Transcript

[00:00:00] Today’s episode is brought to you by Dax CoPilot from Microsoft. Dax CoPilot is your AI assistant for automating clinical documentation and just being more efficient, reducing administrative burden, all that stuff that makes us feel overwhelmed and burnt out. To learn more about how Dax CoPilot can help you help improve healthcare experiences for both you and your patients, stick around after the episode or visit aka.

daxcopilot. com. That’s aka. ms. knockknockhigh. Good evening, everybody. Welcome to knock, knock. Hi, sorry. No, it’s not knock, knock. Hi. It’s not knock. I with me, your host, Dr. Glaucon Flecken.

I decided to try a [00:01:00] slightly different introduction by saying good morning because I’ve been watching. This like my new favorite series on TikTok is, uh, especially in the month of October is this woman who does 31 days of haunted hydrology, like scary water. Thing like natural waters and caves and and and lakes and just spooky things I’m a big spooky guy.

I like spooky stuff. I like scary movies. I like Haunted books books about haunted things. I just I don’t have any haunted books. I don’t have anything haunted in my house But I do like scary month. I like spooky month. I like spooky season. This is a great time of year I’m enjoying it. Although it’s I’ve got something coming up.

I’m not too excited about that’s right My final call week of the year is is commencing [00:02:00] in a little over a week I’m already mentally preparing myself everyone. It’s just in the back of my mind. It’s like it’s coming. It’s coming. It’s gonna be here It’s gonna be here You’re gonna have to cover a bunch of hospitals.

You have to see a bunch of patients. You have to come in on the weekend. You gotta do the thing that, that ophthalmologists just dare to go to places where ophthalmologists dare not venture. Places like the ICU. The hospital at night? I don’t know. Anyway, I’m not gonna worry about it now because it’s it’s like over a week away.

So I’m just I’m just gonna enjoy the last remnants of of Of october while I can. It’s a great month october. I love halloween. All right. Well, I’m glad you’re with me today I’m glad you’re here to learn about some eyeball stuff. Maybe a few other things too. Uh, the first thing I want to do right off the bat here just got back not too long ago from Pittsburgh.

We had [00:03:00] two live shows in Pittsburgh and I gotta say Awesome crowds. Like, we always have like really good crowds, but sometimes the crowds are just engaged. They’re just, they’re ready. They’re like, they were so enthusiastic and excited and more costumes, I think, than I’ve ever seen. Uh, it’s, it was almost like they just rarely Ever get any internet comedian, ophthalmologists coming through for live shows in Pittsburgh.

I, who knows when last time that happened. And, uh, I, I just, I loved it. I love the crowd. They, they, they, they showed up. So all of you in Pittsburgh, if you’re listening, if you’re watching, thank you for coming out to the show, uh, wife and death, we had a wonderful time. I just enjoyed, you’ve been keeping Pittsburgh a secret.

Okay, what’s the deal here? Like, I did not know what to expect. I, honestly, I did not do any, like, [00:04:00] research into what Pittsburgh was like before I went out there. I thought it was just gonna be all factories. I don’t know why I thought that. I don’t know, Steelers, Pittsburgh, it feels like it’s like a, Factory town just by name and, and from what little I know about it, which is like almost nothing.

I, I thought like just steel mills everywhere, which apparently there used to be a lot of, that’s why they were called the Steelers, but not so much anymore. And the town though, it’s not a factory town. No, it’s, it’s, It’s beautiful. There’s these rolling hills. It was very, the leaves were turning colors.

There was the foliage. There was, uh, uh, uh, uh, uh, There’s wonderful water features, the rivers going everywhere, and there’s, there’s beautiful bridges. It was great. It was very pleasant to look at Pittsburgh. [00:05:00] And, um, so I enjoyed talking about that with the crowd and, uh, uh, I did make a joke about how, you know, why would you ever want to choose to live in Philadelphia when Pittsburgh is an option?

