Breast Intentions

Dry Eyes, Blurry Vision & Menopause: What Women Need To Know

• Nadine & Cynthia • Season 2 • Episode 13

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Episode summary

In this episode, Dr. Amit Chokshi, an ophthalmologist from Jacksonville, Florida, shares insights on eye health during midlife, focusing on hormonal impacts, dry eyes, vision changes, and innovative treatments. Discover practical tips and the latest advancements to maintain optimal eye health as you age.

Key topics

- Hormonal effects on eye health during menopause
- Dry eyes and their management
- Vision changes and corrective options in midlife
- Innovative treatments like serum eye drops and SMILE surgery

Chapters

00:00 Introduction to Ophthalmology and Dr. Chokshi's Journey
04:01 Hormonal Changes and Eye Health
09:58 Understanding Dry Eyes in Midlife
14:01 The Role of HRT in Eye Health
17:57 The Importance of Omega-3 for Eye Health
21:03 Managing Dry Eyes and Treatment Options
24:57 Understanding Vision Loss and Its Impact
26:24 Holistic Approaches to Eye Health
29:48 The Aging Eye: Presbyopia Explained
32:30 Vision Correction Options: LASIK and Beyond
36:51 Preventative Eye Care and Aging
39:32 The Role of Eye Exams in Overall Health
44:21 The Eye as a Window to Systemic Health
48:50 Understanding Eye Health in Midlife Women
51:01 The Connection Between Eye Conditions and Overall Health
52:32 Innovations in Eye Care: Addressing Dry Eyes
54:42 Key Takeaways for Midlife Women Regarding Eye Health
56:54 Practical Tips for Eye Care and Screen Time Management

 resources

Florida Eye Specialist - https://www.floridaispecialists.com
Serum Eye Drops (Autologous Tears) - https://www.aao.org/eye-health/treatments/autologous-serum-tear-drops
Ev'r Beauty Cosmetics - https://www.evrbeautycosmetics.com
SMILE Surgery - https://www.lasik.com/solutions/smile
Cataract Surgery and Lens Implants - https://www.mayoclinic.org/tests-procedures/cataract-surgery/about/pac-20384655

Disclaimer

Breast Intentions is intended for informational and entertainment purposes only. The content shared on this podcast is not a substitute for professional medical advice, diagnosis, or treatment. Any views or opinions expressed by the hosts and guests are their own and do not necessarily reflect the views of any affiliated organizations. Always consult with a qualified healthcare provider for medical advice or concerns.

Resources & Mentions:

• Find Dr Chokshi on Instagram (@florida_eye_specialists @floridaeyecustomvision) 

• Follow us on Instagram and Facebook (@breastintentionspodcast ) 

Connect With Us: Have a topic or guest suggestion? Email us at breastintentionspodcast@gmail.com 

SPEAKER_00

You know, cataract surgery was always thought to be like, okay, we'll do it when uh the cataracts are ripe or like they've lost a lot of vision, something kind of in their 60s and 70s. But the uh the technology has been so um safe and effective now that a lot of my patients are actually electively doing it earlier in life, in their mid-40s, 50s, 60s, to actually fix their vision, not need contacts, not need glasses. A lot of a lot of my it's it's women that are kind of going through these vision changes and they want their vision fixed, you know. Um so they're actually getting lens replacements done uh earlier in life. So then they'll never need cataract surgery. It's almost like a preventative flag treatment. Right, right. So it's uh it's really that that portion of our practice has become uh has has been growing because uh patients want to kind of take control of their lives, they want in all parts, right? Their health, they're they want to kind of be the best they can. And this is um, you know, if they're not interested in glass or contact, this is a way that they can um really kind of just wake up and start seeing things the way that they they want to.

SPEAKER_03

And not have to wait until it gets to a point where you're just so bad. Like you're like, I'm gonna get in front of this.

SPEAKER_00

Yeah, exactly. Yeah, exactly. I tell my patients all the day, we don't have to wait till you're blind to fix your vision, right? We can we can fix it, you know, much earlier and um it it's gonna improve your quality of life. And it's really uh quite quite a rewarding, not obviously obviously for my patients, but also for myself, just to be able to offer that.

SPEAKER_03

Welcome to Breast Intentions, the podcast where we take off the bra of expectations and dive into honest, empowering conversations. We're your hosts, Nadine and Cynthia, two Canadian girls who swap snow boots for flip flops in the Cayman Islands. This is your space to feel seen, supported, and a little less alone. So grab a cup of coffee or a glass of champagne and get ready for your weekly handful of truth, wellness, and empowerment. Welcome back to Breast Intentions. Today's guest is Dr. Amin Choxi, a leading eye surgeon with over two decades of experience at the forefront of vision care. Today we're diving into what every midlife woman needs to know about eye health, from changing vision to dry eyes and beyond and how to protect and support your eyes as you age.

SPEAKER_04

So on today's episode, we have Dr. Choxie from Jacksonville, Florida joining us. Welcome to the show.

SPEAKER_00

Thank you.

SPEAKER_04

Thanks for coming on. And um, for any of our listeners that are listening, what is an ophthalmologist? And also how did you get into ophthalmology?

SPEAKER_00

Yeah, uh great. Uh thank you, Nadine. Thank you, Cynthia, for uh uh having me on your uh show. I look really excited to uh talk about uh uh the health of the eyes and how it uh applies to uh uh women going through uh other changes in their body, uh uh kind of in their midlife. And uh, you know, ophthalmology, I've been practicing ophthalmology for 20 plus years now in Jacksonville, Florida. Um I uh in medical school, um I always knew I wanted to be um uh a surgeon, and um this was the field that allowed me to not only um uh uh you know have perform surgery, but also help people with a such a valuable uh sense organ um and such an important part of their lives with vision. Um the other really nice thing I liked about ophthalmology is that uh I really get to build bond with patients. I get to see them every year, um get to know themselves, get to know their family, um, even take care of multiple generations. Uh so really in um in my world, that was kind of the best of both worlds, and um, and and it's been great. It's been a perfect choice. Ophthalmology is a uh is a medical uh profession. So I completed medical school and uh performed uh or completed training in residency, which means that I learned about eye surgery and how to perform eye surgery. Uh so an ophthalmologist uh takes care of general eye exams uh plus uh advanced care such as surgery, uh including medical diseases of the eye, um, as opposed to perhaps a optometrist, which uh is more of a um they they perform medical eye exams but also more glasses and contact lenses. So we we have tons of um optometrists in our practice as well that help us take care of um a lot of our patients. So it's a um it's a kind of conjoined effort. The the easiest analogy would be like in a primary care practice, you have nurse practitioners and you have physicians' assistants. In our world, we have ophthalmologists and optometrist.

SPEAKER_04

Got it. Okay. And where do you practice out of?

SPEAKER_00

So our practice is in uh Jacksonville, Florida. Uh I've been practicing here for uh, like I said, about 20 plus years. Uh uh had my I've been this is our home, had all of our family here and kids here. And uh uh we have a uh our our main practice is Florida Eye Specialist. It's a uh comprehensive uh uh advanced care uh practice taking care of anything from general eye exams to uh advanced cataract surgery and vision correction. Uh specifically, uh we're part of a practice uh within Florida, especially called Florida Eye Custom Vision, uh, where myself, um uh my colleagues Dr. Hassan and Dr. Maida uh take care of vision correction as well. So things like LASIK, uh lens implants, uh something called SMILE, which we can get into later. But uh for patients uh that are interested in actually uh becoming less dependent on glasses. In fact, just a personal story. Uh I've had LASIK myself. I had LASIK uh about uh 20 uh plus years ago. I was uh very nearsighted. Um in my uh I had it when I was 30, um 50 now, and 20 years of uh fantastic vision, which has allowed me to see things uh very well in the distance. So uh I kind of uh allow uh allows me to tell patients but kind of both angles, both from the doctor perspective, but also from the patient perspective about uh what what these type of procedures can can offer and also you know if they're a good candidate or not.

