Transcript

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Visit aka. ms slash knock, knock high again. That’s AKA. Dot m s slash knock, knock. Hi. Knock, knock.

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Hi everybody. Welcome to knock, knock. I with me, your host, dr. Glaucon Fleck. And thank you for joining me today. Uh, this is your one stop shop for all things eyeballs. Uh, we got some good topics [00:01:00] today. Uh, got some comments to share with you all, uh, and, uh, a couple of topics. Yeah. So the most recent, um, uh, episode of, of, of knock, knock, I, that went up on our YouTube channel, I talked a little bit about dry eye, some dry eye things.

Man, you guys really want to hear more about dry eye, which doesn’t surprise me because it’s the most common thing I see in the eye clinic. I was asked about that recently. What is the most common thing you see? I did an Instagram live, um, with, uh, uh, with somebody. And, uh, that was one of the questions and.

It is, that’s it, it’s a dry eye, everybody has got dry eye in part because of all the screen time that we, we have, but which I talked about in the previous episode, but it’s, it’s, um, oh, all day, I’ve got a script in my head, I just run through everything, I’ve got it down like to the, to the letter. I know exactly how long it’s going to take me to get through a talk with a patient about dry eye.

Uh, and so we’re going to [00:02:00] go over a few things, address some of the questions that you guys have. Um, also something happened at the Oscars that I’m excited to just mention. Um, uh, there was, uh, uh, an, an eye disease. That that got some airtime during the Oscars. Very exciting, very exciting in the world. It doesn’t take much to excite us in the world of ophthalmology, but being mentioned something that we treat all the time at the Oscars, Oh, that’s high up there.

Okay. Uh, also I’m going to talk about a, a, a surgery that every now and then we’ll make the rounds. In, um, like popular science, uh, type publications, uh, you know, mainstream media, because it sounds kind of science fiction and far fetched. Um, but I’m going to talk about using your teeth to, uh, to, uh, transplant a cornea.

So that’s kind of the rundown here, but first, before we get into all that, um, I thought I, I, I, I have like a, [00:03:00] an idea for a piece of content that at some point I want to do, um, and I’d love to hear your thoughts, but I just wanted to talk it out because I. You know, I do a lot of speaking, so I, I, I’ve got a handful of, um, of keynotes and stuff lined up this year, different specialties.

Um, uh, that I’m excited about. And one of them is I’m, I’m going to Australia. Yeah. I I’ve been to Australia twice before. Love Australia. Fantastic. Yeah. The sun, the UV index is roughly like 83, but, uh, it’s, um, uh, it, it will, you can kind of feel it too when you’re there, like in the summer. Really anytime.

And the it’s cause it seems like it’s always hot. Uh, you, you, the sun’s beating down on you. You just, you feel your skin simmering. You can feel the UV rays irradiating your entire body. Um, that’s the only downside. Otherwise wonderful place. Wonderful people. I’m giving a talk, uh, in a couple of months in May to [00:04:00] Australia’s.

Surgeons. It’s like the big surgery group of Australia. And, uh, one thing that they, they wanted me to talk about is, um, is just the U S healthcare system as like a cautionary tale, basically. Like, Hey, Dr. Glockenfleck and there are, imagine me saying this, but an Australian accident, which I’m not going to try to do a good day.

Oh, God, I’m so bad at it. I don’t do accents, you guys. Um, so please edit that out. Actually, don’t, you know, I’ll just, I’ll accept the humiliation of trying to do it. They said, um, they said, Dr. Glockenflecken, uh, there are some things happening in our country. Uh, that’s like moving toward privatization and corporatization and basically.

Insurance companies trying to gain private insurance companies, getting a much bigger foothold in our country. And so can you talk about your experience? [00:05:00] Boy, can I, oh my goodness. I’m so glad you asked Australia. And so I am very excited. To bring that element into my keynote in May in Australia, in Sydney, I’m so pumped.

I just, Oh, what do you want to know about health insurance companies? I will get, I’ll tell you everything. And the great part about it is I’m in a different country, so, uh, they can’t come after me for that. I don’t think so. I’ll say, you know, whatever I want to say. And, uh, hopefully, you know, I mean, there’s no need for any aggressive security or anything because, uh, I’m not on us soil at the time.

So, although I’d probably say the same thing anywhere, I I’m thrilled. I’m thrilled to do it, but it also got me thinking so. Kristen and I, my wife, uh, lady, lady G we are, uh, we’ve been putting on these shows, these wife and death shows, or we talk about our life story and I dress up in characters and stuff.

