Knock Knock Eye: What Are All Those Machines at the Eye Doctor's Office?
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Hello, everybody. Welcome to Knock Knock Eye with me, your host, Dr. Glockenflecken, your one-stop shop for all things eyeball-related, orbit-related, the space around the eye, the skin of the eye. The eye doesn't really have skin. It's the conjunctiva, but there's skin around the eyeball.

Everything to do with the eyeballs right here. I'm coming back from a week of intermittent time off over the holidays. I banked a bunch of episodes and so we didn't have to skip a week. You guys, hopefully, hopefully none of you were learning about ophthalmology like on New Year's Eve or something or Christmas Eve. You did take a break from my podcast as well. That's okay to do. And so, but so I took a little time off.

And, um, I had some, it got to spend some time with the family. I had family come in, just had some, some decompression time where I wasn't recording anything. Haven't done any skits in a little bit. I did one on New Year's Eve. I did like a big New Year's Eve party, uh, skit, which was fun. Uh, but, uh, now I'm trying to get back in the swing of things and it's, it's always so challenging, uh,

Those first couple days when you come back from an extended period of time off, and for me, it was like maybe a week. It was like a little bit less than a week. I didn't take much. I never take a lot of time off, but that was like the most time I've taken off from anything, from glockenflecken and from my day job as an ophthalmologist in a while at one time. I'll take like days off here and there. That's typically what I do, but it's been a while since I've taken like an extended time off.

And coming back is like going from zero to 60. It's, it's hard. Maybe it's just part of like, I'm just getting older and it's just like my body. I need to get it back accustomed to being in clinic, but it shouldn't, I don't feel like I should be deconditioned after six days. I don't know. Maybe there's something wrong with me. I am almost 40 this year, turning 40 guys. So anyway,

I apologize if this episode is a little rough because I'm also getting back into podcasting because I haven't recorded anything in like three weeks. So here we go. We'll do our best. I have been catching up on a lot of the comments over the last few episodes because I haven't addressed any of them. Some fantastic comments. So I have a list of a few. It's going to take me a few weeks to catch up. And so keep coming back.

to these episodes every week. I'll be doing comments that you guys have left me on the YouTube channel videos for the next however many weeks it takes to get through all the ones I want to address. You've given me a lot of topics, a lot of things to cover, some great questions, some follow-ups to some of the things that I've said over the last few weeks. I'm excited to address it all. So we'll get there.

First, I just got back from a trip, a short trip. It was like a one-day trip. I went to speak at a conference for the American Medical Association State Advocacy Summit. So I got to talk about all the things that I advocate for personally, all the things that I think physicians should advocate for, and all the things that I think the AMA should

Regardless of what you think of the AMA, it has its problems. It does some great things. It does some not so great things, but they're a very powerful organization with a lot of political capital and people listen to the AMA. And so I got to talk with them about the things that I would love to see the AMA do more of primarily things that affect like physician ownership and healthcare.

So many people are leaving private practice. So many new graduates are afraid to go into private practice. Optum and hospital corporations are buying up practices, private equities buying up practices. So we're just, we're losing the private practice aspect of medicine, which I think is not a great thing because that is, a private practice is like the, is the,

place where I feel like you can really be yourself as a physician and, and practice the way you want to practice. Now that's, you can do that in a lot of places, but, but definitely if you're your own boss and you're dictating how, how your care runs and pay, and then, and it's becoming harder and harder for people to do that in some of these like private equity owned corporations where they dictate to you how they want you to do things. So anyway,

I don't know. I think it's a big problem among a thousand big problems, prior authorization, just wellness in general. And, and, you know, I don't know. There's, there's a whole bunch of things. But it was a, it was a productive meeting. But the reason I bring this up is not because of all that. It's because I had a, this happens so every so often. So usually I get recognized in the airport.

At least once, sometimes two or three times. It's never overwhelming. I'm not that famous. I'm really not. But it does. People do notice me because, you know, on TikTok, I have a lot of followers and every video is my face the whole time.

