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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.

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.

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Announcer: Health information from experts supported by research. From University of Utah Health, this is thescoperadio.com.

Interviewer: Sometimes when people lose their vision, they start having hallucinations. It's a condition called Charles Bonnet Syndrome. CBS might not be well-known or documented, but it is extremely common and harmless. Lisa Ord is a licensed clinical social worker. She also has a Ph.D. in social work, and is the Patient Support Program Director at the Moran Eye Center.

So, first of all, Lisa, it's fascinating that many people might actually have this condition but don't say anything about it because they're afraid they'll be diagnosed with mental illness or dementia. So tell me more about that part of it first.

Lisa: Well, I think it's really important for people to realize that they're not going crazy. So the big difference between Charles Bonnet Syndrome and say psychosis caused from mental illness or dementia is the level of insight for number one. People realize that what they're seeing isn't really there. It can't be there. If they don't realize that when it is explained to them that this is caused because your brain hates to have a void, it's used to a lot of visual stimulation. And so it's creating this for you, then it's like, "Oh, okay." Whereas somebody with psychosis or dementia, you can't get them off of that idea that it's real.

Interviewer: And when a lot of people that have this condition are in a support group and they hear that their loss of eyesight also might be related to these hallucinations, they sigh a sigh of relief.

Lisa: Yes. Yes, because here they've kept it a secret. They haven't wanted to tell their family. They haven't wanted to tell their healthcare provider for fear that they're going to be carted off and not able to live alone anymore. A lot of our patients do live alone and quite independently.

Interviewer: Yeah. It's fascinating. So if you start losing your vision, your brain wants to see so badly that it just starts. Tell me more about how it's filling that void.

Lisa: Well, it's interesting to me. We don't know a lot about it, but what we do know is that through some fMRI studies that it's the same visual pathways that are engaged when somebody is seeing a hallucination from the Charles Bonnet Syndrome as when they're actually seeing the object. But when they're just imagining the object or visualizing the object, it doesn't engage those same pathways. So we do know that it is as if we are seeing that thing that we're seeing, and people see a variety of different kinds of things.

Interviewer: Yeah. Do you have any examples?

Lisa: Yeah. So I have a patient who saw the Grand Canyon opening up in front of her. Rather disconcerting. She knew it wasn't there, but still it was a little bit unnerving.

Interviewer: Like the ground opening up . . .

Lisa: The ground opening up.

Interviewer: . . . as if it's a Grand Canyon. Wow.

Lisa: Yes. I've had people that saw flowers or patterns. I've had a gentleman who saw a train and just passing in front of his eyes. A lot of people actually see other people, and these are not necessarily people they recognize.

Interviewer: Yeah.

Lisa: In fact, most the time they don't recognize them.

Interviewer: Can those hallucinations be dangerous?

Lisa: No. They're not dangerous at all.

Interviewer: Not even the person that thinks they see the train? I guess that's better than not seeing a train. Of course, they can't . . .

Lisa: I guess it depends what do you do with it, right?

Interviewer: Yeah. If they're losing their vision, then they're not seeing it. Yeah. Right.

Lisa: Right. But there are lots of things you can do to get the visions to go away.

Interviewer: So is there a point in vision loss where it starts to happen? Is there a threshold where if it's going to happen, it might start happening at that point?

Lisa: Well, what we see is usually people who have more of a severe vision loss also maybe a field. A visual field defect where they have a blind part of their vision and that's actually where they're going to see the hallucination is in that blind spot.

Interviewer: And do some people still see some real things and then that's also the hallucinations are on top of that as well?

Lisa: Yes. Hallucinations can be almost superimposed on top of that as well. Yes.

Interviewer: Like virtual reality in a way.

Lisa: Yes. Exactly.

Interviewer: Yeah. So is it primarily older people that get the condition, or is it just we tend to think of it in older people because they're more likely to have lost their vision?

