Knock Knock Eye: How Hurricane Helene Caused A Nationwide IV Fluid Shortage

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Hello everybody. Welcome to knock, knock. I with me, your host, Aaron Reuben. Dr. Glockenflecken, your one stop shop for all things eyeballs. Why would you go anywhere else for eyeball related things? [00:01:00] This is it. This is the only place you need to be. And, uh, it’s, I’m recording this, uh, late at night as I usually do.

Hope you had a wonderful day. And, um, uh, and now I’m ready. All my. My parental duties are complete. Um, I, and my, my, whatever, I’m ready. I’m ready for this. I’m ready to talk. I’ve got some topics I want to discuss. Um, first I’ll just, I’ll tell you a little bit about, about my day today. So as usual on, on Wednesdays, I have surgery and so I was operating, I did 11 cases this morning.

And, um, and I, I had one of those cases. That one of those surgeries, uh, that you leave just feeling like you operated at the peak of your powers. Like I came out of this surgery, [00:02:00] this particular surgery, like I am a good surgeon, like I did that and I did that well. And, uh, I was, I was just like very proud of myself.

And I think it’s, it’s okay to like, Like acknowledge that, I think it’s good to acknowledge that because also there’s going to be some surgeries that you’re going to have in your career that don’t go well and you kind of feel like you’re terrible, even though you’re not, but you feel that way. Well, it’s, let’s acknowledge the surgeries where you come out of like a, damn, I just, I was on one there.

I just, I, I crushed that surgery. And so anyway, uh, this surgery, I’ll just tell you about it because it’s, it ended up, this patient’s going to see so well, it’s going to be amazing. This is a patient who was older in their, I think he was in his 80s, and he had a cataract that was pretty dense. So here’s the deal with cataracts.

It’s It’s always better to do cataract [00:03:00] surgery sooner than later, because throughout your life, the lens inside the eye that develops a cataract, you know, when you’re born and when you’re, you know, until you turn about 60, your lens is generally quite soft. It’s just clear. It’s perfectly translucent. You can see it on the exam, but it’s, it’s, it’s all the light just comes right through the lens because it’s young and it’s, it’s a healthy lens and it’s completely clear and, and, and so, so it’s a, so if you were to operate on a, on a cataract like that on a young person, say, because sometimes we do have to do cataract surgery because there’s certain types of cataracts that can occur in young people.

Um, but. Every time you operate on a cataract in someone who’s like, I’d say, under the age of like 40, the lens is always very soft. And that’s because it’s just a young lens. Yeah, it can have cortical spoking, it can [00:04:00] have a posterior subcapsular cataract, a certain cataract that does affect just a small part of the eye.

Lens, but that’s enough to cause lots of vision problems, as opposed to like an age related cataract, which you would normally get and the vast majority of people get later in life after the age of 60, um, where the lens just gets darker and cloudier. That’s called nuclear sclerosis. The center of that cataract is just getting tougher and denser and darker.

Later on exam, when I look at that cataract, when I look at that lens. It’s going to look yellow, uh, and eventually it gets into like a deep, darker yellow, and then brown, and then eventually black. And so, once that cataract starts to affect someone’s vision, we want to get it out. Because why do you keep it around?

Like, it’s, it’s just causing problems. And when you have [00:05:00] cataract surgery earlier, when the lens is a little bit softer, when it’s not as dense and hard, It’s easier to remove. So that’s what I tell patients. I was like, you know, if you’re having problems with your vision and, and, and your, your, in your numbers on your exam, it’s clearly starting to affect you.

Get the surgery done because the longer you wait, the more dense that cataract gets, the more difficult it is to remove. And also you’re older. You never know how healthy you’re going to be as you get older. And so it’s always easier to have something like cataract surgery. Okay. It’s always easier on your body, easier on you, whenever you, whenever you’re younger and healthier.

