Search for tag: "eyes"

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.

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Interviewer: Broken blood vessel in the eye. Dr. Troy Madsen, ER or not?

Dr. Madsen: Well, a broken blood vessel in the eye is one of those things that's just absolutely obvious to everyone you see. Everyone is going to ask you about it, say, "What happened to your eye?" It's essentially just a bruise on the eye. If it happened on your hand and you had a bruise there, no one would ask about it, but the blood vessels in the eye are so small that, sometimes, maybe while you're sleeping, you just turn wrong and bump something, and it causes a little bruise there. You don't need to go to the ER for it.

Now, if you've had significant trauma to the eye, you've been hit in the eye, if you notice that there's blood behind the cornea, so in front of the colored part of your eye, that's much more concerning. But if you just wake up one day, you've got some red on your eye, it's going to heal up after a few days. No need to rush to the ER.

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Interviewer: Find out how sun exposure can affect your sight and how best to protect yourself. Coming up, on The Scope.

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

Interviewer: We're with Doctor Jeff Pettey. He's an ophthalmologist from the University of Utah Health. What are some of the problems and risks that people face with sun exposure and their eyes?

Dr. Pettey: That's a really great question. All of us are at risk for sun damage to our eyes. The same effects on our skin from chronic exposure to the sun can occur in our eyes. That can result in things like cataract which could cause blurring of vision, that can also result in things such as growths on the surface of the eye or in some cases, even increasing your risk of tumors or cancers on your eye.

Interviewer: So what type of activities and exposure should people be on the lookout for with their eyes?

Dr. Pettey: Similar to the same type of concerns that you would have with skin. If you're out somewhere where you can get reflected ultraviolet rays at you, skiing, boating, really even out in our Utah deserts, you get a lot of reflection, that's going to increase the dose of ultraviolet light that's hitting your eyes.

Now, there are acute events that can occur for instance, particularly in our climate, it's a sunny day, you'll get the intense UV light from being at altitude. Often as much as 90% of that ultraviolet light can be reflected. So you get these double doses and that could result in one of the worst most painful eye conditions we see, something called ultraviolet keratitis. It's been described aptly as taking sand, opening your eyes and just pouring the sand directly in your eyes, and then closing your eyelids.

Interviewer: So that's for people out in extreme exposure, people that are skiers, hikers, adventurers, what about just everyday people? People driving to work every day without their sunglasses, what kind of problems can they feel?

Dr. Pettey: The specific issues that we find are chronic conditions such as cataracts, and the specific growths that you can see on the eye. One is called a pterygium. The other is called a pinguecula. That's long-term scar tissue that can develop. Pterygium can actually start growing across the front of your eye. In many parts of the developing world, we'll actually find people who are actually blind from the chronic sun exposure from pterygium.

Interviewer: So these aren't people that are like looking at the sun directly. These are just every day long-term type of effects?

Dr. Pettey: Yeah, correct. That's long term effects. Now, one thing that is pertinent to something like an eclipse is when people view the sun directly and if they do view the sun directly, whether that's on a regular day or whether that's during an eclipse, they're at risk of having something called solar maculopathy. That's basically where the sun's rays are all being focused on a part of your eye called the macula. The macula is responsible for all of your detail vision.

So looking at the sun for too long directly can result in you having a permanent smudge in the center of your vision as you try to read a line of print, you have that smudge follow you as you look at someone's face, that smudge will be directly on their face. And in in its worst form, that's permanent.

Interviewer: So chronic high altitude, direct looks and stuff like that, all sorts of problems that can happen with the eye. What are the best ways for people to protect themselves?

Dr. Pettey: So let's just start simple with sunglasses. Sunglasses will block out likely 100% of the UV light. If you look, your sunglasses, they should have a certification saying it blocks 100% of both UVA and UVB light. If you wear regular glasses, I'm not talking sunglasses but just regular glasses, day to day, those lenses will also have UV protection built into the lens itself. And so that's just as good as wearing sunglasses when you're outside.

Interviewer: Really? So just because they're darker doesn't necessarily mean they protect you from the sun more?

Dr. Pettey: That's correct. There's a layer in the glasses that's actually built into lenses nowadays that will block ultraviolet light and that will block ultraviolet light whether it's a clear glass that you need just for simple nearsightedness or farsightedness. That same layer will be in sunglasses. So having a darker tint just overall allows less light into your eye.

The tips for the type of sunglasses you would want, bigger is better. The more coverage you can have of your eyes, the better. You do not need to get dark tint. Tinting doesn't actually decrease the amount of ultraviolet light hitting the eye. That ultraviolet light will be blocked by the glasses themselves.