And it’s just, it’s been, it’s been awesome. We, and we still [00:06:00] have a few of those shows we’re doing this year. And, um, those are in the works. Um, stay tuned, Florida. And the Northeast. All right. That’s coming. Um, and so we’ve been really enjoying it, but I’m thinking of like, okay, what, what’s, what’s the next show going to be?

Cause I don’t know. I just can’t be satisfied with what I’m currently doing. I have to be looking for like the, the next project. So what about this? You guys, what about like a, a glock and Flecken explains? US healthcare, because if everybody in Australia, like wants to know what’s going on in the US healthcare and why is it so bad and how did it become that way and what can, how do you fix it and how do you prevent it from happening?

If you’re in a different country, well, then maybe there’s other countries, other people in other countries that also want to hear that information. And maybe even just people in the U S that are like, what the hell happened? How did, how does, how did we get to the point where Optum owns everything? Where there’s like four [00:07:00] insurance companies and they just vertically integrated all of it, the whole healthcare experience.

So, uh, maybe I’ll put on a one man glock and Flecken show. Where I, um, it, it Glock and Fleck and explains healthcare. And I could, I could like dress up in different characters. Uh, I could do family medicine and how family medicine gets abused by like unnecessary prior authorizations. And, and I could, I could be Jimothy.

I don’t know. I, I, I haven’t thought at all about it. It’s just the idea. I mean, I could easily put an hour of content together and then, um, and then tour it around to theaters and. That’d be fun. I think it’d be great. It might be extremely depressing, but I promise it would be funny. So there you go. I mean, tell me what you think.

Would you come to that? I hope so. I love, I love performing. I love seeing all of you, all the glockenspiel fans, all the glockenspiel fans. All the, the, the, the Glock flock folks, I love [00:08:00] seeing all of you in person. It’s been really a joy to see people come out for the live shows. And so I want to be able to keep that going and, um, and bring something new.

And I think that’s, that makes a lot of sense. And we are, I mean, we just launched, um, uh, in our newsletter and on, uh, some of the, on, on Instagram, uh, and I think Facebook as well are, um, uh, we’re rerunning our 30 days of us held my, my 30 days of us healthcare. Um, uh, series that I did a couple of years ago, all of it’s still relevant.

And not much has changed. So anyway, uh, maybe I’ll turn that into like a stage show and I’ll sing and dance. No singing. If you ever wanted to, if you thought my impressions of different, uh, acts with different accents were bad, just wait till you hear me sing. It’s not that pretty anyway. Uh, that’s, that’s kind of what I’m thinking.

That’s just, uh, I’m, I’m, I’m just, uh, kind of. Vomiting words at you at this point. Uh, so anyway, Oh, the next thing. [00:09:00] So Oscars, I love watching the Oscars. Even though I, I usually at best, I’ll see like half of the movies that are the, the, the big movies. Um, I do, I do, I like it. I’ve been watching it since I was a kid.

I love movies. Part of the reason why I like doing the content that I do, uh, something very, very exciting happened. Uh, Goldie Hawn went up with Andrew Garfield and, uh, presented a, uh, an and, uh, during the back and forth that they had with each other. Goldie Hawn said that she couldn’t read the teleprompter because she has cataracts.

Cataract, cataract got mentioned during, during, uh, during the Oscars. And, and then there was a, there was a, a spike in Google searches about cataract. And I know this sounds silly to be very excited about this, but I am an ophthalmologist at heart. I mean, [00:10:00] in real life, but also at heart, like my, my. I’m my whole, my whole presence is, is, uh, is intertwined with the world of eyeballs.

And so when something in mainstream media and something like the Oscars, they mentioned an eyeball thing. I’m going to get excited about it. And everyone else’s too. So cataracts were mentioned and people were talking about cataracts very briefly. Uh, and, um, and, and, and I will say. Afterwards, I was looking around to see what kind of, um, new stories popped up about this.

And there were a few headlines and there were always the most click baity headlines you can imagine. It’s like Goldie Hawn reveals shocking diagnosis. The woman is 79 years old. If she didn’t have cataracts, that would be the modern medical miracle. All right. Not a surprise. [00:11:00] 79 years old. In fact, you probably should have had them removed by now.

