Knock Knock Eye: What Are Ortho-K Lenses and Are They Worth It?
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your AI assistant for automated clinical documentation and workflows. To learn more about how Dax Copilot can help improve healthcare experiences for both you and your patients, visit aka.ms slash knock, knock, hi. Again, that's aka.ms, they're like Microsoft, you know, you know, slash knock, knock, hi. Knock, knock, hi.

Hello, everybody. Welcome to Knock Knock Eye with me, your host, Dr. Glockenflecken. Thank you for joining me. I'm excited about this episode. I've got a lot of great comments and questions to get to, to talk about some interesting eyeball topics, an unusual TikTok trend I was just informed about, and I'm not too happy with it.

And, uh, and, uh, just, this is your one-stop shop. All things eyeballs as usual. Uh, this episode will go up on, uh, any place you get your podcast also on our YouTube channel at Glock and plugins. I was just talking to Kristen cause she's not involved with this. She's she, trust me. She isn't one.

want to really know anything about eyeballs. She's, she's heard it all. She's heard everything, all the things that I have to say. Uh, but I just informed her, uh, about how I was so excited about how many comments I've been getting on these knock, knock eye episodes. And you guys are coming to me with great stuff, great insight, uh, your own experiences, questions, topic ideas. It

It's fantastic. I'm just very excited. And it's been a long time since I've gotten excited about comments on my social media pages because thousands, tens of thousands over the years of comments. But this feels different. It feels like we're really forming this little community of people who really are just interested in ice.

I, I, it's like, it's a, we're just a big family here. A big eyeball family. Some of us have big eyes. Some have small eyes. Some have crossed eyes. Uh, but we all have, and some of us actually don't have eyes or maybe you've lost an eye. That's okay. All eyeballs are welcome here.

And so, uh, uh, where it's late. It's, it's, I'm a little punchy already. Haven't had anything to drink. Nothing. Cause I'm operating tomorrow. I operated today. I'm operating tomorrow. It's a day with two OR days, a week with two OR days. Uh, tomorrow is my, my, my hospital based operating room day.

So normally I'm at our outpatient surgery center as part of our, of our private practice, but I go to the hospital for patients who are not healthy enough for an outpatient setting or an outpatient surgery center, I should say.

There's just a higher level of care that can happen at a hospital. Now, it's going to be interesting because the hospital I'm going to to do surgery is a hospital that's on strike right now. I don't know if you guys have heard the Providence system hospital system is there's a ton of nurses, like five thousand, six thousand nurses on strike.

Uh, but this is different because for the first time in Oregon's history, and honestly, this just doesn't happen much anywhere. Some, there are physicians who are on strike too. So there's some, um, OBGYN hospitalists also like internal medicine hospitalists. I think there's over a hundred physicians and that's like, that doesn't seem like a lot, but yeah.

There's obviously exponentially more nurses in the country than there are physicians. And nurses are no, they're very, they have strong unions. It's not, they're just, they're better organized than physicians are.

So for physicians to get organized enough to be able to have a large, a significant group of them strike because of, of adverse working conditions, not enough, um, staffing, not enough help to where they feel like unsafe taking care of patients in the hospital. I think it's, it's very, it's, it's, uh, courageous. It's, um, it's, it's remarkable. It's historic. And I think we're going to probably going to see a lot more of it.

I've talked to the, I went out and visited the people that were striking at the hospital near one of my practices. And, um, it's, uh, they're just, they're just, they're just regular people just like you and me. They're all, they're just trying to do their job and they know what it takes to do their job safely, to take good care of patients. And that's what they're trying to do. And so I commend them for what they're doing, uh, putting themselves at financial risk, uh,

uh, to, to, to, to strike and try to get Providence to come to the bargaining table. So I've been learning about it, hearing updates, uh, from, uh, some wonderful people, uh, on social media. Jennifer Lincoln is a physician who's been posting like every day, giving updates about the, uh, the strike, uh, on Tik TOK. So go, if you're interested in this, which, uh,

If there wasn't so many other things going on in the news right now, like the LA fires recently, obviously the inauguration and the 500 executive orders that Trump, everybody's still waiting through that. If there wasn't so many other things taking up the news cycle, I think we'd be hearing more about what's happening in Oregon right now.

