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Interviewer: Age-related macular degeneration is a leading cause of vision loss in adults in the United States. The effects on the central vision caused by this disease can significantly impact your life, including the ability to do daily activities, the things you enjoy, and it could also lead to a loss of your independence. However, the good news is, if caught early, the progress of the disease can be slowed.

Dr. Monika Fleckenstein is a professor of ophthalmology and vision sciences at the Moran Eye Center. She's a retina specialist with an emphasis on this condition. Dr. Fleckenstein, let's start with what is age-related macular degeneration. What's going on?

Dr. Fleckenstein: Yeah. So age-related macular degeneration, and we usually say AMD, this is a disease in the back of your eye, and it causes that your central vision may get worse over time. As the name says, the most important risk factor is your age, where you cannot do a lot about it. But we also know other risk factors, which is, for example, smoking or unhealthy lifestyle. And we also know that there's a strong genetic component in this disease.

Interviewer: You called a . . . it impacts your central vision. Is that what you said? Explain what that means.

Dr. Fleckenstein: Yes. So if you look at a paper and try to read, you do this with your very central vision. So this is the area of sharpest vision. This is an area in your eye which we call the macula. And the very center of this macula is the fovea. This is actually the area of sharpest vision, and this is the area you need for reading, for recognizing faces. So this is the highest resolution in your eye.
How Age-related Macular Degeneration Impacts Daily Functioning

Interviewer: I want to know how age-related macular degeneration impacts people's vision in their daily functioning. Talk to me about that, from what you've seen with your patients.

Dr. Fleckenstein: We have different stages of age-related macular degeneration, early stages where you may not experience any symptoms, and then we have the later stages of the disease that you may develop a grayish area in your central vision. In certain subtypes of the disease, you may even develop a central dark area where you're not able anymore to recognize faces or read.

The symptoms patients experience is dependent on their disease stage, but usually, when I see patients with earlier stages, I actually ask them, "Do you have difficulties in dim light?" And so when you go to a restaurant and if you try to read the menu and the light is dimmed and maybe candlelight, this is actually where the patients realize first symptoms. Then also, when they come from bright light outside entering a room, and they may realize it takes them longer to adjust to these changing light conditions as before in their life or compared to the people they are surrounded by. So these are typically the first symptoms of the disease.

And so in later stages, when there is the real damage of the cell layers, the photoreceptors, patients may experience that they have difficulties to read. In very late stages, patients may even not be able anymore to recognize faces. And this is probably, you know, the end stage of the disease where they are not able anymore to read or recognize faces.
Early Detection of Age-related Macular Degeneration

Interviewer: And the importance of early detection in age-related macular degeneration, it's pretty critical, from what I understand. Can you expand on that?

Dr. Fleckenstein: Most sad situations are those where patients have the wet stage and did not receive treatment, and then you face a stage where treatment is not possible anymore or is not really effective anymore if patients have developed scar tissue. And this is why it's so important that if you realize symptoms, never hesitate to reach out to your doctor and ask to have a look.

And when I'm seeing actually my patients with earlier stages of the disease, I explain to them the symptoms of the later stages and tell them, "Please never hesitate to contact me and my team if you experience these changes." And I even tell them it's, you know, "Even if you do not have these specific changes, but if you have a weird gut feeling, please reach out," because sometimes, you know, patients just experience something is off, something is weird here. I cannot really say what it is. Never hesitate. Try to be seen by an ophthalmologist just to make sure that nothing is going on.

Interviewer: And if it's caught early, there are some things you can actually do about it. Tell me about that.

Dr. Fleckenstein: In the earlier stages of the disease, there are certain constellations or certain findings in the back of your eye where we would recommend that you take certain nutrition supplements. So it has been shown in a large clinical trial, the AREDS study, that a certain combination of supplements may delay the progression to late stages, but just if you have a certain constellation of the disease. So the study has also shown that just taking these supplements without having any sign of AMD will probably not have a positive effect. But if you have certain signs, it has been shown that the disease may be slowed down.

In general, we would always recommend, but this is more or less a general recommendation to the whole population, to have a healthy lifestyle, not to smoke. And actually Mediterranean diet has been shown, not only in age-related macular degeneration but also in cardiovascular diseases, that this can be beneficial to prevent the development of macular degeneration and also of the late stages. And Mediterranean diet, this means vegetables, fruits, olive oil, fish. So more a combination of nutrition into this direction.
When to Get Checked for Age-related Macular Degeneration

Interviewer: So since catching it early is so crucial, how often should somebody actually get their eyes checked for macular degeneration?

Dr. Fleckenstein: Yeah. So this really depends on age. So the American Society of Ophthalmology, they actually recommend to have an eye check when you become 40. Then it highly depends if your ophthalmologist finds anything, if you have any signs of a disease in the back of your eye. With ages of 65, we would recommend yearly eye exams. But of course, if you have a positive family history for age-related macular degeneration or if you have certain risk factors, I would recommend to be seen by an ophthalmologist more often and even in earlier ages.
Diagnosing Age-related Macular Degeneration

Interviewer: And in the diagnosis part, are you able to diagnose the disease? How far in advance before a person starts experiencing symptoms are you able to diagnose the disease with the equipment you have?

