Knock Knock Eye: Can You Take Your Cataract Home?

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Transcript

[00:00:00] Today’s episode is brought to you by Microsoft, who is committed to helping physicians reclaim their work life balance and restore the joy of practicing medicine, discover DaxCopilot, your AI assistant for automated clinical documentation and workflows to learn more about how DaxCopilot can help improve healthcare experiences for both you and your patients, visit aka.

ms slash knock, knock high again, that’s aka. ms. They’re like Microsoft, you know, you know, slash knock, knock. Hi. Hi everybody. Uh, welcome to knock, knock. I big disclaimer. See sometimes. I’m an idiot and I, I, you think that I would have this whole recording thing down with the podcast, considering we I’ve done over a hundred episodes of, of, of this stuff.

Uh, but anyway, I didn’t have my, my good mic on my, my only mic. This is the only mic I didn’t have it [00:01:00] on. I was recording. So I spent the whole episode, uh, talking into a mic that wasn’t actually working, but I did have audio through my computer. It’s not going to be the audio you’re used to. Like it’s going to be a little bit lower quality.

So just please bear with me. I apologize for that. I know many of you come to hear my golden voice, uh, in, in all its high quality. Glory. But it’s just this episode, a little bit different. So sorry about that. I’ll do better next time. Uh, please enjoy this episode. All right. Thanks everyone.

Hi.

Hello, everybody. Welcome to Knock Knock Eye with me, your host, Dr. Glockenflecken. This is your one stop shop for all things eyeballs. The only person out there [00:02:00] talking about eyeballs. That’s not true. But, uh, uh, uh, maybe one of them. There’s not that many of us. There’s not a lot of. I specific podcasts out there, the American Academy of Ophthalmology runs one, but I shouldn’t be telling you to go and, and, and go check out other podcasts.

All right, you’re, you’re where you need to be for eyeball stuff. Okay, right here. Uh, and, uh, I’ve got, uh, some more. Questions, uh, from you guys to answer, to talk about all kinds of eye related topics. Uh, I, it’s kind of what this podcast is, is these knock knock eye episodes are turning into is just you leave me questions.

On the YouTube channel, by the way, subscribe to the YouTube channel at Glockenfleckens. All right. It helps with the algorithm and for people finding it. And, uh, and I just like seeing you guys there. Uh, and this is turning into a podcast where I just, I see those comments. Uh, whether they’re, they’re comments or questions and I just, do we talk about it?

And it just gives me [00:03:00] things that I know. It helps me realize, like, figure out what is on the minds of. Of people who are just not in ophthalmology, maybe not even in medicine. Uh, what you’re thinking about with eyeballs, what are you wondering about it? And so I love doing it this way and I’ve got the more I talk about this every time, every episode, I’m like telling you to leave me comments on the YouTube channel.

And I think it’s working because I’m slowly getting more and more comments on each episode. And so I really appreciate that. Um, and so keep it coming. I’ve got a lot of things. We’re going to do some starry eyes. I did that a while back where I took like a celebrity, famous person and talked about their eye problem.

I’ve got a couple for you today and a few other little disease things, some questions. It’s going to be great. But first, there’s news and social media. If you’re not [00:04:00] aware, if you’re not on Tik Tok, it’s, it might be going away for good this time. Now, this has come up like two or three times in the past couple of years where people think it’s imminently going away and it’s not.

It’s just people like in Congress talking about having hearings, discussing with the CEO of Tik Tok, you know, how much of a threat to national security is this app and, and, but that’s it. It’s never like actually going away. So people talk about they’re all concerned, people try to tell people where to find all their content, and then inevitably the next week, oh, TikTok’s still here.

This time it seems imminent. It’s, it’s because there’s a law now, and unless somebody stops, unless the Supreme Court steps in, in just a few days, I think it’s the 20th, January 20th, I’m recording this on January 15th, um, so by the time you hear [00:05:00] this, we’ll know. But, uh, it’s, unless the Supreme Court takes preventive action, it’s like TikTok’s gonna go dark in the U.

S., and I’m not happy about it. And it’s, it’s, it’s because, you know, TikTok seemed very much just like a novelty at first when it first started up in the U S like 2019, 2020, just right at, right with the pandemic blew up in popularity because of the pandemic, because we were all on social media, we had nothing else to do.

