Transcript

[00:00:00] Today’s episode is brought to you by DaxCopilot from Microsoft. DaxCopilot is an AI assistant that helps automate clinical documentation and workflow to let you be more efficient and reduce all the administrative burden that comes with patient care. To learn more about how DaxCopilot can help improve healthcare experiences for both you and your patients, visit aka.

ms slash knock, knock high. Again, that’s aka. ms. Dot ms slash knock, knock. Hi.

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Hello everybody. Welcome to knock, knock. I. A midday edition. I am recording this. I just finished operating, uh, and I, uh, in lieu of my customary, uh, catnap [00:01:00] after operating, I have decided to, uh, try to impart some ophthalmology knowledge to you all, uh, and so, uh, which, which I, I, you know, it’s fine. I can, I can nap later, I’m an ophthalmologist, I’ll have some time at some point.

So hope you’re excited, hope you’re ready. Before we get to our big topic of today, which I have a good one, one we haven’t done yet, you would think that it’d be easy for me to come up with eyeball topics, but like, you know, the thing is And this is true for probably any physician, is you end up, through your career, like seeing the same things like 90 percent of the time.

It’s the last 10 percent where things go awry, things get a little crazy out there, and you end up with uh, having some interesting Uh, uh, diseases, interesting presentations, things to talk about. And so, um, I’ve had to, to dig deep into my, the recesses of my mind slash, [00:02:00] uh, old textbooks to come up with topics that I know a thing or two about to talk with you.

Uh, but, uh, you guys gave me a good suggestion today. We’ll get to that in a second. But first there’s a trend going on TikTok that’s it’s a little bit old now But it was like top five things you wouldn’t do as a blank doctor now I because I’m a smartass, you know, I I made a joke video about it. I was like, okay, here’s five things I would never do as an ophthalmologist number one heart surgery number two A colonoscopy.

I would never do those things as an ophthalmologist because I’m not trained to do them. Wasn’t obviously the intention of the, the, the trend. And so I thought I could actually do a real one this time, since I just did a joke one last time on Tik Tok. So, uh, we’re going to do it right here on knock, knock.

Hi. Alright, so, top five things. Now there’s like a lot of things I wouldn’t do as an ophthalmologist, um, but I’ll limit it to five. A few [00:03:00] of them, if you’ve been following me for a while, you just, you know some of the things I’m gonna say. Uh, so we’ll go with a couple of the obvious ones to start out with.

Number one, I would never use Visine, okay? Now it’s not just Visine, Visine’s just the easiest punching bag for me. It’s, it’s redness relievers. So, the redness relievers. are bad. They’re, they’re terrible drops for your eyes and it’s because they have, typically they have this harmful chemical called tetrahydrozoline, which is, and it’s a vasoconstrictor, which is why if you actually were to, to, to down, to drink an entire bottle of Visine, like you might die.

It’s, it’s been implicated as the cause of the murder weapon in a few cases out there. Like people have poisoned their spouses, uh, with Visine, like it’s happened. And so it’s, it’s, it can be a very dangerous thing if you, uh, if, if you consume it [00:04:00] or by mouth. Um, but it’s, it’s also not great for your eyes because people use it obviously to get rid of redness.

Nobody likes having red eyes, but your eyes are red for a reason. Now, there can be a lot of reasons for that. Over time, as we get older, our eyes get more red. We have more blood vessels on our conjunctiva. That just happens. You look at a little kid’s eyes, totally, perfectly white. There’s no, because their vasculature, they have deeper vessels that are so good, so robust, so strong that they don’t have to have a bunch of extra veins everywhere to, to drain the blood and collect the blood.

Um, the vasculature they have is just perfect. It’s amazing. Well, that just changes as you get older and you start just needing more blood vessels. There’s some angio, angiogenesis going on and you end up with blood vessels that you might not like that might make your eyes look red. So that’s one reason why your eyes can get more red over [00:05:00] time.

It’s just the natural aging process. No one likes the A word. Sorry. We all do it. It happens. If we’re lucky enough, we get to age, folks. Okay, but there’s hundreds of other reasons why your eyes could be red. Most commonly, things like dry eye, conjunctivitis, like viral conjunctivitis in the kind of acute phase, but also just chronic dry eye blepharitis.