They ate that up. I try to, I like to do a little bit of pandering to the crowd. Not much, not, not too much that it’s, it’s, you know, uh, uh, it, it comes across as heavy handed. I try not try to, to be light with it. Uh, but I did do a little bit of pandering, so, but it, it, it was coming from the heart because I honestly, I was very impressed, very impressed by Pittsburgh.

So, uh, shout out to that city. Uh oh. Also, I gotta say I went. I went to a Steelers game! So this is the thing, Kristen is always, I do a lot of traveling, go to all these cities all over the country, around the world, to do speaking, and you know, I’ve been doing this for a couple years now, and Kristen’s always telling me, you need to have [00:06:00] fun when you do these things.

What I’m terrible at is, is that exact thing. I’m just, I tend to go to these cities, whatever it is, and I just, I’ll do the thing I’m supposed to do. And then most of the time hang out in my hotel room. And just counting down the hours until I go back to see my family again. Um, but Kristen’s like, stop it.

Like live your life. I didn’t save you for nothing. Go have fun, do something. And so I did something in Pittsburgh. I went to a Steelers game by myself. I was like, I’m going to spend a couple hundred bucks on a ticket last minute. And I did, and I went to a Steelers game, and I don’t regret it. It was awesome.

It was actually my first NFL game. First NFL game. I’ve been, I love football. I love football. The first time I’ve been to a game, I was on the 40 yard line, lower level, about, uh, I don’t know, 30 rows [00:07:00] up. So I had a nice, nice overview of the field. I could actually see that everything is happening. Um, and, uh, I had an awesome time.

I was waving my terrible towel around. I, cause someone gave one to me at the show and, uh, I’m not a Pittsburgh fan. Uh, I rooted for the home team because it was either the Steelers or the Jets. That’s that’s it. It’s an easy decision to make. I think, uh, I mean, when you’re, you’re among the home crowd, you know, it’s, it’s, you want to, you want to, you want everybody to be happy around you.

So it was really, it was really a wonderful time. Uh, uh, it, it really, it made me want to go to a lot more NFL games around the country. So I think that’s going to be my mission. Now I’m going to try to go to all of the different, uh, Uh, cities that have NFL teams. Uh, I don’t know when the next one’s going to be.

It’s probably going to be a while because I don’t know if I have much more going on before the end of the season, but it was a lot of fun. It’s a lot of [00:08:00] fun. I enjoyed it. All right, let’s take a, uh, you know, let’s go ahead and take a break. And, and then I got some, uh, number of other things for you guys.

All right.

Okay. So, uh, this is a time of year I’ve been seeing a lot of posts on social media Um, interview season for residency. And it, it kind of shocked me to learn that residency interviews are once again, this year, almost entirely virtual. So this started with the pandemic and it’s, I guess it’s just, it’s kept going.

Um, I, I guess I thought they would be in person by now. And it sounds like a lot of programs are actually preferring, you know, Um, from what I can see on social media are, are, are actually preferring to do it virtually just because of the costs and time savings that you [00:09:00] get, um, uh, mainly on the applicant side, because it’s a tremendous cost.

You go into debt. I took out extra loans just so I could go on like 10 different interviews around the country. Uh, you know, uh, at that time there was no Uber when God, there’s so many things that remind you how old you’re getting, uh, no Uber. So I was, I was getting rental cars everywhere. I was going hotel rooms, flights.

Um, it’s expensive. It’s expensive. And so, uh, I don’t know. I feel like I’m kind of torn and not that it matters what I think, but in terms of like, like, is it better to do residency interviews virtually or in person? What, like, what’s the, the, the pros and cons? What’s, what’s the breakdown here? My gut reaction is like, Oh, it’s terrible.

It should always be in person. Like you want to see [00:10:00] the place that you’re going to be living for X number of years, but then the financial benefit of, of just staying at home and doing a virtual interview, plus what’s the most important thing? You know, yeah, like seeing the hospital, like, okay, that’s great.