None of us were working. We’re in lockdown. And so people, including myself, flock to TikTok, started making content. The rest is history, right? For me, at least. And for so many other thousands of other creators. Who now have livelihoods based on TikTok. Now, think about that, you know, people had different thoughts about whether that’s like a legitimate thing to, to have a career [00:06:00] doing.

I think it absolutely is. How is it any, honestly, any different than any other job in the entertainment industry where you’re, you’re entertaining people, you’re educating people, you’re making them laugh. It’s, it’s just. The next generation, the next iteration of entertainment is content creation. And so I, I feel bad for, uh, there’s going to be a lot of people that are going to struggle financially, emotionally, reputationally, uh, from tick tock going away and.

It’s it’s a very flimsy reason. I don’t think it’s a good reason. I think the the the funny thing to me is that over the past week with this impending decision of tick tock going dark and and all of a sudden everybody’s looking for outlets under things there. Nobody wants to go to Metta Facebook Instagram.

They don’t want to go to X with [00:07:00] Elon Musk. And so the the ban on tick tock. Is pushing people to actually like Chinese owned apps. There’s red note. That’s what everybody’s talking about right now. People are learning Mandarin. People are interacting with with Chinese citizens. It all seems very, uh, very wholesome.

Actually, it’s almost as if the Chinese people are not this, this, uh, this, this scary group that, that we’ve like grown up being told about. And, uh, I imagine that the powers that be, the people in Congress who are all for this TikTok ban probably did not expect people to all of a sudden go to an app that has more Chinese ownership, which is not U.

S. TikTok, like it’s, it’s the, the CEO is like Singaporean, like it’s, it’s, it’s totally not that. [00:08:00] And so it’s, it’s like having the, the, the, the, the effect, the other, the opposite effect, people are now going to, uh, uh, um, potentially you could think of as more of a threat. I don’t even know for sure. I don’t know anything about red note, but, um, I’m, I’m, I’m talking in terms of, of what’s probably going on in the minds of these idiots in Congress who are, who think that tick tock is a security risk.

Everybody has our information. You guys. Like, and there, I promise you, there are people that are doing more nefarious things with your information than TikTok. How about health insurance companies? How about any corporation that you’ve given your email address to? Uh, I mean, the list goes on and on. Like, none of your information is private.

Like, that’s a pessimistic thing to say, but in general, generally, I think it’s true, you know. I just assume that everything about me is out there [00:09:00] somewhere, and you just hope that nobody does anything bad about it, and you try to protect yourself the best you can. But, I mean, come on. So it’s a flimsy reason why they’re banning TikTok in the first place.

And it’s going to be bad for creators. And like, I, I, this is part of the reason why, just part of the reason. There’s a lot of reasons why I’ve maintained my, my medical career and not just given up. Cause I do, I make enough money on social media and doing the Glockenflag and stuff that I could quit medicine, but I, I, I in no way, shape or form want to do that.

Partly because I guess what? I do still like it. Like I like being a doctor. I like doing cataract surgery. I like I like, you know, helping people in my community. It’s it’s fun. It’s still fun for me. But the other part of this is that is is more stable. I I’m [00:10:00] generally a risk averse person as many people in medicine are.

That’s part of the reason why we like medicine so much because it is inch. Although there’s a lot of difficult things happening in medicine, there’s a lot of uncertainty about a lot of different things. It’s always going to be there. And, uh, and I can’t say the same thing for a career in content creation on social media because you make your money.

A lot of people make their money based on the income from those apps from those, those companies. And if something like TikTok goes away.

Well, you’ve just lost a revenue stream. If the algorithm changes, if YouTube changes their algorithm in a certain way that deprioritizes your content, well, guess what? That’s going to affect your wallet. And so it’s, uh, it’s a much more fickle thing. It scares me a bit. And unfortunately, like this has gotten, this TikTok ban is going to affect a lot of people.