Finally, things like polarization again, polarization helps with optics, but it has no effect on ultraviolet blockage through the lens. So as long as you have a pair of glasses that are relatively large to provide good coverage, that's the best recommendation. And wear those every time you're outside in the sun.

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.

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.

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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: 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.

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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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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 Dr. Miller and I'm here with Dr. Mark Mifflin. He's the Professor of Ophthalmology and his practice includes refractive surgery, otherwise known as LASIK to many.

Now if we go to the operative day where they're going to have the procedure, is that a fairly involves surgery or is it fairly straightforward, done under local anesthetic, or do they have to be under general anesthesia? Just describe that procedure a little bit more.

Dr. Mifflin: Yeah, the actual procedure itself is outpatient and pretty user-friendly. I like to think of it that way. Amazingly, most modern eye surgery, at least on the anterior part of the eye, and this would include laser vision correction surgery, is done with what's called topical anesthesia which means we just actually numb the eye with several eye drops, maybe three or four sets of numbing drops. Amazingly, that can result in a pain-free surgery. And typically, for vision correction surgery there's no sedation, no IV, and it's done in kind of a clean setting in a laser room but the person doesn't have to change into a hospital gown or anything like that.

Dr. Miller: So patients coming in for the surgery might be anxious on the operative day. Some people are very concerned about having their eye touched, and I can understand that. That gives people a sense of squeamishness. How do you calm patients who are coming in for surgery? Obviously they're going to be awake. You mentioned that you're going to use a topical anesthetic so they're going to know pretty much what's going on during the surgery, and I would suspect a number of people would be anxious. How do you calm them and how do you get them through the surgery so that you have a really good outcome?

Dr. Mifflin: The day of surgery is actually a culmination of a long process of teaching the patient and kind of letting them know what the whole experience is going to be like, not only preoperatively, but during the surgery itself and then also the recovery phase. It's actually very easy for most people to go through. We literally handhold. We have a staff of about three or four people in the laser room. We have nurses and technicians who have been doing this for decades, some of them. So anything from gentle coaching by the surgeon in which there is constant verbal interaction. Some people even call it a vocal local, meaning kind of calming the patient by talking to the patient and coaching them and kind of telling them what to expect.

Dr. Miller: Vocal local. That's good. So I'm assuming that they've got to be completely still while that laser is performing the procedure, doing the changes, sculpting on the lens.

Dr. Mifflin: Interestingly and that . . . you're absolutely right. It's a great source of anxiety for patients. Not only, number one, we have really strong reflexes to keep things away from our eyes. That's just ingrained in us. The concept of somebody doing something to your eye is unpleasant, but again, through the educational process and also a very stepwise process where we kind of ease in to the surgery, it's amazing that pretty much anybody can tolerate it.

Part of that process again is the fact that it is pain-free and the laser technology actually tracks the eye just like a weapons technology laser or something would track a target. That's how the laser technology works, so even though the patient is a little bit worried about not looking in the right place . . .

Dr. Miller: The laser is sophisticated enough to be able to do that automatically.

Dr. Mifflin: That's absolutely right. The patient looks at a target. The surgeon is aligning the laser, and then the laser has a camera and/or lasers in it that is tracking the pupil. Between those things, I've never seen one of these laser tracker fail. It's very, very accurate. So if the patient should look away more than about a half a millimeter the laser automatically quits firing.

The actual sculpting or laser ablation typically would last between 5 and 20 seconds per eye, so it's very quick. In LASIK surgery the initial stage of the surgery is cutting a flap and that takes about maybe 30 seconds, so the actual time under the laser where they are really kind of critical things going on is really usually less than a minute per eye.

Dr. Miller: Do you usually do one eye per session or do you do them both?

Dr. Mifflin: Very early, we recognized that this was extremely reliable technology and by doing one eye at a time it was mostly just inconveniencing the patient. Rarely, we still see patients that are a little bit uncomfortable with the thought of doing both eyes and we offer that option. Most people are afraid to have this surgery, but by the time we have finished educating them and get them to the day of surgery they are very comfortable.

The other fear that patients have is that they are able to do something to cause a bad outcome, and that is actually not true. It is such a safe surgery and we have such a low tolerance for risk in an elective eye surgery like this that we have literally made it risk-free in terms of anything the patient can do to cause a bad outcome.

The patient can put themselves at risk by being non-compliant with postoperative care. There are medications, prescription eye drops that are necessary. There are certain protective and common sense things that are required during the healing period. Barring that, it's almost risk-free and that really boils down to having a good conservative screening process that steers away people who are better served by wearing glasses or contact lenses.

