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Good Eye Care

During the COVID-19 pandemic many people have put off routine care.  Dr. Abraham describes recommended practices for maintaining healthy vision, including the importance of regular eye exams.
Good Eye Care
Featured Speaker:
Nathan Abraham, MD
Doctor Nathan Abraham is an ophthalmologist on the medical staff of Henry Mayo Newhall Hospital.

Melanie Cole (Host):    Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole, and during the pandemic, many people have put off routine care. But today we're talking about recommended practices for maintaining healthy vision, including the importance of regular eye exams. Joining me is Dr. Nathan Abraham. He's an ophthalmologist on the medical staff at Henry Mayo Newhall Hospital. Dr. Abraham, it's a pleasure to have you join us today. So, we've heard how some people have avoided hospitals for heart attacks and even stroke for fears of COVID. Tell us a little bit about any collateral damage that you've seen specifically about ophthalmology. Has that been hit particularly hard?

Nathan Abraham, MD (Guest): Melanie good morning, and thank you again for this invitation. Again, my name is Dr. Nathan Abraham, and yes, I would say that of all the specialties, ophthalmology has been hit pretty hard with the impact of the pandemic and just how safe patients feel about visiting doctors and particularly outpatient and more elective type services, including ophthalmology. And that's one thing that I'd love to share with you about my insights on.

Host: Well, that is certainly why we're here today. So, discuss for us why patients shouldn't be delaying their eyecare, how important it is to keep up with your regular eye exams, even during COVID. And how have you seen delays in patients coming in? Has that impacted their vision in a measurable way?

Dr. Abraham: It's a very good question. Many times within the specialty of eyecare, there are certain silent killers of vision, and a lot of them, you don't have symptoms until the very end where, you know, something like glaucoma, where a lot of patients don't even know they have glaucoma and they can go months and years without having any symptoms. So, that's one of the conditions that is an example of why it's important to get regular eye care checkups. Another one is diabetes. As we know, diabetes affects a lot of different parts of the body and the eyes are no exception. So, diabetic retinopathy and making sure you follow up with your regular diabetic eye exams is very important for catching diabetic damage early in the eyes and addressing it before it becomes a bigger issue.

So, absolutely it's a big, a very important thing. I believe part of why a lot of patients were hesitant, it's just because of the nature of this pandemic and, you know, going to doctors just across the board, a lot of patients have had some skepticism and concerns. That includes on the inpatient side with going to, you know, inpatient ER type visits, as well as outpatient services, including ophthalmology. But I do think that it's very important to get regularly scheduled eye exams.

Host: Well, thank you for that. And now for a lot of people that have been fearful about going in, Telemedicine has really been a valuable tool for so many practices. However, certain things for eye exams, interocular pressure, and visual field evaluation, all of these things can't be so easily conducted virtually. Tell us how you have been able to use Telemedicine and where you feel that it's been challenging for you.

Dr. Abraham: That's a great question. I think Telemedicine is a very important part of medicine and it is becoming an integral part of how we evaluate and treat patients moving forward. In the field of ophthalmology, we rely so heavily on physically seeing patients and that's one of the beauties of our specialty is you can actually look at the eyes and see exactly what's going on.

We have specialized microscopes called slit lamps that we have in all of our clinics, and even in some hospitals that allow us to get a magnified picture of how the eyes look and we can see exactly what's going on. That's a difficult part to replicate on the Telemedicine front, but the good thing is many eye conditions do have symptoms.

I'll give you an example, like dry eyes. I mean, I've had patients that complain of dry eye over Tele-health visits. Doc, my eyes are burning. They're red. They get itchy, especially as the day goes by, or if I'm doing a lot of computer work and that's one of the conditions where we can actually kind of triage it and know what's going on over the phone or over a video visit and that luckily we can treat with simple over the counter remedies, artificial tears, eyelid hygiene, and those kinds of things. But ophthalmology is one of the fields where the physical exam is still extremely important in how we manage patients. We do have a lot of advanced diagnostic testing. We can do scans from the front all the way to the back of the eye. However, all of those equipment are in our offices, generally speaking. So, it's been challenging, but I do think that Telehealth and Telemedicine is an important tool in our toolbox to help patients.

Host: So an interesting thing, Dr. Abraham has been that more people are working from home and more people are on social media and on their computers, as we've changed. This whole global pandemic has really changed how we look at so much of what we'd been doing. Can you tell us a little bit about how our eyes might be effected by spending so much more time on screens, our kids in school, even our socializing. Can you discuss any best advice for us, whether it's blue light glasses or anything you'd like to tell us about what we're doing to our eyes, staring at screens all day.

Dr. Abraham: Absolutely. I'm going to kind of group this answer into two categories. One is for adults, like people that are 18 and over, and one is for children, meaning, you know, birth to about four or five, six years old. The reason is because I think that the challenges and the issues that are important to me as an eye doctor vary. So for adults, the important thing is that when we look at screens all day, whether it be on the computer at home or in the office, or, you know, watching our TV or iPads or iPhones, the common denominator is we're so fixated on what we're looking at that oftentimes we forget to blink. What happens? The eyes get dry the whole time.

