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There used to be just one operation for treating cataracts but those days are gone. Today, there are a lot of options, and you can choose what’s best for you. Eye surgeon Dr. William Barlow…
August 26th, 2015
Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.
Interviewer: It's The Scope Health Sciences Radio, broadcasting live at Be Well Utah in South Jordan. It's the South Jordan Family Fair and we're learning all sorts of great things about health and right now we're going to learn a little something about the eyes and cataracts. Doctor Barlow, I don't know what your first name is. William.
Dr. Barlow: William.
Interviewer: Dr. William Barlow is an Ophthalmologist at Moran Eye Center. And we're going to talk about cataracts. And if I understand correctly, many years ago, there weren't a lot of options. There was just kind of one thing you did, but that's changed now.
Dr. Barlow: That has. So, back in the day, cataracts, you'd have surgery, remove the cataract, and then a few weeks later you'd get your glasses prescription. Doctors loved it because it was simple, it was easy, and you didn't have to spend a lot of time educating patients. You just said, "You've got a cataract, you need cataract surgery," we do cataract surgery, and then they come and get their glasses. Today, we have a lot of technology, a lot of different options available to patients. So some patients may choose to have cataract surgery and have their glasses updated after surgery, but other patients that would like to be spectacle independent or to be free of or less dependent on glasses, there are lots of surgical options available to them, different lens technologies that are available.
Patients do have a lot of astigmatism and we have beautiful toric lenses that help to correct that. Patients who are interested in seeing well at distance and up close, if they have a healthy eye other than the cataract they can have what's called a multifocal lens. It's almost like a bifocal inside the eye that allows them to see distance and up close comfortably without glasses.
Interviewer: Wow, really? A bifocal inside the eye, is that annoying? Because from what I understand, one eye is corrected one way and the other eye is corrected the other way, right?
Dr. Barlow: So that's monovision, that's the concept you're talking about, which can be done with cataract surgery. People who have done that with contact lenses are usually very good candidates for that where you have one eye, your dominant eye typically, targeted for distance vision, and then the non-dominant is a mild nearsightedness to allow you to see up close. The multifocal lens allows you to do that with both eyes together, provides you with a little bit better quality vision up close, relative to monovision, but both are very good options.
The bifocal idea is slightly different than what you would think of when you think of a bifocal, a lined lens, with one part for distance and one part for near. It's a, what we call, a diffractive pattern so it has little rings that separate the light into two focus points simultaneously, and the brain chooses the image based on where you're looking. So when you're looking a distance one image is going to be in better, sharper focus. The brain will focus on that. Or if you're looking at things up close, the brain will choose the image that's in better focus for that. So you've got those two focus points. It works very well.
There have been several iterations of this technology. The most recent iterations have been demonstrated to be very effective without causing a lot of problems that were noted with the original lens technology with this multifocal concept where that had a lot of glare and halo effect with bright light sources That has been reduced significantly with adjustments to those patterns that are used in the lens.
Interviewer: It sounds like whatever you thought you knew a few years ago, probably you don't know anymore and should really talk to an expert like yourself.
Dr. Barlow: Yeah, it continues to change. The technology is ever advancing. Lots of different areas in the world, obviously in different aspects but certainly with ophthalmology, no difference.
Interviewer: And when a patient comes in, you start talking, "All right. Here are your options," I mean it's very personalizable, depending on what a person wants, right? Like what their lifestyle is, do you ask a lot of those types of questions before making a decision?
Dr. Barlow: Absolutely, you want to ask about what they like to do, are they outdoors oriented, do they do a lot of mountain biking, climbing, hiking, golfing? Do they do a lot of computer work, do they do a lot of reading, do they do a lot of sewing, whatever it is, where is their world located
Interviewer: It's a different procedure, yeah.
Dr. Barlow: Where do we want to target their vision and vision quality? And it's not just lens technology that's available. There are different technologies that help in terms of doing this surgery. So a femtosecond laser that helps to do steps with the surgery, can do it more precisely than any of us can do as a surgeon and we're pretty good surgeons, but the laser's just more accurate. It's just the reality. So these different technologies are being introduced that help us to make the surgery potentially more accurate, more safe, so it's an exciting time for us.
