In this episode of What the Health, we discuss the importance of eye care and common vision problems with Dr. Purnima Patel from the American Academy of Ophthalmology. The conversation covers various topics, including the prevalence and risks of eye diseases such as cataracts, macular degeneration, glaucoma, and diabetic retinopathy. 

Dr. Patel emphasizes that losing vision with age is not inevitable and highlights proactive measures to maintain eye health, such as wearing sunglasses, eating a diet rich in leafy green vegetables, regular exercise and routine eye exams. The episode also debunks myths surrounding eye exams and explains the advanced technologies available for detecting and managing eye conditions. The discussion aims to encourage listeners to take an active role in protecting their vision. Additionally, the episode underscores the societal impacts of chronic conditions like diabetes on eye health and the importance of early detection and treatment.

00:00 Introduction: The Importance of Eye Health

01:01 Common Eye Problems and Diseases

02:03 Expert Insights: Dr. Patel on Eye Care

02:54 Understanding Vision Changes with Age

12:31 Eye Health Tips and Misconceptions

17:12 Diabetic Eye Disease and Macular Degeneration

23:08 Glaucoma and Other Eye Conditions

33:26 Conclusion and Final Thoughts

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A Clear Look At Eye Health with Dr. Purnima Patel

Yes, adults do find themselves wearing glasses with age, but of course, putting on a pair of specs isn't isn't cause for deep alarm. It's a natural reflection of needed adjustments that come over time. It's also relatively easy to address. However, eye diseases and other problems like cataracts, macular degeneration, glaucoma, and diabetic retinopathy are more concerning and dangerous.

Unfortunately, millions also suffer from these types of diseases. Why is this happening? And how are eye diseases inevitable? Well, there are various reasons for the causes, but thankfully, people are not powerless when it comes to the health of their eyesight, but too many are less than proactive in keeping their eyes and vision strong.

Not surprisingly, we've lined up an authority who is ready, willing, and able to provide some crystal clear vision on how we can all take better care of our eyes so that we can see straight at any age.

This is the best part of every one of our broadcasts. It's when we get to delve into a particular subject, in depth with an expert. And today we have a great expert on hand to talk about eye care and eye health and why it's so much more than just glasses. So I would like to welcome Dr. Patel, who's representing the American Academy of Ophthalmology. Welcome to the broadcast and thank you for joining us.

[00:02:14] John Salak: Great. And just as a reference, Dr. Patel is from Nashville, Tennessee, where we just discussed that there are a bunch of water buffalos running around the streets of Nashville. So if a water buffalo comes in behind her, that's just a given down there, though Dr. Patel is now in Georgia and not in Nashville.

So in talking of eye care, I wear glasses. I don't know if you do. My wife wears glasses for reading. My mom wore glasses. It seems that everyone eventually winds up wearing glasses or a lot of people do. The point is people think about eye care and eye health. I think they, they just naturally do.

I'm not sure they do a lot about it. Is that a fair assessment? Do we just assume as we get older our eyesight is going to deteriorate and we just, that's inevitable and we're just going to wear glasses and that's all there is about it.

And the other thing is glasses is not our only solution. It is a solution that typically helps a eye that sees fine otherwise, but just needs a little help with extra power, or a little less power with the glasses to focus an image right on the retina. And that's basically the only purpose of glasses or contact lenses.

But if you, have vision threatening eye conditions that may affect your ability to see well even with glasses. But we have, depending on what eye problem you have, we have so many different solutions that glasses are a big part of, but not the only solution. So two things is one, people do not need to be resigned to losing vision or feeling like they're going to lose vision.

And two, that there are a lot of things that we can do to help unprotect eye health, but it involves patients coming in to be seen.

I don't know what it is. I don't even want to see pictures of my eyes when I go for an eye test. Do you think people are naturally a little insecure about their eyes.

Why don't people assume there's more they can do for their eyesight or just taking care of their eyes?