SPEAKER_04

Right. And what's the the logo? Is Jacksonville Jaguars? Is that what it is?

SPEAKER_00

So so we're um uh so so we uh so Jacksonville Jaguars is our uh local NFL uh football team, and we're actually the uh we're actually the eye doctors for the Jaguars. So we're sponsors, uh uh so we we take care of uh uh the team, their their team needs medical exams, surgery, things like that. So uh most of our uh uh most of our uh uh gear, including our shirts, have a little little Jaguars representation too.

SPEAKER_04

That's cool. That's cool.

SPEAKER_00

Yeah, thanks.

SPEAKER_04

Okay. Um so one of the reasons why we did want you on the episode was we haven't covered anything from eye health yet. And we were just talking before, where I think from a midlife side of things for women, there's probably two things that I'm really only familiar with. And one is um when you are starting to go through perimenopause and menopause, um, dry eyes is something that can show up. And then also I think your vision starts to change like rapidly when you're in your 40s. Um but one of my questions for you is how do hormonal changes during perimenopause and menopause affect eye health? Like what is the leak?

SPEAKER_00

Yeah, absolutely. That is a very uh common um uh a lot of my patients on a daily basis are are asking that. And and frankly, they they think that something's wrong. They think think that something is wrong with their eyes and their eye health when um it is um just the change in the hormones. And and and it can um affect uh things like dry eyes on multiple different levels. Um it can affect vision, um, and it can also uh uh you know lead to maybe some intolerance of contact lenses. If someone that's been doing contact lenses for years, and then all of a sudden they can't wear their contact lens, they think that something's wrong with their eyes, something's wrong with their contact lens, they need a change in prescription. But in fact, it's kind of boils down to um just even you know mild changes in in hormones with perimetaboles. They don't even realize that they may be going through uh you know hormonal changes, but it can kind of affect the eyes uh initially. So, really uh front to back of the eye, uh all the way from the tear film to the uh cornea to the lens and all the way to the retina and to the optic nerve, really the full you know, our the eye is a very small organ, but every part can get affected, and all of which kind of lead to blur vision or changes in their vision.

SPEAKER_04

Right, right, okay. And when we are talking about like the dry eyes, we do hear a lot about dry skin and hot flashes, but where dry eyes are so common, like they're very common in midlife for women. Um, so how like why does that happen? Is it because of like the loss of estrogen or yeah? Is that why just the change in the hormone?

SPEAKER_00

Well, so so the the the tear film um which which is the front uh you know basically when we tear up, it's that front coating of the eye, and um it's composed of multiple different layers. So there's a um there's there's a tear gland that produces the water component, and then there's the oil glands that that prevent it from evaporating. Now the tear gland itself, the lactal gland, which is uh right above our eye, is very uh has a lot of these androgen receptors, uh estrogen and you know uh testosterone and progesterone receptors, and uh sure enough, once the uh estrogen and progesterone, testosterone levels decrease, uh the lacrimal gland does not produce enough tears. So the water component of the tears uh are less, so you get you have less tears. Now, on top of that, it's kind of like a double hit. Um, our oil glands, which are aligned uh along our eyelid margins, that's kind of where we get styes, that's where our eyelashes are. We have 30 to 40, what we call mybomamine glands, and uh those glands are like the oil glands, they're like our sebaceous glands of our face, uh the glands that cause like little pimples, that's that's also on our eyelid margins. Now, in in order now we need oils. We need oils in our tears because otherwise the tears would just evaporate. So these oils basically are provide some surface tension on the surface of the eye and um and prevent evaporation. So um so in our world we have dry eyes because you don't have enough tears, and then we have dry eyes because the tears aren't good quality or they evaporate. So evaporative dry eyes or aqueous deficient dry eyes. So hormones can affect both. So um in uh in the uh in the lacmal gland and you they don't produce enough tears, is because the uh the uh the gland is very sensitive to hormonal changes and you just don't get enough tears, but then on top of that, it's like a double hit, the oil glands get affected and you don't have good quality oil. So then whatever tears you are producing just evaporate, you know. So um, and then so it's it it for those two reasons um when when I when we see our patients, we have to try to figure out okay, is it more of a what we call aqueous deficient dry eyes or more of an evaporative dry eyes? But oftentimes it's both, and we have to treat both pathways. Um and uh but but but hormones can affect both. Now, dry eyes are very tricky because symptoms can be across the board. Um one of the one of the most um uh so patients will come to me and it's like doc, my eyes are tearing a lot. Like, why you know why are they tearing a lot? And I tell them they have dry eyes, and they're like, What are you talking about? They're tearing a lot, you know, and um they they can't believe that uh someone that's tearing a lot actually has dry eyes, but because our brain has this reflex that okay, uh my eyes are very dry, I gotta produce more tear. So in fact, it does, uh, but then they have nowhere to go except down your cheek. There could your eye can only hold so much, um, but it's not good quality tear, so it just kind of produces tears, produces, and then it goes down your cheek. So then uh one of the main symptoms that we get kind of surprise symptoms or more like uh what we'll call reflex tearing. Uh so that can be a sign of dry eyes. Now, another very common symptom of dry is not so much the feeling that your eyes are dry or the feeling of tearing or the feeling of irritation, but blurred vision and fluctuating vision. Oh, where you have to like try to um focus a bit more because you feel a little bit focused more, you've got to blink a little bit more, the contact lenses aren't working as well, those kind of things. So that's a very and then um and then sure enough, as soon as we start treating and fun uh uh the dry eyes, their vision gets better. So, you know, it's it's uh uh dry eyes are very um, you know, unfortunately with dry eyes there's no cure. I hate to say there's no cure, but we have a lot of uh things that we can do to treat dry eyes um and and really to identify patients that do have dry eyes, and the symptoms that they do have are actually dry related.

SPEAKER_04

Okay, so I had a client um who I had seen her after a long period of time and um found out she was on HRT and she had said to me, you know, everything in my body was dry, um, everything, and including my eyes. And then when she did go on HRT, um everything got better.

SPEAKER_00

So it's not actually curing it, but it's so right, right, exactly, exactly. Because the underlying um issue is that when the tear film and once a lacrimal gland starts getting um not as productive, right, um they will um always need some sort of uh uh basically treatment, right? So like in if for in that example, if she stopped the hormones, right, then they would have come right back, right? It's not curing it, right? Uh right, so right. So um, but you know, to your point is that I mean, we don't necessarily need a cure, we just need something to manage it, to maintain it. And uh sounds like that, that person uh found what they uh what they needed. Uh but but the point I kind of tell my patients is that this is gonna need active treatment. This is gonna need something that's gonna maintain your eyes, the health of your eyes, uh, not just for quality of life, but to also prevent kind of things down the road from happening. Um so it's uh it's it's something that is definitely treatable though, and uh we have a lot of successful treatment options and clean procedures that can help.

SPEAKER_04

And you were saying as well that um it it's it can be from a drop in testosterone. Like would you see a lot of men coming in with dry eyes as well?

SPEAKER_00

Uh not as much, not as much. So if I see, I always tell my patients, if I see 10 dry patients, nine and a half are gonna be women. You know, so it's uh so it's uh it's a it's a it's a rare event. So testosterone levels would really have to drop down, you know, um you know, uh to almost like the you know, basically they're they're coming in not just because of dry eyes, you know. Um so occasionally I do I will have patients, uh men, uh that do have a drop in testosterone, but usually it's not enough to cause uh you know dry eyes.

SPEAKER_04

Dry eyes. Wow, okay. What is your perspective on HRT and eye health? And does it how help, harm, or does it depend on the individual? I guess we may have answered that already. Yeah, exactly.

