Knock Knock Eye: The Wildest Eye Surgery You've Never Heard Of
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Knock Knock Eye

Man, you guys really want to hear more about dry eye, which doesn't surprise me because it's the most common thing I see in the eye clinic. I was asked about that recently. What is the most common thing you see? I did an Instagram live with somebody and that was one of the questions. And...

It is. That's it. It's a dry eye. Everybody has got dry eye and part because of all the screen time that we have, but which I talked about in the previous episode. But it's it's all day. I've got a script in my head. I just run through everything. I've got it down like to the to the letter.

I know exactly how long it's going to take me to get through a talk with a patient about dry eye. And so we're going to go over a few things, address some of the questions that you guys have. Also, something happened at the Oscars that I'm excited to just mention. There was an eye disease that got some airtime.

During the Oscars. Very exciting. Very exciting in the world. It doesn't take much to excite us in the world of ophthalmology, but being mentioned something that we treat all the time at the Oscars. Oh, that's high up there. Okay. Also, I'm going to talk about a surgery that every now and then will make the rounds easier.

in popular science type publications, mainstream media, because it sounds kind of science fiction and far-fetched. But I'm going to talk about using your teeth to transplant a cornea.

So that's kind of the rundown here. But first, before we get into all that, I thought I'd I'd I'd I have like a an idea for a piece of content that at some point I want to do. And I'd love to hear your thoughts. I just want to talk it out because I.

I do a lot of speaking, so I've got a handful of keynotes and stuff lined up this year, different specialties that I'm excited about. And one of them is I'm going to Australia. I've been to Australia twice before.

Love Australia. Fantastic. Yeah, the sun, the UV index is roughly like 83, but it will, you can kind of feel it too. When you're there, like in the summer, really anytime, and it seems like it's always hot, the sun's beating down on you. You feel your skin simmering. You can feel the UV rays coming

irradiating your entire body. That's the only downside. Otherwise, wonderful place, wonderful people. I'm giving a talk in May to Australia's surgeons. It's like the big surgery group of Australia. And one thing that they wanted me to talk about is just the US healthcare system.

as like a cautionary tale, basically. Like, hey, Dr. Glockenflecken, there are, imagine me saying this, but in Australian accent, which I'm not going to try to do. A good day. Oh God, I'm so bad at, I don't do accents, you guys. So please edit that out. Actually don't, you know, I'll just, I'll accept the humiliation of trying to do it.

They said, they said, Dr. Glockenflecken, there are some things happening in our country that's like moving toward privatization and corporatization and basically insurance companies trying to gain private insurance companies, gaining a much bigger foothold in our country. And so can you talk about your experience?

Boy, can I? Oh my goodness. I'm so glad you asked Australia. And so I am very excited to bring that element into my keynote in May in Australia, in Sydney. I'm so pumped. I just, oh, what do you want to know about health insurance companies? I will get, I'll tell you everything. And the great part about it is I'm in a different country. So they can't come after me for that. I don't think.

So, I'll say whatever I want to say, and hopefully there's no need for any aggressive security or anything, because I'm not on U.S. soil at the time. So, although I'd probably say the same thing anywhere, I'm thrilled. I'm thrilled to do it, but it also got me thinking. So,

kristen and i my wife lady lady g we are uh we've been putting on these shows these wife and death shows where we talk about our life story and i dress up in characters and stuff and it's just it's been it's been awesome and we still have a few of those shows we're doing this year and um those are in the works um stay tuned florida and the northeast all right it's coming um

And so we've been really enjoying it, but I'm thinking like, okay, what's the next show going to be? I don't know. I just can't be satisfied with what I'm currently doing. I have to be looking for like the next project. So what about this, you guys? What about like a Glockenflecken explains U.S. healthcare?