Lisa: Exactly. It can happen to anyone who has had vision before. Your brain has to know how to see. It has to be used to that visual stimulus. But like you said, most blinding conditions are happening in the elderly or they're age-related conditions. So that's the population that we're more likely to see them in. It can happen in children.

Interviewer: What are some of the specific conditions where it starts happening? So macular . . .

Lisa: Macular degeneration . . .

Interviewer: . . . could be one of them. Yeah.

Lisa: The big one. Glaucoma, diabetic retinopathy. There's many different kinds of conditions that cause blindness. It doesn't really matter. It's not really tied to one condition or another.

Interviewer: Got you. Is it curable?

Lisa: It is not necessarily curable. There are things you can do to get the hallucination to stop. Sometimes they just stop on their own.

Interviewer: Okay. So just because it happens once doesn't mean it's going to continually happen?

Lisa: Right.

Interviewer: Okay.

Lisa: I have some patients who have it continually quite a bit. Other patients it's like, "Yeah, that's happened to me once or twice."

Interviewer: Okay. All right. And what are some of the strategies for managing it?

Lisa: So one thing that you want to do is change the lighting in your room. So if you are in a dim room, turn on the lights, open the drapes. Another thing that you can do is blink rapidly, change your location, do something else, something that engages your brain, whether it's a hobby or talking to someone else, giving your brain another kind of stimulation.

Interviewer: If somebody believes if they or a loved one has Charles Bonnet Syndrome, what should they do at that point? Should they go see an eye doctor? Do you go see somebody else?

Lisa: Well, they can go see an eye doctor. They can see their primary care, but not being afraid to mention that, "I have vision loss and I am also seeing these interesting or not so interesting visions." That doesn't necessarily mean you're crazy. And providers, even though they may have learned about this once in medical school, they don't think to ask people. So if you are a provider that works with elderly people, remembering if they have vision loss to ask, "Do you see things that aren't there?"

Interviewer: Yeah. And frame it.

Lisa: And frame it.

Interviewer: And frame it that this is . . . yeah.

Lisa: We have patients who see things that aren't there and they know that. Is that happening to you?

Interviewer: What about if you have somebody that has lost vision in your life. Is this a conversation you should have with them, just to make it safe for them to talk about it?

Lisa: Yes. I think just opening up that conversation saying, "I heard about this the other day, and I was wondering if that's ever happened to you."

Interviewer: Yeah.

Lisa: It's totally normal.

Interviewer: And I bet a conversation like that could take just a load of stress off of somebody that thinks that they're going crazy, right?

Lisa: Huge.

Interviewer: Yeah. What do you think that the ultimate takeaway that you would like somebody to have as a result of the conversation we had about Charles Bonnet Syndrome?

Lisa: I think the ultimate takeaway is that it is not as rare as we once thought. We find that about one in four of our patients with vision loss have experienced this. So talk to somebody about it. You're not going crazy.

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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.

Dr. Miller: Rubbing your eyes might feel good, but it is really bad. Is that true? We're going to talk about that next on Scope Radio.

Hi, I'm here with Dr. Mark Mifflin. He's a professor of ophthalmology at the University of Utah. Mark, is rubbing your eyes too much a problem? Can that lead to some bad outcomes?

Dr. Mifflin: Yes, actually, it wouldn't be necessarily intuitive that rubbing one's eyes could result in actual damage to the eye, but it's fairly common.

Dr. Miller: Now everybody at some time has got to be rubbing their eyes. So are we talking about a small number of people?

Dr. Mifflin: Well, we actually see a category of disease, perhaps two, that are related to chronic eye rubbing. Certainly, short term eye rubbing is probably not going to cause a problem except for maybe a very few patients who may have some kind of severe problem underlying their eye condition. But chronic eye rubbing can result in the weakening of the cornea and distortion of the cornea called keratoconus.

And it's often associated with people with very bad allergic conjunctivitis or itchy eyes and, unfortunately, some of these people are so itchy that they nothing feels better that . . . I call it the knuckle rub to the eye. Unfortunately, over time, that can actually weaken and distort the eye.