Dr. Fleckenstein: So we can see on a micron level changes in the back of the eye. Within the last decades, we have seen such a rapid improvement on resolution. And again, we can see tiniest changes in eyes. We indeed also see patients without any symptoms who are not aware of having any problems, and we may pick up earlier signs of the disease, and we can certainly see if macular degeneration is present or not.

Interviewer: That peace of mind is probably great for a lot of patients when you tell them, no, that's not it, that's something else.

Dr. Fleckenstein: Yes. But, you know, I tell my patients as well, as the time has changed so much and we have these dynamics right now, having the diagnosis of AMD today is something completely different than 20 years ago.

Interviewer: And why is that?

Dr. Fleckenstein: Because first of all, I believe within the next 10 years, you know, we will have more treatments available, and for the wet late stage where everyone is so scared about, we have wonderful treatment available, and this treatment really works well. And I always say I have respect for the wet late stage, but I'm not scared of it anymore because if this is treated well, patients can keep their vision for many, many years.

Interviewer: Are you working out from home with exercise bands? Well, you might want to watch out for this injury.

Dr. Troy Madsen is an Emergency Room physician at University of Utah Health. And a lot of us are trying to get in some exercise at home, and we might reach for those exercise bands. But, Dr. Madsen, I understand that there could be some risk working out with those exercise bands. Tell me more about that.

Dr. Madsen: You know, Scot, I have used exercise bands, and this is a risk I've never really considered, but apparently there is an increase in risk and injury to the eye that has been something that's been noted since the pandemic started. So what we're seeing, I think, more and more people are not going to the gym, they're working out from home, and a great tool is a resistance band. If you've ever used this, it's like a giant elastic band. You know, these things are huge. You put it around your foot, and then maybe you're leaning back or doing something with your leg, all kinds of different things, stretching, strengthening.

Well, at the University of Miami, they actually published their experience with seeing multiple patients come to the Emergency Department with injuries to their eyes from these resistance bands. So the title of this article is "Ocular Trauma Secondary to Exercise Resistance Bands During the COVID-19 Pandemic," published in the "American Journal of Emergency Medicine."

And you can imagine how this can happen. I don't know if this has ever happened to you, but let's say you wrap it around your foot, and you're stretching your leg out, and that thing is really tight. And then, maybe you've got socks on or something, and it slips off your foot and flips back and hits you in the eye.

Interviewer: Oh. Ow. Oh.

Dr. Madsen: Yeah, sounds miserable. Sounds absolutely miserable.

So they reported their experience in the "American Journal of Emergency Medicine," and they talked about 11 patients they had seen, and these were not minor injuries to the eye. So they said 11 patients, 14 eyes, so that means several of these patients had both eyes injured. Eighty-two percent of these patients had a hyphema.

So a hyphema is a pretty big deal. That's where you get blood behind the cornea. And, you know, if you ever look in the mirror, you see the cornea, you see your iris, the colored part of your eye. The cornea is the clear part over the top of that. And if you ever see blood there, it just looks like just this red line that's filling up behind there, that's a pretty big deal. That's a serious injury.

And then, vitreous hemorrhage in 36% of these patients. That's blood back behind the iris, back in kind of the main part of the eye. That can really affect your vision. Potentially, if it causes enough damage, potentially have long-term effects. Same thing with a hyphema if it's not treated.

So these are not minor injuries, but they saw a number of these, and just given the number they've seen, they reported on it in the "American Journal of Emergency Medicine" to make people aware that things are happening with resistance bands.

Interviewer: All right. So not happening to, necessarily, a large number of people that we know of, but is in the realm of possibility of happening apparently.

Dr. Madsen: Exactly. And I think the reason they published this and their conclusion was, if you're using a resistance band, wear glasses or consider wearing goggles. I mean, it may seem like overkill. It is something that emergency departments are seeing. This is one emergency department's experience. I'm sure it's happening elsewhere. I have to be honest. I have not seen this in the ER yet, but if we talk to some of our ophthalmologists, my guess is that they probably have. So it's out there, it's happening. You know, takeaway, be aware of it and consider wearing some glasses or goggles if you're using a resistance band.

Interviewer: Yeah, or consider just making sure that you're looking at how you're using it, and "If it was to slip right now, would it slip back and snap me in the eye?" And is there an adjustment you can do in your form that would, you know, prevent that from happening?

Dr. Madsen: Yeah, exactly.

Announcer: Need reliable health and wellness information? Don't listen to the guy in the cube next to you. Get it from a trusted source, straight from the doctor's mouth. Here's this week's listener question on The Scope.

Interviewer: All right, today's patient question is from a gentleman named Ken. He says that his dad is starting to lose his eyesight, and they're concerned that his driving isn't as good as it needs to be.

