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The Dose Transcript for April 19, 2023

Host: Dr. Brian Goldman

STORIES FROM THIS EPISODE

BRIAN GOLDMAN: Hi, I'm Dr. Brian Goldman. Welcome to The Dose. Well, recently I went for my first eye checkup since the pandemic. I'm betting it's been a while for many of you, too, especially if you don't wear corrective lenses. But there are some vision saving reasons why you must get regular eye checkups, even if you have 20/20 vision. So this week we're asking, what do I need to know about taking care of my vision. Hi Lesya, welcome to The Dose.

LESYA SHUBA: Thank you so much, Dr. Goldman. Thank you for inviting me. And I'm very happy that you actually went for your first eye exam since the pandemic. But you should have gone earlier.

BRIAN GOLDMAN: You know what? I will consider myself appropriately scolded because that was really my bad. And dental care was another thing, too. But that's a completely different story. I'm looking forward to this conversation a lot. But even before we start that, you are part of an initiative helping ophthalmologist in Ukraine. Since the war started there, we've done a show on some some efforts of Canadians in Ukraine for our other show, White Coat Black Hearts. I just wanted you to talk about the kind of work that you've been doing there.

LESYA SHUBA: Thank you for asking me that question. So, yes, I am Ukrainian. I was born and grew up in Ukraine. I came to Canada when I was an adult. So the situation in Ukraine is especially dear to my heart. And when the war in Ukraine started, one of the positive things, if you can call it positive that happened for me with this war is that I've I've met a lot of Ukrainian ophthalmologists in Canada, I should say ophthalmologist with Ukrainian background. And when the war started, we formed an organization called Eyes on Ukraine and we formed it under the supervision, I guess, of Canadian Ophthalmological Society. The goal of this organization is to provide any assistance we can to ophthalmologists in Ukraine who are providing care to patients who are injured in war or civilians who are injured in war, or just patients who need care in war situation. So since the war started over a year ago, we've collected quite a bit of money that we are spending on equipment that we sent to Ukraine, medications that we spent, sent to Ukraine, and we also translated a manual for home about eye injuries that was written by the American military ophthalmologist. So we translated that into Ukrainian that Ukrainian ophthalmologist can now use to care for their patients. Lots of different things we are doing, and I am very happy that we can help in this small way Ukrainian people.

BRIAN GOLDMAN: And I'm glad you got to talk about that. We don't we don't often start in this kind of way when we're doing The Dose. But but I'm so glad you were able to fill us in on the great work that you're doing. But before we begin this week's topic on The Dose, can you give us a Hi, my name is Tell us what you do and where you do it.

LESYA SHUBA: Hi, my name is Lesya Shuba. I am an ophthalmologist. I work at the Victoria General Hospital in Halifax. I spend 80% of my professional life looking after patients in clinics and I do surgery. My special interest is in glaucoma. I spend also some of my time teaching residents and medical students and fellows, and I'm a director of the fellowship program at Dalhousie for Glaucoma.

BRIAN GOLDMAN: And I think that's an excellent place to begin our conversation last year. So you treat a lot of people with glaucoma, as you've just said. Remind us for those who don't know what is glaucoma.

LESYA SHUBA: So first of all, glaucoma is not one disease, it's a complex of conditions that have similar cause and similar outcomes. But the mechanisms are very different. The most common type of glaucoma is a chronic disease that happens over a long period of time. It is caused by a high pressure in the eye and the high pressure in the eye damages the optic nerve, which is a part of the eye that connects the eye to the brain. And the vision loss happens very slowly. It starts in the periphery as people lose their side vision first. And because it's so slow and insidious for very long time, patients will have no symptoms because there is no pain really. There is no very obvious vision loss. And because of that, quite often, unfortunately, patients present quite late. And then whatever vision is lost from glaucoma we cannot bring back.

BRIAN GOLDMAN: And of course, Lesya, that is quite different from something that I see as an emergency position from time to time. Not that frequently, fortunately, but there's another type of glaucoma called acute angle closure, glaucoma. What's the difference between chronic glaucoma and acute angle closure glaucoma.

LESYA SHUBA: Acute glaucoma can be caused by angle closure. So it's one type of acute glaucoma. There are other types of acute glaucoma. And basically what acute glaucoma means is that the pressure in the eye increases quite quickly. It could be over hours and days and can be very high. And when that happens, patients do have symptoms and the symptoms that they usually present with to the emergency room or to their eye care providers or family doctors is it could be headache, could be just a general headache in the front, like in the forehead, or could be just a kind of headache feeling over the eye that is affected when the pressure is quite high. Patients can actually present with nausea and vomiting and could be initially misdiagnosed with, some problem with the stomach or the digestive system. The vision is usually affected, but it could be quite blurry. But probably the most common symptom would be seeing halos around the light.

