TIME -- UM, THIS IS A RATHER 
CASUAL GET-UP.
I HAD A SILLY ACCIDENT 
YESTERDAY, I THINK ALL OF THEM 
ARE SILLY, SO I'VE GOT TON SPEND
WAY TOO MANY HOURS ACROSS THE 
STREET WHERE THINK OUTFITTED ME 
IN THIS.
NORMALLY, I DON'T WEAR THIS 
PROP, BUT IT'S HELPING TODAY.
ANYWAY, WE'LL TRY TO DO A TOUR 
OF THE MOST COMMON QUESTIONS AND
HOPEFULLY LEAVE YOU WITH A SENSE
OF HOW THE EYE WORKS, WHEN IT 
DOESN'T WORK WHAT ARE THE COMMON
DISEASES YOU'VE PROBABLY HEARD 
ABOUT.
MAYBE YOU HAVE YOUR FAMILY OR 
YOURSELF WHO WAS TREATED FOR 
DISEASE.
THINGS YOU CAN DO TO HELP 
YOURSELF KEEP YOUR EYES HEALTHY.
SO HOW WE SEE.
COMMON EYE DISEASES, I'LL TAU L 
CALL THOSE THE TOP FIVE, AND 
SOME OF THE TREATMENTS WE USE TO
MANAGE THESE DISEASES.
OTHER COMMON QUESTIONS THAT I 
GET.
SOME TRUTH OR MYTH STATEMENTS 
THAT YOU CAN TEST YOUR OWN 
UNDERSTANDING BY.
TIPS FOR KEEPING YOUR EYES 
HEALTHY, AND MY GUIDELINES FOR 
WHEN YOU WOULD WANT TO GO SEE 
YOUR EYE DOCTOR.
OKAY.
SO HOW WE SEE.
THE WHOLE REASON WE CAN SEE THE 
WORLD OUTSIDE IS BECAUSE LIGHT 
HITS OBJECTS IN OUR WORLD, 
TRAVELS THROUGH THE EYE, 
REGISTERS AND SENDS SIGNALS THAT
GET CONVERTED TO NEUROLOGIC 
SIGNALS -- DO VI A POIRNLTER, BY
THE WAY?
LET'S SEE.
IT'S KIND OF WEAK BUT YOU CAN 
SEE THAT, RIGHT?
-- THAT TRAVEL.
LIGHT ENTERS THE EYES, GETS 
CONVERTED FROM LIGHT ENERGY TO 
LIGHT SIGNAL WHICH IS TRIGGER 
NERVE IMPULSES THEN GETS 
CONVERTED INTO SIGNALS THAT 
TRAVEL DOWN THE OPTIC NERVE, 
MEET UP AND HAVE A LOT OF 
COMPLICATED CONNECTIONS AND 
VISION IS PROCESSED BYBACK IN 
THE VISUAL CORTEX AND THAT'S 
WHERE WE SEE.
WE SEE ACTUALLY FROM THE BACK OF
THE BRAIN, SO IT'S LIGHT THAT'S 
REQUIRED TO GENERATE WHAT WE 
EXPERIENCE AS VISION.
AND DISEASE OF THE EYE AND LOSS 
OF VISION CAN HAPPEN ANYWHERE IN
THIS ENTIRE PATH.
SO WE THINK OF THE EYE AS BEING 
RESPONSIBLE FOR VISION, WHICH, 
OF COURSE, IT IS, BUT IF THERE'S
BLOCKAGE, WE'RE NOT GETTING THE 
LIGHT.
IF THE FOCUS ISN'T CORRECT, IF 
ANY OF THE STRUCTURES WITHIN THE
EYE AREN'T WORKING, IF THE 
NEUROLOGIC CELLS WHO'S FUNCTION 
IT IS TO RECOGNIZE THE LIGHT AND
CONVERT THE SIGNAL, IF THE NERVE
IS DAMAGED, IF THERE'S A STROKE 
TND PATHWAYS ARE INTERRUPTED, IF
THERE'S DRAW TRAU MA TO THE BACK
OF THE BRAIN, YOU CAN SEE, YOU 
COULD HAVE INSULT ANYWHERE ALONG
THIS PATH AND IT WILL IMPACT 
VISION.
VISION IS MUCH MORE THAN JUST A 
LITTLE FIVE CUBIC CENTIMETERS 
THAT CONSTITUTES THE SPHERE OF 
THEEYEBALL.
HOW DO WE FOCUS LIGHT?
LIGHT HITS AND -- THAT'S WHERE 
YOU GET LAY SIC SURGERY IF 
THAT'S SOMETHING YOU'VE 
CONTEMPLATED.
THAT BENDS THE LIGHT, THAT'S 
RESPONSIBLE FOR ABOUT TWO-THIRDS
OF THE FOCUSING POWER OF THE 
EYE.
THE LIGHT THEN TRAVELS THROUGH 
THE PUPIL, WHICH IS SHOWN HERE 
AT BEING DILATED.
THAT'S YOUR IRIS.
AND HIT LENS.
THE LENS OF THE EYE BENDS IT 
FURTHER AND IN AN IDEAL 
SITUATION, FOCUSES IT RIGHT ON 
THE RETINA WHERE THE SIGNAL GETS
CONVERTED SO WE CAN BEGIN TRO 
PROCESSING VISION.
THE STRUCTURES OF THE EYE VERY 
BRIEFLY SO YOU UNDERSTAND THE 
DISEASES THAT WE'LL THEN 
DISCUSS.
I MENTIONED THE CORNEA, THIS IS 
THE IRIS.
IT SERVES AS AN APP CHUR LIKE A 
CAMERA LETTING IN MORE LIGHT YOU
SHOULD DIM ILLUMINATION, LESS 
LIGHT UNDER BRIGHT ILLUMINATION.
OF COURSE WE HAVE DIFFERENT 
COLORS.
THE LENS WITH THESE FIBERS WHICH
KEEP IT IN PLACE A LITTLE BIT 
LIKE A TRAMPOLINE WITH THE WIRE 
COILS THAT HOLD A TRAMPOLINE IN 
PLACE.
THEN THERE'S THIS BIG VOID OF 
SPACE THAT SHOULD BE OPTICALLY 
CLEAR.
THAT'S THE JELLY.
LIGHT HAVE HAS TO TRAVEL ALL THE
WAY TO THE BACK OF THE EYEBALL 
BEFORE IT HITS THE RETINA.
THEN IT MAKES ITS IMPRESSION ON 
THE CONES AND RODS, THE 
PHOTORECEPTORS, AND THEN 
EVENTUALLY THE SIGNAL GOES 
THROUGH THE OPTIC NERVE, WHICH 
IS THE HOLE IN THE EYE, AND 
THESE ARE THE RETINAL BLOOD 
VESSELS THAT SERVE THE INNER 
LINING OF THE RETINA, WHAT YOU 
CAN SEE HERE.
DISEASES THAT AFFECT BLOOD 
VESSELS, AFFECT THE RETINAL 
BLOOD VESSELS.
DISEASES THAT AFFECT NRS, AFFECT
THE INFER OF THE EYE.
SO THE EYE IS JUST ONE MORE 
TISSUE IN THE BODY AND BECAUSE 
THESE ARE COMMON FEATURES TO ALL
OF OUR TISSUES, WE CAN SOMETIMES
SEE DISEASES IN THE EYE BEFORE 
WE WOULD CHECK OTHER PLACES IN 
THE BODY.
WE CAN SEE CHANGES IN A PATIENT 
WITH DIABETE, PERHAPS BEFORE 
THEY KNEW THEY HAD DIABETES 
BECAUSE IT'S THE ONLY STRUCTURE 
IN THE BODY WHERE YOU CAN LOOK 
IN DIRECTLY AND SEE NERVES AND 
BLOOD VESSELS.
THAT'S PART OF WHAT MAKES IT 
VERY EXCITING FOR THOSE OF US 
WHO REALLY LIKE EYES BECAUSE WE 
CAN SEE EVERYTHING.
WE DON'T JUST RELY ON LAB VALUES
AND STUFF.
I GET EXCITED ABOUT THIS STUFF, 
MAYBE YOU WILL  TOO.
I'M NOT GOING TO GO IN INTO A 
LOT OF DETAIL ABOUT VISUAL 
PROCESSING, BUT I WANT YOU TO 
APPRECIATE THAT IT'S QUITE 
COMPLICATED ABOUT THE FIBERS.
SO THERE'S QUITE A LOT OF 
COMPLEXITY TO VISUAL PROCESSING.
WE CAN TALK MORE ABOUT THERE 
THAT IF THERE ARE SPECIAL 
QUESTIONS YOU HAVE WHEN WE HAVE 
TIME.
SO, WHAT ARE THE BIG FIVE 
CONDITIONS OR DISEASES THAT I 
THINK IF YOU WANT TO UNDERSTAND 
THE EYE YOU SHOULD HAVE SOME -- 
AT LEAST HAVE HEARD OF.
THE NEED FOR GLASSES, HAVING 
WHAT WE CALL A REFRACTIVE ERROR 
AFFECTS ABOUT A THIRD OF 
AMERICANS OVER 40 YEARS OF AGE.
THAT'S NOT TALKING ABOUT 
KNEADING READING CLASSES.
THAT MEANS SOMEBODY IS 
NEAR-SIGHTED OR FAR-SIGHTED.
THAT, I DON'T CALL A DISEASE.
THAT'S JUST AN OPTICAL CONDITION
OF THE EYE.
WE FIX IT EASILY WITH GLASSES.
THAT'S NOT A DISEASE.
BUT CAT, AFFECTING MORE THAN 20 
MILLION PEOPLE IN THE UNITED 
STATES IS VERY HAPPILY CURABLE 
DISEASE BECAUSE WE DO SURGERY, 
BUT THAT'S A COMMON PROBLEM.
DIABETIC EYE DISEASE, LESS 
HAPPILY WE DON'T HAVE PERFECT 
ANSWERS FOR HOW TO RESTORE 
DAMAGED TISSUES.
MACULAR DEGENERATION AFFECTING 
THE EYESIGHT OF MORE THAN 2 
MILLION PEOPLE WITH FOUR TIMES 
THAT MANY, MORE THAN 8 MILLION, 
BEING AT HIGH-RISK FOR 
PROGRESSING TO VISION LOSS.
THAT'S A VERY SERIOUS PROBLEM.
AND GLAUCOMA, AFFECTING MORE 
THAN 2 MILLION PEOPLE IN THIS 
COUNTRY.
OKAY.
SO JUST REAL QUICK ON 
NEAR-SIGHTEDNESS, 6-
FAR-SIGHTEDNESS, WE ALL ALL OF 
THIS REFRACTED ERROR.
NEAR-SIGHTEDNESS MEAN THE LIGHT 
IS BENTD MORE THAN IT SHOULD BE.
IT MEANS THE EYE IS A LITTLE 
LARGER THAN WHAT THE ARCH EYE 
WOULD BE, SO IT COMES INTO FOCUS
SOMEWHERE IN THE MIDDLE OF THE 
JELLY WHERE THERE ARE NO 
PHOTORECEPTORS TO PICK UP THE 
SIGNAL.
BY THE TIME IT GETS BACK TO THE 
RETINA, IT'S DEFOCUSED, BUT BY 
PUTTING NEAR-SIGHTED CORRECTION 
IN FRONT OF THE YOEYE, THAT CAN BE
CORRECTED.
FAR-SIGHTEDENNESS IS6
BLURRY AT THE POINT OF THE 
RETINA, SO AGAIN THE GLASSES 
BRING IT INTO FOCUS RIGHT ON THE
RETINA.
ASTIGMA TICHLT JUST MEANS THE 
BENDING POWER IN ONE AXIS OF THE
CORN NAH IS DIFFERENT THAN THE 
OTHER AXIS.
A VERY SIMPLE ANALOGY.
IF YOU WERE TO CHOP THE FRONT OF
A BASKETBALL, YOU'D HAVE THE 
SAME UP AND DOWN AND 
SIDE-TO-SIDE.