These are typically the reasons why people start having red eyes and they start using things like Vizine. But the problem is, in Vizine, credit where credit’s due, it’s great at getting the red out. Alright, it’s not false advertisement, they just leave out what happens after that. Because it treats the redness, it constricts the blood vessels, your eyes look much more white.

But then once that medication wears off, that redness comes roaring back. Often worse than before, and so what does the person do after that happens? They use more Vizine and then the redness [00:06:00] goes away and then a while later it comes back and they use more Vizine. So you get into this cycle. You can see how this cycle is very, very good for Vizine.

Oh, they love it. You get into the redness, redness reliever cycle and the problem, you’re not actually like addressing the reason the eyes are red if there is one. If your eyes just look a little red and you have no symptoms whatsoever, It’s probably just your eyes. It’s, it’s not something that needs to be treated.

And so I always, the joke I always say is, is the only people that are, it’s okay to use redness relievers are teenagers trying to hide their pot smoking habits from their parents. That’s fine. That’s the only legitimate cause that I, or excuse that I can, I can think of. Uh, and it applies to all redness relievers, not just Visine.

Clear eyes is another one. Roto. People love Roto because it like, it’s like, it feels like menthol to your eyes, like it has this cooling sensation. That’s just what it feels like [00:07:00] when the surface of your eye just dies a little bit. Sorry. Don’t use it. Don’t use Roto. Don’t use ClearEyes. Don’t use Visine.

Um, and while we’re on the subject, don’t use homeopathic drops either. Simylacin. You guys have seen Simylacin? Look at the ingredients. It’s tap water. They’re filling up a bottle with the tap. And just selling it for 20 bucks, like don’t use the assimilation, that’s, that’s garbage. It’s stupid. It’s dumb.

It’s unregulated, even worse of all. Oh, okay. So number one on my, I would never do that as an ophthalmologist. I would never use redness relievers in particular, Vizine, my sworn enemy. I’m on the record of, uh, if I ever run for public office, one thing that’s on my agenda will be to. Um, send all the visine on earth into the sun on a big rocket ship, probably owned by Elon Musk.

Number two, [00:08:00] fireworks. You will never find fireworks in my house. I will never spend a dime on fireworks. If I take my kids, my family to a firework show, I will be very far away from the fireworks. No sparklers, no nothing. I have seen some horrendous trauma from fireworks. You can ask any emergency physician, any plastic surgeon, fingers, faces.

That’s what takes the brunt of the fireworks. Someone can’t figure out why their fireworks are not firing, they look down into it as if that’s going to help, and then explosion in the face. There’s a famous case in Iowa, it was probably maybe the year before I arrived, of a newscaster who had a major firework facial injury.

A firework blew up in his face, had to have multiple reconstructive surgeries, lost an eye. It’s bad news and if you’re not a professional, like the average person just should not dabble in explosives. That’s, that’s, you know, [00:09:00] call me crazy for that stance, but I truly believe that. The average person should not dabble in explosives.

That’s number two. Number three, using bungee cords. Another thing I’ve seen numerous injuries for, those things, they come loose. It’s going to pop right back and hit you in the eye and there’s the immutable law of physics of the universe that says if you stretch something out really far and when it comes back and hits you it’s always going to be in the eye.

I don’t know what it is, there’s some kind of magic out there and there’s some terrible black magic that makes things find the eye. Might just be because we’re always looking at the stuff we’re doing, but man, it does seem like those things always find the eyeball. Just direct shot, blunt trauma, horrible blunt trauma to the eye.

I’ve seen it with airbags too. It’s kind of a similar situation. You know, you get this direct trauma, basketballs, baseballs, softballs, tennis balls. [00:10:00] Blunt trauma can be devastating to the eye. You’re getting hyphemas, which is blood in the front of the eye. Uh, sometimes you can get ruptures of the retina that can cause bleeding, cause vision loss, cause retinal detachments.

You can get an open globe. There are two weak points to the eye that can be ruptured with a hard enough blunt trauma right at the edge of the cornea where the cornea reaches, touches the eyeball. And the other spot is right behind your extraocular muscles. That’s a weak point of the sclera. You can get a rupture.

