Transcript

Will: [00:00:00] Knock, knock,

knock, knock. Hi.

Hey everybody. Welcome to Knock, knock. With me, your host, Dr. Glaucomflecken. This is your one stop shop for all things eyeballs. Thank you for joining me today. We’ve got some, some, uh, some interesting things to talk about, A little bit of eyeball stuff, something that’s called Alice Wonderland Syndrome.

Some comments from all of you and some things that have happened on social media that have frustrated me. I feel like every episode now I’ve got something like, some kind of soapbox I get on or I’m complaining about something. I try not to be too pessimistic, but man, there’s a lot of just like, ugh, stuff going on.

You know? I’m a little tired, a little grumpy as as we are sometimes it just, it happens. [00:01:00] Uh, and part of that’s just ’cause I had a long. Long day yesterday, Kristin and I, um, lady Glaucomflecken, we gave a joint keynote at the Women in Ophthalmology conference in on Amelia Island in Florida. It was hot, it was humid, but it was a great event.

Uh, and we talked about social media, our story. I’m just all kinds of stuff. Um, and it’s okay that I was there because my wife was there with me. She’s a woman. I’m an ophthalmologist. And so between the two of us, we qualified to be at the Women in Ophthalmology Conference. Uh, it was a great time, first time I’d ever been there and let, I’ll, I’ll lemme say something about ophthalmologists, it’s, I always get a, a bit nervous when I go to ophthalmology, meetings, conferences, whatever you wanna call them, symposiums.

Congresses. I, I don’t even know what, like, all these are all synonymous, but everything, everybody calls their, their event something different. Um, I’m, [00:02:00] I just get a little bit nervous ’cause I obviously bring, try to bring a lot of humor into my keynotes. Um, but ophthalmologists, they aren’t known. Uh, for being the funniest people in medicine.

In fact, I would say we are like the bottom quartile of, of funny doctors. I, I, I don’t know what it is. I, I think the more, uh, the more academic, I mean, every specialty has academic components to it, but there are some that just feel more. Academic, more cerebral, more just sitting around talking about things.

And on this surgery side, ophthalmology is like up there in terms of like one of the more cerebral, not to say we’re smarter, just like more on the spectrum of like internal medicine than surgery. It feels like that sometimes. And that bleeds over into our. Conferences. And so I, I’m always kind of holding my breath when I get to an ophthalmology event I’ve never been to is like, what’s the audience gonna [00:03:00] be like?

Are they, are they, uh, are they gonna laugh at my jokes are, are they gonna have a sense of humor? Sometimes people are like, what the hell is this guy doing up here? He’s trying to make us talk. I’m supposed to be learning things at this conference. Uh, but this one, women in Ophthalmology, best ophthalmology conference I have ever been to by far.

I, I think part of it is there are so many residents and med students there whenever that those. You guys are my people. All, all the, oh man, like the, that generation of, of new doctors and soon to be doctors. You guys like have all grown up watching my videos and so you just, the excitement in the room, the laughter.

You don’t take yourselves, yourselves too seriously yet. You’re, you haven’t been jaded by the healthcare system. Uh, and so it, it, it always makes me very excited when I see, uh, a, a lot of young people at a conference. ’cause like, I know it’s gonna be a fun time, it’s gonna be great. Even if it’s like nine o’clock in the morning when I’m speaking, it’s still gonna be fun.

[00:04:00] Um, and so that was the case at this particular conference. Uh, but, uh, you know, it’s, it’s not that way everywhere. So it’s, it’s, it’s a little bit hit or miss. Um, but this was a good one, so I definitely recommend it for anybody who’s looking for an ophthalmology conference. It’s probably a very small percentage of the people listening to this right now.

Uh, so anyway, uh, shout out. Women in ophthalmology, uh, Florida. Very humid. It’s like choking on the air. It’s, it’s like, it’s incredible. I mean, coming from Oregon, it’s just so different. Uh, but, um, good time. Good to, I’ve got to spend some time swimming in the ocean. It’s good. Uh, alright, so. Let’s talk about, uh, before we take our first break, I’m just going to bring up this thing on social media.

It’s, it’s been going on for a while and maybe, you know, I can’t remember what I talked about last week, so you know it, I apologize if I’ve like talked about some of this stuff already, but, all right. I’m just gonna tell you, this is a tweet from RFK Junior, [00:05:00] the US Secretary. For the health and human services.