And so, [00:11:00] um, I hope that between. By the time you’re listening to this, maybe the Supreme Court will have stepped in and stopped this, filed an, what do you call it, an injunction, I don’t know, something, I, I, that’s, I’m now talking about things I don’t know anything about, but whatever it is, I hope they, they stop it from going away because you talk about, Uh, restricting freedom of speech and censorship and like, is this not the most egregious example of censorship, impending censorship that we’ve seen in a long, long time?

I mean, this is like one of the most popular apps, certainly the most popular app for people under the age of 30, and we’re just going to get rid of it because of a perceived security risk. I mean, people like just making up and silly skits and dancing and singing and showing their talents and I mean, come on, guys, what are we doing?

All [00:12:00] right. Anyway, that’s, that’s my rant about this whole tick tock thing. Hopefully it won’t come to anything. We’ll see. I’ll check back in next week. We’ll have an answer for you. Um, and, uh, but let’s take a break. We’ll come back. We’ll talk about those.

Hey, Kristen, I know you’re a big fan of Demodex mites, you know, the eyelid mites that are on your eyelid. They’re just right there in your eyelid. Yeah, thank you. Uh, well, what if they flew at you? Oh, God! What if they jumped? What if they jumped? Would that bother you even more? Oh, it’d be even worse. Jumping bugs are always worse.

Good news for you. They, they’re not jumping. They don’t jump at you. But they are there and they can cause like crusty, flaky, itchy, red, irritated eyelids. So I can tell you’re a little bit grossed out. It’s a disease. It’s called Demodex blepharitis. It sounds like no fun. Well, it, but it’s pretty common and a lot of people don’t really know about it.

Yeah. But I mean, these [00:13:00] like they’re, they’re, they are kind of cute. I gotta admit, just a little, just a little cute. Maybe a little cute. Regardless, you shouldn’t get grossed out by this. You should get checked out. Okay. All right, go to eyelidcheck. com for more information. Again, that’s E Y E L I D check.

com to get more information about these little guys, andemodex blepharitis.

Okay, here we go. We listen, let’s blow through some, some great questions and comments. Uh, we’ll start with, uh, at Steven just, oh, one said when people get teeth pulled, sometimes the dentist lets you keep them. Has anybody ever asked to keep their teeth after they’ve been pulled? That’s kind Like again, I mean, at first I would think, like, that’s weird, but then again, like, we make a big deal out of it when you’re, when you’re children, when you’re a kid and you lose your teeth.

Like, uh, we made a whole story about a fairy coming in and [00:14:00] taking your teeth and leaving you money. That’s weird too. So I guess it’s not that weird, but the question is, do ophthalmologists let patients keep their cataracts? So, I don’t know. 99. 9 percent of the time, the answer is no, because for the average cataract, when I go in there and remove a cataract, I’m like, we, we, it’s a process called emulsification.

I am creating a cataract soup inside the eye and sucking it out through a vacuum. I don’t describe it to patients that way because it sounds horrifying that this is happening inside your eye, but that’s basically what happens. I’m just breaking it up. Breaking the cataract up into a bunch of different pieces using a little cutter thing that just tears it up and then it ends up being just this soupy mess and then I bring it out so it’s it’s all you wouldn’t see there’s nothing to show you you could take the little bag of fluid home I guess uh but then why that’s just weird uh the one exception would be if you have a severe [00:15:00] enough cataract you Where, if the cataract gets too advanced, maybe you should have had cataract surgery done 20 years ago, but for some reason you wait.

The cataract will get, your cataract will get so dark and dense that it is a literal rock, like a diamond inside the eye, where there’s no way with our current techniques that we can break that rock. into different pieces. I’ve seen this one time in residency. One of my attendings did a special type of cataract surgeries.

And it’s actually what we used to do, cataract surgery, where you make a larger incision. It’s called an extra cap, where you make a larger incision and you pull a cataract out in one piece. You don’t break it up, pull it out in one piece. Uh, and now we only do that. If it’s in this situation where the lens is so dense that we can’t break it up.

And I saw this one time and, and [00:16:00] the, the attending took out this lens in one piece and it was like black. It was, it was hard as a rock. It sits in your, in your palm of your hand, it’s very, very small as you can imagine, and it did, it felt, you tap on it, it’s, it’s hard, it’s very hard, and that you could give to somebody, if they wanted it, um, only time I’ve ever seen that, very infrequent, you’d have to go to a place, an underdeveloped country, where they do a lot of The mission cataract work where you see a lot more of those types of problems in the U.

