Speaker 1: 0:00

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Speaker 2: 0:04

Welcome to the Healthy Matters podcast with Dr. David Hilden , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, healthcare and what matters to you. And now here's our host, Dr. David Hilden .

Speaker 3: 0:21

Hey everybody, it's Dr. David Hilden, your host of the podcast, and welcome to episode 22, which is going to be all about your vision and your eyes. Joining me today is the chair of the Department of Ophthalmology at Hennepin Healthcare in downtown Minneapolis. Dr. Kevin Engel, he's an expert in your eyes, and we're gonna chat about a variety of things that affect so many of you. Kevin, welcome to the show. It's

Speaker 4: 0:43

Good to be here. Thanks for inviting me. Start

Speaker 3: 0:45

Us off by just a simple question about what is the difference between an ophthalmologist, which is you and an optometrist? Alright ,

Speaker 4: 0:53

Great question. The first thing is, both of them are very important parts of the eye care team, but they have different purviews. An optometrist is someone that went to college for four years and then they did four years in a specialized school where they learned all about the eye called optometry school. And when they're done, they're a doctor of optometry and they treat eye diseases, they prescribe glasses, they prescribe contacts, they do all of those things. An ophthalmologist is someone that went to college and then they went to medical school and then they did a residency and maybe a fellowship in ophthalmology and did eye stuff that way. And because of that, they are bent towards the medical side of eyes and the body, how the eyes react to the body, and specifically surgery. So anytime you need laser on your eyes or surgery inside of your eyes, those are things that are under the purview of the ophthalmologist. And I

Speaker 3: 1:48

Happen to know, you do a lot of that here at Hennepin, not only for routine eye conditions, but for trauma. Your team is operating on the eyeballs of Minnesota each and every day. That's

Speaker 4: 1:59

Right. Yep .

Speaker 3: 1:59

I don't know how you do that. You, it is so small, and when you talk to me about the surgeries you do on the eye, you never cease to amaze me. Um, because it's a delicate , uh, small space to work on, isn't it?

Speaker 4: 2:10

It is, it is. It's uh , it's something that we practice all the time as trying to get smaller and smaller and more precise and precise with our movements. It's

Speaker 3: 2:19

Incredible work you do. And thank you for that. Now let's talk about a variety of vision problems. I wanna start out with vision loss, just the common occurrence of all of us who eventually don't see as well as we used to. Could you talk about what is happening in that situation? So

Speaker 4: 2:35

The biggest thing that's going on is changes in the lens inside of the eye. So our eyes work like a camera. That's the best way to think about it. And cameras have a lens in them that we usually think about as like a , a piece of glass that's shaped like a lens. And there's a lens inside of our eye that looks just like that. The only difference is , is that it's not made out of glass. It's soft and squishy. And that soft, squishy lens changes shape by muscles that pull on it. And that's what focuses our eye. And just like lots of other things in our body as we get older, that lens and the material it's made out of gets stiffer and it doesn't change shape like it's used to. And in just about everybody at exactly age 45, that lens gets stiff enough where it doesn't focus like it used to. And suddenly you find yourself not being able to see up close like you used

Speaker 3: 3:28

To. And that's why people go to their drugstore and get reader glasses. And that's why some people have to get prescription glasses or bifocals or what I have, which is like the super duper multifocals.

Speaker 4: 3:39

That's right. Yep .

Speaker 3: 3:40

So when you get readers or when you get glasses, how do they work? So

Speaker 4: 3:45

When your lens doesn't change shape like it's used to, the muscles aren't changing it so that it can focus up close. And when you get reading glasses, the reading glasses bend the light some of the way so that it can be bent the rest of the way when it gets into your eye and focuses onto the retina. So it just starts and helps the lens bend the light so that it'll come into a picture on your retina.

Speaker 3: 4:06

There's a name for this, right? What do you call it?

Speaker 4: 4:08

Presbyopia.

Speaker 3: 4:09

Presbyopia is the medical term for what almost everybody experiences. You said it happens at age 45. Why is that and why is it so commonly in their mid forties ?