Basically the person in charge of the healthcare system in the US is what he said a few days back. Doctors, hospitals, insurance companies, and pharmaceutical giants, profit by keeping Americans sick.

So I saw this and. I was like, kind of that meme was the guy’s like pointing at himself like, me, me, you’re, you’re lumping in Doctors Hos, uh, with hospitals, insurance companies and pharmaceutical giants. But this is not a new thing for, for RFK. He’s in his mind. We are all equally the problem with, in, in why people are not healthy in this country.

Like, it’s, it’s, it. All of us equally, which is so incredibly [00:06:00] wrong that it’s almost like, like what do you even do as a physician to like combat this? Because this is the person who is, has the, is the most famous person in the healthcare system, is running the healthcare system saying these things. So let’s take these entities one by one and look at, okay, logically.

Does it make sense for them to quote, keep Americans sick in order to make profit? So let’s start with hospitals. This is the only one where I’m like thinking, okay, like I could see how you could come to that conclusion. Like just because hospitals, in order for them to make money, they have to have sick people.

But it’s the thing that you’re saying keep Americans sick. Are we trying to. Keep you in the hospital? Well, considering medical decisions in a hospital are primarily made by physicians, and I can tell you 100% physicians are not keeping you sick [00:07:00] in order to profit. Then I have some questions about whether hospitals are keeping you sick.

Also, considering a hospital is just a building, but anyway. Let’s look at insurance companies, insurance companies, profit by keeping Americans sick. Actually, I don’t agree with this because insurance companies either want you to be paying them premiums while completely 100% healthy, or insurance companies want you to die very quickly.

They don’t want you sick because that costs them money. They just want to be raking in premiums. That’s what they want. They wanna delay care RAK in premiums, so they love the 20-year-old. Healthy person just got a job is paying premiums. That’s great. They, they love that because you’re not gonna get sick.

Uh, it’s once you get sick. And so it’s what is the financial incentive for a health insurance company to keep you sick? It just, that just, it just doesn’t logically [00:08:00] make sense. Uh, they, they want you either completely healthy paying premiums or if you become sick, they want you dead. That’s insurance companies.

Pharmaceutical giants profit by keeping you sick. So obviously, and you know, with these, we’re not talking about like their primary motives, like they’re, they’re obviously the motive for hospitals, insurance companies, and pharmaceutical giants, especially the for-profit ones, which is most of them out there.

Their job is to create revenue for their shareholders, right? And so they are trying to make profit, but the question is, does that profit come from like looking at patients and being like, I want to make you and keep you sick. That’s what we’re, we’re evaluating here. So pharmaceutical giants, they make the medications that physicians prescribe.

And I can tell you like those medications, there’s [00:09:00] no medication that I’ve ever prescribed or ordered in a hospital that was intended to keep somebody sick. What is, what are you talking about, RFK? Like what is, what do, what is going on in the, obviously you can imagine the replies under this tweet. It’s, it’s just a, a who’s who of bots and, and.

People with a blue check that are probably also still bots. I, yeah, it’s just a, it’s, it’s a mess. It’s a mess. And then obviously we we’re at doctors. Um, this is a trope that like will not die it, and it’s only getting worse now where people think that we, there’s no incentive for us to make you better as physicians because then we are not gonna make money.

We’ll lose our jobs. We’ll have nothing to [00:10:00] do. We’ll be destitute. We won’t have, won’t be able to pay back our student loans or acquire wealth, or whatever you wanna say about it. And so we have no incentive to make patients healthy.

Okay. First of all, like we spent a decade or more of, of the, of our, the, our youth, our twenties and thirties. Like learning how to make people better, how to treat disease. Now, I know for the vast majority of you listening, like, I don’t need to be, you know, these things. Alright. This is, I, I imagine the people that are, that are supporting this statement from, from RFK, uh, they’re, they’re not gonna listen to my podcast.

They’re not fans of me. Um, but, but, but I, I gotta say it anyway, I can. I could make people, I could make every one of my patients better, 40 patients a day. I could make them better. I might even [00:11:00] cure some disease. I cure disease all the time. I cure cataracts almost every day. I could take all my patients and, and make them better, all of them, all 40 of them.

And guess what? The next day I’m gonna have 40 new patients. I can make better. Guess what? The next day I’m gonna have 40 more patients I could cure, and so on and so forth. For the next 100 years, I could sit there and make people better every day, and I will never run out of patients to then make better or cure, like as if disease doesn’t stop.