So anyway, I had a patient who had a vitrectomy, which is a surgery that, uh, where you remove the, Vitreous jelly in the back of the eye and you have to do that for a variety of reasons in this case is because this patient had a [00:06:00] retinal detachment and so, um, uh, they had to remove the jelly in the back of the eye and then do other fancy things to reattach the retina.

Very cool surgery. Well, one thing that happens when you have that type of surgery, when you have a vitrectomy, is that it causes your cataract to progress faster. And so someone who might not, like if you take someone who’s, we’ll say 70 years old, and they had one eye that had a vitrectomy, the other eye did not have any prior surgery.

And from the point of their vitrectomy, you go forward like two years in time, that vitrectomy, the cataract in the eye that had the vitrectomy is going to be like twice as bad. Dense, twice as bad, the vision will be worse, versus the other eye that didn’t have a vitrectomy, the cataract will just be progressing at a normal rate.

So anyway, the cataracts progress very fast after a vitrectomy. And typically, after a vitrectomy, we [00:07:00] want to do cataract surgery like within a year. maybe two years at most. Often it’s like within six months that cataract is starting to cause problems. Well, this patient, for a variety of reasons, just didn’t have cataract surgery for 15 years.

15 years after vitrectomy. This patient shows up, needs cataract surgery, and you can guess, yeah, this lens was dense. It was deep, dark brown, almost black, um, uh, just very, just very hard lens. And, uh, and so of course, I mean, the vision was terrible. And so, everything in the eye, the rest of the eye exam, Perfectly fine.

And so I was like, if I can get this cataract out, this patient’s going to see so much better out of this eye. And so on the one hand, I’m like excited for the patient. I’m talking like my, my mental, uh, [00:08:00] what I’m thinking about, like, as I get closer to doing the surgery, I’m thinking like this is going to love this.

It’s going to see so much better. But on the other hand, I’m like. Oh, this is going to be a hard, a very difficult surgery. And when I say difficult, the way we do cataract surgery, and I’ve talked about this before, and I think I did a prior episode on cataract surgery, is that all the cataract surgery typically is done through a very tiny incision, about two and a half millimeter incision.

And you go in with instruments through these tiny incisions and you break up the cataract into five, six, seven different pieces. You chop it up, Essentially like a piece of pie, like a, like a pie into different pieces. And, uh, and then you break up the, and then you continue to break it up and eventually pull it out through a vacuum, all through this little tiny instrument that gets inserted into the eye through a two and a half millimeter incision.[00:09:00] 

And so that requires you to be able to break up this cataract. You got to be able to break it into different pieces. And if the lens is very dense, like someone who’s had a vitrectomy 15 years ago. It makes it for a very difficult surgery. And so I sit down, I know this surgery is going to be a little bit tougher.

So I just sit down to do it. Everything’s going okay. Um, I, I get the capsularexus done, which is basically just opening up the lens and do a little hydro dissection, just loosening it up so I can maneuver around and, and move the lens around and, and, and take out the pieces. Uh, and then I, I start to do what we call faecal emulsification, where the act of kind of breaking apart.

The lens, very leathery lens, very difficult, taking a lot of energy, a lot of work, a lot of, a lot of sculpting, what we call sculpting the lens. Basically just trying to, to, [00:10:00] to, to, to dig into the lens to be able to break it up in different pieces. Having a lot of difficulty, but also I’m noticing that the lens itself is very loose in the eye.

So the lens, your natural lens is suspended in the middle of the eye by these, these little, these little strings that are called zonules. It’s called the zonular apparatus. Hundreds of little strings that hold your lens in the middle of your eye. And there’s lots of different reasons why. You can lose those strings over time that cause the lens to be unstable.

There’s certain diseases like, uh, pseudo exfoliation. Uh, there’s, um, uh, just trauma. Uh, if you get hit hard enough in the eye, it’s going to break those strings and cause the eye to be a little bit loose. And in this case, if you have a prior eye surgery, that can [00:11:00] cause loss of those zonules. And I think that’s what happened in this case.