A FOOTBALL IS OBLONG AND IF YOU 
WERE TO CHOP THE FRONT OFF 
THERE'D BE STEEPER CURVATURE 
WHERE YOU PUT YOUR HAND AND LESS
STEEP WHERE YOU THROW.
NEXT.
WE'VE MOVING QUICKLY BECAUSE 
THERE'S QUITE A LOT.
CATARACT, YOU REMEMBER ARE WHERE
THE LENS SITS IN THE EYE.
CATARACT IS ANY CLOUDING IN ANY 
PART OF THE LENS THAT'S IN THE 
EYE.
KIT BE INSIDE, OUTSIDE, VERY 
BACK OF THE LENS.
WE GIVE THESE DIFFERENT NAMES 
BUT IT REALLY DOESN'T MATTER.
IF LIGHT IS TRYING TO GET 
CLEARLY BACK THROUGH THE RETINA 
AND HAS TO TRAVEL THROUGH THIS, 
IT'S GOING TO BE DISTORTED.
SO WHEN PATIENTS NOTICE BLURRED 
VISION, GLARE AND HALOS AROUND 
LIGHTS, YOU CAN IMAGINE IF 
YOU'VE GOTTEN INTO YOUR CAR ON A
FROSTY MORNING AND THERE'S FROST
ON YOUR WINDSHIELD ON A BRIGHT 
DAY AND THE LIGHT HITS IT AND IT
SCATTERS AND IT'S SO BRIGHT YOU 
REALLY NEED GLASSES, THAT'S WHAT
THE CATARACT IS DOING INSIDE OF 
PEOPLE'S L EYES.
THESE ARE LITTLE CARTOONS TO 
HELP DEMONSTRATE WHAT VISION 
WOULD BE NORMALLY AND THEN IF 
SOMEONE HAS A GENERALIZED 
BLURRYNESS FROM CATARACTS.
WHAT DO WE DO?
THIS IS SOMETHING WE LOVE TO DO 
BECAUSE PATIENTS COME BACK HAPPY
IN THE COURSE OF A HALF HOUR, WE
TAKE OUT THE CATARACT, PUT IN A 
CLEAR PLASTIC LENS IN ITS PLACE.
IS THE SORT OF LENS I USE, THIS 
IS A MULTI-FOCUSED, AND THEY CAN
SEE CLEARLY.
IT'S A WONDERFUL SURGERY BECAUSE
IT'S SO EFFECTIVE AND THE 
TECHNIQUES HAPPEN TO BE 
VERY-WELL DEVELOPED.
THIS CLEAR PLASTIC IMPLANT LENS 
SITS RIGHT WHERE THE NATURAL 
LENS USED TO SIT AND LIT STAY 
WITH A PATIENT FOR THE REMAINDER
OF THEIR LIFETIME, IF ALL GOES 
WELL.
OKAY.
ANY QUESTIONS ABOUT CATARACTS?
YES, SIR.
>> [LOW AUDIO].
>> CATARACT IS ONE OF THE 
DISEASES THAT'S AGE-RELATED.
THE LENS KEEPS GROWING AS WE 
ANAL.
JUST TO CLARIFY, BUT CATARACTS 
CAN ALSO DEVELOP FROM OTHER 
CAUSES, FROM MEDICATIONS, 
DIABETICS HAVE A HIGHER RATE.
THERE ARE MANY THINGS WHICH CAN 
CAUSE A CATARACT.
MOST COMMON CAUSE IS NATURAL 
AGING.
>> [LOW AUDIO].
>> SO MY PHILOSOPHY ON SURGERY 
MAY NOT BE EVERYBODIES, OKAY.
SO IF YOU HEARD SOMETHING 
DIFFERENT, THAT'S FINE.
I AM AN ADVOCATE OF SURGERY WHEN
THE PERSON'S LIFESTYLE IS 
AFFECTED.
THAT'S AT A DIFFERENT POINT FOR 
DIFFERENT PEOPLE.
OKAY.
FOR MOST CATARACTS IN THIS 
COUNTRY, THEY'RE NOT SO SEVERE 
THAT WE HAVE TO SAY, WE REALLY 
RECOMMEND SURGERY OR SOMETHING 
BAD IS GOING TO HAPPEN TO YOUR 
EYES.
IF THE CATARACT IS INTERFERING 
WITH OUR ABILITY TO MONITOR EYE 
DISEASE, IF THE PATIENT HAS 
DIABETES -- I SAW A PATIENT 
YESTERDAY, THE CATARACT WAS 
INTERFERING WITH WHETHER WE 
SHOULD CARE FOR THAT EYE, BUT IN
MOST CASES, ONE PERSON WILL WANT
SURGERY WHEN THEY'RE SEEING 
20/40.
ANOTHER PERSON WILL BE HAPPY 
THEIR VISION WILL BE MUCH WORSE 
AND THEY'RE SAYING I'M DOING 
EVERYTHING I WANT TO, I'M NOT 
IMPAIRED IN ANY WAY.
I DON'T ENCOURAGE THAT PERSON TO
GET SURGERY, I JUST MAKE THEM 
AWARE THAT PROBABLY SEE BETTER 
IF DECIDED THEY WANTED TO.
IT'S DIFFERENT TIMES FOR 
DIFFERENT PEOPLE.
BECAUSE THERE'S A RISK TO 
SURGERY, WE DO LIKE TO HAVE A 
CERTAIN AMOUNT OF INVOLVEMENT 
THAT JUSTIFIES THAT RISK.
IF SOMEONE COMES TO YOU WITH 
20/25 VISION WITH A HAIR LESS 
THAN WHAT THEIR NORMAL VISION 
MIGHT HAVE BEEN AT 20/20, I'M 
RELUCTANT TO OPERATE ON THAT 
PATIENT BECAUSE THERE'S VERY L 
TO GAIN AND A WHOLE LOT TO LOSE 
IF SOMETHING GOES WRONG.
IF IT'S A PILOT COMING TO ME 
WITH 20/25 SURGERY AND HE CAN'T 
FLY -- I'VE OPERATED ON PILOTS 
BECAUSE THEY'RE GROUNDED AT 
20/25.
YES.
>> [LOW AUDIO].
>> IT DOES CONTINUE TO GROW, BUT
IT CAN ALSO BECOME OPAQUE EVEN 
WITHOUT GROWING.
THERE ARE KINDS OF CATARACTS 
THAT WILL CAUSE CLOUDINESS.
IT CHANGES IN COLOR.
MANY CHANGES CAN HAPPEN.
IF YOU IMAGINE AN OPTICALLY 
CLEAR STRUCTURE AND IN ANY WAY 
ALTERING THAT WITH CLOUDINESS, 
CHANGING COLOR, THAT WOULD BE A 
CATARACT.
>> [LOW AUDIO].
>> IF YOU HAVE TRAUMA IN ONE 
EYE, IT'S VERY COMMON YOU'LL 
HAVE A CATARACT IN THAT EYE.
CATARACTS CAN DEVELOP 
ASYMMETRICALLY, IT HAPPENS ALL 
THE TIME.
YES, MA'AM.
>> [LOW AUDIO].
>> RIGHT.
>> [LOW AUDIO].
>> SO IT'S VERY HARD TO GIVE -- 
TO TELL YOU WHAT'S GOING ON IN 
YOUR EYES FROM ACROSS THE ROOM, 
BUT, UM, WHAT IS COMMON IS THAT 
THERE'S A KIND OF CATARACT WHERE
THESE LITTLE IE CYCLE-LIKE 
STRUCTURES DEVELOP ON THE LOWER 
PRT OF THE LENS OR ON THE LOWER 
AND NASAL PART, THE PART CLOSER 
TO YOUR NOSE, AND AS YOU READ, 
YOU TEND TO LOOK DOWN, AND SO 
YOU MIGHT BE LOOKING THROUGH THE
AREA THAT'S MORE AFFECTED WHEN 
YOU'RE READING.
YOU HAVE A CHOICE, YOU CAN LIFT 
YOUR READING MATERIAL UP A 
LITTLE OR YOUR OPHTHALMOLOGIST 
COULD PROBABLY EXPLAIN IF THERE 
ANYTHING YOU COULD DO LIKE 
INCREASING LIGHTING, 
STRENGTHENING YOUR GLASSES.
IF YOU SAY, I'M SORRY, I CAN'T 
READ COMFORTABLY ANYMORE, THAT'S
WHEN I'D SAY NOW IT'S TIME FOR 
SURGERY BECAUSE YOU'RE UNHAPPY.
>> [LOW AUDIO].
>> RIGHT.
FACING WHATEVER THAT WOULD BE, 
THE TIME FOR SURGERY IS WHEN 
YOU'VE HAD ENOUGH OF IT AND YOU 
JUST CAN'T DO WHAT YOU LIKE TO 
DO.
THAT'S MY BAROMETER.
ONE MORE QUESTION THEN WE'LL 
MOVE ON JUST TO MAKE SURE WE GET
THROUGH EVERYTHING.
>> [LOW AUDIO].
>> WELL, THAT'S A WORD I DON'T 
USE.
I DON'T LIKE IT BECAUSE I DON'T 
THINK OF A CATARACT LIKE A 
FRUIT, BUT, UM, THERE'S A 
NOTION -- THE CATARACT CAN 
EVOLVE TO SUCH A DEGREE THAT IT 
THEN I WILL QUESTION FIES IN THE
MIDDLE.
THIS IS THE TYPE OF CATARACT WE 
MIGHT SEE IN VERY SEVERE 
CATARACTS OFTEN IN THE 
DEVELOPING WORLD, PEOPLE WHO 
HAVEN'T BEEN ABLE TO GET IT 
MANAGED SOON ENOUGH.
THAT WOULD BE CALLED, IT'S 
RIPENED.
THAT'S LITTLE TOO LATE TO BE 
ADDRESSING.
WE CERTAINLY DO SURGERY AND HELP
THAT PERSON.
THE WORD IS USED HERE AS WELL.
IF THE OPT OPHTHALMOLOGIST WANTS
TO SIMPLIFY, THEY MIGHT SAY IT'S
NOT RIPE ENOUGH.
I JUST USE DIFFERENT WORDS.
IT'S NOT BOVRTERRING YOU, IT'S 
NOT BOTHERING ME.
IF IT'S BOTHERING YOU, THEN IN 
ANY OPINION, IT'S RIPE, IF YOU 
WANT TO THINK OF IT THAT WAY.
GOOD?
OKAY.
DIABETES IS A DISEASE THAT IS 
UNFORTUNATELY VERY UNKIND TO THE
EYE.
THE BLOOD VESZ LTS ARE ABNORMAL.
THEY LEAK THE LIPIDS WITHIN THE 
BLOOD, THEY CAN BLEED, THEY CAN 
LEAD TO AREAS OF THE RETINA THAT
DON'T GET ENOUGH BLOOD FLOW SO 
THEY'RE STARVING FOR OXYGEN AND 
THEN ABNORNL L BLOOD VESSELS 
GROW TO TRY TO FIX THE PROBLEM, 
WHICH THEY CAN'T DO.
THE PROBLEM WITH DIABETES IS 
MANY FOLD.
WHEN OWE TALK ABOUT WHAT A 
PATIENT EXPERIENCES -- AGAIN, 
THE NORMAL VISION -- THE 
DIABETESIC PATIENT WHO MAY HAVE 
DEVELOPED SWELLING IN THE CENTER
OF THEIR VISION -- THIS AREA, BY
THE WAY, HERE ARE THE BLOOD 
BLESS VESSELS, THIS AREA IS 
CALLED THE MAC LA.
IF YOU HAD TO LOOK AT ALL THE 
REAL ESTATE IN THE RETINA, THIS 
IS THE MOST IMPORTANT 
CIRCUMSTANCE UNTIL THE RETINA 
BECAUSE IT MAPS OUT SHARP 
VISION.
SO IF YOU DAMAGE THIS IN ANY 
WAY, EVERYONE THOUGH ALL THE 
REST OF THE RETINAL TISSUE IS 
WORKING JUST FINE, YOUR VISION 
WILL BE SIGNIFICANTLY REDUCED.