So how do you have that conversation to take away the keys? It can be a scary thing to do. And to help answer this question we have Lisa Ord. She's a licensed clinical social worker. She also has a PhD in social work and is the Patient Support Program Director at the Moran Eye Center.

So how do you have that conversation?

Lisa: Having that conversation with one of your parents is probably one of the toughest conversations you're going to have, especially here in the West where we rely so much on driving and how much of our individual freedom is attached to be able to get in the car and go where you want when you want to. But the problem is that when someone isn't seeing as well as they need to be seeing, it gets frightening.

And it's not only frightening for them, but it's frightening for anybody else that's on the road or walking on the side of the road. So being able to have the conversation with your parents is very important. And to start with saying, "You know, dad, you've just had your eye checkup, and I see that it's not getting better. They can't correct it. Have you thought about other ways of getting to where you need to go other than driving yourself?"

Interviewer: And then you just pause and wait for that answer?

Lisa: And you pause and wait. Exactly. And it may be met with anger and just being able to be with that and say, "I know that this is a tough conversation, not something you even want to talk to me about." But the tougher conversation is the conversation after you've hit somebody because you didn't see them.

Interviewer: So this is a conversation that if you feel that somebody that you love is not seeing well, you need to have a . . . you outlaid a very direct approach. Are there other ways, if you don't think the direct approach is going to work with your particular loved one?

Lisa: I've had patients use different approaches. One patient said, excuse me, one daughter of one of my patients said that she finally said, "My children will not ride with you in the car. We either need to have someone else drive, or you're not going to be able to take them where you want to take them." So it was kind of like putting it in terms of, "I don't feel safe enough to be in the car with you. I don't feel safe enough for you to take my children in the car with you."

Interviewer: And that really kind of brought the reality to bear?

Lisa: To bear, yeah.

Interviewer: Is there somebody else you could involve, like a health care professional perhaps, because maybe they would be more willing to take it from a third party?

Lisa: I have a lot of patients that say, "But my license doesn't expire for another two years, so I don't have to worry about it." And that's not the case. You're still going to be very much liable whether your license is expired or not. If you're not safe to be driving, your eye care professional will have to fill out a medical form stating what your visual acuity is, and your visual field if you are not being able to be corrected to 20/40 or better. So that is something that they're going to have to do. Having the health provider have that conversation with your parent is sometimes easier because it does kind of put that onus on the healthcare professional.

The other thing is that if you really can't have the conversation, you really are concerned about your parents' driving or anyone's driving, you can make a report to the DMV, and they will take it upon themselves to have that person do a driving test.

Interviewer: Okay. All right. Probably not the way that most people would want to handle it. But I guess as a last resort . . .

Lisa: As a last resort. And I have had some family members who say their parents are so adamant that they're, you know, having extra keys made every time the keys are taken away from them, things like this. And so you're left with no other resort, except for to call in the people whose ultimate responsibility is to take away the license, and that is the driver's license division.

Interviewer: Ultimately, though, if somebody is faced with a vision impairment that could endanger them or others while driving, whatever you do, you would recommend something has to be done.

Lisa: Yes.

Interviewer: Don't leave it to chance.

Lisa: Don't leave it to chance. Not a good plan.

Announcer: Have a question? Ask it. Send your listener question to hello@thescoperadio.com.

Announcer: Is it bad enough to go to the emergency room, or isn't it? You're listening to ER or Not, on the scope.

Interviewer: All right. Play along if you will. ER or Not with Dr. Troy Madsen from University of Utah Health. Today's situation is you got sprayed with pepper spray, so you'd got some pepper spray in the eyes, and we're just going to go ahead and pretend that it was an accident and you weren't some sort of an assailant.

Dr. Madsen: That was my first question. How did you get pepper spray in your eyes?

Interviewer: It was an accident, either it went off or you were playing with . . . I don't know, all right?

Dr. Madsen: We won't ask questions. We won't judge.

Interviewer: Pepper spray in the eyes, ER or not?

Dr. Madsen: Probably not, because anything we do in the ER you can probably do at home. Just the question is, are you going to be able to tolerate it and be able to do this? So, like you mentioned, the big concern is going to be the eyes. It can get in your face, can get on your hands. It's going to irritate it, cause it to get red and painful.

Interviewer: Oh, even beyond the eyes, it's going to be painful and annoying?

Dr. Madsen: Absolutely. It will be. But the big issue is going to be the eyes. So there's a little saying I've heard some people say, "The secret to pollution is dilution." And if you've got pollution in your eyes like pepper spray, you just have got to wash it out.

Interviewer: Or anything else.

Dr. Madsen: Anything else. The secret is dilution. You've just got to dilute it, so that's the key. So what we would do in the ER if you came in, we would try and wash your eyes out as well as possible. And we have got different tools we can use to do that. One of them, actually, we put numbing drops in the eye and put what looks like a really thick contact lens and then we hang a bottle of normal saline, just as normal sort of fluid that we can run in there, and it just washes it all out. It just sits there and washes it.

As you can probably do something very similar at home if you can get your face under the sink or something and just let water run in it. If you let it sit there for 5 to 10 minutes and you can tolerate that with lukewarm water, you're probably going to be okay and avoid coming to the ER.