Bad news. So, bungee cords. Just use ropes, alright? Something that doesn’t have that major bit of elasticity that can come back and snap you right in the face, alright? Ropes are fine. Especially as we get closer to, um, It’s Christmas season, you know, uh, you know, you buy your Christmas tree, you fix it to the top of your car, like, use ropes, please.

Don’t use bungee cords. Please. I don’t want to see any of those this winter. [00:11:00] Uh, number four! Sleeping in contacts. Here we go. That’s another one I’m always harping about. You know, don’t, if you’re going to wear contacts, don’t sleep in them. The night, the people that say they’re contacts, the manufacturers that say they’re night and day, you can sleep in them, like, don’t believe them.

No, there’s no world in which sleeping with a contact on your eye is safe. It creates an environment where you’re not getting enough oxygen to the eye, uh, and you have basically like a, it’s almost like a biofilm. Sitting on the surface of the eye. If you have a little scratch on the eye, if you have tiny little microabrasions, Bacteria is gonna get in there.

Especially if you have a biofilm sitting on your eyeball all night. Don’t do it. All right, don’t do it. You’re going to get an infection at some point. You’re playing with fire if you sleep in contact. So I would never, as an ophthalmologist, sleep in contact. Personally, I would never. Wear contacts, but that’s easy for me to say as someone who doesn’t need contacts.

Contacts are a wonderful thing for people who have very strong [00:12:00] prescriptions. I fully endorse contacts, particularly dailies if you can afford them, they’re expensive, but uh, daily contacts are the way to go, you don’t have to get up out of bed, you’re in bed, you go to sleep, you’re going, you’re drifting off to sleep, oh I forgot to take out my contacts, dailies are great, you just take them out, you put them on the dresser, you throw them on the floor.

Sleep in them in your bed next to you, not in your eyes though, just don’t do it, okay? It’s not worth it. I’ve seen horrible, horrible infections. Endophthalmitis, melting corneas. The bad stuff, don’t do it. And then finally, the last one, which is something that’s come up recently in my clinic, and I’m reminded every time this happens.

Don’t wait on cataract surgery. This is for all my patients over the age of 60. Once you have a cataract that is It’s starting to affect your vision, you’re having glare problems, you can’t see road signs, you’re having [00:13:00] trouble doing your hobbies, even a good pair of glasses isn’t cutting it. The glasses aren’t helping you see as good as you’d like because of cataract and someone has diagnosed a cataract in your eye and it’s visually significant and they say you can have surgery if you want.

Do it. Don’t wait. Don’t wait. You can wait a little bit, but not, don’t wait until you’re 90. Nobody should still have a cataract, I would say by the age of 80. By the age of 80, you should have cataract surgery. You’re gonna see so much better. We can do awesome, amazing things with cataract surgery. Don’t wait.

And the biggest thing is because the longer you wait, the more dense that cataract is, and the more difficult your surgery, The riskier it is, the more, the higher the likelihood of having a complication during surgery and it just, it makes our lives as surgeons much more difficult when you wait and wait and wait and all of a sudden you’re 90 years old, you’ve got a terrible cataract and you’ve got a really hard [00:14:00] surgery that’s more difficult for you to recover from.

It’s a longer recovery. Get the cataract surgery done sooner! There’s no reason. It takes six minutes. I could do a six minute surgery for you. But if you wait, maybe that turns into 20 minutes because things go wrong because you’re 90 and you got a terrible cataract, loose zonules, and it’s a struggle. So anyway, don’t wait on cataract surgery.

Once you qualify for it, just get it done. You’re gonna have to have it done eventually. What are you waiting for? You’re just kicking the can down the road. You can’t avoid unless you don’t make it, you’re going to end up getting cataract surgery. So it’s considered a privilege. You’ve lived long enough to be able to get cataract surgery.