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Interviewer: What's the future of glaucoma treatment? 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. Norm Zabriskie is a glaucoma expert at the Moran Eye Center, and if you know somebody who has glaucoma or been diagnosed yourself, you know that you can't necessarily cure it right now. All you can do is treat it, and manage it, and keep it from getting worse. But is there something in the future that might change that? What is the future of glaucoma treatment? Is it always going to be about managing or are there some cure possibilities in the future?

Dr. Zabriskie: Well, we sure hope there are, and we would love to be able to talk with patients about reversing their disease, or even maybe making it where they didn't have to take drops every day.

Interviewer: Yeah

Dr. Zabriskie: So to talk about the first of those, and that is what would make just what we do now easier? There are a number of, for example, extended drug delivery mechanisms and instruments that are being developed right now. For example, maybe an implantable drug that would be good for six months or something like that.

Interviewer: So you don't have to do those daily drops, yeah.

Dr. Zabriskie: So you don't have to do a drop every day. So that's one part of it that is very, very important. And I see some of those things being relatively near in the future, where either you could put a little plug into your tear duct or you could maybe inject a little medicine that would be good for six months and you wouldn't have to worry about drops for six months.

Interviewer: That would be awesome, wouldn't it?

Dr. Zabriskie: And come back and do it again and you're good to go.

Interviewer: Yeah.

Dr. Zabriskie: That would be great. And I think those are pretty near in the future, actually. The other part of that equation is really what we would like to talk about, and that is somehow, someway, reversing or improving damage that has already been done, basically regenerating the optic nerve. And that's really the Holy Grail, not only of glaucoma but of spinal cord injury, of stroke, all of those things are kind of in the same basket, so to speak.

Interviewer: Yeah, meaning once the damage is done . . .

Dr. Zabriskie: Yeah, that's right. How do you get it back? But all of the research, in my opinion, all of the research that's being done in all of those areas will all be cross-applicable. You know, if the spinal cord injury problem is solved, potentially the glaucoma problem will be solved as well because it's all involving the regeneration of nervous tissue.
Stem cells, you know, is probably what most people look toward as a possible treatment modality in the future where we can actually talk about regenerating lost or damaged nervous tissue which is really what we want to talk about in glaucoma. Don't have a timetable for that. There is certainly tons of research being done around the world, not only in glaucoma specifically, but as I mentioned, spinal cord injury and others that hopefully will unlock some of those answers in the not too distant future.
But that's really what we're looking toward. So the idea there, as I mentioned previously, what we do now is just lower the pressure. But what we'd like to talk about is actually regenerating the optic nerve, or even maybe a step before that would be protecting the optic nerve. Right now the only way we can protect the optic nerve is to lower the pressure. But there is research and attempts being made to try to find drugs and other medicines that might protect the optic nerve from further damage that are pressure independent, meaning they don't just involve lowering pressure, but they actually directly inhibit some of the processes that are going on in the optic nerve that result in the damage.
So I'd say those three things are the future of glaucoma treatment. Better drug delivery systems that are much more extended so we don't have to do drops every day, coming up with drugs and treatments that actually protect the optic nerve from damage that is occurring, and that protection is independent of lowering the pressure. It's direct neuro-protection, we call that. And then the final, the ultimate, would be to actually be able to regenerate lost or damaged nervous tissue. That's probably the furthest down the road. But that's what we're hoping for.

Interviewer: What about even before that, preventing that pressure from even happening? I mean, are there people looking at that?

Dr. Zabriskie: Sure, that's another important thing of looking at what it is in the processes of the eye and the balance of pressure that caused the pressure to go up in the first place.

Interviewer: Which is the cause, that's the thing that makes it all happen.

Dr. Zabriskie: In many instances, but yet we know, see, we know that there's probably 25%, 30% even of people that never have a high pressure and yet have severe glaucoma. So we know there's like this black box of other factors, be it genetic susceptibility, something about that optic nerve that just makes it susceptible to damage, maybe blood flow, maybe other factors that we don't even know about yet that are damaging the optic nerve other than pressure. But certainly, pressure is what we concentrate on the most now, because that's what we can treat. And as I mentioned, it has been proven now that lowering the pressure is absolutely beneficial. I don't think there's any doubt about that.

Interviewer: But as far as figuring out a way for those instances where pressure is the cause, how do you prevent that pressure from happening in the first place? Not quite sure at this point yet?

Dr. Zabriskie: Don't have that yet, yeah. You know, a way to actually go into the system, the drainage system itself.

Interviewer: Yeah, and figure out what's happening.