Like there’s really very few people that really still should hold off on cataract surgery at the age of 79. The vast majority of people get that surgery in their 70s. And so, uh, Goldie Hawn, I, you’re, I have to assume you’re a fan of Dr. Glockenflecken. Go get cataract surgery. I’m happy to help you out. If you want to come up to Portland, all right, let’s, let’s get this done.

We have wonderful artificial lenses. We can put in your eyes. Uh, we can get your distance vision better. No glasses. We can correct your stigmatism. We can correct your near vision. We can do all of those things. We can even put a lens inside your eye and then change the shape of it afterward to dial it in exactly how you want it.

That’s the latest technology, very expensive, but you’re Goldie Han, I think you can afford it. So go out, get yourself some cataract surgery guys. Don’t wait. All right. If you’re 79, all my 79 Glock flock members go get your cataract. [00:12:00] If you’re in your seventies, you got cataracts and chances are they’re visually significant.

It doesn’t take much to convince insurance companies to pay for the cataract surgery, which is because everybody gets cataracts. That’s probably the reason why Edna a couple of years ago tried to. Enforced prior authorizations for all cataract surgery. You guys remember that? That was a big deal, made videos about it, um, basically we just have to, we have to show that there’s, there’s some, you know, difficulty with your activities of daily living because of the cataracts.

It can be glare problems, trouble seeing road signs, trouble reading, trouble recognizing faces, trouble navigating around your home because you can’t see as well or in dim light or there’s, uh, so many things. We do glare testing and, and, and it doesn’t take much, uh, uh, to warrant cataract surgery, because if you don’t do cataract surgery, [00:13:00] when you need it, like more health problems can arise because you don’t get surgery.

What if you trip and fall? What if you have an accident? What if you hit somebody? What if you hurt yourself? Uh, you can’t see steps as well. You don’t see a curb when you’re walking around outside. It’s so many things can happen and that could lead to broken bones. All right. The ortho bros, they have plenty of business.

They don’t need more. So go get your cataract surgery done. Let’s take a break.

Hey, Kristen. Yeah. I’ve got some friends. I’d like you to meet. I see that you seem a little too friendly with them. I have to say, aren’t they cute? I sure, but the little beady eyes and their little little hands, the hands, the claws, I don’t know. Appendages. Okay. How about that? Yeah, it works. But anyway, they just like, well, they’d like to say hi.

Okay. Like, [00:14:00] okay, wonderful. They’re not, they, Oh, look, the one sticking around sure is right on my mic. These little guys are a Demodex and they live on your eyelashes and they can cause flaky, red, irritated eyelids. See, that’s not cool. That’s a party foul. You just kind of want to like, rub them. Mm hmm.

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

Dot com for more information about these little guys and demodex blepharitis All right speaking of surgery There was another a news article again. I mentioned earlier this comes up every so often This is a surgery. That’s [00:15:00] called osteo odonto keratoprosthesis Osteo, I’ll try to say it quickly. Osteo I was putting that in an ophthalmology note, in like a consult note, because as we all know, ophthalmology notes are indecipherable.

I would probably call it, I guess, OOKP. Oh, okay. P baby. Ostia. Odonto carotid prosthesis. Very, very awkward. Um, but, uh, it’s, it’s a surgery that, that is so wild sounding that it pops up in, um, on media sites, even though it, as if it’s a new thing, even though it’s a surgery that’s been around for like 60 years.

Uh, so it was pioneered by Italian ophthalmologist Benedetto, I don’t know if that’s how you say it. Benedetto strompelli. Benedetto Strampelli. Here we go. I’ve already tried to do two different accents in one episode. This is not going well. In the [00:16:00] early 1960s, tooth and eye surgery, I guess that’s what they’re calling it as opposed to keeping continuing to type osteoodontic keratoprosthesis.

Tooth and eye surgery is intended to minimize the risk of a patient of a patient’s body rejecting a foreign implant. By mostly relying on its own biological material. So this is the reason that this is even like thought of as an idea. When someone has, we’re going to take one disease for example, a bad chemical burn to the eye.

Chemical injury, let’s say you get sodium hydroxide. A big splash of it. Right in your open eyes. It’s severely basic. It’s a high, high base pH of, um, what are the basic ones? High pH. So we’re talking like 12, 13, uh, really high pH that can cause a dramatic, uh, burn and scarring of the cornea. So you have [00:17:00] that accident and over the course of six months or so, your eye slowly scars over.