Because if everybody in Australia wants to know what's going on in the U.S. healthcare and why is it so bad and how did it become that way and how do you fix it and how do you prevent it from happening if you're in a different country? Well, then maybe there's other countries, other people in other countries that also want to hear that information. And maybe even just people in the U.S. that are like, what the hell happened? How did we get to the point where Optum owns everything?

where there's like four insurance companies and they just vertically integrated all of it, the whole healthcare experience. So maybe I'll put on a one man Glock and Flecken show where I, a Glock and Flecken explains healthcare. And I could, I could like dress up in different characters and,

I could do family medicine and how family medicine gets abused by like unnecessary prior authorizations. And, and I could, I could be Jimothy. I don't know. I, I haven't thought at all about it. It's just the idea. I mean, I could easily put an hour of content together and then, and then tour it around to theaters and it'd be fun. I think it'd be great. It might be extremely depressing, but I promise it would be funny.

So there you go. I mean, tell me what you think. Would you come to that? I hope so. I love, I love performing. I love seeing all of you, all the glock and fleck and flan flans, all the glock and fleck and flans.

all the, the, the, the Glock flock folks. I love seeing all of you in person. It's been really a joy to, to see people come out for the live shows. And so I want to be able to keep that going and, um, and bring something new. And I think that's, that makes a lot of sense. And we're, I mean, we just launched, um, uh, on our, in our newsletter and on, uh, some of the, on, on Instagram, uh, and I think Facebook as well are, um, uh,

uh, or rerunning our 30 days of us health, my, my 30 days of us healthcare, uh, uh, series that I did a couple of years ago, all of it still relevant. Not much has changed. So anyway, uh, maybe I'll turn that into like a stage show and I'll sing and dance. No singing. If you ever wanted to, if you thought my impressions of different, uh, accent with different accents were bad, just wait till you hear me sing. It's not, not pretty.

Anyway, that's kind of what I'm thinking. I'm just kind of vomiting words at you at this point. So anyway, oh, the next thing. So Oscars. I love watching the Oscars. Even though I usually, at best, I'll see like half of the movies that are the big movies. I like it. I've been watching it since I was a kid. I love movies.

Part of the reason why I like doing the content that I do. Something very, very exciting happened. Goldie Hawn went up with Andrew Garfield and presented an award. And during the back and forth that they had with each other, Goldie Hawn said that she couldn't read the teleprompter because she has cataracts. Cataract. Cataract got mentioned.

During the Oscars. And then there was a spike in Google searches about cataract. And I know this sounds silly to be very excited about this, but I am an ophthalmologist at heart. I mean, in real life, but also at heart. My whole presence is intertwined with the world of eyeballs. And so when something in mainstream media happens,

And something like the Oscars, they mentioned an eyeball thing. I'm going to get excited about it. And everyone else's too. So cataracts were mentioned. People were talking about cataracts very briefly. And I will say afterwards, I was looking around to see what kind of news stories popped up about this. And there were a few headlines and there were always headlines.

the most click-baity headlines you can imagine. It's like, Goldie Hawn reveals shocking diagnosis. The woman is 79 years old. If she didn't have cataracts, that would be the modern medical miracle. All right? Not a surprise. 79 years old. In fact, she probably should have had them removed by now.

Like there's really very few people that really still should hold off on cataract surgery at the age of 79. The vast majority of people get that surgery in their 70s. And so, Goldie Hawn, I have to assume you're a fan of Dr. Glockenflecken.

Go get cataract surgery. I'm happy to help you out if you want to come to Portland. All right, let's get this done. We have wonderful artificial lenses we can put in your eyes. We can get your distance vision better. No glasses. We can correct your astigmatism. We can correct your near vision. We can do all of those things. We can even put a lens inside your eye and then change the shape of it afterward.

to dial it in exactly how you want it. That's the latest technology. Very expensive, but you're Goldie Hawn. I think you can afford it. So go out, get yourself some cataract surgery. Guys, don't wait. All right, if you're 79, all my 79 Glock flock members, go get your cataract. If you're in your 70s, you got cataracts and chances are they're visually significant. It doesn't take much to convince insurance companies to pay for the cataract surgery.