SPEAKER_00

Yeah, usually it usually it depends. But I mean um you know, we uh just like you know, just like the example you show, we I I see tons of uh uh uh women uh that have described the same scenario where uh they take HRT, not not obviously not because I prescribe, because you know they're OBGYN or maybe an endocrinologist uh prescribed HRT, and not necessarily just because they have dry eyes, because of all the other symptoms they may have. But then sure enough, as a byproduct, they noticed that you know their um uh their their dry eyes got better. Now, they may have seen me for uh maybe five years prior because they have were having dry eyes, and uh maybe it's an early perimonopause, kind of like they that may be one of the first symptoms, but you know, it's manageable. Use some teardrops, maybe don't wear the contact lenses as much, wear glasses more, things like that. You kind of they can brush it on the rug for a little while until it starts maybe affecting kind of more of their body, you know.

SPEAKER_04

Yeah, yeah, until it starts to really rear its ugly head.

SPEAKER_00

Right. So to answer your question, I mean it's uh it's you know, I um you know, uh that's just not not my specialty to know enough about you know HRT to kind of tell you that, okay, this works and this doesn't work, you know, as far as dry eyes. But what I advise my patients that you know, whoever your OBGYN is, whoever your endocrinologist, whoever's managing that portion, uh I will continue to manage in a coordinated effort, you know, your your eye health. And um as soon as your um you know, it and if if it becomes where every other symptom is being managed well, but somehow the dry eyes are not being managed as well, we can report that back to uh whoever's providing treatment, or we can just supplement with more eye-specific treatment, you know, more tears, more precise, you know, more warm compresses, maybe, you know, um maybe you know, more omega-3 supplementation. I was just gonna ask you about it. Okay, perfect, perfect.

SPEAKER_02

I was just gonna ask you.

SPEAKER_04

Read your mind. Because I can't remember if that was one of the questions, but I'm gonna ask you anyways. Um, and the one of the things that's really cool is that like if you're ever looking for omegas, um, where a lot of people don't really realize that there is a connection, um, sometimes if you're looking for a certain omega-3, you can find ones that are I don't know if they're specific for eye health. I don't really know what like the ratio of the EPA and the DHA and stuff like that is. Um, but where does omega-3 come in for eye health?

SPEAKER_00

Right. So, I mean, this is one supplement that's been you know scientifically proven with the case. It's not talked about a lot, though. Yeah, you're right. Yeah, yeah, it's not, it's not. Um uh, but it, I mean, we I use it every day. Um uh we we have a supplement in our office. It doesn't have to be this specific sauce one, but it has the omega-3, you know, DHA you know, EPA component that uh basically um you know at the end of it, those are anti-inflammatory, you know, they they they help inflammation, and and at the core of dry eyes, it does produce uh surface of the eye inflammation. So uh ultimately that's where the connection is between why does the omega-3s help dry eyes? Because it's anti-inflammatory. Now, you know, it's an also, it's a it's also an oil, right? It's an also so like so. Basically, it does help your mybomin gland uh, you know, I was mentioning on your eyelid margins uh to prevent that evaporative tear component. Um so there's a lot of different pathways that it works, and I don't know if we know like every single detail about like it, but I those are the two main uh components that the anti-inflammatory, it also helps the quality of the tears. Um we we use omega uh 3s all day long in our in our practice, and it's a really good kind of uh almost like a gateway type of intervention uh because omega-3s have really kind of um become such a mainstay in a lot of different medical areas, you know, heart health, you know, uh antiamp, autoimmune health, right? Like and so these are all kind of uh um, you know, and I'll have patients that maybe took it for a different reason, and then all of a sudden they realize their eyes got better, you know? Yeah. Or vice versa, they'll take it for their eyes and like, hey, my joints feel a lot better. You know, so it's there's a there's a lot of neat things where it kind of like, okay, hey, that that really helped me.

SPEAKER_04

Okay. And I don't know if um if you can answer this or not, but is there a certain amount that you usually usually suggest for people to take?

SPEAKER_00

Uh you're right, two to three thousand you know, milligrams. Yeah, yeah, yeah. That's kind of like and that's kind of like a it's it's on the heavier uh you know side, but it's as long as they can tolerate it and uh and uh right they don't have the usual you know GI sometimes uh issues that come along with that. Uh but um you know the tricky thing gets into like you know when there are maybe uh dietary restrictions, you know, like vegetarians or you know, vegan that you know maybe want to avoid the the fish products. It's it's a little harder to get those. But in general, uh that that's kind of the dosage that I recommend. I take it by the so my myself by the way too, so it helps my dry eyes. Yeah, I do. Yeah, I had LASIK and um I you know I got I had dry eyes uh you know, not not severe, but uh uh after LASIK and uh uh yeah, and sure enough it it did help me as well.

SPEAKER_04

So would you say that if someone came to see you with dry eyes uh and you sent them away with uh just an omega-3, like a lot of it can be I don't want to call it cured, but it can be solved?

SPEAKER_00

Or I so um I like to start with more you know uh kind of less is more type of uh you know philosophy. Um so you know when I meet a patient for the first time, it's it's can be sometimes overwhelming to kind of throw prescriptions and procedures and you know, so you know it usually involves a very um uh you know uh I don't want to call it like superficial, but very kind of like a non-prescription, more more kind of natural, so to speak. Uh and and so that that does become a kind of the first line treatment for law and page. But now it's not just omega-3s. Um so it's simple things like okay, lubricating eye drops, right? You get over the counter, you see tons of lubricating eye drops. That that's very helpful. Of course, it's just a supplement, right? But I mean it it helps in the process. Um warmth, warm compresses to the eyelid. Uh, you know, that's sometimes uh not not used as much, but uh those those those oil glands I was telling you about, they're very sensitive to heat. And um and and providing just maybe five to ten minutes of heat gets those oil glands to kind of express a little bit more and provide a good quality tear. So we have a kind of a whole dry eye kind of regimen that we um uh tend to kind of at least start off with. And then um then they'll you know, just like most falls, we'll come back in maybe four to six weeks, let's see how you're doing, and then we can maybe go a different route if we need to.

SPEAKER_03

I have a question about the drops um before we move on. Um those so the over-the-counter drops for dry eyes. Can you so I know when I was younger, I used to do like the nasal spray, and you know, when you do that, you need to keep doing it, or else it's like what is it called? The rebound effect, or I don't remember. Dependence, right? And that happened with the eye drops as well. Like, should you use them with caution, use them like not right every every two hours, or is it that kind of thing?

SPEAKER_00

Right, yeah. Yeah, yeah, no, that that's a that's a very common uh question. So like the uh like the nasal sprays and the visine eye drops, they have a kind of uh what we call a vasoconstrictive uh component where it helps temporarily, but then if you kind of use it more, it actually become dependent on it. You actually get yeah, you become more congested, or your eyes get more red, or things like that. These teardrops have no medication in them, it's a it's simply a Saline drop. Yeah, they all have their little slightly different formulations, but um it's like drinking water. You can drink a lot of water. Doesn't mean you're gonna get, you know, you're gonna get more dependent on water. It's just that's you know, you can drink, you know, so that that's kind of how I've explained to my patients. Really, and and really for a lot of like my really dry patients that maybe they need some kind of more intense therapy, I'll tell them to take it every 15 minutes to half an hour, no problems. Now, now one thing I will say is that um, and you probably have seen it over the counter, there's there's there's drops that come in a bottle, and then there's drops that come in these little individual vials. You know, the bottles have preservatives in them, the vialed ones don't have preservatives. So if yeah, if you're putting a bottled one in your eye, then um you want to kind of you don't want to do it every hour because you actually put in the preservative in your eye every hour, too, right? Um so anyone that needs it maybe like three or four times a day, I'll say, okay, let's stick to the uh preservative free one. Uh and those are, I mean, those you can use as much as you need, no problems. You won't get dependent, you won't get uh, you know, uh, it won't lose its effect, you know, that kind of thing.

SPEAKER_03

That's great. Okay.