Sometimes just doing in the middle of a surgery, if you didn’t do the wrong thing, you put a little too much pressure on those zonules, the patient’s a little bit older, you can also break them yourself, which is something I’ve done. But I think in this case, it was probably the fact that the patient was a little bit older, in his 80s, had had a prior surgery, that the lens was loose.

So I’m in a tough situation now because, um, the, the cataract is very dense. But also the cataract itself in the eye is unstable and you really need that stability, especially if you’re trying to take out a dense lens. So I’m kind of like, my stomach’s kind of dropping a little bit. I’m like, Ooh, this is, this is going to be tough.

Um, so I use these special hooks that we have, these capsule hooks. I put them into the eye to pull apart the, the, the capsule and keep it stable. So I was able to keep the lens. I was able [00:12:00] to basically establish stability to the cataract and then just painstakingly eventually was able to break this lens into a bunch of different pieces, pull them out with a vacuum.

And by the way, halfway through the pupil started to come down. You need a nice dilated pupil. So I had to do a late. Malyugan ring to a pupil expanding device to keep the pupil open, uh, and which was challenging because you’re supposed to do that earlier in the case, but I did not. I thought it would stay open, but it did not.

It came down and then, um, eventually got the cataract out, put the new lens in, removed all the devices I was using and didn’t have to suture the, the, the incision. It sealed it up nicely. It was like a 40 minute case, which might not sound like a long case. That is an eternity to be doing cataract surgery and you can feel it in your body.

Like I, because the, the, the stress is a little bit higher when you’re doing a surgery [00:13:00] like that. I mean, I was focused, but, um, that’s the type of case that makes you like at the end of the surgery day, you just want to use like your, the adrenaline kind of wears off and you just want to take a nap, which is exactly what I did today.

I came home at my lunch break. Fortunately, I didn’t have any meetings, didn’t have to do any glock and fleck and stuff, uh, and I was able to get like a 45 minute nap, which was glorious. It was a wonderful thing. But I just, I left that surgery. Thinking this patient’s going to do great. The vision, it’s not going to be very good at first, but when you have a severe cataract like this, um, uh, there’s lots of swelling in the eye afterwards.

So it’s going to take about a week for this patient’s vision to really look a lot better. But he’s going to get there. And, uh, and I just, I used a lot of just the, the, the expertise I’ve developed, the skills I’ve developed over the years, [00:14:00] um, the wisdom I’ve acquired in doing a lot of different cataracts that are very similar to this to be able to do what I think was as good of a surgery as I possibly could have done.

And I just, I just love it. Very proud of myself. So I wanted to share all of that with you. All right, let’s take a break and then we’ll get into some other stuff

All right. I am done patting myself on the back for today, but let’s there’s a couple of Recent events. I would love to explore with you all the first is the IV fluid shortage So I don’t know if you guys have heard about this. I mean, those of you who are in healthcare definitely know about it because this is affecting just everybody.

So Hurricane Helene, uh, took out in North Carolina, took out a factory that I guess, I didn’t even know this, produces the [00:15:00] vast majority of the IV fluids in this country. And, and that’s a bad thing because we use a lot of IV fluids in health care and, uh, and so I’ve been getting emails from our local hospitals out here in Portland.

They’re, they’re, they’re saying, uh, they’re having to, to postpone or encourage people to not schedule, um, elective surgeries to conserve IV fluids for patients that really need them. for emergency surgeries for, uh, for patients up in the ICU or just, just, you know, resuscitations. Um, and fortunately this doesn’t really affect ophthalmology because we don’t give IV fluids for our surgeries.

Um, if I have to give any IV fluids during surgery, like something has gone horribly wrong. Uh, and so that it doesn’t really bother us too much, but I feel for all my [00:16:00] colleagues and, um, and I’ve been hearing about it on social media. And the one thing is, this, this seems like poor planning, doesn’t it? Like what, why, why would we have one facility producing like upwards of 90 percent of our IV fluids in this country?