Speaker 4: 4:19

It's just, you know, some things in life are very predictable and that aging of the lens where it gets to the point where it doesn't change shape enough to focus up close, happens very regularly at age 45.

Speaker 3: 4:32

I think a lot of people maybe don't know a, that you have a squishy lens in your eye and b, that it's controlled by muscles and, and it, that doesn't change the shape as well as it should. How is that different? Or is it from nearsightedness or farsightedness? It's

Speaker 4: 4:45

Different because nearsightedness or farsightedness all have to do with how does the light focus when that lens is completely relaxed. So when the lens is completely relaxed and the muscles aren't pulling on it, does the lens focus the light directly onto the retina or in front of it or behind it? That's what nearsightedness and farsightedness is. Is

Speaker 3: 5:05

There any way to slow this process down or prevent it from happening? You know, people talk about, well, you shouldn't read and dimm light, it's gonna make your vision go bad or you shouldn't strain at the tv. I remember growing up, you know, you weren't supposed to sit real close to the tv, you're gonna hurt your eyes that way. Is any of that true? Or is there anything that can be done other than get your readers get your prescriptions?

Speaker 4: 5:25

There's nothing that can be done. Those are all old wives tales. Like, it doesn't matter. You can play video games, you can sit up to the TV up close , you can read books late at night in the dark. None of those things are gonna affect the presbyopia. It's still gonna happen at exactly the same time. So

Speaker 3: 5:40

When I was like eight years old, sitting four feet from the, the TV screen watching happy days, you know, with the fawns, you know, I , I could have , I could have done that.

Speaker 4: 5:49

You could have done that and it would not have changed the outcome at all. Okay,

Speaker 3: 5:52

Good. Good. 'cause the outcome wasn't great anyway, on my eye . So <laugh> so that, that's kind of vision loss. So before we leave that topic, the, the reader glasses or the, as some people call 'em the cheater glasses, is that a beneficial thing to do or is it better to go and get a prescription?

Speaker 4: 6:08

So the reason that cheaters are , uh, available in the drugstore is that universally almost everybody needs them at some point. Uh, you can never hurt your eyes by using reading glasses. So that's another thing that people worry about. Or that if they start wearing reading glasses, they're gonna make their eyes lazy. That also cannot happen. But sometimes it's not, you don't really know which ones you need and maybe you need , uh, you already have a glasses prescription that the reading glasses have to be added onto. And so for all of those things, it's sometimes important to go to see your eye doctor to, to know what do I need to get to be able to, to cross this hurdle? Yeah .

Speaker 3: 6:44

You might not know what you're missing. That's

Speaker 4: 6:46

Right. Oh, that's very common is that people walk around and suddenly realize that there's leaves on trees again, <laugh>.

Speaker 3: 6:52

Exactly. And they, and they were, they bought a $15 pair of readers at the drugstore and it helped 'em a little bit, but it could have been so much better if you had an evaluation of your eyes. That's exactly

Speaker 4: 7:02

Right.

Speaker 3: 7:02

Let's move on to a new topic that, that so many people experience that being dry eyes. What causes it pretty

Speaker 4: 7:08

Much exactly what you'd think is that, again, normally as we age, our tear production goes down and then , uh, the surface of the eye starts breaking down , uh, just because it's dry, just like dry skin. And we start having those itchy burny feelings that we all experience. The other thing that's super common is that as we concentrate on things, especially in our life where we're focusing on screens, so much of the time we have screen time where we're looking at computers or we're looking at our phones. Whenever you're concentrating, you're not blinking as much as you normally would, and when you stop blinking, your eyes start drying out. So those are two super common reasons for dry eyes.

Speaker 3: 7:48

So when you're staring at a screen, it doesn't affect your vision, but it can make them dry if you're not blinking enough. I've never thought of that. Yep . Say a little bit more if you could, Kevin, about , uh, the purpose of tears and blinking, because you've alluded to that. Yeah . And I don't know if many of us have really thought that through.

