Transcript

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everybody. Welcome to knock, knock. I, a subsidiary of Knock Knock High, I am your host, Dr. Glaucomflecken, uh, thank you for joining me on this very special, uh, lunchtime edition. Normally I record these late at [00:01:00] night, I’m coming to you on my lunch break, I had a little extra time and, uh, I could, I, it was easy for me to think of stuff to talk about, so I was like, let’s just record it.

Let’s be efficient with our day as opposed to my usual lunchtime activity, which is either listening to podcasts or taking a nap, if I can. Love naps. Big fan of nap time. But, uh, I’m foregoing that today so I can talk to all of you about eyeball things. Uh, the first thing I want to mention is I was going through the comments on, um, uh, the most recently post, uh, uh, episode of knock, knock.

I, in which I talk a little bit about the IV fluid shortage and uh, one of the comments at 6fiona6p6 said, you can’t put a facility that manufactures IV fluids in the middle of Iowa. So I was talking about how this whole IV fluid shortage, like one of the big problems is that there was [00:02:00] this one facility that made the vast majority of the IV fluids in this country.

And it’s like on the coast, in like a hurricane zone. And so I was like, well, let’s put it in the middle of the country, let’s put it in Iowa. But Fiona here makes a good point, says you can’t do that. Tornadoes hit Iowa pretty frequently. As of August 2024, data has shown that Iowa has been struck by 122 tornadoes.

So first of all, Fiona, thank you so much for doing your research. You put a lot more thought into this than I ever would have. I really appreciate that. Uh, and that amount of tornadoes, by the way, in Iowa, in 2024, has set a new state record. There you go. Iowa, record setting tornadoes this year. Uh, and then Fiona goes on to say that I have heard Juneau, just Juneau, Alaska, that is, might be the safest place as far as weather goes.

Really? That’s surprising to me. I don’t know. It’s, I mean. [00:03:00] Yeah, maybe no, like, natural disasters, but my god, the cold, and the distance. Like, it seems like it’s hard to, like, get stuff in and out of, of that place. Maybe not. Maybe it’s easy. Who knows? Maybe we should just do all of our manufacturing in Alaska.

The bears could get into it though, you gotta, don’t you have to put all your IV fluids up high so the bears won’t get to it? I don’t know. Anyway. Juneau, Alaska. IV fluid factory location. Think about it. Um, okay, so, life update for me. I just wanted to deal with, that was surprising, I wasn’t, I did not think about the tornadoes in Iowa.

Iowa, I’m always trying to drum up more business for Iowa because I’m a big fan of Iowa, but I guess that, I didn’t think that one through. Alright, so, uh, what’s been happening with me recently? Well, we just had our shows in, uh, in Houston. I went home. I grew up outside of Houston at a place called Deer Park, [00:04:00] Texas.

It’s just right next to Pasadena, which you’ve never heard of Pasadena. It’s right next to dozens of oil refineries. That’s the environment that I grew up in. Made lots of good jokes about that, but it was great coming back to the improv in Houston and seeing lots of family and friends. Had a sold out show there and a sold out show in Dallas.

Um, and yes, maybe I did a little, stoke a little bit of rivalry between the two leading up to the shows. But, uh, I mean, as we all know, for a long time, for decades, maybe even centuries, Houston has been, um, so much better than Dallas in, in every possible way. This is, this is a fact. This is not up for debate.

Uh, but I will say that the tide is turning. Dallas is there. It’s, it’s coming up. It began there. I say that for two reasons. Number one, the good people of Addison, Dallas, the DFW area for [00:05:00] this show, they, they came out in costume. A lot of people wear costumes to my, to our shows, to the, to our life and death shows.

It was to another level with you Dallas folks. Like it was unbelievable. I had someone recreate the original. Tabitha microscope. So if you’ve been following me for a long time, if you’re like an OG follower from the videos way back in the beginning, really like one of the first character videos where they were talking to each other was the, uh, it was first day of, of pathology rotation and actually it may not have been then that video when I debuted the pathologist.