That doesn’t seem like good planning. A factory on the coast, by the way. Like, things happen on the coast, on the east coast you get the hurricanes, on the west coast you have earthquakes, tidal wave potential, I, I don’t know, like, put it in the middle of Iowa. Like, Polar Vortex isn’t gonna take out the IV fluid factory in Iowa, they know how to do factories in Iowa.

I don’t know. How about just having more than one? This is, it seems, it seems crazy to me. Like, what are we doing? Is our like, [00:17:00] like, infrastructure just so bad in this country that, that we could just have a hurricane that just totally takes out the ability to function normally at every hospital around the entire country?

That should never happen. So anyway. It’s been a hot topic in healthcare. So if you are a patient, if you’re just hearing about this for the first time, like you might have to be a bit patient as a patient, uh, when it comes to any kind of elective procedures or just hospitalizations in general, just, just realize that that’s happening right now.

And, uh, this, the episode should come out. I’m sure it’s still going to be an issue, but anyway, that’s what we’re dealing with. Ever since Hurricane Helene, uh, took out all the IV fluids. It’s not funny, but it’s just more like, like shock, exasperation. Like, like [00:18:00] we clearly don’t know what we’re doing here.

Um, but one thing that, that I got some content out of it, I’m getting content out of it right now, but I did make a video that was inspired by this. There’s this surgeon, this cardiothoracic surgeon on Twitter. that I’ve had some run ins with. We’ve emailed back and forth, not exactly like fun, happy emails, but, uh, I don’t know, we just, we don’t see eye to eye on a lot of things.

I’ll say that, but he had this tweet, um, basically saying, complaining about the IV fluid shortage, but in the context of why are we able to Uh, you know, do Botox, but, uh, I can’t do elective cardiac surgery. Basically like making it more about him. Versus like everyone else [00:19:00] and it just came off as like a bit of a selfish type thing.

I don’t know. Cardiac, cardiac thoracic surgeon, it happens. But anyway, um, it inspired me to make a video. So if you go to my other YouTube channel, if you’re watching this on YouTube, um, or just any of my social media platforms, you can see it. The great IV fluid shortage where I had all the surgeons in the hospital, except for ophthalmology, uh, uh, reacting to the fact that they would have their surgeries canceled.

Because of the IV fluid shortage. So I had a lot of fun making that one. I think it went over some people’s heads. People, some people just didn’t, weren’t really aware of what’s going on there. But I, generally I make, I make the content for other physicians. I. Have you realized that you probably have? Um, uh, it’s, that’s like in my, because that’s how I think.

And so when I’m making videos and I make a writing skits, I’m writing from the perspective of a [00:20:00] physician really what I think is gonna be funny for other physicians. It’s just fortunate that other people that are not a physicians also find it funny. I’m very fortunate for that. And, and I, I thank you all for sticking with my content, even if you’re not a physician, because it, I guess it does relate.

Or other people can relate to it. You don’t have to have gone to med school, but maybe this, some of the videos do, I think, really do go over people’s heads. But anyway, I really enjoyed that one. And, and so hopefully my cardiothoracic surgeon friend on the internet, um, adversary, whatever you want to call him, uh, saw it too.

Uh, so IV fluid shortage. The other thing, here’s the, here’s another thing that’s, uh, come up recently. I was sent an article by one of my partners. Um, I would say I should just have a segment that’s called surgeons behaving badly because, you know, we did a couple episodes. I’ve talked about, [00:21:00] um, the, uh, what was it?

The, the surgeon that accidentally. Accidentally, we, we don’t know the whole story, but took out a, a liver when he was supposed to take out a spleen. Um, and so I got a, a met, so here’s the story. Uh, a surgeon at a, um, NHS hospital in the uk, which is, it’s a university hospital’s Sussex. So this, uh, it’s described as a crisis hit.

NHS hospital. So I guess they’re, they’re having a tough time. Um, this surgeon could not find, because he had to do an emergency surgery in some setting, could not find a scalpel. And, uh, which is like the first red flag, like, that’s weird. Like, unless you’re just so strapped for supplies that you can’t find a, like a sterile knife, [00:22:00] like those things are everywhere.