which is because everybody gets cataracts that's probably the reason why etna a couple years ago tried to enforce prior authorizations for all cataract surgery you guys remember that that was a big deal made videos about it um basically we just have to we have to show that there's there's some you know difficulty with your activities of daily living because of the cataracts it can be

glare problems, trouble seeing road signs, trouble reading, trouble recognizing faces, trouble navigating around your home because you can't see as well or in dim light. There's so many things. We do glare testing and it doesn't take much to warrant cataract surgery because if you don't do cataract surgery when you need it, more health problems can arise because you don't get surgery.

What if you trip and fall? What if you have an accident? What if you hit somebody? What if you hurt yourself? You can't see steps as well. You don't see a curb when you're walking around outside. So many things can happen, and that could lead to broken bones. All right, the ortho bros, they have plenty of business. They don't need more. So go get your cataract surgery done. Let's take a break. Hey, Kristen. Yeah. I've got some friends I'd like you to meet. I see that.

You seem a little too friendly with them, I have to say. Aren't they cute? Sure. With the little beady eyes and their little hands. The hands? The claws? I don't know. Appendages. Okay. How about that? Yeah, it works. Anyway, they just like, they'd like to say hi. Okay. They'd like to say hi. Okay. Wonderful. They're not, they, oh, look, the one's sticking around. It sure is. Right on my mic. These little guys are demodex and they live on your eyelashes. Yeah.

And they can cause flaky, red, irritated eyelids. See, that's not cool. You just kind of want to rub them. You're not welcome here if you're going to do that. And it's caused sometimes by these little guys. Yep, that's rude. Demodex blepharitis. But you shouldn't get grossed out by this. Okay. All right, you got to get checked out. Yes, get checked out. To find out more, go to eyelidcheck.com. Again, that's E-Y-E.com.

L-I-D check.com for more information about these little guys and Demodex blepharitis.

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All right, speaking of surgery, there was another news article. Again, I mentioned earlier, this comes up every so often. This is a surgery that's called osteo-odonto-keratoprosthesis. I'll try to say that quickly. Osteo-odonto-keratoprosthesis. If I was putting that in an ophthalmology note, like a consult note, because as we all know, ophthalmology notes are indecipherable.

I would probably call it, I guess, OOKP.

OKP baby osteo otontokeratoprostase is very, very awkward. But it's it's a surgery that that is so wild sounding that it pops up in on media sites, even though it's as if it's a new thing, even though it's a surgery that's been around for like 60 years. So it was pioneered by Italian ophthalmologist Benedetto. I don't know if that's how you say it. Benedetto Strampelli.

benedetto strampelli here we go i've already tried to do two different accents in one episode this is not going well in the early 1960s tooth in eye surgery because that's what they're calling it as opposed to keeping continuing to type osteo odonto keratoprestesis tooth and eye surgery is intended to minimize the risk of a patient of a patient's body rejecting a foreign implant

by mostly relying on its own biological material so there this is the reason that this is even like thought of as an idea when someone has we're going to take one disease for example a bad chemical burn to the eye chemical injury let's say you get sodium hydroxide a big splash of it right in your open eyes it's severely basic it's a high high base

ph of um what are the basic ones high ph so we're talking like 12 13 really high ph that can cause a dramatic uh burn and scarring of the cornea so you have that accident and over the course of six months or so your eye slowly scars over and what that means is

You have your conjunctiva. We've talked about the conjunctiva. It's like the skin of the eye. Well, whenever you have a severe injury to the cornea, severe enough that it burns off what we call the corneal limbal stem cells. So you have stem cells that kind of right on the edge of where the conjunctiva, the white part of your eye, meets the cornea. That's where your limbal stem cell, that's called the limbus. It encircles your eye, your cornea.

