe enough for insurance to cover surgery. But they want surgery. Well, you’re still you’re subjecting this patient who probably sees perfectly fine to a surgery that could end up blinding them.

So surgery is a lot of it’s about weighing the risks and benefits. And, and, um, sometimes the benefits don’t outweigh the risks. And so that’s, that’s another factor to it. Um, I think in the end though, Most people just don’t want to have cataract surgery. [00:39:00] Like, most people don’t want to have surgery if they don’t need it.

With a few exceptions. So, um, so anyway, that’s your answer. You know, people have cataracts by 60, but they’re not causing problems at 60. Sometimes they are. Sometimes they cause problems sooner. But just because you have cataracts again doesn’t mean the cataracts need to come out right away. You can just live with cataracts.

People live with cataracts for 10, 20 years sometimes. And that’s what my job is, is to look at all the data, look at the patients functioning in their normal day to day life, look at their testing, their vision, look at the cataracts themselves, how severe do they look on the exam? I have a grading system for them and determine does this person, would they benefit from surgery and do the benefits outweigh the risks?

Usually they do because it’s a very safe surgery. All right. Good question. All right. One more question at actually, or [00:40:00] Jacobs says, here’s a question. What’s the difference between macular wrinkle, macular tear and macular hole. Those are all three different terms. Uh, is it just what it sounds like? Are there different it’s an outcomes treatments?

Okay. First of all, macular wrinkle is a thing. Macular hole is a thing. I. I have not heard of macular tear. A macular tear would be like a, like a retina tear because the macula is your retina, so that’d be a retinal tear. There’s other things called schisis, retina schisis, which is like a splitting of the layers of the retina, but not actually a torn retina.

But macular wrinkle is a more of a colloquial term we’ll use with patients. You have a wrinkle on your eye. What it actually. Is, is, is what’s called an epi retinal membrane. So it’s this, [00:41:00] I described it as scar tissue. It’s not really scar tissue, but it’s, it’s this layer of, of, of cells. I just, they don’t even know what they are.

It’s kind of embarrassing, but anyway, it acts kind of like. This, this filminess that sits right on top of your retina, and it can contract and cause distortion of the retina, giving you like wavy lines in your vision, or sometimes even pulling at the retina so much that it creates a hole, a macular hole.

And the reason that all this is so important is because the macula is the center of your retina. That’s where you’re focusing light, very important part of your eye. And so you get this, and by the way, a lot of people. In fact, I’d say most people by the age of like 60 have at least a little bit of a, of a wrinkle and epiretinal membrane on their macula, but most of the time it doesn’t cause any problems.

You can [00:42:00] have a wrinkle on your macula. For years and years and years, your whole, you know, 60s, 70s, 80s, 90s, and it never causes any problems. But if it does, sometimes it does, it starts to cause that distortion, causes you to start losing vision. That’s when we think about doing surgery. And surgery is actually going into the back of the eye, called a vitrectomy, removing the vitreous fluid in the back of the eye and peeling off.

Filming this, that film, just peel it off. I make it sound so easy. It looks extremely difficult and I love my retina colleagues for being able to do it because that looks like a stressful surgery, but they make it look so easy. I don’t know how they do it so well, probably all the training. Not something I wanted to do in my life.

Great question. Thank y’all. We’ll do some more questions next week. That’s it for knock, knock. I thank you for listening. I am your host. Will also known as Dr. Glock and Fleck. And thanks to my producers, Aaron Corny, Rob Goldman, and [00:43:00] Shanti Brick, editor engineer, Jason Portiza. Our music is by Omer Binz V.

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Um, I’m trying, we’re trying out some new stuff. It’s always good to just keep evolving. It’s good for my creativity and my, and Kristen and we just, we love. bringing new things, uh, into the fold. So be on the lookout for that. Uh, but I’m going to keep doing these knock, knock guys, as long as you guys are there and keep commenting and keep watching.

So thank you for your support. Knock, knock. Hi is a human. I’m talking. I is a human content production. That’s all I’ve got to production. We’ll see you next time, folks.[00:44:00] 

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