Like, I know, like, I mean, I mean, we had a, an IV fluid shortage. So you never say never, but man, like there’s no shortage of sharp things in a hospital that you can use to cut things with. So anyway. This surgeon, apparently, couldn’t find a sterile knife and so decided to use his Swiss Army Pen Knife. His own personal Swiss Army Knife that apparently he uses to cut up fruit for his lunch.

He decided to use this to open up the chest of a patient. Again, because he claimed he could not find a sterile scalpel. They interviewed this expert witness, Professor Graham Hauston, who’s a witness on clinical negligence and a former [00:23:00] consultant surgeon, which is like an attending surgeon, said, uh, it surprises me and appalls me.

Firstly, a penknife is not sterile. Correct. Yes, that’s correct. Secondly, it is not an operating instrument. And thirdly, Uh, all the, the, the kit, the surgical kit should have had one in there. I agree. Like it’s, it’s, something’s not adding up here. And then when you look into it, this surgeon has had other issues at their place of work.

So is that some, some bad outcomes? Uh, you know, just have some review type things going on. There’s a bad culture at that clinic, at that, uh, in that surgery department. So anyway, they’re, they’re doing like a, an investigation into this surgeon to make sure like, but then, I mean, come on, like I would, I’m trying to put myself in that position, like.

I would not even cross my mind that, like, I can’t [00:24:00] immediately find a scalpel, like, I have someone go and find me one, if I can’t find one myself. Like this, in that hot, there’s, there’s going to be something sharp. That’s sterile that you can use to make an incision with. I would never think, God, I will just pull out my keys, open up my Swiss army knife and get busy.

Like, I, I just, I don’t know. I don’t know. I don’t know the thought process here. I mean, again, I don’t know the details of the case. I really think there’s time though. I mean, to just find a scalpel, like how long did he wait? Who knows? Anyway, not a great decision by the surgeon. The patient survived though, so I don’t know what they had done or what the, what the surgeon, what the, uh, the procedure was.

I mean, the patient’s alive, but obviously, um, that, and, and the, the, the risk, by the way, if, if you’re not sure what the big deal [00:25:00] is, uh, it’s gotta be sterile. If you make an incision with something that’s not sterile, like your own Swiss Army knife, that you cut your lunch with, um, is very, very, very high risk of introducing some kind of infection.

And if you’re doing a, certainly an operation on the chest, it sounds like. I’m not a, a chest surgeon. In fact, I make the chest surgeons mad at me apparently. Uh, but that’s not a place you want an infection, I assume. So anyway. At least this surgeon was not in Florida like the last one was. So, a surgeon’s behaving badly.

Don’t do that. Surgery tip of the week. Don’t use your own Swiss army knife to make an incision on a patient. Should be self explanatory, but you never know. All right, let’s take one more break.[00:26:00] 

All right. I got a little bit more ophthalmology stuff for you guys. Uh, you got a little bit, I wasn’t planning on going into such, um, depth and in depth discussion on my case earlier, but you got some ophthalmology there. Some of you might’ve gotten your Fix with the, um, the talk about, I try not to throw too many, the very ophthalmology specific words, but maybe you like that.

Maybe it’s like, it’s like white noise. You know, if I say enough about, uh, capsulorhexis, hydrodissection, hydrodelineation, uh, nucleus disassembly, uh, faecal emulsification, and, uh, what else we got? And, uh, irrigation aspiration. Lens insertion. If I use all these, all these, uh, all these things, uh, let’s see what else we got.

Uh, the keratome. Maybe, maybe, maybe it just, maybe it’s soothing. Do you find all these [00:27:00] ophthalmology terms soothing? Let me know. Maybe I’ll do a part of this podcast every week where I just, I just say ophthalmology terms. I don’t know. I could define them. Maybe not. Maybe just say You guys can research them yourself.