And so of course it's like pattern recognition. Like I pop up on people's for you page. They're going to notice me whenever I'm walking out and about. So it happens. And it's always a wonderful thing. Like I still remember the first time it happened at the airport. That was the first time I had ever been noticed in public. And I thought it was the coolest thing ever. It's like, really? Wow. This Tik TOK thing really is going somewhere. I was like, when I,

first realized, wow, okay, this is getting real. People are noticing me in public. Now I'm kind of used to it. That's been going on for over a year now.

And it's always wonderful interactions with people. Like, I love it. It's great. They come up to me, talk to me about their favorite characters or favorite videos. Sometimes, uh, uh, they tell me what's the specialty they are and how they want to see more videos about OBGYN. I hear you obstetricians and gynecologists. Okay. Send me ideas, please. Because it's that specialty scares me a little bit. I don't have a lot of firsthand knowledge. I need some help.

pet peeves, arguments, or anything when you butt heads with other specialists. Give me all the dirt. Give me all the tea. Give me all the stuff under the surface. I want to hear about that. Then I can start making some videos. But people, it's always short interactions. We'll take a photo sometimes. One time I had a urologist whose kids came up

and acted out one of my videos in front of me. Their kids were like six and eight years old. It was the cutest thing ever. So they're fun interactions. But every now and then, I'll get someone that comes up to me and they ask me medical advice. It's kind of a line. It's like, okay, we're at the airport. You're asking me to give you medical advice about...

you an eye problem you're having we don't know i know you some people feel like they know me we don't know each other and i'm not going to give someone like medical advice with a couple of exceptions and this is one of those exceptions i had someone come up to me at the airport at first it was just like oh we love your content and everything and then they they started talking about how they went to see an eye doctor and they were told that um they would be a great candidate for lasik

and whether or not they should get it. They were asking me, like, what do you think? Should I get LASIK? Of course, it's a little bit of an uncomfortable conversation, but this time I said unequivocally, no, you should not get LASIK because this woman was 60 years old. She told me how old she was. 60 years old. Going back to my several discussions on this podcast about whether or not you should get LASIK, if you're over 60...

LASIK has diminishing returns as you get older. It becomes harder and harder to get you to be glasses independent as you get older. And once you're 60, you have cataracts. We can do more with cataract surgery in terms of giving you fancy lenses. You want to pay $3,000, $4,000 out of pocket to get a surgery, get cataract surgery.

Because the lenses are fancy, very fancy. We have lenses that give you distance and near. We have lenses that we can adjust after we put them in the eye. If you don't like your initial vision, we can change it. Amazing things we're doing with lenses with cataract surgery that we cannot do with LASIK.

And LASIK, I think, has the potential for more significant side effects. A lot of people have heard about patients that suffered severe debilitating dry eye, which is the vast minority, but it is a risk. And other issues with the flap and regression after LASIK. And then you're still going to end up needing cataract surgery. So if anybody ever asks me in public whether they should get LASIK and they're really over the age of 50,

My answer is going to be no, because I wouldn't do it. I wouldn't let my family members do it. So anyway, that was like the one exception. I was like, well, I was like, yes. Okay. Here's my medical advice. Don't do it. So anyway, but I don't, please, I would caution you to don't get in the habit of approaching like medical influencer people and, and asking for medical advice. It's, I don't know. It's just not, we'll do it on the podcast. How about that? Yeah.

But it was a very nice woman and just kind of took me off guard a bit. And so I mentioned something about this. I posted on X for the first time in a few weeks talking about this. And then all of a sudden, I got a whole bunch of questions about LASIK, so I should have known better. And so everybody wants to know about LASIK. It's a young person's procedure, you guys.