That's where your stem cells are. So if you have like a corneal abrasion, like a minor trauma, your stem cells will get active. They'll start running. They'll start creating new cornea tissue to fix that corneal abrasion. Well, if you scar your eye severe enough to where you kill off all those cornea, those limbal stem cells, all of a sudden the cornea itself cannot regenerate tissue.

You can't create more cells to heal the cornea and keep it nice and clear. You need that cornea perfectly crystal clear so you can see through it. But if you don't have limbal stem cells, you're toast. No chance. And so what happens is you can't regenerate corneal tissue. And so what takes over? Your conjunctiva. So your conjunctiva is like, oh, shit.

we don't have corneal stem cells. Someone's got to come in and cover and try to heal whatever's left of the cornea so we don't have an open globe, so it doesn't just melt away and the eyes open and then you lose your eye. So what the conjunctiva will do, it somehow senses that there's no stem cells there, and it starts to grow over the cornea.

And it's called conjunctivalization, another silly, crazy word we have. And so the conjunctiva will just totally grow over the cornea. And so you see the white part of your eye. Well, imagine the white part of your eye, but it covers the entire front of the eye. That's what it kind of looks like. It's just the conjunctiva covering the cornea. When that happens, it's extremely hard to regain normal vision because the

In a lot of cases, you have this conjunctivalized cornea, but behind it, inside the eye and in the back of the eye, the retina might be totally pristine. It might be perfectly fine. And so if you can just get rid of that conjunctivalized cornea and replace it with a normal cornea, well, you can restore vision. So that's what people did for a long time. Okay, we developed techniques to try to

basically create a little punch hole in the center of that diseased cornea and replace it with an artificial cornea. It's called a penetrating keratoplasty. And it works. It removes that bad tissue and you have a nice clear cornea in its place. The problem is you still don't have limbal stem cells. And so...

Before too long, the conjunctiva is going to grow back over that new cornea. And so you've kind of wasted that corneal tissue, that donated tissue from a cadaver because it just, it'll last maybe a few weeks, a few months, and then you're back at square one. So there was, there's a need to figure out a way to create a opening right there in the front of the eye.

That will not just scar over very quickly and that you can potentially have normal vision.

And one of the ways that we've tried to do that is with osteo-odonto-keratoprostesis. I had to look at it because I still can't quite get it right. Osteo-odonto-keratoprostesis. Let me tell you how this works because this is fascinating. So the surgeon, the first thing the surgeon does, and this will be a dental surgeon. God, you don't want an ophthalmologist going anywhere near your teeth.

What the surgeon will do is extract a tooth. It's typically a canine. It's one of the big ones. And then they'll shave that tooth down to form basically just a rectangular layer. So they make it kind of thin and rectangular shaped. And then within that tooth, they drill a hole in the center of the tooth. So you have a little rectangle of tooth tissue with a hole in the center of it.

Once, and that's called the frame. Once the frame is finished, the doctor will then install a tiny plastic telescopic lens, which is ideally what the, you know, that's what the plan is for the patient to see through that little lens. So they put that into the, into the frame through that hole. And then that implant is actually sutured into the patient's cheek.

All right, where it's going to stay there for a few months as new tissue grows around it. Because you have to be able to have, you have to have your own tissue to suture onto the eye to allow that lens inside the tooth to remain steady and where it needs to be. And so you allow your own tissue in your cheek to grow around that implant, that tooth, and

So that you can then take it out of your tooth and suture it onto the front of the eye in place of that diseased tissue we've been talking about. Wild. It's wild. Can you imagine? You get that suture in your teeth. You just have your own tooth sutured into your cheek. But the outcome of this...

