Transcript

[00:00:00] Today’s episode is brought to you by Microsoft, who is committed to helping physicians reclaim their work life balance and restore the joy of practicing medicine. Discover DaxCopilot, your AI assistant for automated clinical documentation and workflows. To learn more about how DaxCopilot can help improve healthcare experiences for both you and your patients, visit aka.

ms slash knock, knock, hi. Again, that’s aka. ms. They’re like Microsoft, you know, you know, slash knock, knock. Hi.

Knock, knock. Hi.

Hello, everybody. Welcome to knock, knock. I with me, your host, Dr. Glaucum Flecken. Thank you for joining me. I’m excited about this episode. I’ve got a lot of great comments and [00:01:00] questions to get to, to talk about some interesting eyeball topics. A and a unusual tick tock trend. I was just, uh, informed about, and I’m not too happy with it.

And, uh, and, uh, just, this is your one stop shop. All things eyeballs as usual. Uh, this episode will go up on, uh, any place you get your podcasts also on our YouTube channel at glock and plugins. I was just talking to Kristen cause she’s not involved in this. She’s. She, trust me, she doesn’t want to really know anything about eyeballs.

She’s, she’s heard it all. She’s heard everything, all the things that I have to say. Uh, but I just informed her, uh, about how I was so excited about how many comments I’ve been getting on these knock, knock I episodes, and you guys are coming to me with great stuff. Great insight, uh, your own experiences, questions, topic ideas.

It’s, it’s fantastic. I’m just very excited. And I, I, it’s been a long time since I’ve gotten [00:02:00] excited about comments on my social media pages, because I’ve thousands, tens of thousands over the years of comments, but this, this feels different. It feels like we’re really like forming this little community of people who really are just interested in ice.

I, I, it’s like, it’s a, we’re just a big family here and a big eyeball family. Some of us have big eyes, some have small eyes, some have crossed eyes. Uh, but we all have it. Some of us don’t actually don’t have eyes or maybe you’ve lost an eye. That’s okay. All eyeballs are welcome here. And so, uh, uh, we’re it’s late.

It’s, it’s, I’m a little punchy already. I haven’t had anything to drink. Nothing. Cause I’m operating tomorrow. I operate today. I’m operating tomorrow. It’s a day with two OR days, a week with two OR days. Uh, tomorrow is my, my, my hospital based [00:03:00] operating room day. So normally I’m at our outpatient surgery center as part of our, of our private practice, but I go to the hospital for patients who are not.

healthy enough for an outpatient setting, uh, or an outpatient surgery center, I should say. There’s just a higher level of care that can happen. Now it’s going to be interesting because the hospital I’m going to, to do surgery is a hospital that’s on strike right now. I don’t know if you guys have heard the Providence system hospital system is, uh, there’s a ton of nurses.

000 nurses on strike. Uh, but this is different because for the first time in Oregon’s history, and honestly, this just doesn’t happen much anywhere. Some, their physicians are on strike too. So there’s some, um, OBGYN hospitalists, uh, also like internal medicine hospitalists. I think there’s over a hundred [00:04:00] physicians and that’s like, that doesn’t seem like a lot, but.

There’s obviously like exponentially more nurses in the country than there are physicians and nurses are no, they, they, they’re very, they, they have strong unions. It’s not, they’re just, they’re, they’re better organized than physicians are. So for physicians to get organized enough to be able to have a large, a significant group of them strike because of, of adverse working conditions, not enough, um, staffing, not enough help.

To where they feel like unsafe, taking care of patients in the hospital. I think it’s, it’s very, it’s, it’s, uh, courageous. It’s, um, it’s, it’s remarkable. It’s historic. And I think we’re going to probably going to see a lot more of it. I’ve talked to the, I went out and visited the people that were striking at the hospital near one of my practices.

And, um, it’s, uh, they’re just, they’re just regular people just like you and me. They’re [00:05:00] all, they’re just trying to do their job and they know what it takes to do their job safely to take good care of patients. And that’s what they’re trying to do. And so I, I commend them for what they’re doing, uh, for putting themselves at financial risk, uh, to, to, to, to strike and try to get providence to come to the bargaining table.

So. I’ve been learning about it, hearing updates, uh, from, um, uh, some wonderful people, uh, on social media. Jennifer Lincoln is a physician who’s been posting like every day, giving updates about the, uh, the strike, uh, on Tik TOK. So go, if you’re interested in this, which. This is like, if there wasn’t so many other things going on in the news right now, like the LA fires recently, the, obviously the inauguration and the 500 executive orders that Trump just like, everybody’s still like waiting through [00:06:00] that.

