EP 589: Too Late For Lasik? Dr. Wong Has Surgery Options For Eyes of Every Age

Today, Dr. Shannon Wong of Austin Eye stops by to discuss surgical fixes for age-related vision changes. By the time many people realize their vision is changing, they're already too old for Lasik surgery. That's right--you may feel young for your age, but your eyes don't lie! Learn why cataracts and glaucoma should be in your sights and find out whether Lasik or premium lens replacement surgery might have you seeing the world with fresh eyes.

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Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

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Transcript

Speaker 1 0:07

Welcome to the armor. Men's health hour with Dr . Mystery and Donna Lee .

Speaker 2 0:17

Hello and welcome to the men's health hour. This is Dr . Mr . Your host here as always with my co-host the effervescent wonderfully haired. Co-host

Speaker 3 0:26

I got all this hair, Donnel Lee under my headphones, our old school headphones.

Speaker 2 0:31

I can't wait till we have your hair stylists on this show.

Speaker 3 0:33

We're gonna,

Speaker 2 0:33

We're gonna he's super cute. He's amazing. Mm-hmm

Speaker 3 0:36

<affirmative> his abs are amazing .

Speaker 2 0:37

<laugh> I am a urologist, a board certified urologist, a men's health show. Uh , this show is brought to you by the urology practice started in 2007. This is our 15th year. Donna. What? I know you're so old. I'm mid-career now they say

Speaker 3 0:52

Really, is it mid, mid career ? Felt like you were ending it soon. The other day. <laugh> I , I

Speaker 2 0:58

Quit. Somebody's gonna kill me. <laugh> uh , N AAU urology specialist. We have , uh , four offices all throughout Austin. We have , uh , four physicians. We have five or four.

Speaker 3 1:09

We have four mid-level, four

Speaker 2 1:10

Mid levels . We have two physical therapists. We have a sex therapist. We're just like really here to take care of all of you.

Speaker 3 1:16

We're all over the place. Yes, we have one me,

Speaker 2 1:19

One

Speaker 3 1:19

Me, one , one you ,

Speaker 2 1:20

One me too. Um, well, you know, sometimes we have guests on this show.

Speaker 3 1:24

We do, we have awesome guests.

Speaker 2 1:25

We have awesome

Speaker 3 1:26

Guests, especially in Austin, Texas,

Speaker 2 1:28

And I wear glasses. You know that

Speaker 3 1:29

I did know that actually every day .

Speaker 2 1:32

Yeah , well ,

Speaker 3 1:33

But you can't see me

Speaker 2 1:34

Otherwise. I cannot see it , uh , makes everything a lot better actually, sometimes when you can't see anything, but , uh , in surgery , uh , throughout my entire life, I've worn glasses. And so , uh , we are very, very fortunate to have Dr . Shannon Wong here with us today. Hey, Shannon. Thanks for joining us. Thanks for

Speaker 4 1:48

Having

Speaker 3 1:48

Me welcome. I'm sure you've seen his commercials on TV, cuz I see them every morning.

Speaker 2 1:52

They're really nice on

Speaker 3 1:53

CA view

Speaker 2 1:53

Mm-hmm <affirmative> I I and , um , uh , Shannon you're with Austin . I who started Austin? I ,

Speaker 4 2:00

My dad in 19 69, 19 60.

Speaker 2 2:03

Wow. Well he beat us if I , a little bit.

Speaker 3 2:05

Yeah , couple years. <laugh> a couple years <laugh>

Speaker 2 2:08

And so , um, you know , um, going to the eye doctor today is a different experience for me than it was when I first started wearing glasses when I was in junior high. Um, maybe you could talk a little bit about kind of what's the importance of getting your eyes examined and what can you expect when you go to either an optometrist or an ophthalmologist and maybe even what the difference is between the two,

Speaker 4 2:31

The eye exam done by an optometrist and an ophthalmologist are probably very similar. Um, they're going to refr you and determine your eyeglass prescription. They're going to , uh , assess the overall health of the eye. They'll use some diagnostic devices, computers to image the various facets of your eye. And then they'll go over , uh , your overall health of your eye and then prescribe glasses. If you need them , um, or contacts, if , uh , you're being seen by an ophthalmologist, they may actually go over surgical treatment options to more permanently correct your vision. Um , and, and the eye exam is , uh , focused differently based on the age. So if you have a younger person, you're kind of mainly just looking at glasses or the need for glasses or the lack thereof when you're in your forties , uh , we all enjoy this aging process called presbyopia. You lose your ability to refocus from far to near, so you might need ring glasses or bifocals. So there's a discussion centered around that. And then when you're , uh , in your fifties, sixties, seventies, the conversation kind of veers into age related , eye conditions, cataracts, glaucoma, things like that.