S. Typically, we get to cataracts before they get to that point. Uh, and so it’s just a soupy mess. So here’s your answer. Thank you, Stephen. Uh, by the way. At Glockenfleckens, that’s where I get all these questions. So these are coming from, uh, the questions today are coming from the episode that I just posted recently.

The weirdest eye questions you’ve always wanted to ask. Talked about a lot of different [00:17:00] things. Uh, here’s another question, uh, from the comments section on the video. Well, this is more of a, um, this, I talked about eye rubbing a bit, and I think I scared some people. I feel bad about that, but, uh, some people, uh, there, uh, a couple of comments are not, I didn’t think that was an issue.

Oh, here we go. At Appalachian cat, Appalachian, Appalachia, Appalachian. I learned that you don’t say Appalachia, Appalachia. I think that’s right. Anyway, Appalachian Cat said, Now I have anxiety over past eye rubbing. If, if, if, if you used to rub your eyes And your eyes are okay, and your vision’s good, then you didn’t cause any permanent damage.

But, yeah, if you habitually rub your eyes, you can cause problems. Keratoconus, you can permanently change the shape of your cornea to make your vision worse. You don’t want to do [00:18:00] that, so try to avoid that. Uh, and then I think I talked about in the episode, uh, at a very severe case of, uh, optic neuropathy where someone rubbed their eyes, someone with mental health disorder rubbed their eyes so hard that it damaged the optic nerve, which is in like the back part of the eye.

Imagine that. So anyway, it can be really severe, so try to avoid that. Alright, at justwhistlingpixie said, Is castor oil safe and or effective for use in the eyes? This is a great question. I don’t think I’ve addressed castor oil. This is another One of those things that shows up on social media, uh, in the last episode, I talked about the whole, you know, classes make your eyes worse, which is nonsense.

Uh, castor oil is another one. Yeah, because people are all about. old folk remedies. Why? I don’t know. I think it’s just trying to push back [00:19:00] against the pharmaceutical industry because there’s so much bad PR around pharmaceuticals that people want to go to something that was in a book. from the middle ages and be like, Oh, maybe that, maybe they were on to something.

Maybe they know more than our scientists in the year 2024. No, they don’t. They’re like, you know, using leeches and stuff. But anyway, castor oil is one of those things. It’s like been described for, for centuries. I don’t know the centuries, but long, long time. And, uh, so I always see it as like, Oh yeah, you should totally just natural use castor oil.

Uh, so anyway, what What is, what is castor oil good for? So it’s a fantastic lubricant. So that, that’s, if there’s one thing that I think castor oil could be actually really good for is if you have a prosthetic eye and you want to keep that prosthetic nice and lubricated [00:20:00] so it doesn’t cause chafing or atrophy of the orbital tissue where you’re putting that

So I do have patients that use castor oil just as a lubricant for their prosthetic that goes in their eye. Great, great use of it. So, but the, the, the most common reason that people say they use castor oil is to treat dry eye. So is it worth it there? I liken this to people who use Or, or recommend marijuana for glaucoma.

Is it a, is it a treatment? Sure. Yes. Yeah. There have been studies, some studies, that show marijuana does have a very, very mild eye pressure lowering effect to help with glaucoma. Just like there are a few even smaller studies that aren’t that great, aren’t that powered, that show There is an effect on treating [00:21:00] dry eye Using castor oil the problem number one already mentioned it like this It’s not like conclusive studies that show this is this is helpful.

But just like marijuana for glaucoma. There are Dozens of better treatments. I’m not trying to sell you on any treatment for dry eye, but I will tell you that All the over the counter eyedrop brands, you know, Refresh, Sustain, Blink, Theratears, even some of the generics, like, they just do a better job of treating dry eye than castor oil.

And castor oil, it can cause redness, inflammation in the eye, but in general, it’s not going to cause blindness. It’s not going to, and some people might actually find it useful, but I, as an ophthalmologist to a sworn oath to practice evidence based medicine, I [00:22:00] can’t recommend castor oil to you or to any of my patients because the evidence isn’t there for it.