If there wasn’t so many other things taking up the news cycle, I think we’d be hearing more about what’s happening in Oregon right now. This is massive, big enough to where. There’s federal mediators coming in the big, big, big guy, big guns. They’re coming in to try to solve this because it’s, it’s obviously a huge problem.

So hopefully it’s, they come to a resolution, some kind of agreement that can make everybody feel better about being able to do their jobs and take care of people is ultimately that’s what it’s about. It really is. It really is. I mean, people need to be paid fairly, but people also need to be able to have, you know, be working in a place where they, they feel supported and, uh, and safe and doing the, the very difficult things that they’re doing in, in, in patient care in the hospital.

I don’t presume to know a lot of [00:07:00] what those things are. I like to pretend I know in my skits, but again, I am an ophthalmologist. So, uh, the level of my knowledge is a bit limited. But, uh, I, I wish nothing but the best for all the people out there striking and it’s cold in Oregon, you guys. Oh, it’s, it’s, it’s a bit chilly.

Uh, so when I went out there, they had, they had little fire pits going. They even had a taco truck. So they can, uh, some really nice support from the community, lots of honking. Lots of, uh, for some reason people dressed up in, in like, like, uh, inflatable dinosaur costumes. Maybe it’s warm. Maybe it’s like warm inflatable.

That actually would feel really good on a cold day. Other news before we get into your comments and questions is, uh, tick tocks back. You guys, it’s, it’s back. I know there was never a doubt, like it was never going to go away and, and, and stay away forever. Like that wasn’t going to happen. I don’t think [00:08:00] anybody really honestly thought that that would happen.

Actually. I think there were some creators that did because there was a lot of goodbye messages and, but it was, it was mostly like, Oh, well, if it doesn’t come back, you know, if this is my last video type of stuff. Um, and, uh, I don’t think anybody realized it was only going to go on for like 14 hours.

There were, there were, there were internal medicine doctors who I’m sure were rounding throughout the entirety of the tick tock ban 14 hours. And it was back. I didn’t even know it was back. I was still making jokes on blue sky. Uh, and, uh, and because I am a millennial, I’m an, I’m an, a middle aged millennial.

And as we all know, blue sky is the millennial retirement home. So that’s, that’s, that’s why I was there. And I was, uh, uh, uh, telling jokes and then somebody in the comments is like, oh, it’s back. I felt like an idiot. I was like in, in, in classic elder millennial form. [00:09:00] I’m just a little late to the game, to the social media.

So anyway, it was, I would learn it was back and it looks, it’s like it never left, but I did learn that, uh, I think you can’t download the app anymore. Like if you have the app on your phone, it works. TikTok works, but. If you don’t, I don’t think you’re able to download them. I didn’t fact check that, but I heard, I saw videos about it, people talking about that.

Uh, so, uh, that means that your phone with tech talk on it, uh, might someday be worth soon, some people may be worth a lot of money on the secondary marketplace could sell your phone like that people flappy bird game. That was a big deal. Like people that still had flappy bird that worked, they sold their phones for like a thousand dollars.

People that wanted to play flappy bird, maybe even more. I don’t know. Anyway, it’s back. And you know, there was a lot of, you know, I, I, I still check out Twitter. Um, [00:10:00] blue sky, you know, I, I check in from time to time and a lot of people were dunking on Gen Z and people who were probably a little too old for Tick Tock like myself, uh, about, you know, Oh, I guess I’m gonna have to get real jobs now, you know, all this stuff.

And it’s, it’s very clear to me that people that just don’t. I’ve never spent any time on Tik TOK. Don’t really know what Tik TOK is. It’s not a dancing app anymore. Like, yeah, it probably like back in 2020 when no one really knew what to do with Tik TOK, it was this brand new thing, fast pace scrolling through just video after video.

So addictive, nobody knew what to do with it. And so, yeah, there’s just, and it was like the music, the way you could incorporate music into your video so easily. Yeah, it was a, it was a dancing app for a while. It’s so much more than that. No, it’s like people have found real communities on Tik [00:11:00] TOK. Uh, people have legit businesses.

I talked about this last week and, um, and so to, to diminish it, my saying it’s a dancing app and we don’t really, who cares, like a lot of people care. But I, I, I am not going to sit here and tell you that it’s never going to get banned because I think it’s like 75 days. We have 75 days to figure it out, to see if Mr.

