Eye Doctors on Common Eye Conditions
In this episode, we're sharing highlights from previous interviews with a glaucoma specialist, retina specialist, and a low vision doctor. Listen in to learn more about common eye conditions, treatments, and what to expect at these specialist appointments.
Hadley Presents
Eye Doctors on Common Eye Conditions
Presented by Ricky Enger
Ricky Enger: Welcome to Hadley Presents. I’m your host, Ricky Enger, inviting you to sit back, relax, and enjoy a conversation with the experts. In this episode, we hear from specialists discussing diagnosis and treatment of several eye conditions, along with information about getting the most from your remaining vision.
You know, I’ve learned so much during my time as host of Hadley Presents, and I’ve gotten to chat with some really incredible guests. We have had topics on vision loss, ranging from art to technology to marriage, and pretty much everything in between I think. One thing that we heard a lot from many of our listeners was that they wanted to know more about vision loss itself. So they wanted to understand their own eye conditions better, and they wanted some idea of what to expect going forward. Thankfully we were able to find the guests who could speak to that really well. We’ve had a number of eye doctors and low vision specialists who were willing to share their time and their expertise with us, so we figured why not gather some of that info all in one place – kind of like a one-stop shopping for low vision information.
So I think one of the most common eye conditions is glaucoma. So many people have it, but it’s not actually caused by just one thing. There’s not even a single, definite symptom that tells you that you have it. So what exactly is glaucoma, and how does it get diagnosed. For the answer to that, we approached Dr. Jullia Rosdahl.
Dr. Jullia Rosdahl: So, glaucoma is actually a group of eye diseases, and what they have in common is that the optic nerve, which is the cable that connects the eye to the brain, it's when that optic nerve becomes thinned out because of those neurons, those retinal ganglion cells that, of those neurons dying. So when the nerve dies off like that, people lose vision and it usually affects their peripheral or side vision first, in glaucoma. The most common type of glaucoma in the United States is primary open-angle glaucoma, and one of the main problems that we have with glaucoma is that people have it and they don't know it, because the vision loss happens really slowly.
And once you lose vision from glaucoma we can't get that vision back. So early detection and diagnosing glaucoma early is really important for saving sight. You asked about risk factors, so they include having a family history of glaucoma, older age is an important risk factor for glaucoma too. And actually, Black race and Hispanic ethnicity are risk factors, although a lot of white people can get glaucoma too.
Ricky Enger: Okay, so how does someone get to the point where it’s clear that they should be screened for glaucoma. And what is a typical glaucoma exam like?
Dr. Jullia Rosdahl: The scenario that we hope for is that people are going along in their regular lives, and they're getting regular complete eye exams with their local eye doctors. That local eye doctor recognizes some early sign. Maybe the eye pressure is a little elevated, or maybe the optic nerve looks a little suspicious, family history is noted. And that savvy local eye doctor either does some of the glaucoma testing themselves or refers them to someone like me as a glaucoma specialist. And then I see them. We do what we call a glaucoma evaluation, which is a pretty lengthy visit in-clinic, where they get a lot of special testing and an in-depth eye exam. And we ferret out whether they do have glaucoma, or just some risk factors that need to be followed.
So that's the scenario that we hope for, where the disease is diagnosed early before really any vision loss has occurred, and we can start treatment early and prevent vision loss. So we also get referrals for help in managing patients who've already sustained vision loss from glaucoma or already have advanced glaucoma. And sometimes the reasons that they come to us are because they need surgery, or they need some additional treatment that that local eye doctor is not able to provide. So there are lots of different ways that patients come to see a glaucoma specialist, but we always hope that they're coming early enough where we can save vision, and that frequently is the case. Actually, most people who are diagnosed with glaucoma and treated for glaucoma don't go blind from it.
Ricky Enger: Okay, that’s awesome news. So then what can someone expect as far as how glaucoma is treated?
Dr. Jullia Rosdahl: The main treatment for glaucoma is to lower eye pressure. And we have a lot of different ways to do it. Typically, we'll start with eye drop medications or a laser treatment to the drain of the eye. And then, there are also surgical treatments that we typically reserve for cases where we cannot control the glaucoma with the drops or laser or where those treatments are just not effective or not possible. For example, a patient who has a lot of eye drop allergies, cannot tolerate any of the drops, then surgery may be considered for a more mild case as well.
