For the Love of Health

What Your Vision is Trying to Tell You with Dr. Benjamin Chaon and Dr. Tomilade Adepoju

• ChristianaCare • Season 2 • Episode 25

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0:00 | 17:44

Our eyes are working for us every second we're awake. Yet eye health often falls at the bottom of our wellness priority lists, taken for granted until problems arise.

Keeping your eyes healthy doesn't just protect your vision - it can prevent serious health problems down the road. But when you have a question about your eyesight, should you see an ophthalmologist and an optometrist? ChristianaCare ophthalmologists Dr. Benjamin Chaon and Dr. Tomilade Adepoju join us to discuss the difference between the two types of providers and when to escalate your care beyond corrective lenses. They also share important information about common eye conditions such as dry eye, inflammatory eye disease, glaucoma, and diabetic retinopathy, along with critical warning signs that everyone should be aware of.

Don't be left in the dark over what's happening with your vision. Listen now for an eye-opening conversation to protect your precious sight.

Benjamin Chaon, MD, is Medical Director of the Wilmington Eye Clinic, and member of the Christiana Care Department of Ophthalmology. He specializes in the medical and surgical management of uveitis and ocular inflammatory diseases, such as iritis, scleritis, retinitis, and ocular infectious diseases, as well as the medical treatment of retinal diseases, such as macular degeneration, diabetic retinopathy, and retinal vascular diseases. Dr. Chaon also performs both routine and complex cataract surgeries, using the latest cutting-edge technology.

Tomilade Adepoju, MD, is an ophthalmologist who specializes in treating patients diagnosed with glaucoma and other related eye diseases. Her focus includes helping her patients with general ophthalmic needs, ranging from diabetic eye care to routine eye exams. She works with her patients and families to understand their eye disease diagnosis and to create a comprehensive eye care plan.

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Speaker 2

Thank you vision. It can prevent serious health problems down the road.

Speaker 1

To help us see this topic clearer, we're joined by ophthalmologist Dr Benjamin Sean and Dr Tomilade Adepoju.

Speaker 2

Ben and Tomi. Thank you both so much for your time today.

Speaker 3

You're welcome, I'm really happy to be here.

Speaker 4

Yeah, thanks for having us. We're excited.

Speaker 2

You are both ophthalmologists, can you?

Speaker 3

explain for our listeners the difference between your work and optometry. Yeah, I think it's a really big common misconception because most people just say it's my eye doctor, my eye doctor, and which is correct for either an optometrist or an ophthalmologist. But with an ophthalmologist, which Ben and I are, we're medical doctors. We went to medical school. We went to ophthalmology training like residency programs and specialize. I'm a glaucoma specialist. You know Dr Sean is uveitis and retina. So I think medical school really is the difference between the two and the fact that we are surgeons. You know we can handle more surgical issues with the eyes and deal with more in-depth disease of the eye overall.

Speaker 4

Yeah, I think you said it well. We're medical doctors, so the training is a bit different. I think we work very closely with optometrists, but optometrists are really responsible for primary care-related eye disease and they're really good at helping us prescribe glasses and contact lenses and things like that. But when we are seeing more complicated patients, I think it's sometimes useful to see an ophthalmologist complicated patients, I think it's sometimes useful to see an ophthalmologist.

Speaker 1

As far as explaining it to the average listener to this podcast, what would they know? What should they know? As far as, okay, I have this issue Should I see an ophthalmologist or should I see an optometrist?

Speaker 4

I think it's a great question. I think you know again, you know optometrists are great at prescribing glasses and contact lenses but I think if you've seen an optometrist and perhaps are still having issues maybe you're having blurry vision, maybe you're having eye pain, maybe you've tried a couple things that have been recommended by the optometrist and they haven't necessarily been working then I think it's a great time to perhaps see an ophthalmologist. Have been diagnosed with an eye disease like diabetic retinopathy or macular degeneration or glaucoma, for instance, then I think it's really helpful to see an ophthalmologist, because often the care that we're able to provide to patients is a little bit beyond what an optometrist might be able to provide in terms of we're able to provide surgical care, laser treatments and things like that that most optometrists are not performing.

Speaker 3

Yeah, I agree 100%. My rule of thumb really to patients is that if you have an underlying medical disease of any sort, I think it's a good idea to at least have one visit with an ophthalmologist and if there is nothing else going on they can go back to an optometrist. But really, like he mentioned things like diabetic retinopathy, if you have hypertension, any autoimmune diseases, a lot of those things tend to also have manifestations in the eye as well. So it's always a good idea, rule of thumb, to just see an ophthalmologist at least once a year.