It can be life-changing for people because these are people, the only people that get this type of surgery are those who have just bilateral, no light perception vision. These people, they just, they're totally blind. They cannot see anything, not even light most of the time. And all of a sudden you put this, it sounds aggressive and it is, but sometimes it's the only option for trying to get someone to allow someone to heal.

or to recover some of their vision. You put this in there and there are some patients that they can recover 2040 vision, 2020 vision in fact. There are reports of people being able to ski

with one of these in. Before, there were no light perception. All of a sudden, they can do this. Now, granted, this is like very specific types of patients would benefit from this, right? There are lots of different types of blindness caused by a lot of different things. If you have retinal blindness, you've had a bad retinal detachment or multiple retina surgeries, or maybe you had retinopathy of prematurity as a kid, or maybe you had a central retinal artery occlusion,

terrible diabetic retinopathy, any number of things. You had a melanoma of your eye that was treated. None of those things, this will not restore your vision. This is pure corneal blindness, what we call corneal blindness. The reason you're blind is because your cornea is diseased and it's got to be a specific type of corneal blindness as well. So it's not a large group of people, but the fact that we can do this is remarkable.

Now, here's the biggest problem. These types of eyes, these types of implants are prone to complications. Glaucoma can be a big problem. And part of this is just because the underlying disorder, the reason why this happened to the patient in the first place,

I mean, chances are it's damaging other parts of the eye, including the trabecular meshwork, which is right next to the cornea. So it's not hard for like a chemical injury to damage the cornea. It can also damage the trabecular meshwork, which is the drainage system of the eye leading to glaucoma.

So glaucoma is very common in this patient group. Infection after something like this is unfortunately fairly common. They've got a tremendous amount of drops and a maintenance regimen to keep this as healthy as possible. But even so, I remember seeing patients that didn't have this specific type of surgery done, but a similar one of keratoprosthesis that had wonderful vision for three to five years.

And for a lot of people, that is worth it. That's worth the frequent, every...

a couple of month visits for years, the frequent, sometimes every two hour eye drops they have to take around the clock, like just to have some useful vision, it's life-changing for people. And you may only get it for a few years, but that's like three more years of vision that you wouldn't have normally. Three more years of being able to see your loved ones in the face and see them when they're talking to you and watching your kids grow up.

and, and being able to see a sunset and, and play with your dog or whatever, you know, just think about like, that's, that's, that's amazing to give to someone, even if it's just for a few years. So I hope that work continues on these keratoprostesis. I know it is. Um, and it's hard to do research on this type of thing, unfortunately, just because

of, you know, anytime you have a disease or something that's affecting a small group of people, it's hard to get research funding for it. But there's lots of people doing lots of great work around keratoprosthesis and it's helping a lot of people. Hopefully that still continues to be the case, even with what's going on with research funding in this country, which is very sad and a challenge. So let's take a break. We'll come back and do some comments.

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That's BlueNile.com. All right, guys, I'm getting these comments that you guys left on the most recent episode that was published. Is there a way to reverse eye dilation? Not my most popular episode.

I don't know what it is. I guess you guys just aren't, aren't that maybe it was a bad headline. Um, but I, I'm still trying to figure out what hits for people and what doesn't hit for people. So, uh, anyway, we'll keep tinkering around with it. Uh, that's okay though. You had some, you guys gave us some, uh, some great comments here. Uh, so I'll just read a few. Um, all right. At never time to try again. It's always time to try again. So curious, uh,

Some psychiatric disorders like schizophrenia come with soft neurological symptoms like slow blinking. That's true. Parkinson's is the classic one. Very slow blinking. Just everything slows down. This psychomotor slowing, slow blinking symptoms.

Do these patients have higher rates of dry eye? I've never asked a patient, but maybe. Absolutely. Oh, yeah. This is one of the, like for Parkinson's in particular. The two things I talk about with Parkinson's a lot is dry eye.

Because I'll sit there, I'll have the patient who's got kind of, usually it's more moderate to severe Parkinson's. I'll sit there and watch them. They're looking at me the whole eye appointment and not once do they blink. And I point that out to them. I was like, you know that the whole time we've been talking, I've not seen you blink one time. Most people blink every seven to eight seconds. Like that's what's typical. You're probably blinking right now because I'm talking about blinking. I know I am.