It’s a wonderful thing. Notice what didn’t make my list? LASIK. LASIK is a great procedure. It can really help you see better. Certainly, there’s, for sure, there’s potential for complications as there is with any surgery. But it’s a wonderful procedure for people who qualify for it. Alright, let’s take a break.[00:15:00] 

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All right, we are back. And, uh, what I got for the topic today. Is, uh, comes from a comment on our YouTube channel, so all these episodes, Knock Knock High and Knock Knock High are up on our YouTube channel at Glaucomfleckens. I might, just because I want people to, to like, discover the Knock Knock High, because Knock, knock, I, because I get feedback from time to time, I get emails from people, they’re like, oh, I just learned you have a podcast.

I think part of that is we separated, I took them off of YouTube, my normal YouTube channel, because it was confusing the algorithm, and started putting them on their own YouTube channel. So people are having a little bit more trouble finding it. So I might start [00:17:00] like posting little clips from knock, knock, I, Um, on my YouTube channel, because it’s all ophthalmology.

That’s kind of what we do, what I do. And so, uh, uh, just to help people to, to discover, uh, cause I want people to know that they shouldn’t be playing with fireworks, like the more people, the better, like tell a friend, tell them to come check out, learn some eyeball stuff in their free time. So who wouldn’t, who wouldn’t want to do that?

All right. So here’s a comment I got. From, um, a patient, uh, I’m sorry, not a patient, I’m still like in, in like work mode. Alright, here’s a, I hope, I hope no patients are commenting on my YouTube channel. Um, okay, at Annie H1315, a follower on YouTube, says, hospital dietician here, question below about eyeballs.

Love your content. I’m continually intrigued by the overlap between nutrition and ophthalmology, like for Wilson’s disease. I talked about a patient. [00:18:00] Who I was consulted to see if they had a Kaiser Fleischer ring, which is a telltale sign of Wilson’s. Like for Wilson’s, dieticians are there to help reduce copper intake absorption from food.

If you haven’t already, could you talk a bit about the overlap between nutrition and eyes? Everybody thinks of vitamin A. That’s a good one, but there’s One condition that more people, including health professionals, need to be more aware of, in my opinion, Wernicke Korsakoff syndrome, caused by vitamin B1, thiamine deficiency.

Dietitians are taught these days to look for ophthalmoplasia, good idea, when doing a nutrition focused physical assessment. I love that, yes. So, um, And a follow up question here. I see them in acute care. So let’s see. Do you ever see these patients with Vernick, uh, cortico syndrome? Does the ophthalmia and that usually go away completely?

Uh, yes. It can go away completely if you, you get treated now, usually by the time you see [00:19:00] ophthalmia from Vernick and encephalopathy, like the patient’s in pretty bad shape. But, and I don’t see a lot of it, honestly. In fact, as a dietician, I’m like, you might be seeing these just because of your patient population.

You might be seeing a lot more of these types of patients than I do. I can actually count on one hand the number of patients, like two fingers maybe, the number of patients with that disease that I’ve seen and it’s, uh, it’s often, uh, you get cranial nerves involved, third nerve palsies, um, sixth nerve palsies.

As, as you, you’re, you don’t have the, the co-factors, the vitamin, the thiamine, the B vitamin, co-factors necessary for, for health of neurons because that’s what’s going that you, that’s why you need B one thiamine. That, that, it, it, it, it, it’s. It’s essential for the health of your neurons and your central nervous system.

So I don’t see it a lot. Um, uh, I have seen a patient that [00:20:00] did get better. The ophthalmia did improve. Um, but I don’t think that’s all, all the time that that happens. So, because those patients are often quite sick. But this is a good, uh, a, a, a great comment. So I appreciate that Annie. Uh, because there is actually a lot of vitamin related eye problems, not vitamin, sorry, just.

So, nutrition related eye problems, most of them are vitamin related, but a lot of things that we can talk about. So, uh, just, you know, we talked about a Renneke encephalopathy and, um, you know, the biggest risk factors, I think, for, for a lot of these are, um, Um, first of all, just lack of consumption. So you see it a lot in people with alcohol abuse, um, because often they’re not eating anything.

They’re just drinking, they’re drinking a lot. And so they have this, this lack of nutritional intake. Um, you can see it with obviously like anorexia, um, mental health disorders, uh, [00:21:00] where people stop eating, malabsorption of the gut. So people have had bariatric surgeries, um, um, They, they can get themselves into trouble by not eating, not taking supplements, vitamins, and um, sometimes pregnancy you can see some of these uh, nutritional deficiencies that can cause eye problems.