So I think that's one reason why maybe people are not seeking eye examinations and eye care. And this is when patients don't have symptoms. I think patients are very quick, for the most part to come in if they're having a problem. The part to your question about fear of examinations, I think it's the same with a lot of doctor's visits.

People have apprehension about the unknown, not necessarily wanting to walk into a room and get bad news, for example. People also think that, we still do that puff test to check eye pressure, which we do not. We have much better, easier tolerated, procedures in checking a patient's eye pressure that even, children tolerate without any kind of fuss.

So that's something that is a myth that I wanted to spell. The eye exam is actually pretty easy. The second thing, I feel like patients feel, fear is, sometimes the anxiety of the better one, better two. I don't know, there isn't a right answer. We know that and we have a lot of other machinery and technology that we use to compare a patient's answer to arrive at something that is the best for the patient.

The dilation is temporary. It makes you light sensitive, but most eye clinics provide sunglasses so patients can tolerate and at least complete most of their activities for the rest of the day without too much difficulty.

Are we all going to face some of that? Is it genetic? What causes it? What can we do about it? And then later I want to get into some of the eye diseases or eye problems that are different from just generic aging that people really need to be looking out for. So first, let's tackle everybody's eye health as they get older. Is it likely to deteriorate and what can we do about it?

We can see or brains can see. Any clouding of that lens will scatter light. So patients will notice early on that maybe colors don't look as bright. They're needing more light in dark or lit situations to be able to read. And then as it progresses, they may notice glare from oncoming, headlights.

Cataract surgery is the most common surgery that's done in America and it's very, very safe and it reverses this problem. So having a cataract does not mean that you're going to lose vision. That's something that's a reversible cause of blindness. The other thing that we see as people get older is more dry eyes.

And part of that is exacerbated by our major lifestyle changes that all of, humanity for the most part has experienced in the last several decades. Where we're staring at a screen all day or a device and that makes us not blink as much and that can exacerbate dry eyes. There's no cure for dry eyes, but we certainly have many, many treatments that we can make patients feel more comfortable and improve the quality of their vision.

Sometimes people will have just changes in their corneas that will develop as they get older. But for the most part, those are the two major things that kind of affects sight. Another thing that's age related that can happen in the eye is development of floaters. The back of the eye is filled with a clear jelly.

That's the consistency of uncooked egg whites. Starting in our fifties or so, people will start developing liquefaction of that jelly and start seeing floaters. So it looked like little squiggly lines or feeling like a bud that they're going to swat at. That is an age related change. It happens to everybody, pretty much before age 70, but we don't know in the 50s to 70s when exactly that, jelly change is going to occur.

At the time that the jelly change occurs and people see floaters, there is a risk of a retinal tear or a hole or a detachment. So we do ask patients when they first experience this to come in. So we can dilate their eyes and take a careful look at the retina. And if there is a hole or a tear, we'll address that.

But those are the major age related changes that, are common. And pretty much everyone, if they have enough birthdays, will experience. So cataracts, dry eyes, and floaters.

[00:10:49] Purnima Patel: No, so, remember a lot of people start needing glasses even as, as children, and most of the time, the majority of need for glasses is there's a mismatch between the power of the natural lens that a patient is born with and the length of their eye. And so all the glasses do is if the focal point is in front or behind the retina, they'll just move the focal point.

It's just using physics. Sometimes it'll be a cornea problem that also helps us bend light or lens problem that helps us bend light, but it's taking the total bending power of light in your eye and the glasses is just adding or subtracting power in order to compensate for any issue there. After patients get older, sometimes there can be changes in the shape of the cornea, change in the lens of the eyes, especially when cataracts form, that to some degree, the glasses will help neutralize.

Now, all of us, after we hit about 45 are going to lose our ability to see up close. So, we need start needing help. We either have to hold our arms, a little bit further out, or we have to get some classes to help us see up close. When you're young, you still retain that ability to reshape the lens of your eye to help you focus up close.