THIS IS WHERE IT ALL MATTERS THE
MOST.
DIABETES CAN LEAD TO SWELLING IN
THIS TISSUE.
IT CAN LEAD TO THE LEAKAGE I 
MENTIONED.
IT CAN LEAD TO BLEEDING WHEN 
ABNORMAL BLOOD VESSELS BREAK AND
THE DIABETIC PATIENT MIGHT 
EXPERIENCE SOMETHING LIKE THIS.
THE OPTIMAL CONTROL OF DIABETES 
CONTROLLING THE DISEASE, ITSELF.
THAT IS OPTIMAL BLOOD SUGAR 
CONTROL, EXERCISE, ETC.
AS AN OPHTHALMOLOGIST, IF A 
PATIENT DOES HAVE DAMAGE IN THE 
WAY I JUST SHOWED YOU, SOMETIMES
WE LASER ABNORMAL AREAS.
SOMETIMES WE GIVE INJECTIONS OF 
MEDICATIONS SUCH AS SOME OF YOU 
MAY HAVE HEARD OF VASCULAR 
ENDOFEEL Y'ALL GROWTH FACTOR.
IT'S A MEDICATION WHICH CAN HELP
CONTROL THE SWELLING IN ABNORMAL
BLOOD VESSELS AND SOMETIMES 
STEROIDS ARE HELPFUL INJECTED 
AROUND THE EYE OR INTO THE EYE, 
AND THEN SURGERY IS SOMETIMES 
NEEDED IF THE PATIENT DEVELOPS A
RETINAL DETACHMENT OR BLEEDING 
IN THE EYE WHICH DOESN'T CLEAR 
AND NEEDS TO BE CLEARED OUT 
SURGICALLY.
SO, OF COURSE, IT'S MY HOPE THAT
WITH BETTER MANAGEMENT OF 
DIABETES, WE'LL SEE LESS 
DIABETIC EYE DISEASE.
AS YOU ALL KNOW T EPIDEMIOLOGY 
IS POINTING TO INCREASED 
PREVALENCE OF DIABETES, BETTER 
CONTROL RESPOND THE GOOD NEWS IS
A LOT OF THE DIABETIC PATIENTS 
AREN'T GOING ON TO HAVE AS MANY 
OF THE PROBLEMS THAT SAY 20 OR 
30 YEARS AGO THEY DID, BUT SIT
SIT -- IT IS A BIG PROBLEM.
NEXT I JUST WANT TO SPEAK ABOUT 
MACULAR DEGENERATION.
AGAIN, THE NORMAL EYE WITH THE 
OPTIC NT BLOOD VESSELS, THE 
CENTER OF VISION AND THIS AREA I
TOLD YOU IS CALLED THE MAC LA.
IN MACULAR DEGENERATION -- I'M 
SORRY THIS DOESN'T PROJECT SO 
WELL -- THERE'S A DISTURBANCE OF
FAVORING THE CENTRAL MAC LA, 
WHICH IS WHY IT'S GIVEN THAT 
NAME.
WORTH GOING INTO A LOT OF 
DETAILS OF HOW THIS DEVELOPS, 
UM, THERE APPEARS TO BE A LOSS 
OF FUNCTION OF THE CLEARING 
MECHANISMS OF THE CELLS WHICH 
ARE NEEDED TO KEEP VISION 
PROCESSED AND SIGNAL PROCESS 
WORKING WELL.
SO WHAT CAN GO WRONG?
WELL, THERE ARE TWO KINDS OF 
MACULARER DEGENERATION.
WHAT MACULAR DEGENERATION AND 
DRY MACULAR DEGENERATION ARE THE
COMMON WORDS WE WOULD DESCRIBE 
THIS TO OUR PATIENTS AS.
WET MACULAR DEGENERATION 
INVOLVES THE GROWTH OF ABNORNL L
BLOOD VESSELS WHICH CAN THEN 
LEAD IN THE CENTRAL MAC LA.
DRY MACULAR DEGENERATION RESULTS
FROM AN ATROPHY FROM A DYING OFF
OF IMPORTANT CELLS IN THE 
RETINA.
A PATIENT WITH MACULAR 
DEGENERATION MIGHT EXPERIENCE 
SOMETHING LIKE THIS SCENE HERE 
WHERE THE CENTER OF VISION IS 
BLOTCHED OUT, BUT THE PERIPHERAL
VISION WILL NOT BE BLOTCHED OUT 
AT MACULAR DERATION.
PEOPLE WITH MACULAR DEGENERATION
CAN BE REASSURED THAT NO ONE 
WILL TURN THE LIGHTS OUT ON 
THEIR VISION, THAT WILL NOT 
HAPPEN, BUT THEY CAN LOSE 
CENTRAL VISION AND BE REALLY 
RELIANT ONLY ON WHAT'S IN THE 
PERIPHERY.
IT'S A BIG LOSS BUT IT'S 
DIFFERENT THAN BLACK-OUT VISION 
BECAUSE IT AFFECTS THE CENTRAL 
MAC LA ONLY.
WHAT DO WE DO FOR MACULAR 
DEGENERATION?
THE NATIONAL EYE INSTITUTE CAN 
BE QUITE PROUD OF SOME OF THE 
WORD IT'S PIONEERED IN THIS 
FIELD, NOT THANKS TO ME, BUT I'M
PROUD PROUD TO BE ABLE TO SHARE 
IT WHICH IS IN THE PAST TEN OR 
ELEVEN YEARS WE'VE BEEN 
RECOMMENDING TO CERTAIN PATIENT 
WHO'S EXAM HAS SHOWN TO BENEFIT 
FROM THIS, THE USE OF 
SUPPLEMENTS, VITAMIN, MINERAL 
SUPPLEMENTS, WHICH HAVE BEEN 
SHOWN TO REDUCE THE PROGRESSION 
OF HIGH-RISK MACULAR 
DEGENERATION TO ADVANCED 
DISEASE.
WE CAN IDENTIFY WHICH PATIENTS 
ARE HIGH-RISK, BUT NOT EVERYBODY
WHO'S TOLD THEY HAVE A FEW 
LITTLE SPOTS, A FEW LITTLE 
YELLOW -- NOT EVERYONE WHO HAS A
FEW OF THOSE HAS BEEN SHOWN TO 
BENEFIT FROM THIS FORMULA.
ONLY THOSE WHO HAVE HIGH-RISK 
CHARACTERISTIC.
THIS IS SOMETHING THE 
OPHTHALMOLOGIST HAS TO SHARE 
WITH THEIR PATIENT.
THAT'S ON THE PREVENTION FRONT.
WHEN THE DISEASE DOES PROGRESS 
TO ADVANCED DISEASE, WHETHER WET
OR DRY, THEN SIGNIFICANT VISION 
LOSS, THERE'S THE POTENTIAL FOR 
THAT.
UNFORTUNATELY WITH THE ATROE IF 
I CAN DRY MACULAR DEGENERATION, 
WE DON'T HAVE ANY TREATMENTS FOR
THAT AT THIS TIME.
IT'S VERY UNFORTUNATE BECAUSE, 
OF COURSE, WE LOVE TO HELP 
PEOPLE AND FIX PEOPLE AS DO ALL 
DOCTOR WHO IS TAKE CARE OF THEIR
PATIENTS, AND THAT'S A CONDITION
WHERE WE CAN'T OFFER ANYTHING 
EXCEPT LOW-VISION SERVICES, 
SHOULDÑi THE PERSON BE UNLUCKY 
ENOUGH TO HAVE BOTH EYES 
INVOLVED.
BUT IF THE TYPE OF ADVANCED 
MACULAR DEGENERATION THAT THE 
PERSON HAS IS THE ABNORMAL 
GROWTH OF BLOOD VESSELS, WHAT WE
CALL WET AMD, THEN IN THE LAST 
FIVE, SIX YEARS WE'VE LEARNED 
THAT IF THOSE EYES RECEIVE 
TREATMENT OF FACTOR INHIBITORS, 
THE NAMES OF THIS IS A 
[INDISCERNIBLE], AND AVASTIN AND
LUCENTIS.
WHEN WE INJECT THIS INTO THE EYE
IT CONTROLS THESE VESSELS AND 
PRESERVES VISION, IN MANY CASES 
IMPROVING VISION.
THIS IS REALLY PIONEERING 
TREATMENT BECAUSE BEFORE THIS 
TIME WE HAD ATTEMPTED MANY 
THINGS INCLUDING LASER SURGERY 
AND OTHER THINGS WITH MUCH LOWER
SUCCESS.
PATIENTS WITH WET MACULAR 
DEGENERATION IN THE PAST FIVE, 
SIX YEARS HAVE OPTIONS THAT ARE 
MUCH, MUCH BETTER THAN WHAT WE 
HAD BEFORE.
OF COURSE, WE KEEP TRYING TO 
IMPROVE THOSE.
YES.
>> [LOW AUDIO].
>> AS LONG AS IT'S NEEDED TO 
CONTROL THE DISEASE.
>> [LOW AUDIO].
>> YEAH.
IN FACT, THAT'S QUITE COMMON TO 
NEED MONTHLY OR EVERY COUPLE OF 
MONTH INJECTIONS FOR A YEAR, TWO
YEARS.
>> [LOW AUDIO].
>> I'M SORRY.
>> [LOW AUDIO].
>> SHE MAY NEED TO ANTICIPATE 
THAT IT COULD BE NEEDED FAR 
WHILE.
>> [LOW AUDIO].
>> OH, VERY GOOD.
A
AND I CAN REPEAT THEM TOO IF 
YOU'RE BURSTING WITH A QUESTION 
BEFORE BEFORE YOU MAKE IT TO THE
MICROPHONE.
WHAT'S SOMETHING PEOPLE CAN DO 
IF THEY HAVE MACULAR 
DEGENERATION TO HELP THE 
MONITORING AT HOME?
WELL -- SORRY.
THERE'S SOMETHING CALLED THE 
ANSWERLER FWRID.
THE IT'S JUST A GRAPH PAPER WITH
A DOT IN THE MIDDLE.
THE PURPOSE OF THIS IS TO TEST 
ONE EYE AT A TIME, AND IF THE 
LINES WHICH ARE NORMALLY 
STRAIGHT SHOULD BECOME WAIVE VI,
DARK, ABSENT, THAT'S A SIGN THAT
SOMETHING UNNORMAL IS GOING ON 
WITH THE RETINA.
THEY BECOME WAVY BECAUSE THEY'RE
BEING LIFTED UP OR SOMETHING 
LIKE THIS.
PATIENTS WITH MACULAR 
DEGENERATION ARE ASKED TO PUT 
THIS LITTLE GRAPH PAPER UP ON 
THE FRIDGE OR WHAT HAVE YOU AND 
TEST THEIR EYES WITH A A CERTAIN
FREQUENCY, ONE EYE AT A TIME, 
AND IF THEY NOTICE A CHANGE, TO 
BE SEEN RIGHT AWAY.
THAT'S SOMETHING EMPOWERING FOR 
PEOPLE WHO ARE SCARED.
THEY'VE BEEN TOLD THEY HAVE 
SOMETHING AND THEY WANT THE 
MONITOR IT, OKAY, AND THAT'S 
IMPORTANT.
IF THIS WERE TO CHANGE, THAT 
PATIENT WOULD BE TOLD YOU NEED 
TO GO SEE YOUR OPHTHALMOLOGIST 
RIGHT AWAY.
IF IT'S 9:00 P.M., YOU DON'T GO 
AND SEE THEM RIGHT AWAY, BUT THE
NEXT MORNING.
THE LAST OF OUR BIG SLIDE IS 
GLAUCOMA.
IN SIMPLEST TERMS PEOPLE OFTEN 
THINK OF GLAUCOMA AS BEING HIGH 
PRESSURE IN THE EYE AND THAT'S 
THE END OF THE STORY.