It, it’s always there. It’s, it’s, it’s, it never goes away. Every physician on earth could spend every waking hour, quote unquote making people better or curing them or whatever [00:12:00] that means to RFK. And we’re still the next day gonna have a whole new group of people to make better and or cure. So this, this, this idea that, that.

In order to protect our livelihood, we don’t, we wanna keep people sick so that we can keep seeing them and making money off of them and profiting is absolutely ludicrous. And I just, I hope people understand well. I know that people who are are reasonable understand that. But then there’s a lot of people that are not reasonable, that don’t understand that and, and that, that absolutely believe everything that comes out of RF K’s mouth.

Uh, let’s take a break and we’ll come back with what I said on social media as a response to this and tell you what people said about it.

Hey, Kristin. Hmm. I know I like to talk to [00:13:00] you about the little dex mites. Mm-hmm. And little tiny guys. Mm-hmm. Thought we could give that a break and just talk about the, the eyelid disease that they cause when there’s an overgrowth of Dex. 

Kristin: I like that idea. No mite talk. 

Will: So Dex blepharitis it, it gets missed, it gets misdiagnosed, uh, because a lot of the symptoms overlap with other eye conditions.

Kristin: Hmm. Okay. So what are the top symptoms that people should be looking out for? 

Will: Itching, swelling, irritation of the eyelid margin, redness. 

Kristin: Yeah. That kind of sounds like it could be allergies or something else. 

Will: Exactly. It could be a several different things. But the key is if your doctor spots little crusties, that’s, they’re called collarettes, but you know, they like little crusty technical term.

Exactly. Uh, then, um, uh, that’s dex Blepharitis. You just know it. 

Kristin: Hmm. I like that there is a clear sign to know. 

Will: Yep. And once you’re diagnosed as a prescription eye drop treatment. Available for Dedex Blepharitis. Whew. 

Kristin: That is good to know. 

Will: To learn about the common symptoms of Dedex [00:14:00] blepharitis and more visit mites love lids.com.

Again, that’s M-I-T-E-S-L-O-V-E-L-I-D s.com To learn more. This ad is brought to you by Tarsus Pharmaceuticals.

All right, so I saw this, this tweet again, doctors, hospitals, insurance companies and pharmaceutical giants, profit by keeping Americans sick. And I was like, uh, I, I just thought about it for a while. I had to sit there with it and just like, where, what is going on? Like, we do not need a, a, a leader with this much visibility saying these things.

Um, and so I just said, first of all, I did write a skit. I have not filmed it yet, where, um, it’s all of these entities talking with each other, so, so look for that. By the time this comes out. I’m sure I have filmed it and posted it, um, by now. But here’s what I said. This is on Twitter. My first mistake, all I said, this is all I [00:15:00] said.

I said, doctors want you to get better. That’s it. That’s the, those was the only words I sent out and I purposefully made it as simple as possible. No jokes. Just doctors want you to get better and just, here are a few of the replies. Okay. Just not as much as they want to get paid. Then why do most give you medications instead of talking to you about lifestyle changes?

Yes, and they use fraudulent science to do it. Hospitals want doctors to bill for medical services. I used to believe that. Now I’m not so sure with like 20 likes on that one. Not all doctors. I suspect Massachusetts may have the worst doctors in the United States at this point. Someone really doesn’t like Massachusetts.

Doctors want you to get out of their office. Over a [00:16:00] hundred replies on Twitter. To this, and most of them are like that. A few a, a, a good, a good amount over like, you know, supporting my statement. Um, but it, it, it’s discouraging. It’s, it’s like there, those of us out here are really trying to do what we can on social media to show people that, like doctors, you can trust us.

Like a, a trust in physicians has never been lower. It started, like the pandemic’s a big part of that. All right. There’s a lot of bad advice given a lot of it, it, and a lot of misinformation. It’s just gotten worse since then. And it, it’s like, and what, what can we do? It’s like, honestly, I’m, I’m kind of asking you like, what, what do I do?

What do any of us do? When you say doctors want you to get better, like in our hearts, in our motivations, in our actions, [00:17:00] we. Do things because we want you to get better, and people just say, no, you don’t.

I, I try to be as optimistic as possible. I don’t know how to defeat this idea. I don’t know what to do about it. On a population level, it doesn’t feel like there’s anything to do for some people. I think the only hope is that they. Have a personal and an individual interaction with a doctor that changes their mind.