Interviewer: And same with the skin? It will irritate the skin, but just rinse it off with water and there shouldn't be any other issues, really.

Dr. Madsen: There shouldn't be unless you were to have some sort of weird allergic reaction to it or something, which would be kind of a different scenario. But if it were to happen to me, you know, personally, I would get in the shower in lukewarm water, trying to run it in, trying to get my eyes up under the shower to wash it off kind of at angle as well as I could. And that's really the best thing you can do. But if you're just not going to be able to do that, you've got to get that irrigated out of there and dilute it, and we can certainly do that in the ER.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at thescoperadio.com and click "Sign Me Up" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.

Interviewer: Those little squiggles that move around in your eyes, I'm talking about floaters, is that something you should be concerned about, and is there anything that can be done about them? We'll find out next on The Scope.

Dr. Brian Zaugg is an ophthalmologist at the Moran Eye Institute. I know I have them, and I know some other people that have them. Floaters, you know, those things where you close your eyes and you see little squigglies moving around, or sometimes if you're looking into a bright light, you might see them? What's going on there and should I worry about them? First of all, what are they?

Dr. Zaugg: Yeah. Floaters are a big annoyance. I see a lot of patients who complain of floaters every day in my clinics. Generally speaking, what they are is they're condensations of a part of the eye called the vitreous. So the vitreous is a gel-like substance in the back of the eye. When you're younger, it'll liquefy a little bit and collapse on itself, and you'll get little floaters of proteins floating around in the surface inside the eye. As those floaters move around, they create a little shadowing on the retina, so the light can't get to the retina and it creates a floater-like symptom for you.

As you get older, that vitreous continues to liquefy and as it liquefies, it actually shrinks. When it shrinks, it pulls away from the retina. It's kind of adherent to the retina in a few places. Where it's more tightly adherent as it pulls away from there, it creates larger floaters. So they generally get more annoying the older you get if you get floaters.

Interviewer: You might see more the older you get, as well?

Dr. Zaugg: Correct.

Interviewer: All right. So it's not going to get any better on its own for me?

Dr. Zaugg: Well, it usually gets better after the initial onset of the floaters.

Interviewer: Okay.

Dr. Zaugg: So when you get the new floaters coming in, they're very annoying, they're large, there's many of them, and then over time they usually do settle down.

Interviewer: All right. Is it something that I should really be worried about, beyond just an annoyance?

Dr. Zaugg: So when you get new floaters, you should always be thinking about anything else that's going on with the eye. There are definitely associated symptoms that you should pay attention to. A new floater can be a sign of, what we most commonly fear is a retinal detachment. If you have a retinal detachment or a tear in the retina, those can be, not life threatening, but vision threatening symptoms. So if you have flashing lights, that can mean that there's some tugging or mechanical motion that's happening to the retina. The retina only knows light. So if something stimulates it, it sends a message back to the brain that you saw light.

The other thing that's really bad with floaters is if you have a dark curtain blocking part of your peripheral vision. That could mean that the retina has folded over on itself and it's detaching, and that can mean that you're having a more serious complication from floaters.

Interviewer: So if I understand correctly, floaters on their own without other symptoms just are part of life.

Dr. Zaugg: Correct.

Interviewer: But with some of those other symptoms you mentioned, then that can be an indication of a more serious issue?

Dr. Zaugg: Correct.

Interviewer: Okay. How often does it get into that serious world, generally?

Dr. Zaugg: It's more common the older you get.

Interviewer: Okay.

Dr. Zaugg: So if you're over the age of 50 and you're getting a lot of new floaters, then you're a little bit more worried about it, because you're getting the complete collapse or separation of the vitreous from the retina, and it can pull the retina with it. So those are times when you really want to get an eye exam to really determine, because you're not going to know for sure if you're having a retinal tear or detachment. Sometimes you have no symptoms other than the floater. So getting a complete eye exam by an ophthalmologist or an optometrist can help to distinguish if it's a more serious eye condition.

Interviewer: That sounds terrifying. But generally, as long as the floaters are the same old floaters, I'm fine?

Dr. Zaugg: Correct.

Interviewer:And is there anything that you can do about, first of all, the annoying floaters?

Dr. Zaugg: Well, generally speaking, they do decrease with time. Again like I said . . .

Interviewer: Understood. Okay.

Dr. Zaugg: . . . if you get a new floater, it usually goes away with time. Either your brain will start to filter out the floater or gravity will actually bring it down in the eye, so it's not in your visual axis. Usually, they'll come up when you're looking at bright backgrounds. So a lot of times when you're looking at a computer, when you're reading, when you're driving on bright, sunny days.

So outside, something that you can do is wear sunglasses. It filters out the floater a little bit. Inside, if you're working at a computer, it's a little bit more tricky. You can get displays that cover the computer screen that kind of filter it a little bit, use a little bit less contrast in your screen. Sometimes that will diminish the floaters as it bothers you.