And so I talked to them about how dry eyes, very common because everything slows down. We don't blink. That's the windshield wiper of our eye. All right, we got a blank. Those eyelids have a purpose. And also convergence is a big thing with Parkinson's. So people start having lots of double vision problems trying to read.

And part of the trouble with reading is because the eyes are dry as well. But you have trouble converging your eyes. And so that's really challenging. Sometimes we have to do prism glasses to try to correct that. And so we talk about artificial tears frequently.

And then there's other, you know, schizophrenia is a good example. Some of the medications slow people down, but also there are certain symptom symptomatology with schizophrenia or other delusional disorders and other psychiatric disorders that result in slowing down. And people just they don't have a normal blink. Anything that doesn't give you a normal blink is

Either the rate of blinking or just the physical mechanics of the eyelid, like Bell's palsy. They're trying to blink, but the facial nerve is paralyzed. And so they're not able to close their eyes all the way. In that situation, I'll have people tape their eyelid closed at night. And that's a way to combat that.

We're using lots of ointment because ointment's a much better lubricant than eye drops. The problem with ointment is that it causes lots of even more blurriness because no one likes having ointment in their eye. But yeah, psychiatric diseases and certain neurologic diseases have dry eye does become a big problem. Great question. I'll talk a little bit more about dry eye, just a couple of things. So

Dry eye is one of the, like I said, it's the most common thing that I talk to patients about. There's different types of dry eye. And the reason I want to talk about this is because there are a lot of people out there, a lot of eye doctors, both ophthalmologists and optometrists, that offer very expensive treatments for dry eye that you might not need. So I'm always in favor of people getting a second opinion for surgery, especially on eyes, LASIK, even cataract surgery.

Um, but mostly refractive surgery, high ticket items. Uh, uh, I, I always encourage you to get another opinion. All right. It does no harm in doing that. You might be out a little bit of money, but I mean, LASIK, you know, that's going to cost you 10 grand. So you might as well like get another opinion. Just make sure that the first doctor you saw knows what they're talking about. As a physician, I, I welcome that. It's totally. In fact, sometimes if a patient I'm seeing in clinic, uh,

I can tell they're skeptical. They don't quite believe what I'm saying. I'll say, you know, I'm happy to set you up with someone to talk, you know, if you want another opinion. It's not going to hurt my feelings because this is a big decision for people.

And it's, you know, I want, just like I want to be comfortable operating on somebody, I want the patient to be comfortable. And if that means just checking in with another surgeon to make sure that I know what I'm talking about, totally fine. No problem. So you should feel empowered to get multiple opinions. In the world of dry eye, there's lots of cash pay options.

small little procedures that as opposed to cataract surgery, which is just ophthalmologists, a lot of optometrists also offer dry eye treatment. So it's both optometrists and ophthalmologists. So you're going to get a lot of people offering you a lot of different things for dry eye. So I just want to talk about the different types of dry eye. So first there's the type of dry eye where you just don't make tears.

This is probably the least common form of dry eye. You don't make tears. So you have a problem with your lacrimal gland. Maybe you had surgery on your lacrimal gland. Maybe you had a lacrimal gland cancer or some kind of congenital abnormality.

You could also have an autoimmune condition like Sjogren's, where you have inflammatory cell infiltration of the lacrimal glands because you have lots of different lacrimal glands. You have the main one, you have accessory lacrimal glands, all of them produce tears. So if you have an autoimmune condition that's cutting off the tear production, you're going to get dry.

That has different types of treatments. All right. So for that, we would treat with certainly artificial tears. You have to substitute the lack of tears with more tears, but also things like restasis. It's good for something like that. The other thing that I would lump into this category would also be dry eye as a complication of LASIK. Because in LASIK, your...