And what that means is Look at you, you have your conjunctiva, we’ve talked about the conjunctiva, it’s like the skin of the eye. Well, whenever you have a severe injury to the cornea, severe enough that it burns off what we call the corneal limbal stem cells. So you have stem cells that kind of right on the edge of where the conjunctiva, the white part of your eye meets the cornea.

That’s where your limbal stem cell, that’s called the limbus, it encircles your eye, your cornea. That’s where your stem cells are. So if you have like a, a, a corneal abrasion, like a minor trauma, your stem cells will get active. They’ll start running. They’ll start creating new cornea tissue to fix that corneal abrasion.

Well, if you scar your eye severe enough, To where you kill off [00:18:00] all those cornea, those limbal stem cells, all of a sudden the cornea itself cannot regenerate tissue. You can’t create more cells to heal the cornea and keep it nice and clear. You need that cornea perfectly crystal clear so you can see through it.

But if you don’t have limbal stem cells, you’re toast. No chance. And so, um, what this, uh, so what happens is you can’t regenerate corneal tissue. And so what takes over your conjunctiva? So your conjunctiva is like, Oh shit, we don’t have a, we don’t have corneal stem cells. Like someone’s got to come in and cover.

And, and, and try to heal the, whatever’s left of the cornea. So we don’t have like an open globe. So it doesn’t just melt away and the eyes open and then you lose your eye. So what the conjunctival will do. It’ll, it somehow senses that there’s no stem cells there and it just starts, it starts to [00:19:00] grow over the cornea and it’s called conjunctivalization.

Another silly, crazy word we have. And so the conjunctival will just totally grow over the cornea. And so you see the white part of your eye. Well, imagine the white part of your eye, but it covers the entire front of the eye. That’s what it kind of looks like. It’s just the conjunctiva covering the cornea.

When that happens, it’s extremely hard to regain normal vision because in a lot of cases you have this conjunctivalized cornea, but behind it, inside the eye and in the back of the eye, the retina might be totally pristine. It might be perfectly fine. And so if you can just get rid of that. That conjunctivalized cornea and replace it with a, a normal cornea where you can restore vision.

So that’s what people did for a long time. Okay, we developed techniques to try to [00:20:00] basically create a little punch hole in the center of that diseased cornea and replace it with an artificial cornea. It’s called a penetrating keratoplasty. And it works. It, it, it, it removes that, that, that, that bad tissue and you have a nice clear cornea in its place.

The problem is you still don’t have limbal stem cells. And so before too long, the conjunctiva, it’s going to grow back over that new cornea. And so you’ve kind of wasted that corneal tissue, that donated tissue from a cadaver, because it just, it’ll last maybe a few weeks, a few months. And then you’re back at square one.

So there was, there’s a need to figure out a way to create a opening right there in the front of the eye that will not just scar over very quickly and that you can, you can potentially have normal vision and [00:21:00] one of the ways. That we’ve tried to do that is with odonto osteo odonto keratoprosthesis. I had to look at it because I still can’t quite get it right.

Osteo odonto keratoprosthesis, let me tell you how this works because this is fascinating. So the surgeon, the first thing the surgeon does, and this will be, this will be a dental surgeon. God, you don’t want an ophthalmologist going anywhere near your teeth. What the surgeon will do is extract a tooth.

It’s typically a canine. It’s one of the big ones. And then they’ll shave that tooth down to form basically a, just a rectangular. Layer. So they make it kind of thin and rectangular shaped. Um, and then they, in within that tooth, they drill a hole in the center of the tooth to have a little rectangle of tooth tissue with a hole in the center of it.

Once, and that’s called the frame. Once the frame is finished, the doctor, uh, will then install a tiny [00:22:00] plastic telescopic lens. Which is ideally what the, you know, that’s what the plan is for the patient to see through that little lens. Um, so they put that into the, into the frame through that hole, and then that implant.

Is actually sutured into the patient’s cheek, all right, where it’s going to stay there for a few months as new tissue grows around it, because you have to be able to have, you have to have your own tissue to suture onto the eye to, to allow that, that lens inside the tooth to remain steady and where it needs to be.

And so you allow your own tissue in your cheek to grow around that implant, that tooth. So that you can then take it out of your tooth and suture it onto the front of the eye [00:23:00] in place of that diseased tissue we’ve been talking about. Wild. It’s wild. Can you imagine like you get that suture your own tooth.