This is massive, big enough to where there's federal mediators coming in. Like the big, big, big guy, big guns. They're coming in to try to solve this because it's, it's obviously a huge problem. So,

Hopefully, they come to a resolution, some kind of agreement that can make everybody feel better about being able to do their jobs and take care of people. Because ultimately, that's what it's about. It really is. It really is. I mean, people need to be paid fairly, but people also need to be able to be working in a place where they feel supported.

and safe in doing the very difficult things that they're doing in patient care in the hospital. I don't presume to know a lot of what those things are. I like to pretend I know in my skits. But again, I am an ophthalmologist, so the level of my knowledge is a bit limited. But I wish nothing but the best for all the people out there striking. And it's cold in Oregon, you guys. It's a bit chilly outside.

Uh, so when I went out there, they had, they had little fire pits going. They even had a taco truck. So they can, uh, some really nice support from the community. Lots of honking, lots of, uh, for some reason, people dressed up in, in like, like a inflatable dinosaur costumes. Maybe it's warm. Maybe it's like warm inflatable. That actually would feel really good on a cold day. Other news before we get into your comments and questions.

as a tick tocks back. You guys, it's, it's back. I know there was never a doubt. Like it was never going to go away and, and, and stay away forever. Like that wasn't going to happen. I don't think anybody really honestly thought that that would happen.

Actually, I think there were some creators that did because there was a lot of goodbye messages. But it was mostly like, oh, well, if it doesn't come back, if this is my last video type of stuff. And I don't think anybody realized it was only going to be gone for like 14 hours. There were internal medicine doctors who I'm sure were rounding throughout the entirety of the TikTok ban.

14 hours and it was back. I didn't even know it was back. I was still making jokes on blue sky.

uh and uh and because i am a millennial i'm an i'm an a middle-aged millennial and as we all know blue sky is the millennial retirement home so that's that's that's why i was there and i was uh telling jokes and then somebody in the comments is like oh it's back i felt like an idiot i was like in in classic elder millennial form i'm just a little late to the game to the social media game the trends there so anyway

I learned it was back and it looks, it's like it never left. But I did learn that I think you can't download the app anymore. Like if you have the app on your phone, it works. TikTok works. But if you don't, I don't think you're able to download. I didn't fact check that, but I heard, I saw videos about it. People talking about that.

uh so uh that means that your phone with tiktok on it might someday be worth soon some people may be worth a lot of money on the secondary marketplace you could sell your phone like the people did with the the flappy bird game that was a big deal like people that still had flappy bird that worked they sold their phones for like a thousand dollars people that wanted to play flappy bird maybe even more i don't know anyway it's back and you know there was a lot of

you know, I, I still check out Twitter, um, blue sky, you know, I, I check in from time to time. A lot of people were dunking on Gen Z and people who are probably a little too old for TikTok like myself, uh, about, you know, Oh, I guess I'm going to have to get real jobs now. They're going to, you know, all this stuff. And it's, it's very clear to me that people that just don't

I've never spent any time on TikTok. Don't really know what TikTok is. It's not a dancing app anymore. Like, yeah, it probably like back in 2020 when no one really knew what to do with TikTok. It was this brand new thing, fast paced, scrolling through just video after video. So addictive.

nobody knew what to do with it. And so, yeah, there's just, and it was like the music, the way you could incorporate music into your video so easily. Yeah. It was a dancing app for a while. It's so much more than that though. It's like people have found real communities on Tik TOK. Uh, people have legit businesses. I talked about this last week. And, um, and so to, to diminish it and by saying it's a dancing app and we don't really, who cares? Like a lot of people care.

But I am not going to sit here and tell you that it's never going to get banned because I think it's like 75 days. We have 75 days to figure it out to see if Mr. Beast will buy TikTok. I don't know. Having been through one social media app that I really enjoyed, which was Twitter, having that bought by a billionaire,

It hasn't gone real well, so I am a bit dubious that somebody, an American billionaire or two or three or four, because it's going to be much more expensive than Twitter was, can swoop in and just everything's fine and stays the same and the algorithm is just as good. I have my doubts. So I don't know. We'll see. But that means I get to keep making videos. And I decided today that I'm going to start working on a new

um a new series of skits i did the first day of medical student rotations like first day of gastroenterology first day of general surgery first day of ophthalmology so on well i'm gonna i did one i did one already this is like probably months ago i just forgot that i had done it i'm gonna do last day of rotations the last day of anesthesiology the last day of internal medicine of

of infectious disease, all of them, neurology. So I've got some good ideas for my first one with surgery. I'm excited about it. I mean, it's fun because I've been in a bit of a rut with like just finding the time and energy to keep making skits. But sometimes you just get an idea and it just, it's really still exciting for me, which is anyway. So stay tuned for that.