Speaker 2 3:52

So when it comes to eye conditions like cataracts, let's say so , uh , my father has cataracts. He's having cataract surgery are cataracts, just kind of something that's gonna happen to everyone. As we get

Speaker 4 4:03

Older gray hair, wrinkles and cataracts, everybody gets them . Oh , good times.

Speaker 2 4:07

Oh my Lord. <laugh> I think it's time just to end we'll dis all end it 50 then . Yeah . And so , uh , cataracts cause uh , what, like how , how , how do I know if I have a cataract

Speaker 4 4:17

You by the age of 40, when we evaluate your eye through a microscope and look directly at the lens inside of your eye, we're all , we all have a cornea, which is the front cover of the eye. And we have a lens which is just behind the colored part of the eye known as the Iris. That lens is clear when you're younger and inevitably it gets cloudier and cloudier. So pretty much everybody by age 40 is starting to show some slight clouding of the lens and it only becomes more pronounced as the age.

Speaker 2 4:49

And so it's the lens that gets the cataract. Correct. And then , uh , what is cataract surgery?

Speaker 4 4:55

It's where we remove the natural lens at various times of a person's life. And we replace that aging lens with a lens implant. That's a manmade implant. And that implant gives the person the ability to see better than they could with their natural lens.

Speaker 2 5:14

So , um, uh , cataracts are an age aging related issue. Losing your vision from far near the focus difference is something that can happen with age. Uh , is glaucoma also something that we can expect naturally with age?

Speaker 4 5:27

No, I would say about five to 10% of the population over their lifetime will develop glaucoma, but we screen for it cuz it is , uh , a potentially irreversibly blinding eye condition. So we always screen people for it.

Speaker 2 5:41

So even though it's relatively a minority of the population, making sure that you don't have glaucoma, so you don't lose your eyesight, will you have a change in your eyesight when you have glaucoma or is it like you just have it ? And then one day you're blind

Speaker 4 5:53

When I was a resident in ophthalm no, excuse me. When I was a medical student in ophthalmology , uh , a resident was describing glaucoma as your fall , you've jumped off of a skyscraper and you feel fine until you hit the bottom. Uh, that's kind of what glaucoma does. You don't feel anything? Your vision seems okay until the right , at the very end. It it's a condition. Glaucoma's a condition where the eye pressure's too high. It causes damage to the nerve that connects your eye with your brain. And that nerve can withstand progressive damage over years. But once it reaches a critical point where it's damaged enough, then you begin to have significant decreases in vision. And by that time it's, it's next to impossible to reverse that and

Speaker 2 6:44

Loss. And most of the time we use medicines or eyedrops that just decrease that eye pressure. Is there a surgery also that's done

Speaker 4 6:49

Correct. Yes. Some you can have eye drops to treat it. And that's usually the most common way to treat glaucoma if a person has it, but we also use a certain laser treatment to also help normalize and control the elevated eye pressure. So actually somebody coming in for treatment of , or if they're newly diagnosed with glaucoma, they have a choice. You can have a laser treatment or you can start drops to control your eye pressure.

Speaker 2 7:17

It's, it's really a very important point that you're making because , uh , I emphasize on the show all the time that sometimes the expertise of your doctor or your surgeon really defines how you're gonna get something treated. So, you know, if you're going to an optometrist to manage your glaucoma, who doesn't do laser surgery, but does do eyedrops. That may be the only thing you're ever offered. And if you go to an eye surgeon who doesn't do lens replacement to improve your vision, you're not gonna get that as an option for you. So it's really a goal of this show to really kind of make sure that patients out there or potential patients know that there's more than one way to skin the cat when it comes to dealing with different problems. You know, for us, it's gonna be problems between the nipples and the knees.