Speaker 4: 8:03

Yeah. So one thing we maybe don't think about is that our eyelids are there to act as one thing is for protection for our eyes , so that if something comes at us that our eyes close and it protects our eyes. But the other thing our eyelids do is they act as windshield wipers and they distribute those tears across the surface of your eyes, kind of like a windshield wiper, smooth out the raindrops as they hit the surface of your windshield and make it into one nice clear film.

Speaker 3: 8:29

Do you need to manage dry eyes if somebody's having irritated eyes? Is , uh, do you recommend that they do things like I'll I'll say specifically eyedrops and , and if so, are there good drops and bad drops?

Speaker 4: 8:40

Absolutely. Absolutely. So, you know, we've all faced the problem where we go into the drugstore and we look in the eye section and there's just this wall of eyedrops and you wonder what is the eye drop that I should be using? Your eye doctor is gonna tell you that, you know, there's all kinds of different eyedrops, but in general, for dry eyes, you need to be looking for something that is an artificial tear, just a lubricating eyedrop. And there's many different kinds of them, and everybody kind of has to find their favorite. Well, what's the difference? Some of them are thinner, some of them are thicker, and the people that like the thicker ones say, oh, these are more soothing. They make my eye feel better. And then other people say that the thick ones feel too sticky and they don't like looking through the goofiness of the thick eyedrops and they like the thinner ones. So you kind of have to just try some until you find that perfect drop for you.

Speaker 3: 9:34

Okay. So those are lubricating drops, and for some people with dry eyes, they might be helpful. What about those drops that claim to get the red out ? What about those?

Speaker 4: 9:42

We in ophthalmology like to call those the drops of the devil. I have

Speaker 3: 9:46

Heard that before. You, you are unequivocal , uh, opposed to those kind of drops. Why is that?

Speaker 4: 9:52

The reason for that is, is that the way they work is not the healthiest for your eyes. No one's gonna go blind from using those drops, but they're not the healthiest. So the way they get the red out is they actually have a vaso constrictor in them. And that means that there's a drug in there that causes the blood vessels on the surface of your eye to constrict. And that's why your eye suddenly gets more white. And that's how it gets the red out after you put those drops in. But we can all think making the blood vessels in your eye constrict maybe isn't the healthiest thing to do because then it's not getting as much blood flow as it should. And what actually happens is that after those drops wear off, our eyes are a little bit starved for oxygen and that actually makes the blood vessels get even bigger than normal. And when that happens, the next thing people do is put in more drops and you start to have this vicious cycle that starts happening. And again, it's not something where you're gonna go blind, but it's something where it's not very healthy and it's gonna lead to more irritation than health . Yeah.

Speaker 3: 10:56

You don't wanna starve your eyes of oxygen. That's right. Why do some people get those unsightly blood vessels on the whites of your eyes? There's

Speaker 4: 11:04

Lots of reasons for that. But again, it usually boils down to your eye is irritated for some reason or another. Either allergies or dryness or just fatigue. All of those can be great reasons for the eyes to become red like that.

Speaker 3: 11:18

And your advice would pretty much be just let it go,

Speaker 4: 11:21

Let it go. Or use artificial tears, lubricating eyedrops, just stay away from the drops that say, gets the red out.

Speaker 3: 11:27

Okay, we've talked about vision loss, we've talked about dry eyes and drops. Let's move to floaters. What are they?

Speaker 4: 11:35

Floaters? Those are those things that you see when you like move your eye around. And then there's suddenly these little spots that move in your vision. And again, we'll go back to that thing of our eyes working like a camera. And there's a film in the back of the camera called the retina. But in the back part of the eye, the back part of the eye is filled with this kind of fluidy stuff. It's like a gel that's called the vitreous. And that's what gives shape to the eye and holds it in place. And that vitreous gel can sometimes get little either white blood cells or other little particles of pigment that are suspended in there and float around and move, and those cast a shadow onto the retina. And cause that thing that to you looks like a fly that's moving around in your vision. It's just a little tiny either piece of pigment or cellular debris in your vitreous that's casting a shadow onto your retina. Well, it

Speaker 3: 12:27

Doesn't sound good to have little particles floating around in your vitreous. Is it dangerous?