But when you get older, your muscles can't, your eye muscles can't do that anymore. And you need a little bit of help for near reading glasses.

[00:12:42] Purnima Patel: So some of it is, is time and that we can't turn it back. But there are certain things that we could do to just put our eyes in a better position for maintaining and preserving vision. So one is, decreasing cataract formation by wearing sunglasses. And anytime you're outside in daylight.

Whether it's a cloudy day or not, because the UV light can penetrate through the clouds, you still want to wear sunglasses. The sunglasses also offer protection to the skin around the eyes and decrease risk of getting skin cancers on your very delicate eyelid skin. So that's one major thing, wearing sunblock.

It helps the eyelid skin as well. Eating a lot of leafy green vegetables. They're full of antioxidants like our kale and our colored greens, spinach, and also incorporating vegetables of all different colors. We kind of call it eating the rainbow. All of those different colors, provide different antioxidants, and those antioxidants are very helpful to a busy organ.

Like the eye, the eye people forget uses a lot of oxygen and a lot of nutrients because it's literally seeing all day. It's, really working. The other thing is exercise, getting out there and doing 30 minutes of exercise. There's studies that have proven that it enhances eye health because it increases the amount of oxygen that's getting to your eyes.

Those are three major things that you can start with to help with eye health. The fourth is really coming in to get those eye exams because there's a lot of eye disease that can get picked up early. If you come in without any symptoms, come in for your routine eye exam and we can pick up diabetes. We can pick up glaucoma.

We can pick up even autoimmune disease or anything going on in your eyes. So it's important to compliment these habits, with the sunglasses, the healthy eating and the exercise with the eye exams.

[00:14:51] Purnima Patel: So the Academy has well studied guidelines on when people need yearly eye exams and things. So most people do not need a yearly eye exam until they hit 50 and then other than that will say, every two years, every three years, if they're below 40 and things are doing well, then they don't have any medical problems.

We may say you can even go five years without an eye exam.

[00:15:20] Purnima Patel: Yes, like even walking, anything that gets your heart rate up. Walking is a very, because it's not a jazzy exercise, but it has so many benefits, so many cardiovascular benefits that sometimes can even, equate to like those high intensity interval training exercises as well. It doesn't have to be intense and crazy.

If you can just get your heart rate up for 30 minutes, it still helps, general health. It helps mental health. So there's a lot of powerful benefits of just getting out there walking, but it could be swimming, it could be hiking, whatever that's getting you out and moving.

[00:16:09] Purnima Patel: They are, but they're not like the only thing.

[00:16:12] Purnima Patel: a bunch of carrots and your eye vision won't be great. Not true. But, it is certainly part of the rainbow that we want

[00:16:27] Purnima Patel: Yes, there are. With fruits, you always have to balance out the sugar content, but like, you know, berries and, blueberries, strawberries, acai, all of those have a lot of really wonderful antioxidants.

People know about them. What are some of the other potential diseases that people need to be aware of when it comes to eye health. And with that, and we have, we'll follow it up afterwards, what are some of the symptoms they know?

So what are some of the most prevalent dangers people may not be aware of?

And based on that yearly eye exam, their eye doctor will convey whether they need to be seen more frequently or not. In a protective mechanism, the eye is really trying to retain the vision as long as they can in diabetic eye disease. So sometimes you can have really advanced diabetic eye disease or retinopathy we call it, and still have good vision, but you're not gonna be able to keep the good vision if it progresses and becomes to a point where it's irreversible.

That's why we recommend yearly eye exams because a lot of times people will have diabetes for much longer than when it was initially diagnosed. So it's already causing damage. And the reason why diabetes is so bad for the body as a whole is it damages blood vessels and some of the tiniest blood vessels in your body or in your eye.