Cutting the nerves, you're making a flap in the cornea, and that does cut some of the nerves that can make it to where you decrease the sensation of the cornea. And that is something, your corneal sensation, all the nerve growth factors involved in keeping your cornea healthy is what helps to produce more tears.

And so you cut the flap, the LASIK flap, it's going to cut some of those nerves. And it's really pretty common to have a little bit of dry eyes. Some people have a lot of dry. Some people have severe debilitating dry eye. That's very, very rare, but it does happen. And so same treatment rules apply artificial tears, but also something like restasis, which is cyclosporine has been shown to, to promote tear production. And so,

That probably would be the first-line treatment. But then you can also try to keep the tears on the eye with punctal plugs. You put a little plug in the tear drainage tube that allows the tears that you do make to stay on the eye a little bit longer. That's another treatment option for people that just don't make enough tears. That's not the most common form of dry eye. I would say the most common form of dry eye that we see is evaporative dry eye.

So that means that the tears that you make are not working well enough. They are leaving the eye. And the reason that happens is because you do not have an oil layer that supports, that insulates those tears because you have a problem with your eyelid. You have a problem with your meibomian glands, which are the glands in the eyelid that produce that oil. So what happens normally is your eye produces oil that covers the

that insulates those tears and keeps them on the eye for longer. If you don't have that oil layer, the tears that you make will evaporate. That's why we call it evaporative dry eye. They evaporate into the atmosphere. They drain. You just don't have them. They don't last as long as they should, and you end up with dry eye symptoms. So people that get styes, I know a lot of you listening probably had styes. That is a problem with your meibomian gland. That gland gets plugged up,

The oil builds up in the eyelid, gets red and angry and inflamed. You have meibomian gland disease, and that leads to dry eye. Now, the treatments for that are different than the treatments for just not making tears. You can't treat meibomian gland disease with restasis, or you can't just treat it with supplemental tears.

or with punctal plugs, that doesn't make any sense. You're not treating the reason your eyes are dry. You got to improve the health of the oil glands. And so that requires, you can do, that's when we start talking about hot compresses for people. Sometimes we'll give anti-inflammatories like prednisolone or Tobredex or Maxotrol. These are common medications that can decrease the inflammation along the eyelid margin. Sometimes we'll treat Demodex.

Demodex is a little mite that lives on in most of our bodies that can cause blepharitis, inflammation of the eyelids that causes those oil glands not work as well. And so we'll treat that. So my point is, it's not just dry eye. There's lots of different reasons for dry eye. Maybe you have dry eye because you've been using contacts, you've been sleeping in contacts, or you've just been wearing them for 30 plus years and

And you've just rubbed your eyes raw and you have lost some sensation on the surface of the eye. That's totally different. That's called neurotrophic keratitis. You don't have sensation on the cornea. Similar to LASIK, a little bit different. So that's why, and so you can very easily be offered a treatment that costs a thousand bucks that may not be actually getting to the reason that your eyes are dry.

And so don't hesitate. If someone says, oh, you know what? You'd really benefit from this, this, and this. We have a package for you. It's going to be about 3,800 bucks. Go ask somebody else first. Maybe you need that. Ask someone else. Don't be afraid to do that. Don't feel anybody that pressures you into a cash pay option, like a car salesman. They don't want to let you leave the lot. Talk to someone else first. That's not the way you practice medicine.

That's not okay. All right. You present the options. You don't pressure someone into an expensive treatment. All right. That's, that's not okay. All right. Let's a couple more of the comments here.

Oh, oh. In the last episode, I talked a bit about reversing. Obviously, the title of the episode was reversing dilation. So at Shay McG 9148 said my optometrist no longer dilates my eyes. There's this machine that takes pictures of the back of the eye. Is that OK? Yes, yes.