Seeing the city you’re going to be living in. That’s, that’s fine. I would, I would argue though, with residency, those things are probably not as important. And that’s mainly because, man, you’re working so much in residency. Like you see more of the hospital, you see more of the. The people in the hospital, the people you’re going to be working with day after day, you’re going to be seeing them a lot more than you will probably even your own family for long stretches of time, much less the surrounding city.

And so, what do you, you’re losing some things with a virtual interview, sure. Like it is nice to see where you’re living, but that can [00:11:00] also be done kind of at a later date, but you’re still able to at least have a conversation with the people that you’re going to be with and get a sense of what their personality is, what their values are, you can ask all your questions, all that.

So I, I don’t know, I’m starting to come around on the idea that yeah, maybe these interviews really can like be good enough virtually that you can get a good sense of how you want to create your rank list. And I’ve seen posts from people that are like, this is horrible, like this, how can you possibly keep doing these virtual interviews?

But I don’t know. There’s, I, I see, I, I see the argument for, and I’m starting to lean more toward, there’s a better argument for having virtual interviews than not having virtual interviews. And they’ve been doing it for now four years. And I, I, I mean, I guess it’s going okay. So I don’t know. I would love to hear from people though.

Any residents want to chime in, uh, [00:12:00] about your experience with, with, uh, virtual interviews, or I guess now it might even be fellows or attendings who had virtual interviews, um, I loved interview season, I did, but it was crazy expensive. And I still remember that. I’m still paying for it. I’m still paying for it, but um, so, I don’t know.

I don’t know. I don’t know what the right answer is, but um, I’m more accepting of that than I, than, than I guess I, I was when I initially recoiled in horror at the idea that in 2024, we’re still making them do virtual interviews. Kind of does make sense. All right. Um, okay. So here’s a, I got a couple of I things that I want to do.

First one, uh, I thought we could have a little bit of fun and not have such a serious topic. I don’t like doing too many serious things. For you guys, let’s have a little fun. So let’s do, um, I, I decided to put together a list of what I [00:13:00] think, according to me, a board certified ophthalmologist, what I think are the five most impractical glasses worn in cinema.

Now that’s, there’s a lot, a lot of glasses wearers in movies and TV shows. Okay, but this is the, these are the, these are five that I think are just, like, what are they doing? What kind of glasses are we talking? What are these? They’re terrible. They don’t help you see better. They’re just, just, just impractical.

Impractical, not so much the worst, more just impractical because like, obviously you can have some artistic license when you’re having a costume and if someone’s wearing glasses, uh, it’s like, uh, I’ll use Steve Urkel as an example, like obviously Steve Urkel’s glasses, they’re not great. They’re not even for the time period.

They’re not great. They’re the red giant kind of, they got the chain on them. It just, it just not [00:14:00] great. But they make sense for that character, all right? So they’re not impractical. It makes sense. Guy’s a nerd, all right? He’s got, he’s supposed to have some kind of nerd glasses. In this case, they chose nerd glasses that would also do well on, uh, the, the show, um, with, uh, all the old ladies in it.

What’s it? Designing women? No, the, uh, God, what’s the name of that? Anyway, I can’t, it’s escaping me now. They are, they’re kind of old lady glasses. That’s, that’s, I guess that’s the point. Uh, so anyway. These are five impractical pairs of glasses that I have seen, um, uh, in my research and in my life. All right.

The first we’re going to go with Morpheus from the matrix. You guys now I love, I love the matrix. I love the movie. But come on, Morpheus. I mean, everybody else is wearing more practical sunglasses, and we’re all talking sunglasses here, because day or night, that’s the first thing. They’re all wearing these [00:15:00] sunglasses at night.