SPEAKER_04

That actually leads me to my next question with um Cynthia saying, like, you know, every two hours and stuff like that. When is, let's just say dry eyes, like when is it a a something more than just being like, oh, you know, it's just aging and I just have dry eyes and I'm just gonna ignore it. Like at what point should you not be ignoring it? Is when you're doing the eye drops every two hours or yeah, definitely.

SPEAKER_00

Well, I I I I think, you know, I my general rule of thumb is that if it's if it's either kind of affecting your quality of life with either the symptoms or the treatment, right? If you're doing something every two hours and it's like you can't like always try to reach for like something, you know, I'm like, okay, you probably need to get kind of checked, right? Not not that something's going wrong, but like you probably need to get checked to see what um maybe something is um off, um, or maybe we need to consider some more um uh you know stronger treatment options, maybe a prescription drop for dry eyes, maybe even a uh in-office procedure. Um, you know, so for those reasons, now you know, even with dry eyes, we can um we can tell you that okay, it may be kind of okay, perimenopause, menopause kind of situation, but you know, there's a lot of conditions linked to dry eyes as well. And one of the most common conditions that that happens mostly in women, unfortunately, is an autoimmune condition. So things like rheumatoid arthritis, lupus, um, you know, fibromyalgia, choke's syndrome, like all that, that whole autoimmune category. Some of my patients actually have that. So then when they come to see me and they have kind of uncontrolled dry eyes, I'm like, let's let's do some lab work just to see if there's some maybe more inflammation kind of floating around the body. And sure enough, every every once in a while I'll find someone that has this systemic condition and I need help. Uh patient needs help. We have to refer to maybe a rheumatologist or their primary care doctor. Okay, we need to have a conjoint effort uh to not only treat your dry eyes but also treat systemically as well.

SPEAKER_04

Well, I don't know if um when we were having our initial conversation that I told you that I carry the HLA.

SPEAKER_00

Oh, I yeah, I think you did. HLA Well, I can't remember what it's called.

SPEAKER_04

Uh B.

SPEAKER_00

HLA B27.

SPEAKER_04

B27, yeah. That I carry that gene, and that gene is in the ankylosing spondylitis, rheumatoid arthritis um family. I have never been affected by any of those, but when I was giving birth to my son, um it was when it attacked my eyes. And um it was awful because I was that person that then had to do eye drops in my eyes every 15 minutes with a one-day old child. And um I couldn't see out of my left eye, and I suffered with it for about seven years. And um it knock on wood, I haven't had a flare in I think six years now. Um but yes, that's that is the the one thing that actually has happened to me too.

SPEAKER_00

Right right. So, you know, I mean, you know, I everyone says the the eyes can be kind of the windows to the soul, but it's kind of it it it really in in my practice and and all of in ophthalmology practice, like we have this kind of unique ability uh to not only see what's going on with our eye, but every once in a while it's it's something more than that. And um, you know, it sounds like you experienced it, but it happens, it happens all the time. Yeah.

SPEAKER_04

Yeah, that's terrible too. And it's not something that you want to ignore.

SPEAKER_00

No, no, absolutely not. Absolutely not, yeah.

SPEAKER_04

Then you're then you're in big trouble. And the eyes are I don't know, for me, um, eyes are like one of the things that scares me the most because I would I would never want to lose sight or not be able to see the way that I do now. Um that's very scary for me.

SPEAKER_00

So yeah, we you know, and and when when I'm seeing patients that are, you know, some sometimes people think that okay, those just dry eyes, but they don't present as dry eyes. They they present as blurred vision. That that's how that that's how a lot of people present. And and they they don't know if they're losing vision. They don't know if it is dry related, if it's something that's treatable, not treatable. So um, you know, uh, you know, losing vision is a very uh can be a very traumatic, you know, uh and nerve-wracking, anxiety-producing type of event. Um and and so being able to kind of sort out, you know, what what actually is going on, and then obviously offer some treatment, um, you know, is it to kind of you know make sure that my patients know that okay, you're gonna be fine, you know. We just have to kind of get you along this path, you know.

SPEAKER_04

Right, right. So with anyone that is suffering from I I guess the the dry eyes or that has like autoimmune or anything, um I guess you do also take a holistic approach, which is like the omega-3s and like supplementation. Um, is there anything that you talk to people about from a nutrition side? I guess anti-inflammatory.

SPEAKER_00

Right, right. You know, we um we'll touch on this. Um, you know, the the the problem that that sometimes I run into is that it's not for the in the eye world at least, it's not completely backed by like hard science, you know, like so it's like we don't have like all the uh yeah. So what what I'll tell my patients is that you know yeah, and and and anti-inflammatory diets are becoming kind of a um uh much more popular. So uh uh, you know, certainly uh things like uh omegas, um uh turmeric, you know, turmeric has been uh you know really really helpful in in some of my patients. Um one interesting thing that I think a lot of patients are looking for more of a natural approach is um there is uh an eye drop that we can make now uh from actually your own blood. So there's called something called serum eye drops. Um so basically um a patient will have their blood drawn, and uh I'm sure you've seen it where there's a centrifuge, and uh basically the centrifuge will separate out the serum, the clear part, from the the red, the red blood cells, basically, right? Um and then compounding pharmacist can take the serum component and actually at a different percentage, we use 20% and make tears out of that. So really it's coming, it's coming out of your own body, and then you can actually use it as eye drops. And it's extremely effective because you know, over the counter you can get um tears, you can get tears all the time, but it doesn't have your you know, growth hormones, it doesn't have your you know um factors in it, it doesn't have your you know what's what's in inherent to you, and then you get as a lubricating drop. So um, you know, my patients are looking for more of that you know holistic approach, they love that, and and it works, it absolutely works. I mean, it's a little bit of a effort to get it made, and you have to find the right compounding part. It's not everyone does that, but um it's something that that I found very effective in my um for a lot of my patients.

SPEAKER_04

What is this called?

SPEAKER_00

It's called it's called autologous, which means you know, from yourself, serum eye drops.

SPEAKER_03

That's really cool. Yeah, never heard of that. I've heard of it for other things, like they'll do that for like PRP, yeah, and facials and stuff. It's similar, yeah.

SPEAKER_00

Yeah, very no, no, we have we have we have it. We've had it actually for a long time. Oh my gosh, um, it just hasn't caught as much uh kind of mainstream attention, but uh yeah, we use it, we use it all the time.

SPEAKER_03

That's so cool.

SPEAKER_04

Very neat.

SPEAKER_03

Okay, I'll go. So I I feel like I'm probably um like a textbook midlife person. I didn't need glasses my whole life. My mom did, my dad did, my brother did, and I was like, I just I'm just you know, I'm just better than you guys. I don't need glasses 2020, right? And then I turned, oh my goodness, probably probably mid-40s, probably 45. And uh suddenly I was like, I needed uh I needed my phone light to read the menu and and stuff like that. Um I like to tell people that it's it was when I moved to K-Man, that's when I just suddenly did it, needed the needed the phone light and stuff, couldn't read the menu, and they're like, oh wow, really? It has nothing to do with the fact that I was turning 45. Um but yeah, so I think I'm pretty much in that I think that happens a lot. Um what is actually happening to our vision in midlife? Like, why does this happen?