Beast will buy Tik TOK. I don’t know. I having been through one social media app that I really enjoyed, uh, which was Twitter, having that bought by a billionaire, like it hasn’t gone real well, so I’m, I am a bit dubious that. Somebody, uh, an American billionaire or two or three or four, because it’s going to be much more expensive than Twitter was, um, can swoop in and just everything’s fine and stays the same.

And the algorithm is just as good. I have, I have my doubts. [00:12:00] I don’t know. We’ll see. But that means I get to keep making videos. And I decided today that I’m going to start working on a new, um, a, a new series of skits I did. The first day of medical student rotations, like first day of gastroenterology, first day of general surgery, first day of ophthalmology, so on.

Well, I’m going to, I did one, I did one already. This is like probably months ago. I just forgot that I had done it. I’m going to do last day of rotations. The last day of anesthesiology, the last day of internal medicine of, of, of infectious disease, all of them neurology. So, um, I’ve got some good ideas for my first one with surgery.

It’s I’m excited about it. I mean, it’s, it’s fun because I’ve, I’ve been in a bit of a rut with like. Just finding the time and energy to keep making skits, but sometimes you just get an idea and it just, it’s, it’s, it’s [00:13:00] really still exciting for me, which is anyway. So stay tuned for that coming out to you on all the social media platforms.

All right, let’s take a break. And then we’ll get to some of your questions and comments.

Hey, Kristen. I know you’re a big fan of Demodex mites. Uh huh. You know, the eyelid mites? Yeah. They’re on your eyelid. Uh huh. They’re just right there in your eyelid. Yeah, thank you. Uh, well, what if they flew at you? Oh, God. What if they jumped? What if they jumped? Would that bother you even more? Oh, it’d be even worse.

Would that be better? Jumping bugs are always worse. Well, I have good news for you. They, they’re not jumping. Oh, that is good. They don’t jump at you. But they are there and they can cause like crusty, flaky, itchy, red irritated eyelids. So I can tell you’re a little bit grossed out. It’s a disease. It’s called Demodex blepharitis.

It sounds like no fun. Well, it, but it’s pretty common and a lot of people don’t really know about it. Yeah. But I mean, these like they’re, they’re, [00:14:00] they are kind of cute. I gotta admit just a little, just a little cute, uh, maybe a little cute. Regardless, you shouldn’t get grossed out by this, you should get checked out, okay?

Alright. Go to eyelid check.com for more information. Again, that’s E-Y-E-L-I-D check.com to get more information about these little guys and Dex Blepharitis.

All right, so, uh, thi this, um, uh, these are, are, are comments. On my most recent knock, knock I, uh, which was titled, what are. All those machines at the eye doctor’s office, not my most popular episode, but I, I, I still got a lot of great content from you guys. Uh, so I appreciate all the comments. Uh, nobody had any questions about the, the, the machines though.

So [00:15:00] I think I overestimated how interested people would. Uh, would think the equipment at the eye doctor is, I, I don’t know. I don’t know what I was thinking. I think it’s Fanta I think it’s really, uh, you know, interesting and impressive, but I can, I can understand how that would be a very just a me thing and not a, like everybody thing.

So, uh, but, uh, some topics did come up during that episode and, uh, one of them was the idea of, is it. Okay. To go up to a random person as a physician and diagnose them with things like you’re in the airport, you see someone with something Bell’s palsy, whatever cancer, skin cancer, melanoma. Is it okay to go up and talk and say, Hey, Hey, I think you might have this.

You need to go get checked out. I discussed some great responses. A lot of people, uh, were [00:16:00] generally were like, if it’s life threatening, tell me. Otherwise, keep your mouth shut, nosy doctor man. All right. That’s, that was the general like consensus here. Uh, so a few of them kind of made me laugh though at Chris, uh, pre Pollack five, six, one, six said one of the gastroenterologists I work with diagnosed someone with melanin in an airport bathroom by the smell and told them to get a referral for a colonoscopy.

He’s he’s in, he’s in Canada. Uh, they were not letting that go. Oh man. So Melana, those of you who may not know what Melana is, if you have like a lot of like bleeding in your Upper or middle GI tract as the blood like goes, travels through your intestines and your GI tract, it’ll get metabolized and end up [00:17:00] black.

It’ll turn your stool black. And it’s like tarry. That’s honestly, if I’m being honest with you. I have never once seen Melanin. I know it’s probably like surprising that even though I’m an ophthalmologist, I did go through all of med school, a bunch of clinical rotation. I did a GI rotation for God’s sake.