That is okay. It's called a Optos. That's the name of the machine. And it basically, it takes a wide angle image of your retina. It's a 2D image. And that's part of the problem. Like there's,

Well, a couple of problems. First of all, I don't think I can, I can still get a more detailed picture of the back of the eye just by doing a dilated exam. So I still think it's superior. That's my personal preference. You can see a lot with the optos image. The other problem with it is that you pay for that. You are paying for that optos image versus just a regular dilated exam.

Like that goes to your insurance. You don't pay extra for that. So you're going to be paying for both the exam and that extra picture, that extra picture that they take versus maybe just an exam. So anyway, there's cost to that. And it's usually something like 50 bucks or so, 50 to 100 bucks. Typically, I think it's around there. So there are downsides to that. You get, I mean, you know, imaging costs money. And so, you know, keep that in mind.

Um, at Jim Belter too, with regards to screen time, can closing your eyes for 20 seconds work the same as looking away? It does in a way. Uh, yes, you can. We always tell people to take 20 second breaks. Uh, and so you can just blink your eyes. That's fine. That's kind of what we're trying to get people to do by looking away from the screen. You're looking away from the thing that is just sucking in your attention.

and keeping you from blinking. So by having people look away, it does two things. One, that can be the reminder to yourself to blink. You look away, you blink. But also, it's not just looking away from the screen, it's looking in the distance. Because what that also does is it reduces the strain because you're constantly focusing your eyes up close. So by looking away from the screen, ideally you're looking out the window if you have a window. Or at least looking like more than...

you know, six feet away because it allows you to relax your accommodation muscles, your ciliary muscles, and can help reduce eye strain.

So yeah, you can just keep looking at the screen if you're still remember to blink, but, but you're not, you might still have some of the eye strain component of screen time, uh, which by the way, blue light blocking is not going to take care of that. No studies have shown it helps with eye strain, just circadian rhythm stuff, sleeping at night, but not eye strain on a computer all day. Uh, all right. Question from at Jemima lamb, uh,

um, Jim, I'm a lamb seven, eight question. Is it normal to have a different eye pressure in each eye? Yes. Uh, often they are, unless you have glaucoma or something, some disease process, the eyes will typically have, they might be the same, but they're typically within two or two or three points of one another. So yeah, it's really common. Each eye, uh,

is they're separate eyes. So they act, they work together to look at things, but in a lot of ways, they are independent things. And so you can have something happen with one eye, you can get glaucoma in one eye and not get it in the other. But typically, unless you're in a disease situation, a glaucoma situation, they are roughly the same, but they can be a little different. So don't let that worry you. All right, and then...

Let's see. At never time to try again. Wait, I think it

Oh yeah, this is the second comment from Never Time to Try Again. Said, I would pay that, referring to the reversing dilation drops. I keep getting shamed over refusing dilation, but I do my appointments before work. I have to work and see my computer. I'm sorry. You know, that's a great point. And maybe we should be keeping those on hand. And so letting people know that that's an option. I don't have any problem with it. Like I said before, those drops, they're just kind of expensive.

And from a practice management standpoint, I don't think it's cost effective for us to keep them in the clinic. But if I hear from enough patients that want it, then my mind can be changed on that, I guess is the point.

All right. Thank you, guys. We'll stop there. We'll do more next time. I appreciate all the questions. Again, at Glockenfleckens is where all these video episodes are posted of Knock Knock Eye. If you want to see me, I always come in after operating and do these recordings.

So I typically kind of look like a mess. So if you want to see me looking like a mess, then check out YouTube at Glock and Fleckens. Leave a comment. That's where I get all of these that I'm reading to you. But if you're not a YouTube person, well, just listen to me anywhere. And thank you for listening, by the way. I'm your host, Will Flannery, also known as Dr. Glock and Flecken. Thanks to our executive producers, Aaron Corny, Rob Golden, and Shanti Brooke. Our editor-engineer, Jason Portizzo. Our music is by Omer Bensfi.

Thanks all. Knock Knock High is a human content production. We'll see you next time. Bye. Knock Knock. Goodbye. Human content.