SPEAKER_00

No, that that's uh that's great. We didn't we didn't touch on this, so I'm glad that's a good introduction. So, you know, we uh we we had uh touched on uh dry eyes. Now the the the most common thing that happens kind of in in our midlife, and and we're not gonna blame this on hormones, this happens to everyone, right? This is uh for men and women, is that our uh we have we developed something called presbyopia. So presbyopia is basically a fancy way of saying um our our our natural lens that allows us to focus light when we're born, you know, all of our life, um loses its strength. It loses its the lens becomes thicker and it can't flex as much. And um and so when it can't flex as much, this is what is allows us to read. So you can imagine when you it doesn't flex as much, then your reading becomes poor and uh you can't just pull things and read normally anymore. And then your your arm gets shorter and shorter because you can't, you know, you can't you can't pull it out far enough. So uh and and then what and then when it gets too short and you can't pull out, that's when you start needing you know reading glasses. Now, some people um instead of just uh needing reading glasses, then they need you know bifocals and progressives, right? And it's it's uh it's a thought that oh my eyes are you know getting worse. This is a very kind of normal, um, you know, I say AGE process, and it's kind of like a uh it's something that happens to all of us. And um and uh now you know there's a lot of good solutions though, right? So the most common thing is right, okay, put a pair of reading glasses on, right? Um the but but some not everyone wants glasses, right? So then, okay, well, let's try some contact lenses, right? So we could, you know, sometimes be there's multifocal or bifocal contacts. There's even even patients do like one eye for distance, one eye for reading. It's called monovision, and that can be simulated with uh contact lenses as well. And then if we want to take it one step further, that's kind of like more my specialty, is um um they want correction. They don't want glasses, they don't want contacts, they want to do LASIK, they want to do something called smile, um, where you know we do we put them through a whole evaluation, and then they uh for for for folks that really want to kind of be out of glasses, that's really kind of a liberating kind of thing because that's like like it's like they got their life back, right? They they had they were in glasses, they're in contacts, and all of a sudden they don't need that anymore. Uh and so that can be a very kind of a uh a big part of kind of their journey as they're kind of uh maybe uh thought to be losing their vision.

SPEAKER_04

With LASIKs, uh is it something that has to be redone after a certain amount of time?

SPEAKER_00

Right uh so so LASIK is um is and I'll give you myself as an example. So I had LASIK when I was 30. I didn't have any reading vision problems, right? So I had I had LASIK uh for sharp, sharp distance vision, perfect, one of the best things I did for myself, right? And now I'm 50 and I can tell that that reading thing is happening, right? Like I, you know, yeah, you know, yeah, it's it's happening, right? So so um so it's not so much that my LASIK wore off, right? It's more that something else in my eye and my body is changing, right? I'm not just losing a little bit reading vision. The other kind of big milestone that um that everyone goes through is that at some point, this is more like maybe 60s and 70s, is uh you get cataracts. So everyone gets that. It's not it's not a it's not a uh disease, it's not anything, it's just kind of a the composition of your lens changes. We call it a cataract, and then your eyes can change again. So again, so someone had LASIK and then they develop cataracts, it's not so much for a LASIK wore-off, right? Or they need um, but then now something else in their eye is changing. And the good news is that kind of in every stage of life, we we have ways to kind of correct that. Now, ultimately, when someone develops cataracts, right, um, there's no glasses or cocktails that will fix that. That at this time that that's the only solution is cataract tree, right? Okay, um, but now the cataracts can be replaced by lens implants that really are game changers at this point. I mean, they can get your vision back, you can get your vision back to how you were in your 40s, and you're talking to like a 65-year-old or a 70-year-old, right? And they they they get to see better than they have in years and years. It's kind of truly a life-changing you know type of experience. Um but uh you know, so sometimes we have to do lacing again. Uh sometimes it, you know, it doesn't quite, you know, kind of take as well as we want, but most of the time it's because something in their something else changed in their eyes that um and and then and then maybe we we go a different route to kind of help them with their vision.

SPEAKER_04

Okay. And then what is the smile thing?

SPEAKER_00

So smile, so so um in our field, we have uh, you know, you everyone's heard of LASIK, right? LASIK is like you know, LASIK is like the vision correction procedure. Um, you know, uh and it's and one of the things that's become very uh known about LASIK is a very quick recovery. So someone that's been wearing glasses for years um all of a sudden uh gets LASIK, and then by the next day they're seeing, well, that happened to me. The next day I was like, oh my gosh, this is amazing. Like this, it just worked, right? Um, but but LASIK does uh, you know, it's been around for 30 plus years, at least in the US, it's been FDA approved for about 30 plus years. And you know, when when thousands and thousands of people get it, you realize that okay, maybe people get dry eyes with it, maybe you know, there's some other, you know, uh some minor issues that kind of come along the way. So uh as technology improves, one of the treatments that has become available is something called SMILE. Um, in SMILE, um the same type of correction is done, except it's considered a flapless LASIK, so we don't have to create a flap beforehand. And so it's thought to be a little bit better for dry eyes. It's a uh it's thought to have more strength on the cornea. So um people that do suffer from dry eyes um still could be maybe not a LASIK candidate, but maybe we could offer them something like SMILE, you know. Um and then, and then even kind of going one step further, um, you know, patients that um, you know, cataract surgery was always thought to be like, okay, we'll do it when uh the cataracts are ripe or like they've lost a lot of vision, something kind of in their 60s and 70s. But the uh the technology has been so um safe and effective now that a lot of my patients are actually electively doing it earlier in life, in their mid-40s, 50s, 60s, to actually fix their vision, not need contacts, not need glasses. A lot of a lot of my it's it's women that are kind of going through these vision changes and they want their vision fixed, you know. Um so they're actually getting lens replacements done uh earlier in life. So then they'll never need cataract surgery done. It's almost like a preventative kind of treatment. Right, right. So it's uh it's really that that portion of our practice has become uh has has been growing because uh you know, but I mean, you know, patients want to kind of take control of their lives, they want in all parts, right? Their health, they're they want to kind of be the best they can. And this is um, you know, if they're not interested in glass or contact, this is a way that they can um really kind of just wake up and start seeing things the way that they they want to.

SPEAKER_03

And not have to wait until it gets to a point where you're just so bad. Like you're like, I'm gonna get in front of this.

SPEAKER_00

Yeah, exactly. Yeah, exactly I tell my patients all the day we don't have to wait till you're blind to fix your vision, right? We can we can fix it you know much earlier and um it it's gonna improve your quality of life. And it's really uh quite quite a rewarding, not obviously obviously for my patients, but also for myself, just to be able to offer that.

SPEAKER_03

So how do we know if it's just normal aging eyes or if it's something else that might need medical attention?

SPEAKER_00

Right. I think listen to your listen to your gut, right? Listen to like you know what you're gonna I I mean in general, um when your eyes do start changing, uh it's gonna come out as some symptom, maybe some dryness, maybe a change in vision, maybe fluctuating vision, maybe things like floaters or flashes. Whenever you, you know, say you get in get in front of the eye doctor. It could be an optometrist, it could be an ophthalmologist, and let's just kind of get some baseline kind of exam of your eyes. And at that point, I think you know, the the eye care professional could tell you, okay, you need a yearly exam, you need a you know, every two years, this is kind of what you need to look out for. Big thing is family history. Is there a family history of diabetes, family history of hypertension, family history of maybe retinal problems, you know, um, maybe you know, glaucoma, macro degeneration. Those would kind of set the bar a little bit more frequent, like instead of every two years, maybe you have to do every year, you know. Um, and and most of these exams you can tell then at that point. Um now, unfortunately, there are some eye conditions that are what I call silent ones, you know, silent ones where you don't know like if things are changing in your eyes, right? Um, things like macro degeneration, things like glaucoma uh not don't necessarily have symptoms. Thankfully, these are conditions of much later in life, uh, which when we do definitely recommend yearly eye exams. Um but um but but but because if someone has a family history, we we tell them to kind of maybe do uh annual exams a little bit earlier.

SPEAKER_03

And those any of those conditions would be caught if you do go to the eye doctor regularly.

SPEAKER_00

Correct. Assuming exactly, exactly. Okay, right? Because most most eye exams um will involve um obviously a check of the vision, check to see if you need glasses, but um uh there's something called dilation where we you know dilate your pupils and we look in the back of your eyes, your retinal exam, the optic nerve exam. Um so when you do a full exam like that, we are able to see uh not only what's wrong with your eye, but also again, like I said before, maybe some other systemic conditions that you may be um you know maybe more prone to getting.

SPEAKER_03

Are there preventative strategies that we can do to maintain our our vision as we age?