There’s no excuse for me not looking in a toilet and seeing Melanin. Other than the fact that I did not want to do it. I don’t know why I did that rotation. Very much not something that I, the one thing I remember from my GI rotation, like all the internal medicine rotations required a lot of rounding.

GI, I think it was just the, the fellow that I worked with the team. Oh man, those rounds, the rounds on GI were worse than any rounds I had ever experienced in med school, the length, the amount of. [00:18:00] Of toilet peeping, like peering, looking into the toilet. So I had to look at so many toilets. I had to see so much poop.

It’s I don’t know. I mean, the colonoscopies were cool. It’s kind of fun to watch once you’ve seen one. I feel like I saw them all. And so that’s probably why I didn’t want to do gastroenterology. Anyway, I’m getting sidetracked here. The point is this good doctor, this gastroenterologist did a great thing.

And could smell, could, could figure it out just by smell alone, that someone had black tarry stool and probably had an upper GI bleed and needed to get checked out. So maybe it wasn’t a colonoscopy that they recommended. Maybe it was an endoscopy, a scope. We’ll say scope. Um, what other, what else could you diagnose just by smell?

That’s a good one. Obviously C diff is a big [00:19:00] one. Like everybody talks about you. I think even I, I know what C diff smells like, so I could probably diagnose even now that’s something that sticks with you. You just, you kind of know, and you never, you don’t, you know, uh, I could, um, I think pseudomonas also has a particular smell.

Um, what else? I think because of my time. In close proximity to people at a slit lamp. So when you’re at a slit lamp, your face, unfortunately, is like within what a foot, sometimes even a little less than the personnel. Hopefully your slit lamp has a little plastic shield separating you, your breath from someone else’s breath, but not always.

And, uh, And, um, it’s the emergency department slit lamp [00:20:00] exams that, oh, I struggle with, but anyway, because of the, the, the thousands upon thousands of exams in close proximity to someone’s mouth, I can kind of tell when someone’s got like, like a rotten tooth or like some kind of infection, this is getting gross.

Anyway, I think that’s a smell I could probably figure out. Um, What, tell us what other smells could you like, is it like an instant single neuron arc? Like you smell something like what, give me the hospital smells that you just know immediately. Oh, that, it doesn’t have to be a gross thing either. It could be this is whatever.

What, what, what is a smell during the course of your normal work day at a hospital where you’re like, Oh, I could, I’ll remember that for the rest of my life. I know exactly what that smell is. I guess most of them are probably going to be bad smells if I had to guess, but I, I’d be, I’m interested in what you guys have to say about that.

All right. A couple other, uh, [00:21:00] comments about the whole diagnosing someone just by looking at them. Um, this is a good comment at, um, Amar, I E B 29. Sorry if I butcher any of these usernames. I have a physically visible genetic condition, neurofibromatosis, that among other things causes numerous skin bumps, non cancerous tumors.

Uh, obviously, uh, it says a doctor has never walked up to me and said something, but occasionally someone else will say something. I hate it. It’s embarrassing and makes me feel ugly. Unless you are a doctor, see something that is life threatening. I don’t think you should walk up to someone and point something out.

They are likely aware and would rather people didn’t say anything. Absolutely. That is the final. Uh, the judgment on this, on, on doing this, unless it’s life threatening. Don’t say anything. The person probably knows. [00:22:00] All right. Thank you for that comment. I really appreciate that. Uh, one more at Layla can feel three three Oh four said I work with a general surgeon who spotted a suspicious mole.

On a lady at one of his kids sports games. He did not know her, but went up to her, told her he’s a surgeon. And he thinks she has a melanoma. She said, thanks. And a few months later found him and thanked him because it was melanoma. Good job, general surgeon. Personally, I would melt in a puddle of gratitude.

If someone pointed out a potential malignancy to me, you’re all saying the same thing, if it’s potentially life threatening, let someone know, but otherwise keep your trap shut. All right, we’ll go with that. That’s good. All right. Thank you. Uh, for, for the, for the feedback. I love, I love this. I love we can, we can, uh, I can crowdsource some of these decision making points here.

Um, somebody, Oh, here’s one at CCRLH. We’re changing gears [00:23:00] here. 85 said, apparently there’s a recall on sustained due to fungal contamination and sealed vials is the first one I’ve seen where a major brain was contaminated. I haven’t talked about this yet. I need to look into that and see like how extensive this I did hear about the sustained fungal contamination.