BRIAN GOLDMAN: So that's very different from the chronic glaucoma that you see and treat. And how is chronic glaucoma treated?

LESYA SHUBA: The goal, first of all, is to decrease the pressure, basically, this is how we start treatment of glaucoma and we usually aim for about 20 to 30% reduction in the pressure is is a kind of first line of treatment. And if it's the first time they do a laser and all. We can start with eyedrops. There is unfortunately no cure for glaucoma, only treatment. So whatever treatment we start with quite often needs to be modified or something may need to be added. None of the treatments always work, so the success of any treatment is a first line. Treatment is about 70%, so nothing always decreases the pressure. But most of the time we can find something that works. And then the important next step is to continue to follow patients. Because even if the first treatment was successful, either laser or drops, it can stop working and the pressure may need to be decreased further. So it's very important to continue to see this patients in follow up to make sure that the treatment that you started is still working.

BRIAN GOLDMAN: So how frequently do you need to see people who have glaucoma to make sure that their pressure's down and that and that you're monitoring them to make sure that they're not developing ongoing damage to the optic nerve?

LESYA SHUBA: Excellent question. So there are guidelines that are Canadian guidelines or American guidelines. They're all very similar European guidelines are similar. And basically the frequency of follow up depends on how advanced glaucoma is and how well-controlled the pressure is and the optic nerve changes and the visual field changes. We haven't talked about the visual field, but visual field is a functional test that we use to assess how much vision is lost or is remaining from glaucoma. So if somebody has glaucoma that is well-controlled, it's not progressing or changing and let's say they have early glaucoma, then these patients just need to be assessed once a year. If the glaucoma is advanced, those patients need to be seen more frequently and really sometimes every four months. And this is for those who are well-controlled. If the pressure is uncontrolled, if there are changes in those patients need to be seen more frequently.

BRIAN GOLDMAN: So that's glaucoma. What are some of the other eye conditions that you see commonly in practice that have a bearing that could have an adverse impact on vision?

LESYA SHUBA: Well, I think you probably can't talk about eyes these days and not mention a cataract. Cataract is really the the most common eye condition and the most common cause of vision loss in the world. But luckily it's a reversible vision loss. So if the cataract is diagnosed, it can be treated successfully, very successfully with the surgery. Most patients are very satisfied with their cataract surgery. I think it's probably one of the most satisfying surgeries that we do in medicine in general. And patients who have cataracts, they do have symptoms. So they will notice that their vision is not clear. Some of the first symptom symptoms might be glare of the lights, especially when they dry or halos around the lights. The whole vision is just not as clear. When they notice those problems, they will seek out help and they will be diagnosed with cataract and case will be treated. So that that's one condition. Another common condition that we see and you probably hear quite a bit about it in the news and reading newspapers is age related macular degeneration, and that's a condition that happens usually in patients who are older than 65. And it's a condition of the retina of the center of the retina called macular. And again, it can affect vision quite significantly. And there is no cure, unfortunately for it. But there are some treatments so they can be quite successful.

BRIAN GOLDMAN: So that's another condition that that can limit or compromise vision. You haven't mentioned diabetes.

LESYA SHUBA: Yes, diabetes definitely can affect the vision. And this is another condition where I feel that it is very, very important for patients who have diabetes to have regular eye exam, even if they're totally asymptomatic as far as their eyes, even if they're seeing see change in their vision, have no problems with their eyes. They should have their eyes checked because diabetes is the condition is a condition that can affect any part of the body. And quite often the damage happens very slowly. The patient will have no symptoms until some really terrible outcomes can happen. But if it is detected early, then they can be treated and the treatments are either lasers or injections of different medicines in the eye, depending on what exactly is happening in the eye, because of diabetes, right different things that diabetes can cause in the eye.

BRIAN GOLDMAN: You know, to stay on top of of these conditions that that you've talked about. How often should people be getting their their eyes checked?

LESYA SHUBA: So for adults who are younger than 65 and have no comorbid conditions and have no diabetes and they have no family history of any significant eye disease, especially especially glaucoma, because family history is a different risk factor for glaucoma. So if you have no no risk factors, if you were healthy, no family history of anything, you are under 65. Having an eye exam every couple of years is sufficient and one should have an eye exam whether you have symptoms or not, whether you feel that your eyes are working fine or not, you just need to have somebody check your pressures, look inside your eyes to make sure that everything is good. You may not need glasses and glasses. Requirement is not a disease, it's just the way our eyes are. You may not need glasses, but you need to have somebody look inside the eyes. If you have risk factors like family history of glaucoma or if you have diabetes, or if you're 65 and older, then you should have your eyes examined once a year at least.