THAT'S ACTUALLY, OF COURSE, NOT 
THAT SIMPLE BECAUSE NOTHING 
REALLY IS THAT SIMPLE, BUT 
GLAUCOMA IS A DISEASE OF, IT'S A
KIND OF NERVE DAMAGE DISEASE.
AGAIN, HERE'S OUR CARTOON.
THERE'S THE NORMAL=#Ñ
OPTIC NERVE IN THE EYE WHO'S 
FUNCTION COLLECTS ALL THE NERVE 
SIGNALS AND TRANSPORTS THEM BACK
TO THE BRAIN.
IN GLAUCOMA, OFTEN BECAUSE THE 
PRESSURE IN THE EYE IS TOO HIGH,
THE NERVE TISSUE GETS DAMAGED 
AND, IN FACT, NERVE CELLS DIE 
OFF, AND SO INSTEAD OF SEEING 
WHAT LOOKS LIKE A DOUGHNUT WITH 
ALL THIS YELLOW-ORANGE TISSUE 
BEING HEALTHY, WE'RE LEFT WITH 
WHAT LOOKS LIKE AN ONION RING, 
JUST THIS BORDER OF REMAINING 
TISSUE BECAUSE WHAT WAS IN THE 
MIDDLE HAS ALL DIED OFF.
A PATIENT WITH GLAUCOMA, THE WAY
THE NERVE FIBERS ARE DAMAGED IN 
THIS DISEASE, SOMEONE WITH 
GLAUCOMA WILL LOSE PERIPHERAL 
VISION BEFORE THEY LOSE CENTRAL 
VISION.
SO IT CAN ACTUALLY BECOME QUITE 
ADVANCED BEFORE SOMEONE EVEN 
KNOWS THAT THEY HAVE GLAUCOMA, 
WHICH IS WHY YOU'LL SEE SOME 
RECOMMENDATIONS FOR EYE EXAMS 
BECAUSE A LOT OF THESE PROBLEMS 
I'M TALKING ABOUT, THE EARLY 
SIGNS WILL ESCAPE SOMEONE 
NOTICING IT IF IT'S GOING ON IN 
THEIR OWN EYES.
IT TAKES LOOKING INTO THE EYE, 
EXAMINING THE TISSUES AND SEEING
ABNORMALITIES THAT CAUSE US TO 
DIAGNOSIS THESE DISEASES.
A CLAW COMA PATIENT WILL HAVE A 
TUNNEL EFFECT.
IF IT'S REALLY SEVERE, IT CAN 
EXTINGUISH VISION ALL TOGETHER.
THAT'S QUITE TRAGIC.
WE INTERVENE MUCH EARLIER THAN 
THAT AND DO OUR BEST TO CONTROL 
IT-HOW DO WE DO THAT?
MOSTLY WITH EYE DROPS.
LASER SURGERY CAN CONTROL THE 
PRESSURE IN MANY CASES, EITHER 
ALONE OR IN COMBINATION WITH EYE
DROPS.
SOME DOCTORS NOW USE LASER 
SURGERY FIRST.
THERE ARE DIFFERENT TREATMENT 
STYLES.
WHEN THOSE FAIL, IT'S REALLY 
JUST IN THE MOST COMMON KIND OF 
GLAUCOMA, WHICH IS CALLED 
PRIMARY OPEN ANGLE GLAUCOMA, IF 
THE PRESSURE IS HIGH, SURGERY 
CAN BE USED TO CREATE A ESCAPE 
ROUTE FOR THE PRESSURE THAT'S 
TOO HIGH.
IT WOULD BE AS IF YOUR TIRE 
PRESSURE OF YOUR CAR IS TOO HIGH
AND YOU PUT A IN THERE THAT LETS
A LITTLE AIR LEAK OUT SLOWLY.
LIKE ALL THE STRUCTURES IN OUR 
BODY THERE'
THE FLUID THAT FILLS THE EYE IS 
CONSTANTLY BEING PRODUCED AND 
DRAINED, AND IN GLAUCOMA, FOR 
BUNCH OF SPECULATED REASONS, THE
FLUID CONTINUES TO BE PRODUCED 
BUT IS NOT DRAINING WELL.
SO OUR SURGERY CREATES A LITTLE 
CONDUIT, EITHER BY PUTTING A 
TUBE IN OR BY USING JUST A 
NATURAL EYE STRUCTURES TO DO IT.
A LITTLE CONDUIT BETWEEN THE 
FRONT PART OF THE EYE THAT YOU 
SAW IN THE PICTURE AND THE 
TISSUES JUST UNDERNEATH THE 
WHITE COATING.
FRAUD TRICKLES OUT THROUGH THAT 
OPENING AND THAT'S HOW THE 
PRESSURE IS REDUCED.
SURGERY HAS PRESERVED VISION IN 
MANY, MANY PEOPLE.
THAT'S AN IMPORTANT TOOL IF THE 
OTHER TOOLS ARE NOT ADEQUATE.
THERE IS A KIND OF GLAUCOMA 
CALLED -- OH, AND I MADE A BIG 
MISTAKE.
IS ANGLE-CLOSURE GLAUCOMA.
FORGIVE ME.
THIS HAS A DIFFERENT MECHANISM, 
I'M NOT GOING TO GO TO IN 
DETAIL, BUT FOR THAT SURGERY, 
LASER SURGERY THROUGH THE IRIS 
CORRECTS IT.
AND THAT'S THE MINORITY OF 
CASES.
OKAY.
THIS IS NOT ONE OF THE BIG FIVE,
BUT I INTRODUCED YOU TO THE 
ANATOMY OF THE EYE AND SAID THAT
DAMAGE ANYWHERE IN THE PATHWAY 
FROM LIGHT ENTERING THE EYE TO 
THE EYE, ITSELF, TO THE 
PROCESSING WITHIN THE CENTRAL 
NERVOUS SYSTEM, DAMAGE ANYWHERE 
IN THAT PATHWAY CAN LEAD TO 
VISUAL FUNCTION LOSS, AND SO 
HERE, I'M GIVING AN EXAMPLE OF A
PATIENT WHO'S HAD A STROKE.
-- ON THE LEFT SIDE OF THEIR 
BRAIN.
THE VISUAL FIBERS WHICH WAS 
PASSING THROUGH THAT AREA WERE 
INTERRUPTED BY DAMAGE TISSUE.
LEFT SIDE OF THE BRAIN PROCESSES
THE RIGHT SIDE OF YOUR VISUAL 
WORLD FOR BOTH EYES.
SO A PERSON WHO HAS A NORMAL 
VISUAL FIELD, AND THIS IS A TEST
WE DO IN CLINIC, WOULD HAVE -- 
THIS IS A NORMAL VISUAL FIELD.
THAT LITTLE BLACK SPOT -- DOES 
ANYONE KNOW WHAT THAT IS IN A 
NORMAL VISUAL FIELD?
>> [LOW AUDIO].
>> THAT'S WHERE THE OPTIC NERVE 
IS BECAUSE WHERE THE NERVE S THE
HOLE IN THE EYE, FIBERS TRAVEL 
BUT THERE ARE NO PHOTORECEPTORS 
RIGHT ON TOP OF THOSE FIBERS 
DELIVERING VISION SIGNALS.
NORMAL BLIND SPOTS.
THIS PATIENT WITH A STROKE IN 
THE LEFT SIDE OF THE BRAIN HAS 
LOST VISION ON THE RIGHT SIDE.
THE WAY THESE PATTERNS PLAY OUT,
WE CAN GUESS WHERE THE STROKE 
TOOK PLACE BEFORE WE HAD IMAGING
OF THE CENTRAL NERVOUS SYSTEM, 
YOU COULD LOCATE WAS IT IN THE 
TEMPORAL LOBE, WAS IT THE PRO 
RYE TALL LOBE OR PERHAPS A 
STROKE JUST IN THE XIB TALL 
CORTEX?
NOW WITH MRI, WE DON'T WAIT FOR 
SOMEBODY TO BE ELEGANT ABOUT 
READING THE VISUAL FIELD.
WE GET AN MRI AND THEN IT 
CORRESPONDS TO WHAT WE'RE SEEING
IN VISUAL FIELD.
WHAT ARE SOME OTHER COMMON 
QUESTIONS THAT I GET ASKED THAT 
I FIGURED YOU MIGHT HAVE SO I'LL
BREEZE THROUGH THEM.
RAISE YOUR HAND, PLEASE, IF I 
DON'T EXPLAIN IT AND YOU WANT TO
HEAR MORE.
WHY DO YOU EYES FEEL DRY AND 
WHAT CAN I DO ABOUT IT?
THERE ARE MANY GLANDS WHICH 
PRODUCE TEAR FILM.
IT'SÑi COMPLICATED NOT JUST SALT 
WATER.
IT HAS OILS, PROTEINS, MANY 
COMPONENTS, AND WITH NATURAL 
AGING, WOMEN MORE SO THAN MEN 
POSTMENOPAUSAL WOMEN MORE SO 
THAN PREMENOPAUSAL WOMEN T TEAR 
PRODUCTION SEEMS TO DECLINE WITH
AGING.
OFTENTIMES PATIENTS DEVELOP DRY 
EYE SYMPTOMS; GRITTYNESS, 
SENSITIVITY TO LIGHT, REDNESS, 
IRRITATION.
THAT'S COMMON DRY EYE SYMPTOMS.
THAT'S TREATED WITH LUBRICATING 
EYE DROPS.
THERE ARE ANTI-INFLAMMATORY EYE 
DROPS, RESTASIS.
WE SDIEM SOMETIMES PUT LITTLE 
PLUGS IN TO CONSERVE IN THE 
DRAINAGE TUBES IN THE EYE TO 
CONSERVE TERS THAT ARE PRODUCED.
IN F THE CAUSE IS THAT THE 
GLANDS ARE NOT WORKING 
OPTIMALLY, WE GIVE SOME TIPS FOR
HOW TO IMPROVE THE HEALTH OF THE
GLANDS SO THAT THEY CAN EXPORT 
THAT OIL ON TO THE EYE SURFACE 
MORE EFFICIENTLY.
THINGS LIKE THAT.
THERE'S LOTS WE CAN DO TO HELP A
PERSON WHO'S EYES ARE JUST 
REGULARLY UNCOMFORTABLE.
BUT THE FIRST TIP I WOULD GIVE 
IS, IF THAT HAPPENS TO YOU, MORE
OFTEN WHEN YOU'RE READING, USING
THE COMPUTER, THINGS LIKE THAT, 
JUST TRY USING LUBRICATING EYE 
DROPS DURING THOSE PERIODS AND 
TRY TAKING LITTLE BREAKS, BILL 
CLINTONING YOUR EYES AND LETTING
YOURSELF RESTORE THE NATURAL 
BLINGING BECAUSE WE BLINKLESS 
WHEN WE DO THOSE NEAR-TASKS.
SHOULD I GET LASIK?
THAT COULD OCCUPY SEVERAL HOURS 
ALONE, BUT LASIK IS CORN Y'ALL 
SURGERY TO CORRECT THE NEED FOR 
NEAR-SIGHTEDNESS AND 
OCCASIONALLY FAR-SIGHTEDNESS.
MY ANSWER TO THIS IS VERY 
PATIENT-SPECIFIC.
FOR THE RIGHT PERSON, IT'S 
FABULOUS, AND FOR THE WRONG 
PERSON, IT'S REALLY NOT.
SO THIS IS NOT A ONE-LINER 
ANSWER WHEN YOU GET ASKED AT 
COCKTAIL PARTIES.
IT FENDS ON YOUR EXPECTATION, 
PAST TIMES AND DEPENDS ON HOW 
MUCH YOU'RE GOING TO BE BOTHERED
BY NEEDING READING GLASSES WHEN 
YOU HIT 45 OR OLDER IF WE MAKE 
YOU PERFECT FOR DISTANCE.
OKAY.
JUST A WORD ON THAT BECAUSE I 
DIDN'T MENTION IT WHEN I WAS 
TALKING ABOUT NEAR SIGHTEDNESS 
AND FARSIGHTEDNESS AND ALL.