Speaker 1

I'm assuming an optometrist, if they ran into some of these issues, would make the recommendation for someone to see an ophthalmologist. But you're saying there are plenty of cases where someone should just take that initiative themselves and go see one.

Speaker 3

Yeah, I don't necessarily think you have to wait for the optometrist to make that recommendation. If a patient knows that they have any underlying medical disease, especially like in our clinic, you can just call. A referral is not necessary. As long as they let us know that there's an underlying medical issue, we will see them.

Common Eye Diseases Explained

Speaker 1

You've already mentioned a few of the most common eye problems that you are dealing with, but let's go through those a little more in depth here.

Speaker 4

Give us that list of some of the most frequent things you're dealing with in your practice we see a lot of patients with medical eye disease, so eye disease that's related to things like diabetes, so diabetic retinopathy. We see folks with macular degeneration, so aging-related changes in the eye, Folks who have high blood pressure, hypertension that can sometimes manifest in the blood vessels inside the eye and that can cause problems, as well as other things like dry eye, red eye, you know, eye pain. These are all you know, common reasons for folks to see an ophthalmologist.

Speaker 3

I agree 100%. Another one really common one, especially in our elderly population, is cataracts. So when people start getting to like 50 and above and start to have, you know, just chronic blurry vision, a lot of the times it can be their cataracts that are just advancing and it's, you know, it's time to do surgery to get those taken out. And you know patients that maybe have high. They're really nearsighted, they've been nearsighted for a very long time. Maybe at that's the point where they need to see maybe a cornea specialist. So yeah, we see everybody with, like, blurry vision of some sort.

Speaker 2

So let's talk about some of these misconceptions about the issues that you all both mentioned Dry eye, for example. Ben, you mentioned dry eye. Most people probably listening to this are like yeah, I go to the store, I get drops, I put them in. It is what it is. I have dry eye. But at what point is it more than I should just go get drops to the store? I get drops.

Speaker 4

I put them in. It is what it is. I have dry eye, but at what point is it more than I should just go get drops at the store? So there's a lot of a spectrum when it comes to dry eye disease. So some people may have just mild blurring of the vision or mild pain, mild redness, but it really can progress to the point where people end up with actually corneal problems, you know, problems with the clear window that lets light into the eye related to the dry eye.

Speaker 4

And there's so many treatments for dry eye. Drops are certainly kind of the mainstay of treatment, but often people are overwhelmed when they go to the drugstore and see gosh, there's dozens of different kinds of drops. Which ones should I use? Should I use the ones that say redness relief, those types of things? So we see patients certainly on the more severe end of the spectrum with dry eye disease and you know, in addition to drops there's prescription medications, there's topical steroids that can sometimes be used and then there's procedures that help folks with dry eye, and so I think as ophthalmologists we're able to offer those treatments to our patients and that can be very helpful in certain situations.

Speaker 2

Ben, you also focus on inflammatory eye disease. What is the difference between inflammatory eye disease and dry eye, and is it also something people should just be going to the store for, or is it something they need to be more conscious about?

Speaker 4

Inflammatory eye disease kind of refers to a group of conditions that cause inflammation in the eye, basically, and so we can kind of think of these things as either being infectious, related to some type of systemic infection like syphilis or Lyme disease, or some types of viral infections that can affect people who are immunocompromised, or autoimmune conditions that can cause inflammation in the eye, and these would be associated with things like sarcoidosis or other types of autoimmune conditions like multiple sclerosis. So often folks with inflammatory eye disease need to be on specific medications or steroid treatment in order to control their inflammatory eye disease. So often it's much more complicated than just going to get eye drops at the store, even though some of the symptoms might be very similar to a patient who has dry eye. Initially they might have red, painful eyes, they might have a little bit of light sensitivity or photophobia. Many patients are sometimes misdiagnosed as having conjunctivitis or dry eye before it's recognized that they actually have an underlying inflammatory eye disease and might need other types of treatment.

Speaker 2

Another one you mentioned people with hypertension. You said it can manifest in the blood vessels. I am imagining. Okay, it looks like you have bloodshot eyes, you didn't sleep well, you have allergies. Whatever the case may be, I'm not automatically thinking this is related to hypertension in some way. So what are those warning signs that someone with hypertension should then come see you?

Speaker 4

I think it's a good question because a lot of the times folks don't realize that they have an issue with their eyes that's related to high blood pressure. So often when we're seeing patients it's when something has happened related to blood flow through the retina. And often I should clarify it's the blood vessels that we're talking about are the blood vessels in the back part of the eye, in the retina. So the retina is like the light-sensitive tissue in the eye that's kind of responsible for our vision, and so folks who have high blood pressure, like the blood vessels, are all over the body. We can see them in the retina so we can examine them.