Another thing that can be associated with chronic eye rubbing is actually laxity of the eyelid. The eyelid can, over time, lose its elasticity and that's a less serious problem, but still not something that we want to happen.

Dr. Miller: So if somebody was rubbing their eyes because they have severe allergies in the spring or even year-round, how do they end up at your doorstep? Is it that their vision is blurred at some point?

Dr. Mifflin: Yes, typically, most of the patients who we feel that actually there is an association between chronic eye rubbing and disease fall into the diagnosis of the condition called keratoconus, which is a structural abnormality of the cornea causing poor vision due to an abnormal shape to the surface of the eye. The shape causes irregular astigmatism, which often cannot be corrected by glasses or even contact lenses in its severe stages.

One really important is that this disease may run in families and, typically, may start even in childhood. So certainly, parents should be advised to try to seek treatment for their young children who may have severe allergic disease and in the case of eyes, typically allergy eye drops are very effective in eliminating itch. And behavior modification just through teaching can help children not rub their eyes.

Dr. Miller: Now, how do you know if you're rubbing your eyes too hard?

Dr. Mifflin: I tell my patients that the amount of pressure needed to wash one's face with a washcloth gently or dry with a towel is the appropriate amount of pressure to put on one's eye. Anything more than that is probably unhealthy for the eye.

Dr. Miller: So if you're rubbing to the point where you're seeing stars, then it's a bad thing?

Dr. Mifflin: It is possible to induce the sensation of light or the perception of light without actually seeing light. And this can occur with the eyelid closed and these little sparks of light are called photopsia and certainly, when one rubs their eye hard enough to induce photopsia, that is not a good thing.

Dr. Miller: And if you do that repetitively, you might end up in the ophthalmologist's office.

Dr. Mifflin: I would say that there is a good chance that if you do it over a period of years, you could end up with even worse than that.

updated: October 12, 2018
originally published: April 17, 2016

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.

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: 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.

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.

Dr. Miller: Your vision has been changing rapidly over time, could that be a problem with you cornea? We're going to talk about that next on Scope Radio, and I'm Dr Tom Miller.

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: I'm here with Balamurali Ambati, and he's a professor of ophthalmology here at the University of Utah. And we're going to talk a bit about problems that arise with the cornea, which is the foremost part of the eye that faces the environment.

Dr. Ambati: The cornea is the front window of the eye, and it has layers to it. Even though it's very thin, it's only about 0.5mm thick, it has five different layers. And the two most common problems of the cornea are a condition called keratoconus, where the cornea changes from its normal spherical shape into more of a cone-like shape.

Dr. Miller: And it does this over time?

Dr. Ambati: And it does this over time. And usually it does this in the late teenage years, 20s and 30s. So it's a condition primarily of young adults who may know or report that the eye has been unstable and changing. Most people, the eye stops growing by age 20 or 21, and the prescription...

Dr. Miller: Like the bones almost.

Dr. Ambati: Exactly, the prescription is stable. But if someone's astigmatism is changing... Astigmatism is when the cornea is shaped more like a football than a perfect sphere. That can be an early sign of keratoconus, and patients might report needing to go from soft lenses to soft toric lenses, or to hard contact lenses. They might report increasing near-sightedness and increasing astigmatism over the course of years. And this is something that is often undiagnosed till late stages, and so if you do have an unstable refraction or fluctuating vision over time it would be wise to get a cornea scan with an ophthalmologist.

Dr. Miller: What's the difference between, as you mentioned, fluctuating eyesight and progressive worsening of vision? Can you give a definition of that? I know you mentioned that when we talked about keratoconus as a problem.

Dr. Ambati: In fluctuating vision, which can occur especially in Fuchs' Dystrophy, the vision is different between morning and afternoon. In progressive loss of vision over the course of years, people recognize that their vision was not as bad a year ago, or two years ago.