Ricky Enger: I imagine eye drops aren’t at the top of anyone’s list of favorite things. Still, it’s helpful to know how much they can really do, and what to expect if this is the treatment you’ll be working with.
Dr. Jullia Rosdahl: It's really, really important that patients follow those eye drop treatment regimens. I like to say to my patients, "This eye drop is a very powerful way to lower eye pressure, but it does not work if it is sitting in the bottle. It needs to go into your eye." There are a lot of different types of eye drops that we prescribe, and so the regimens can vary quite a bit.
I would say the most simple one would be a once a day eye drop that you might use at bedtime. But sometimes, we have patients on three or even four eye drop medications. Some of them need to be dosed two or even three times per day, and it's quite a feat getting them all in at the right times. But it's really quite important. Those eye drops lower eye pressure for a certain amount of time after they're instilled, and then that eye pressure will go back up once that eye drop medication has worn off. So that next dose is timed to really maintain that lower eye pressure. And we think that maintaining a lower eye pressure and really keeping it low without those kind of big fluctuations can really help protect the optic nerve, help preserve that sight.
The biggest misapprehension about glaucoma treatment I would say is about the effects of treatment. Most people expect that glaucoma eye drops will make their eyes feel better or help them to see better, but that really isn't the case. Eye drops for glaucoma help to lower the eye pressure to prevent future vision loss, so they help keep your vision, but they don't make vision better. And they can have some side effects. Most of them are manageable. People do great on their drops, but there can be some stinging or redness and sometimes, we do need to even stop or change drops because of side effects. So that misapprehension about the effects of treatment, that's one that I'd like people to know about too.
Ricky Enger: Thank you, Dr. Rosdahl, for giving us such a great overview of not only what glaucoma is and how it’s diagnosed, but also what to expect when it comes to treatment. Knowledge is power, right?
So, I guess, when it comes to eye conditions, there’s one part of the eye that gets mentioned quite a bit, for a number of reasons. So many eye conditions affect the retina, so we wanted someone to talk about that. What is the retina? What does it do? And what options do you have when something goes wrong with it? Well, who better to answer those questions than a retina specialist, so we approached Dr. Tim Murray to talk about that.
Dr. Tim Murray: I think the retina is the key to the vision that we enjoy. And for us that are a little bit older, the retina is much like the film in the camera. You know that light comes into the eye. It gets focused through the clear cornea and the lens which allows us to focus the image. But what actually takes that image and transfers it in an electrical way to our brain so that we can see is the retina. So, if the retina doesn’t function, you cannot see. For most retina specialists, we’re referral-based, which means that you've seen an optometrist or another ophthalmologist that has seen you and recognized that you have a retina specialty problem and has referred you. And most of those referrals are actually quite urgent. So, they may see a tear in the retina or a detachment, or tumor, or evidence of a stroke, or bleeding from diabetes. So, most of our patients, when they're made aware that they need a retina specialist need one quickly. A lot of times we have conditions that run in families. And so, we know that a family member may have a parent or a child or sibling that could have disease, and we'll actually, as the retina specialist, ask them to bring their family members in to be seen.
Ricky Enger: One of the most common diseases affecting the retina, especially in older individuals, is macular degeneration. And people who have been diagnosed naturally have a lot of questions about it, like what treatment options are available, and what’s likely to happen once they’ve been diagnosed.
Dr. Tim Murray: First of all, the most important thing is to recognize that most types of macular degeneration, which is the dry type of macular degeneration, never need to be injected. So, it's very important to get the correct diagnosis, as you might imagine. And the technology to do that has become incredibly precise. We have technology now that's called OCT, or Optical Coherence Tomography. It takes a laser scan of the retina that is so precise, it's better than what I used to see in the microscope when I was in medical school.
And those testing evaluations allow us to be incredibly precise about how we treat the patient. And at this point, we really personalize our therapy. So, it is not one size fits all. Every patient gets personally identified and targeted treatment based on how they're responding. Some patients are blessed and may need one injection only and never need to be injected again, and some patients need to be injected for their lifetime. But having said that it's worth it to do it well. Because before these injections, and I'm a little bit more mature, every person that we took care of with wet macular degeneration went blind. I almost never see that. And when I do see that it's because somebody came late, or for some reason, they weren't able to continue to be treated. So that's an amazing change, even in the last 10 years.