Coming out to you on all the social media platforms. All right. Let's take a break and then we'll get to some of your questions and comments. Hey, Kristen. Yeah. I know you're a big fan of Demodex mites. Uh-huh. You know, the eyelid mites? Yeah. They're on your eyelid? Uh-huh. They're just right there in your eyelid? Yeah. Thank you. Well, what if they flew at you? Oh, God. What if they jumped? What if they jumped?

Would that bother you even more? Oh, it'd be even worse. Would that be better? Jumping bugs are always worse. Well, I have good news for you. They're not jumping. They don't jump that cheap. That is good. But they are there and they can cause like crusty, flaky, itchy, red. That's not good. Irritated eyelids. So I can tell you're a little bit grossed out. Yeah. It's a disease. It's called demodexblepharitis. It sounds like no fun. But it's pretty common.

And a lot of people don't really know about it. Yeah. But I mean, these like, they are kind of cute. I gotta admit, just a little, just a little cute. Maybe a little cute. Regardless, you shouldn't get grossed out by this. You should get checked out. Okay. Go to eyelidcheck.com for more information. Again, that's E-Y-E-L-I-D check.com to get more information about these little guys and Demodex blepharitis.

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All right. So, uh, this, um, these are, are, are comments on my most recent knock, knock. I, uh, which was titled, what are all those machines at the eye doctor's office?

Not my most popular episode, but I still got a lot of great content from you guys. So I appreciate all the comments. Nobody had any questions about the machines though. So I think I overestimated how interested people would think the equipment at the eye doctor is.

I don't know. I don't know what I was thinking. I think it's fantastic. I think it's really, you know, interesting and impressive, but I can, I can understand how that would be a very, just a me thing and not a like everybody thing. So, uh, but, uh, some topics did come up during that episode. And, uh, one of them was the idea of, is it.

okay to go up to a random person as a physician and diagnose them with things like you're in the airport, you see someone with something, Bell's palsy, whatever, a cancer, skin cancer, melanoma. Is it okay to go up and talk and say, Hey, I think you might have this. You need to go get checked out. I discussed some great responses. A lot of people were

generally we're like if it's life-threatening tell me otherwise keep your mouth shut nosy doctor man all right that's that was the general like consensus here uh so a few of them kind of made me laugh though at chris uh pre-polick 5616 said one of the gastroenterologists i work with diagnosed someone with melanin in an airport bathroom by the smell

And told them to get a referral for a colonoscopy. He's in Canada. They were not letting that go.

Oh man. So melanin, those of you who may not know what melanin is, if you have like a lot of like bleeding in your upper or middle GI tract, as the blood like goes, travels through your intestines and your GI tract, it'll get metabolized and end up like black. It'll turn your stool black and it's like tarry. That's honestly, that's,

If I'm being honest with you, I have never once seen melanoma. I know it's probably like surprising that even though I'm an ophthalmologist, I did go through all of med school, a bunch of clinical rotation. I did a GI rotation for God's sake. There's no excuse for me not looking in a toilet and seeing melanoma other than the fact that I did not want to do it. I don't know why I did that rotation.

Very much not something that I, the one thing I remember from my GI rotation, like all the internal medicine rotations required a lot of rounding GI. I think it was just the, the fellow that I worked with the team. Oh man, those rounds, the rounds on GI were worse than any rounds I had ever experienced in med school. The length, the amount of, of toilet peeping, uh,

like peering, looking into the toilet. I had to look in so many toilets. I had to see so much poop. It's, I don't know. I mean, the colonoscopies were cool. It's kind of fun to watch. Once you've seen one, I feel like I saw them all. And so that's probably why I didn't want to do gastroenterology. Anyway, I'm getting sidetracked here. The point is this good doctor, this gastroenterologist did a great thing and quit smoking.

could smell, could, could figure it out just by smell alone that someone had black tarry stool and probably had an upper GI bleed and needed to get checked out. So maybe it wasn't a colonoscopy that they recommended. Maybe it was an endoscopy, a scope. We'll say scope. Um, what other, what else can you diagnose just by smell? That's a good one.