BRIAN GOLDMAN: There are ophthalmologists and there are optometrists. Can you talk a little bit about the difference in who can see which kinds of patients and when it's it's really important that you see an ophthalmologist.

LESYA SHUBA: Ophthalmologists are medical doctors. We go to medical school first, become a medical doctor, and we do a residency. It's a five year residency training in ophthalmology. And then we become ophtalmologists and then many ophthalmologists then go on and further training to become subspecialists. Then glaucoma or retinal cornea. Optometrists are doctors of optometry. They attend optometry school, and I think some of them also may specialize in some specific aspects of the eye, are not very familiar with their training, but optometrists can definitely do screening eye exams and they're excellent at that. And if somebody has no eye pathology, doesn't need any treatments. They should see an optometrist every year or two, depending on their specific risk profile and often just wonderful at doing this eye exams. They also measure the eyes and see if glasses are required and then if the optometrist notices any pathology or are concerned about glaucoma or cataract or macular degeneration or changes from diabetes or any other eye conditions that now need treatment, then they would refer them to ophthalmologist.

BRIAN GOLDMAN: So we've talked about getting regular eye exams. What can people do between visits to take care of their eye health besides, you know, taking the medication as prescribed?

LESYA SHUBA: Excellent question. Well, taking medications as prescribed is actually very important.

BRIAN GOLDMAN: It is, yes, I know.

LESYA SHUBA: Complieance are absolutely, compliance with the treatment, and compliance with appointments is at least for glaucoma. And this is my subspecialty is is very, very important. But besides that, looking after their general health with, you know, regular physical activities and healthy diet, it's important for your general well-being. It maintains your blood pressure. It prevents or treats diabetes, healthy lifestyle and physical activity. And because of that, your eyes will be healthy as well because they will not be affected by diabetes. There are some also eye conditions. It can happen quite suddenly and they can be quite devastating in patients because of high blood pressure. So again, if you do all these healthy lifestyle routines, your blood pressure will get better and then you'll be at lower risk of developing. These are usually vascular conditions, kind of basically a stroke to the eye, and they are devastating. The vision is lost suddenly and irreversibly, and the main cause is not really eye pathology, but your general health pathology, your high blood pressure or maybe use of high cholesterol. So first of all, looking after all those things is is very helpful specifically for eyes. Preventing eyes from sunlight is important. The evidence center for evidence is not very strong, but it's a very difficult study to do, to have a conclusive evidence. But there are some studies indicating that preventing your eyes from direct sunlight over your lifetime is helpful in preventing cataracts and age related macular degeneration. It doesn't prevent everything but those particular two particular conditions. For age related macular degeneration, there are some vitamins that are helpful in preventing macular deterioration, especially in patients who have significant family history of my study duration or in patients who have lost vision in one eye from this disease. If if you don't have macular degeneration or if you have no family history of macular degeneration just eating diet full of orange, yellow, red and green vegetables is is probably just as helpful. But you do need to get these vitamins somehow in your system, either directly from the from the healthy diet or if you if not, then maybe supplement vitamins.

BRIAN GOLDMAN: Your mother was right. You should eat carrots.

LESYA SHUBA: Oh, absolutely. Yes. Carrots and peppers. And so another thing that will just maybe help your eye, not necessarily help, but comfort and help, can help your vision is just give you eyes it arrest. If you spend a lot of time in front of a computer or television or driving the all these activities will not damage your eyes, but they will make your eyes feel uncomfortable and tired. Usually the most common causes drying is because you're staring at your screen and you forget to blink. The eyes become dry, they become uncomfortable and the vision becomes blurry. So remember to blink. And if that's not enough, add artificial tears and just take an occasional break from the screen. You look at the distance and then come back. Get back to your work.

BRIAN GOLDMAN: How much are you concerned about blue light from screens?

LESYA SHUBA: I don't think that's really, there is distinctive evidence that the amount of blue light that our screens is emitting is damaging to the eye. There is no evidence that is damaging to our eyes. It may affect our sleep pattern, but as far as the eye damage, I don't think there is any evidence that is damaging.

BRIAN GOLDMAN: Much of what you're doing is to try to to monitor patients and prevent them from suffering devastating vision loss. You've seen this, I'm sure, in your practice. What kind of impact does does profound vision loss have on on your patients, particularly considering that that they may be older to begin with? Maybe they don't adapt as well to vision loss as somebody who's much younger when it happens.