That is the only way where I don’t think there’s a way to, to get people to understand who doctors are, why is it we’re doing this until they actually like, interact with a, with a real life doctor in, in, in person. So it’s, um. It’s frustrating. So here, here’s what, what I decided to do, because this is, uh, the newest, the latest thing is like the root cause stuff, [00:18:00] right?

Like doctors, they don’t actually treat you. They don’t, they don’t, they’re not interested in treating the root cause of disease. And what they’re getting at is that we don’t care about lifestyle. And this is RFK as well, like talking about now mandating that, uh, med stu med schools have nutrition lectures, which obviously we do.

That was a part of our education. Absolutely. Along with hundreds of other topics. Uh, and so, but this is, this is the latest thing, right? You hear it all the time. You don’t treat the root cause and what, what they’re getting at is this, this, um. This feeling? I don’t know what it is. Uh, this notion that, that we don’t care about lifestyle.

We don’t talk about lifestyle with patients. So again, I’m an ophthalmologist. Every specialty, every type of doctor has a different type of like lifestyle changes that they might recommend. So for mine, that’s focused on eyeballs, obviously. [00:19:00] Even, uh, even as an ophthalmologist who has nothing to do with anything below the nasal bridge, even I have lifestyle changes that I discuss at length with my patients.

Alright, here we go. I’m gonna tell you, these are the lifestyle things, the things I would recommend to patients, which I do like pretty frequent, like almost daily. Some of these I’ve already done today in just a morning clinic. Uh, these are lifestyle changes that are good for your eyes. Taking breaks from screens, we have a 20 20 20 rule.

Uh, we have studies that show that the longer you look at a screen, the less you’re likely to blink, and then the more dry your eyes are going to get. So we have the 20, 20 20 rule. Every 20 minutes, you should take 20 seconds and look off into the distance, at least 20 feet away. That is going to stimulate you to kind of, you lose your focus on the screen and all of a sudden you blink again.

All right? It’s, and, and so it [00:20:00] allows you to just reset your tear film, redistribute it over your eye, help with your dry eye symptoms. It really does make a difference. Every 20 minutes, take 20 seconds and just look away in the distance and just blink a few times, blink, maybe put some artificial tears in, refresh, sustain, blink.

There are tears, any of those. Here’s another lifestyle thing I talk to patients about not sleeping in contacts. That’s a lifestyle change for some people, or just general good contact lens hygiene, good eyeball hygiene, eyelid scrubs for people that need them. Not everybody needs to do eyelid scrubs, but some people really do wearing safety glasses when you’re doing dangerous activities that involve high speed projectiles.

Um, not wearing your contacts when you’re in a swimming, when you’re in a, um, uh, a swimming pool or most, um, mostly a hot tub. You should not go into a [00:21:00] hot tub with your contact lenses in like none of these people would. These are lifestyle changes. Like there’s, these are things that like. Like I, I, you know, people like accuse me of like profiting off of, of, of practicing medicine.

But in what way would I profit off of telling people these things? I just want you guess what? I just want you to, to stay healthy and get better. That’s, that’s what I want. That’s why I’m telling you all of these things take a break. Some screens not sleeping in contacts, wearing safety glasses, when you do almost literally anything that’s.

My own neurosis playing in there, wearing sunglasses. Sunglasses, right? You know what sunglasses do well, uh, UV light can be harmful to the macula, the retina, it can be harmful to the cornea. Um, that’s what snow blindness is. You know, snow blindness is when you have, uh, um, uh, snow white snow, uh, what other color would snow be reflecting [00:22:00] light up from the snow?

Bright, sunny day. Light UV light hits the snow, bounces up into your eyes and can cause corneal abrasions so that sunglasses will help prevent that eyelid cancers, sunglasses can help prevent that, right? UV blocking technology, important lifestyle change, eating dark, leafy green vegetables, that’s another lifestyle change.

I, I talked about that with people who have macular degeneration. Uh, having a diet that’s relatively high in antioxidants now, I usually talk about that for people who don’t qualify for areds, maybe they have very mild macular degeneration. They don’t have a macular degeneration that’s severe enough.

Where they need to take the AREDS vitamins. It’s like this, this combination of vitamins. You may have heard of preservation or acuvi. It’s just like vitamin A, vitamin C, vitamin E, [00:23:00] Zia, xanthin, lutein. All of these you can find individually, but they just put ’em in one little thing and then sell the pill.