Speaker 4: 12:32

It's not dangerous. And it happens to everybody. And you know, over our lifetime, slowly some of them can get absorbed and new ones can form. And so it , it's common, very common in something that happens to everybody.

Speaker 3: 12:44

Is there a time people should be worried about them and seek treatment for it? Or is the message almost universally don't worry about it?

Speaker 4: 12:50

No , there's, there are times certainly when if you have suddenly a lot of floaters or if you have floaters that are accompanied by flashes of light, where you're seeing things that look like someone's doing flash photography, those are symptoms that would make you want to go to an emergency room right away, because those are the warning signs of possible retinal detachment.

Speaker 3: 13:11

Okay. So floaters in general, not dangerous. Usually not, not so dangerous. But there are some conditions , uh, uh, that you should seek emergency care. I tell that to people all the time. If you're really worried, if you're having , um, something new acute with your vision, acute meaning something new is happening right now , um, don't mess around with your eyes. Go, go get that looked at. And I would, I would bet you would agree with that.

Speaker 4: 13:32

Oh, absolutely.

Speaker 3: 13:32

We are gonna take a short break. We are talking to Dr. Kevin Engel about common things that just about all of us experience with our eyes when we come back from the break. We're gonna talk about some specifics like glaucoma and cataracts, and we're also going to give you tips for taking care of your eyes. Stay with us. We'll be right back.

Speaker 2: 13:50

You are listening to the Healthy Matters podcast with Dr. David Hilden . Got a question or comment for the doc, email us at Healthy matters@hcme.org or give us a call at six one two eight seven three talk. That's 6 1 2 8 7 3 8 2 5 5 . And now let's get back to more healthy conversation.

Speaker 3: 14:13

And we're back. We've talked about the common conditions that just about all of us will experience at one timer another. Now let's move on to a couple particulars. Let's start with glaucoma. What is it?

Speaker 4: 14:23

So glaucoma is a disease , uh, that affects the optic nerve where the optic nerve doesn't carry information from the eyeball to the brain as good as it should. And it's a disease that's affected by the pressure inside of our eyes.

Speaker 3: 14:39

Is that what causes glaucoma? Too much pressure.

Speaker 4: 14:42

That's right. So if you think about the eyeball, just like a basketball, and you think about the eyeball being overinflated where there's too much pressure, that's what causes the damage inside of the eye, and that's what leads to the glaucoma.

Speaker 3: 14:55

How common is it? It's

Speaker 4: 14:56

Pretty common. It's a disease that increases in, in its prevalence the older we get. So

Speaker 3: 15:02

What are the symptoms of a glaucoma?

Speaker 4: 15:03

That is the thing about glaucoma that's the scariest, is that it doesn't have symptoms. And that's our job as healthcare and eye care providers to find out and to test your eyes before the symptoms occur. Because everyone thinks that if the pressure in their eyes were high, they would feel it and they would notice it and they would go into their eye doctor. But it is a painless vision loss. So

Speaker 3: 15:27

During a routine eye exam, many of us have had arc pressures measured to look for a glaucoma. How is that done?

Speaker 4: 15:33

There's lots of different ways that we can measure the pressure in your eyes, and lots of times people will even go to their eye doctor and leave and not even realize that the pressure was measured. But usually when you have that part in the eye exam where that blue light comes really close and then suddenly goes away, that's the point in time where the doctor was actually checking your pressure.

Speaker 3: 15:54

That kind of freaks me out. It

Speaker 4: 15:55

Freaks everyone out.

Speaker 3: 15:55

Yeah, you know , you just don't want things coming at your eye, but that's literally just a little pressure measurement. Okay, so let's say someone has , uh, an elevated pressure. How is it treated?

Speaker 4: 16:05

So again, just like lots of things, there's lots of different ways to do it, but usually the first thing we do is eyedrops. And so there's different eyedrops that we can put you on that lower the pressure, and that is our mainstay of treatment. Um, and then there are other ways, including laser and then actually surgery for cases that, that maybe the eye drops aren't working as well as they used to.