SPEAKER_00

I yeah, there are. There are. I I think you know, in general, I always uh you know, UV protection, right? That that that I think is a big uh you know, UVA, UVB protection, wearing your sunglasses, wearing a bit, you know, brimmed hat. Um you know, some some you know sometimes UV can affect the surface of the eye just like it affects skin. Sometimes UV can affect uh your lens. Sometimes people that get a lot of UV exposure are maybe more prone to getting cataracts a little bit earlier in life. Um and then retinal, you know, the retinal health, uh, UV exposure is very uh very important. So, you know, for for all those reasons, UV UV protection I think is is is important. Now, you know, these are things that affect or that improve um not just eye health, but just in health in general, right? Um no smoking. Like, for example, you know, we macro degeneration and smoking, there's a clear link, you know, to that. Um, you know, eating kind of green leafy vegetables, there's a clear link to eating green leafy vegetables and preventing, you know, macro degeneration. Um and then uh, you know, and then if you do have some systemic conditions, if you do have diabetes, if you do have hypertension, you may not be having necessarily eye problems, but uh, for example, diabetics, we want to check their eyes every year because uh diabetes can cause these small leaky blood vessels called diabetic retinopathy that we you wouldn't be able to know until we actually start uh examining your retina. So most uh primary care doctors, most you know, most docs that that diagnose diabetes individuals will say, Have you seen your eye doctor? You know, and so they'll say, Well, I don't I'm not having any eye problems. Well, but you need to see your eye doctor every year because we don't we don't know if there's little maybe subtle changes um uh that are happening.

SPEAKER_03

Right. Also, uh question, I don't know, can you just let me know if this is true or false? Where if I wear my glasses more, will I need to need them more and potentially make my eyes worse and need to get a stronger prescription because I'm wearing my glasses so much?

SPEAKER_00

Great question. And that I get that all the time. All the time. I get that with glasses, I get that with teardrops, I get that, you know, and it's um uh the short answer is no. The short answer absolutely is no. So uh, you know, uh you're you need glasses or someone needs glasses because that's how your eye is shaped and that's what your eye needs, right? And that's the that's the optics of your eye. Um uh and if you wear them more, you your your eye is not gonna change a shape. They're not gonna get worse because I'm wearing my glasses.

SPEAKER_03

Okay.

SPEAKER_00

Exactly, exactly. There they if they do get worse, it's not necessarily because you wore glasses, it's because they're just gonna get, you know, worse. Maybe maybe you need more, yeah. Maybe you like for example, the the the classic, the classic one is the reading vision, right? We talked about this before. Like your arms get, you know, they don't get long enough, so you start wearing reading glasses, but um maybe you'll go over the counter, you'll start with like a plus one reader, and then you'll go to a plus one twenty five. It's not because you keep on wearing them, it's because your eyes are getting worse, right? So uh right. So you just need more, and then by the time you're like in your mid fifties or you know, then you need like a plus two or plus two twenty five. Uh so that's uh that's a very normal, very you know, natural thing. So I would I would tell I would tell my patients, like, you need to see well, wear your glasses, and uh and then and then and then your annual exam will tell you if things are getting worse or not.

SPEAKER_03

Okay. Yeah, that's good. Um are there hormone eye drops?

SPEAKER_00

There are. That's a really exciting uh kind of field of uh of dry eyes because uh you know, as I mentioned before, uh, you know, with the lacmal gland and also those mybomin glands, there's these uh androgen, uh estrogen receptors, and uh so delivering eye drops that have the estrogen, progesterone, and testosterone directly to that area has been uh shown to be helpful. Now, it's still kind of in the you know, kind of I would say early clinical, you know, uh data trials because one of the challenges, and it's just like you know, getting hormone replacement therapy is like how do you compound it, how do you make it, right? And um and there's so many different ways to kind of make it and to test each different ways is become this is somewhat of a challenge. So there's nothing commercially available, so you have to go to these compounding pharmacies to get them. Uh so it makes kind of the trials for these a little bit difficult, but but but anecdotally, you know, the patients I've had on them um, you know, have you know have have had improvements, you know. Now that's not their only treatment, or obviously we have they're on the the other dry eye treatments, uh, but uh I I do think this is an exciting area, um, and I I do think it's gonna be eventually show that this is actually very effective.

SPEAKER_03

Yeah. That's cool. Very good. Yeah.

SPEAKER_00

Like now, it's like HRT for the eyes. Yeah, exactly.

SPEAKER_03

Yeah. It's like they're making it.

SPEAKER_00

So maybe someone doesn't tolerate like a yeah, maybe someone doesn't tolerate systemic uh HRT. Well then now you can you know do it locally and install it. Specifically, yeah. Yeah, exactly. Exactly.

SPEAKER_03

That's amazing. I love it. Um so you said earlier that the eyes are the windows to the soul, um, and they can also be the windows into other health-related issues. Uh, what can you detect through a retinal exam?

SPEAKER_00

So um, you know, again, we're I always say we're blessed as being an ophthalmologist because we really can kind of uh do a in a very non-invasive way, see kind of like um um very much the health of the uh of that of that patient's body. So so when we do a dilated exam um and I'm I'm able to see the retina. The retina is a part of your nervous system, it's an extension of your brain, and um it goes through the optic nerve into your retina, and the retina has uh uh these uh blood vessels. Now, those blood vessels are an extension of your uh cerebral arteries, your your neck arteries, your cardiac arteries, right? So it's an extension of that, but we can actually see them. So we get this kind of very uh detailed view of how uh your nervous system is and also how your um you know retinal or your vascular system is. So vascular system, I mean we all know this, right? Um if you have blockage of your arteries, if you have high cholesterol, well, most of the time you have to do some sort of like invasive ultrasound, or you have to do not ultrasound invasive, but like maybe a catheterization or something like that to really kind of look or maybe a CAT scan. But when we can look at the eyes, we can actually see the lining of the blood vessels become somewhat uh the caliber becomes less. Now we won't we don't always see like a plaque or anything like that, but I can we can kind of start tell us like maybe you need to kind of get this check, maybe you need to, you know, get a your cholesterol check, maybe you need to um some more cardiac testing. Um we can also see how the vessels are moving in the eye, and that can tell us some hint and maybe there's some hypertension. Um we can also test anemia. We can also see if there's some blood spots, we can see there's someone you know anemic. Um with the retina and the optic nerve, for example, sometimes we can diagnose multiple sclerosis with uh optic nerve exam because of the way the uh you know some inflammation of the optic nerve. So um there's a whole the whole list of uh you know things that we can kind of diagnose uh potentially uh with an eye exam. Uh but even um, you know, just kind of getting to the point of kind of getting in uh at least an annual checkup just to kind of see as a baseline where things are at.

SPEAKER_03

Yeah, because even if you're not able to sort of diagnose, you could sort of say, you know, this doesn't quite look right. Maybe you should go see your cardiologist or your whoever.

SPEAKER_00

100% correct. Absolutely.

SPEAKER_03

I have a question though. I so this is uh like a drop that you put in the eye to to to do that exam? To dilate it. Or something like to dilate it?

SPEAKER_00

Right, right. Yes.

SPEAKER_03

I don't think I get that done.

SPEAKER_00

So um so some some providers do a um they'll take a picture of the eye instead. Um may you get that done. And and some of these uh some of these diagnostic kind of imaging camera systems allow us to see kind of the full uh you know periphery of the retina. Um but uh you know my it my opinion is that uh nothing beats kind of a good dilated exam where where the provider is is actually seeing kind of what's in front of them and seeing your vessels and seeing your retina and seeing your outfit. Now it is kind of a pain to get dilated, and you know, I'd if you've been ever done dilated, but it takes up four to six hours to kind of wear off, you lose a little bit of reading vision. Yeah, so it's a it's I've definitely not had that done. Yeah, yeah, yeah. No one likes to get dilated, you've got to wear sunglasses afterwards, but uh you know, for for kind of a maybe, maybe one time get a dilate exam, and then maybe, you know, next couple years get the picture, you know, kind of something along those line. Yeah, right. Exactly.