Dr. Miller: The end result of that would bet at some point perhaps the contacts and lenses are no longer are effective in changing the vision, would that be the end stage?

Dr. Ambati: That can occur. The end stage of keratoconus requires what is called a cornea transplant, to replace the cornea with a donated cornea from someone who's passed away and donated their eye. Fortunately now, in the last five years, we've really changed the management of keratoconus to where we can prevent advancement from mild or moderate keratoconus to advanced keratoconus.

With things like intacs, which are rings that are placed inside the cornea that provide structural support, they're essentially an under-wire for the cornea to change it from a cone to a sphere. As well as the emerging technology of cross-linking, where we use a laser to stiffen the cornea and prevent weakening of the cornea.

Dr. Miller: So there are different options in the treatment?

Dr. Ambati: Very much so.

Dr. Miller: So is this a hereditary problem?

Dr. Ambati: It is a hereditary problem with what's called variable penetrance. So if you have a first degree relative with it you're at a higher risk for it.

Dr. Miller: Somewhat like glaucoma.

Dr. Ambati: Indeed.

Dr. Miller: And so if someone has a family history of keratoconus should they seek out an ophthalmological examination and a cornea scan?

Dr. Ambati: I think that would be advisable if they have any significant near-sightedness or astigmatism. And certainly it would be advisable if they are considering LASIK. One of the things that we do at Moran Eye Center is to carefully screen patients coming in for potential LASIK or laser vision correction to make sure they don't have keratoconus or other cornea problems.

Dr. Miller: So just to be sure, if one has keratoconus does it always require a transplant or is there, as you said, variable stages of the development of the problem?

Dr. Ambati: It is definitely a spectrum of progression, and if we can catch it in the mild or moderate stage the goal would be to employ intacs, or cross-linking, or some of these other options to prevent the need for cornea transplant.

Dr. Miller: Are there any other problems with the cornea? I notice since the cornea is the forward facing part to the environment, UV radiation, sunlight, does that affect the cornea more so than other parts of the eye such as the lens or retina?

Dr. Ambati: Certainly patients who are exposed to a lot of sunlight and UV light can develop pterygium, which is a growth on the surface of the cornea.

Dr. Miller: So that's a result of UV exposure sometimes?

Dr. Ambati: Indeed. And the UV radiation can also damage the back layer of the cornea, which is the endothelium. And those cells are actually what's called post-mitotic, they can't replace themselves. And so that can contribute to a condition called Fuchs' Dystrophy, where the cells of the back of the cornea slowly die. And that does require a partial thickness cornea transplant, but not a full cornea transplant, just replacing the back layer of the cornea. And those two conditions, Fuchs' Dystrophy and keratoconus, are probably the two most common causes of needing a cornea transplant procedure.

Dr. Miller: So in summary, would it be advisable if one has a family history of either of these problems to probably seek an ophthalmologic examination sometime in their 20s, or perhaps if they are having changing vision or astigmatism?

Dr. Ambati: Yeah, if you have fluctuating vision it is advisable to see an ophthalmologist at any time of your life. If you have a family history of keratoconus, in your brothers, sisters or parents, I think it would be advisable to see an ophthalmologist in the early or mid 20s. And if you have a family history of Fuchs' Dystrophy, that usually presents itself in the 40s or 50s, so that would be the best time to present.

Dr. Miller: Untreated what would be the end result of this if it continues untreated?

Dr. Ambati: Without therapy you would eventually lose vision, your eye would become cloudy and scarred. But generally people come well before that.

Dr. Miller: Thank you very much.

Dr. Ambati: Thank you.

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: Cataracts, what do you need to know? We're going to talk about the basics of cataracts next on The Scope.

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

Interviewer: We're with Dr. Craig Chaya. He's with the Moran Eye Center. Talking about cataracts today, we're going to cover a little bit of ground here in case you're kind of curious as to what they are, what kind of damage they can cause and what solutions are out there right now. Thank you Dr. Chaya, I appreciate your time.

Dr. Chaya: Thank you, Scott. I appreciate it.