Okay, sure. It’s an artistic decision, like, they’re all cool, wearing leather, wearing dark sunglasses. Surely at night, but Morpheus, he’s got these sunglasses that I don’t even know what they’re called, but you don’t even see them like in the real world. Uh, that they just, they pinch your nasal bridge and that’s how they stay on.

There’s no ear pieces. They just pinch and stay right on the face. Like Morpheus at any moment could have to fight agents. There’s no way those things are staying on. you They, there’s, they, they can’t be that well made that they stick to your face that well, it just, it irritates me every time I see them.

It irritates me as, as, as a connoisseur of, of eyewear. Not happy with that decision. Alright. Just give us some normal sunglasses, like what’s the deal? [00:16:00] Is it supposed to be cooler that, did you just, like, they, they, that they don’t have earpieces? I don’t know. I don’t buy it. No, it just, it just seems impractical to me.

All right. So Morpheus, not a fan, not a fan of your sunglasses, bro. Uh, okay. Next Superman. I mean, technically Clark Kent, right? I mean, first of all, we all know like this, I won’t spend a lot of time on this one. It’s, it’s, uh, it’s a costume that’s not full on anybody except everybody at, in Metropolis, apparently.

But, um, uh, clearly I, I always, I dingeon if, if, if there, I mean, If in the story, they’re obviously non prescription glasses. Superman doesn’t need glasses. He has, he’s super. He has no refractive error. The guy’s, he’s not even presbyopic. How could he be? He’s perfect in every way. He’s got, I’m sure his, his super ness, his [00:17:00] super powers extend to his physiology, right?

It must. So why would that not extend also to his visual function? He’s not presbyopic. He’s probably he’s I mean his all his muscles are so strong that must include his ciliary muscle in his eye cause allowing him an extreme amount of accommodation that guy even though in Superman he’s what 30s 40s Uh, I’m sure he can, he can, the rest of us have started to dramatically lose our accommodative ability by the age of 40.

Superman, Clark Kent. No, like he’s, he’s got, he’s got max accommodation, obviously, because he can, because his, his ciliary muscles are, are massive. He’s got massive ciliary muscles. Probably causes all kinds of problems. He might even have like plateau iris, maybe even at risk for angle closure [00:18:00] glaucoma because of how massive his ciliary muscles are.

See, what happens is if you have like excess ciliary muscle or if it’s more anteriorly positioned, uh, then, um, it can, it can bow. a part of the iris forward and give you what’s called a plateau iris. And if the iris is moved a little bit too far forward, then just like you would see in like a phacomorphic type of glaucoma, where the lens inside the eye, which sits behind the iris, it gets so massive.

It starts to push that iris forward until eventually the iris just closes off the trabecular meshwork and you get a, um, You get high pressure. Well, I, I just assumed Superman would have massive ciliary muscles that would cause the iris to kind of move forward. You get this plateau iris. Bam! Closing off the trabecular meshwork.

Not great, Superman! Anyway, I’m not a fan of people who are clearly wearing [00:19:00] fake glasses. Get a better disguise. Someone else could use those glasses. Who are you fooling? The thing is though, in the original Superman with Christopher Reeve, you can tell in some of the pictures, he’s actually wearing prescription glasses.

Like he’s got progressive lenses. There’s some ad power to the bottom of those lenses. Why? You don’t need the help, Superman. You got super physiology. You’re not presbyopic. Stop wearing progressive lenses. Doesn’t make any sense. I said I wouldn’t spend much time on it, but here we are. All right. So that’s my second one.

Superman, Clark Kent. Uh, next one. We’re going to go with, um, Scrooge McDuck. All right. Now you might have to go and look up Scrooge McDuck’s glasses, but they are, they’re sitting right on his bill. Very similar, in a lot of ways, to Morpheus’s [00:20:00] glasses, um, they are, there’s no earpieces, which kind of makes sense because ducks don’t have ears, or at least cartoon ones don’t, and, uh, uh, but they sit on his bill and they’re so small he doesn’t even look through them!