Um, microscope, but one of the, the recurring gags with the pathologist character is that, uh, they name their microscope. The microscope just becomes its own character, uh, that I named Tabitha. And initially I [00:06:00] didn’t have an old microscope at home. I do now. So Tabitha has transformed into a real microscope, which is important because the cardboard version of.

Tabitha that I made out of an old Chex cereal box. It, it like broke down. It was, it was falling apart. It was made of that and like toilet paper rolls. And anyway, someone came to the Dallas show and built their own Tabitha using the same materials. I was blown away and, and it, by the way, very well built.

Like I, it wouldn’t shock me if you could actually do some pathology. With this thing, it was, it was impressive, very impressive. I signed it for that person. And, um, uh, and not only that, but there are people who made custom shirts. There was a couple of neurologists that came with a shirt that said they hate us cause they ain’t us along with the, um, like, uh, I, the, [00:07:00] the gold rimmed aviators that I wear with the neurologist character, that kind of stuff.

Like going out of their way to like come in, in, in homemade Glaucomflecken lore gear. Loved it. Absolutely love it. So I, I was a big fan of you guys. If you came to the show, if you’re listening, um, you guys really brought it. And of course there are tons of unicorn headbands, uh, tons of, of, um, uh, of bicycle helmets.

Those are always two really popular, uh, um, really popular costumes. Okay, so not only that, not only the costumes and the wonderful people, but also, um, the What was also really cool was, uh, um, the fact that Dallas now has what I have to assume is the largest eyeball sculpture on earth. If you’ve ever been to Dallas, you Dallas people, you know what I’m talking about, alright?

In the heart of Dallas, in downtown, they have an eyeball [00:08:00] sculpture. It is just a large blue eyeball, like the iris is blue. The eyeball’s a normal color, but it’s enormous, and it’s there, and I’ve seen it, and, um, it’s, it was like a, like a pilgrimage for, uh, me as an ophthalmologist to go see the giant eyeball of Dallas.

And so that alone moved Dallas far up the rankings. It’s challenging Houston. Houston, you gotta pick up your game. That’s all I’m saying. You got it. You got some work to do. Like, give me like a, uh, a, uh, a giant oversized optic nerve or maybe even a cataract. I don’t know. Something got to give me, you got to have something.

Even Vegas has the sphere that can turn into an eyeball or more recently what I’ve seen on social media, they’re doing a special Halloween edition of the Vegas sphere where it turns into hundreds of eyeballs. I love it. Absolutely. I wish I was there. So anyway, [00:09:00] um, had a great time. Loved it. I mean, all, honestly, the crowds at these shows, uh, have been, have been phenomenal, and it’s, the, the, the best decision we ever make was, was trying to, to do this tour, um, and, you know, I’ve, I’ve done a lot of keynotes, and the keynotes are great, going and doing stuff, but Speaking for a conference, but being able to put on a show yourself, that’s your own story, you can creatively do whatever you want with it, because it’s comedy club and anything goes.

Uh, it’s, it’s been a highlight of, of just the Glaucomflecken experience for me, at least. So, um, anyway, we got a couple shows left. We’re going to Denver and Chicago. I think both of those shows are sold out, but we’re, uh, we’re going to be coming back around. We’ll You know, we’re not going to stop. It’s too much fun.

All right, we are going to take a quick break, and then I’ve got some very interesting eyeball stuff for you guys today, so be right [00:10:00] back.

Okay, and we are back. So, Going through the YouTube comments, um, I got some, uh, uh, I’m going to address, there’s one comment in particular that, that triggered a, a, um, uh, that jogged a memory of a, of a disease that actually we see pretty frequently in the eye clinic. So I’m going to talk about that here in a little bit.