Dr. Zabriskie: And clear it out or drain it out. Again, some of our surgeries are designed a little bit to try to do that. But as far as a drop or something that really gets at that issue, don't have anything that's super effective in that regard.

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Interviewer: Your eye doctor says you have glaucoma. Now what? We'll talk about 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. Norm Zabriskie is a glaucoma expert at the Moran Eye Center. So Dr. Zabriskie, I've gotten the diagnosis. My optometrist told me that I have glaucoma. I want to take it seriously because I know it can make me blind and it's irreversible. What next?

Dr. Zabriskie: You bet. Well, treatment for glaucoma, first off, I think this is a very important point. For many years now, we didn't know for sure that our treatment was even that effective, and treatment consists fundamentally of lowering the eye pressure. Within the last 10 to 15 years, there have been multiple, very large, very well-designed and well-conducted studies both in the United States and in Europe and elsewhere, that in my opinion have fundamentally proven that lowering intraocular pressure, though not a cure, is absolutely beneficial in terms of either stopping or at least delaying the progression of glaucoma. So I am absolutely 100% an advocate of treatment which consists of lowering the intraocular pressure.

Interviewer: All right. But it's not a cure. It can only slow or stop . . .

Dr. Zabriskie: It's not a cure. It does not cure disease nor does it reverse damage that has been done. It just slows down or stops the progression. So then we look at, what are the options for lowering the intraocular pressure? And they really consist of three things. One is medicines which is usually topical medicines given in the form of eyedrops. The second is laser treatment, and the third is surgical treatment when required.
In the United States most of the time we would initiate treatment to lower intraocular pressure to treat glaucoma by initiating eyedrops. We have a number of different eyedrops to choose from with varying profiles of efficacy versus side effects, and we manage those drops. We usually start with one, an individual will try it for maybe a month or so, come back, we'll see if it lowered the pressure and also of course was well-tolerated by the patient. And depending on that result, we might add a second drop or feel like we're fine for right now, and we'll just follow it from that point forward.

Interviewer: Is that always the first thing that you try to do, the least invasive, the drops first?

Dr. Zabriskie: Yeah, in almost all instances we try drops first. Now there might be some circumstances where, say, laser was used first and we also have good literature, good studies that support the use of laser first. But if you just look at the practice trends in the United States, most of the time drops are initiated first. And part of the reason is that I think we have very good drops, very good medicines for treating glaucoma.
There's one class of drugs that was introduced . . . now, my goodness, it's been 15 to 20 years ago now, which in my opinion is just really an outstanding class of drugs not just in ophthalmology but in just all of medicine. When you look at their ease of application, they're just once a day, they have excellent 24 hour efficacy and they tend to be very well-tolerated, I mean, that is a drop class that is really revolutionized the treatment of glaucoma over the past 15 to 20 years and has been very, very effective. We have others that are also effective. So I would say that in most instances, really, in most instances a patient with glaucoma can be well-controlled with drops, and especially if the diagnosis is made early and we're catching it early, that patient tends to do very well in their lifetime. They're treated, yes. They require a lifetime of drops, but they do well. They see well.

Interviewer: And they get to see for the rest . . .

Dr. Zabriskie: They get to see.

Interviewer: I mean, that's a fair trade-off, right?

Dr. Zabriskie: And then things are well-maintained. Absolutely.

Interviewer: Even if I'm the kind of person hates putting drops in my eyes, that's kind of a good balance or payoff to . . .

Dr. Zabriskie: Absolutely, absolutely. Now if drops for whatever reason either prove ineffective or poorly tolerated, then we can moved on and a laser treatment that we have available to us, I think is also an excellent option. The laser is great in that it is non-invasive, okay, so we're not making surgical wound, we're using a laser to treat the eye. It tends to be quite effective. It doesn't last forever but we can oftentimes get several years of pressure lowering from a single laser treatment, and in some instances that laser can be repeated down the line which can give us yet another boost of pressure lowering. So I think laser is a very, very good option when needed.
Now beyond that, there does tend to be a group of patients who for whatever reason their disease is progressive despite our best efforts using drops and laser, and in that individual, surgical options are available. And there are several surgical options that are available to treat glaucoma, although I must emphasize again that even the surgery, all the surgery does is lower the pressure. It doesn't reverse any damage that has been done, I wish it did, but it doesn't. But we're grateful that we have these surgical options to lower the pressure and really quite effectively in this kind of more aggressive category of patients that are losing vision despite treatment with drops and laser.

Interviewer: But the important thing to remember is when you get a treatment, especially the drops, you've got to do it. Otherwise it doesn't do any good.