That’s pretty rare. So, you know, it’s, these in general are not very common. Again, I’ve only seen a handful of patients with a, a, a nutritional induced Eye problem, um, but for Vernicke’s with prompt thiamine replacement, it can be reversible, but there are often residual deficits, but it can be permanent if you don’t get the treatment fast enough.

So this is like a kind of pretty, a fairly urgent thing, especially Vernicke’s encephalopathy. Um, the other telltale signs of this disease, including ophthalmoplegia, would be gait, Ataxia, very unsteady, [00:22:00] you can see nystagmus of the eyes, so nystagmus is little, the eyes are just flicking back and forth, uh, and there’s a slow phase, it slowly moves across and flicks back, slowly moves across, flicks back, that’s nystagmus, and just mental status changes generally.

Uh, okay, so that’s for Nicky’s encephalopathy. Here’s another one, probably one that’s actually a little bit more common that I’ve seen more of, and that is nutritional Optic neuropathy, pretty uncommon, but it’s almost always bilateral, symmetric, progressive vision loss. And that’s because this is a systemic problem that’s causing problems with the eyes, so it’s going to affect both eyes simultaneously.

One of the great things about ophthalmology is we have two eyes, and so it just gives us a chance to, if you have something happening, and I talk about this with patients all the time, patients are like, I’m getting flashes in both eyes. Could it be a retinal detachment? Probably not, because how rare would it be to have a simultaneous retinal [00:23:00] detachment in both eyes?

That doesn’t happen, right? So, it really does help us figure out, could, you know, if you’re having a some kind of vision, positive visual phenomenon, like a flash or bright lights happening in both eyes simultaneously, much more likely to be something happening in the brain, like a migraine, versus just one eye or both eyes at the same time.

But individual, simultaneous, that just doesn’t happen. So, nutritional optic neuropathy, we get changes, vision loss in both eyes at the same time. Now, this type of thing, you know, it doesn’t happen as much anymore. I think like there’s some diseases that are a bit more of like a historical precedent like, you know, back in when we had like periods of famine.

In the world, like you would see a lot more of this. That’s probably where all the research comes from about these disorders. Um, but, uh, we, they do still pop up every, every now and then. Vitamin B complex vitamins are really where you see all of [00:24:00] the, the nutritional optic neuropathy. So vitamin B9. Folate, uh, vitamin B12, we’ve talked about thiamine, B1, vitamin B6, pyridoxine, that’s really important.

And so you think about the, the risk factors, what sets someone up to have one of these vitamin deficiencies? We talked about some of them. Another one would be like how someone has a really strict vegan or vegetarian diet. But they, they don’t take the precautions to make sure they’re getting enough B vitamin because obviously a lot of B vitamins are found in meat.

And so you have a really strict vegan diet. You may not get it unless you’re taking the supplements you need to, or I’m not sure if there are, uh, what’s in, I don’t have a vegan diet. So I’m not sure. Maybe there are certain foods. I’m not aware of what they are that do have like vitamin B12, B1, B9. Um. But, uh, uh, so, that’s, that’s one risk factor.

I think we covered all the other ones, alcoholism, yeah, [00:25:00] um, just in general malnutrition. So, this is one of those diseases though, it’s nutritional optic neuropathy where, uh, the, the exact mechanism, we don’t really know. For some reason, Having a lack of these B vitamins causes stress on the optic nerve.

Something, probably something in the production of ATP, oxidative phosphorylation within the optic nerve, the neurons is disrupted. But the symptoms, the signs that people will come in with, um, usually it’s, It’s subacute. So, it’s not like someone’s going to turn out the lights and all of a sudden someone’s lost their vision.

It’s more subacute over the course of weeks, sometimes months, uh, and it’s bilateral symmetric vision loss and it’s painless. It’s painless vision loss. Usually what they’ll do, if you do an automated visual field, So an automated visual field is you put your head in like this [00:26:00] bowl. Patients hate this, by the way, because the testing, it takes a while and it requires a lot of concentration.