But first. You guys really enjoyed hearing me talk about a recent, uh, difficult, complicated surgery that I had. Uh, the surgery, everything went well, but I, I, I discussed, you know, the, the, the extra steps I took to try to do this surgery safely. And, uh, and so, I figured maybe I’ll, I’ll try to do more of that.

Uh, bring up Um, either difficult surgeries that I do as an ophthalmologist, uh, or just difficult patients, uh, in the clinic and, uh, you know, diagnostic challenges, [00:11:00] you know, things I’m not sure about or things I am, you know, my thought process and that’s actually what we’re going to do right now. So, let’s get started.

So, recently I had a, um, a, a, most, a lot of times, honestly, the patients where there’s some diagnostic uncertainty, uh, where, you know, I’m not totally sure what’s going on, but, um, use my, my clinical reasoning that I’ve developed throughout my career to try to come up with the best path forward to figuring out what to do for this patient.

Most of the time, these types of Patient encounters occur in the realm of neuro ophthalmology because neuro ophthalmology is very difficult. There’s a lot of things to consider. So recently I had a patient who came in with um, it was a referral, we had never seen this patient before. She was in her, I think, uh, in her 70s and had a complaint of headaches.

Common, you know, a lot of people [00:12:00] will have a headache and, or have a chronic headache or they’ve been having headaches for weeks or months and they’ll come in to see an eye doctor first because that, you know, they feel like either maybe they’re having some vision changes. It’s just, it’s really common.

for me to be like the first line of defense against headache. Um, even though technically I’m not a headache specialist, honestly a neurologist would know more about different headaches and things than I do, but um, it’s, it does seem easier to get in to see an eye doctor than it is to see a neurologist.

Our appointments last much longer. These are much shorter, usually we can see more patients in a day in clinic and so, um, my wait list is typically a lot less than the neurologists in our community just by the nature of the work we do. Um, but this one actually came from a primary care physician, uh, and they had done some limited workup, uh, surrounding, you know, trying to see if there’s any sinus disease.

That’s a really common problem. [00:13:00] Patients come in, they, they have pain behind their eye. Or pressure behind their eyes very common and it’s often related to sinus disease. Because you have sinuses, your maxillary sinus, your frontal sinus, your sphenoid sinus, your ethmoid sinuses, these are all, they are surrounding and behind your eyeball.

So if you have sinus pressure, a lot of people think that it’s It’s eye pain, it’s eye pressure, something pushing the eye forward, that’s a problem with your eyes. And so they’ll come and see me, often it’s sinus, it has nothing to do with the eyes, the eyes are fine. But this is a patient that was having kind of stabbing, stabbing pains, like in the, kind of the maxilla, like the.

cheek, uh, going to, to behind the eye, over to the ear, uh, sinus, they were treated for sinus disease or evaluated for it and that didn’t seem to be the case, um, and, uh, the patient was also having a little bit, this is the information I got before I even saw the patient, was having some droopiness to the eyelid.[00:14:00] 

So when I have a patient that comes in with some kind of pain in or around the eye and a droopy eyelid, what am I thinking? Before I’m even going in. I try to, you obviously want to keep an open mind, uh, and a, and a wide differential until you actually talk to the patient and examine them and everything, but, um, I’m always, it’s always like, what’s the worst case scenario?

Like what’s the thing that, that in, in that patient, like I want to make sure I don’t miss. The first one would be, um, giant cell arteritis. Because that can be devastating, that can be deadly. Other things that can be deadly would be like a third nerve palsy, especially with a droopy eyelid, that would go along more with a third nerve palsy.

So if you have a third nerve palsy, you have um, ptosis, which is that droopy eyelid on the affected side. Uh, you have often will have, you know, Pupil differences, like what we call anisocoria, where the affected side has a larger pupil. And then double [00:15:00] vision is also really common. Binocular double vision, which is where the patient, both eyes are open, they have double vision.