Dr. Zabriskie: That's exactly right. You have to take the drops everyday or it doesn't help, it doesn't work. And here's the thing. Why it can be difficult for a glaucoma patient to take their drops is that so often they are taking a medicine to treat a disease that is really not causing them any problems. They still see fine, they feel like they're doing fine, and yet I'm telling them, "You have glaucoma. Thankfully it's early and I need you to take this eye drop to keep it in this early phase."
That's a relationship that I have to build with the patient to have them realize, "Okay, I'm taking this drop every day and even though I don't really think I have a problem, I'm taking this drop every day to prevent what could be a significant problem down the line." And that's something that a glaucoma patient just has to kinda buy in to, that it's all about prevention, so I'm taking this medicine now to prevent the problem further down the line. That's a very important thing that a glaucoma patient has to accept.

Interviewer: So the important thing to remember here is that if you are diagnosed with glaucoma, there are some excellent treatments out there.

Dr. Zabriskie: There are.

Interviewer: Most likely starting with eye drops and moving on.

Dr. Zabriskie: Correct.

Interviewer: Any final thoughts for somebody that just had that diagnosis and they're a little frightened, scared?

Dr. Zabriskie: Absolutely. It is a scary diagnosis but my counsel is to realize that many, many, many patients, if not by far the majority of patients, if they take their drops or whatever treatment is recommended to them by their doctor and they're faithful about it and compliant about it, most of them do well. And they live the rest of their life with good vision and functioning very, very well.

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Interviewer: When it comes to things that could be a threat to your eyes, a lot of people don't think of things around the home as a possibility, like construction sites, sure; and maybe athletic events, yes. But around the home there are a lot of dangers to your eyes, and we're going to find out how you can make sure you and your family are safe. We're with Dr. Bill Barlow. He's an ophthalmologist at the Moran Eye Center.
The home is an unlikely place, at least that people think eye injuries can happen, and nothing could be further from the truth. Tell me about that.

Dr. Barlow: When people were surveyed, just a general survey about where they were likely to have an eye injury, less than half of them mentioned the home as a possible place for an eye injury to occur.

Interviewer: Where are the places people think they are happening then?

Dr. Barlow: Well they think they're happening; I'm a construction worker at my worksite, and specific places like that, or paintball.

Interviewer: Sure, yeah.

Dr. Barlow: Gun ranges, things like that, things when they're thinking about risk of injury, and not just eye injury, but other types of injuries.

Interviewer: But home doesn't really cross people's minds, so they get a little lax I'd imagine?

Dr. Barlow: Yeah, home is a place where you take your shoes off, kick your feet up, and you're there to relax, it's safe, it's a comfortable place. You're not thinking of a place that you're comfortable in as a place with potential dangers lurking, so to speak.

Interviewer: Yeah. So what has been your experience with the types of eye injuries that happen around the home?

Dr. Barlow: Eye injuries that happen around the home include exposure to chemicals, cleaning chemicals, making sure that people have good ventilation or eye protection to avoid being exposed to those. People who like to cook, especially with grease or oil that can sometimes splatter and splash up into the eye causing significant burns.

Interviewer: Really? Wow.

Dr. Barlow: People who use curling irons, or other types of heated devices to do their hair or other things that they get around their eyes and their faces, inadvertently will strike the eye and that can cause a burn or a serious injury to the eye.

Interviewer: I guess I never thought about that; that things hot. How hot are those things, 400 or 500 degrees, probably, huh?

Dr. Barlow: I don't know the exact temperature, but yeah, high enough to create a significant burn in a very short period of time.

Interviewer: Yeah, if you make one misstep.

Dr. Barlow: Exactly.

Interviewer: Wow.

Dr. Barlow: So it's important to be thinking of these different things, for children, different toys can become projectile objects very easily if they throw them or things like Nerf Guns where they shoot these soft bullets. But when they're shot at a very high velocity they can cause significant blunt trauma injury to the eyes. So it's important that you're thinking about these things and making sure that your kids are aware of that.
Outdoor activities, such as mowing the lawn, trimming the lawn, anything that's loose debris can become a high projectile, essentially a missile if you will if it's picked up and flipped up towards either the person who's doing the activity, or an innocent observer. So it's important to wear eye protection when you're doing those higher risk activities at home.

Interviewer: I wear glasses; does that qualify as eye protection, or should I have something else?

Dr. Barlow: It's important to have something that wraps around and doesn't leave a lot of open space. So if you wear glasses, getting something that would go over them that wraps around that is ANSI certified. That's A-N, as in Nancy, S-I; that's an acronym for the American National Standards Institute. They have set specific standards based on testing to provide adequate protection in these situations.