Interviewer: So it's about decreasing the glare . . .

Dr. Zaugg: Correct.

Interviewer: . . . in those situations?

Dr. Zaugg: Yes.

Interviewer: That's also the gravity thing, is why when I close my eyes, I'll see them float up sometimes, and then I open my eyes and they go away?

Dr. Zaugg: Well, that's usually a little bit of just the eye movement.

Interviewer: Oh, okay.

Dr. Zaugg: Because when your eye closes, your eye actually moves underneath your eyelid and it'll move the floater.

Interviewer: All right. Is there anything else that I should be aware of floaters? My kind of takeaway is they're a part of life for a lot of people. There are some things you can do to minimize seeing them if they're bothersome. If you start getting some new floaters with other symptoms, I should go see someone like you.

Dr. Zaugg: There's a couple other medical conditions that you should be thinking about other things. So if you're diabetic, sometimes floaters can be a sign of bleeding inside the eye. Diabetics have a lot of eye problems when they're uncontrolled. So they usually have an eye doctor that they've been with, and that would be a reason to get an eye exam more quickly than others. Other things that can happen, if you've had a recent eye surgery, that's a warning sign that something could be going wrong. So have your eyes examined.

There's other rare inflammatory conditions of the eye, in a category called "uveitis," where the floaters can actually be conglomerations of inflammatory cells that could be signs of other serious eye conditions. So the bottom line is if you get a new floater, get an eye exam so that they can determine what's causing it. If it is one of these benign floaters, then that's great. You move on with your life. But we have to make sure that there's not something more serious going on.

Interviewer: How often do you recommend somebody get an eye exam, anyway?

Dr. Zaugg: Well, that kind of depends on how old you are, and if you wear glasses, if you don't wear glasses.

Interviewer: Sure.

Dr. Zaugg: If you're doing well and there's no issues with your eyes when you're younger, getting an eye exam every 10 years is probably fine.

Interviewer: Oh, okay.

Dr. Zaugg: As you get into your 40s and 50s, maybe every five years. As you get into your 60s, every year or two.

updated: September 30, 2020
originally published: May 17, 2017

Interviewer: You think you or maybe your kids have pinkeye. How will you know for sure and what should you do about it? We'll talk about that next on The Scope.

Announcer: This is From the Front Lines with emergency room Dr. Troy Madsen on The Scope.

Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health Care. Pinkeye. Let's talk about how you would diagnose a case of pinkeye and then what you would do about it because I hear it could be kind of difficult to diagnose like a school nurse, for example, might not be able to tell the difference from allergies or not. Is that the case?

Dr. Madsen: That is the case. And that's always what I'm thinking in my mind. So the most common thing we have is someone comes in and they say, "My eye hurts" or "My eyes hurt". I look at their eyes, they're red. So a couple of questions I ask and I say, "First of all, did this start in both eyes or did it start in one eye and spread to the other?"

If it starts in one eye, that's more likely what we would call pinkeye. And pinkeye is a bacterial infection often. Sometimes it's a viral infection but it's really tough to tease out which are bacterial and which are viral. Of course the ones we worry more about are the bacterial infections because we're going to treat those with antibiotic drops, but you figure it's not going to necessarily start in both eyes at the same time. It kind of start somewhere. It's going to start in one eye and then maybe you're rubbing that eye and then it spreads over to the other eye. So typically with pinkeye, that's the case.

Interviewer: Okay, so one eye hurts before the other generally.

Dr. Madsen: Exactly.

Interviewer: Red like bloodshot red, what's that red look like?

Dr. Madsen: So the red . . . Yes, that's tough to distinguish from allergies.

Interviewer: There's nothing really unique about it, huh?

Dr. Madsen: Not particularly. It can look a lot like allergies where just if you've ever had like allergies, just seasonal allergies, your eyes are bloodshot, they hurt, they itch, pinkeye looks very similar. With pinkeye though, we often see more discharge or more drainage from the eye. This kind of stuff that's not so much, just your eyes watering, which you have with allergies, but stuff that's kind of a little more whitish in color that looks more like you would imagine an infection looks.

So someone who says they wake up and my eyes are like matted shut. Again, allergies, we can sometimes see that but it's usually more with pinkeye. They have to pry their eye open or their kids' eye or they use like a washcloth and hold it on there to kind of loosen that up and pry it open. That's pretty typically with pinkeye and that helps me out to make that diagnosis.

Interviewer: All right. So then what does treatment look like? You said if it's a bacterial cause, then you would use antibiotic drops. It's hard to tell though, so you just . . .

Dr. Madsen: It is.

Interviewer: You just use antibiotic drops across the board or . . .?

Dr. Madsen: Typically yes, and you don't want to over-treat with antibiotics, but in practical terms, if I were to try and get a culture of the eye, send that to the lab, it takes couple days to get the result. It's not really that useful. So even though it might be viral, it's often bacterial so we treat with antibiotic drops. It means using drops several times a day or often for a week just make sure this clears up. Most people are going to have improvement in their symptoms after two or three days.