THE NATURAL AGING PROCESS OF THE
EYE LOSES THE ABILITY TO ADJUST 
FOCUS WITH AGE.
PARTLY -- WE DON'T UNDERSTAND 
THE MECHANISMS ENTIRELY, BUT WE 
SPECULATE THAT IT HAS TO DO WITH
THE CHANGES THAT TAKE PLACE IN 
THE LENS.
SO YOU KNOW GRANDPARENTS ARE 
USING READING GLASSES.
PARENTS ARE USING READING 
GLASSES AN THEN EVENTUALLY, WE 
ARE OR WILL BE USING READING 
GLASSES IF WE DIDN'T NEED IT FOR
FAR AWAY THINGS.
THAT DOESN'T MEAN THE EYE IS 
DAMAGED OR DISEASED OR GOING 
DOWNHILL.
IT JUST MEANS THAT IT IS 
SHIFTING AS IT SORT OF BIOLOGYebQC 
PLANNED IT TO FROM A MULTIFOCUS 
SYSTEM TO A SINGLE FOCUSED 
SYSTEM.
IF YOU'RE IN YOUR 40s, YOU NEVER
WORE GLASSES AN YOU'RE FINDING 
LOW AND BEHOLD YOU CAN'T READ 
THE BOOK OR THE NEWSPAPER OR 
WHAT HAVE YOU, PROBABLY MEANS 
YOU NEED READING GLASSES AND YOU
COULD TRY A
STORE, GO SEE YOUR OPTOMETRIST, 
BUT THAT'S A NORMAL AGING 
CHANGE.
I BRING IT UP AS I TALK ABOUT 
LASIK BECAUSE IF SOMEBODY IS 
LIKE ME, MINUS 1.5, I WEAR 
GLASSES FOR DISTANCE BUT UP 
CLOSE EVERYTHING'S QUITE PERFECT
AND WILL BE.
SO IF I WERE TO GET LASIK, I 
WOULD HAVE PERFECT DISTANCE 
VISION AND EVERY TIME I WANTED 
TO LOOK AT SOMETHING UP CLOSE, 
I'D HAVE TO GRAB GLASSES.
I WOULD FIND THAT EXTREENLLY 
ANNOYING.
SO I'M PERFECTLY HAPPY BEING 
FINANCE 1.50.
BAG LITTLE NEAR-SIGHTED MIGHT BE
VERY NICE FOR YOUR LIFESTYLE.
MY WORLD IS UP CLOSE, MOSTLY.
SO, ANYWAY, NOT SUCH A SIMPLE 
QUESTION.
DEPENDS ON EACH PERSON.
IS IT NORMAL TO LOSE VISION AS 
WE AGE?
THE ANSWER IS NO.
IF A PERSON COMES IN AND THEY'RE
80 AND THEY SAY I DON'T SEE SO 
WELL BUT I'M 80.
THAT'S NOT AN EXCUSE FOR ME.
I NEED TO KNOW WHY YOU'RE NOT 
SEEING SO WELL BECAUSE I EXPECT 
THE EYES TO BE DELIVERING YOU 
GOOD VISION UNTIL YOUR 100.
THAT'S NOT AN EXCUSE.
AGE IS NOT AN EXCUSE TO NOT SEE 
WELL.
WHAT IS LOW VISION AND WHAT CAN 
BE DONE TO HELP ME PERFORM DAILY
ACTIVITIES?
PEOPLE WHO HAVE ADVANCED DISEASE
WHETHER FROM MACULAR 
DEGENERATION OR A NUMBER OF 
DISEASES WE DIDN'T TALK ABOUT 
BECAUSE THERE'S ONLY SO MUCH WE 
COULD TALK ABOUT IN A SHORT 
TIME, BUT THERE ARE LOW VISION 
SERVICES AND IT'S IMPORTANT THAT
PEOPLE KNOW THAT AND GET 
CONNECTED TO SPECIALIST WHO IS 
CAN HELP THEM TAILOR THEIR HOME 
SUCH THAT THEY CAN CONTINUE TO 
DO ACTIVITIES DESPITE THE FACT 
THAT THEY'RE VISION IS 20/200 
SUCH AS 20/20.
THOSE SERVICES EXIST.
I WANTED TO MAKE SURE PEOPLE 
HEAR THAT BECAUSE ALL IS NOT 
LOST JUST BECAUSE VISION IS 
REDUCED.
VERY IMPORTANT TO FEEL EMPOWERED
AND MANY PEOPLE MAINTAIN 
INDEPENDENCE DESPITE LOW VISION.
HOW DOES MY FAMILY HISTORY 
IMPACT MY EYES?
WELL, VERY BRIEFLY, UH, IT DOES.
FAMILY HISTORY IS IMPORTANT IN 
MANY MEDICAL CONDITIONS AND IT 
IS IN A LOT OF YOUR EYE 
CONDITIONS AS WELL.
MACULAR DEGENERATION AND 
GLAUCOMA P AND MANY OTHER 
DISEASES.
THE GUIDANCE YOU'RE GIVEN BY 
YOUR OPT MOLS, HOW OFTEN SHOULD 
VI EXAMS WILL NOT DEPEND ONLY ON
YOUR EXAMINE BUT ALSO ANY FAMILY
HISTORY YOU MAY HAVE WITH A 
PARENT WITH GLAUCOMA OR MACULAR 
DEGENERATION AND SO ON.
WHAT'S THE DIFFERENCE BETWEEN AN
OPTOMETRIST AND AN 
OPHTHALMOLOGIST?
AN OPHTHALMOLOGIST IS A MEDICAL 
DOCTOR WHO WENT TO MEDICAL 
SCHOOL AND THEN TRAINED IN OPT 
AND PERFORM MEDICAL AND SURGICAL
CARE OF THE EYE, EYE DISEASES.
OPTOMETRIST IS SOMEONE WHO SPENT
MANY YEARS TRAINING SPECIFICALLY
ABOUT THE EYE AND VISUAL 
FUNCTION, AND WHO IS 
PARTICULARLY WELL-TRAINED IN 
PRESCRIBING GLASSING, WHETHER 
THEY BE THE GLASSES, CONTACTS, 
THINGS LIKE THAT AND IN 
SCREENING AND RECOGNIZING EYE 
DISEASE.
SOME OPTOMETRISTS TO VARYING 
DEGREE MANAGE SOME EYE DISEASES,
BUT IN GENERAL, OPHTHALMOLOGIST 
MANAGE EYE DISEASE.
WE DON'T SPEND ALL DAY GIVING 
PRESCRIPTIONS FOR GLASSES, BUT 
WE DO GIVE PRESCRIPTIONS FOR 
MEDICATIONS AND TREATMENTS THAT 
ARE KNEADED, AND OPTOMETRISTS 
SPEND MORE OF THEIR ENERGY 
PROPERLY FITTING PEOPLE IN 
GLASSES AND SO ON, SCREENING FOR
CONDITIONS WHICH MIGHT THEN NEED
TO BE DEFERRED TO 
OPHTHALMOLOGISTS AND THEN 
MANAGING CERTAIN PROBLEMS THAT 
HAPPEN TO THE EYES.
OKAY.
WHERE CAN I GET MORE 
INFORMATION?
WELL, THE NATIONAL EYE 
INSTITUTE'S WEB SITE CAN 
EXCELLENT.
AS A LOT OF INFORMATION.
I LISTED SOME OF MY IMAGES FROM 
THAT SITE.
I RECOMMEND THAT.
THE AMERICAN ACADEMY OF 
OPHTHALMOLOGY HAS A LOT OF 
INFORMATION AT THE CONSUMER AND 
PATIENT LEVEL.
OF COURSE, GOOGLE WILL GET YOU 
ALMOST ANYTHING.
OKAY.
WE'RE ALMOST DONE.
TRUTH OR MYTH.
EATING CARROTS WILL IMPROVE MY 
VISION?
HOW MANY MYTHS?
HOW MANY TRUTHS?
IN TRUTH, THIS IS MORE A MYTH 
THAN IT IS TRUTH BECAUSE IT'S 
NOT CARROT  SPECIFICALLY.
I WILL TELL YOU A HEALTHY DIET 
DOES HELP.
WHAT IS HEALTHY FOR YOUR WHOLE 
BODY IS ALSO HEALTHY FOR YOUR 
EYES.
I DON'T DESCRIBE PRESCRIBE A 
EYE-SPECIFIC DIET WITH THE 
EXCEPTION OF PEOPLE WHO ARE -- 
MY DAUGHTER HAS RETURNED FROM 
HER THREE-DAY FIELD TRIP -- WITH
THE EXCEPTION OF PEOPLE WHO MEET
THE ANAL-RELATED EYE DISEASE 
STUDY FOR MACULAR DEGENERATION 
WHO ARE GIVEN SUPPLEMENTS THAT 
HAVE CONCENTRATED AMOUNTS OF 
NUTRIENTS THAT WE FOUND HELPFUL.
WITH THE EXCEPTION OF THAT, EAT 
CARROTS BUT EAT EVERYTHING ELSE 
THAT'S GREEN AND ORANGE AND 
HEALTHY.
CARROTS ALONE WITHOUT FIX EYE 
DISEASE.
SITTING TOO CLOSE TO THE TV WILL
DAMAGE ANY EYES.
TRUE.
FALSE.
OH, YOU GUYS HAVE TO 
PARTICIPATE.
TRUE.
FALSE.
GOOD.
WELL, THAT IS NOT TRUE.
THE EYE IS JUST A SENSORY ORGAN 
SITTING TOO CLOSE TO THE TV 
MIGHT CAUSE EYESTRAIN.
IT MIGHT GIVE YOU A HEADACHE IF 
YOU'RE HAVING TROUBLE FOCUSING, 
BUT IT WILL NOT HURT YOUR EYES.
YOUR EYES ARE THERE TO PICK UP 
LIGHT SIGNALS.
OKAY.
THEY'RE GOING TO BOUNCE OFF THE 
SCREEN OF THE TV AND INTO YOUR 
EYE AND GIVE YOU AN IMAGE.
WHETHER YOU SIT 100 FEET AWAY OR
ONE FOOT AWAY T EYE'S JOB IS TO 
COLLECT THOSE IMAGES AND SEND IT
TO THE BRAIN.
IF YOU WANT YOUR KIDS NOT TO SIT
CLOSE, YOU CAN TELL THEM IT WILL
BUT DON'T TELL THEM I SAID SO.
[LAUGHTER]
READING THE IN DARK WILL WEAKEN 
MY EYESIGHT?
TRUE?
FALSE?
WELL, THAT MEANS YOU LEARNED 
FROM STATEMENT NUMBER TWO 
BECAUSE THE SAME APPLIES.
READING IN THE DARK, THERE'S NOT
VERY MUCH LIGHT, YOUR EYES ARE 
GOING TO BE WORKING EXTRA HARD 
TO PICK UP WHATEVER SIGNAL THEY 
CAN GET, BUT YOU'RE NOT HURTING 
YOUR EYES BY TRYING TO DO THAT.
DOES THAT MAKE SENSE?
IT'S REALLY LITERALLY JUST A 
SENSORY ORGAN, IT'S THERE 
PICKING UP SIGNAL AND SENDING IT
BACK.
ALL THAT BEING SAID, LOOKING AT 
THE --HOLD ON ONE SECOND AND 
THEN I'LL GET TO YOU.
LOOKING AT THE SUN WHERE YOU'RE 
GETTING TOO MUCH RADIATION TO 
THE EYE, THAT CAN HURT YOUR 
EYES, SO WE DON'T WANT YOU DOING
THAT.
I SAY IT'S FINE, YOU'RE GETTING 
SIGNAL YOU CAN'T HURT YOUR EYE 
BUT IF YOU HURT YOUR EYE BY 
GIVING IT CONCENTRATED UV LIGHT,
YOU CAN BURN THE RETINAL TISSUE 
AND CREATE A PERMANENT SCAR 
WHICH WILL LEAD TO PERMANENT 
VISION LOSS.