SPEAKER_03

Could it I don't I I'm gonna make sure of this uh like on Tuesday when we're back to work. Um could it be that I'm not seeing an ophthalmologist, but I'm seeing an optometrist for my glasses, or no, not likely.

SPEAKER_00

If if you are getting just kind of a glasses exam, you know, and just uh maybe a kind of a general eye examples. Right, it's more than likely an optometrist. Um but uh it's it's um it you know hard to say. I mean, you know, you because we even do those do those general eye exams as well. So it's but well like for example, like our practice, we don't do we don't like necessarily make classes or do contact lens exams. So we wouldn't kind of go that route because um because that's you know we're we're more of a medical specialty.

SPEAKER_04

Right, right, okay. Do you um for the dilating, is this like a once-a-year thing, or is it like once every couple years?

SPEAKER_00

So um it it usually depends on how often you need your eye exam, right? So like if if if your doc tells you, hey, you know, I see every two years, probably every two years you're gonna get dilated, right? If your doc's like yeah, yeah, it just depends on like how we're not gonna get it. Yeah, it depends on yeah, exactly. But you know, the the the diagnostic pictures that uh people take are are very good still. I don't want to kind of pull you kind of you know, I mean they're still very good, but but every once in a while a good dilated exam is um I I think critical.

SPEAKER_03

Yeah, it makes sense. Yeah, I'm gonna look into that. I think I'm gonna see if I can do that for my next one. Um because, you know, even if I do it now and I don't do it for a few more years, like assuming everything is okay. Um but I would like to sort of have that baseline and I would like to see. Are women in midlife uh like me, are we at a higher risk for certain eye diseases?

SPEAKER_00

I I think you know, we we touched on a few of them, right? Okay, there's there's there's there's dry eyes, obviously, um, there's um and not not just women, right? The the whole presbyopia thing. I think those are two of the biggest kind of um uh things that kind of affect you know uh uh midlife women uh the most. Now I would say the uh autoimmune inflammatory type conditions are more prevalent um in women, especially if you have a you know a family history, you know, of that. And you know, those are tricky, tricky conditions because they can present in so many different ways and sometimes unfortunately gets undiagnosed because they just they maybe have not developed all the symptoms yet. Um so I would say uh potentially that that is more of you know, you know, uh kind of more we see that in women. Um now those all those conditions in incidentally can cause dry eyes as well. So it's kind of like everything kind of like you know, everything's kind of related. Uh so uh so again, sometimes we're the first ones seeing those uh those patients. But I would say those are kind of the main things. Now, you know, it you know, this is not necessarily because uh a woman in midlife, but if you have a family history of glaucoma, if you have family history of diabetes, you have family history of hypertension, then you probably need to get in front of the eye doctor a little bit sooner and maybe more frequent.

SPEAKER_04

It's so interesting because and Cynthia, I don't know if you think the same way. None of those I I never thought any of those were interconnected.

SPEAKER_03

No. No. Not at all. No.

SPEAKER_04

Um I I think that that's why it's just so important to have these conversations and why we created this platform is there's so much information out there that we don't know how it relates to what it is that we're going through. And like menopause, perimenopause is somewhat of like this still this new conversation, this new topic. And being able to help people and give them this information of you know, the dry eyes. Now we get to actually talk about the dry eyes. Now we get to look at the connection that it has with um perimenopause and menopause, but it also has the connection to all of our other health ailments that we may have as well, right?

SPEAKER_00

Yeah, absolutely. Now, one thing that I you know, so in our practice, just to um, you know, we dry eyes are such a uh important part of our practice, we actually created a dry eye center. And um, and uh and the doctor that leads our dry eye center, her name is uh Dr. Kim Reardon, and um basically she has taken dry eyes to the next level. She she really um you know uh does kind of proper scans and and presents all treatment options. But one really cool thing that um I think she's done uh recently is that one question that she gets asked incessantly, and I don't get this question as much because I I think because I'm a male and I don't I don't get it, but is makeup, right? Makeup around the eyes, especially for dry eye patients, right? So eyeshadows, mascara, liner, right? Like, you know, one of the most common, hey doc, is my makeup? Is it my makeup causing is is my makeup old? Am I allergic to my makeup? Things like that. Um, so she created a line. Uh, I'm gonna give her a plug if you don't mind. It's called Ever Beauty Cosmetics, and she created a line that she she looked at as a dry eye specialist, she looked at all the ingredients that are in makeup products, and she basically vetted them out to see which are the safest uh for the eye. Um so uh so not only for like dry eye patients that maybe you know, I have patients that are like, Doc, I haven't worn makeup in years. Of course they they want to wear makeup, but like they just they feel like they they can't or they're gonna harm their eyes. Now she has kind of a line of products. I I I fully plan on uh using that yet. And it's um but but this is just kind of a one piece of the whole kind of dry eye center where we can really kind of analyze why patients are getting dry eyes and what kind of the next treatment you know option for them would be.

SPEAKER_04

Good for her. We will make sure we get her on.

SPEAKER_00

That's exciting.

SPEAKER_04

She loves it. Yeah, for sure. Love to talk about it.

SPEAKER_03

All right, so just to sort of, as one last question, um I guess are there is there anything that you want women in midlife to know about their eyes that we maybe haven't talked about or that we have that you want to highlight, or any kind of warning signs that we shouldn't ignore during perimenopause or menopause?

SPEAKER_00

I I think I think the biggest thing is reassurance. So reassurance that um that more than likely the the symptoms that um you know my patients that are uh midlife women have are um are number one, 100% normal um and uh and and probably treatable, um, maybe not curable, but treatable in some way. Um and uh and it's really just kind of getting in front of the eye doctor to try to uh you know sort out what's the problem. Now, you know what what ends up happening, and I'm sure you know you have women friends, patients that that experience is that there's so many things going on, right, with their bodies and their life that like you know, maybe the eye gets overlooked.

SPEAKER_04

I was gonna say your version. Probably like kind of no offense, um, like the last on the list to go and get it.

SPEAKER_00

I totally get it. Totally get it. And it's uh and it's gonna be like that because there's other more kind of quality life issues that need to be taken care of before the eyes, right? Um, because maybe they're not as as bad. Now, if the eyes get you know very bad, they'll they'll hop right in, but usually it's not as the symptoms aren't as kind of profound with their you know overall light. But um most of the time it's okay, let's put you on some tiers and omega-3s, and I think you're gonna do just fine. Most of the time it's okay, let's try some reading glasses first, right? Let's before we kind of jump into like something wrong with your eyes. And oftentimes it's uh when we can kind of get past some of those symptoms that are eyes, then then maybe they can concentrate on the rest of their body, right? Maybe they can concentrate on other things that are kind of going on because they can feel like they there is a solution. I would tell you that most of the time it is a simple solution. They just have to get in front of the eye doctor and like figure, you know, sort out what's gonna help them the most.

SPEAKER_04

So for any of our listeners, and our listeners are you know Cayman, uh North America, all everywhere else in the world, I'm assuming you only work within your state.

SPEAKER_00

Uh yes. Hopefully, maybe that will change, but uh, as of now, yes. As we as we mentioned before.

SPEAKER_04

So anyone that is within the uh Flor state of Florida, um, how would they get in contact with you if they wanted to come and see you?

SPEAKER_00

So um, you know, our our practice, uh we uh you know our website is uh FloridaEyspecialists.com or alternative Floridaeye Custom Vision.com. Either way, they they can kind of get a um uh get a hold of us. Um you know, if they're in the States, our um you know simple number 904-564-2020 is our number. And uh it's a uh purposely, believe me. Uh and uh, you know, it's uh so I I do have a lot of patients that travel. They travel from the uh, you know, so we don't have a big medical tourism type of uh presence, but I mean I have patients that come from the Caribbean uh you know all the time and uh it's a quick uh kind of commute.