Speaker 3 7:59

Mm-hmm <affirmative> are there any dirty eye jokes ?

Speaker 2 8:02

That's why I couldn't become an ophthalmologist. You see, because there's no dirty because after I eyeballs, that's it like, that's it? You know what I'm saying?

Speaker 3 8:09

Well , I'm sure Dr. Wong has one in his pocket. I would think this ,

Speaker 2 8:12

I don't know .

Speaker 3 8:13

He seems pretty relaxed.

Speaker 2 8:14

I'm sure. Yeah. Yeah. He seems pretty relaxed. <laugh> so , um, what do you do nowadays to fix somebody's vision? So they don't have to wear glasses because I think that when the aliens come to this planet one day and see people like me wearing glasses, they be like, what is this backwards? Like

Speaker 3 8:31

Four .

Speaker 2 8:31

Are they doing? Why don't they just fix the problem? So , um, LASIK I think is the, is the more commonly known , uh , surgery. Could you just talk briefly about , uh , what is LASIK? What is, am I saying it right? Is it LASIK?

Speaker 4 8:46

LASIK? LASIK is what you give. Okay. LASIK is what I give.

Speaker 2 8:52

Okay. Oh ,

Speaker 3 8:53

Nice. You put you , you in new place, I guess take that

Speaker 4 8:56

Lasix. It helps you with that area that you treat. Yes . The ed

Speaker 2 9:02

Lasix. I think that's how I know this. Guy's not a real doctor. I don't prescribe medicines. Oh,

Speaker 4 9:07

You don't? No,

Speaker 2 9:08

No, no. I'm a surgeon baby. Oh , okay . That's weird. So , um, so when somebody has poor vision and LA LASIK, the, the, the , what does it stand for?

Speaker 4 9:18

Laser assisted inside to Carto MI uses . Oh,

Speaker 2 9:23

Oh man.

Speaker 4 9:24

Yeah . We call it LASIK.

Speaker 2 9:26

And so when what , yeah , thank God. And so it's been around for what

Speaker 4 9:30

20 19 91 started in 1991.

Speaker 2 9:34

And so , um, maybe you could go through the , the , the process of what , what happens to the person when they get that done

Speaker 3 9:39

And talk about for people like me who are scared for people to touch their eyeballs,

Speaker 4 9:43

Right? First of all, it's painless. And as long as we screen you properly and deem that you're a good candidate is generally very, very, very safe. So it's surgery to the front window of the eye, which is known as the cornea. The cornea is about the thickness of a credit card. It's about the diameter of a , a dime. And we reshape the cornea to help make that individual focus normally. And it enables them to see normally for their age. So the best window of time for somebody to have LASIK is pretty much between the age of 18 to 40 to 45 after the age of 45 presbyopia, the age related process of the lens sets in. And so if we make somebody see normally, and they're over the age of 45, they're also going to need reading glasses, even though they've finally got their vision corrected with LASIK. So after the age of 45, we generally move to another structure in the eye, the lens, and we replace the lens to optimize their vision. Cuz the lens implant will make them see younger, give them more stable vision over time and they won't need cataracts.

Speaker 2 10:52

What is the difference cataract between like a , um, like a, like a, one of these high volume popup LASIK centers and something else? You know, we, we talk about that a lot in our, on the show about mm-hmm <affirmative> , you know, like there are people who treat eye problems and then there are people who just do LASIK, right ? So there are people who treat ed like us, right ? And then those that just do shockwave therapy. And there's a difference between what you're getting. So maybe you could just speak to the quality that people can expect when it comes to a , a LASIK, a LASIK provider

Speaker 3 11:24

Uhoh I see thought bubbles popping up over Dr. Wong's head.