LOOK AT THE SUN DIRECTLY IS NOT 
RECOMMENDED ESPECIALLY DURING AN
ECLIPSE AND SO ON.
YES.
>> [LOW AUDIO].
>> WELL, SO A NUMBER OF THINGS 
CAN CAUSE THE EYESTRAIN.
REMEMBER, I SAID YOU HAVE THE 
FOCUSING ABILITY OF THE EYE 
CHANGES WITH AGING.
THOSE FOCUS MUSCLES ARE TRYING 
HARD TO PUT EVERYTHING IN FOCUS.
YOUR BRAIN IS TRYING REALLY HARD
TO MAKE SENSE OF IMAGES FOR 
WHICH IT DOESN'T HAVE A CLEAR 
IMAGE, IT'S BLURRED OR IT'S 
FAINT, VERY LOW CONTRAST IF 
YOU'RE READING AT NIGHT.
IT'S SORT OF THE EFFORT OF ALL 
THE OTHER PARTS, BUT THEY'RE NOT
LEADING TO DAMAGE AS WE THINK OF
DISEASE AND DAMAGE.
THEY'RE 'CUZZING YOU TO 
EXPERIENCE AN UNCOMFORTABLE 
SENSATION.
NOT CAUSING OCULAR DAMAGE.
THE ONLY EXCEPTION IS IF YOU'RE 
REALLY STRAINING YOUR EYES AND 
THEY'RE GETTING DRY AS A RESULT 
BECAUSE YOU'RE FOCUSING SO HARD.
USING GLASSES OR CONTACTS WITH 
WEAKEN MY EYES AND CAUSE ME TO 
BE DEPENDENT ON GLASSES OR 
CONTACTS.
WHO THINKS THAT'S TRUE?
TRUE?
TRUE?
DOESN'T IT SOUND TRUE?
FALSE.
YOU'RE ALL WAY TOO SMART, BUT 
THERE IS A LITTLE BIT OF 
AMBIGUITY IN THIS IN THAT WE'RE 
TRYING TO UNDERSTAND EYE 
DEVELOPMENT, WHY THE RATE OF 
NEAR SIGHTEDNESS HAS INCREASED 
IN THIS COUNTRY AND THINGS LIKE 
THAT.
I BELIEVE WE'RE GOING TO LEARN A
LITTLE MORE ABOUT THIS STATEMENT
IN COMING YEARS.
THE TEXTBOOK ANSWER IS, THAT'S 
FALSE.
EYEGLASSES AND CONTACTS WON'T 
CAUSE YOUR EYE TO CHANGE OR 
WEAKEN OR ANYTHING, AND WHAT I 
THINK THE TAKE-HOME MESSAGE 
ABOUT THIS STATEMENT WOULD BE IF
YOU HAVE AN INCENTIVE TO NOT BE 
WEARING GLASSES AND PUT UP WITH 
BLURRY VISION BECAUSE YOU'RE 
THINKING THAT'S GOING PREVENT 
YOU FROM NEEDING THE GLASSES 
EVEN MORE, I THINK YOU'RE MAKING
A POOR CHOICE.
YOU SHOULD BE ENJOYING GOOD 
VISION YOUR WHOLE LIFE AND 
WEARING WHATEVER THE GLASSES YOU
NEED TO DO THAT.
THERE ISN'T EVIDENCE THAT BY 
HOLDING OFF YOU'RE GOING TO 
PREVENT IT FROM GETTING WORSE, 
BUT WHETHER THERE'S A SUGGESTION
THAT A WHOLE LOT OF NEAR WORK OR
NOT ENOUGH EXPOSURE TO OUTDOOR 
LIGHT OR THINGS LIKE THIS, THAT 
THIS MIGHT BE CAUSING INCREASING
TREND OF NEAR SIGHTEDNESS IN 
THIS COUNTRY, WE DON'T IS HAVE 
THE ANSWERS YET.
QUESTION QUICK ANSWER IS MYTH, 
BUT THERE'S STILL LOTS OF LEARN.
WE HAVE A FEW MORE MINUTES.
I WANTED TO MAKE SUGGESTS ABOUT 
KEEPING YOUR EYES HEALTHY AN 
THEN WHEN TO SEE AN EYE DOCTOR.
SCREENING EYE EXAMS WHEN SHOULD 
YOU HAVE THEM?
VISIONS SHOULD BE SCREENED FROM 
CHILDHOOD ON.
THE PROCEEDIATRICIAN SHOULD BE DOING
THAT.
THE AMERICAN ACADEMY OF 
OPHTHALMOLOGISTS IS LITTLE 
RELUCTANT TO SAY THE TIMES WE 
SHOULD BE DOING COMPLETE EYE 
EXAM.
A COMPLETE EYE EXAM MEANS THE 
DOCTOR HAS BEEN ABLE TO LOOK AT 
ALL THE STRUCTURES THAT I SHOWED
YOU IN THOSE PICTURES.
THAT MEANS THEY HAVE TO  DILATE 
THE PUPIL.
A DILATED EYE EXAM MEANS YOU 
WERE GIVEN DROPS, YOUR SENSITIVE
TO LIGHT FOR A FEW HOURS 
AFTERWARDS, AND THAT MEANS 
SOMEBODY GOT TO SEE EVERYTHING 
THEY NEEDED TO, TO DO WHAT'S 
CALLED A COMPLETE EYE EXAM.
SCREENING EYE EXAMS I GENERALLY 
SAY, SOMETIME IN YOUR 20s, YOU 
SHOULD BE SEEING AN EYE DOCTOR.
IF THEY SAY EVERYTHING IS GREAT,
THEN IN 30s.
AT 40 YOU SHOULD BE SEEING AN 
EYE DOCTOR.
I SAW MY AT 40 TO 50 BECAUSE OUR
WEB SITE RECOMMENDATIONS HAD 
CHANGED TO 50.
I STILL TELL PEOPLE AT AGE 40 IF
YOU NEVER HAD AN YOOID EYE EXAM 
YOU'RE DUE FOR ONE.
AFTER ANAL 40 MOST OF THE EYE 
DISEASES WE TAKE CARE OF 
INCREASE IN FREQUENCY WITH 
AGING.
AFTER AGE 40, WE'RE GOING TO 
BEGIN TO SEE THE SIGNS OF 
GLAUCOMA.
AFTER AGE 60, ALL THE NUMBERS 
JUMP UP A WHOLE LOT MORE.
>> [LOW AUDIO].
>> SO AND FOR THAT THAT'S NOT A 
TEXTBOOK ANSWER.
THE FREQUENCY OF RECOMMENDED 
EXAMS DEPENDS ON ALL THE 
VARIABLES THAT ARE UNIQUE TO 
YOU.
HOW DO YOUR EYES SFLOOK DO THEY 
SHOW ANY RISK FACTORS FOR 
ANYTHING?
DO YOU HAVE TA FAMILY HISTORY?
DO YOU SMOKE OR HAVE DISEASES 
THAT CAN AFFECT YOUR EYES?
ARE YOU ON MEDICATIONS WHICH 
HAVE SIDE EFFECTS WHICH AFFECT 
YOUR EYES?
THAT FREQUENCY NEEDS TO BE 
DETERMINED BY YOUR EYE DOCTOR.
OFTEN IT WILL BE LIKE EVERY FIVE
YEARS AFTER THE AGE OF 40 OR 50.
AFTER THE AGE OF 60, 65, EYE 
EXAMS ARE RECOMMENDED EVERY YEAR
OR TWO BECAUSE THE FREQUENCY OF 
PROBLEMS IS SO MUCH HIGHER IN 
THE OVER 60 AND 65 GROUP.
OKAY.
>> [LOW AUDIO].
>> THERE'S NOTHING DIFFERENT 
ABOUT WHAT I SAID.
YOU TO GO TO ALL YOUR FOLLOW-UP 
EXAMS AFTER CATARACT SURGERY, 
BUT THEN HOW OFTEN DO YOU HAVE 
EXAMS?
LET YOUR DOCTOR TELL YOU.
IF YOU HAVE AT-RISK NERVES, 
YOU'LL HAVE THEM MORE OFTEN THAN
SOMEONE WHO DOESN'T.
IF YOU'RE ON A MEDICATION, 
YOU'LL HAVE IT MORE OFTEN THAN 
SOMEONE WHO DOESN'T AND SO ON.
YES, SIR.
>> [LOW AUDIO].
>> WHY IS SMOKING BAD?
SMOKING HAS BEEN ASSOCIATED WITH
HIGHER RATES OF DIABETIC CHANGE,
MACULAR DEGENERATION, AND IT'S 
REALLY FUNNY.
SMOKING AFFECTS BLOOD VESSELS 
Ke AFFECT
AND OTHER THINGS THAT CAN@
YOUR LUNGS.
THE TISSUE WITHIN THE EYE IS 
DIFFERENT IN A SMOKER'S EYE.
YOU WOULD SEE HOW COULD THAT BE 
SO?
WHEN YOU DO CATARACT SURGERY THE
TISSUE YOU'RE WORKING WITH IS 
ALTERED.
SO SMOKING IS A RISK FACTOR FOR 
SOME OF THE EYE DISEASES EVEN IF
WE DON'T KNOW ALL THE 
MECHANISMS, IT'S VERY CLEAR, 
IT'S A RISK FACTOR FOR CERTAIN 
EYE DISEASES.
YES.
MAINTAIN HEALTHY DIET.
WE ALREADY TALKED ABOUT THIS.
WEAR UV PROTECTION.
SO, YOU KNOW THE LIGHT FROM THE 
ATMOSPHERE HAS UV RAYS.
THEY CAN DAMAGE YOUR SKIN, 
DAMAGE THE SURFACE OF THE EYE 
WHICH IS THE WHITE PART ARNGD IT
CAN DAMAGE THE CORNEA, WHICH IS 
THE CLEAR PART.
CANCERS CAN FORM AROUND THE EYES
ON THE SKIN, AND ABNORNL L 
THICKENING OF THAT WHITE TISSUE,
WHEN YOU LOOK IN THE MIRROR YOU 
SEE WHITE AROUND YOUR CORN YEAH,
THAT CAN BECOME THICKENED AND 
BECOME VERY UNCOMFORTABLE AND 
EVEN GROW ON TO THE CORN Y'ALL 
SURFACE DUE TO UV DAMAGE.
SO WEARING SUNGLASSES IS VERY 
IMPORTANT.
WEARING SUNSCREEN, OF COURSE IS 
IMPORTANT.
WEARING A BIG HAT DOES A LOT OF 
WHAT SUNGLASSES DOES.
SO UV EYE PROTECTION, EXTREMELY 
IMPORTANT.
IT'S ALSO BEEN SHOWN TO CAUSE 
DAMAGE IN THE INSIDE EYE 
STRUCTURES.
WE NEED TO BE COGNIZANT OF THAT 
AND BLOCK OURSELVES FROM 
OVEREXPOSURE TO UV DAMAGE.
WEARING EYE PROTECTION.
INJURY, MEANING PROJECT TILE 
INJURY OR BLUNT TRAUMA TO THE 
EYES.
PEOPLE DOING SPORTS, KISD AND 
ADULTS, OUT MOWING THE LAWN, 
TRIMMING THE BUSHING, NAILING 
STUFF INTO THE WALLS.
STUFF CAN FLY INTO THE EYE AND 
THE EYE IS NOT VERY FORGIVING.
IF A SHARD OF METAL HITS IT, IT 
CAN FLIP RIGHT INSIDE AND REALLY
CAUSE A LOT OF PROBLEMS.
I'VE TAKEN WAY TOO MANY THINGS 
OUT OF EYES THAN I WISH I HAD, 
AND, UM, I'LL TELL YOU THAT THE 
IRON A
IRONY OF THIS IS IT'S USUALLY 
THE PERSON WHO HAD ALREADY 
FINISHED MOWING THEIR WHOLE LAWN
AND SAY I GOT TO GET ONE MORE 
THING.