If you don’t have a certain level of severity of macular degeneration, then that pill, it doesn’t do anything for you. It’s okay to take it, but it’s not actually gonna. Prevent, or not prevent, but decrease the risk of developing wet macular degeneration, which is bleeding in the back of the eye. So I recommend it for moderate, dry macular degeneration.

Those are the people that qualify, uh, to take areds and everybody with worse with macular degeneration. That’s worse than that level should be on it as well, but that’s what it does. It helps prevent the, the wet form from from happening. A hundred percent, but it’s one of the best things we got. So, um, but for people who don’t qualify for that, you know, just taking, just having high antioxidants in your diet.

So, you know, spinach, [00:24:00] kale. Other dark leafy green vegetables. I don’t know what they are. I’m not a big, dark leafy green vegetable eater, although I should probably take my own recommendation and start eating that. I don’t have macular degeneration, but it just seems like a healthy thing to do. But guess what?

That’s a lifestyle change. How about fish oil or flax seed oil supplements? That’s a lifestyle thing, you know, either through a pill or just your diet, you know? Increase the amount of fish in your diet that’s healthy for you. Uh, there’s some studies, we’ve had some studies that it’s actually equivocal with the benefit that this has on dry eye.

There are some studies that suggest big benefit to taking some Omega-3 fatty acid, uh, adding that into your diet. Some studies suggest, uh, maybe it’s a, that’s a little bit of an overblown thing and we don’t, it doesn’t really do a whole lot. Um. Because it’s equivocal. I usually tell, I always tell people that, [00:25:00] but I’m like, there’s really not that much of a downside.

As long as like you can tolerate the, the very, very mild amount of, of blood thinning that occurs with Omega-3 fatty acids, then just, you can take it, it’s safe. Alright? Might give you fish burps. People don’t like that, but flaxseed oil is another substitute. But guess what? That’s a lifestyle change conversation that I have all the time with people.

See then this is the problem. People, you’re, you are molded by your experiences and unfortunately all it takes is one or two bad experiences with a physician for, for some people to, to, to think that, oh, it must be all physicians. That sucks. It it, it sucks because they then they, they go out and talk about this as if it is [00:26:00] all physicians and then other people start talking about it because it’s all physicians and when really they’re probably just talking about one or two people.

I don’t know. I don’t know. And it’s not like you can go on social media and be like, you know, it’s not, not all physicians. Because then you look like, you know, you’re, you’re invalidating their experience. It’s just that it, it’s not accurate to, to take an anecdotal experience and generalize it to an entire workforce of people.

But that’s what, that’s what’s happening on social media. And the last thing, the last, um, uh, just in, in like five minutes before I started recording, the last thing I could think of. As far as uh, uh, lifestyle modification is, um, is when people, when I diagnose, um, idiopathic intracranial hypertension, and typically this occurs, this disease occurs in overweight women around the age of 40.

That’s the classic demographic. And so we [00:27:00] talk about weight loss, we talk about how it’s going, what are the strength, what has worked, what hasn’t worked, what are they doing? I’m not a, a dietician, but I can give basic advice. I could tell people what has worked for other patients that I’ve, I’ve, I’ve I, that I have with the same disease, lifestyle modifications.

It’s not some taboo topic that we just don’t discuss. We do it. It’s part of our job. Guess what? We also prescribe medications. I don’t know where this either or thing came, like doctors, they’re either prescribing medications or, or, or they’re, or, or they’re actually good doctors giving lifestyle modification advice, finding the root cause of disease.

That’s the way people are thinking. They’re thinking people just thinking black and [00:28:00] white. Now there is no nuance to any of this stuff, and it’s it. The result is that. We as physicians are being lumped in to the, the disaster that is health insurance companies exemplified by a tweet from the head of US Healthcare on on.

Alright, let’s take a break. We’ll, on a high note.

All right, let’s, um, let’s do an, an eyeball topic here. This is a, a short one. Um, but it’s, it’s an interesting, uh, an interesting disease that you don’t see a lot. And I, I, it came up, uh, I think I, I saw a patient not too long ago that had a history of that, or maybe it was ’cause I don’t usually see kids and most of the time it’s in kids.

It was a parent that was talking about their kid that has this, um, either way. Let’s talk about Alice in Wonderland Syndrome. [00:29:00] So this is a neurologic condition, so not nothing wrong with the eyes, and now there anytime, because obviously the eyes are so intricately connected to the brain, uh, that there’s a lot of overlap.