Speaker 4 11:27

Well , uh , he knows what we're I don't work in a LASIK only practice. And historically, so LASIK only practices , uh , emerged pretty much around the year 2000 and a lot of them were chains. Uh , and they would offer, they would do high volume and the surgeons were incentivized to do high volume , uh , LASIK surgery. And there was quite a bit of marketing involved and , um, price cutting emerged as a , a part of that , uh , business model. A lot of those centers eventually , uh , filed for bankruptcy. So LASIK only practices are not as common. Um, they still exist. I , I think there, there is at least one in the Austin area , uh , to my knowledge, it , it has a , a fine reputation. So they do exist. But if it's it's they say, if you are a what's that saying? Uh , if, if you're a , a hammer, everything looks like a nail mm-hmm <affirmative>. So we've used that analogy before we really do. Yeah. So they nailed it really they're they're marketing to the younger crowd, the , the younger being 18 to 40, 45 years of age. Mm-hmm <affirmative> anything beyond that probably. I mean, you could have LASIK. So like I , there it's it's public knowledge, but I think that , you know, you see some celebrities getting LASIK and they're older and I'm just thinking, why don't you have lens replacement? Because now you're gonna see like a , a normal sided mature person and you're gonna need reading glasses. And so after 45 50, I think lunch replacement's better cuz we make them see younger.

Speaker 2 13:14

So if you're, if you're older, the problem is if your goal is to get out of glasses, mm-hmm <affirmative> then maybe a LASIK operation wouldn't wor work for you necessarily because, because you're still gonna have to wear reading glasses,

Speaker 4 13:26

It would work. It would make you see normal for your age.

Speaker 2 13:29

Understood. Yeah. And so , um, it's interesting because it , it didn't occur to me that it would be really that younger crowd of, of, of potential patients that would really benefit the most from, from , from LASIK. Um, what , uh, technological advancements would you say , uh , have occurred recently with LASIK? Is it , or is it the same thing since 1991?

Speaker 4 13:53

It's smaller improvements. Uh , so now it's all laser generally procedure used to be. We would make the initial step with a mechanical blade followed subsequently by application of a laser. Now it's a laser flap , um , a laser treatment , uh , that's more custom to the very minute optical imperfections of each individual's eye. So the outcomes are generally very accurate and I think we've gotten better at , uh , screening people. And I don't think it's because the changes are largely gone. There's there's I think a better screening process going on.

Speaker 2 14:29

How long does it take to do each eye

Speaker 4 14:32

For both eyes? It's generally about 15 minutes, 10 to 15 minutes .

Speaker 2 14:35

And you'll do both eyes at the same time

Speaker 4 14:36

For most people.

Speaker 2 14:37

And how long of a healing time afterwards?

Speaker 4 14:40

Uh , we'll tell them that your eyes are gonna sting for about three hours and they'll, and then you'll feel fine. And so most people can go to work the next day.

Speaker 2 14:47

And how much can people expect to pay for just a standard LASIK if they don't have anything else going on with

Speaker 4 14:51

Them ? Uh , I I'll just tell you, we charge about 2,500 per eye. I'm sure you can find it for less and you can probably find it for more so

Speaker 2 15:00

Well ,

Speaker 3 15:00

But if you

Speaker 2 15:00

Want the best. Yeah . But if you want the best you come here in the , in the last few years, I've been amazed to learn that we can now fix eyesight with surgery. That's beyond LASIK. And we've talked about LASIK, which is that , uh , what , what does it stand for again?

Speaker 4 15:14

Laser assisted in CTU Carto uses that's

Speaker 3 15:19

Hard.

Speaker 2 15:19

I , I don't think he that's a lot of , I think he's making up a word. I don't remember the M in the LASIK.

Speaker 3 15:23

I thought there was an X involved. There's no X God, it's just a K.

Speaker 2 15:26

So we're not gonna talk about that. What I want to talk about is lens replacement and did this kind of , uh , when people grow older, cataracts are something that, that they get and that's a cloudiness of the lens, right? Correct. And then, so for years you've done surgery where you open up the eyeball somehow, and then you go at that, that , that lens and you replace it. Did you just replace it with like a , just a , like a clear piece of plastic back

Speaker 4 15:51

Then, it's a manmade lens implant. That's , uh , custom sized to bring that individual into focus , uh , with their new lens.