Sutured into your cheek, but the outcome of this, it can’t, it can be life changing for people because these are people, the only people that get this type of surgery are those who have just bilateral, no light perception vision. These people, they, they just, they’re totally blind. They cannot see anything, not even light most of the time.

And all of a sudden you put this, it sounds aggressive and it is, but sometimes it’s the only option for trying to get someone to allow someone to heal. to recover some of their vision. You put this in there and there are some patients that they can recover 2040 vision, 2020 vision. In fact, are there reports of people being able to ski with one of these in before they were no light perception, all of a sudden they can, [00:24:00] they can do this now, granted, this is like very specific types of patients would benefit from this, right?

There are. Lots of different types of blindness caused by a lot of different things. If you have retinal blindness, you’ve had a bad retinal detachment or multiple retina surgeries, or maybe you had a retinopathy, retinopathy of prematurity as a kid, or maybe you had a central retinal artery occlusion, terrible diabetic retinopathy of any number of things.

You had a melanoma of your eye that was treated. Though none of those things you, you, this will not restore your vision. All right, this is pure corneal blindness, what we call corneal blindness. The reason you’re blind is because your cornea is diseased and it’s got to be a specific type of corneal blindness as well.

So it’s not a large group of people, but the fact that we can do this is remarkable. Now here’s the biggest problem. These types of eyes, these types of implants are prone to [00:25:00] complications. Glaucoma can be a big problem. Um, uh, and, and part of this is just because the underlying disorder, the reason why this happened to the patient in the first place, I mean, chances are it’s damaging other parts of the eye, including the trabecular mesh work, which is right next to the cornea.

So it’s not hard for like a. A chemical injury to damage the cornea, it can also damage the trabecular mesh work, which is the drainage system of the eye, leading to glaucoma. So glaucoma is very common in this patient group, um, infection after something like this is unfortunately fairly common. They’ve got a, a tremendous amount of drops and a maintenance regimen to keep this as healthy as possible.

But even so, I remember seeing patients that didn’t have this specific type of surgery done, but a similar one of keratoprosthesis, um, that had wonderful vision for [00:26:00] 3 to 5 years. And for a lot of people, that is worth it. That’s worth the, the frequent. Every couple months of visits for years, the frequent, sometimes every two hour eye drops they have to take around the clock, like just to have some useful vision, it’s life changing for people.

And you may only get it for a few years, but that’s like three more years of vision that you wouldn’t have normally three more years of being able to see your loved ones in the face. And see them when they’re talking to you and watching your kids grow up and, and being able to see a sunset and, and play with your dog or whatever it is, you know, just think about like, that’s, that’s.

That’s amazing to give to someone, even if it’s just for a few years. So I hope that work continues on these keratoprosthesis. I know it is. Um, and it’s hard to do research on this type of thing, [00:27:00] unfortunately, just because of, um, uh, you know, anytime you have a disease or something that’s affecting a small group of people, it’s hard to get research funding for it.

But there’s lots of people doing lots of great work around keratoprosthesis. Uh, and it’s, it’s, it’s helping a lot of people. Hopefully that still continues to be the case, even with what’s going on with research funding in this country, which is very sad and a challenge. Uh, so let’s, um, let’s take a break.

We’ll come back and do some comments.

All right, guys, I’m getting these comments, uh, that you guys left on the most recent episode that was published. Is there a way to reverse eye dilation? Um, not my most popular episode. I don’t know what it is. I guess you guys just aren’t, aren’t that maybe it was a bad headline. Um, but I, I’m still trying to figure out what hits.

For people and what doesn’t hit for people. So, uh, [00:28:00] anyway, we’ll keep tinkering around with it. Uh, that’s okay though. You had some, you guys gave us some, uh, some great comments here. Uh, so I’ll just read a few. Um, all right. At never time to try again, it’s always time to try again. So curious, some psychiatric disorders like schizophrenia come with soft neurological symptoms like slow blinking.

That’s true. Parkinson’s is the classic one. Very slow blinking. Just everything slows down this, this psycho motor slowing, um, uh, slow blinking. Do these patients have higher rates of dry eye? I’ve never asked a patient, but maybe absolutely. Oh yeah, this is, this is one of the like for Parkinson’s in particular.

Um, the two things I talk about with Parkinson’s a lot is dry eye because I’ll sit there, I’ll have the patient Who’s got kind of, usually it’s more moderate to severe Parkinson’s. I’ll sit there and watch them. [00:29:00] They’re looking at me the whole, uh, I appointment and not once do they blink. And I point that out to them.