And we just have better options that have better evidence. So, could you use marijuana to treat your glaucoma? Yeah, but it’s not going to treat it very well. Could you use castor oil to treat your dry eye? Yeah, but it’s not going to treat it very well. So just use the other things that are better. I don’t know.

I don’t know why people are still pushing castor oil. Um, anyway, but it is a good lubricant, right? So like you put on your skin and it’s a lubricate your skin, kind of like a Vaseline type of thing. I don’t know. So I never recommended it. I don’t think I’ve even mentioned it in exam rooms, like with patients, because again, we have so many other things we can use.

Good question. Thank you. Just whistling pixie. All right. Let’s do let’s do some more. Okay, here we go at joy. [00:23:00] McGrath 2784. What about unequal pupil sizes? I’ve talked about and I what we call an isochoria difference in people sizes, but both pupils react to light. Still, what could be the cause for this ophthalmologist?

Can you explain this to me? Yes, I can. And I’ve talked about this, I think, before. So there’s a thing that 10 percent of patients, 10 percent of people, have, which is called Physiologic Anisocoria. Your pupils just naturally are two different sizes. The most important thing when you think you have two different pupil sizes is that they both react the same way and the same amount.

So we will check each eye separately to see the pupil response and if they both Well, let’s say people’s difference, and usually with physiologic anesthesia, it’s like no more, no more of a difference than like two millimeters. If they’re way different, well, that’s unusual. Something’s going on. If they’re just like one millimeter or two millimeters, [00:24:00] and we can measure this, we have measurement tools.

Then, um, if they both react the same amount, if the small pupil is four millimeters, it goes down to two millimeters. If the larger pupil is six millimeters, it goes down to four millimeters. That’s physiologic anesthecoria. We’re not worried about that, right? So, yes, it’s, it’s, it’s normal. It’s, it’s pretty common for, for people to have a little bit of asymmetry in their pupil sizes.

Doesn’t necessarily mean there’s a big problem, but if you’re ever concerned, that’s something that I always encourage people to go and see an eye doctor, an optometrist, ophthalmologist.

because there are some very serious things that can come with unequal pupil sizes that you wanna be evaluated for. So, this is something that’s fairly easy for us to evaluate for you. Okay. At Jeremiah Walgren! How many people are part of your team for surgeries? You mentioned in a [00:25:00] previous episode, you review each surgery with your team before actually doing them just to make sure you have all the details and equipment.

Yeah. You’re talking about the, um, the timeout, surgical timeout, which Every place has a surgical timeout. There have been lots of studies that have shown increased safety whenever you have like everybody in the operating room goes quiet and the surgeon who’s the one that’s supposed to be running the timeout, I will die on that hill.

Some people disagree with me. They have a charge nurse or whoever it is running the timeout. Surgeons should run. It’s your operating room, your patient, you’re doing the surgery. You need to do the timeout. Um, where we, we, we confirmed the patient, the site that we’re operating on in my situation and my surgeries will confirm the artificial lens that gets put in the eye.

So how many people are part of this team? Well, in my operation, so I just operated this morning. [00:26:00] And there’s always, we have a CRNA, um, that, uh, is there, we have a circulating nurse and we have me and we have a scrub nurse. And I think that’s a pretty typical, there are some specialties that maybe are more, have more, have longer, more intensive surgeries that might have additional team members.

That’s your basic, what you need in an OR, uh, is um, a scrub tech. Or scrub nurse, circulating nurse, someone doing the anesthesia, and the surgeon. And then sometimes, like, I don’t have any in private practice ophthalmology, we don’t have any trainees, no residents, no med students, uh, so I’m just, I’m the only surgeon in the room.

And it works great. Yep. Good team. I love my team. Good stuff. Alright, let’s take a quick break and we have a few more, uh, questions and some, a couple diseases to discuss.[00:27:00] 

Alright, coming back, at Mr. Wheels, 74. Says, since you mentioned papilledema, this is on an episode a couple weeks back, since you mentioned papilledema, could you talk a little about pseudopapilledema? One of the worst things that we do in medicine is take a thing and just put pseudo on the front of it to tell you that it’s not that thing.