And it causes these blood vessels to not function and do all the many functions that an, blood vessels supposed to do, and cause damage to the organ. And so for the eye, it will see bleeding in the eye. We'll see lack of blood flow. So blind spots in the eye. We'll see hemorrhages, so that'll cause, floaters in the vision, all from diabetic retinopathy. The eye is the only place in the body we can actually see blood vessels. So if we pick up diabetic eye disease in the eye, we know that there is, at least in the microscopic level, damage to the kidneys as well, and most often to the peripheral nerves as well. Anytime we pick up eye disease, from diabetes.

And so it's important to, the primary care that their patients get, eye exams so they can get that information as well. So that's, one big cause of vision loss in the U. S. And then two is macular degeneration, which is a leading cause of vision loss, severe vision loss in the older population, 65 plus.

Now that has a, hereditary component, but it's not a hundred percent hereditary. There's some environmental UV light exposure, smoking, exposure that can increase your risk of developing, macular degeneration. There's two types of macular degeneration, a dry kind and a wet kind. The dry kind is much more common, it's 90 percent of patients.

And with this, the symptoms that patients notice is distortion in their central vision. It really does not affect their side vision. It's mainly the central vision that's affected by the macular degeneration. And they can have the distortion or wavy lines. They have missing spots where like you can look at a face and the eye will be missing or something.

They don't see that. And it again, early detection is very important, especially for the wet kind where we have a lot more treatment, even though it's less common. We have a lot of wonderful treatment that can really help patients save their vision and now we're getting more treatments or newer treatments for the dry kind of macular degeneration, a specific component of that.

But it's important to just come in and get one evaluated so you get diagnosed early and get started on a treatment plan and also educated on what to look out for and when to call into the office for a more urgent follow up.

[00:21:14] Purnima Patel: Yes. So oftentimes, just by looking, getting that dilated examination and it's really important to have the dilated examination because we can see so much more. And, some places will say, Oh, you can just get a picture and it's different. We don't have the 3d like we do when we use both of our eyes to look in a patient's eyes, but at least something to look at the more peripheral retina.

So the whole retina will be more helpful, but we can pick it up with an examination. A lot of the times, if someone is detected to have diabetic retinopathy or early macular degeneration, we will follow it up with a very high resolution test or photograph called an OCT. It's just a picture with a very fancy camera, and we can pick up at the microscopic level, even early changes.

[00:22:18] Purnima Patel: Yes, oh, yes. So, like, would, if someone doesn't know they have diabetes and they came in for an eye exam, could we pick it up? Absolutely. And unfortunately, we do that, several times a year where we're the first ones to diagnose that they have this, Diabetic, even diabetes. But that what could happen with several other eye conditions as well.

We can pick up hypertension or hypertensive, disease in the body through looking at the eyes. We can pick up a lot of other autoimmune conditions and things by just looking at the eyes. So certainly same thing with diabetes. Sometimes patients will come in with a known diagnosis and sometimes they'll come in with very specific findings that, suggest diabetes.

[00:23:07] Purnima Patel: I think one that we, spend a lot of time, screening for is glaucoma. So glaucoma is a condition where people lose their side vision and oftentimes it's painless. So they don't have any pain or, trouble seeing because it's retaining their central vision. But sometimes they'll notice that, Oh, you know, I'm having to turn my head a little bit more.

The damage once it's occurred in glaucoma is irreversible. So we spend a lot of time screening patients and kind of risk stratifying whether we think they have glaucoma or not, and going ahead and deciding on treatment, whether it be drops or laser, or as a last resort, surgery. But because it is largely asymptomatic, we do want to screen patients.

It does run in families, so you know, if you have a first degree family member that has glaucoma, and especially if they're being treated for glaucoma, it's important for you to go and get your eye exam and see where you are on the risk stratification of how likely you are to have glaucoma or not.

[00:24:27] Purnima Patel: So diabetes for sure. High blood pressure changes in the eye. Obviously that has effect on, your risk of stroke and heart attack. A lot of the autoimmune disease, I've brought that up a lot. Like lupus, rheumatoid arthritis, that is all can manifest in the eye.