Speaker 2 16:02

And so why don't you tell me what is lens replacement for , um, for eyesight

Speaker 4 16:09

Lens replacement is for, and I'm referring to elective lens replacement is for the person who doesn't yet need cataract surgery or have visually significant cataracts. But they're , let's say wearing bifocals in their fifties, or they're wearing reading glasses in their forties. And they hate the fact that they can't refocus their eyes unless they wear bifocals or reading glasses. So we, we do lens replacement, which is basically identical to cataract surgery, but we do it on a younger demographic and we use lens implants that give a dynamic range of focus. So those individuals receiving these, we call 'em premium lenses can see far mid and near , largely with minimal to no use of glasses at all. So they see younger indefinitely.

Speaker 2 16:58

If I was , um, if , if I were to say to you that this is like putting a contact lens into your eye permanently, how would I be? Right. And how would I be wrong if I was trying to explain that to

Speaker 3 17:09

Somebody? Good question. That was good.

Speaker 4 17:12

<laugh> I'm impressed. You would be, you'd be basically wrong, right? Basically. Right. He went to Baylor culture .

Speaker 2 17:20

S what I'm saying, that's right. Y'all are so smart . We don't have the word wrong

Speaker 4 17:23

Smarty. So , uh , but the natural lens in your eye does degrade over a lifetime. So it starts clear. It gets bigger. It gets , uh , less flexible. Uh , so it gets stiffer. Mm-hmm , <affirmative> , there's your urology. We that there it is . And it gets cloudier as you age. So as you age, the lens doesn't work as well. And so eventually we do the lens, implants, outperform our natural lenses.

Speaker 2 17:51

So , um, this is not for everybody who is it? Not for

Speaker 4 17:58

Somebody who has an unrealistic expectation of being able to see perfectly at all distances with zero side effects and to see like they're in their twenties all over again. It does not deliver on that high, high, high bar. It makes a person see , like they're basically a normal 40 to 42 year old.

Speaker 2 18:19

Now a , a lot of times as we get older, we have trouble seeing , uh , like during dusk and Dawn, when there's low light conditions or we're worried about , um, uh , especially when we're driving , uh , uh , I've noticed that getting harder for me as I get older. Um, what, what role does a , a lens replacement have in that , those kinds of age related changes that are, that , that , that , that we , that we can expect to our vision ?

Speaker 4 18:43

Well, if you're , if your lens is starting to gradually opacify, and it's not allowing as much light to pass through it, then your vision at night will not be as good. And that's when you'll notice , uh , changes when you're driving at night, maybe get some glare from the oncoming headlights causing defraction as the light passes through the optical imperfections in your natural lens, which are cataract changes. So then we remove that natural lens and replace it with a , a lens implant, which is more optically normal. And it, you see better at night.

Speaker 2 19:17

So you had a lens replacement.

Speaker 4 19:19

I did. Oh,

Speaker 2 19:20

And did you do your

Speaker 3 19:21

Own, like

Speaker 4 19:22

It is that , uh , my partner did that's right . Did my surgery two , your own

Speaker 3 19:26

17 did your own

Speaker 2 19:26

Vasectomy? I did not do my own vasectomy. That is a terrible, that was a terrible rumor.

Speaker 3 19:30

I've heard you talk about that.

Speaker 2 19:31

I had to show him my left VA deference,

Speaker 3 19:35

How to do it. No,

Speaker 2 19:37

It just it's. Okay. But it is generally considered very , very poor form to do your own vasectomy as ologist . Just so you know,

Speaker 3 19:44

Just like doing your own eyeballs,

Speaker 2 19:45

Although we all have a story of some guy who tried to do his own.

Speaker 3 19:48

Oh, I'm sure.

Speaker 2 19:49

Yes.

Speaker 3 19:50

Oh my gosh.

Speaker 2 19:51

I don't.

Speaker 3 19:52

We need to give Dr . Odette more credit. So he took care of your eyeballs. You do not take care of your own.

Speaker 2 19:56

So , um, you know , uh , I think of , um, these things, I , I , I had a friend who was a plastic surgeon when , um, uh , when I was in residency and he went and got LASIK and back then, this is almost 20 years ago. I was like, aren't you afraid that you're gonna lose your vision. It's gonna ruin your career. You know, this is what we're . And he said, listen, you can't be a surgeon. If you don't believe in other surgeons, I was like, okay, you're right.