Interviewer: First of all, let's talk about cataracts. What is, on the very basic level, a cataract?

Dr. Chaya: The cataract is basically when the lens, the natural lens of the eye, becomes cloudy and it no longer can focus light properly and it tends to scatter light and that's what leads to the blurry vision that often people complain about with cataracts.

Interviewer: Like Vaseline on a camera lens maybe?

Dr. Chaya: Or fog...

Interviewer: OK.

Dr. Chaya: ...looking through a smoke screen.

Interviewer: Sure.

Dr. Chaya: Those are common symptoms that people describe.

Interviewer: And what causes that?

Dr. Chaya: What happens is the lens which is normally very clear and as it ages or it undergoes certain changes that promote the development of a cataract certain proteins develop in the eye and accumulate in the eye that cause it to become cloudy and it's no longer able to maintain that transparency.

Interviewer: Yeah, do we know why that happens?

Dr. Chaya: Yeah, mainly these proteins accumulate. Oxidative damage occurs in the lens. There are certain medications that can sometimes cause acceleration of cloudiness...

Interviewer: Uh-huh.

Dr. Chaya: ...of the lens and basically that's the bottom line is the cloudiness, whether it comes from different pathways or it's trauma or inflammation or just age related changes, the lens, the end all is that it gets cloudy.

Interviewer: So, is there anything that I can do to prevent them if they're going to happen to me?

Dr. Chaya: Yeah, you know there's a lot of things that you can do to prevent cataracts. Most of the cataracts that we see are age related cataracts and those age related cataracts are often due to a variety of things but the main top risk factors include things like excessive UV light exposure, excessive sunlight exposure, also certain medications like steroids can promote the development of earlier cataracts. Trauma is another one that could lead to cataract development.

Interviewer: Like what kind of trauma?

Dr. Chaya: Eye trauma...

Interviewer: OK.

Dr. Chaya: ...of any kind, whether it be hobbies related or sports related...

Interviewer: Oh, okay...

Dr. Chaya: ...accidents...

Interviewer: ...some assault to the eye of some sort.

Dr. Chaya: That's correct. Direct blows to the eye, that concussive nature of the energy can go back and disrupt the lens fibers and cause clouding of the lens.

Interviewer: Alright, so it sounds like wear some eye protection if you're really concerned.

Dr. Chaya: Definitely.

Interviewer: Uh, maybe wear sunglasses.

Dr. Chaya: Yes.

Interviewer: But, uh, don't get freaked out about the sun because it's, is it a real major problem?

Dr. Chaya: You know, in this part of the world we have such great tools, great technology to be able to address cataracts. The great news about cataracts that I think we should really highlight is that it's reversible.

Interviewer: Yeah.

Dr. Chaya: Yeah, we can actually take the cataract out, put a new artificial lens in there and really restore people's vision back.

Interviewer: And I've heard that as far as getting something that that's one of the best things you can get because your eyesight is going to be fantastic.

Dr. Chaya: Often times, patients after surgery are really amazed at the level of quality vision that they can see with, with the new lens.

Interviewer: Yeah.

Dr. Chaya: And we like to call it high definition vision after the surgery and people are just dramatically, their vision is dramatically improved and their perception of colors is often one thing that they really vividly describe to us.

Interviewer: And from what I understand, this surgery is not that bad.

Dr. Chaya: You know what; it's come a long way. Maybe thirty years ago patients were admitted to the hospital for a week, they had sandbags over their eyes. They really couldn't move around very much.

Interviewer: Wow.

Dr. Chaya: And now it's outpatient surgery and most of the time the surgery's done under 30 minutes. Patients don't have to be put to sleep and the recovery is very quick.

Interviewer: Wow, that's crazy, so like two, three day recovery and you're seeing clearly, more clearly than you had in years probably?

Dr. Chaya: Yeah, many patients describe the next day saying "Wow, this really has made a difference."