They’re seeing two images. And um, and sometimes headaches, sometimes not. Yeah, that’s, that’s kind of hit or miss. So, you know, I’m keeping these things in the back of my head when I go and see the patient. And after talking to the patient, you know, I got, you know, all that information I just told you about the headaches.

Uh, there’s no symptoms that would suggest, uh, giant cell arteritis, which would be kind of a temporal headache. The headache was a little bit, was much, much lower on. It wasn’t a temporal headache on the side of, on our side of her head. It was kind of more in the cheek, the facial area. Uh, more behind the eye to the ear.

Also there was no scalp tenderness, there was no jaw pain, so no recent weight or appetite changes, no abnormal fatigue. And so there was nothing that made me think, oh, this might be giant cell arteritis. So I very quickly kind of [00:16:00] ruled that out in terms of a possibility for what was going on with this patient.

Um, and then I, I, I did my exam and the exam was kind of interesting because there was, you know, when you measure. someone’s eyelid position. We check what’s called an MRD, which is a, a mid, Oh man, you know what? I’m, I’m totally blanking on what MRD stands for. That’s embarrassing! Okay, I know what it is though, um, so the way, the way we do, the way we check eyelid position to check for ptosis or droopy eyelid is I shine a bright, a pinpoint light source right in front of the patient.

I have them look right at the light and I look at where the reflection is in their pupil and what we’re doing is we’re measuring that reflection to the upper, to the margin of the upper eyelid. So from the reflection To the margin of the upper eyelid, that’s the [00:17:00] MRD. And it should be about the same on both sides unless there’s ptosis or some abnormality or retraction of the eyelid.

Well, this patient is also in her 80s and so A lot of times there is age related ptosis, and she had some of that as well, but when I did measure the eyelid position, it was 2mm on the right. I would say normal is above 2, so she had some ptosis already, but the left eye, and what I’m really looking for is a difference between the two, the left eye, which was the side where the headache was, where the symptoms were, was 1.

5. Not a big difference, but it was there. It was real. A lot of times when people are noticing a drupia that I also try to look at old photos. I’ll take a look at their, their, you know, driver’s license or, or, um, you know, other photos to see, okay, is this a new ptosis? Now, whenever it’s, it’s a 0. 5 millimeter difference like this patient, hard [00:18:00] to really see.

Tell, just based on photo, that’s such a small amount, you really got to be in person looking at them to be able to tell. So I was like, okay, yep, little bit of ptosis on that side, so I’m still, third nerve palsy still rattled around my brain. So I look at the pupils, that’s the next thing, always very important.

When I saw this patient was coming in, I told my technicians, don’t dilate this patient. Let me look before we dilate because I have to be able to get an accurate pupil exam. And so what am I looking for? Well, if it’s a third nerve palsy on that affected side, I’m looking for a pupil that’s larger on that side than the other.

Well, the problem with that is that about 20 percent of people have just what we call physiologic anisocoria. They normally, they just naturally have a different, slight difference in pupil size and it’s always a small difference. And so when I looked at this patient’s pupil, sure enough, the left pupil was a little bit larger than the right.

And so I measured it. So we have pupil measuring [00:19:00] devices. It’s just a little card. And so you measure when the lights are all off. You shine just a really dim light and see when it’s as dark as possible, what are the pupil sizes. And then, I also measure the pupil sizes on both eyes with really bright light.

I shine a bright, bright light, patients love it by the way, bright light right in front of the patient’s face. Get those pupils as small as possible and then I’ll measure them. If it’s physiologic anisocoria, alright, the pupil difference should not only be a small amount, but it should be even. Equal, the difference should be equal in both dim light and bright light.

That’s normal. And that’s what the patient had. If it was a third nerve palsy, what I would expect would be that in bright light, that affected pupil would be normal. It doesn’t constrict [00:20:00] as much as the normal side. It stays dilated. Kind of more of a fixed dilated pupil if there was sign of a third nerve palsy.