No, don’t do that. You got better things to do with your time. Okay. So what I thought I’d do today is, uh, you know, I had a rousing, uh, I’ve talked about the clinic day or sorry, the surgery day, but in the afternoon I had clinic. It was a rousing clinic. I got what I, what I decided to do today in preparation for this podcast is keep track of all the questions that patients ask me.

Uh, and looking at the list of questions, like that’s it. It was kind of fun, like, to look and see, okay, what are people who come in to see me for an eye appointment? What are they interested in? Um, a lot of this, a lot of the same questions like kept coming up, uh, but, um, one thing I, I, I always [00:28:00] do for every clinic encounter.

I just, I ask patients, you know, what questions do you have for me? That’s how I frame it. What questions do you have? Because they have questions. I don’t ask, do you have any questions? It’s like, I know you got the questions. What are they? Give them to me. Let’s talk eyeballs. So, um, so one thing I do see on surgery days, I see a lot of post ops.

So I do get some questions about people who have had eye surgery. One of the more interesting questions I get is, can I, when can I fly? People are always concerned after a surgery that they’re, when they’re allowed to travel. And with cataract surgery, You can travel. I tell people that once you get past like post op day three to four, maybe post op day five, you’re outside of the, the generally accepted Infection time frame.

Uh, and so I’m okay with people flying with people traveling, [00:29:00] uh, you know, after about five days. And if, and that’s like not a hard, hard and fast rule. If, if, if, if people have somewhere they gotta be, if they gotta travel, they gotta go to a wedding, whatever, then do it, you know, you’re going to be fine.

There are certain situations though, um, where. It’s not okay to fly until you explicitly are given permission by your surgeon. And this, uh, is a situation when you have air bubbles inside the eye. So there are some, some surgeries. Uh, where we have to put gas, a gas bubble in the eye, um, uh, so one example would be corneal transplants.

So when we treat things like Fuchs dystrophy, which is, uh, where you have breakdown of the inside layer of the cornea. We strip the diseased. layer, the decimase membrane. We strip it, [00:30:00] pull it out, and we put the, the, the, um, and then we, we put the, uh, the graft, cadaver graft of that cell layer, very tiny, very thin.

We put that in the eye. Well, we have to push it up against the, the inside of the cornea to get it in place. And we do that using a gas bubble. SF6, so, which is Sulf, Sulfur, Sulfur Fluoride 6, I don’t, I don’t do that, I just call it SF6, so what’s the, God, that’s going to bother me, what is SF6, SF6, SF6 compound name.

Sulfur hexafluoride. God, my chemistry teacher would not be happy with me right now. Sulfur hexafluoride. So SF6, um, it’s a gas bubble that, uh, it does expand a little bit, but you have to do the right concentration of gas, um, so that it doesn’t expand [00:31:00] too much. Well, if you go on a plane. If you’re at 30, 000 feet, that gas bubble, just like when you get a bag of chips on a plane or a water bottle, it’s going to start blowing up.

It’s going to start expanding. Well, same thing will happen to that gas bubble inside your eye. It’ll start to expand. And, uh, And that, this, that is not what you want, uh, because you can imagine you have this gas inside the eye that’s getting bigger. It’s going to cause a tremendous amount of pain. It’s going to increase the eye pressure to a dangerous level.

And if you’re up there for, on a plane for two hours with an, I mean, first of all, you’re, uh, someone’s going to call a doctor because you’re going to, you’re going to, you’re going to be throwing up severe 10 pain. Like this is bad, bad eye pain. You’re going to be probably nauseous, maybe throwing [00:32:00] up. Uh, you’re going to get the attention of a flight attendant.

They’re going to call, uh, is there anybody, uh, uh, is there a doctor on the plane? And, um, and. Then they’re gonna, whatever that doctor is, let’s say it’s like internal medicine, emergency medicine, radiologist, neurosurgeon, I don’t know, whatever. Anybody but an ophthalmologist, um, the flat ten is gonna be like, this is a patient with severe eye pain, and that person’s gonna go, Dammit, because generally they don’t know anything about the eyes.