Which is unfortunate because you get the most bang for your buck in your 20s and 30s, but you don't have enough money to pay for LASIK. So as long as you know what you're getting into going into it, the risks, the benefits, make sure you're going to go to a reputable place. But yeah, 20s and 30s, it's a great procedure. In your 40s, that's when it changes a little bit. Start needing reading glasses.

If you're going to get LASIK at 40, you got to get one eye distance, one eye near what we call monovision, which does take away some of your depth perception. Some people love that. Not the lack of depth perception, but the distance and near because that's the way, the only way to get you glasses independent with LASIK after the age of 40 is by one eye good for distance, one eye good for near. Sounds weird, but it works for some people. Some people hate it. They feel off balance. They feel like they're going to fall over at any given time.

The worst part, though, is when I get a patient who had LASIK at the age of like 45 and suddenly no one told them that they need glasses, that they'll need reading glasses. So they're nearsighted. They get good distance vision, but that immediately puts them into reading glasses. And we're never told that.

Not a good situation. So it just gets dicey when you get over the age of 40. By 50, 60, don't do it. It's not worth it. We have better options that are coming for you down the road. All right, let's take a break. All right, let's just jump into some of these questions because they bring up some great topics. So I'm going to start with a question. Again, these are coming from the at Glockenfleckens YouTube channel.

So I read all these. It's going to take me a while. I'm catching up now. There have been about, I think, three or four episodes where I haven't gone through all the comments.

And so every episode for the next few weeks or however long it takes, I'm going to take a handful of comments, of questions and address them on the podcast. So give me those. I love seeing that you guys have been giving me fantastic notes, anecdotes, ideas for topics, questions, everything. It's great. I love it. I love it.

So please send those, uh, send those along at Glock and Fleckens. Just post them right there in the comments on these episodes. So these questions today come from the episode where I talked about what the different subspecialties are in ophthalmology. I went through all of them from most common to least common. Go check that out. Uh, but then I got a comment from at Kevin M Bergman, nine, three, six, eight, which actually goes well with the discussion about airports, uh,

Said, you mentioned that you can quite often diagnose someone by seeing them. Any stories about seeing someone in the wild that you can see had an issue that you helped out? So yes and no. I have seen people with eye issues, but I have not yet said something to them about it. But it got me thinking.

In the, you know, whenever I mentioned that I can diagnose someone from the door, that's like in the exam room. Like I can sell, I made actually a list of things that I can, I can diagnose you just by looking at you for like a couple seconds if I'm close enough to you. So that means in the exam room, obviously passing by you at the airport, sitting next to you on a train, whatever it is.

So eyelid cancers, basal cells, squamous cells, melanomas, I would be able to diagnose those for the most part. Sometimes they're pretty small, but they have a, you know, especially basal cells, which are the most common, very characteristic appearance, kind of this pearly edges of this ulceration in the center. I just kind of a gnarly looking bump on the eye that sometimes has bleeding and it just doesn't look good.

Uh, so eyelid cancers, I could probably pick out those certainly strabismus. Yeah. You got, got the googly eyes. Like I, I could see that most people can, um, ptosis. You have a droopy eyelid. I'm probably better than most. And by most I'm talking about non-ophthalmologist at picking out ptosis. I could, I could see pretty subtle ptosis, um, pretty easily.

Because I'm just trained to do that. That ptosis can portend a more severe underlying diagnosis, like a third nerve palsy. And so anyway, that's another one. Proptosis, where one eye is pushed out more compared to the other. People with thyroid eye disease. I could pick out thyroid eye disease from a lineup. Easy. Give me a lineup of 10 people. You say three of them have thyroid eye disease.

I got this. All right. I'll win the grand prize. No problem.

A severe cataract. Cataract's bad enough. You're going to see it when you look at someone's pupil. It's going to be white-ish. Bell's palsy. You get a little droopiness on one side of your face. I got that. Conjunctivitis. Your eye's red. We can all see that. Allergic dermatitis, which is something that comes up not infrequently. I sound like an internist. Not infrequently. You'll see a somewhat mild case of conjunctivitis in public.