Doesn’t look through them. I’ve met now at one time. Does he ever look, actually look through, even when he’s reading something, they’re so small and the eyes are so big that people does not pass through. The visual access does not pass through those lenses. No way. Scrooge McDuck. That’s my number three.

What are you doing? And how are they even staying on his bill? I, he’s the, the guy’s swimming in a vat in a, in a vault full of gold coins. Comes out still wearing his stupid glasses on his bill. Pissing me off. Scrooge McDuck, get yourself some real reading glasses. Now, [00:21:00] Scrooge McDuck is someone who’s clearly presbyopic, alright?

It takes years to amass that amount of gold coin in your vault, alright? He’s old. He’s presbyopic. He needs a real pair of reading glasses. Not these little wimpy ones that you can’t even look through because they’re so small. Speaking of small glasses, There’s a, the guy he’s in, uh, um, I forget his name.

He’s a replicant in Blade Runner 2049. The, uh, wrestler guy. I’m being very vague here, but he’s also got a similar problem. Small glasses. Very small glasses, doesn’t even look, now we’re talking about a real person though, very tiny glasses on a big face and big head, uh, can’t, doesn’t even look through them.

See, small glasses, so sometimes medically that’s necessary. Sometimes you need, if you’re highly myopic, [00:22:00] your glasses have to be so thick. If you’re like a minus 10, minus 12, your glasses have to be so thick that they’ll be extremely heavy. And you can get all kinds of distortion if the lens is too large.

So what do they do, what opticians do, what optical shops do is they will make the glasses much smaller with a high index of refraction so that you can get a smaller lens that sits on the face, is not, is not weighing down somebody and causing pain on the nasal bridge, causing headaches. And so small glasses would make sense.

If the character is highly myopic, it’s clearly not the case though. These things are non prescription. So, the replicant guy in Blade Runner 2049. And last one, last but not least, my last impractical glasses, uh, until I go and look at [00:23:00] more, is, uh, Peppa Pig’s dad. You guys seen this guy? You guys seen this illustration?

It’s outrageous. Peppa Pig, there’s no reason. His name is Daddy Pig. I feel very uncomfortable calling him Daddy Pig. Peppa Pig’s dad, Daddy Pig, wears glasses for some reason. Both of his eyes are on the same side of his head. There’s no, he’s got a nose, but the glasses do not sit on them. He’s not using his nose, uh, and he’s got ear pieces on his glasses.

Thank goodness. But, uh, from what I can tell, there are actually no ears on the side of his head. They’re on the top. There’s no ear holes. I don’t know where the ear holes are. The glasses just are sitting there. With nothing keeping them on, but it’s really like, I’m putting myself in the seat of the optician trying to make a pair of glasses for this pig.

Wow, that’s difficult. [00:24:00] Both eyes on one side of the head. Don’t know how you do that. How do you keep those things on? They’re in good position. Optician did a great job, but I don’t know. Not a big fan of that. I just don’t, don’t give daddy pig glasses, like let him just go without. How about contacts? Yeah, that seems like a reasonable option for contact lenses anyway.

All right, that’s it. Let’s take a break and we’ll talk about something that’s actually real helpful for you and you’re in, well, maybe it’s not, but at least real information.

Okay, here we go. So, um, We’re going to do a little bit here, uh, uh, right now we’re going to do a little bit on eye symptoms. So I was looking at the YouTube comments again, all these episodes of Knock Knock Eye are posted, uh, anywhere you want to listen to [00:25:00] your podcast, but also we put them up, the video episodes up on our YouTube channel at Glaucum Fleckens.

So I was going through the comments on the most recent, um, the most recent episode where I talk about, uh, child eye problems that you shouldn’t ignore. Had some good comments. People really enjoyed the, the, the, the pediatric stuff, a little bit outside my wheelhouse. I don’t see a whole lot of kids. I know a lot of the major, as a comprehensive ophthalmologist, I dabble in all different areas of the eye.