I was like, you know, that the whole time we’ve been talking, I’m not seeing you blink one time. Most people blink every seven to eight seconds. Like that’s, that’s what’s typical. You’re probably blinking right now because I’m talking about blinking. I know I am. Uh, and so I talked to them about how dry eyes, very common because everything slows down.

We don’t blink. That’s the windshield wiper of our eye. All right. We got a blank. Those eyelids have a purpose. And also, um, convergence is a big thing with, with Parkinson’s. So people start having lots of, um, a double vision problems trying to read. Uh, and part of the trouble with reading is because the eyes are dry as well, but you have trouble converging your eyes.

Um, and, uh, and so that, that, that, that’s really challenging. Sometimes we have to do prism glasses to try to correct that. And, uh, uh, and so we talked about artificial tears frequently. Uh, and then [00:30:00] there’s other, you know, um, schizophrenia is a good example. Some of the medications slow people down, but also there are certain symptom, symptomatology with schizophrenia or other, uh, you know, delusional disorders and, uh, other psychiatric disorders that, um, uh, results in slowing down and people just, they, they, they don’t have a normal blink.

Anything that doesn’t give you a normal blink, either the rate of blinking or just the. Physical mechanics of the eyelid, like Bell’s palsy, they can, they, they’re trying to blink, but the, the, the facial nerve is paralyzed. And so they’re, they’re not able to close their eyes all the way. In that situation, I’ll have people tape their eyelid closed at night.

And that’s, that’s a way to combat that. We’re using lots of ointment because ointment is a much better lubricant than eye drops. The problem with ointment is that it causes lots of, [00:31:00] uh, even more blurriness because no one likes having ointment in their eye. Uh, but yeah, uh, psychiatric diseases, um, and certain neurologic diseases, uh, have, uh, uh, dry eye does become a big problem.

Great question. Um, Let’s I’ll talk a little bit more about dry eye. Just a couple of things. So dry eye is one of its, like I said, it’s the most common thing that I talked to patients about. There’s different types of dry eye. And the reason I want to talk about this because there are a lot of people out there, a lot of eye doctors, both ophthalmologists and optometrists that offer very expensive treatments for dry eye that you might not need.

So I’m always in favor of people getting a second opinion for surgery, especially on eyes. LASIK, even cataract surgery, um, but mostly refractive surgery, high ticket items. Uh, uh, I, [00:32:00] I always encourage you to get another opinion. All right. There’s no harm in doing that. You might be out a little bit of money.

But I mean, LASIK, you know, that’s going to cost you 10 grand. So you might as well like get another opinion. Just make sure that the first doctor you saw knows what they’re talking about as a physician. I, I welcome that. It’s totally, in fact, sometimes if a patient I’m seeing in clinic. I can tell they’re skeptical.

They don’t quite believe what I’m saying. I’ll say, uh, you know, I’m, I’m happy to set you up with someone, uh, to talk, you know, if you want another opinion, totally, it’s not gonna, you know, it’s not gonna hurt my feelings. Because this is a big decision for people and it’s, it’s, uh, you know, I want, just like I want to be comfortable operating on somebody.

I want the patient to be comfortable. And if that means just checking in with another surgeon to make sure that I know what I’m talking about, totally fine. No problem. So you should feel empowered to get [00:33:00] multiple opinions in the world of dry eye. There’s lots of cash pay small little procedures that as opposed to cataract surgery, which is just ophthalmologist.

A lot of optometrists also offer dry eye treatment. So it’s both optometrist and ophthalmologist. So you’re going to get a lot of people offering you a lot of different things for dry eye. So I just want to talk about the different types of dry eye. So first, there’s the type of dry eye where you just don’t make tears.

This is probably the least common form of dry eye. You don’t make tears. So, you have a problem with your lacrimal gland. Maybe you had surgery on your lacrimal gland. Maybe you had a lacrimal gland cancer, um, or some kind of congenital abnormality. Uh, you could also have an autoimmune condition like Sjogren’s where you have Inflammatory cell infiltration of the lacrimal glands, because you [00:34:00] have lots of different lacrimal glands.

You have the main one, you have accessory lacrimal glands, all of them produce tears. So if you have an autoimmune condition that’s cutting off the tear production, You’re going to get dry that has different types of treatments. All right. So for that, we would treat with, um, certainly artificial tears. You have to substitute the lack of tears with, with more tears.