So the eyes are extremely red and a weepy. You got matter glued to the eyelashes. Kind of gross. I would recommend staying home if you have a rip roaring case of conjunctivitis. But allergic dermatitis is a very classic appearance. You get this kind of scaly appearance.

indurated looking skin just all around the eyes, just the eyelids, upper eyelids, lower eyelids. And people look kind of miserable. They come blinking a lot, rubbing their eyes. That's allergic dermatitis. You could see that.

And then things like dermatocollasis, all this extra skin that kind of sits on the eyelashes. Brow ptosis, where as you get older, the eyebrows will dip down. They start obstructing your superior vision. All very, very common things. If it's large enough,

Anisocoria, which goes along with the third nerve palsy that I mentioned earlier. Big difference in pupil size and maybe a droopy eyelid, maybe a little bit of strabismus. Classically, one eye is out and down. That's your classic appearance of a third nerve palsy. Sure, I can pick that out. Now, how many of these things would I actually...

would would would prompt me to go up and say something to somebody keeping in mind that i i have a a a moderate amount of social anxiety uh i'm a bit of an introvert which might seem surprising given what i do but uh it's it's true so i i i don't like talking to people out of the blue in public

But there are some things I probably would. I have never done this though. I have never gone to someone at the airport and be like, you know, you've got viral conjunctivitis because why? Like what am I? That's the thing with ophthalmology. Most of the things I've talked about already are they're not emergencies. So what other than just seeming kind of like an asshole, like what's this doctor coming up telling me I have a droopy eyelid. Like why?

Unless I was absolutely 100% convinced that a patient has a third nerve palsy. But then again, they probably know they have a third nerve palsy. They have, if they're walking around, just going to the airport with double vision and a droopy eyelid, like that's it's, they know about that kind of thing. So the one thing,

Same with like thyroid eye disease. Like I don't need to be diagnosing people telling them they have thyroid. They might have thyroid disease, although maybe that would be helpful for people. I don't know. I just, it feels weird. I don't know. What do you guys think? Like, how would you feel if a doctor came up to you and told you that you might have a disease?

that you needed treatment for not like a life-threatening disease because most of these things besides like a third nerve palsy are not life-threatening would you feel violated would you feel relieved i'm honestly curious i really would love to know what the public thinks about this um i don't know it's it's a it's an interesting question i think and so i personally

I would think it was weird. I wouldn't get mad at a doctor who came up and told me, hey, you might have a skin cancer on your cheek. It's weird, but I would say, oh, okay, I'll get checked out. Thanks. And then I'd quickly...

shuffle away from that person i might actually be embarrassed too it's like oh my god my how embarrassing i've got a skin cancer on my cheek i don't know but that is the one thing that i might like if i saw a a very obvious skin cancer on someone's eye i might actually i can see myself going and saying hey listen i i'm an ophthalmologist i just i just want to make sure that you have that spot looked at because it might it looks a bit suspicious but

so that that is the because i've seen those get out of control they can metastasize it takes a while and usually they get caught early because we're always looking at our own faces in the mirror and and so we people tend to be on their weird eyelid things fairly early so usually we catch them before they spread but that's one thing that i might actually say something to somebody about so

Yeah, but I haven't done it yet. Maybe I should, but you guys tell me, I really want to know your opinion on this. So a third nerve palsy. Yeah. I'd be like, Oh, go somewhere. You've got your eyes pointed out. You've got a blown pupil and your eyelid is totic. What are you doing? Just flying somewhere at the airport. So you need to go somewhere now and get, get an MRI. I don't know.

Or if you have a story where you have done that, if you are a medical professional and you have gone up to somebody, how did the interaction go? I'm definitely curious. All right, let's go move on. Here's, I got a few more here. So at spiky green said, love your episodes and other podcast idea. Could you talk about different eye scans and exams?