If the parasympathetic nervous system was being affected by an aneurysm or whatever was causing this third nerve palsy, then the parasympathetics wouldn’t work. And what parasympathetics do is they constrict the pupil. And so you’re gonna see a bigger difference When the pupil, when you’re, when you’re in a bright light, you know, conditions, so that’s why we check in bright light and in dim light.

And checking in both eyes, you know, there was a one millimeter difference in pupil size for this patient’s pupils, and that was consistent in dim light. And when I shine a really bright light in her eyes. So I’m still, I’m less convinced now, I’ve never, I was never convinced that there was a third nerve palsy, but I’m even less convinced now.

My pre test probability [00:21:00] is that this is a third nerve palsy is steadily declining, which is great. No one wants to have a third nerve palsy. And the third big element of a third nerve palsy, double vision. Is there any double vision? So I do cross cover, cover uncover testing, distance and near, do head tilt, head turn, just trying to find any sign of any double vision, any diplopia.

She’s not having any double vision. I’m not seeing any misalignment to the eyes. So basically, after all of that, what I’ve discovered is that there is slight ptosis on the affected side. That might, it’s most likely age related, it’s very subtle ptosis. There’s physiologic anisocoria, not what you would expect with a third nerve palsy.

There is no diplopia. So, I really have no reason to think this patient has a third nerve palsy. And the optic nerve is normal, [00:22:00] otherwise exam was totally normal. So the big question, do you do neuroimaging in a situation like this? I really have no reason to do neuroimaging for this patient. So what I’m going to do is see her back pretty soon.

So she’s going to come back and see me in like a month. And we’ll see if there’s, I have all these measurements, I’m going to see if it’s any worse. And in the meantime, uh, uh, this is someone that I think could have like a trigeminal neuralgia. Um, and so we’re going to set her up with a neurology appointment as soon as we can.

They’re much better at treating headache conditions than I am. Because from my perspective as an ophthalmologist, the eyes, The eyes are great. The eyes are perfect. She was 20, 20, great. She just had these, this thing, none of these things are new. She had never noticed that her pupils were different sizes.

Uh, she’d, she’d noticed droopy eyelids for quite some time. Um, and so I’m just going to follow her a little bit more closely, and then if I see any worsening of any of these [00:23:00] things, Then we can pull the trigger on doing neuroimaging, but um, and so, and sometimes that’s, that’s, you know, I, I am, I’m confident in what I know and, and the testing that I did to be able to say that this patient does not have like a life threatening problem going on with her eyes.

Um, but to put her at ease, to put myself at ease, I’m going to follow a little bit more closely. We’ll check again. So, anyway, that was my reasoning for this and that’s a, those are, those are, those are always just challenging because the neur, the neurologic system is so complicated and um, uh, you know, sometimes for these I’ll also go and talk with some of my partners and be like, hey, can you take a look or let me run this by you, let me know what you think of my reasoning and um, and so, uh, I don’t know, it’s just, it’s kind of interesting.

I kind of like it when, when patients like this come in just because it, it. It’s just different than my usual, like, you know, diabetic exams and [00:24:00] cataract evaluations. It’s just, it allows me to. Uh, use some of the other tools and, and knowledge that I’ve gained over the years. And just the, the drawing on my experience of, of just seeing a lot of patients like this and, and, you know, I’ve seen a lot of third nerve palsy, so I know what they look like and that’s, that’s so important in all of medicine to be able to do like this.

Pattern recognition, but even more so in ophthalmology, because everything is so visual, so to speak, right? I mean, it’s a visual specialty. It’s eyes, but we can, most things we diagnose, we can physically see. We can see the things. Now, not so much with neuro ophthalmology type stuff, but the signs on exam are readily apparent, and I’ve seen a number of third nerve palsies.

I know what they look like. I know what to look for, and so I’m, I was drawing on That experience to inform my opinion on how likely it is that this patient has [00:25:00] something like a third nerve palsy. So anyway, I don’t think these headaches are anything, anything to do with the visual system whatsoever. What could be causing it?