That can be the first sign of those diseases, but they certainly have, effects elsewhere in the body. But the macular degeneration, the glaucoma, those are both isolated to the eye, cataract isolated to the eye.

[00:25:09] Purnima Patel: With a macular degeneration, we have seen increased numbers for a couple of reasons. One, better detection, more awareness. Now that there's a better, more effective treatments, everybody's kind of looking and screening. But also we have, our baby boomers who are getting into the, age range where they can develop macular degeneration.

So we've seen an uptick in the numbers because of that. And for, diabetic eye disease, our numbers and trends do not look good. The rates of diabetes and as it goes along with obesity are just increasing in our country, and so people are getting diagnosed at younger ages, people are having it at older ages, so we're just seeing a lot of diabetic eye disease, and so, you know, having, there's a lot of focus on early screening and detection using technology, AI, that's one of our first uses of AI and ophthalmology, That's been incorporated for, several years , trying to look at these photographs and getting the computer to be smarter about picking up diabetic eye disease, but sometimes they can pick up even other things.

We are seeing an uptick in both of those conditions in the U. S.

[00:26:35] Purnima Patel: So with the macular degeneration, we know there's a higher risk in patients that are lighter skin, less pigment, because we know the pigment is protective towards anything that can be exacerbated by UV light exposure. It's not that we don't see, macular degeneration in darker skin patients.

It's just a lot more common in lighter skin patients. With diabetic eye disease, there's a lot of socioeconomic, overlap, due to, poor control and access to care and cost of care. So that's pretty pervasive in all different ethnicities, but I'd say with a macular degeneration, we see a lot more in, our lighter skin patients.

There is a higher risk or more glaucoma that we see and more severe glaucoma in the African American population in the U. S.

I'm assuming that probably has some benefit.

[00:27:50] John Salak: Or they're wearing them on their hat and they're not wearing them on their face.

[00:28:06] John Salak: Okay. Alright. What are some of the symptoms? You're an average adult, you're or a child, children are getting eye exam in school and whatnot, but, glaucoma, as you said, start to see a little limited vision on your side and you may find that disconcerting or maybe you're really aware that's a problem.

Maybe you're not. What are some of the other indications people may have a problem? Are there standard indications other than let's say I can't read or my vision is a little off, what are warning signs that, you may have another problem surfacing?

I think if they're having more pain or aching around their eyes or getting a new symptom of double vision, like anything that's changing with their vision, if it's new and it's, It's not going away. It's something that needs to be addressed. We need to look at it because there's clearly a change that went on and there's so many different reasons why you can get any given symptom.

It's important to get a thorough eye exam with a thorough history to figure out, what's causing your issue.

[00:29:38] Purnima Patel: Yeah. I mean, if you're getting hit with a ball, you should definitely come in and be seen.

[00:29:43] Purnima Patel: I think one of the things, the challenge area, we're mostly kind of talking about adult population, but kids aren't great at saying that they have a new symptom. But teachers are really good at noticing, students behaviors and that they're squinting more or they're having to move up further, like, Closer to the board.

So you know, just having that conversation , our teachers are saints and their work so much and they get, they have so much going on and more and more gets put on them. But , being like asking if you notice something at home to just corroborate it with the teacher that tends to spend, potentially more time with a child.

If you're thinking, well, man, some of the dumb things people say to you, or think, and you don't have to name names, but, that people think, what are the greatest misconceptions you see?

But just know that when they come in for their first examination, most of the time we are not trying to do a major procedure on them that day. We want the patient to feel comfortable, feel educated, and then we will whenever, , if it's non urgent to, to plan a intervention, that they understand that they, can get behind.

That's another thing. And then, even the glasses, some people feel like I'm just stuck wearing glasses, like I'm getting older and I'm just going to have to wear readers. Well, even for that, we have so much new technology, with the newer lenses, with cataract surgery, where our patients don't have to wear glasses anymore, even for up close.