Interviewer: All right, so out in the yard, that was one thing that came to mind. Another is I do some woodworking, and I generally wear eye protection, and then I'd imagine you'd really recommend that?

Dr. Barlow: Absolutely, you're hammering on things, especially on hard objects, something happens and you didn't recognize something underneath that wood. You hammer on that nail and it can flip up and become a high velocity missile and again, can strike the eye and cause significant injury, or obviously soft tissue injury to other parts. So it's important to be wearing protection.

Interviewer: What are some of the less common threats around the home that somebody should be aware of that they might not have considered?

Dr. Barlow: Things to think about in terms of less common threats are loose rugs, or sharp edges to furniture, especially if you have children or elderly individuals in the home. They are more likely to become unbalanced, slip and fall. If they hit their face or their eye on one of those objects it can cause a serious injury to the eye. So either creating some way to soften the blow with soft padding on those sharp edges, or tacking down loose rugs so they are not easily tripped over; that can be very important, and it's not something that many people think about.

Interviewer: We talked about some precautions wearing proper eye protection that's certified. Inside, if I'm using cleaners and I'm cleaning the bathroom mirror, do I need to be wearing goggles?

Dr. Barlow: You may not need to wear goggles, but make sure you read the label and know how you're supposed to use that substance and in some cases they may want good ventilation. And some people like to mix chemicals or mix cleansers, and make sure you're not mixing those.

Interviewer: More than just getting it in your eye, the fumes...

Dr. Barlow: Yeah, the fumes can be toxic to any mucous membranes, and the surface of the eyes is a mucous membrane.

Interviewer: Oh, I never think of that.

Dr. Barlow: Also the mouth, and the lungs.

Interviewer: Right.

Dr. Barlow: So if you're inhaling those substances it can be very damaging to those mucous membranes as well. Really avoiding getting them in the eye by wearing eye protection is important. But reading the label and making sure that you're being safe in the way that you're using it and following the directions that they've provided to make it safe.

Interviewer: What should I do if something does happen; say I do get something in my eye? You mentioned a bunch of different scenarios; chemicals, or something that hits the eye. Is it all kind of the same, or are there different procedures?

Dr. Barlow: If you're getting chemicals in the eye, the first and foremost thing to do is to flush the eye, and then you think you're done, to flush it some more. And that's to neutralize any acidic or non-neutral ph substance as quickly as possible to minimize the extent of injury.

Interviewer: Okay.

Dr. Barlow: With other things, of course, if you're struck by a high velocity object it's getting in to be seen by a trained ophthalmologist as soon as possible to have that evaluated and look for any significant injury and have that treated as appropriate based on the injury. Those things require medical attention and evaluation. Obviously the exposure to chemicals does as well, but rinsing and flushing the eye is the first thing you want to do and have somebody else call to make the appointment or make arrangements to get you seen on an emergency basis. But flush the eye and flush it some more to neutralize any non-neutral ph substance that has gotten into the eye.

Interviewer: What about, like you said, trauma or a scratch to the eye? Is there anything I should do other than just call somebody and get in?

Dr. Barlow: In those cases if it's significant trauma, we recommend you take something like a paper cup, cut out the edge and just tape it over the eye to protect it from getting bumped by anything else. That would be the only other thing that I would recommend, and again, it's getting in to be seen to evaluate the eye for injury and determine if it's a blunt injury or a sharp injury and what treatment is needed to try and recover the injury.

Interviewer: What's the threshold though; say I get whacked by something in the eye and it hurts, but I can open my eye, and I can still see. Do I still need to come in?

Dr. Barlow: I would recommend it. If you've been hit by something that's high velocity, you have an irritation, even just a corneal abrasion, there is the risk of developing an infection or other problem associated with that; making sure, particularly if it's vegetable matter, like something that came out of the lawn, there's a little bit higher risk of infection, making sure there are no signs of that, and making sure treatment is instituted to avoid or prevent injury and infection.

Interviewer: So when it comes to your eyes, better safe than sorry.

Dr. Barlow: Better safe than sorry, exactly.

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Interviewer: If you have cataracts today, it could be a whole different treatment plan than it was 15 or 20 years ago. We'll examine that next on "The Scope".

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

Interviewer: It used to be there was one way to treat a cataract. Now there are a lot of different ways and it's actually very personalizable. We're going to find out more about that with Dr. Craig Chaya right now from the Moran Eye Center. Let's talk about some of the treatment options for cataracts because it used to be real simple. There was one thing that could be done. Now there are a lot of things. There are a lot of treatment options somebody might want to consider.