Interviewer: What's on the horizon? I mean, you're talking about all the things that have changed just recently. Is there anything on the horizon that you can talk about? Now that I've got an expert here, I'd love to hear about it.
Dr. Barlow: So on the horizon, lens technologies, there's discussion of a lens that can be placed in the eye and then we can use different types of light to adjust it and set it, if you will. So if we're slightly off with the prescription one way or the other we can use that light to adjust it.
Dr. Barlow: There are certainly concepts or ideas about lenses that are flexible inside the eye. So our natural lens when we're young, the reason we're able to see a distance and then look at things up close is that we can flex and change the shape of the lens, so people are looking at that, softer materials, different things. These are still very primitive in terms of where we're at, but that's where we're going, that's where we're headed to try and recreate the natural lens. We lose the ability to see things up close and we start to develop cataracts related to these lens changes. Can we maybe be able to do surgery at a younger age at some point to correct those issues?
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Diabetes often leads to eye problems that can eventually cause blindness. Dr. Bill Barlow, ophthalmologist at Moran Eye center discusses how this happens and what patients with diabetes can do to…
November 13th, 2014
Interviewer: If you have diabetes, you are at higher risk of eye disease than people without diabetes. We'll talk about that, and what you should know 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.
Dr. Barlow: Well the goal with that exam is to number one, identify diabetic changes at an early point in the disease, so that treatment can be instituted to try and prevent more severe damage that is vision threatening and cannot be reversed.
Interviewer: Diabetes is just brutal, and the cause of so many different health issues. What type of eye diseases are most threatening to people with diabetes? Are there some that are more so than others?
Dr. Barlow: Diabetes can cause a number of different things, or different problems in the eye. Retinopathy, which is damage to the retina, that's the back part of the eye, it's the wallpaper if you will of the back part of the eye that's the initial light sensing organ of the eye. So, that light signal is taken by the retina and transmitted to the brain for interpretation.
Interviewer: It's pretty important.
Dr. Barlow: If it causes damage to that, our vision quality drops significantly. So, it can cause swelling in the retina, bleeding in the retina. It can cause abnormal blood vessels to grow inside the eye which can leak and bleed, and can cause scar tissue that can pull the retina off the back of the eye, and cause significant damage, and in some cases, permanent damage that can't be reversed. And so, that's why it's so important to take good care of the eyes, checking at least annually, or if there are diabetic changes, we will of course check it more frequently to monitor for treatment if it's needed, to try and prevent those particular problems from causing permanent vision loss.
Interviewer: Is that type of eye disease just for people that have diabetes, or do people without diabetes get that?
Dr. Barlow: There are some diseases that can cause things that look somewhat like it, but these changes are mostly diabetic-related.
Interviewer: Okay. What about other eye diseases that are common to regular people; people with diabetes, are they more susceptible to it?
Dr. Barlow: Diabetes does tend to cause cataract formation to occur at an earlier age. It can be associated with other eye health problems. It doesn't necessarily cause an increased risk of a lot of other issues. I mean, the main concern with diabetes is looking at the retina, protecting the retina from permanent damage from blood vessel damage from the diabetes.
Interviewer: If your diabetes diagnosis changes, does the threat of that eye disease change as well?
Dr. Barlow: So for example, somebody who has Type 2 diabetes, so they're diagnosed in adult age, they have a lot of weight loss that they're able to obtain through changing their diet and exercise patterns, in some cases their diabetes is "cured." They don't have diabetes any more. In that case, they can lower their risk substantially of developing diabetes-related problems. Again, the risk of developing diabetic changes is directly correlated with blood glucose control.
Interviewer: Is there anything else that somebody could do, other than annual eye exams if they have diabetes, to protect their eyes?
Dr. Barlow: The most important thing in terms of protecting their eyes, and this is a message I give to every patient I see that has diabetes, work with your doctor that's helping you manage that. Ask them, "How can we get the blood glucose control better than it is now?" Keep working to improve that. The tighter the blood glucose control, the better that control is, long term; the lower the risk of having problems long term.
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Many eye injuries occur in the home. From chemicals to weed trimmers, eye protection is an important consideration. Dr. Bill Barlow from Moran Eye Center discusses home eye safety and what to do if…
October 28th, 2014
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: 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.
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.
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.
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.
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.
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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