Speaker 4

But we see changes in the blood vessels that are related to the very high blood pressure. So we can see narrowing of the blood vessels. We can see kind of crossing changes between the veins and the arteries that suggest problems with blood flow. And then, as things get more severe, we can see spots in the retina that are related to kind of poor blood flow, called cotton wool spots. And then sometimes we can see things like macular edema or swelling in the central part of the retina that can make a patient's vision very blurry and they may need treatment with either injections or laser treatment to try to recover vision if it's progressed to that point.

Speaker 1

Glaucoma is another one that you've mentioned, and it just seems like most people would getting into that think, oh, my vision's getting worse, I'm getting older, I probably just need stronger glasses. What are those warning signs somebody who might be dealing with glaucoma need to be aware of?

Warning Signs of Serious Eye Conditions

Speaker 3

With glaucoma. It's a very slowly progressive disease and oftentimes it could take years, even decades, before someone even becomes aware of the fact that their vision is declining due to glaucoma, because it tends to affect your peripheral vision first and slowly, slowly then comes in until the patient could possibly have tunnel vision. So I try not to wait, tell my patients to wait for those kind of warning signs because that could take years. But what I do let them know is do you have a mom or a dad that had glaucoma? Or sometimes they don't know that it was necessarily glaucoma, but they had a relative, an aunt, an uncle, a parent, a grandparent that went blind for reasons that maybe were unknown to them. So I ask questions like that Did a family member go blind for a reason maybe you do or don't know about? Do you know a family member that maybe uses eye drops for reasons other than dry eyes, maybe a prescription eye drop? I ask questions like that have they noticed maybe over the last decade or so has their vision started to decline slowly? So those are questions that I kind of ask as like my triage, to just get a general idea as to whether or not glaucoma is something that we should be on our radar for them. And if anything is a yes to any of those questions, I just do our you know, just routine screening test.

Speaker 3

To number one, check the pressure inside of the eye. Because glaucoma is a disease where if the pressure is too high inside of the eye it starts to cause damage on our optic nerve, which is the main nerve that we use to process everything that we're seeing in our outside world. So if the pressure is too high, that pressure, it tends to cause a mass effect on the optic nerve and causes those nerve cells to die out and that's why the patient will start to have that peripheral vision slowly, slowly, slowly declining. So the way we treat the glaucoma, it's first to start with eye drops. There are also laser procedures. Essentially, the goal is to try to decrease that pressure inside of the eye.

Speaker 2

Cataracts could be. You know, someone is aging, similar to what Jason said about glaucoma. Oh, you know, obviously my vision is getting worse. Maybe I shouldn't drive at night. People who just kind of write it off as something that naturally happens as we age. But what should they really be paying attention to? That shows that, oh, this may be a cataract. I should go see someone.

Speaker 3

Something you mentioned about how a lot of patients come in and say they're having more issues driving at nighttime.

Speaker 3

A lot of the times that's because the headlights coming at them causes glares, halos for them and it becomes very disruptive to their vision. So majority of the time, cataract is more of a natural aging of the lens. So you tend to see it in the older population and so when it starts to really affect someone's ability to just participate in their activities of daily living, that's really when we say you know what? I think it might be time to get that cataract out and put a new lens inside of the eye. You know there are also times where we may have younger patients come in and have cataracts. So patients that have really bad diabetes or maybe they've had some sort of trauma to the eye in the past that can cause the lens to get older faster, essentially, or if the diabetic, cataract develops much more quickly, these are patients that, even though they may not be elderly, it does tend to affect their activities of daily living as well, and we recommend cataract surgery for those patients also.

Speaker 4

It's a great point. We see a lot of older patients with cataract, but there are certain medications. I'm a uveitis specialist so I see patients with inflammatory eye disease and patients that might have been treated with steroid drops or oral prednisone. Some of these medications, particularly steroids, can cause cataract to form more quickly, so it's not uncommon for us to see cataracts in younger patients if they've been treated for uveitis.

Speaker 1

And as someone who has a diabetic in the family, I know that that can play a major issue with vision. Talk to me about diabetic retinopathy and what people need to be aware of where that's concerned.

Speaker 4

Diabetic retinopathy can really severely impact a patient's vision and often patients may have some diabetic retinopathy and still maintain good vision. So the recommendation really is for folks who are diabetic to have a yearly dilated eye exam so that we can examine the retina and see if there's diabetic retinopathy present. So diabetic retinopathy really refers to changes in the blood vessels that occur due to the diabetes. So the diabetes kind of causes problems with blood flow all throughout the body, but particularly in the retina. It can cause a number of things to happen. One can be swelling in the central part of the retina called the macula and folks can develop something called diabetic macular edema and if that develops it can impact the vision, make the vision blurry. They may require treatment with injections or lasers to try to help the swelling and help improve their vision.