So that's the most important message to get across is that these conditions that routinely were blinding in our grandparents' decade are now very treatable and the key to that is early diagnosis and seeing a specialist that's equipped to take the best care of the patient.
Ricky Enger: There are actually two types of macular degeneration, so what if you’ve been diagnosed with dry macular degeneration? Do you have to still be seen by a retinal specialist, and if you do, how often does that need to happen?
Dr. Tim Murray: The reason why you want to be followed with dry macular degeneration is because it can convert from dry to wet, and wet is incredibly treatable and wet is typically the type of macular degeneration that leads to blindness. Dry macular degeneration usually doesn't have a significant impact in the visual function of the patient unless they develop what's called geographic atrophy. And that's literally where the retinal tissues in the center just become dysfunctional and they essentially wither away. Fortunately, that's a very rare component of macular degeneration. So, I think the last thing you want to do as a patient, when you have a condition that we know has long-term issues, is not to continue to be seen.
Ricky Enger: It’s interesting because a lot of people, regardless of their eye condition, end up having cataracts. So of course, they get cataract surgery to deal with that, and then the vision should be way better after that, right? Well, sometimes when a cataract is removed, a specialist can see more about what’s going on in the eye now that the view isn’t blocked by that cataract. So what happens at that point?
Dr. Tim Murray: One of the things that we try to teach our colleagues that are going to do cataract surgery is that it really is critical in this day and age to look at the macula with imaging before cataract surgery. Because if a patient has preexisting macular degeneration and that is the reason that the vision is being impacted, taking the cataract out is only going to unmask the macular degeneration. So, I think it's fair to counsel patients ahead of time by looking at the macula to say, "Look, we're going to take your cataract out, but you have macular degeneration, and it may require additional treatment by a retina specialist."
If you have your cataract removed and for any reason there is not a really good outcome visually, I think every one of those patients should see a retina specialist. Because many of the conditions that limit vision after cataract surgery are eminently treatable by a retina specialist.
Ricky Enger: Thank you, Dr. Murray. That information is so helpful for anybody with a retinal eye condition, and especially for those with mac d. It’s great to know what to expect. Now we’ve talked a lot about particular eye diseases and how they’re treated, but what we haven’t really talked about yet is what happens in addition to any medical treatment you get. You still have to figure out things like glasses, lighting, that kind of thing. And honestly, it’s hard to even know what’s available, as far as what can really help you get the most out of your remaining vision. And that’s where a low vision specialist can really make a difference. We talked with Dr. Mark Wilkinson about what you can expect when you walk into an appointment with a low vision specialist.
Mark Wilkinson: We want to know what the person's visual history is, what they've been told about their vision, their diagnosis, prognosis, what types of tools they've tried or have used in the past and what difficulties they're having at this point accomplishing the visual tasks that they need to do on a daily basis.
From there, we're going to assess their vision, both their distance and their reading vision, oftentimes a little bit different than might be done by their medical eyecare provider. We're going to double check their glasses prescription, which many times has not been done for a number of years, see if an alternate glasses prescription will help distance and/or reading vision.
We're going to review their contrast needs because contrast is very, very important for being able to function better. The real world is not perfectly black and white. And so that's one of the things I always tell people, is the eye exam room is the most unnatural place you can be because it's perfect lighting, perfect contrast, and the real world is not like that. From there, we'll review devices and strategies that can enhance the remaining visual abilities and allow them to do the things they're currently finding difficult or impossible to do.
I think that care is always ongoing, but that said, not everybody needs to be seen every few months or even every year. And I tell my patients if you don't have to see me, that's a good thing because it means your vision is stable and you're doing well with the devices you have. But with that in mind, I have a plan that I set up with each patient so that we know when we're going to see them again based on their individual needs and situations. And we always tell them you can come back and see me sooner if needed.
So, I don't necessarily have to see somebody on a regular basis, but certainly we're available. For instance, if they're having issues with driving or something, we'll have to see them on a more regular basis for that, or if they have some progressive condition. It also depends on their age. So, lots of variables, but definitely it's not a one-shot deal.