Interviewer: What if it's viral though and you're using the drops, they're not doing anything, will it just get better on it's own or . . .?

Dr. Madsen: It will.

Interviewer: Really?

Dr. Madsen: It will. Yes, with the viral it will just get better on its own and the antibiotic drops probably aren't going to do a whole lot for it but, again, it's hard to say because maybe after two or three days, you're feeling better and it could be that the virus got better on its own or maybe the drops treated the bacteria. But it's not the sort of thing, again, where a culture would be that helpful because it's going to take two or three days to get the results back. If it's bacterial, it could get significantly worse and really progressing, cause some issues wherein you can get infections around the eye or extending behind the eye as well.

Interviewer: And untreated, could it cause long term problems if you didn't go into anything about it or would it eventually just clear up regardless?

Dr. Madsen: It could clear up but the concern with the bacterial infections would be something that progresses, again, to where it spreads around the eye.

Interviewer: Infects the rest of, yes, other parts of your eye.

Dr. Madsen: Exactly. And so that's why even though in my mind I say, "Okay, this could be a viral infection," I'm also saying, "I want to treat this as likely a bacterial infection because the possibilities with the bacterial infection could be pretty significant." And I don't necessarily want to tell this person, "Wait two or three days and then come back when you have a significant infection around your eye that might require even something like IV antibiotics or hospital admission," if it got to that point and got that serious.

Interviewer: And don't need to go to an emergency room for this sort of thing. Urgent Care or a primary care provider probably would be able to take care of it.

Dr. Madsen: Absolutely.

Interviewer: And you could . . . even if you have to wait a day?

Dr. Madsen: Yes. Even if you had to wait a day, you're probably okay. I think the challenge for most parents is if their kid gets pinkeye, they're not going to let the kid come to school because it is highly contagious. You've got to make sure you're washing your hands, your kid's washing their hands. Kids get this at school, they pass it to other kids. So a parent's probably not going to want to wait a day to get in to see their primary care doctor. They'll go to an Urgent Care. If you have to come to the ER, you come to the ER. Either way, I'm guessing most parents want to get that treated and get their kid back to school and get them out of the house as soon as they can.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: October 2, 2018
originally published: August 19, 2016

Dr. Gellner: We'd all have x-ray vision if we could, am I right? Do certain activities we've been warned about actually hurt our eyes? Old wives' tales about eyes today on The Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering The Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: They say eating carrots will improve your eyesight, not true. But this old wives' tale has a really cool back story. It may have started during World War II when British intelligence spread a rumor that their pilots had remarkable night vision because they ate lots of carrots. They didn't want the Germans to know they were secretly using radar.

Carrots and many other vegetables high in vitamin A, do help maintain healthy eyesight, but eating more than the recommended daily allowance won't improve your child's vision. In fact, it can turn your child orange like a Oompa Loompa. That's called beta-carotenemia. Not good.

Reading in dim light will damage your eyes. False. Although reading in a dimly lit room won't do your child's eyes any harm, good lighting can prevent eye fatigue and make reading easier during the pile of homework they have to do every night.

Too much TV is bad for your eyes. Well, watching television won't hurt your child's eyes no matter how close to the TV they sit. But too much TV is a bad idea for kids. Two hours of screen time or less people. Research shows that kids who consistently spend more than 10 hours a week watching TV are more likely to be overweight, aggressive, and be behind in school. So get them outside playing instead.

And we've all heard this one growing up. If you cross your eyes they'll stay that way. Sorry mom, not true. Only 4% of children in the United States have strabismus, a problem with the eyes are not aligned correctly giving the appearance that they're looking in different directions. Eye crossing however does not lead to strabismus.

And no, your child will not shoot their eye out if they play with BB guns responsibly. But when it comes to your child's eyes, if they have any problems, see a pediatric eye doctor right away.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard be sure to get our latest content by following us on Facebook, just click on the Facebook icon at TheScopeRadio.com.

Interviewer: What are some of the common lawnmower injuries that an ER doc might see? We'll find out next on The Scope.

Announcer: Health tips, medical news, research and more for a happier healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Dr. Troy Madsen's an emergency room physician at University of Utah Hospital. It's that time of year again when you get out the lawnmower and start mowing. What are some of the common lawnmower injuries that you see? I mean, the first thing I think of when I think of lawnmower injury is cutting something, like you get your foot under there, you get your fingers under there. Do you see a lot of that?

Dr. Madsen: Not a lot, but we do see it.

Interviewer: Okay.

Dr. Madsen: Either from people for whatever reason they, like you said, may get a foot under there. Who knows exactly how that happens sometimes. Maybe they got their hand under there and the lawnmower is on.

Interviewer: Yeah, some of those lawnmowers can continue to run, you can take the bag off, empty it. Maybe there's a little . . . and you think you can clean out a little bit of . . . I mean, I don't know. You would think most people wouldn't do that and most people don't, it sounds like.