I am not happy folks. Sustained was supposed to be one of the good ones. What’s going on with these artificial tears. I I’ve, I’ve so hurt because I have been probably on this podcast, certainly, uh, on social media elsewhere, I have sung the praises of brands because they didn’t have a big outbreak like this.

There were no episode, no, no instances of refresh Optiv advanced. One of my favorites. Or blink or sustain ultra. None of them killed people by introducing pseudomonas to their brain. [00:24:00] Not, it didn’t happen, but now things are happening. It was always the generics, the, the, the, the strange names that you only find in like Topeka, Kansas, or not, not nothing about Topeka.

It’s just the first thing that came to my mind. Uh, but it was those, the, the, the random generics. You never heard about the major brand names, but that’s not true anymore. I don’t know what to believe folks. Uh, I’ll look into it. I’ll see if it’s, it’s, if it’s been contained yet and get back to you next week, or maybe I’ll say something on social media about it.

All right, let’s do some more. Uh, let’s see how we’re doing on time here. Oh, we’re doing all right. All right. So I’ll do one more and then we’ll take another break. Let’s see. How about. Oh, this is a good topic. So I’ve got a couple of kind of deeper topics to get to. Um, all right. This one at, oh, it’s a bunch of random words.

It’s just another user. HR 9ZV, blah, blah, blah. [00:25:00] Been hearing a lot about ortho K, ortho keratology. Would love to hear you talk about these other types of vision treatments besides contacts, eyeglasses and surgeries. Love the podcast. Thank you so much. You should get a real name for your, I think it was just like a randomly generated one anyway.

I appreciate that comment. Uh, uh, thanks for listening and watching the podcast. So yeah, I talked a lot about obviously glasses, mostly. Uh, mostly glasses because I love glasses. They’re great. They’re safe. Uh, I talked about contacts, talk about LASIK. I’ve talked about that several times over the past few months.

Uh, but I don’t talk about the other potential options and there’s one called ortho keratology. So. This is not as commonly used. So ortho keratology also known as ortho K is it’s still a contact lens, but for a slightly different purpose. So these are rigid gas [00:26:00] permeable lenses. Basically the type of lens that people that, that like contacts used to be.

Before we had the soft, like dailies, monthlies, they used to be just hard contact. We still have patients that come in wearing hard contacts. There’s still a market for hard contacts for different eye diseases. But that’s what all contacts used to be as hard lenses. Well, now you have these specialty hard lenses.

That are used for ortho keratology. And, uh, what it does is these lenses will temporarily reshape your cornea to improve your vision. Uh, so kind of like, kind of like orthodontics for your eyes, like braces for your eyes, you, you wear the lenses at night and it reshapes the front service of the eye. So if you have.

These are primarily, I think they’re only used for myopia is my understanding. I don’t do this. Nobody in our practice does this. So that’s why I’m [00:27:00] saying it’s not as common because they’re just, there’s just better, safer options and we’ll get to why in a second. But, uh, uh, these lenses will reshape the front of the eye.

And so if you’re myopia, then it’ll, it’ll flatten the surface of the eye. Which, which moves the focal point further back on and, and, and helps to treat your nearsightedness. Uh, so it just flattens the cornea. So you wear it at night. It’s flattening the cornea. You take them out in the morning. So obviously our first red flag with these things is you’re sleeping in them now.

And that’s the biggest, and that’s probably the reason that like 99 percent of, of ophthalmologists are like the hell no. Like I’m not recommending that to my patients because there’s other options. We have surgical options. We have non surgical options, regular contacts and glasses that can treat your myopia.

So I’m not wanting to put someone’s eyes at risk. [00:28:00] Now I would say there are some patients that this would be okay trying. The problem is that the biggest market for this type of thing are. Kids are young people who are too young, who have myopia, and we’re talking like mild to moderate myopia, not high myops, we’re talking like minus two, minus three, who, um, are too young for LASIK, for something more permanent, and so, Parents will come in and be like, well, are there any options?

Well, ortho keratology is an option. And so you wear these at night and take them out in the day and then, but it takes, it takes several weeks of using these. And the issue with having kids in contact, especially in contacts that reshape your cornea, Do they work? Sure. Yeah. They, they re they do. They reshape your cornea.

Now, are they, how effective are they? The studies we have, uh, show [00:29:00] that, um, most patients will get to like a 2040 level, and so you may not get the full desired effect of like perfect vision, like you would with like LASIK and it’s temporary. So that’s, that’s, that’s something in the, in the pro column, I suppose, if you want to just try something out and see if it works when you’re putting, when kids are using these, you have to be so worried.