SPEAKER_04

It's a quick so you can um you don't have to live within the state of Florida to see you. You can come from to see you. No, no, no, no.

SPEAKER_00

No, no, no, no. So so uh like for example, like our geography, we're located kind of on the northeast corner of Florida. So like I would tell you that 20% of my patients are from Georgia, right? Because they they just kind of you know go down. So there's no issues kind of in between that, and then um patients can come from anywhere. They they they travel you know to see me. Um uh and it's it's it's not a not not an issue to see me. So we you know we're happy to kind of at least do a consultation, and then they can, you know, so a lot of patients what I you know sometimes they'll do like maybe initial consultation with me and then maybe get some of their eye work and I care, you know, maybe post-operative work even by their local you know ophthalmologist, whether that be in a different state or different country.

SPEAKER_04

Now, for anyone who can't come and see you, um, what would you say is like maybe the top couple of things that they should be asking their eye doctor for the next time they go in and see them?

SPEAKER_00

Yeah, absolutely. Well, I think we touched on one of the dilated eye exams. Yes, yes, we touched on that. Um, you know, and then um I I think I think any um ophthalmologist will do a compar comprehensive eye exam, um a check for glasses if they want contact lenses, excuse me, um that could be uh kind of a way to start. And then um and then really uh uh some basic tests for dry eyes, which I think most ophthalmologists would do you know as well. And I think it's really just ask for a compreh comprehensive eye exam, and then uh that should kind of lead them down the right path.

SPEAKER_04

And I do think that also for anyone that's listening, to probably even make sure that you feel comfortable enough talking about other things other than just your eyes. So like kind of come in with a list of maybe some other things that might that you might be going through because they may have that link to the eyes, or vice versa.

SPEAKER_00

Absolutely, absolutely. Yeah, one of the first questions I asked, you know, my patients, you know, even if I get their eye exam is like, how's your overall health? Tell me something new that happens that you know what what are you what are you going? And now they may not open up to me, you know, as much as maybe their you know their OB or their primary, right? You know, but uh you know, at least is kind of a way to start, you know. The one one thing I didn't touch on is uh screen time. So let me just kind of briefly talk about screen time, right? So so uh screen time is um obviously it's taking over our lives, we're doing that right now, right? So it's like uh basically um you know you know, and and what some of the blurred vision is not you know that people notice is not necessarily for like driving and distance and maybe watching television, it's on the screen, right? On our phones, on our computer, our tablets. And one of the key things is that if you have dry eyes, um, and then on top of that, you are staring at a screen. Um, and it's not so much the screen and the you know the blue lights or not blue lights that are kind of kind of affecting you, it's more that we don't blink as much. So, like if you and I are talking face to face, um, where our blink rate is probably once every couple seconds, right? And then and then, but as soon as we're on the screen and it's just kind of how we're hardwired, our blink rate goes down to once every maybe 20 seconds, 25 seconds, right? So then if your tears don't have the blinking involved to kind of coat the surface every time you blink, then it tends to evaporate a little quicker. And then if you um if you already have an evaporative problem, like we mentioned with the mybomin glands, then they can evaporate a little quicker. Then what do what do we do? Like if you if you're getting blurry on the screen, what do you do? You try to rub your eyes, you try to like blink a little bit more, and and sometimes people stare more. Somebody's like, If I really stare at this, I'm gonna like you know see it a little better, and and then it's just kind of a vicious cycle where you know things get um a little bit a little bit more blurry. So, one kind of quick little suggestion is every maybe 20 minutes take a little break, look out in the distance, maybe purposely blink your eyes, you know, um even carry some of those lubricating drops, kind of if you know you're gonna be on the screen for like you know a little while, um, just to kind of help help the eyes get a little bit more moist and you don't have those big fluctuations in your vision.

SPEAKER_04

Oh, good to know.

SPEAKER_00

Little tip.

SPEAKER_03

Yeah, yeah. Does watching too much screen time or being on my phone too much, does that make my eyes worse?

SPEAKER_00

It the I would tell you that um if you were like say a teenager, right, or like maybe even younger, right? Um the more time that you spend kind of up close, the more chance you may become a little bit more nearsighted, right? You may develop, you know, kind of glasses. Not necessarily your eyes are kind of getting right, right. But you know, after like say our mid-20s and onward, right, our eyes aren't really changing from that component. Um but but the biggest thing I would tell you is the uh the dry eyes, right? So the dry eyes and and and and not blinking. So sometimes that can be blur vision, sometimes that can be irritation, that could sometimes it can be burning, right? Uh so I you know, in that sense, um theoretically, right, if you keep on doing that without any sort of treatment, yeah, your eyes will get a little bit worse uh from a dry perspective, your vision may get worse as well. Uh but I think that's a that's a simple solution. I mean, in this day and age, we we use screen time so much, it's so it's not so easy to say stop using screen time, right? Yeah, yeah, yeah. But uh there are little tricks that we can do to kind of help um you know at least get a little bit more comfortable.

SPEAKER_03

But like as a parent or a teacher of children in their teens, it is fair to say like that's you're too much screen time or you're too close to the kids and my parents used to say, you're too close to the TV, you're gonna wreck your eyes. Right. And so it is fair to say that it does impact or can impact.

SPEAKER_00

It can. It can. And and and one uh you know, we're seeing we're seeing in general rates of myopia, rates of myopia progression, which is uh the the progression to nearsightedness is like is very much on the rise. So yeah, yeah. Yeah, so I mean I you know, I I would love to say it's something else, but I I think it's just the how much we're in front of things, right? So, you know, now you know it's uh you know, um compared to other countries, like for example, like Japan, uh we're we're far less for you know, I think I think they've been in screen time a lot longer, right? But I think we're kind of on that trajectory of uh, you know, we're near sight is gonna be become a big uh a big thing. Yeah. What one one one little one other tip. Okay, one other tip. This is why it's in my head. So unrelated to myopia and screen time, but um uh and I get this a lot from my um uh and I I wish I brought it up before, but my middle-aged uh women uh obviously get hot flashes, right? Hot flashes are you know and so what what do they do? They put a fan in when they sleep, they sleep, right? Fan or an air conditioning vent, right? And um, and and and so a lot of my patients, their eyes may not close all the way. And uh or when you sleep, it tends to kind of stay open just a touch. So you can imagine kind of the air conditioning or the vent or something kind of basically evaporating their tear film as they, you know, because they they need that fan. Um so so a lot of my patients will complain that you know, hey doc, my eyes aren't dry all the time, they're just when I wake up, right? So um and then I'll ask them, Hey, do you sleep with a fan? Now I I they'll I I totally appreciate that that is a non-negotiable event. That you cannot just take your pan away. That that is not gonna happen, right? That's uh so so the the the better way is to protect your eyes at night. So using usually I'll tell my patient, okay, look, if that's happening, um, you know, maybe direct it not directly in your face, you know, maybe just like a little offsetter, you know, or use like a gel drop at nighttime to help coat your eye, you know, like a non-class.

SPEAKER_04

Look at like an eye mask.

SPEAKER_00

Or a sleep mask. Yeah, sleep mask. Yeah, exactly. Yeah, something like that. So that's um, I know something that probably a lot, a lot, a lot of um patients going through perimenopause, menopause. That's a big, a big part of what uh didn't even think about that.

SPEAKER_03

So yeah, yeah.

SPEAKER_00

Last last little tip I have.

SPEAKER_03

That's great.

SPEAKER_04

It's a good one.

SPEAKER_03

Yeah. Well, this is wonderful. Yeah, this was great. Thank you so much for joining us. Absolutely, guys.

SPEAKER_00

Yeah, this is great. And uh yeah, hopefully uh can help uh help your listeners uh learn a little bit about their iHealth.

SPEAKER_03

Yeah, yeah, definitely.

SPEAKER_04

It was great, it was very informative. Yeah. Well, thank you.

SPEAKER_00

Perfect, guys. Thank you. All right, very good.

SPEAKER_03

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