Speaker 3: 16:26

Is there anything anybody can do to prevent it? Or is this just something that is , uh, uh, inevitable?

Speaker 4: 16:32

So it tends to be something that's inevitable. There's nothing you can do to prevent it, but the important thing is, is to go to your eye doctor, because if we catch it, we can make sure that it never gets to the point where it actually causes vision loss that affects you.

Speaker 3: 16:45

Okay, that's glaucoma. Let's shift to cataract. What are those?

Speaker 4: 16:49

Okay, we're gonna go back like we did in the first part and talk about that lens inside of your eye. So remember at age 45, that lens started to become stiffer than it used to. And as we keep going past age 45, not only does it keep getting stiffer and stiffer, but just like newspaper, it starts to yellow over time. And so that lens starts to become yellow and cloudy, and that's what cataract is. It's the lens inside of our eye becoming yellow and cloudy just due to the normal aging of that material.

Speaker 3: 17:21

That also doesn't sound good. Now, this is something people might notice, although it happens gradually so you don't notice it overnight, but what would people experience in their vision due to this condition?

Speaker 4: 17:31

Uh , one of the first things they're gonna start experiencing is glare and halo around objects at night. So their night vision starts to get worse where they're seeing glare around headlights and stoplights and things like that. And then their vision starts getting blurrier and blurrier where they're just like not able to see the things that they wanna see to live their life. It

Speaker 3: 17:50

Is , it's so gradual though. It's hard to even realize that it's happening sometimes, isn't it?

Speaker 4: 17:53

Sometimes, sometimes people don't realize until they've actually had cataract surgery and had it fixed how much they were missing out on.

Speaker 3: 18:00

So how common is this condition? Cataracts

Speaker 4: 18:02

Is something that, again, if you live long enough, you will get cataracts. It's part of being human keeps

Speaker 3: 18:08

You in business though, doesn't it? It

Speaker 4: 18:10

Absolutely does.

Speaker 3: 18:11

I i I might be wrong on this, but I seem to have it in my head that it's the most common surgery performed in the United States of any kind. It at least it's way, way, way up there.

Speaker 4: 18:19

Nope , you're correct. It is the most common surgery done

Speaker 3: 18:21

On any part of the body. It's cataract surgery . Okay, so talk us through that. This is something you do. Yep . All the time. What are you doing in a cataract surgery?

Speaker 4: 18:29

So even in 2023, there's no medicines that we can give someone to make that yellow lens turn back to become clear again. So the only way we can fix cataracts is to replace the lens. And luckily is scary as that sounds. It's something that we can do. So during cataract surgery, what we do is we go inside of the eye and we take out the yellow cloudy lens and we replace it with a new plastic lens. And that fixes the problem.

Speaker 3: 18:56

It seems to fix the problem, but , uh, uh, but you just told us that vision kind of counts on that lens being shapeable and , and a little bit mushy. A plastic one doesn't sound like it would be able to do that. So how is your vision with after cataract surgery?

Speaker 4: 19:10

So before you had cataract surgery, that lens was already not changing shape, so you were using reading glasses. And there are different ways that we can approach the subject of it not changing shape either you're gonna wear reading glasses again after surgery, or there are multifocal lenses that we can put inside of your eye that can have multiple focal lengths to allow you to see in the distance and up close.

Speaker 3: 19:33

You can put one in the eye,

Speaker 4: 19:34

Inside the eye. Um,

Speaker 3: 19:35

Before I'd let you go on the cataract thing , um, I get asked this a lot by my, my own patients and frankly , um, by people just in my life. Can you talk us a little bit more through how you, how you get that lens out and, and specifically, is this a painful procedure and what can people expect in a cataract surgery? So

Speaker 4: 19:54

Cataract surgery is not a painful procedure. Uh, it is an outpatient procedure. Lots of people still think that they're gonna come into the hospital and have to stay overnight or in the hospital for a while . It's something that we do as an outpatient, and for the most part, it's a surgery that's done when the person is awake, which is another thing that people are usually surprised about. And what we do during cataract surgery is we numb up the eye so they don't feel anything. In fact, most people have no idea that surgery is even occurring as they're, they're having the cataract surgery. And then we use ultrasound to cut up that lens into little tiny pieces and to suck it out of the eye. And then the new lens gets rolled up like a cigar and inject it into the eye and then it's unfurled and put into place.