Dr. Craig Chaya: Right. For example, there are a lot of patients with cataracts that actually suffer from astigmatism as well. Astigmatism is a curvature issue with the cornea and often times that needs to be corrected in order for patients to have their best vision. Some of those options include glasses after cataract surgery or sometimes we can do some certain types of incisions that we can make on the cornea to make it more round and spherical, more regular shaped.

Interviewer: So actually while you're in there doing the surgery you might be able to do fix some of that other vision as well.

Dr. Craig Chaya: Correct. And now we've got these great lenses that not only reduce or eliminate the cataracts, but also help to reduce astigmatism at the same time, almost a two for one. And that really for the patient helps to reduce the dependence on glasses.

Interviewer: Yeah, so that's one treatment option. What are some of the other treatment options?

Dr. Craig Chaya: Some of the other treatment options are there are certain types of lenses that allow people to see both far away and up close without having to use glasses, really giving people independence from glasses and helping patients to be able to be more youthful so to speak in order to be able to enjoy their life, and not be so dependent on needing glasses for certain tasks. So those lenses are what we call multifocal lenses and those can be a benefit for the certain type of patient that's really motivated to want to get out of their glasses, and they are willing to accept that.

Interviewer: So kind of like bifocal lenses.

Dr. Craig Chaya: Correct, yeah.

Interviewer: Yeah.

Dr. Craig Chaya: We would call them multifocal lenses with this certain type of technology, so that's another advancement in technology that has been beneficial for many patients. Another one would be being able to just customize where we would put a lens. I can think of one patient particularly that loves to read in bed. And that person didn't want to have to read with glasses in bed. So for that particular patient I chose a lens that allowed that patient to see clearly while reading and then that person decided to have glasses to be able to see far away. So that choice was really an individual decision that I could not make for that person without having . . . hear them tell me what their hobbies were, what their expectations were before and after surgery.

Interviewer: So it sounds like you ask a lot of those types of questions now to make sure that it fits their lifestyle.

Dr. Craig Chaya: I think it's important. You have to, I think. Otherwise, patients are . . . You put them in a possibility of being disappointed after a cataract surgery and I've had some. And part of that has stirred me to be more informative preoperatively to ask patients, "What is it that you're expecting after cataract surgery? What is it that you desire with the lenses afterwards? And what are your hobbies? What are some things that you like to do? Ultimately many patients say, "Doctor, help me choose. I'm not sure what to do." But I think this conversation needs to take place ahead of time in order to be able to choose the appropriate lens for a patient.

Interviewer: So are there any other considerations when it comes to cataract procedures that somebody should be aware of?

Dr. Craig Chaya: Yes, in the several years there has been a new advancement in technology. Traditionally we've taken cataracts out by using ultrasound technology by breaking lens up into small pieces and then vacuuming it out, but now we have the assistance of using lasers. Lasers allow us to be a little bit more precise or actually a lot more precise than we can by our own hands. And lasers have been employed in cataract surgery to help soften the lens to make it easier to remove. So what would normally be a very difficult lens to remove in very challenging circumstances, laser cataract surgery may help us to make those changes and do those surgeries, and make them more routine and safer for the patient.

Interviewer: Yeah, a lot more safe.

Dr. Craig Chaya: Yeah.

Interviewer: What else is on the horizon that you're excited about?

Dr. Craig Chaya: Well, the Holy Grail is a lens that has excellent vision, both at the near and at far, and we're still waiting for that lens. We don't have one that has really met all the different criteria for an excellent lens that can focus up close and far away with no decrement and quality of vision.

Interviewer: Yeah, that's a challenge I'd imagine.

Dr. Craig Chaya: Yeah, and people are working hard at it. It is truly the Holy Grail of cataract surgery, so I think we're getting a lot closer than we were ten years ago though.

Interviewer: I don't know. I think the Holy Grail would be the Steve Austin bionic eye. I think that would be pretty neat.

Dr. Craig Chaya: X-ray vision, that would maybe be the next Holy Grail.

Interviewer: Yeah, do you have any final thoughts for somebody that's facing some cataract surgery? I think you gave some great points of consider what your hobbies are, consider what your lifestyle is. Anything else?

Dr. Craig Chaya: I think it's important for anybody that's undergoing cataract surgery or about to undergo cataract surgery to have a really deep conversation with their doctor to let them know what their expectations are because sometimes in a busy practice it may go unnoticed, or it maybe an issue where a doctor may assume that a patient wants a certain type of lens. But I think it's important for patients to know that there are options now. It's not a one size fits all. We really want to try to tailor make this cataract surgery for the individual.