Speaker 3 20:24

So he did not go to Baylor. That guy.

Speaker 2 20:26

He did. He

Speaker 3 20:26

Did.

Speaker 2 20:27

He's a brilliant, oh , brilliant plastic surgeon now . Um , why , what prompted you to get a lens placement? Uh , because that gives other people confidence to know that. I mean, you believe in it. So, you know, that's why you did it.

Speaker 4 20:39

It's a process for everybody. You eventually can't see up close. You can't read labels on your, your, your food. You can't , uh , read your phone. You can't read your watch. You can't see , uh , people's faces close to you. You can't look at photographs on your phone without putting on reading glasses. So it's, you lose your near , which is a , uh , visual power that you have in your youth. And , uh, you get increasingly frustrated. You have to blow up the font on your phone. Mm-hmm <affirmative> , um , you have to buy a larger phone. Um ,

Speaker 3 21:13

That's me

Speaker 4 21:14

<laugh> and then you, you have to eventually carry reading glasses with you. They're on your person all the , all the time. Um , and then when we're doing surgery, we're testing vision where we're , we're helping people see, they were, the patients were seeing better than I was. Uh , and so I said, yeah , this is kind kind ridiculous. That's a sign. Maybe I , I should like, practice what I preach. Right. And so, yeah, you reach a breaking point , uh , where you can't see something like it. For me, it's , it's a whole bunch of little things. Like , couldn't read a receipt. I couldn't read, I couldn't figure out the tip on a , on my bill cuz I can't read it. Um , so I was essentially seeing like an old person that, that stereotypical blue haired lady at Lubies I would see like that person. And uh, so I don't

Speaker 3 22:01

Look at me

Speaker 4 22:02

We're I finally got tired of it and I said, let's, let's do this.

Speaker 3 22:05

That's what I need to do. I have 27 pairs of reading readers in my house. <laugh>

Speaker 2 22:10

So , um, uh , is it the case that most people need both eyes done?

Speaker 4 22:15

Sometimes you can just have one eye done and then that's all you need.

Speaker 2 22:20

And if you get that done, you'll never have to worry about cataracts, right? Correct. Oh , which is kind of a cool thing. That is cool doing that. So , uh , well , what's your , your , your target age that you think people should start considering? Um, a lung replacement

Speaker 4 22:35

Pretty much 45 and up.

Speaker 2 22:37

Okay. I think you're just talking to me because I'm 46 and you earlier said that I'm too old for LASIK and I can only get a lens replacement.

Speaker 3 22:45

He is talking to you, God . He's like, Hey old man. He's such a good salesperson. He's been in practice for 15 years. Oh , jealous . You need to preserve your

Speaker 2 22:51

Eyesight. I'm jealous of him. Uh, how much can people expect to pay? Uh , if they're , uh , getting , uh , a lens replacement with, or without a cataract,

Speaker 4 23:01

If they're having elective lens replacement , uh , it will vary practice to practice, but it's usually several thousand dollars per eye.

Speaker 2 23:10

Okay . And then if , but if you're , if you have a cataract, you can switch out your bad lens with one that can make you see better. Right?

Speaker 4 23:17

If you have , if you have a visually significant cataract and you have insurance, then usually the surgeon can , uh , or the patient's costs will be less because they can use their insurance for a portion of the procedure and they'll pay a lesser amount than they would if they had completely elective lens replacement surgery.

Speaker 2 23:39

Well, I can't thank you enough to impart this knowledge on us. I mean, for me personally, learning that there was, there's a surgical way to fix vision is really something that is, is something new to me really. Uh , you know, I feel like if there was a surgery to fix high blood pressure , uh , we would all, you know, we would lose that medicine. We have surgeries for BPH. We have surgery for diabetes, you know, it , there , there often is a way to eliminate the use of medicines and other prosthetics to help us feel better. So thank you so much for giving us that information. Thank

Speaker 3 24:12

You . Thank you for joining us, Dr. Wong , if you wanna reach out to him , email us at armor men's health, gmail.com , where you can call during the week (512) 238-0762 .