Well, that’s helpful. It really doesn’t, like, if you look back, look, like, step away from it, and look at, like, nothing, it doesn’t make sense. Why are we doing this? Why are we calling things like pseudo papillonema? Pseudo Hypoparathyroidism. There’s also pseudo pseudo hypoparathyroidism. I think it’s hypoparathyroidism.

I don’t even pretend to like know what that is. I just remember that it’s a thing and it’s irritating to have to learn about that kind of thing. So anyway, yes, there is a thing. There’s papilledema, which is, uh, the definition of [00:28:00] papilledema is increased pressure around the brain that’s causing swelling of Your optic nerves, which is different than optic disc edema, which doesn’t suggest that there’s increased pressure around the brain.

That’s papilledema specifically, the connotation there is that you’re talking about swollen nerves because of increased pressure around the brain. Optic disc edema, these are semantics that are very important to ophthalmologists and probably nobody else, is just swelling of the optic nerves. It could be due to papilledema.

But we don’t know that, right? So I will diagnose optic dyskinemia in a brand new patient who comes in with optic nerve swelling. And then I get an additional test, like an LP, like an MRI. And sure enough, it looks like there’s signs and symptoms and imaging findings, uh, that show that there’s increased pressure around the brain.

[00:29:00] Okay. We can call it papillodema. Just a little semantic thing. All the neuro ophthalmologists will agree with me because I have been yelled at in my career by neuro ophthalmologists for not making that distinction. It’s fine. Everybody’s got their thing. Everybody’s got their thing. So what is pseudopapillodema?

It’s, it’s, uh, classically, the, when people say pseudopapilema, that, what that implies is that this is a patient who has, it looks like they have optic disc edema, but it’s not real optic disc swelling. And the most common reason why that might be the case is due to something called optic disc drusen. So pretty frequently I’ll get.

I’ll get a, refer to a patient from a local optometrist, uh, who looked at an optic nerve, thought it looked raised, thought it looked elevated, thought there [00:30:00] might be optic disc swelling, and sent, and they send the patient to me for further evaluation, which is a very reasonable, very good thing to refer somebody.

Now I’ll look back there, and I’ll get measurements, I’ll get pictures, and turns out, And I’ll do an ultrasound sometimes, and it turns out that it’s not actually a swollen nerve, but the nerve head, which is the optic nerve head, is what, when I look into an eye and I look at the optic nerve, that I’m looking at the optic nerve head, um, it’s elevated because there are things called optic disc drusen, you can get, and these are, uh, more, mostly, most common in, uh, in Caucasian people, people of Northern European ancestry typically have these a little bit more, uh, uh, You can get these, the calcium deposits within the structure of the optic nerve head and [00:31:00] it can elevate the appearance of the nerve and make it look like they’re swelling, but there’s really not swelling.

It’s just those calcium deposits. Now, are those dangerous? Is it bad to have those? Well, guess what? I have one. I had an ultrasound. They’re like, Oh, you got it. Optic dystruzine. I was like, great. It’s not that it’s a bad thing, but it can be, because I’ve had some people that have really severe optic dystruzine, and I had an attending that likened it to, um, Stepping on a hose, like putting a, like a, a hose on a rock and stepping on it, and it can stop the flow of the hose.

Well, in this case, the hose is like the, the nerve fibers traversing the optic nerve back to the brain. Well, if you have these, these rocky calcium deposits, they’re putting pressure on Those nerve fibers. And if there’s enough of those rocks, enough of those optic disc drusen, then it just crowds [00:32:00] out the optic nerve and you start losing some of those nerve fibers.

And so, um, the unfortunate thing is there’s nothing we can do about these optic disc drusen. We can’t go and remove them. that would just damage the optic nerve. Uh, we just have to hope that it doesn’t cause further damage. There have been some studies that have showed that treating it as if it’s a glaucoma, so lowering the eye pressure, can just decrease the amount of pressure that’s being, that’s being transferred onto the nerve fibers from these drusen.