When kids are using any kind of contact lenses, much less ones you can sleep in. Um, you have to worry about hygiene. Hygiene is such an important part of, of safe contact lens use. And that’s what makes me so nervous because that’s who’s asking for ortho K. It’s, it’s the kids. It’s, it’s the teenagers, uh, who come in with their parents and they’re, they’re asking about ortho K.

I’ve never, I’ve never known a single adult using ortho keratology. Um, I think probably mostly because as you get older, you start [00:30:00] to appreciate your mild to moderate myopia. People like being a little bit nearsighted, so they don’t want that taken away from them. Um, but, uh, in our eyes just don’t tolerate contacts as well as we get older, but it’s, uh, it’s the hygiene.

Like you’re, you’re putting that kid at risk and much higher risk of infection than even with like a regular contact lens. Because they’re sleeping in them. They’re in them for a long time. Now they’re gas permeable, which helps, right? There’s still oxygen able to get to the surface of the eye, but it still makes me very nervous really to have any like 12 year old in a contact.

Um, and so, uh, but that doesn’t mean it’s unethical or it can’t be done. It just requires, it’s, you gotta pick the right patients to do it with. And you have to have a lot of counseling, make sure they’re doing everything right. Washing their hands, using fresh solution, lens, uh, lens cases, all these things.

So anyway, um, but [00:31:00] it’s, it’s the safety issues that I think are, uh, push a lot of, I, I, I doctors away from, from doing this type of thing. Also, the other thing that people don’t like about it, it’s freaking expensive. I, I, I, I don’t know the insurance coverage for something like ortho K, but ortho K prices, it rain, it’s usually like a thousand, even up to like four or 5, 000, like for the treatment.

That’s a lot of, but like those that’s LASIK prices right there. Right. So, um, I dunno, I’m just, I’m not a fan for the price, the risk. It’s, it’s just, I dunno, just get glasses and glasses are in now. They’re so, they’re, they’re, they’re popular. Let’s take a break. All right. Here’s another question. At Julie Rose N2O said, are there different strengths of medications to dilate the pupil?

I have been seen by a retina specialist and afterward, the [00:32:00] dilation lasted for 24 hours and was incredibly painful. I’m so sorry. I’ve had many eye exams, but that was the worst. Yes. We have different concentrations and strengths of dilating drops. People don’t know this. So our go to dilation, like 90 percent of ophthalmologists are just going to jump to this.

This is what we’re going to use. We’re going to use a medication called phenylephrine 2. 5%. That is an alpha agonist. So it activates your. Your, your sympathetic nerves, your fight or flight response, which will help to, to, um, uh, uh, contract the pupil dilator muscle. All right, it’s actually a muscle that helps to open up the pupil.

All right. So we attack it from the sympathetic side with phenylephrine. All right. 2. 5%. [00:33:00] We also do. Go out from the other way. So we block, we activate the sympathetics with phenylephrine and we block the parasympathetics with, um, uh, tropicamide. That’s our go to. There’s two different concentrations. So if someone comes in and said, I really would like the, you know, something that doesn’t dilate my eyes for very long at all.

Well, we can use half percent, 0. 5 percent tropicamide, which is, uh, um, uh, it’s, uh, anticholinergic. So it blocks the parasympathetics. So basically does, so we activate the sympathetic block, the parasympathetics, the parasympathetics help to constrict the pupil like Pilocarpine. That’s a parasympathetic type medication.

It’ll, it’ll, it’ll bring the pupil down. Well, if we block the Parasympathetics, it just, that’s actually the strongest way of dilating the pupil is with. Parasympathetic blocker and anticholinergic. [00:34:00] Um, the sympathetic that it’s phenylephrine, it doesn’t do it. It’s not enough. It’s weak. It’s very weak, but the two.

In conjunction with each other, it works really well. So the half percent that’ll get you like a couple hours of dilation, which is great. That works well. Uh, it doesn’t dilate as well. So for this person, Julie Rose here who went to the retina doctor, see retina specialists, especially if they’re looking for things like retinal tears, retinal detachments, you really need a wide open pupil.

You want that pupil as dilated as possible. 1 percent tropicamide and phenylephrine, again, our go to combination, that’ll probably get it. But some people, especially people with much darker irises, it might not give you as big of a dilation as you want, and so you gotta bring out the big guns. So we have [00:35:00] cyclopentolate.