LESYA SHUBA: Or it's it's really, really devastating. It's devastating for everyone. And I have, unfortunately, patients who have lost the vision when they're quite young. I have some who lost their vision when, say, young children even, or a loss of vision in adulthood, in the middle of their adulthood when they're, you know, raising a family and trying to go to work and they have patients who lost vision late in life, and each of those careers has their own devastations. And it is very difficult to tell patients that, unfortunately, there is nothing I can do to bring your vision back. It's it's very, very sad. One of the hardest things I do, actually, is tell patients that they cannot drive. For those of us who drive, we think that we will never stop driving. It's just such a second nature for us to be able to drive. And then you tell patients they can drive because the vision is not legal to drive and it really changes people's lives.

BRIAN GOLDMAN: So it's really important that you see a qualified professional on a regular basis to to monitor you, to make sure that you're not developing a condition that can compromise your vision. And I wanted to close out. I of course, as I've already said, I'm an emergency physician. What are the key visual symptoms that should prompt you to drop what you're doing and seek immediate care? If you can't reach an ophthalmologist, immediately go to the emergency department.

LESYA SHUBA: The obvious one is vision loss. Like if you suddenly can't see anything. Usually it happens in one eye from one eye. Even if there is no pain, it's probably some sort of a stroke to the eye. And there are different types of stroke, but if you can't see light from the eye, that's what it is. You should be seen and you can have severe pain in the eye like a headache feeling with nausea and vomiting, as I described earlier, and change in vision halos. And those are signs of acute glaucoma that those patients definitely should be seen. If you have any injury to the eye, you know, blunt or with the kind of sharp object. I think those are kind of obvious indications that patients should be seen. Even if you think things are okay if you have an injury with a ball or a hockey puck or a hockey stick, because there are subtle things in the eye that can get damaged and that can later in life cause problems, usually glaucoma. And so these patients would be seen as well flashes and floaters, it's, that can be a sign of retinal detachment. And so if patients, especially patients who are very nearsighted, they had increased risk of retinal detachment. If they see flashes of light like lighting in the eye and they see floaters and black flies in their vision or a curtain going over their vision. Those can be signs of retinal tear or retinal detachment. And that is a condition that needs to be treated. And another large group of patients, those who have had recently eye surgery. Infection, is usually the kind of most devastating and a problem that can happen after any eye surgery. So if you have pain that is getting worse after eye surgery, discharge that is kind of a green or yellow or the vision is getting worse as opposed to getting better after surgery, they should go to the emergency room.

BRIAN GOLDMAN: Thank you so much for that. That's a great review of emergency symptoms. And Dr. Lesya Shuba, thank you so much for getting us up to speed on the conditions that can compromise vision and how often you need to be checked. Thank you so much for speaking with us on The Dose.

LESYA SHUBA: Thank you so much, Dr. Goldman, for inviting me and for your interest in vision. It is very precious to all of us.

BRIAN GOLDMAN: It sure is. Thank you.

LESYA SHUBA: Thank you. Bye bye.

BRIAN GOLDMAN: Dr. Lesya Shuba is an associate professor in the Department of Ophthalmology and Visual Sciences at Dalhousie University and the director of the Dalhousie Glaucoma Fellowship. Here's your dose of smart advice. Everyone, regardless of how well they see, needs regular eye exams to check vision and look for eye diseases. Early detection means they can be treated before any significant vision loss. The frequency of checkups depends on your age, vision and whether or not you have diseases that can affect vision like diabetes. Children should have a comprehensive eye exam before they go to kindergarten. Adults under the age of 65 with no health or vision problems should have an eye exam every two years and annually if they have diabetes or a family history of glaucoma. Those age 65 and older should have an eye exam every year. Ophthalmologists are medical specialists who provide full eye care. They diagnose and treat complex eye diseases and perform eye surgery. Optometrists are professionals who provide many of the same services as ophthalmologists. You can see an optometrist for a screening eye exam during that assessment. You'll be checked for several eye conditions that can cause loss of vision. They include cataracts, glaucoma, age related macular degeneration and diabetes. A healthy lifestyle helps preserve your vision. That means regular exercise, weight loss and lots of orange, yellow and green vegetables. Reducing eye exposure to UV radiation helps prevent macular degeneration and cataracts prevent dry eyes by giving them a rest from computer screens and by using artificial tears. Seek emergency eye care if you have sudden vision loss or visual distortion, severe eye pain flashes or floaters in your vision. If you have topics you'd like discussed or questions answered, our email address is the dose at cbc.ca. If you like this episode, please give us a rating and review wherever you listen. This edition of the Dose was produced by Isabelle Gallant, our senior producer. This week is Jeff Goodes. The dose wanting to be better informed about your health. If you're looking for medical advice, see your health care provider. I'm Dr. Brian Goldman. Until your next dose.

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What do I need to know about taking care of my vision?- Transcript

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