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

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Interviewer: So Leah, tell me your name and your title. What do you do here?

Dr. Leah Owen: My name is Leah Owen and I am a Chief Resident in ophthalmology here at the John Moran Eye Center.

Interviewer: So you've recently had some new research come out. What can you tell me? What is it about?

Dr. Leah Owen: Well, I've been fortunate enough to work with Meg DeAngelis, who has a lab here at the Moran Eye Center. Together we've studied some of the genetic causes for Age-related Macular Degeneration. This disease effects a lot of people age 60 to 65 and over, and is present in two different distinct forms. And one, people may have heard of as the dry form and the other is termed the wet form of Macular Degeneration. We studied specifically some genetic causes for the wet for of Macular Degeneration so that we could better understand what causes it on a genetic level and hopefully use that information to design more targeted therapies for treatment of this condition.

Interviewer: Where was it published?

Dr. Leah Owen: It was published in I.O.V.S.

Interviewer: What does that stand for?

Dr. Leah Owen: Investigational Ophthalmology and Visual Sciences. We have collaborators all over the world. We replicated our findings within patients from Korea, from Ireland, and from Greece. And so we have wonderful collaborators who are co-authors on our paper from those countries as well as collaborators at Harvard who we worked with on the initial patient population. And all of them are co-authors on the paper.

Interviewer: So what did you uncover here that was new and surprising to you?

Dr. Leah Owen: Well, we looked at a gene pathway that is involved in the specific problem in Wet Macular Degeneration which is that there are blood vessels that grow in your retina, which is the back part of the eye that's very responsible for your ability to see. And these blood vessels disrupt the normal architecture of your eye so that you're no longer able to see within the central portion of your vision. You can't recognize faces. You can't drive. That's the part of your vision you use most on a daily basis. So this condition affects your quality of life and it affects your vision quite drastically. In fact, it's responsible for greater than 70% of all legal blindness that's relate to Macular Degeneration. So it's a very significant problem and we need to find better treatments for it. We looked at a gene pathway that's known to form blood vessels since that's such a prominent part of this disease. We looked at certain genes in that pathway and within individuals who had Wet Macular Degeneration. We looked for any mutations that were present in those people who had Wet Macular Degeneration and compared that with genes of people who were matched, and otherwise identical, but who didn't have Wet Macular Degeneration so that we could find mutations that were specific to people with Wet Macular Degeneration.

Interviewer: So where could this lead? I know you mentioned new treatments. AMD is a big problem and is this a piece of the puzzle? Where do you see things headed next?

Dr. Leah Owen: Yeah, this is a really exciting piece of the puzzle. We've described several mutations that are present just within one of the genes we looked at in this larger pathway. And so it points us to this gene being important in the Wet Macular Degeneration disease process. And this is a gene that although we've known about it, we haven't targeted therapies directly towards the activity of this gene. And so I think our research raises the possibility that targeting this gene and this gene's function within Wet Macular Degeneration disease process might be a more effective way of treating it. And so going forward we are going to ask that very question.

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

Announcer: 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: Dr. Owen you're here today to tell us about a new initiative going on here at the Moran Eye Center encouraging people to rest their eyes. What can you tell me about it?

Dr. Owen: Well, we see a lot of patients coming in with eye strain, eye fatigue, and certainly dry eye in this dry climate, and so our new initiative is termed 20-20-20, and it's something that's actually going on all over the country, but it's just to help remind patients that when we do a lot of focused work, including computer work and reading work, we don't blink as often. It's difficult to remember to blink, but it's easier to remember that every 20 minutes to try and look up, look 20 feet away, focus on something in the distance for about 20 seconds, and that allows your eyes to rest. It allows you to blink more normally and moisturize the surface of your eyes and that will alleviate a lot of the eye strain, eye fatigue, eye irritation, and eye dryness that you might experience otherwise.

Interviewer: You mentioned eye dryness. What causes that condition, and do we have more of it here in Utah than other places in the country?

Dr. Owen: There are a lot of causes of eye dryness. There's quite a spectrum so if you have significant concerns about eye dryness, I would see a professional, an eye doctor in the clinic, but in general, we do have a greater proportion of people with dry ocular surface because we're in such a dry climate. In general, people develop dry eyes when there's an imbalance between either the amount of tear that they're making to wet their ocular surface or an inability of their tears to adequately moisturize the surface of their eyes. Often we will prescribe artificial tear drops, which are available over the counter, and they're a way that you can replenish some of the tear on the surface of your eye to keep in more continually moisturized so your body isn't trying to compensate for all of this dryness by itself.

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