Dr. Madsen: Most people don't, but occasionally, it does happen. And that's kind of the obvious thing. You think, "Okay. Lawnmower. The blade's spinning." You don't reach in there, you don't reach into the shoot and try and clean grass out while it's running. Just don't do it. It might catch a finger or maybe you're moving and you get your foot under it.

Interviewer: What you're seeing are those things that we don't expect. Dr. Madsen: Yes.

Interviewer: I'm thinking, "Like what?"

Dr. Madsen: Yes. Kind of the interesting things we see are, okay, I'm a conscientious lawnmower, I tell myself do not run the mower when I'm cleaning grass out from the shoot. So I turn the lawnmower off and then I reach into the shoot and I've got all this grass, this wet grass stuck in there. I'm pulling it out. Well, that wet grass, you've got a blade in there with a spring on it, it may have really tightened that spring up. It may have a lot of tension, I pull that grass out and then that tension releases and the blade gets my finger. And I have seen that happen. We see it with snow blowers and we see it with lawnmowers.

Interviewer: So the smart thing to do: turn it over and use a stick?

Dr. Madsen: Use a stick. And I wouldn't even turn it over. If it's stuck in the shoot, get a stick in there, just pull that stuff out and just try and clean it out as well as you can before trying to put anything in there that's going to cause any tension release if there's tension in that blade.

Interviewer: All right. What are some of the other things you see in the ER when it comes to lawnmower injuries?

Dr. Madsen: Well, the other thing would be that occasionally happens is you're mowing a lawn and you hit a rock or something in the grass and then it just flicks it. Occasionally, we will see people who have been hit in the leg by something like that. You do have the other lawnmower, the weed whackers or whatever you call them, that have the little kind of cable that spins around that obviously puts you at higher risk for things getting flicked into your eyes. We do see things in people's eyes either in the eye or hitting the eye and causing a scratch or an abrasion on the eye. That's the other thing you obviously have to watch for as well.

Interviewer: All right. Some good tips for some things to look out for when you're mowing your lawn. Any final thoughts? When you mow you lawn, eye protection?

Dr. Madsen: Yes, absolutely, eye protection.

Interviewer: Cargo shorts?

Dr. Madsen: Long pants and wear good shoes. Don't go out there in your flip-flops.

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Interviewer: When you think of vision correction surgery, most people think of Lasik. It's not the only option. We'll discuss what the other treatments might be next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: We are in the office of Dr. Amy Lin today. She's an ophthalmologist at the Moran Eye Center at the University of Utah. Dr. Lin, first of all, tell me why someone would even need to go get Lasik.

Dr. Lin: People get Lasik to get out of their glasses or contact lenses. They want to correct their nearsightedness or their farsightedness or their astigmatism. That's why someone would want to have Lasik.

Interviewer: That's not the only option, I'm hearing. There are other surgery options besides Lasik.

Dr. Lin: That's correct. The most common alternative to Lasik is something called PRK. PRK was actually the precursor to Lasik, but we still do a lot of PRK nowadays because there are certain advantages with PRK. And it does the same thing as Lasik, corrects nearsightedness and farsightedness and astigmatism. Instead of having a flap in the cornea like there is with Lasik. With PRK, there is no flap in the cornea, but your eye has to heal over naturally.

Interviewer: When a patient comes to the office and they ask you for suggestions of what treatments and what surgery they should do, how do you decide Lasik is better for you or PRK?

Dr. Lin: We do a whole variety of measurements in the office. We measure the steepness and the shape of the cornea. We measure the thickness. We measure the prescription in the eyes. And based off of that data, we decide is the cornea thick enough for Lasik and PRK because you do need a thicker cornea for Lasik. Is the prescription too high for Lasik and maybe still ok for PRK? That's kind of one objective measure that we have for choosing one or the other.

There are other parameters that we look at. We actually look at the patient and if they have a lot of dryness in their eyes, like they can't wear the contact lenses for a long time because their eyes become too dry, with Lasik, we know that you get a lot of dry eye afterwards than with PRK. If you have dry eye existing, it may be a better option to go with PRK rather than Lasik so you don't worsen your dry eye.

Interviewer: When your doctor tells you that they recommend PRK as your treatment, does that mean that you are not a candidate for Lasik? Can you not do Lasik if you are recommended PRK?

Dr. Lin: Usually, people are either candidates for both or candidates for just PRK. If a doctor recommends to you that they recommend PRK, usually, it means there's something that usually bothers them in Lasik and they think it might be too risky to do Lasik, but it would be safe to do PRK.

Interviewer: Now, are the outcomes of both of the surgeries the same?

Dr. Lin: Yes, the outcomes are the same. When they do the studies that compare PRK versus Lasik, the visual outcomes are the same. PRK takes a lot longer to heal whereas Lasik is a lot faster. Lasik people are saying well after a day or so. With PRK, it takes several weeks. That's not to say that you're blind for several weeks. It's just not to be quite as crisp and clear for several weeks, but the vision does get there. Interviewer: With gradual outcome.

Dr. Lin: Exactly.

Interviewer: With Lasik, from what I understand, there is a laser involved that corrects your eye vision for you. Tell me about PRK. Is that the same thing? Is there a laser involved or is it some totally different procedure?