Not great evidence to suggest that really does much, but that’s something that I do for patients because it’s, it’s really. easy to do, and it’s, it’s a low risk, uh, and you might want to just try something. But I’ve had patients, I’ve had patients that have lost a tremendous amount of their peripheral vision, um, because they have a lot of these optic dystrus.

So that’s, when people say pseudopapilledema, That [00:33:00] is most likely the cause of it. I guess you could refer to Pseudopapiledema as someone that just ends up not actually having a swollen nerve. They just have a really crowded, maybe very small nerve, and that does happen. It’s normal anatomy. It just looks like optic nerve swelling, but it’s not actually a pathologic appearance to the optic nerve.

So, Optic Disc Drusen, Pseudopapiledema. If you want to impress your ophthalmologist, ask him. Do you see any optic dystrus in her neck? We’ll be very surprised by that. I don’t think we’ve ever had a patient ask that. So, anyway. Don’t tell them that Dr. Glockenblech had told you to say that, though. You’ll lose all your street cred.

Let’s do a couple more! Alright. At Alan Enderlin, 1164, says, Why is the optic nerve and blindness a first? Sign of possible MS, multiple sclerosis. This is a great question. So, one of the defining, [00:34:00] uh, symptoms of, of new multiple sclerosis is sudden vision loss. So, that, that’s a very classic presentation for a patient is to come in, classically, a young woman, 30 year old woman comes in, uh, they’ve lost vision.

They’re like, count fingers. Poor vision. And then you do a swinging flashlight test, you diagnose an afferent pupillary defect in one eye, you get an MRI. And it shows up, you have lesions in the brain or the optic nerve and it turns out this patient has optic neuritis, which can be a sign that a patient will end up developing multiple sclerosis.

But they are two different diseases. You can have optic neuritis without actually having multiple sclerosis. But for patients with Multiple Sclerosis, it’s very common to have an episode of Optic Neuritis. Not all the time. If you just had a patient yesterday, [00:35:00] Multiple Sclerosis has never had Optic Neuritis.

Because Multiple Sclerosis, it’s a disease that causes demyelination. of nerves in your central nervous system, because your central nervous system is where you have myelin. And so, for the eye, you know, your optic nerve is sheathed in myelin once it gets through, like, out of the eye. And which is part of the reason why we actually usually don’t see much of anything on the eye exam.

Like, when I look at someone who has optic neuritis, when I look at their optic nerve, chances are that optic nerve is going to look normal. Because there’s no sign of inflammation on that part of the optic nerve. The optic nerve head, what I look at when I look in the back of the eye, there’s no myelin on that part of the optic nerve.

And so I’m not going to see inflammation of that myelin sheath when I look at someone’s optic nerve on [00:36:00] their exam. You have to get an MRI, but there’s other ways you can figure out just by other clues, demographic of the patient, symptoms, mass and vision loss, pain with eye movements, these are all very common with optic neuritis, and then you get an MRI, and then you’ll see the certain sequences on MRI, the optic nerve, and then will light up because there’s optic neuritis.

That nerve is inflamed, but it can happen with any part of the white matter. You get white matter lesions, any part of the brain, central nervous system, spinal cord, you can get these white matter lesions. So if you don’t have a white matter lesion on the optic nerve, you’re not going to get optic neuritis.

So it could present in any way, but it’s just a relatively common way for people to be diagnosed. with multiple sclerosis is with an episode of optic neuritis. Now the good news about optic neuritis is, um, like 92 [00:37:00] percent of the time patients recover normal vision or close to normal vision. So it’s actually a really good prognosis, an episode of optic neuritis.

Um, obviously it can be a devastating disease, multiple sclerosis, but the optic neuritis part of it, uh, Most patients recover useful vision, great vision, even normal vision sometimes. And so it’s, it’s, uh, from an eye standpoint, it’s, it’s something that you can recover from. Uh, but it is a very devastating thing to be diagnosed, for people to be diagnosed with multiple sclerosis, obviously, but, and I have a number of patients with it.

That’s a great question. Uh, optic nerve blindness, and. Multiple sclerosis. All right. Uh, let’s see, did I hit all of them? Uh, castor oil, phages. Uh, oh, what I didn’t do is starry eyes. Oh my God, I forgot. I told you guys I would do that. Okay, we’ll do one. Here’s one. This is a good one. This is a good one. So, um, uh, at Veronica Cinello [00:38:00] 9024, uh, said you asked in one of your episodes for topic suggestions and starry eyes celebrities.