I’m not sure. You know, the pain’s going into the ear. And so, you know, potentially down the road, maybe an ear, you know, an otolaryngologist might weigh in, um, or neurologist and I don’t know, we’ll see. So, um, that was a fun one. Alright, let’s take one more break.

Alright, here we go. I got one more eyeball thing for you. Let’s see. Uh, okay. This is from a, so this is based on a comment here on, um, on YouTube. So by the way, go and check out our video episodes of our podcast, both Knock Knock High and Knock Knock High. You can find them on at Glaucomfleckens, the YouTube channel.

Alright, I read all those comments. I love it. I love the knock knock, the knock knock eye in [00:26:00] particular comments because you guys give me good suggestions on things to, um, to talk about. So I really do appreciate that. Uh, somebody asked, here’s a fun one, at Nikki White 476 says, I have a very important question.

Is that a Jonathan on a stick behind you? It’s gone now. You don’t see it in this one. In fact, I left a mess. I just threw my jacket back there. But yes, I do have Jonathan on a stick. I have several of them because I went to an event once and someone made a bunch of Jonathans on a stick and I was like, can I have those?

Because I could make use of that. And she gave me some Jonathans on a stick. I have like five or six Jonathans on a stick. So yes, occasionally if I, if I have, have everything together, If, if I have the wherewithal to think about it, I will put random stuff behind me during these recordings, uh, for all of you who like to watch on YouTube.

So yes. Alright, here we go. This is a comment from at Dan Evan or [00:27:00] Dane Vaughn, maybe Dane Vaughn 91 said, curious if there are any eye color specific diseases. That is a great question. And so I, I interpret that question to be like. If you have this color eye, does that, could you might, could you get a disease just based on the fact that you have that eye color, as opposed to diseases that are more likely to occur in patients with certain eye colors.

So, So, like, um, let me think, like blue eyes, you know, light colored eyes can carry, you know, an increased risk of, of certain diseases. You have more light that comes into the eye, so, you know, potentially things like, um, you know, macular degeneration or cataract formation, uh, just because you have more ability for, for light to penetrate into the eye.

Because with a blue iris, you don’t have as much pigment that [00:28:00] can absorb the light coming in. Now this is, none of this is like a major issue, honestly. Like it’s great, no matter what color eye you have. But there is one disease, specifically, that occurs. Almost exclusively, in fact I’ve never seen in any other color eye, brown eyed people like myself.

And that is a disease called Pigmentary Glaucoma. So, what happens here is those of us who have really dark colored irises, so we have a lot of pigment in the iris, that’s what gives it that brown color. We’re just loaded with pigment. Our blue eyed friends, we’re They don’t have as much pigment. Alright, so you get a reflection off the end, you just have more of a blue color.

So the more pigment you have in your iris, the darker your eyes will be. Well, there is a disease called [00:29:00] pigmentary glaucoma, where you have that pigment that’s supposed to be just sitting in your iris, gets released in the eye and starts to clog up the drainage system in your eye, the trabecular meshwork, and if you plug, if you plug the drain Fluid’s gonna build up, pressure’s gonna rise, you’re gonna end up with glaucoma.

So the pathophysiology, physiologically what happens here, this is very common, this is a common disease, the demographic is typically. Young adult men who are myopic, like a minus one, minus two, and what will happen is if you have a particular anatomic setup inside your eye, your lens, which again sits behind the iris, the lens sits behind the iris.

Your lens can rub up [00:30:00] against the back of the iris where all that pigment is. It kind of chafes that pigment off of the iris. And what typically does it is because the lens has movement to it, right? When you’re accommodating, that’s why it’s young people, because you can accommodate. You can, you can contract your ciliary muscles inside the eye that causes the lens to change shape because the ciliary muscle has zonules, these little strings that are attached to it.