Ricky Enger: It sounds like one of the key things that a low vision specialist does is to develop a plan for how to approach things in a successful way, just by helping to figure out what tools are going to work best in a person’s daily life. So how can you prepare for a discussion like that?
Mark Wilkinson: I often times have to tell people your vision has been compromised, and because of that compromise, we're going to have to do things in a little bit different way. And so, there isn't a sort of a magic pair of glasses that's going to restore your vision back to the level that it was in the past. We're going to have to do things differently, which might mean holding things closer with a stronger pair of reading glasses. It might be holding a device. It might be using reverse contrast, the dark mode on your smartphone, or using some sort of video magnification device or increasing the magnification on your Kindle or your iPad. So, we're going to have to do things in a little bit different way, but when we do that, most often we can accomplish the goals and the tasks that you're still wanting to do.
I think that it's very important that they bring the devices they've been using so we can see what they've worked with, see what has worked for them, maybe worked well in the past, and then from there, determine what's going to be the best options for them.
Oftentimes people are buying things online, are mislabeled, and so they'll say, "Well, I'm using a 6X," and actually it's a six diopter, which is 1.5X. And so, seeing the devices that they've been using, what they've been successful with and what has not worked for them is very important.
I always remember my grandmother who had diabetic retinopathy, somebody would send her a new magnifier for Mother's Day and Easter and stuff, and she just looked at it and put it in a drawer and never used them. So, there's a lot of things that sound good by the advertising, but don't work because they're not really prescription devices.
Ricky Enger: I think that description of this drawer full of magnification devices sounds pretty relatable, pretty familiar to a lot of people. So, what should you expect a magnification device to be able to do? Do you have to get a different device for each task you’re doing, or is it possible to get a lot of general functionality with just one thing?
Mark Wilkinson: Many people can do well with one device. If they have mild vision loss, they may just need some stronger reading glasses. Other people who need electronic magnification may have a full-size video magnifier. They may have a portable one that they take with them when they're away from home. Now we have different apps that you can use and make your smartphone work like a video magnifier. You can have your smartphone read materials with text to speech.
And so, you have lots of options that are available, and it just really depends on what the person's having difficulty with. They might want to read, do hand work, but they also might want to play the piano. And so, they would need different devices for those different things. So, it really comes down to what the person wants to do, and then the different tools that will help them to do that.
Ricky Enger: Thank you, Dr. Wilkinson, for sharing just how important a low vision specialist can be for helping you to figure out how to get back to doing the things you love just by learning about some devices and tools that can help you use your remaining vision effectively.
We really do appreciate all the experts who have shared their time and their valuable knowledge with us. If you want to learn more about anything we’ve shared in today’s episode, including the full interviews with each of our guests from today, you can check out the show notes for links to lots of great resources. Also, Hadley is available to answer questions and help you find information, so yeah, you can give us a call. That’s 800-323-4238, and it can help to just have a conversation about some of this stuff, like what to expect at the eye doctor, or how to find a low vision specialist, you know, what magnification devices are out there, all those things we’re happy to talk through with you. Thanks again to our guests for spending some time and sharing their knowledge with us and thank you so much for listening!
Got something to say? Share your thoughts about this episode of Hadley Presents or make suggestions for future episodes. We'd love to hear from you. Send us an email at Podcast@Hadley.edu. That's P-O-D-C-A-S-T@Hadley.edu, or leave us a message at 847-784-2870. Thanks for listening.
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Episode 40
Photographer Michael Nye chats with us about his latest art exhibit, "My Heart is Not Blind," a collection of photos and audio interviews of people with visual impairment. Through these stories, Michael provides a look into what he calls "our shared humanity and shared fragility," as well as common misunderstandings about blindness.
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Episode 39
Champion blind golfer Chad NeSmith talks about how vision loss shaped his life, and how he shares his passion for golf with others with vision loss.
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Episode 38
Doug Walker, Hadley co-director of R&D, and Ed Haines, Hadley Chief Program Officer, chat about the making of Hadley's "Adjusting to Vision Loss" workshop series. The series guides people through the emotional aspects of vision loss. Doug serves as the series' personal storyteller and narrator.