I did, I, I’ve done a few, a handful of celebrities that have, I like Fort Whitaker with his ptosis. Uh, so here’s why she said Daniella Rua, who I, I didn’t know who Daniella Rua is, but she’s NCIS, Los Angeles. If you guys aren’t fans of that show, she is, uh, a, the star on, uh, NCIS Los Angeles. A spin off of NCIS and she has an eye disorder where she has a, um, a pigmentation of her eye that’s been present since birth.

It is a, a, a finding called Nevis of Ota. This is a really good one. I’m glad, I’m glad you sent this one to me. So Nevis of Ota, um, it’s also known as oculodermal melanocytosis. And, uh, it presents at birth, uh, but it can. It can be very faint and can appear more [00:39:00] prominently during puberty or during pregnancy with all the hormone changes.

It can make the pigmentation of the skin or the eye, uh, more prominent. It’s, uh, uh, much more common in, uh, in females than males with a 5 to 1 ratio, and it occurs predominantly in patient, in people of Asian and African descent. So, darker pigmentation, you’re more likely to have anevus of OTA. And patients with this, uh, Well, I’ll tell you kind of what it, how it, what it looks like generally.

Um, so it can affect basically anything in the trigeminal nerve distribution from, um, one, the first branch and the second branch of the trigeminal nerve. So that would be, uh, anywhere from the sclera, your iris, your eyelids, your nose, your forehead, your cheeks, uh, the side of your face, basically above the mandible.[00:40:00] 

That’s what we’re looking at. And you just get this, this violaceous, darker pigmentation, um, of, of that skin. It can be small, it can be large, a large distribution. If it involves the eye, which it doesn’t always involve the eye. If it does involve the eye, specifically the sclera, the white part of the eye, then it can cause glaucoma.

So these patients have about a 1, I always get this stat wrong, I think it’s 1 in 400, yeah, 1 in 400 risk of developing, oh sorry, they have a 10 percent risk of developing glaucoma, that’s what it is. These are borns questions that I used to know at one point. So 10 percent of patients with this, um, develop glaucoma.

And it’s because the melanocytes actually invade the drainage system of the eye and basically cause kind of like a blockage there, angle closure in a way, uh, that leads to high eye pressure and glaucoma. 1 in [00:41:00] 400 patients with Mevus avona can develop a choroidal melanoma in the affected eye. So you have pigmented tissue, the choroid that’s Mostly in the back of the eye.

You can develop a melanoma there. So, uh, people like this, like, uh, Daniela Rua, I promise you, she is getting regular eye exams, sometimes every six months, to monitor. Because 1 in 400, like you think of the general public risk of a uveal melanoma is about 1 in 7 million. And so, um, uh, this, 1 in 400 is a, it’s a risk level that would scare me.

And so I’m sure her, she has ophthalmologists that are very diligent about following her and making sure, doing a thorough exam, making sure that there’s no sign of any melanoma. But that’s nevus abodin. It’s not, not real common. Uh, I’ve only seen a couple of patients with it. Um, and it’s, [00:42:00] uh, That’s fascinating.

That was a good one. Thank you for that. I’m going to save. There’s another, uh, a couple of ones that, um, Veronica here, uh, sent me for starry eyes. I’ll save them for next time. All right, that’s it. That’s knock, knock. I, uh, thank you all for listening. Thank you to my producers, Aaron Cordy, Rob Goldman, and Sean DeBrick, editor, engineers, Jason Cortese.

Our music is by Omer Bintzvi. Uh, everybody, uh, just pray for TikTok. I don’t want it to go away. I like making, I’ll still make my videos every so often. Um, it’ll just be harder and more annoying because it’s TikTok makes it so easy to make those videos. So I hope it doesn’t go away. I hope it sticks around for a long, long time.

Um, and, uh, yeah, so, uh, well, we’ll, we’ll see what happens. We’ll see you next time. Thanks for listening. Have a great day. Goodbye.[00:43:00] 

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