There’s a lot of diseases that will give you either an illusion or hallucination or a visual distortion. That’s actually nothing with the eyes. Nothing happening in the eyes. The eyes are totally perfect. It’s a brain thing like ocular migraine, a misnomer because it’s not actually anything wrong with your eyes, it’s just a migraine that starts in the occipital lobe and the vision cortex, and that stimulates it, causes you to see things.

Alright, so Allison in Wonderland is a neurologic condition that causes. Temporary distortion in how a person, usually a kid, perceives their body and the bodies and the world around them. [00:30:00] So, um. People have, uh, these, these visual or sensory disturbances. So they either see objects as like larger or smaller, what we call mysia or masia, or sometimes the objects are closer or further away than they actually are.

It can also affect like time and sound perception can be distorted. Um, and it’s, uh, obviously named after like the, uh, you know, Alison Wonderland, Lewis Carroll book. Because of the, the, the distortions that Alice experiences in being big and being small and, and heads being bigger and, and legs being taller longer and, you know, all this stuff.

So, uh, the key characteristics of this disease is, um, the most, most common symptom is that visual distortion. Uh, and it can be very concerning for parents. Uh, usually they’re the ones that are more concerned than the kids. The kids just, sometimes they don’t even talk about it. In fact, some of you [00:31:00] listening maybe like, oh yeah, I had that.

I remember that as a kid. Um, and it’s, it’s, uh, and maybe it’s something you never brought up because it, you know, you were seeing okay, it’s like you were bumping into walls. It’s just, oh, heads were a little, looked a little long, a little funny. Um, but for parents who come in with their kids tell, telling them they had these symptoms, it can be very, very concerning.

Um, now the duration of this distortion. Can is typically very short. Alright? So it’s not like this is constantly there. Usually, uh, they last a few minutes at most, half an hour, maybe an hour, but not really much longer than that. Uh, so what are the triggers? Like, why does this happen? So. We don’t really know for sure like the pathophysiologic mechanism behind this, but we do know that sometimes it’s triggered by migraines.

So migraines can almost just like a, a different type of a visual aura, which makes sense. [00:32:00] Um, infections can do this flu, severe flu, um, epilepsy agents with epilepsy can have this, uh, even just stress can trigger this like. Visual aura, distortion response. Uh, important things to know. This is not a hallucination, right?

So hallucination would be like, uh, Charles Benet syndrome, where patients with massive vision loss, lots of big dark areas in their vision, your brain tries to fill in that dark space with a, with an image that’s not there. One, I always, um. Refer to, which is a one that a, a patient told me about once is they sit on their porch, had severe macular degeneration, or right in the center of their vision, they see a child swinging on a tree swing.

Uh, and um, patient knew that wasn’t a thing that’s actually there. They know it’s a hallucination. Alright, that. Different [00:33:00] than a delusion, which would be more on the psychiatric side of things. Alright. People with Charles Bonnet syndrome, they know what they’re seeing is not real. And it can still be very difficult for people to, to, to have these.

So Alison Wonderland syndrome is not a hallucination. These images are really there. It should, the stimulus is real. It’s just their perception of that stimulus is altered. Um. Most of the time it’s not a serious thing. Right? It’s, I, I’d say it always is worth getting an evaluation with either a neurologist, pediatrician, eye doctor, all of them will have some experience like hearing about these symptoms.

Um, very rarely, very rarely. Like something like a, like a brain tumor could cause this. Anything that can really disrupt the neurologic pathways. Um, like we mentioned, epilepsy already is something, uh, then it could, it could potentially cost something like this. That’s why it’s important [00:34:00] to at least get it evaluated.

Alright, if. Your kid notices this or you notice this, you know? Uh, but again, most of the time, not something to be too concerned about. That’s Allison Wonderland Syndrome. Really interesting to hear people describe it. Um, uh, it’s fun to, if, if the kid’s able to like draw it. I, it’s always, that’s one of the cool things about ophthalmology, a lot of ophthalmology disorders that cause vision changes, like have people draw it.

It’s actually a really, really helpful thing if you’re on, if you’re in the emergency department and someone’s like, I’m seeing something in my vision. Just draw it, see what it looks like. And that’s actually can be helpful for us, um, as on-call ophthalmologist to hear like, what, what does that look like?