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Episode 37
In this episode we chat with ophthalmologist Dr. Angela Elam from the University of Michigan. Dr. Elam addresses common questions and concerns, and shares her advice for returning to the eye doctor among shifting COVID restrictions.
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Episode 36
Dorrie Rush, OE's Chief Content Officer, joins us for a chat about this wonderful online resource chock full of tips for living well with vision loss. You'll find great articles on using tech tools, tips for health and well-being, stories from others living with vision loss, a terrific podcast, and more.
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Episode 35
Learn about a new service that’s just launched in 2020 called Accessible Pharmacy. Accessible packaging and labeling and personalized customer support all free of charge to the end consumer, and specifically designed for those with vision impairment.
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Episode 34
Audio Describe the World! That’s the mantra of UniDescription: a free smartphone app that provides audio descriptions and navigation tips for US National Parks and other public places.
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Episode 33
In this episode, we chat with low vision optometrist Dr. Mark Wilkinson from the University of Iowa. Dr. Wilkinson answers common questions and shares his advice for getting the most out of low vision optometry appointments.
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Episode 32
Jan and Elgie Dow share how vision loss has changed their relationship and the advice they have for other couples.
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Episode 31
Join Hadley advisor Eddie Becerra as he shares about losing his sight from diabetic retinopathy, and how he gained a new perspective on life.
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Episode 30
Classically trained chef Regina Mitchell shares how vision loss shaped her life. Regina worked her way back into the kitchen and is now helping others cook with confidence, no matter their vision.
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Episode 29
In this episode we sit down with the director of Well Connected, an organization that offers free, call-in groups for adults over 60 on a wide variety of interest areas: games, music, meditation and more.
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Episode 28
Support groups can be a great way to connect with others who "get it." Listen in as as low vision support group leaders Lynndah Lahey and Judy Davis describe how their groups are run and what their members get out of them.
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Episode 27
World-renowned artist John Bramblitt describes how vision loss has shaped his painting and his life.
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Episode 26
In this episode, we chat with Dr. Tim Murray of the American Society of Retina Specialists. Dr. Murray treats eye diseases such as macular degeneration and diabetic retinopathy. He answers common questions and shares his insights into the future of treatments.
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Episode 25
In this episode, we sit down with Dr. Jullia Rosdahl, a glaucoma specialist from the Duke Eye Center, and ask her some of the many questions we’ve heard about glaucoma, its risk factors, and how to treat the disease.
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Episode 24
Hadley learning expert Jessica Smith shares her experience raising a puppy that may eventually become a guide dog. She covers what she’s learned and things to consider if you’d like to volunteer to help out a guide dog school.
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Episode 23
October 15 is White Cane Safety Day, a day to recognize this important tool that empowers people with visual impairment to travel safely and independently. It also brings attention to the general public to be mindful of visually impaired neighbors, giving them additional consideration and right-of-way when needed. We sat down with Kellee Sanchez, an orientation and mobility specialist, to talk about the history of White Cane Safety Day, and how a white cane can help those with vision loss.
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Episode 22
Be My Eyes is a free smartphone app that connects visually impaired users with sighted volunteers for help with visual tasks. We sat down with Will Butler from Be My Eyes to hear how the app started, tips for using it, and exciting new features that provide specialized assistance, including with Hadley.
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Episode 21
Tracy Simon from Eye2Eye peer support program shares her story of vision loss, how her program works, and the benefits of connecting with and supporting each other.
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Episode 20
Ophthalmologist Dr. Lori Provencher chats with us about how the coronavirus pandemic has changed doctor's visits. She shares tips for staying safe, questions to ask, and what to expect before, during and after your next office visit.
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Episode 19
Mindfulness expert Tiffany Guske returns to the podcast to share tips and insights on how to cope with life's challenges, such as vision loss or an illness, building resilience and focusing on self-compassion instead of judgment.
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Episode 18
Author of "When You Can't Believe Your Eyes," Hannah Fairbairn, chats with us about how to communicate in everyday situations when you can't rely on visual cues. Hear Hannah's own story about losing vision, her practical tips on adjusting to vision loss, and advice she has on regaining confidence in social situations.
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Episode 17
In this episode, we continue the conversation on living during the COVID-19 pandemic with a visual impairment. Listen in as we share some experiences, tips, and strategies for coping during these difficult times.