So there can be, living very glasses free, independent lives, not having to, to worry about that. So there are a lot of options. There's constantly, technology and innovation that's happening and being incorporated that really can benefit the patient. So coming in and not being afraid, asking the questions, going over what your goals are so we can really help our patients meet their goals and live the lives that they want to live.

[00:32:33] Purnima Patel: I think readers are a great start, if they're having trouble up close, , and if it's a change, readers are really meant for reading up close activities. We now have computer distance as well, which is a little bit further out. So we don't need, as strong of glasses for our computer as we would for like our phone.

But it's not a bad thing to get. Started, but you know, if it's your first time. It's good to get an examination so we can tell you like this is about the power we'll need. Because sometimes you can go to a drugstore and get something like, for two seconds, look at a magazine and be like, oh, these are great.

But then they might be too strong or not strong enough and that can cause eye strain. I think it's good to at least get measured. And a lot of times we'll, we'll need to combine it with your prescription for distance so that you can both see distance and, up close.

So we can't thank you enough for all your insights, Dr. Patel. You are representing the American Academy of Ophthalmology, and you have your own practice in Georgia, correct?

[00:33:50] John Salak: And that's called your practice in Georgia is?

[00:33:56] John Salak: Okay. And that's where in Georgia.

[00:34:00] John Salak: Okay. All right. Are you Braves fan? You

Am. You have to be in Atlanta.

bet you

[00:34:13] John Salak: Okay. All right. All right. Fair enough. Well, we won't

[00:34:19] John Salak: Okay. All right. Okay. Well, that's good. And we won't hold you being a brave fan against you. But we do thank you for taking the time to talk to us and, giving everybody, forgive the pun, more clear vision on their eyesight.

So thank you very much.

[00:34:37] John Salak: Okay. Thank you.

Before we move on, we want to again encourage listeners to take advantage of the hundreds of exclusive discounts WellWell offers on a range of health and wellness products and services. These cover everything from fitness and athletic equipment to dietary supplements, personal care products, organic foods and beverages, and more.

Now, signing up is easy and free. Thank you. Just visit us at WellWellUSA. com, go to Milton's Discounts in the top menu bar and the signup form will appear. Signing up will just take seconds, but the benefits can last for years. By now, it's apparent that supporting strong eye care is virtually within everyone's reach.

Yes, the challenges and issues may vary from person to person, but ultimately eye care is like anything else when it comes to health care, knowledge and effort are required. So first off, realize no one can completely turn back time. Glasses may be in your future. Proactive eye care can help support stronger vision throughout a person's lifetime.

Also, think sunglasses. They are more than just fashion statements. They can help decrease cataract formations. They can also lessen the risk of developing skin cancer on delicate areas, including eyelids and eye rims. An eye friendly diet is also essential, and this goes beyond just eating carrots. Leafy green vegetables, spinach, kale, etc.

are important because they are full of antioxidants that are needed to support a robust organ like the eye. And perhaps surprisingly, regular exercise is another important element of health care. Your eye health care. Putting in 30 minutes a day of walking, running, biking, or whatever enhances eye health because it increases the level of oxygen to your eyes.

Finally, obviously, regular and thorough eye exams are necessary. And these exams go beyond simply deciding whether someone needs glasses or perhaps an adjustment to their prescription. These exams are essential for identifying diseases that may not otherwise be apparent. And obviously, the sooner a problem is identified, the more effective the treatments.

Okay, that's a wrap for this episode. We'd like to thank Dr. Parmina Patel for providing some important insights and information on eye care. We'd also like to thank the American Academy of Ophthalmology for arranging Dr. Patel's appearance. The association is a great source of information on eye care, so please visit aao.

org. That's aao. org to learn more. Ultimately, thanks again for listening to this episode of What the Health. We hope you'll join us again.