Interviewer: So, is there anything that could go terribly wrong if I have cataracts and I'm not taking care of them, if I don't come in for treatment?

Dr. Chaya: Well, you know cataracts are going to cause blurring of your vision and also are going to decrease your ability to see in certain contrast levels, especially at night. Patients often complain about not being able to see the lines at night or not being able to see street signs until they get close. So, from a safety standpoint, definitely, having cataracts can impair your driving skills. Another common one is balance. You need good vision to be able to stay balanced.

Interviewer: Hmm.

Dr. Chaya: And so, it's been demonstrated that removing cataracts can actually help decrease the risk for hip fractures, for example, in elderly patients.

Interviewer: Wow, and those are terrible when that happens.

Dr. Chaya: Yes, definitely. So, I think improving vision overall, reversing the cataracts and improving people's vision, can help keep people safe.

Interviewer: Yeah.

Dr. Chaya: Yeah.

Interviewer: I just want to be clear on one thing though, if you can't convince Grandma that she needs to go get the operation for a couple of years, her eyes aren't going to suffer anymore are they?

Dr. Chaya: No, cataracts are really not an emergency.

Interviewer: Okay.

Dr. Chaya: It's very unusual circumstances where cataracts actually become an emergency where it's important to get this cataract out sooner rather than later.

Interviewer: Alright, any final thoughts on the topic of cataracts?

Dr. Chaya: Cataracts, I think, it's really important to understand that removing the lens, the lens is responsible for about one third of why you see clearly, the cornea is another important one, so sometimes patients after cataract surgery they may not see as well as they'd like to and there are other reasons, but certainly cataracts are a major important reason why people don't see well in their older years.

Interviewer: But safe surgery...

Dr. Chaya: Safe surgery.

Interviewer: ...good surgery.

Dr. Chaya: Good outcomes, generally people, over 90% of patients, are very happy after cataract surgery and really the lowest complication rate of most surgeries that we have in medicine.

Outro: We're your daily dose of science, conversation, medicine; this is The Scope, University of Utah's Health Science's radio.

Your child's eyes, when do you think they need glasses? When do you think something's wrong? Is this something you can pick up or something your pediatrician needs to pick up? Eye problems, we are going to discuss them today on The Scope.

So when do you start worrying about kids: their eyes, glasses, things like that? The good news is that for most kids, they don't start needing to wear glasses until they are about elementary school age. And you notice they are squinting when trying to do their school work or they have to get moved up to the front of the classroom because they can't really see that well, or complaining of really bad headaches after reading. That's another sign that your child might need glasses.

We actually start vision exams at three and your child should have a vision exam by your pediatrician every year at a well visit starting at age three.

They have different eye charts. You can do letters or you can do ones that just have pictures and the kids can tell us what pictures they are until they are able to learn their letters.

But what about littler kids? What do we start looking for in littler kids when we start shining those lights in their eyes during exams? Well, we are looking for different things in terms of making sure that their eye balls are focusing properly.

So one thing that a lot of people start asking about is, "My newborn baby looks cross-eyed." Well, your newborn baby can't focus their eyes very well and they don't have good control over their eye muscles until they get about two months old. After that, you should be able to notice your child is able to move their eyes in the same directions.

What if your child can't? What if one eyeball is looking down or up or to the left or to the right and the other eyeball's looking forward? That's different.

Strabismus is the fancy name for that. That is where your child's eyes point in different directions. One is pointed straight ahead, the other is pointed in a different direction. Sometimes you get what's called "walleyed" where one or more of the eyes turn outwards towards your child's ears. And then you got cross-eyes, which means they are looking towards your nose.

But both of them are forms of strabismus. Strabismus happens when the six muscles that work together to move your child's eyes don't work together. It can be caused by a problem with the muscles, with the nerves, or problem in your child's brain, but most people with strabismus are born with it and it does tend to run in families.