That's something I haven't done yet. What are all the things that we do when you go to the eye doctor, particularly the ophthalmologist, but really optometrist, ophthalmologist, we use pretty much all of the same, most of the same like diagnostic tools. What are those things? What do you set up? So I'll just kind of take you through like what happens when you check in for an appointment at my, at my office.

so you'll check in you sit down hopefully we're running on time we'll get you back as quickly as possible first thing you sit at is what's called an auto refractor so you're coming in for just a routine checkup let's say actually you know let's say you're coming in for a diabetic exam you have diabetes

Your primary care doctor has been hounding you. Get in, see the ophthalmologist, have them look in the eye. We got to know if you have any diabetic retinopathy. You're like, fine, doc, I'll do it. Okay. You come in. First thing we do is sit you at the autorefractor because as part of your comprehensive exam, we will do a refraction for a couple reasons. Number one, you might want or need glasses and we would love to be able to give you a glasses prescription so you can see better.

But the other reason that we'll do a refraction, sometimes it's not just to give you a pair of glasses, but to make sure that you have the ability to see 2020. Because if you can't see 2020, then we got to figure out why. Something else, some of the disease process is going on, limiting your vision. We got to figure out why that is.

And so the autorefractor, it assists us in the refraction process. It gives us a starting point. It's not the definite. That's when we'll take the printout of what the autorefractor spits out to us. We will put that into the four-opter, which is the giant thing that you do one or two, three or four, five or six.

So we'll take the numbers from the autorefractor and we can put those into the four-opter as a starting point and then we can refine it. So it just, it makes things go a bit faster.

So that's the autorefractor. That's usually in my clinic. We do that. And then then we bring you into the room, do the exam. So have you look at the screen, check your pupils, check your confrontation, visual fields, check your eye movement. We'll check your eye pressure. And there's different ways to do that. So the eye pressure, we can use a tenometer.

on the slit lamp which is that medieval looking torture device that's that we kind of bring in front of you that has the bright lights in the exam room that you're sitting in front of there's a little tonometer it's just a device that it's called a goldman aplanation that's what we're doing kind of the gold standard basically for eye for checking eye pressure

And so we'll do that. Sometimes we'll use a device called a tono pin, just a different way of checking pressure. If you're at an optometry office, you might get a pneumotonometer. That is the dreaded puff of air, everybody. Fun fact, you won't ever experience that at an ophthalmologist's office.

And the reason for that is because of the history of optometrists versus ophthalmologists. Years ago, optometrists weren't allowed to administer eye drops. Why? I don't know. That seems pretty silly. We ask patients to administer their own eye drops, but we didn't let optometrists do it. So, yeah.

The world of optometry developed a, something called a pneumotonometer, which was a way to check eye pressure without having to put in preparacane or numbing eye drops. And people hate it. Like nobody likes the puff of air. I always hear about the puff. You're not going to do the puff of air, are you? No, we're not going to do the puff of air. We don't do that.

as ophthalmologists. And I would guess that most, maybe, actually, I don't know. I don't know what strictly optometry practices, if they still primarily use pneumotonometers. I honestly don't know. But you'll still find that obviously out there because people still keep talking about it.

And then let's say that you come in for your exam and you're not seeing, we do the refraction and you don't see 2020. Maybe out of your right eye, you see 2040. Oh, we got to figure that out. You have diabetes too. Interesting. You've never had cataract surgery. Oh my goodness. And you're 75. Okay. Let's do some testing to figure that out.

So one thing we'll do is called an OCT of your macula, optical coherence tomography. Don't worry about it. It's basically a very specialized cross section of your retina. Your retina, that wallpaper that lines the back of your eye is about a quarter of a millimeter thick, very, very thin. And we have a machine that'll take a cross sectional image through the retina. It's awesome.

And it's great for looking, seeing if there's any swelling in your macula, in your retina. You can get swelling, especially with diabetes. If you have diabetic retinopathy, you can get swelling back there that causes vision loss. So maybe that's the reason you're seeing 2040. Who knows? Let's take a look. Let's do the OCT. It'll also show us things like macular degeneration, bleeding from that.