Okay, emergency medicine, they do know some things, but also, what are we going to do? Really, because what needs to happen, if you have an expanding gas bubble in the eye, you need to actually release. Some of that gas. And so, um, uh, if I was on a plane, I would get in and I was in that situation, patient said, Oh, I had a corneal transplant surgery, uh, two days ago, and now I’m having all this pain.

Then, uh, one thing I could do on [00:33:00] that plane is take a sterile instrument. It’s gotta be kind of sharp, gotta be kind of pointy. And I would actually. try to release some of that gas from inside the eye. And that’s something that can be done on a plane. Um, and if that works, then maybe we don’t have to divert the plane, but, uh, chances are you’re not going to see an ophthalmologist that, that on the plane, we are very elusive bunch and you would need to, you know, get diverted.

So just generally, just here’s the thing, just don’t, Like, listen to your doctors, like, don’t jump on a plane when you have a gas bubble in your eye. You gotta wait until it’s okay, usually it takes about a week, maybe two weeks, uh, for that gas to totally dissipate and go away. Probably more like two weeks.

Uh, so, anyway, got some questions about flying, that’s the biggest thing there. Uh, had a patient with central cirrus retinopathy. This is an interesting disease that, uh, um, is where you get fluid that builds up underneath the retina that can cause [00:34:00] distortion of your vision. So people describe like a, you know, the curtains that were straight, all of a sudden there’s this huge bend in the curtains.

This is a disease that mostly affects men in their like late 20s to 50s, much more common than women. Um, and we don’t really know exactly what causes this. Some kind of leaking in a certain part of the eye, um, uh, underneath the retina that causes a little bit of a retinal detachment, doesn’t require surgery to fix.

Often it’s just time that fixes it. Eventually it will go away and get better. And there are some medications that we can use to try to treat it if it doesn’t go away on its own. But the one thing we do know is stress and steroids are a big risk factor. for developing this disease, central serous retinopathy.

This swelling in the retina, right in the center of the retina too. So it’s like [00:35:00] right in your vision. You have the symptoms. You see there’s something not right with your vision. People come in with this. Um, and steroids or stress are big, big risk factors. So obviously when people come in with this, I tell them just, Have less stress in your life.

No, I’m just kidding. I don’t say that. That would be very unhelpful. Just stop being stressed. By the way, you’re, you’re, you know, uh, I’ve lost vision in this eye, but don’t be stressed about it. So no, we don’t tell people not to be stressed, but we do tell people to avoid Any kind of ingested, topical, any exposure to exogenous steroids, so that includes, you know, prednisone, topical steroids, you know, creams, things like that, even eye drops.

Inhaled steroids from inhalers, injected steroids. Even there’s an association with Viagra and [00:36:00] other ED medications. There is also an association with people who have a type A personality because they do tend to be a little bit more stressed out than others. And so, uh, we try to avoid all the steroids. I mean, if you can cut back on the stress, that’s great, but, you know, that’s not really reasonable for people.

Everyone’s stressed out all the time. But anyway, central serous retinopathy, I do get to tell people who come in with this, it will, the vast majority of the time, go away. Very rarely. Do you stick, do you still have some of that swelling in the retina that sticks around? Uh, so there’s a good long term prognosis from this, but you can have multiple episodes of it.

So if you’ve had an episode of this, you get kind of like a lifelong thing. You want to try to avoid steroids. Um, so I had a lot of questions from a patient about that. And then the last thing, cause I’m running out of time, uh, is, um, uh, what I usually get a lot of questions about blue [00:37:00] light. If I, if I, I I’m just, I’m just tired.

You guys, I’m tired of hearing about blue light, talking about blue light. I’ve got a whole spiel about blue light. People always asking about it. Should I get blue light blocking glasses? You don’t need them. Don’t, you don’t, don’t fall for these companies that try to sell you expensive blue light blocking glasses.