Um, and so, uh, it was, it was fun to. to go through some of those things. Um, there was a couple of comments I wanted to, to point out. Oh, this is, this is a great one. Okay. This is from at Anna Davis 2547 said, I’d love that you mentioned a head tilt and eye covering. So one of the things that I mentioned.

With kids is, uh, these are like signs, things you can look for like as a parent or as a teacher or [00:26:00] whatever. Um, is one thing is, is a child tilting their head or covering their eye. That could be an indication that maybe that they don’t see well or that tilting their head a certain way can indicate a refractive error like a stigmatism or, uh, maybe even a strabismus, a misalignment to the eyes that’s fixed by tilting their head to one side or the other like a fourth nerve palsy, people can adopt a head tilt in one direction to help bring the images together.

So that’s something you can look at, look for in kids. And so this, um, at Anna Davis, 2547 said, love that you mentioned a head tilt and eye covering. We check for amblyopia as teachers in both kindergarten and first grade. Awesome idea. Every kid should be tested for amblyopia around that time in their life.

Five years old, six years old, maybe even a little bit sooner, four. That’s probably as early as you’d really need to. Um, unless there’s a family [00:27:00] history of eye problems. Covering one eye can be hard to spot. The child may rest their head on an arm or tilt the book while reading. That’s something I didn’t even think about.

So, uh, one sign might be a child resting their head on their arm a lot, or tilting their book while reading. That’s a, those are really cool, like, helpful tips. So, thank you for that. Um, and, uh, amblyopia is often caused by strabismus. Yes, I agree. Mild cases can be difficult to see. And that’s great insight from a teacher.

So, um, that’s, that’s the kind of thing you pick up whenever you’ve, like, been teaching for a long time. Like, I could tell that, that Anna, you are a fantastic teacher and have those types of observational skills. So thank you for that, for that comment. Um, and then I asked, you know, what other topics people would like to discuss?

Someone said, can you do an episode on metamorphopsia? Why do we not have an objective way of measuring [00:28:00] Metamorphopsia, an objective way of measuring it. It’s so frustrating to be able to, uh, to not be able to communicate the extent of the problem to an ophthalmologist. I can read the chart just fine, but have no way of describing just how bent out of shape the lines of letters are.

That’s a great question, uh, and I don’t even have to do a whole episode of it. I’ll just do it right here. So, metamorphopsia, the reason we don’t have an objective way of measuring it, of, of, of measuring it is because it’s a subjective complaint. So metamorphopsia is, is the perception of lines that should be straight that you see that they have a curve, or they have, they’re bent in some way.

And that typically indicates a distortion of the normal retina architecture. So the retina has a very classic appearance when you do it like a cross sectional image. It’s fairly [00:29:00] flat, and then right in the middle where the fovea is, that’s your highest point of resolution to your vision, the fovea, you get a little dip.

In the retina right there, and then it comes out of the dip and it goes flat again. So just kind of flat, flat, flat, dip in the middle. That’s the normal retinal, uh, macula, which is the center of your retina. Macular architecture. Well, if you have Anything that distorts that normal architecture, whether it’s scar tissue that causes it to be all bumpy, uh, whether it’s macular degeneration, uh, whether it’s macular edema, you get swelling in the retina.

There’s all kinds of, there’s lots of different things that can cause a change in the shape of the retina. And, um, um, oh, by the way, this was at JLK625, so I want to shout out the person that asked me this, this is a great [00:30:00] question. Um, but the, um, The term metamorphopsia refers to the patient’s perception of that, of that distortion of the normal retina architecture.

So yeah, you have the distortion, but it’s causing that change in your vision. It’s causing lines that should be straight, like curtains, to all of a sudden have a big Um, and so that’s, uh, so yeah, there’s no, the most objective way we have of, of measuring that is having you draw it, which is why we have the Amsler grids.