Shows us lots of things. This gives us a general sense of the health of the macula, that center, most important part of your retina. So that's another machine that we'll do. Let's say that you have on your confrontation visual fields, you have some areas of vision loss. Well, guess what we get to do now? We get to do a visual field test. There's the confrontation fields. We say, do you see vision?

Uh, you know, how many, how many fingers am I holding up here? How many fingers am I holding up here? You're covering one eye. How many fingers, how many fingers, how many fingers that's confrontation? That's a very cursory way to check someone's peripheral vision. Well, if we see something abnormal, we will then do an automated visual field, which gives us a much more detailed map.

of the peripheral vision so that looks like a big bowl you stick your chin in it and you hit a button when you see a light and guess what yeah you guessed it patients hate it nobody likes the visual nobody likes most of the tests that we do for people

But that's also a really common one. It's called the Humphrey visual field. You hit a button when you see a light, it's mapping out your peripheral vision and your central vision. It just gives us a general sense of your health, of your peripheral field for things like glaucoma, stroke. We can see defects from stroke, lots of things. So glaucoma is the biggest one that we use it for. Let's take one more break. We'll come back. I have some more devices for you.

All right, coming back. I'm coming back. Let's do a few more little devices, exams, things that we'll do on our exam, on our eye exam. Let's say you have some bleeding in the back of the eye, or you have what's called a branch retinal artery occlusion, where you have some swelling in the retina, or you have a clot, or you have maybe a nevus, like a little freckle back there. We want to document. Sometimes we'll do

a fundus photo. There's lots of different technology that will do this, but it's exactly what it sounds. You put your head in a thing right there and then you snap a photo and guess what? Patients hate it. It's a very bright flash. Just last for a second. Just whoa. Because by then, by then you're probably dilated. And so bright light and dilation don't go well together. So general people don't like it. What else? Um,

But let's say that your retina looks fine. You get the OCT, the cross-sectional image of your macula, and it looks fine. Well, then what's going on? Why are you seeing 2040? Well, you've never had cataract surgery, and that might be it. So the last...

thing that the machine that's of the more common machines that we'll use in the clinic is called an iol master this one's very easy for you for for patients it's just another thing you just put your chin in it and then it just maps it takes a little scan so you just sit there we give you like a little house or something inside the machine to look at say look at the house

And it'll take measurements of the length of your eye and also the shape of your cornea. And that will help us in planning cataract surgery. So there you have it. Those are all like the major ones. There's other machines that we'll use.

Some machines that we have are very specialized. You only find in academic centers. There's things that look at very fine detail in your cornea. There's ultrasound, like eye-specific ultrasounds that we'll do, especially people that treat intraocular melanoma. They'll do a lot of that. So lots of different things. We love our devices. That's what gets a lot of people into ophthalmology in the first place is because they love the devices.

And the just technology and it's rapidly advancing. And that's not why I got into it. I got into it for the sitting. Oh, I love to sit. We, we operate sitting down clinic. We get to sit down, not good for your health, but man, it feels nice. We all get into different specialties for different reasons. All right. And then my next question from at Riley done one nine zero one, uh, piggybacks off of this.

And she said, hi, Dr. G, love the podcast. Two questions. She wanted me to talk about glaucoma. I'm going to save that.