So when your child's eyes don't tend to work together to look at an object, the brain pays attention to the image from only one eye and ignores the image from the other eye. So what you need to do is to watch: does this happen more when your child is tired or sick? That's usually when we pick this up. When you can see they're getting tired and one of the eyes is just kind of wandering away, it's time to mention that to your doctor.

A good thing is we don't normally see your children when they are tired and tiredness is usually when it happens. Take a picture. That's great because you'll often notice to the red eye reflex, you know when you take a picture and you've got to use that red-eye reduction thing on Photoshop because their child looks like they've got bright red eyes? Okay, those bright red eyes--that's actually good. That's looking at the back of the eye. It's called the retina, and you're looking at all the blood vessels in the back.
We like seeing that. That's what we are looking for when we use that ophthalmoscope and we look in your child's eyes. We are looking for that red reflex. If they are not the same, then you might have a problem with how the eyeball muscles are working.

So that's what we are looking for and if we find it, what do we need to do? Well we usually refer to an eye doctor because they will be able to help with actually managing this. They usually start with patching, or sometimes using eye drops, depending on the age of the child to force your child's brain to pay attention to the weak eye. And then the weak eye works harder and develops more normally.
In severe cases, your child may need surgery on their eye muscles to help re-position where the eyeballs go. They might need glasses, especially if your child has farsightedness from the eyeballs not being in the right direction. The glasses often do help this when started early. And eye exercises.

The eye doctors can tell you about some different eye exercises and what that does is that also helps with helping the eyeballs focus at the right spot. Unfortunately, a lot of the forms of strabismus do not improve with eye exercises, but it's always something that they try.

What's the other kind of thing that we hear most with the eye balls not focusing right? Lazy eye. We hear this a lot too. Lazy eye, the fancy name is amblyopia, and that's also where the eyes just don't go in the right spot.
You see again, you'll notice both eyes normally straight but the one just sort of slightly drifts a little bit too. And the difference is in most kids when you find this early, you can still have normal vision in both eyes. After age eight, the treatment is less successful, so you want to try to watch for it early.

It works the same way in the fact that the brain is getting images from the good eye and not the bad eye and this is more due to the eye ball shape and also the eyeball muscles. So there's more things going on to try to cause amblyopia.
Babies don't often show any symptoms of lazy eye. They may have trouble following objects with their eyes or continue to have the crossed eyes after two months old. Toddlers, they may favor one eye. And if you cover the eye that's really strong, then they kind of fuss because they can't see as well.

So you've tried the patching and the eye doctor says it's time for glasses. So how do you help your child adjust to wearing glasses? Well, that can be hard.
You all remember kids who wore glasses, they're called four-eyes and all sorts of things like that and it's really not very nice. So kids will sometimes "forget" to put them on, "forget" to take them to school because they don't like being teased, they don't want to wear them, they're uncomfortable, they think they look ugly, they can't play sports in their glasses.

You know, it's hard to transition to glasses, but if you help your child understand why they need to wear glasses, they'll be more likely to wear them. Make sure that your school-age kid understands wearing their glasses will help them read. If they get headaches from their vision problems, it will decrease their headaches, and actually a lot of people wear glasses, so it's not like they are alone. Point out people who do wear their glasses, because then you'll be able to say, "See, look at that person wearing their glasses, look how good they can see."
If your child continues to get teased by other students because they are coming to school with glasses now, talk to your child's teacher about it. They often are used to having to deal with situations like this and they can help your child.

Another thing, have your child involved in picking out what kind of frames they like. Have them pick their favorite color, what matches with their wardrobe, some of them have characters on them that they like. Make it something so it's more of a fashion statement than a medical device.
Make sure that the glasses fit properly. Any place that you get your glasses from will have someone who is qualified to make sure that the glasses fit properly around the ears and around the nose piece. And you can usually have them re- adjust them whenever you need them to at no charge.