So we have these little grids that we can give patients who have problems like macular degeneration or epiretinal membranes, um, where they can actually draw their distortion. Uh, and so it’s a, it’s a subjective thing because you’re the one seeing it. And that’s, uh, we, I wish we had a better way of measuring that, but in a way we do, [00:31:00] we can see the distorted architecture in your retina.

We can take pictures of it. So we have that, but we don’t, we don’t have any way of measuring your perception of it, other than just seeing it. listening to you, which hopefully we do, uh, and, and maybe having you draw it out and showing us what you’re experiencing. Because it can be very frustrating, I understand, you know, to deal with something like that.

That’s a good question. Metamorphopsia. It’s a, it’s a pretty common symptom that we, we encounter in the eye clinic. Other common symptoms. We can go through some of these. Burning, you guys know what burning, so this will be a good test for all of you who have been listening to all these Knock Knock Eye episodes over the, over the months, the last few months.

Metamorph, uh, so we’re talking about metamorphopsia. How about burning? You know, remember what burning? Usually indicates, that would be blepharitis. Blepharitis, inflammation of the eyelids. One of the most common things we see in the eye [00:32:00] clinic. Gets worse as you get older. If you’re prone to styes, chalazion, you have blepharitis.

So, blepharitis will lead to stye formation because you get all this inflammation of the eyelid margin that causes the oil glands in the eyelid, the meibomian glands to get plugged up and all of a sudden the stye forms. So burning, someone’s like, my eyes are just burning. That’s blepharitis. You can get a flare of it.

It can come and go. You get this big flare that lasts for a few weeks, goes away on its own or with medication. Anyway, that’s blepharitis. Classic blepharitis is burning discomfort. Itching. What is itching? Itching. Itching. That should be easy. Allergic conjunctivitis. Allergy. Or sometimes you have, I had a patient today, had a horrible periocular dermatitis.

Just terrible allergy on both eyes, just all around the eye, uh, gave some steroid ointment to use that’s safe for the eyes, like Maxitrol, [00:33:00] Toberdex, something like that. Itching. Allergy. Itching is allergy. Flashes of light. Allergies. You guys remember what Flashes of Light is? I’m, I’m, I’m asking you like you’re gonna tell me.

I’m just looking at myself in a camera right now. Flashes would be retinal tears or retinal detachments or some kind of retinal pathology, typically a retinal tear. So you come in, we do a dilated exam, put those nasty drops in your eyes that dilate your eye and make you not see anything for a while. 4 6 hours those things work.

People always ask me. 4 6 hours you won’t be able to see. Then we check and make sure you don’t have any retinal tears, retinal detachments. Uh, how about blackout of your vision? Ooh, that’s an interesting one. Vision blackout. Vision went black. That symptom depends. It depends on how long, but it’s always typically something serious.

So, blackout. If it’s like a second or two [00:34:00] seconds of blackout vision, maybe whenever you change positions, that’s indicative of increased intracranial pressure and often we would see optic disc edema as a result of increased intracranial pressure. Causes the optic nerves to be swollen in what we call transient visual obscurations, because we gotta have a fancy word for everything, TVOs.

Very common sign of, uh, or symptom of Papilledema or optic disc edema, which are two different things, by the way. Optic disc edema is a specific finding in the eye. Papilledema, when you say papilledema, that denotes that the optic disc edema is due to increased intracranial pressure. But there’s lots of diseases that give you an swollen optic nerve, optic disc edema that have nothing to do with increased intracranial pressure.

So if you say papilledema to an ophthalmologist, that [00:35:00] means you’re saying that the patient has increased intracranial pressure. A lot of people use papilledema, really they’re just saying that the optic nerve is swollen, but it’s not technically papilledema. You wouldn’t know that unless you actually got an MRI and did a lumbar puncture to check the opening pressure.