That’s the next step up. If tropicamide doesn’t do it, You have another anticholinergic called cyclopentolate. We cyclo them. Very strong, gets you much bigger dilation. We have a 1 percent cyclopentolate. We even have 2 percent cyclopentolate. Oh yeah. We get after it sometimes, especially with cataract surgery, any kind of eye surgery.

Yeah, we’re going to dilate the hell out of your eye. And with cyclo, it lasts about 24 hours. So you probably did get cyclopentolate and that’s why it lasted about 24 hours. Tropicamide? 1 percent gives you a four to six hours of dilation, cycle penelate for 24 hours. Guess what? It gets even worse. Like we have something called scopolamine.

So you heard of the scopolamine patch. If you put a scopolamine patch on, say you’re, you have a C sickness or something, and you, you get a scopolamine, you’re on a cruise and you want to get a scopolamine patch. If you [00:36:00] touch it and then rub your eye. That scopolamine will get into your eye and you’ll have a dilated eye for about a week.

Scopolamine, even stronger. And then the strongest we have is atropine. So atropine is as big as it gets. Uh, we use that in kids, uh, for a variety of different reasons. Um, the primarily, you know, the one of them is as a treatment for myopia, for, uh, amblyopia. Uh, and myopia, it’s also a myopia treatment. So atropine, that’ll keep the eye dilated for like two weeks.

Very, very strong, very strong. So, um, that’s the, that’s the rundown of, that’s a good question. Rundown of dilating drops. If I had, and I got asked this today, I was like, do you have something that can take the dilation away? If I had an eye drop that could immediately reverse dilation, I’d probably make a lot of money.

I, that doesn’t exist. As far as I know, it doesn’t exist. Uh, that would be convenient though, wouldn’t it? Just put a drop in. We [00:37:00] have things that we can put in the eye at the time of surgery. Bring the, the, the pupil down. I have to imagine though, that if you had something like that, it would cause a tremendous headache because you, to do that, you have to activate your Cholinergic system, which also will activate your accommodation.

And so you’re accommodative, you’ll get this accommodative spasm with any drop like that, that reverses dilation quickly and can, uh, um, oh, you get like this horrendous brow ache. I just, I, I’m pretty sure that’s what would happen there. Good question though. All right. I got one more question for you for this episode.

At Darien dot D 97 infection preventionist here. I recently came across a case involving an amniotic membrane transplant graft, absolutely blew my mind. Could you talk about this type of technology? Are the placenta donors compensated in some way? Great [00:38:00] question. You know, there’s some things you just don’t even like think about.

I got to say that, but, but the are a little strange and unusual. And I got to say, I’ve known. About like amniotic membrane grafts. I’ve used amniotic membrane grafts. I’ve seen them done and used in dozens of eye surgeries over the years. I’ve never once really thought about how amazing that is and what it, where it comes from and what, so I, I just, I did a little bit of research into it, not a whole lot.

All right, sorry, this is supposed to be fun for me. I don’t, I don’t like doing research, uh, but this actually was quite interesting. So, um, amniotic membrane. Is the innermost layer of the placenta. And so it doesn’t, and these, these, this layer of this membrane, it’s, it’s a membrane, it’s a very, very thin, right?

It’s a, it’s, it consists of a, the basement membrane and then the a vascular stromal matrix. And, um, It’s actually [00:39:00] used in different surgical. So specialties, but in ophthalmology, we primarily use it when we need to reconstruct the surface of the eye. There’s a number of reasons why we need to do that.

Like if we do a tritium surgery, tritium is where you have this, this like scar tissue type, basically the white part of the eye, the conjunctiva starts to grow abnormally onto the surface of the cornea. And we have to remove all that. Abnormal tissue, and it leaves a bare spot on the sclera where you don’t have conjunctivitis.

You have to remove the abnormal conjunctiva. Well, you can put an amniotic membrane graft right there in its place, and it just helps to form, it helps, it acts as a scaffold for the, for new tissue to grow over it. Uh, it can also be used as a bandage. For people that have like neurotrophic keratopathy. So a neurotrophic cornea [00:40:00] is when you’re this, the cornea, which is supposed to be the most sensitive part of the body and is normally loses its nerve or its innervation.

And that causes the epithelium of the cornea to slough off and it can’t heal itself. So you have this. Uh, what’s called a neurotrophic ulcer where you have an epithelial defect, basically a corneal abrasion that just won’t heal. It can’t heal. The cornea doesn’t have those nerves and those nerve growth factors to help it heal.