Will this blue light blocking glasses, will it help you? But what do you mean by that? Does it help you keep a healthy eye? No, blue light does not damage your eyes. There’s blue light everywhere. There’s blue light from the sun. There’s blue light from the lights in your house. There’s blue light every, if you have light coming on you from any direction, like there’s blue in it.

And there’s no studies, there have been studies that have looked at this, there’s no studies [00:38:00] that show that blue light damages your eye. Doesn’t cause macular degeneration, doesn’t cause any kind of permanent, like, really any kind of eye strain either. There’s no studies that show it produces eye strain.

Just looking at a screen, looking at your phone for hours on end, that’ll cause eye strain because you’re using your muscles. All of these are great examples of how you can use your muscles to accommodate your eyes to see up close. That can cause eye strain. Blue light is not causing eye strain. The only thing that blue light does Is if you stare at your screen, your phone, for like two hours before bed, it can affect your circadian rhythm.

We do know that. So yeah, if you want to get blue light blocking, if you want to spend 300 bucks on blue light blocking glasses, so you can wear them when you look at a screen right before bed, okay, sure. Or you could just not look at your screen as much right before bed. That’s the free option. So anyway, got to answer some questions about blue [00:39:00] light today and I probably will tomorrow as well.

That’s just the, it’s the market, like the people that market these, these, this technology, they’re really good at it. They really are like in stoking fear among people about blue light. So killer, you know, getting glasses for their kids, a blue light block. It’s just, I mean, you don’t need blue eye blind glasses.

Don’t get them. Don’t spend all his money. Anyway, I could go on and on about blue light, but I think that’s enough. Thank you all for listening. That is our episode for today. I am Dr. Glock. I’m fucking. Special thanks to my producers, Rob Korney, Aron Goldman, and Shahnti Brooke. Editor Engineer is my new friend Jason Portizzo, who I just saw again for our live show in West Nyack, New York.

By the way, I went to Palisades Mall. It’s like a famous mall, I guess. It was, it’s always so weird being in a mall. It’s been years and years since I’ve been in a mall. Went to that massive [00:40:00] Palisades Mall. It’s like four stories, this mall. Apparently it’s sinking. I learned about this. Palisades Mall is sinking.

If you want to go, go now. Because it’s falling into the middle of the earth. So anyway, had a great show though. Thank you for everybody that came out to our show in West Nyack. Uh, and, uh, see, anyway, I saw Jason there. He helped, uh, did the AV stuff and, uh, uh, just save the day with some of the technical issues we were having to, uh, at the venue, but, uh, it was great.

Great show. So thanks to Jason. And thanks to, um, our, uh, uh, music is by Omer Ben Zvi. Can’t leave out Omer. All right. That’s it. You guys. Oh, uh, give me your questions, your comments, your concerns, uh, your stories, whatever you want to talk about. It’s great if it’s eyeball related. Any questions you have that are eyeball related or eye disease related or how a disease affects the eyeball.

I’m all ears, like, and eyes. I’m all [00:41:00] eyes. Like, give me, give me the things. Tell me what you want to hear from, and imagine you’re going to the doctor and your ophthalmologist has 45 minutes to spend with you, which has never happened in the history of medicine. That’s exaggeration. We, we will, if it can happen, depends on the patient.

But anyway, you have, you have your, your, you have all this time you can spend. What would you ask? What would you ask your doctor about your eyes? Those are the things I want to hear about. All right, let’s do it. Anyway, you can email me knock, knock high at human content. com. It’s probably easier just to comment on.

YouTube channel at Glockum Fleckens. It’s the one that we do for the podcast. Uh, you can see episodes of Knock Knock I and Knock Knock Hi there. Leave a comment. I always look at those. Thank you everybody for giving me birthday wishes, by the way, on the last episode, a couple episodes ago. I really appreciate that.

It was a wonderful [00:42:00] birthday. Um, but yeah, leave a comment. I’d love to hear from you. All right. Knock, knock, hi. Knock, knock, I is a human content production. Take care, everyone. Goodbye.