Uh, but also things like restasis. It’s good for something like that. Um, the other thing that I would lump into this category would also be dry eye as a complication of, of, um, uh, LASIK. Because in LASIK, you’re. You’re cutting the nerves using a, you’re making a flap in the cornea and that does cut some of the nerves that can make it to where you decrease the sensation of the cornea and that is something your corneal sensation, all the nerve growth factors involved in keeping your cornea healthy.

[00:35:00] is what helps to produce more tears. And so, you cut the flap, the LASIK flap, it’s gonna cut some of those nerves, and it’s really pretty common to have a little bit of dry eye. Some people have a lot of dry eye, some people have severe, debilitating dry eye. That’s very, very rare, but it does happen. And so, um, same treatment rules apply.

Artificial tears, but also something like Restasis, which is cyclosporine, has been shown to, to promote tear production. And so, that’s, that’s probably the, the, would be the first line treatment. But then, you can also try to keep the tears on the eye with punctal plugs. You’ve a little, put a little plug in the tear drainage tube that allows the, the tears that you do make to stay on the eye.

That’s another treatment option for people that just don’t make enough tears. That’s not the most common form of dry eye. I would say the most common form of dry eye that we see is [00:36:00] evaporative dry eye. So that means that the tears that you make are not working well enough. They are leaving the eye. And the reason that happens is because you do not have an oil layer that supports That insulates those tears because you have a problem with your eyelid, you have a problem with your meibomian glands, which are the glands in the eyelid that produce that oil.

So what happens normally is your eye produces oil that covers, that insulates those tears and keeps them on the eye for longer if you don’t have that oil layer. The tears that you make will evaporate. That’s why we call it evaporative dry eye. They evaporate into the atmosphere. They drain. You just don’t have them.

They don’t last as long as they should and you end up with dry eye symptoms. So people that get styes, I know a lot of you listening probably had styes. Um, [00:37:00] that is a problem with your meibomian gland. That gland gets, gets plugged up. The oil builds up in the eyelid, gets red and angry and inflamed. You have meibomian gland disease and that leads to dry eye.

Now the treatments for that are different than the treatments for just not making tears. You can’t treat meibomian gland disease with Restasis or you can’t just treat it with with supplemental tears or with punctal plugs. That doesn’t make any sense. You’re not treating the reason your eyes are dry.

You got to improve the health of the oil glands. And so that requires you can do, um, that’s when we start talking about hot compresses for people. Sometimes we’ll give anti inflammatories like, um, like prednisolone or Toberdex or Maxotrol. These are common medications that can decrease the inflammation along the, the eyelid margin.

Sometimes, uh, we’ll treat [00:38:00] Demodex. Demodex is a little mite that lives on in most of our bodies that can cause blepharitis, inflammation of the eyelids that causes those oil glands not work as well. And so we’ll, we’ll treat that. So there’s, my point is, it’s not just dry eye. There’s lots of different reasons for dry eye.

Maybe you have dry eye because you’ve been using contacts, you’ve been sleeping in contacts, or you’ve just been wearing them for 30 plus years. And you’ve, you’ve just rubbed your eyes raw, and you have lost some sensation on the, on the surface of the eye. That’s a totally different, that’s called neurotrophic keratitis.

You don’t have sensation on the cornea. Similar to LASIK, a little bit different. So that’s why, and so you, you can very easily be offered a treatment that costs a thousand bucks that may not be actually getting to the reason that your eyes [00:39:00] are dry. And so don’t hesitate. If someone says, Oh, you know what?

You’d really benefit from this, this, and this, uh, we have a package for you. It’s going to be about 3, 800 bucks. Go ask somebody else first. Maybe you need that. Ask someone else. Don’t be afraid to do that. Don’t feel anybody that pressures you into a cash pay option, like a car salesman. They don’t want to let you leave the lot.

Talk to someone else first. That’s not the way you practice medicine. That’s not okay. All right. You present the options. You don’t pressure someone into an expensive treatment. All right. That’s that’s not okay. All right. Let’s, uh, a couple more of the comments here. Oh, Oh, and in the last episode, I talked a bit about, uh, reversing, obviously the title of the episode was reversing dilation.

Uh, so at Shea McGee 9 1 [00:40:00] 4 8 said my optometrist no longer dilates my eyes. There’s this machine that takes pictures of the back of the eye. Is that okay? Yes, that is okay. Um, It’s, it’s, uh, it’s called a, uh, Optos, that’s the name of the machine and it basically it takes a wide angle image of your retina, um, it’s.