So it’s like sometimes like a five to ten minute test where you hit a button every time you see a light. Visual field test. It sounds kind of fun like a game, but it’s really not that fun. No one, you don’t really win anything other than to get your eyes dilated right afterwards. Not a great Uh, prize for, for this, for this game.

But anyway, what people, what you’ll find with a, with a visual field test is you get what’s called a central or a psychocentral scotoma, which is basically a blind spot just right dead center or slightly off center in your vision. So that’s why this is such a devastating problem because it takes out just, A circle right in the center of your vision.

So someone can be 2200. They can have the rest of their peripheral vision is fairly well intact but right dead center you can’t see. [00:27:00] And so you can imagine the problem that causes for people because all of a sudden it changes your ability to see. drive safely in certain conditions you have to have a certain level of visual acuity for to qualify for license and it just it gets to be a problem um and that’s that’s that’s usually how we diagnose it and they’re gonna have they’re not they’re not gonna have some other signs of optic nerve dysfunction like what we call a relative afferent pupillary defect uh because In order to diagnose that, like if someone had a central retinal artery occlusion or an ischemic optic neuropathy, which typically affects one eye, you’re going to have a positive RAPD because you’re comparing the pupil response in that affected eye, you’re comparing it to the unaffected eye.

But if both pupils are affected, Optic nerves are affected at the same time from a nutritional optic neuropathy. You’re not going to have an RAPD because both eyes are reacting the same. They’re both damaged. So you can’t compare one to the other to say, Oh, this is the [00:28:00] one that’s abnormal because they both are.

So you’re going to morally rely on the decreased visual acuity and then automated visual field showing a central scotoma vision loss that’s symmetric. You see it the same way in both eyes. Treatment. It’s obvious. It’s vitamin replacement and visual prognosis really depends on the severity of this. You know, if you catch it early, then you can get some, some studies have shown that you can, uh, you can, uh, get some improvement back.

Sometimes a significant amount of resolution of that central scotoma. But, um, Some patients, especially if it’s been going on for a lot longer, you get that permanent damage to the optic nerves. You don’t gain back that central function. So just like any nutritional deficit, the faster you get on it to replete that, to, to, to replete those vitamins, just get that patient back and fed [00:29:00] and, and nutritionalized, which is a word I just made up the better the prognosis.

So that’s nutritional optic neuropathy. Let’s take a break and I’ll come back and I got one more for you. All right, the, uh, the other classic vitamin related vision. Vision eyeball diagnosis is vitamin A deficiency, vitamin A toxicity, which is a classic, uh, uh, board question where someone consumes, um, uh, polar bear liver.

And they get vitamin A toxicity, much, much less common, not a lot of polar bear livers being consumed, uh, especially in, you know, metro areas where I work. So we don’t really see that, honestly, we don’t see vitamin A deficiency as much either, but vitamin A toxicity has more, uh, hepatic, uh, other systemic issues.

The eyes are really the [00:30:00] least of your concerns when you have vitamin A toxicity, so we’re not really talking about that, but vitamin A deficiency on the other hand, that is very much an issue. Ocular disease. And so we call this disease zero ophthalmia, zero ophthalmia y. I don’t know. It kind of sounds cool.

Like zero ophthalmia. It’s zero up there, there’s an X in there. How many x? How many diseases do you know that start with an X? Like it’s kind of cool. I don’t know why it is. That’s neither here nor there. So vitamin A deficiency, uh, is you get this. Well, first of all, we’ll talk about kind of the scope of this problem because it’s not very common in well developed areas where people are getting, you know, a typical, you know, normal, various, varied diet.

Um, but it’s estimated to cause blindness in, uh, about half a million children each year. And so children who are, um, underfed. [00:31:00] Um, who are, who are, um, not, who are in impoverished regions typically. So it affects, it’s, it’s, it’s actually a large problem. The World Health Organization estimates that 228 million children have vitamin A deficiency with about half a million children going blind.

It’s rare in the U. S. though, so in 2013, estimated at 0. 3 percent incidence, very, very uncommon. I don’t know if that number is coming from the American Academy of Ophthalmology. So what will happen is kind of your typical causes for reduced intake of vitamin A. So inadequate food supply, alcoholism, some of the things we’ve been talking about, mental illness where you’re not taking in enough food.