Speaker 4

And then there's something called proliferative diabetic retinopathy where the lack of blood flow causes new abnormal blood vessels to form and that's probably the most severe complication that can occur with diabetes and that can cause bleeding into the eye. That can cause people to lose vision. People might see blood floaters, dark spots kind of moving around in the vision. That's related to the blood kind of floating around in the eye. They can also develop problems with high pressure related to abnormal blood vessels that can block the drainage pathways of the eye, and we work very closely with glaucoma specialists to treat patients who have what we call neovascular glaucoma, which is high eye pressure caused by abnormal blood vessels from diabetes. They may also need treatment with lasers and injections to help the vision as well, so it's really important that any diabetic patient gets a yearly dilated eye exam from an ophthalmologist.

Speaker 2

So if you are a diabetic with 20-20 vision, you don't necessarily need the glasses, but you should come see you so that they can see if there's anything else going on.

Eye Health Recommendations for Everyone

Speaker 3

Yeah, because I think also there's an idea that just because someone is 20-20, it means that nothing else is going on in the eye. And that's just not true. You can still be 20-20, but also might still have diabetic disease inside of the eye. So that's part of the reason why I think it's a good idea to at least be screened by an ophthalmologist to know if it's okay to just keep seeing their optometrist.

Speaker 1

So we've talked a lot about these very specific types of diseases and issues that people might be thinking about or dealing with, but what are some of those persistent symptoms that should be the sign that people should be looking out for, to say there's something more going on here. I need to be seen by an ophthalmologist.

Speaker 3

Yeah, I always say blurry vision that doesn't really go away with maybe an over-the-counter artificial tear, or blurry vision that even without your glasses you're still not able to just get that crisp vision that you're normally used to. The blurry vision is associated with things like headaches, nausea, vomiting. Those are things that could also be associated with an acute form of glaucoma. I always say, if that keeps happening especially when the light changes from light to dim definitely you want to see an ophthalmologist. If you're aware that any of your medical diseases maybe underlying medical diseases like diabetes or high blood pressure is very uncontrolled, I do recommend seeing an ophthalmologist as well.

Speaker 4

I think also flashing lights in the vision. Some people might ignore flashing and not really be that concerned about it, but new flashes in the vision like camera flashes or lightning flashes, can be a sign of a retinal tear or retinal detachment issue. Similarly, like new floaters that are persistent, not going away. Worst of all, curtain or shadow coming down over the vision. That would certainly be a concerning finding that might be associated with a retinal detachment or some type of hemorrhage inside the eye. So definitely should see an ophthalmologist if you have any of those symptoms.

Speaker 2

Not everyone is currently listening to this saying. I have those symptoms, but everyone has eyes, and some people are 20-20 and some people have been wearing glasses since they were babies. What is your message about eye health in general, something that everyone can take away from this conversation about the importance of taking care of their eyes?

Speaker 3

Same way that everyone does their routine physical examinations, even if they haven't been having headaches all year or stomach aches all year, and they just realize the importance of taking care of their overall body. I think sometimes the eyes can be ignored because they're so small, but it's a really vital organ and I'm sure anyone listening to this knows that if, God forbid, you go blind, you would not enjoy life the way you used to, and so I always tell people that that just shows the significance and how important your eyes are. So same way you do your routine physical, make sure you do your routine physical for your eyes as well. See an ophthalmologist.

Speaker 3

If you have had anyone in the family have any history at all of any kind of eye disease, see an ophthalmologist. It could be something genetics that could maybe be passed down to you. We want to make sure that your eyes are going to be okay down the road and in future. I would say people that have been wearing glasses for a long time as well, it's good to just see an ophthalmologist. There's a reason why you've been wearing glasses for 20, 30, 40, 50 years. Make sure an ophthalmologist can just have routine surveillance of the eyes and make sure that things are okay.

Speaker 4

I would agree wholeheartedly.

Closing and Contact Information

Speaker 2

Tell me and Ben, thank you so much for your time.

Speaker 4

Thank you Thanks for having us.

Speaker 2

Check out the show notes for this episode for more information on eye health and ophthalmology at ChristianaCare.

Speaker 1

You can always keep up with For the Love of Health on social media. Just search ChristianaCare on your favorite platform.

Speaker 2

We'll be back in two weeks with another great conversation.

Speaker 1

Until then, thanks again for joining us for the love of health.

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Megan McGuriman

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