Again, you should also remember to keep safety in mind. Kids will break their glasses, I will guarantee you that one, so make sure that their lenses, instead of being made with glass, are made with something called polycarbonate. It's a safe material. It's lighter than other lenses and if your child plays sports, you can also get sports goggles made with the same material that will help protect them against eye injury.
Another big thing is to make sure you don't nag. Don't nag at your child if you see them taking their glasses off. Have your child remember to put them on and when you see your child wearing their glasses, compliment them. Just say, "Oh I see that you are wearing your glasses, thanks that really helps me to know that you can see well."

And make sure that your child is getting regular appointments with the eye doctor to make sure their prescriptions are up to date. Again, we check their eyes at every well visit, so we do every year and if we notice that their vision is off with their glasses on, then we can even say it's time, even though you saw the eye doctor six months ago, something has changed with your child's eyes and you should go ahead and get your eye doctor to check the prescription again and make sure it's the right one or that they don't need a different prescription.

So the bottom line is if you think you notice something wrong with how a child is looking at things, go ahead, have your pediatrician take a look at them. We can check out the eyes. We can do a vision exam, see how they are looking, if they are old enough to do a vision exam. The main thing is that for children, their eyes are still developing, so the sooner you get an eye problem identified and corrected, the better it will be for their overall vision health.

updated: January 18, 2021
originally published: July 15, 2014

Interviewer: Are women more likely to get macular degeneration than men? We'll examine that 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: Dr. Margaret DeAngelis is at the Moran Eye Institute. She also is on the Utah Women's Eye Health Board. Let's talk about women and macular degeneration. Maybe I'm wrong on this. I kind of thought generally it was men that got it, but that's not the case.

Dr. Margaret DeAngelis: No. Women, it's actually been shown, in two studies done ten years apart from each other in what's called a meta analysis where you combine all the studies that are out there, that women are at higher risk of getting age-related macular degeneration than men. Now, why is that you might ask.

Interviewer: Why is that?

Dr. Margaret DeAngelis: Why is that? Well, we're not sure. So some people, some groups have looked at that it may be due to hormone replacement therapy or estrogen that increases one's risk so certain groups are studying that. Some groups have found an association while other groups have not so there's a lack of consistency from study to study. So we still don't have the answer for why women are at risk. Some people have argued that maybe women are more inclined to join studies, to sign up for studies, but that hasn't been the answer either. Or maybe women smoke more cigarettes or these other things, but after you've controlled for all these external factors, there hasn't been the answer there so we're still looking for the reason for why women are at a slightly higher risk. And we do know that genetics plays a strong role but that is equally so in men and women so what that means is if you have a first degree relative, either a parent or a sibling, a brother or sister, with age-related macular degeneration, you're at six to twelve times higher risk than somebody from the general population of getting age-related macular degeneration yourself. So it's highly recommended if you have a family member with age-related macular degeneration you should get your eyes checked age 50 and over at least once a year.

Interviewer: Six to twelve times more. Put that in perspective for me in relation to other things like smoking which has also been shown to cause macular degeneration or a relationship. How much does that increase my risk?

Dr. Margaret DeAngelis: It depends. Different groups including our group have shown that that's based on the number of pack year so if you smoked a pack of cigarettes a day for one year, the more cigarettes you've smoked or pack years your risk increases exponentially, and smoking by everybody has been shown to increase risk.

Interviewer: Got you.

Dr. Margaret DeAngelis: Please understand that that increases your risk, you're susceptibility. It doesn't mean that you will get the disease because you have a first degree relative or you smoked cigarettes. It means your susceptibility has increased. That's a difference between susceptibility and causality.

Interviewer: Is the direct relative susceptibility? Are we talking susceptibility if I have a first...?

Dr. Margaret DeAngelis: We're talking it increases your susceptibility, correct.

Interviewer: How significant is six to twelve times more susceptible? Put that in a perspective for me. Is it like, "Oh wow, that's a lot. That's frightening. Like you should go see the eye doctor right now."

Dr. Margaret DeAngelis: Six to twelve is a lot. If you're 50 years old and older, the American Academy of Ophthamology recommends that.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah Health Sciences radio.