And so, anyway. Semantic type of thing. All right. So a couple of seconds, transient visual obscurations. If it’s like five minutes or less, uh, then you’re, then you’re, that’s kind of scary territory for giant cell arteritis or any kind of blood clot that could be coming. Maybe you got a little blood clot in your, uh, or a plaque in your carotid artery that’s, that’s throwing like little emboli to your retinal vasculature caused you to have blackout visions.

Basically, it sounds that type of vision loss is vascular, so you’re thinking, okay, there’s something that’s causing a loss of blood [00:36:00] flow to the retina and causing the vision to black out temporarily, and then it comes back after a few minutes. Hopefully it comes back. If it doesn’t come back, then you’re looking for like central retinal artery occlusions.

But basically, A blackout of your vision, you’re thinking vascular, something vascular going on there. So those are some of the more common eye problems, eye symptoms, I should say, that we see. All right, here’s the last vision symptom. How about this? How about a, um, a, uh, colored, jagged lines in your vision?

It lasts for about 15, 30 minutes. Starts off small, gets much bigger, there’s color to it. It’s like a, it’s like a lightning bolt, uh, gets bigger then goes away completely, and you got a headache afterwards. You guys know what that is? That’s a migraine. That’s an ocular [00:37:00] migraine. Yeah, that’s the classic appearance of an ocular migraine.

Migraine that starts in the occipital lobe and kind of spreads out over the brain. Those are very common, and uh, uh, typically don’t go away completely. Don’t mean that there’s any kind of, you know, problem with the visual symptom. This is just, this is a brain issue. So the eyes typically, for a patient that comes in with that, because we always see patients because people freak out, right?

They have changes in their vision. Are they going blind? No, you have a migraine. It just happens to occur in the occipital lobe in the brain. Your eyes are fine. People are very reassured to know that their eyes are going to be okay. That’s, I think that’s good. That’s, those are all the vision symptoms that you guys need to hear about today.

So, um, we’ll do some more. I’ve got, I’ve got some diagnoses we’re going to do. I think next time we’re going to do a little bit on limbal stem cell deficiency. That’s an interesting one. Uh, and, um, I’ve seen some patients recently with limbal stem cell deficiency and those are cool [00:38:00] treatments and surgeries related to that as well.

Um, uh, and so, yeah. We’ll do that next time, uh, as well as some more of your Tik Tok comments. So thank you all. Give me your comments, your, your concerns, your corrections, all those things, our YouTube channel at Glockenfleckens, where you can find these episodes. I always read the comments. All right. I want to hear from you.

Let me know what you think, or if you have any suggestions on other topics, I got some good, uh, suggestions. you guys, uh, that I, you know, some people asked about torch infections, you know, so intrauterine infections, um, and how that can affect the eyes. There’s some good stuff there. Like things like rubella and very interesting things.

A little niche, but yeah, that’s what we’re here for. This is, this is for, this is for niche. This is, this is, it’s eyeballs. That’s like, and that’s what you come here for. Right. Um, but yeah, that’s what we’re here for. Let me know what you want to hear [00:39:00] about, uh, and someone also suggested, um, retinoblastoma, I think, and I think I’ve talked about that before, but we could always, you know what, maybe it’s worth it to just go back and redo some of the topics that I’ve done before, if you guys want to hear it.

We’ll do it. Um, all right. So that’s our show. Our show. That’s my show. Knock, knock. I is mine. No, uh, thank you all for listening. I’m your host. Will Flannery. Also known as Dr. Glockenflecken. Special thanks to our producers, Aaron Korney, Rob Goldman, and Shahnti Brooke. Uh, shout out to Lady Glockenflecken for convincing me to have fun on my speaking trips.

Our editor engineer is Jason Portiza. Our music is by Omer Ben Zvi. Knock, knock. I is a human. Content production. Thank you everybody for being here. We’ll see you next [00:40:00] time.