Impaired absorption, Crohn’s disease, Celiac disease, Pancreatic insufficiency, short bowel syndrome, patients that have had a gastric bypass surgery. [00:32:00] Uh, uh, these are all common reasons why someone can develop vitamin A deficiency. And so, what’ll happen, uh, let’s just talk about the clinical signs of this.

So, the classic one is night blindness. Night blindness. So the reason this occurs is because you have this very important protein called rhodopsin that is found, it’s the pigment protein in rods. So rods, you have rods and cones. Rods are your, uh, your kind of light sensing cells, not color, it’s more just light and dark, alright?

Um, so whenever you’re in a really dim light, uh, dim, like say you’re sleeping, And someone turns on the light like at that moment all of your rods are active and so you see the light feels really bright. You can see a little pinpoint light in a dark room. So rods are very [00:33:00] sensitive to even the smallest amounts of light as opposed to cones which do not work as well in dim lighting conditions.

They’re They’re designed to see detail, color. Um, and so, you know, you’re looking at a painting, your rods or your rods could not care less. Could they, they could not care less about paintings. Cones on the other hand. Love that. They love it. So anyway, you have Rod Dobson. That is the major protein pigment protein in rods.

And, um, retinol, which is a vitamin A derived cofactor is required for the formation of Rod Dobson. So in order for rods to function, they need Rod Dobson and they need retinol in order to make the opsin. And retinol is a vitamin A derived cofactor. So when you don’t have enough vitamin A, you don’t have enough retinol.

You develop night blindness because your rods are not working. We call that [00:34:00] nyctalopia. Nyctalopia or night blindness. The eye’s inability to adapt from light to dark. So that is a really common problem. Uh, another sign is what we call conjunctival xerosis, which is a, a dry appearance to the conjunctiva that gives it like a wrinkling, kind of shiny, almost like Like, uh, shiny, uh, wrapping paper appearance to the conjunctiva, the white part of the eye.

You can look at, uh, uh, pictures of this. And then you get, um, um, those are probably the most, the two most common. And then as, as the, the vitamin A deficiency progresses and gets a lot worse, then you can start having, uh, dryness of the cornea, ulceration of the cornea, uh, keratomalacia, which is basically where the cornea is just melting away because you don’t have enough lubrication.

And then eventually you get just a completely scarred over cornea and that is when you start getting permanent blindness. So this is, other than the nyctalopia, the [00:35:00] rod malfunction, you don’t actually have problems inside the eye. A lot of what causes blindness is the scarring on the surface of the eye.

So it’s a really terrible, sad and entirely preventable disease, um, and unfortunately it affects a lot of people in the world. A lot of people are going hungry, a lot of children going hungry. Uh, and um, uh, so if you go to, to other countries around the world, you’re going to see a lot more of that than you do, uh, in the U.

S. Uh, but, um, treatment, you know, just got to get, get food. You got to get vitamin A. And lots of things have vitamin A, lots of dark leafy green vegetables, orange colored vegetables, carrots, anybody? Fish have a lot of vitamin A, eggs, butter, dairy products have a lot of vitamin A, like we all get it in our diet, assuming we are fortunate enough to have plenty of food.

That’s it. I’ll leave it at that. So, nutritional [00:36:00] disorder, we talked about nutritional optic neuropathy, Wernicke’s encephalopathy, Get your B vitamins any way you can, and vitamin A deficiency, alright, eat those dark leafy green vegetables, um, that’s what I keep telling my kids, for some reason when I tell them about xerophthalmia, uh, and their risk for it by not eating their spinach, uh, they don’t seem to care.

That’s my problem though. So anyway, I’ll work on that. Thank you all for listening. Thank you to my producers, Aron Korney, Rob Goldman, and Shahnti Brooke. I am Dr. Glauconflecken. Our editor engineer is Jason Portizo. Our music is by Omer Ben Zvi. Again, as always, leave me comments. On our YouTube channel at Glaucomfleckens.

I always read those. I love reading what you guys have to say. It gives me ideas for what to talk about on knock, knock. I that’s it. We’ll see you next [00:37:00] time.