I've talked about glaucoma before, but we could always talk more about glaucoma. There's so much to talk about. Our second question, I have a physical disability and I've always found going to the ophthalmologist difficult as I can't stay still enough for the tests. I'm curious, how do you work with patients with disability? And is there anything patients like me can do to improve our experience at the ophthalmologist? So first of all,

yes there are things that we can do second of all it's not on you to improve your experience that is on us it is incumbent upon your physician and the practice you're going to to make it easier for you as easy as possible now it's not going to be easy it's not

It can be easier, but it's, it's, it's chances are it's not going to be easy because as you've just heard me describe all these machines, most of them require you to have, to be able to maintain a certain head position and a certain height. We can move them up and down a bit, but it can be really challenging. I've had patients with MS who have to be in a recumbent position. Uh, they can't do a lot of this testing, uh, lots of patients, uh, with, um, with, with

physical and mental disabilities are not able to perform subjective tests like the visual field test, hit a button when you see a light. Patients can't do that if they have severe dementia or maybe they have severe arthritis.

rheumatoid arthritis, juvenile arthritis, any kind of arthritis that prevents them from being able to press that button. So every day we have patients with a wide range of disabilities. And so sometimes it limits our options on the things that we can do. But we can always still get a thorough exam. We can...

we can still get a vision assessment from you. Even if you can't, it sounds like you said you can't sit still for tests, but usually we can still check your vision. If you're nonverbal, we have ways of assessing visual function. We can't do things like the OCT sometimes, the visual field test, the IOL master, but

We have a ways of taking measurements for cataract surgery that doesn't require you to sit at a machine. We can have you just laying back. There's ways of doing that. Obviously, we can still check pressure on you no matter what position you're in. And we can do a dilated exam. And that's what they pay me the big bucks for, you guys, is taking any patient that comes in regardless of what they're able to do

and figuring out what's wrong, we can do it. I can always just look in the eye and see what the problem is or make sure that there are no problems and that the eye is healthy. And so, um, I, I love this question, Riley, thank you so much for this. And, uh, and I just, I want to reframe it though, because it is not your responsibility to make yourself comfortable.

I want you to know that. I want all of you to know that. All right. If your practice, if your physician is not doing what they can do, we're not doing enough to make you comfortable. That's it's, it's not that it's their problem. And, and definitely advocate for yourself, right? That's another thing you can do. I guess advocate for yourself. Say, I can't do this.

I can't get up to the slit lamp. Well, guess what? We have portable slit lamps. Got the little handheld slit lamps. You can't sit up at the slit lamp. Very common. We'll get a portable slit lamp. No problem. All right. We can always just do it handheld. I'll bring it to you in whatever position you're in. Okay. So we have lots of things we can do to accommodate people. It is very important that everybody feels like they can come in and get a safe, thorough exam. And I promise you, you can. All right. There will be some limitations.

But we'll still figure it out. We'll do everything we can and take care of your vision. Very important. Great question. Okay. I think we'll save the rest. I've got so many good comments. It's great. I think next time we'll talk a little bit about papilledema versus pseudopapilledema, a term we don't even use, but there's some things to talk about there.

Lots of great stuff. So thank you guys. I feel like I knocked the rust off during this episode. That's good. And I'm ready to go. 2025 is going to be the year of the eyeball. Last time I said that was in 2020 and it definitely was not the year of the eyeball. So I hope I didn't just jinx myself because 2025, like it's still decent vision. It's good. You can drive with that.

You can't like be a fighter pilot, but you know, you're 2025. It's, it's, it's, oh, it's fine. It's good. It's good. I've got lots of patients. You see 2025, they function, everything just fine. All right. You got good vision with 2025. Not perfect, but good.

That's what we're aiming for. We're not going to be perfect this year. I'm not going to be perfect. All right? I'm going to try to do the best I can. So stick with me. Stick with Knock Knock High. Knock Knock High as well. Got some exciting things coming from the Glock and Fluckin' universe this year. I'm excited for it. I'm raring to go.

So thank you all for listening. Again, I'm your host, Will Flannery, also known as Dr. Glockenflecken. Thanks to my executive producers, Aaron Courtney, Rob Goldman, and Sean T. Brick. Editor and engineer, Jason Portizo. Music is by Omer Binzvi. Knock, knock, hi. And knock, knock, I is a human content production. We'll see you next time, everyone. Bye. Knock, knock, goodbye. Human content.