And those zonules Those are attached to the lens and so the ciliary muscle contracts, either releases or puts tension on those strings, those zonules, which in turn changes the shape of the lens, allowing you to see further away or further up close. Accommodation, you’re moving your focal point back and forth.

Young people do this all the time, people who are in their late 40s, 50s and beyond. You can’t do that as much, so we don’t see this [00:31:00] disease as often. Young people can do it a lot. So, as with that movement though, if, if your lens is naturally kind of, it’s always really close to the iris, but if it’s close enough, it can chafe.

That movement chafes the pigment off of your iris. And that pigment gets released, and then we see this actually a lot, the classic example of, of, So, the idea of, of how this presents is patients who have an episode of blurry vision shortly after vigorous exercise. So, you’re exercising, you’re running, you’re doing stairs, whatever it is, sprinting, and then all of a sudden, you, you afterwards, you get a little bit blurry.

Sometimes you have some pain, but you get blurry. And then when you come in for an exam, what we will see is we can actually look in your eye with a slit lamp and we just see all this pigment floating around. Inside the eye. And then we take what’s called a gonioscopy lens, which is a special lens that we [00:32:00] put on the eye that allows us to actually visualize the trabecular meshwork, the angle of your eye.

You can’t see that with the naked eye. It’s kind of in the corner. You can’t just, the laws of physics and optics prevent you from being able to look into that part of the eye. So we use a lens that will Bend the light using mirrors to allow us to see into that angle and we will see tons of pigment filling up that space and if there’s enough pigment, it just blocks the egress of aqueous fluid out of the eye, plugs the drain, pressure goes up and it can be 40, 50, it can be a lot and it’s episodic, right?

Because you get these attacks of, of, of pigment. That occur intermittently, often with exercise, and so, and eventually, you know, you can start losing vision because the optic nerve does not like high pressure. So it’s called pigmentary glaucoma, and [00:33:00] the way you treat it, you can treat it just like you would any glaucoma.

Remember, the whole point of glaucoma is, uh, the beauty of treating glaucoma is you have one goal. Decrease the pressure, that’s it, and there are a thousand ways to do it, so you start with the drops, there’s a treatment called Selective Laser Trabeculoplasty, um, Marginal Reflex Distance, that’s what it is, Marginal Reflex Distance.

I just went back 20 minutes. Marginal MRD, the reflection to the margin of the eyelid, duh, MRD, Marginal Reflex Distance. Anyway, I was talking about Selective Laser Trabeculoplasty, SLT, which is um, Um, if you have a lot of pigment, that’s, it, uh, it takes up laser burns really well. And so it can actually, that treatment can be really good for pigmentary glaucoma, [00:34:00] uh, using the laser.

We can just shoot the, the trabecular meshwork and then it just opens up more space in the drainage channels. Allowing more egress of fluid out of the eye. So anyway, that, uh, that is the eye color specific disease that I had in mind. I bet I could think of some more, so I’ll, I’ll, I’ll do a little brainstorm and, and, or if you guys, uh, uh, if I missed any, I missed any, I just, I’ll only give you one.

So hopefully, uh, you can come up with some more that I’m just not thinking of right now. Um, But that was a good one. Thank you for that. Uh, and I think that’s that. Yeah, let’s let’s call it a day. I think that’s good. I got to go back to work. So hopefully, you know, we’ll see. I love the idea of doing these kind of hard cases.

I think those are fun to talk through. Uh, and, um, and so. Let me know though, if you have any other suggestions, any other topics, you can email me knockknockhigh at human content. com. Leave a comment on, uh, these, [00:35:00] uh, our, um, our YouTube videos of the podcast at Glaucomflecken. That’s the YouTube handle. Thank you all for listening.

I’m your host, Will Flannery, also known as Dr. Glaucomflecken. Thanks to our producers, Aaron Korney, Rob Goldman, and Shahnti Brooke. Editor engineer Jason Portizo. Our music is by Omer Binzvi. Knock Knock High is a human content production. Thank you all. We’ll see you next time.

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