IT'S THE EXCEPTION THAT GETS 
PEOPLE ALMOST ALL THE TIME JUST 
LIKE MY SILLY ACCIDENT, BUT 
ANYWAY, WEARING EYE PROTECTION, 
VERY IMPORTANT.
THERE'S A LOT OF SAY ON IT, BUT 
THAT'S REALLY WHAT I WANT YOU TO
KNOW.
THEN WE TALKED ABOUT KNOWING 
YOUR FAMILY HISTORY.
WHEN SHOULD I VISIT THE EYE 
DOCTOR?
IF YOU'VE NEVER HAD A COMPETE 
EXAM, YOU SHOULD.
IF YOU NOTICE A CHANGE IN YOUR 
VISION, NEW SPOTS IN YOUR 
VISION, FLASHING LIGHTS, 
ANYTHING THAT JUST DOESN'T SEEM 
RIGHT, YOU PROBABLY SHOULD GET 
AN EYE EXAM.
OKAY.
IF YOU'RE A CONTACT LENS WEARER 
AND YOU EXPERIENCE REDNESS OR 
PAIN IN ONE OF YOUR EYES, THAT 
COULD BE A CORN Y'ALL INFECTION,
YOU NEED TO SEE THE EYE DOCTOR.
IF YOU'RE A PATIENT WHO'S BEEN 
TREATED FOR DIABETE, YOU NEED TO
SEE THE EYE DOCTOR EVERY YEAR OR
EVEN MORE OFTEN IF THEY'RE 
TELLING YOU, YOU NEED TO BE SEEN
MORE OFTEN.
IT WOULD DEPEND ON THE OPT 
MOVLGS.
IF YOU'RE TAKING CERTAIN 
MEDICATIONS WHICH WE KNOW TO 
HAVE SIDE EFFECTS THAT CAN BE 
TOXIC TO THE EYE, THAT CAN CAUSE
VISION DAMAGE IF WE DON'T PICK 
UP ON CHANGES THAT ARE TOXIC 
AROUND YOUR DOCTOR WOULD BE 
DISCUSSING THAT WITH YOU.
A COMMON ONE IS HYDROXY CHLORIC.
THOSE PATIENTS ARE SCREENED A AT
CERTAIN INTERVALS FOR EARLY SIGN
OF DAMAGE.
MOST PEOPLE NEVER HAVE DAMAGE 
BUT WE WANT TO BE ABLE TO 
IDENTIFY THOSE WHO DO EARLY ON.
THEN WE ALREADY ANSWERED THE 
QUESTION ABOUT THE FREQUENCY OF 
FOLLOW-UP EXAMS.
IT DEPENDS ON
SITUATION.
THERE'S NO SINGLE GUIDANCE GIVEN
FOR THAT.
SO, UM, THAT'S A LOT IN JUST 
UNDER AN HOUR, IN 50 MINUTES AND
I WELCOME ANY QUESTIONS.
THANKS FOR YOUR BEING A GREAT 
AUDIENCE.
[APPLAUSE]
SIR.
>> CAN YOU RECOMMEND A CERTAIN 
TYPE OF EYEGLASSES, SUNGLASSES?
>> WELL, SO SUN GLASSES IN THIS 
COUNTRY ARE REQUIRED TO BE 
LABELED AT UV-BLOCKING, SO IF IT
SAYS IT BLOCKS 100% OR 99% OF 
UVA, UVB, YOU'RE ALL SET.
IF YOU SPEND $2 ON IT, IT'S JUST
AS GOOD UV PROTECTION WISE AT 
THE 300 THERE ARE PAIR YOU'RE 
BUYING.
IF IT SAYS BLOCKED 100% OF UVA 
AND UVB, YOU'RE ALL SET.
>> UVA AND UVB.
>> YES, THOSE ARE BOTH DIFFERENT
KINDS AND THEY BOTH CAUSE 
DAMAGE.
>> [LOW AUDIO].
>> THOSE ARE TWO CONCEPTS WHICH 
DON'T NECESSARILY GO TOGETHER.
THERE'S TRANSITION IN TERMS OF 
THE CORRECTION STRENGTH.
SOME PEOPLE TALK ABOUT THEIR 
TRANSITIONALAL LENSES, BUT 
YOU'RE SPEAKING ABOUT THE 
TRANSITIONAL LENS THAT IS BECOME
TASHG WHEN YOU GO OUTSIDE IN THE
SUN AND LIGHT WHEN YOU GO 
INSIDE.
THE FEATURE TO BE ABLE TO DO 
THAT IS SEPARATE FROM THE 
COATING THAT'S PUT ON THAT 
ALLOWS FOR UV PROTECTION, BUT 
ANY PLACE THAT'S SELLING YOU 
TRANSITION SUNGLASSES, THEY 
REALLY SHOULDN'T BE DOING 
BUSINESS IF THEY'RE NOT PUTTING 
A COATING ON THAT BLOCKS UV 
LIGHT WHEN THEY'RE SELLING YOU 
THAT PAIR OF GLASSES.
YOU BRING YOUR GLASSES TO A SHOP
AND SAY DO THESE HAVE UV 
COATING?
THEY CAN PUT IT IN A LITTLE 
SCANNER AND TELL YOU.
YES, SIR.
>> [LOW AUDIO].
>> CAN YOU TALK INTO THAT ONLY 
BECAUSE NOW I'M TRYING TO 
RESPECT -- 
>> [INDISCERNIBLE] EXERCISE.
DO YOU MEAN [LOW AUDIO].
>> EYE EXERCISES OR BODY.
YES, BODY EXERCISES.
TALKING ABOUT GENERAL HEALTH 
STUFF.
>> [LOW AUDIO].
>> LIFE GIVES YOU ALL THE EYE 
EXERCISE YOU NEED.
WE DON'T DO STRENGTH-BUILDING 
EYE EXERCISES.
>> CAN SAY SOMETHING ABOUT 
VITRIIOS, FLOTUS.
>> YES, I CAN.
WE'RE GOING TO SCROLL BACK HERE 
TO THE PICTURE OF THE EYE.
I THINK THIS IS PROBABLY THE 
BEST ONE.
SO I MENTIONED THERE'S THIS 
JELLY THAT FILLS THE EYE.
IT'S NOT JUST LIQUID.
IT ACTUALLY IS TISSUE WITH 
FIBRILS.
IT'S OPTICALLY CLEAR, BUT 
OVERTIME, THERE'S AN AGING 
CHANGE, AND IT BECOMES LESS 
JELLY-LIKE AND MORE LIQUID-LIKE.
OFTENTIMES IT WILL EVENTUALLY 
SEPARATE FROM ITS FIRM 
ATTACHMENT TO THE RETINA IN THE 
BACK AND PULL FORWARD AND YOU'RE
LEFT WITH WHAT LOOKS LIKE SARAN 
WRAP, A SPIDER WEB, LITTLE FLOAT
TI IN THE EYE AND THAT'S CALLED 
A FLOATER.
WE MIGHT CALL IT A 
[INDISCERNIBLE] DETACHMENT, BUT 
IT TRANSLATES TO BEING A 
FLOATER.
MOST OF THE TIME THERE'S NOTHING
DANGEROUS ABOUT IT.
WE DON'T GO IN AND TAKE IT OUT 
SURGICALLY.
MOST OF THE TIME IT'S JUST 
SOMETHING THAT YOU AND YOUR 
BRAIN WILL GET USED TO AND 
YOU'LL BEGIN TO NOTICE THAT 
FLOATER A LITTLE LESS BECAUSE 
SOMETHING LIKE YOUR NOSE, YOU 
DON'T NOTICE YOUR NOSE, IT'S 
BEEN THERE YOUR WHOLE LIFE.
YOU BEGIN TO GET USED TO THIS, 
SOME PEOPLE IT REMAINS 
IRRITATING FOREVER, IN TERMS OF 
THEY NOTICE IT.
BUT IN RARE INSTANCES WHEN YOU 
NOTICE NEW FWLOETERS IT MEANS 
IT'S SEPARATING AND IT CAN TAKE 
A LITTLE BIT OF RETINA AND IT 
CAN LEAD TO A RETINAL HOLE AND A
RETINAL DETACHMENT.
FOR NEW FLOATERS, I USUALLY 
RECOMMEND AN EYE EXAM AND THEN 
IF SOMEONE HAD NEW FLOATERS AND 
THEY SAW IT WITH FLASHES OF 
LIGHT WHICH MEANS THE RETINA IS 
BEING STIMULATED IN A NORMAL 
WAY, THAT'S MORE WORRY SOME IN 
THAT TLBD THERE COULD BE DAMAGE 
WITH RETINAL TEAR.
MOST PEOPLE BY THE ANAL OF -- 
AGE OF 60 HAS FLOATERS.
WHO HAS THE MICROPHONE?
>> IS THERE A VITAMIN THAT YOU 
RECOMMEND TO REDUCE FLOATERS 
BECAUSE I KEEP HEARING ABOUT 
LUBERDERM, NO, OCTIGUARD.
>> LUTENE IN S A SUPPLEMENT 
WHICH WE BELIEVE IS ASSOCIATED 
WITH GOOD THINGS FOR EYE HEALTH,
BUT RELATING TO FLOATERS, 
SPECIFICALLY, WHICH IS PURE 
ANATOMY, IT'S AN AGING CHANGE, 
THERE'S NO VITAMIN I'M AWARE OF 
OR EXERCISE OR ANYTHING YOU CAN 
DO TO PREVENT IT AND HOPEFULLY 
WE ALL LIVE LONG ENOUGH TO HAVE 
FLOATERS.
[LAUGHTER]
I'M GOING TO LET A FEW OTHER 
PEOPLE ASK IF THEY HAVEN'T AND 
THEN I'LL COME BACK TO YOU.
IT'S 2:00 AND RESPECTING 
EVERYBODY HAS PLACES THEY GO, 
I'M NOT OFFENDED IF YOU LEAVE.
THANK YOU FOR BEING HERE.
BUT I'LL STAY AS LONG AS THERE 
ARE QUESTIONS.
OKAY.
>> THIS MAY BE A LITTLE TOO 
COMPLEX TO ANSWER BUT I'M HERE 
BECAUSE OF YOUR TITLE.
I'VE HAD AN INSATIABLE DESIRE 
FOR CARROTS IN THE LAST TWO 
MONTHS.
WHEN I WAS YOUNG [LOW AUDIO].
I HAD A BRAIN STEM STROKE 
THANKSGIVING DAY, AND IT WAS 
VERY [LOW AUDIO].
MY PROBLEM TODAY [LOW AUDIO] I 
KEEP SAYING TO MYSELF THAT'S A 
HABIT, STOP IT.
I CAN SEE PERFECTLY WELL 
[INDISCERNIBLE].
SOMEBODY AT THE REHAB CENTER 
TOLD ME IF THE VISION CLEARS UP,
OTHER THINGS WILL CLEAR UP TOO 
BECAUSE I'M WALKING AROUND LIKE 
I'M DRUNK ALL>
IN THE MEANTIME [LOW AUDIO].
I DON'T KNOW WHETHER TO GO TO MY
REGULAR OPHTHALMOLOGIST OR TO 
TWO TO THE RETINAL SPECIALIST.
BECAUSE THREE YEARS AGO I HAD A 
RETINAL TEAR AND I DIDN'T KNOW 
WHAT WAS HAPPENING.
I THOUGHT A GREAT BIG OLD SPIDER
WAS COMING DOWN ON MY FACE.
I HAD THE SURGERY THE NEXT DAY.
>> SO -- 
>> SO MY QUESTION IS WHO SHOULD 
I GO TO?
>> WELL THE GOOD NEWS IS, NO 
MATTER WHO YOU GO TO, IF THEY 
CAN'T SOLVE YOUR PROBLEM, THEY 
WOULD BE SENDING TO YOU THE NEXT
PERSON, AND, AGAIN FRSHG ACROSS 
THE ROOM, IT'S HARD TO KNOW 
EXACTLY WHAT'S GOING ON.