So, one of the most common things that I've seen patients get concerned about is Doc, ever since the pandemic hit, and I've been working from home, I stare at a screen all day. I don't take very many breaks. And by the end of the day, my eyes feel super tired. And that's one of the common complaints of dry eye syndrome. And the issue is that we're just not blinking enough. We're not lubricating the eyes. So, taking breaks throughout the day to kind of rest your body and your eyes really helps. And something, even as simple as using artificial tears can help to lubricate the eyes during long working hours in front of a computer.

So, that's the category for adults. Now for children, it's a little bit different, what we think about and what scares us as eye doctors. Main issue we worry about with children is when kids use a lot of screens, especially up close, iPhones, iPads, tablets, anything of that nature where they're fixating on things very up close, that can actually make near-sightedness worse. It's very, well-documented in the pediatric ophthalmology literature that kids that use a lot of up-close screens like phones, iPads are more predisposed to developing myopia or near-sightedness, and that becomes an issue because then they're kind of stuck with having to use glasses and contact lenses for the rest of their adult lives.

Now, luckily, we have other options when they become older, like laser vision correction, including LASIK. But the key is I think that an ounce of prevention can go a long way in this case. So, limiting children's screen time, I think is very important in preventing the progression of near-sightedness. So, just off the top of my head, the pediatric ophthalmology literature suggests children under the age of one should not be using any kind of screens up close. Between age one and two should be really less than an hour. And around two to four years of age, you should really limit it to one to two hours max. Now I know a lot of the parents out there are going to say Doc, you don't get it. It's impossible. The kids need to use this stuff. And I understand, but as much as we can limit the use of up-close screens, like tablets, iPhones, especially for entertainment purposes for the kids, I think would really help to prevent potentially preventable condition in near-sightedness.

Host: Well, I'm one of those parents for sure, Doc. So, I know what that's like, and our kids have to use these screens for school now. And while they're doing bed school, which they love, but what about things like blue light glasses, do they help? And do they help to relax our eyes so we're not working so hard?

Dr. Abraham: That's a very commonly asked question. To be quite honest with you, in my practice, I haven't really seen much of a benefit of blue light filtering glasses. I think if anything, just lubricating the eyes, like we talked about has made more of an impact on my patients that complain of screen related eye issues. So, I haven't really found much of a huge use for blue light filtering glasses. If patients want to try it and they feel like it feels better for them and helps them, great. I don't think it causes any damage. I just usually don't recommend that for patients.

Host: So, as we wrap up and what an important segment, I mean, people don't even think about our eyes as something that's been really affected. And as you say, ophthalmologists, ophthalmology has been hit particularly hard. So, please reiterate the importance of our annual eye exams, whether, you know, they're different than the kids get at school, but the importance of us taking breaks from our screens. And as you say, trying to avoid dry eye and seeing our ophthalmologist on a very regular basis.

Dr. Abraham: Absolutely. I think everything that we talked about is important. I think that preventing eye issues and catching them when they're very early, is also extremely important in maintaining healthy vision into our later years. So, seeing an ophthalmologist regularly for general eye exams is extremely important. If patients have another issue like diabetes, I think that's another important reason to get dilated eye exams regularly scheduled, as well as patients that have a family or personal history of other eye conditions like glaucoma. I just want to mention one other thing, what's really interesting about how the pandemic has changed how ophthalmologists practice is nowadays one of the most common reasons patients come to see me is because they're sick and tired of glasses fog from wearing masks. And they say, Doc, I can't do this anymore. I don't like contact lenses. I like my glasses, but they just fog up too much. Can you help me? And the answer is absolutely. And that's where laser vision correction comes into play.

And we've noticed that actually after the pandemic, patients are super interested in LASIK and other laser, laser vision correction, to get them out of glasses and equally important, when it's time for cataract surgery, we now have advanced technology lenses that can get patients seeing really well at distance, intermediate and near with almost no glasses use.

So, one of the interesting things that's come out of this devastating pandemic is patients just don't like glasses fog, and are looking for an alternate solution to their vision. And that's where laser vision correction comes into play. But bottom line is even with that, we still need to see patients on a regular basis to screen for preventable eye conditions, to treat them early or to talk about things like laser vision correction, or cataract surgery.

Host: What great information Dr. Abraham and I want to have you back on because there are so many, I'm glad you brought up the fogging glasses, but there are so many eye questions. We could do a ton of podcasts on it. So, thank you so much for that great information. And for more podcasts, you can visit and enter the word podcast in the search box at the top of the page. Please also remember to subscribe, rate and review this podcast and all the other Henry Mayo Newhall podcasts.

And that concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Thanks so much for listening.