That’s a big problem because that invites thinning. And atrophy of the cornea. It invites infection in the cornea. Big problem. Well, sometimes we can use amniotic membrane to just help provide some of those growth factors. Some of that tissue that helps, uh, establish a, a better environment for the cornea to heal itself.

So it’s all [00:41:00] ocular surface stuff. That’s what we’re talking about. And, um, um, But where does it come from? That was the, that was the question, right? Where’s the, this amniotic membrane come from? Um, and the way they do it is during elective C sections. So to get, to harvest amniotic membrane, you get informed consent from a patient undergoing an elective C section.

And then, um, They, the thing I don’t know because I’ve never seen this process is exactly how much of the placenta they take. I imagine they have to take, they, they take some of it or maybe all of it. I’m not sure. And they have to section it to get the thin amniotic membrane that they need for, for transplant.

Um, and then they, uh, they screen it for. Infections obviously that like they do with any organ, uh, that’s being transplanted and then it’s cryo preserved. So the way it comes to us is [00:42:00] it comes in like a little sheet and like, uh, I’d say like a, a small, like a dollar bill sized container here and you just open it and it’s, it’s, it’s frozen and you, you thought out and then you just, you, you, you take it out and you can just lay it.

You can suture it onto the eye. You can just lay it on, you can cut it into smaller pieces. If you need a smaller section of it, really amazing, amazing thing. Uh, and the question, one of the questions here was, uh, um, what is it? Oh, are, are the placenta donors compensated in some way? I don’t think they are.

I don’t think they are. Um, because, uh, it’s probably just like it would be any kind of organ donation. You, you can. Um, because I’m nobody in my family has ever gone through a C section. So I’m not sure how this process, someone could, should, it would be great if you could enlighten me. Um, it’s probably just a question that’s asked, like, are you okay [00:43:00] with donating your placenta?

Um, so I would imagine it’s not something that you’d be compensated for, um, because it’s, it is tissue that is, is going to be discarded. Otherwise, usually, right. I think some people. Want to take their placenta with them. Um, but, um, I imagine it’s not. So anyway, I’d love to hear, hear from someone who has actually gone through that or knows a little bit more about this than I do, obviously.

Um, okay. You know what, let’s stop there. I didn’t get to, you know, I’m going to tease. I’m going to tease you guys with a little something. So I learned about, uh, a tick tock trend, uh, that I’m not, I’m not too thrilled with and it involves people. Like trimming, cutting off their eyelashes, like taking like clippers and just cutting their eyelashes.

Why? I don’t know, but I think next time, [00:44:00] next episode, I’m going to talk about a bit about eyelashes. Let’s talk about like, how long does it take them to grow? Uh, what kind of diseases cause you to lose your eyelashes? Is there anything you can do to regrow your eyelashes? Just all about eyelashes. I’ve talked about fake eyelashes and everybody knows my disdain for fake eyelashes.

Don’t like them. Now I’m not a fan, uh, but we’re, we’re going to talk a little bit more about eyelashes, including I’m going to, I’m going to do a little bit more research about this trend. I’m going to watch a couple of tech talks. So what exactly people are doing with their eyelashes? Why on earth they would trim them?

I don’t know like this. Why? Why people would kill for long eyelashes? They probably have killed for long eyelashes. Anyway, so I’ll save that for next episode Thank you all for listening again all these episodes you can Get them any place you get your podcast, but also They’re posted on YouTube. You don’t have to watch me.

If you don’t want to watch my, [00:45:00] look at my face, that’s fine. You don’t have to watch me. But if you have a question or you want me to, to shout you out, uh, if you have a good comment, anything, story. Great stories. I love great stories. You guys know we’re not that high. Love, we love stories over there. Um, uh, or just anecdotes.

See, I guess those are the same thing. Same thing as stories. What am I talking about? Um, or topics you want me to cover, comment on the YouTube channel, subscribe to while you’re there. I really appreciate it. And, uh, and, and I’ll, I’ll try to get to as many as I can. So thanks again for listening. I’m your host, Will Flannery, also known as Dr.

Glockenfleck, executive producers are Will Flannery, Aaron Corny, Rob Goldman, and Sean T. Brick. I guess I’m kind of a producer of my own podcast. I’m producing this podcast for you right now. Our editor and engineer, Jason Parteezer. Our music is by Omer Binzvi. Night Night Guy is a human content. Production.

Thank you all. We’ll see you next time.[00:46:00] 

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