MY RECOMMENDATION WOULD BE TO GO
TO THE REGULAR OPHTHALMOLOGIST 
FIRST BECAUSE WHAT YOU'RE 
DESCRIBING DOES NOT SOUND 
NECESSARILY LIKE A RETINA 
PROBLEM.
IF YOU'RE SEEING WEM FAR AWAY SO
I WOULDN'T GO TO THE RETINA 
SPECIALIST.
I WOULD GO TO THE REGULAR 
OPHTHALMOLOGIST.
THEY MIGHT SEND YOU TO A 
NEUROOPHTHALMOLOGIST WHO DEALS 
WITH EYE MOVEMENTS, IF YOU'RE 
EYE MUSCLES ARE NOT WORKING 
TOGETHER AS THEY USED TO BEFORE 
THE STROKE OR IF THERE'S A 
HIGHER PROCESSING ISSUE MAKING 
IT HARDER FOR YOU TO READ.
FIRST YOUR REGULAR 
OPHTHALMOLOGIST THEN THEY'LL 
DIRECT YOU WHERE YOU NEED TO GO 
AFTER THAT.
>> THIS CARROT CONNECTION HAS ME
MYTHED.
>> I'VE NEVER HEARD OF THIS 
CRAVING FOR CARROTS.
I WISH EVERYBODY'S VICE WAS THAT
GOOD.
I REALLY CAN'T EXPLAIN IT.
YOUR INTERNIST MIGHT BE ABLE TO.
IT IS TRUE, BIOLOGICALLY 
SOMETIMES WE CRAVE THE THINGS WE
NEED.
THE BODY SEEMS TO KNOW TO DO 
THAT EVEN IF OUR BRAINS DON'T 
UNDERSTAND IT.
SO EAT THE CARROTS UNLESS YOUR 
DOCTOR IS TELLING YOU THAT 
YOU'RE HAVING PROBLEMS, EAT THE 
CARROTS, BUT I CAN'T EXPLAIN WHY
YOU'RE DOING THAT.
>> [LOW AUDIO].
>> OKAY.
I WOULD BRING THAT WHEN YOU GO 
SEE YOUR OPHTHALMOLOGIST.
I WOULD.
OKAY.
I THINK THIS WILL BE OUR LAST 
QUESTION, IF THAT'S OKAY.
DO YOU STILL HAVE A QUESTION, 
SIR?
GO AHEAD, ASK YOUR QUESTION.
>> [LOW AUDIO].
>> CAN YOU TALK INTO YOUR 
MICROPHONE?
>> AT THE BEGINNING, YOU SHOWED 
THE PICTURE THAT IMAGE GOING 
INTO THE EYE [LOW AUDIO].
>> YES.
>> AND UNTIL IT HITS THE END OF 
THE EYE THAT IS THE END OF THE 
PICTURE.
>> I'M SORRY.
>> THAT IS A [INDISCERNIBLE].
CHANGES INTO A DIGITAL PICTURE 
AT THE VERY BEGINNING.
>> YEAH.
I SHOWED THIS ONE.
AND THEN THERE'S THIS ONE.
>> [INDISCERNIBLE].
THIS ONE.
OKAY.
NOW BY THE TIME(
[LOW AUDIO].
>> THAT'S RIGHT.
>> [INDISCERNIBLE].
[LOW AUDIO].
>> UM, SO, YES.
LET ME TRY TO ANSWER THAT IN A 
WAY THAT'S BOTH NOT MORE 
COMPLICATED THAN I UNDERSTAND, 
BUT ALSO ACCURATE.
COMPUTERS WORK ON BINARY 
 ONES.
SIGNALS, ZERO OR
WE MODEL -- WE SOMETIMES MODEL 
INTELLIGENT SYSTEMS WITH 
COMPUTER MODELS BUT WE'RE 
DIFFERENT THAN THE COMPUTER 
MODELS, SO BINARY SIGNALS ARE 
NOT THE WAY WE CONSIDER 
SIGNALING IN BUY LONL CALL 
STRUCTURES.
THERE ARE ACTUALLY MANY LAYERS 
WITHIN THE VISUAL CORTEX -- 
STARTS LONG BEFORE THAT -- 
WITHIN THE RETINA ALONE THERE 
ARE DIFFERENT KINDS OF CELLS 
THAT RECOGNIZE DIFFERENT KINDS 
OF SIGNALS.
THERE'S PROCESSING EVEN BEFORE 
THE SIGNAL GETS TO THE OPTIC 
NERVE.
FOR EXAMPLE, AS MAMMALS, IT'S IN
OUR BENEFIT TO RECOGNIZE MOTION 
MORE SELECTIVELY THAN IT IS FOR 
US TO RECOGNIZE STATIONARY 
OBJECTS.
WE HAVE SPECIAL SOFTWARE IN OUR 
RETINA AND OUR BRAINS WHO'S 
FUNCTION IS TO BE HIGHLY 
RECEPTIVE TO RECOGNIZING MOTION.
THAT'LL KEEP YOU FROM BEING 
ATTACKED AND EATEN BY THE 
GRIZZLY.
WE RECOGNIZE STRAIGHT LINES AND 
IRREGULARITIES IN STRAIGHT LINES
VERY EASILY WHEREAS WE MAY NOT 
RECOGNIZE ANY REGULARITY IN A 
DIFFERENT SHAPE.
THERE ARE FEATURES ABOUT VISUAL 
FUNCTION -- I THINK I LEFT IT 
IN -- OH, WHAT DID I DO?
SORRY.
LET ME GO HERE THAT ADDRESS 
PROCESSING.
I DIDN'T GO INTO THIS BECAUSE WE
DON'T HAVE ENOUGH TIME TO GO 
INTO IT, BUT SHAPE, SIZE, COLOR,
MOVEMENT, YOU MENTIONED THE 
BINOCULAR VISION BEING USED TO 
HELP GIVE A SENSE OF DEPTH 
PERCEPTION.
THESE ARE BASIC VISUAL 
FUNCTIONS.
HIGHER LEVEL PROCESSING HELPS US
RECOGNIZE FORMS AND PATTERNS.
HUMANS ARE GOOD AT RECOGNIZING 
HUMAN FACES.
CHIMPS ARE GOOD AT RECOGNIZING 
CHIMP FACES AND SO ON.
THERE'S A LOT OF BIOLOGY THAT 
ARE VERY COMPLEX.
COORDINATING YOUR EYE GIVES 
SIGNALS THAT HELP YOUR BODY KNOW
WRIT IS IN SPACE AND BE ABLE TO 
DO RIDICULOUS THINGS LIKE RUN 
DOWN A FLIGHT OF STEPS HOLDING A
COFFEE CUP AND IT DOESN'T SPILL.
OTHER THINGS PLY INTO THAT LIKE 
YOUR INNER EAR SYSTEM, IT'S ALL 
QUITE AMAZING HOW IT WORKS.
MEMORY, HOW VISUAL SIGNALS ARE 
STORED AS MEMORIES AND 
RETRIEVED.
THE COMPLEXITY IS RATHER 
BEWILDERING THAT WE EVEN 
FUNCTION AS WE DO.
IT'S NOT JUST A SIMPLE BINARY 
SIGNAL OR ANALOG, DIGITAL GUY 
BINARY.
I'M NOT A NEUROPHYSIOLOGIST, SO 
I CAN'T JUST ANSWER EXACTLY WHAT
ION CHANNELS ARE STIMULATED BY 
THE DIFFERENT SIGNALS, BUT IT'S 
COMPLEX, IT'S INTERWOVEN, AND IT
SERVES SPECIFIC FUNCTIONS WHICH 
HAVE BEEN THROUGH SELECTION, 
BEEN SELECTED AS WHAT WE NEED TO
HIGHLIGHT TO SURVIVE SUCH AS 
MOVEMENT.
YES.
>> [LOW AUDIO].
>> WELL, YOUR QUESTIONS ARE 
COMPLICATED ENOUGH THAT YOU 
PROBABLY HAVE PHILOSOPHY.
PHILOSOPHY WILL PLAY INTO THIS A
LITTLE, BUT I'LL TELL YOU, FOR 
EXAMPLE, OFTENTIMES THE ANSWER 
IS BOTH.
THERE'S DISCREET AND THERE'S 
CONTINUOUS.
IF YOU LOOK AT LIGHT, LIGHT CAN 
BE DESCRIBED AS WORKING IN WAVES
AND LIGHT CAN BE DESCRIBED A AS 
INDIVIDUAL PHOTONS OF LIGHT 
ENERGY.
THERE ARE CERTAIN CONCEPTS YOU 
UNDERSTAND BY UNDERSTANDING THE 
WAVE THEORY OF LIGHT.
PROVISION AND OPTICS IS VERY 
IMPORTANT.
WE NEED TO KNOW ABOUT THE BAEF 
THEORY OF LIGHT.
WE ALSO NEED TO KNOW ABOUT TART 
KLS OF LIGHT AND HOW THEY CAN 
EXCITE TO CAUSE, FOR EXAMPLE, 
DAMAGE THAT LIGHT ENERGY, UV 
ENERGY MIGHT CAUSE.
SO BOTH THEORYS ARE RIGHT.
IF YOU SAID TO ME, HOW DOES 
LIGHT BEHAVE IN?
IT IS PARTICLE OR WAVE?
I'D SAY, IT'S BOTH.
IT BEHAVES LIKE A WAVE AND IT 
CAN BE UNDERSTOODU
LIKE PARTICLES.
SAME WITH VISION.
THERE'S CONTINUITY IN THE WORLD 
AROUND US, BUT OUR INFORMATION 
COMES IN FROM DISCREET PACKETS 
OF LIGHT.
I DON'T THINK THERE'S ONE ANSWER
THAT EXPLAINS THAT ELEGANTLY.
IT'S A LITTLE BIT MIXED.
IF YOU LOOK OF THE A MOVIE, A 
MOVIE IS NOT AN INFINITE NUMBER 
OF PICTURES, IT'S A FINITE 
NUMBER OF PICTURES THAT'S SEEN 
TOGETHER IN VERY CLOSE DELIVERY 
OF TIME APPEARS TO BE SMOOTH 
MOVEMENT, BUT, OF COURSE, YOU 
KNOW IF YOU SLOW DOWN A MOVIE, 
YOU SEE IT'S REALLY PICTURES 
SOMEBODY HAS TAKEN SO CLOSE 
TOGETHER THAT YOUR BRAIN DOES 
THIS SMOOTHING OVER AND YOU SEE 
IT AS CONTINUOUS, BUT IT'S NOT 
CONTINUOUS, BUT FOR PURPOSES OF 
YOUR BRAIN, IT'S CONTINUOUS.
>> [LOW AUDIO].
>> WE INTEGRATE IT AND IT MAKES 
SENSE.
I THINK WE HAVE TO GO.
I DON'T KNOW IF THAT SATISFIES 
YOU AND I DOUBT IT DOES, BUT I 
AM HAPPY TO LIKE MAYBE GIVE YOU 
GUIDANCE ON WHERE KD READ MORE 
ABOUT THAT P I WOULD GOOGLE 
VISUAL PHYSIOLOGY.
YOU'LL FIND A LOT WRITTEN AND 
YOU SHOULD EXPLORE IT BECAUSE I 
DON'T THINK I ANSWERED THAT TO 
YOUR SATISFACTION, I'M GUESSING.
OKAY.
I'M GOING TO RESPECT THE ROOM 
LIMITS.
WOULD YOU LIKE TO TALK TO ME 
AFTERWARDS.
THANK YOU VERY MUCH.
[APPLAUSE]
I'M SORRY.
ONE SECOND.
DO YOU WANT US TO CLEAR OUT?
IS ANYONE COMING?
I DON'T KNOW.
IF WE OPEN THE DOOR IF NOBODY'S 
WAITING WE'LL -- 
>> [LOW AUDIO].
>> THAT IS CAUSED BY UV.
>> CAN ANYTHING BE DONE?
>> WELL, THE PROBLEM IS WHEN 
IT'S SEVERE -- LET ME SHUT MY 
MIKE OFF.
MIKE OFF.