Speaker 3: 20:40

You're kidding.

Speaker 4: 20:41

I'm not kidding. <laugh> , this

Speaker 3: 20:42

Is really what you do. Oh , were you just fascinated by this when you were in med school? You go, this is what I'm gonna do. Yes. Did you know all along you wanted to do

Speaker 4: 20:49

This? I did not. I did not know.

Speaker 3: 20:51

I'm fascinated by that. Okay. So that's how cataract surgery's done and it's highly successful, right? Yes,

Speaker 4: 20:57

Absolutely. I mean, I think you'd find that the success rate is in the 99.9% level

Speaker 3: 21:03

Almost unheard of success rates . So it's a safe procedure, it's a painless procedure and it can make you see better with your cataract. So go see your doctor for that one. Well, we've covered a whole bunch of eye topics today ranging from dry eyes to vision loss, floaters, glaucoma, cataract. Kevin, thank you for all of that. That has been , uh, just a wealth of information. If you could leave our listeners with a few tips about their eyes and how to care for them, what would those tips

Speaker 4: 21:30

Be? Okay. Three tips about taking care of your eyes. Number one, I work at Hennepin Healthcare and I deal a lot with ocular trauma. So the number one thing I'm gonna say is where eye protection. You never know. You could be walking down the street and , uh, lawnmower could kick up a rock. And so wearing eye protection, especially when you're doing something dangerous is the most important thing you can do to protect your eyes.

Speaker 3: 21:52

That's great tips. Like you're, you're using drills or you're sawing or you're doing anything, you know, working around the house, eye protection. If

Speaker 4: 22:00

You think maybe, maybe I should wear eye protection, you should.

Speaker 3: 22:04

And you've been at the other end of that. You've seen what happens, not my guess is that you've fished a lot of things outta people's eyes. That's

Speaker 4: 22:09

Exactly right.

Speaker 3: 22:10

So that's tip one. What's tip two?

Speaker 4: 22:11

Number two, see your eye doctor. So for things like glaucoma, you're not gonna know that you have increased pressure inside your eye unless you go see your eye doctor and make sure that everything is okay.

Speaker 3: 22:22

So you said go see your eye doctor. How frequently should people do that?

Speaker 4: 22:25

That's what something that really depends. The the prevalence of eye disease increases with age. So if you're over 60, I'd recommend every year younger than that. You could maybe go every one to two years, but it's really dependent upon you and what you and your eye doctor decide is the right interval.

Speaker 3: 22:41

Good tip number two is get checked for something that you might not know you have. What's number three? Number

Speaker 4: 22:45

Three, your eyes live inside of your body. And so a healthy body means that your eyes are gonna be healthy. So the most important thing you can do to keep your eyes healthy is keep your body healthy. Those

Speaker 3: 22:55

Are great tips. This has been simply a whole lot of information about our eyes that I think is gonna help a lot of people. Uh, Kevin, thank you for being on the show today. Great to

Speaker 4: 23:05

Be here. Thank you.

Speaker 3: 23:05

We've been talking to Dr. Kevin Engel , chair of the ophthalmology department here at Hennepin Healthcare in downtown Minneapolis about your eye health. I hope you've picked up some useful information, as have I listeners, thank you for joining us and I hope you'll join us for our next episode. And in the meantime, be healthy and be well.

Speaker 2: 23:25

Thanks for listening to the Healthy Matters podcast with Dr . David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. You got a question or a comment for the show? Email us at Healthy matters@hcme.org or call 6 1 2 8 7 3 talk . There's also a link in the show notes. And finally, if you enjoy the show, please leave us a review and share the show with others. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas at Highball. Executive Producers are Jonathan CTO at Christine Hill . Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.