What does, what do the patient draw? What do they, what do they think is going on? So, um, helpful, helpful little tip to have patients draw out their vision changes. And lastly we will do, how about a couple of of comments. We’ll just do that real quick. So this coming from the um, episode, should we worry about organ procurement, [00:35:00] procurement organizations?

Um. Episode on our YouTube channel at Glaucomfleckens. So go check it out. I, I, I look at almost all of the comments, uh, that come through here. So a few, in this episode, I talked about another thing that irritated me on social media, which is, um, on TikTok, people talking about how you shouldn’t be giving erythromycin ointment to newborns to protect against things like chlamydia, gonorrhea.

So it, it’s another thing I just got on my soapbox about. Um, so people had some, some great comments about it. Uh, at Sandy CI work in a medical department. In an animal shelter. We use erythromycin ointment to try to save the eyes of young kittens infected with things like chlamydia and feline herpes. I couldn’t tell you how many enucleations, which is eye removal, could have been prevented by using erythromycin sooner.

Thank you. See, it’s helpful not even in, in, uh. In human medicine, but in animals as well. And that’s actually, thank you for that, because I’m giving a [00:36:00] talk, uh, in a month or so to my first veterinary medicine talk. I can’t wait. So, um, I’ll, I’ll keep that in mind. Thank you. Uh, at n Snicker, former l and d nurse in New York State, vitamin K and erythromycin are state mandated for all newborns, no exceptions.

I’ve had this talk many times with new parents. It’s so hard because all involved parties truly believe they’re doing what’s best for the baby. That’s an important thing to remember and remember in this, and when I talked about this, I placed no blame on the parents. They’re just trying to get information, all right.

I, I put blame on the influencers. Uh, the people that are, are portraying themselves as experts telling people not to do this. That’s who deserves all the blame in this. Um. So, uh, uh, but I did not know that there are some states that actually mandated, that’s interesting. I have to look at that. I, I’d be interested to know, like which states mandate it and which ones do not.

Uh, so thank you for that. And so some people were, [00:37:00] uh, shouted out, uh, Jen Hamilton. So because it was a nurse practitioner that was talking about all this, this. Erythromycin, you know, don’t use it. Nonsense. Uh, I shouted out Jen Hamilton as an example of a great nurse, an ethical nurse, uh, um, uh, who is, um, uh, providing accurate information, you know, uh, that she’s learned through the course of her job.

So, uh, check her out if you haven’t already. She’s great. Big fan of hers. Um, couple more. Let’s see. Uh, oh, I talked about in that episode I talked about, uh, uh. Corneal abrasions and how as ophthalmologists, we have bandage contact lenses, but emergency departments don’t have them. Well, at LID j Giller said, I’m pretty sure if you go to the EM doc and say, Hey, here is a free stack of eye contact bandages for your corneal abrasions, please use them.

Those docs will definitely keep that stash in a secret location and use as needed. I’m, you almost got me convinced I might [00:38:00] actually do this. We have a, one of my offices is right next to the hospital. And I great emergency doctors over there. I might actually do that as like a little trial. Let’s just, let’s just check this out.

The, the, the, the challenging thing is, is that whenever you put a bandage contact lens on an ulcer, sorry, on a, never do it on an ulcer, on a cornal abrasion the patient always has to follow up. They have to come back in. You cannot leave that thing in for weeks, months, at a time, right? They have to be seen in follow up.

Oh, here we go. At Don Barett 8 0 2 6 said, the state of West Virginia just passed a law eliminating the mandate for erythromycin ointment for newborn’s eyes. It’s a forehead slap right there. Why, why, why, why, why? I guess you don’t give people the choice, but man, that’s, it’s, it’s stuff like that. It, it’s just ended up hurting people.

There’s no downside. Another comment said, uh, you know, there’s this basically no ability. Uh, [00:39:00] for a newborn to have an allergy, you hear that a lot. Maybe I mention that as well. Um, to, to the, the idea of having an allergy to erythromycin that soon after birth is, is just not. It’s not possible. It’s basically, so anyway, um, alright.

Thank you for those comments, you guys. Uh, and thank you all for listening. I’m your host, will Planner, also know as Dr. Glog plugin. Uh, thanks to my, uh, producers, Aaron Cordy, Rob Goldman and Shanti Brick Editor engineers. Jason pr Music is by Omer, Ben-Zvi. Uh, leave a comment. I’d love to hear what you guys think of the episode.

Thanks for listening. We’ll see you next time. Knock, knock. I is a human content production.

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