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Episode 16
The COVID-19 crisis has brought a wave of change and uncertainty to our everyday lives. Listen in as we share personal experiences, resources and some helpful tips...all from a blind or low vision perspective.
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Episode 15
Assistive technology experts Ricky Enger and Steve Kelley review BlindShell, a mobile phone built for those with visual impairment. They discuss the basic features, how it differs from a traditional smartphone, and how to decide if it's right for you.
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Episode 14
This week we sit down with Dan Roberts, author of "The First Year-Age-Related Macular Degeneration: An Essential Guide for the Newly Diagnosed" and founder of MDSupport website and support group. Hear Dan's own story about being diagnosed with macular degeneration and what prompted him to reach out to others facing similar circumstances.
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Episode 13
Listen in as we explore the basics of using hand tools with a visual impairment. Gil Johnson, a visually impaired home repair expert, shares tips on everything from measuring, to leveling to hammering.
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Episode 11
Elections are right around the corner. So we gathered a panel to talk about options for voting no matter your level of vision. Listen in as we explore everything you need to know, from registering to vote to the many ways you can cast your ballot.
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Episode 12
Ricky sits down with Android Accessibility Product Manager Brian Kemler to discuss what is available on Android phones for those with visual impairment. From adjusting font size and color, or opting to listen with TalkBack instead, the commitment to making these powerful tools more useful to a wider audience is clear.
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Episode 1
In this episode, we chat with Gil Johnson, an experienced home repair and woodworking enthusiast about things to consider when undertaking home repair with blindness or low vision.
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Episode 2
Hadley's Debbie Good sits down to continue a conversation with author and visually impaired world traveler Dr. Wendy David. Together they explore a wide variety of helpful hints covering train, plane, and cruise travel as well as practical information on traveling internationally and navigating hotels.
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Episode 3
In this episode, Ricky Enger chats with Joe Strechay, associate producer on the Apple TV+ series SEE. The show takes place in a future where, after a viral apocalypse, all humans are blind. Joe takes us behind the scenes of the show and his work to help build an inclusive set for the cast and crew, including those with low to no vision. From casting to costumes, scripting to scenery, hear how Joe helped create a science fiction world that strives to be authentic to life with vision loss.
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Episode 4
Hadley's Debbie Good sits down with travel author Dr. Wendy David in this latest episode. In part one of this two-part interview, Debbie and Wendy discuss tips for traveling with confidence as a blind or low vision person, advice on picking destinations, considerations for traveling alone and in a group, and more!
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Episode 5
Ricky Enger is joined by Hadley's Debbie Worman and mindfulness expert Tiffany Guske in this latest episode. Debbie and Tiffany talk about what mindfulness is and the specific benefits that mindfulness can offer for those living with vision loss. Tiffany then walks listeners through a short mindfulness exercise.
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Episode 6
In this episode, Ricky Enger speaks with New York Times columnist Frank Bruni, who shares the story of his sudden vision loss from NAION. Bruni speaks candidly on his adjustment to the change, maintaining a realistic attitude towards his vision loss, and the failure of medical professionals to provide resources after diagnosis.
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Episode 7
Listen in as we share practical tips on how to keep your handwriting readable. This resource-packed episode includes many useful techniques and solutions to common handwriting challenges. Hadley Learning Expert Jennifer Ottowitz chats with Sue Dalton, Certified Vision Rehabilitation Therapist.
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Episode 8
In this episode, Hadley's Steve Kelley speaks with Kendra Farrow, from the National Research and Training Center on Blindness and Low Vision, located at Mississippi State. The episode serves as a guide for those new to vision rehabilitation, including determining who is eligible for services, key differences between the medical and social services models, and how to locate services in each state.
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Episode 9
In this episode, Ricky Enger chats with Microsoft's Jeremy Curry, a Senior Program Manager with the Windows Accessibility team. New vision accessibility features are now available in Windows 10 for low vision and screen reader users.
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Episode 10
In the inaugural episode of Hadley Presents, Ricky Enger and Jonathan Mosen of Aira chat about the ways in which a visual interpreter service, such as Aira, can be used to gain valuable visual information and enhance travel and leisure activities for blind and low vision users.