It’s a, it’s a 2d image and that’s part of the problem. Like there’s a couple of problems. First of all, I don’t think I can, I can still get a more detailed picture of the back of the eye just by doing a dilated exam. So I still think it’s superior. That’s my personal preference. You can see a lot with the optus image.

The other problem with it is that you pay for that. You are paying for that optus image versus just a regular dilated exam. Like that goes to your insurance. So you don’t pay extra for that. So you’re going to be paying for both the exam and that extra picture, that extra picture that they take [00:41:00] versus maybe just an exam.

So, so anyway, there’s, there’s, there’s costs to that. And it’s usually something like 50 bucks or 50 to a hundred bucks. Probably typically, I think it’s around there. Uh, so there are downsides to that. You get, I mean, you know, imaging costs money. And so, you know, keep that in mind, um, at Jim Belter too, with regards to screen time, can closing your eyes for 20 seconds work the same as looking away?

It does in a way. Uh, yes, you can. We always tell people to take 20 second breaks. Uh, and so you can just blink your eyes. That’s fine. That’s kind of what we’re trying to get people to do by looking away from the screen, you’re looking away from the thing that is just sucking in your attention and keeping you from blinking.

So by having people look away, it does two things. One, it can, that can be the reminder to yourself to blink. You look away, you blink, but also it’s not just [00:42:00] looking away from the screen. It’s looking in the distance. Because what that also does is it, it reduces the strain because you’re constantly focusing your eyes up close.

So by looking away from the screen, ideally you’re looking out the window if you have a window or at least looking like more than, you know, six feet away because it allows you to relax your accommodation muscles, your ciliary muscles. And can help reduce eyestrain. So yeah, you can just keep looking at the screen if you’re still remembering to blink, but, but you’re not, you might still have some of the eyestrain component of screen time.

Uh, which by the way, blue light blocking is not going to take care of that. No studies have shown it helps with eyestrain, just circadian rhythm stuff, sleeping at night, but not eyestrain on a computer all day. Uh, all right. Question from at Jemima lamb. Um, Jim, I’m a lamb, seven, eight question. Is it normal to have a different eye pressure [00:43:00] in each eye?

Yes. Uh, often they are, unless you have glaucoma or something, some disease process, the eyes will typically have, they might be the same, but they’re typically within two or two or three points of one another. So yeah, it’s really common. Each eye is there. They’re separate eyes, you know, so they act, they, they work together.

To look at things, but in a lot of ways, they, they are independent things. And so you can have something happen with one eye, you can get glaucoma in one eye and not get it in the other. Um, but, uh, typically, unless you’re in a disease situation, a glaucoma situation, they are roughly the same, but they can be a little different.

So don’t let that worry you. Um, all right. And then let’s see at never time to try again. Wait, I think it. Oh, yeah, this is the second, second comment from never, never time to try again, uh, uh, said I would pay that referring to the, the reversing [00:44:00] dilation drops. I keep getting shamed over refusing dilation, but I do my appointments before work.

I have to work and see my computer. I’m sorry. You know, that’s a great point and maybe we should be keeping those on hand and, and so letting people know that that’s an option. Um, I don’t have any problem with it. Like I said before, those drops, they’re just kind of expensive. And uh, from a practice management standpoint, it, I don’t think it’s cost effective for us to keep them in the clinic.

But uh, if I hear from enough patients that want it. Then my mind can be changed on that, I guess, is the point. All right. Thank you guys. I will, we’ll stop there. Uh, we’ll do more next time. I appreciate, um, uh, all the questions again at Glockham. Fleckens is the, where all these video episodes are posted of knock, knock.

I, if you want to see me, I look, I always come in after operating and do these recordings. So I typically kind of look like a mess. So if you want to see me looking like a mess, then check out [00:45:00] YouTube at Glock and Fleckens, leave a comment. That’s where I get all of these that I’m reading to you. Um, but, uh, if you’re not, if you’re not a YouTube person, well, just listen to me anywhere.

And thank you for listening. By the way, I am your host. Will Flannery also known as Dr. Glockman Flecken. Thanks to my executive producers, Aaron Corey, Rob Golden, and Shanti Brick. Our editor engineers Jason Portizzo. Our music is by Omer Binzvi. Thanks all. Knock, knock high is a human content. We’ll see you next time.

Goodbye.

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