Dr. Lin: Both Lasik and PRK have a laser involved. With Lasik, there are actually two lasers involved. There is one laser that cuts a flap and the cornea and then, there is a second laser that corrects for the vision. And with PRK, we just use the laser that corrects for the vision. After the laser procedure, with PRK, a bandage contact lens is actually put on the eye and that contact lens is kept in the eye for several days so that your eye can heal. Whereas with Lasik, there isn't any extra material put on your eye. Your eye kind of . . . it's fast and your eye is almost kind of healed at that point. There's really nothing to cover up.

Interviewer: Is there one that you would prefer over the other, in terms of their kind of better outcome long-term.

Dr. Lin: PRK could be a little bit safer and the reason is that with Lasik, there's kind of a long life risk of having additional damage to your eye if your eye gets hit really hard. We're talking hard injury like a car accident, baseball to the eye, a big fall, something like that because the cornea isn't that 100% strength. There could be additional injuries to the eye with whatever injury hits you in the eye, but if you have PRK and you get hit in your eye later on, any eye injury you would have wouldn't be any different than getting hit in your eye right now.

Interviewer: PRK is not a surgery that a patient could come into your office and say, "I want this surgery." It's something that you need to evaluate and it's a doctor-prescribed treatment?

Dr. Lin: Exactly. PRK is an elective surgery, but we still need to see if you are a candidate for it. But some people are not candidates for Lasik and some people are not candidates for Lasik or PRK. I think they're both great procedures and the only way to for you to determine that is to see a doctor, get all the testing to see if you're a candidate.

Announcer: TheScopeRadio.com is University Of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest contact by following as on Facebook. Just click on the Facebook icon at TheScopeRadio.com

Dr. Miller: Treatments for a damaged cornea. We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi, I'm here with Dr. Mark Mifflin. He's a Professor of Ophthalmology here at the University of Utah. I'd like to talk a little bit about what patients might expect if they go in for corneal transplantation or mention of some of the newer technologies related to corneal repair. I know you're an expert in that area so you might just tell us a little bit about that.

Dr. Mifflin: Traditionally, corneal transplantation involves basically replacing the front of the eye, the windshield, if you will, which is the curved clear dome of our eye is the cornea. And so in the traditional technique that is actually cut with a special instrument and replaced with a clear cornea from a human donor cadaver eye. The cadaver tissue is processed through an eye bank and it's very safe. It's much safer than obtaining, for example, a unit of blood from a transfusion.

The tissue is carefully screened and selected and amazingly does not need to be tissue-matched, unlike a kidney or a heart or something like that because the cornea does not have blood vessels and the eye has what we call immune privilege, meaning it's designed or evolved or whatever one believes to not scar and to not create an excessive immune response to injury or surgery.

In terms of some of the newer procedures, within the last ten or so years we have made really amazing advances in just transplanting the part of the eye that is actually diseased. So for example, in a condition called keratoconus where basically the structural part of the cornea is weak and distorted, we can replace the anterior part of the cornea, leaving all of the posterior structure intact. This speeds recovery, decreases the rate of rejection and generally results in better vision.

Dr. Miller: How does one choose between the best surgery or technique?

Dr. Mifflin: Well, typically the surgeon has to kind of choose for the patient, and some of the more advanced techniques are not always possible. There are other diseases where only the very inner layer of the cornea is damaged or diseased, and certainly replacing the inner layer only allows for a very quick recovery. For example, comparing traditional cornea transplantation which might take six months for visual recovery, transplantation of the inner layer or the endothelial keratoplasty that we do now may result in good vision in as little as two weeks.

Dr. Miller: That's a huge difference. How many patients do you think would qualify for the partial thickness corneal transplant?

Dr. Mifflin: It's pretty much become the standard of care. It's not that the traditional technique is wrong, but certainly, for example, in our center here at the University of Utah we always try to do the most advanced technique if we believe that it's going to result in the best outcome for the patient. Not all surgeons are necessarily trained in the most advanced techniques, but certainly these things are literally becoming the standard of care for most patients.

Dr. Miller: Dr. Mifflin, could you talk a little about the durability of the corneal transplantation or the partial corneal transplantation?

Dr. Mifflin: Durability in terms of survival rates and longevity of the graft is actually very good. Graft rejection or failure is quite low, in the range of perhaps as low as 1% for some groups or maybe up to 30%. The most difficult transplant patients that we deal with in terms of making the graft work long-term are children. Unfortunately, children do sometimes need corneal transplantation and the success rate is lower, although sometimes there's no option and corneal transplantation is required to prevent irreversible amblyopia or loss of vision due to basically what in layman's terms is known as lazy eye.

Dr. Miller: So either transplantation technique should result in equivalent duration, longevity of the transplant?

Dr. Mifflin: Yeah, and typically transplants will last anywhere from . . . there have been documented successful transplantations lasting more than 60 years. I've only been practicing for 20 years, but most of my transplants from 20 years ago are still doing fine.

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