Obviously C diff is a big one. Like everybody talks about you. I think even I, I know what C diff smells like. So I could probably diagnose even now that's something that sticks with you. You just, you kind of know and you never, you don't, you know, uh, I could, um, I think pseudomonas also has a particular smell. Um, what else? I think because of my time, um,

in close proximity to people at a slit lamp. So when you're at a slit lamp, your face, unfortunately is like within what a foot, sometimes even a little less than the person. Now, hopefully your slit lamp has a little plastic shield separating you, your breath from someone else's breath, but not always. Um,

And, uh, and, um, it's the emergency department slit lamp exams that, oh, I struggle with. But anyway, because of the, the thousands upon thousands of exams in close proximity to someone's mouth, I can kind of tell when someone's got like, like a rotten tooth or like some kind of infection. This is getting gross. Anyway, I think that's a smell I could probably figure out. Um, what, uh,

Tell us what other smells could you like? Is it like an instant single neuron arc? Like you smell something or what? Give me the hospital smells that you just know immediately. Oh, that it doesn't have to be a gross thing either. It could be just whatever. What, what, what is a smell during the course of your normal workday at a hospital where you're like, oh, I could, I'll remember that for the rest of my life. I know exactly what that smell is.

I guess most of them are probably going to be bad smells if I had to guess, but I'd be, I'm interested in what you guys have to say about that. All right. A couple other, uh, comments about the whole diagnosing someone just by looking at them. Um, this is a good comment at, um, Amar I E B 29. Sorry if I butcher any of these usernames.

I have a physically visible genetic condition, neurofibromatosis, that among other things causes numerous skin bumps, non-cancerous tumors.

Obviously, it says a doctor has never walked up to me and said something, but occasionally someone else will say something. I hate it. It's embarrassing and makes me feel ugly. Unless you are a doctor, see something that is life threatening. I don't think you should walk up to someone and point something out. They are likely aware and would rather people didn't say anything. Absolutely. That is the final question.

uh, the judgment on this, on, on doing this, unless it's life threatening, don't say anything. The person probably knows. All right. Thank you for that comment. I really appreciate that. Uh, one more at Layla can feel three, three Oh four said, I work with a general surgeon who spotted a suspicious mole on a lady at one of his kids sports games.

He did not know her, but went up to her, told her he's a surgeon and he thinks she has a melanoma. She said thanks. And a few months later, found him and thanked him because it was melanoma. Good job, general surgeon. Personally, I would melt in a puddle of gratitude if someone pointed out a potential malignancy to me. You're all saying the same thing. If it's potentially life-threatening, let someone know. But otherwise, keep your trap shut. All right. We'll go with that. That's good.

All right. Thank you for the feedback. I love this. I love we can crowdsource some of these decision-making points here.

um somebody oh here's one at ccrlh we're changing the gears here 85 said apparently there's a recall on sustained due to fungal contamination and sealed vials this is the first one i've seen where a major brain was contaminated i haven't talked about this yet i need to look into that and see like how extensive this i did hear about the sustained fungal contamination i am not happy folks sustained was supposed to be one of the good ones

What's going on with these artificial tears? I'm so hurt because I have been probably on this podcast, certainly on social media elsewhere. I have sung the praises of brands because they didn't have a big outbreak like this. There were no instances of refresh Optiv Advanced.

One of my favorites or blink or sustain ultra. None of them.

killed people by introducing Pseudomonas to their brain. No, it didn't happen, but now things are happening. It was always the generics, the, the, the, the strange names that you only find in like Topeka, Kansas or something, not, not nothing about Topeka. It's just the first thing that came to my mind. Uh, but it was those, the, the, the random generics. You never heard about the major brand names, but that's not true anymore. I don't know what to believe folks.

I'll look into it. I'll see if it's, it's, if it's been contained yet and get back to you next week, or maybe I'll say something on social media about it. All right, let's do some more. Let's see how we're doing on time here. Oh, we're doing all right. All right. So do one more and then we'll take another break. Let's see. How about, oh, this is a good topic. So I've got a couple of kind of deeper topics to get to. All right. This one at, oh, it's a bunch of random words. It's just another user. Okay.

hr9zv blah blah blah been hearing a lot about ortho k ortho keratology would love to hear you talk about these other types of vision treatments besides contacts eyeglasses and surgeries love the podcast thank you so much you should get a real name for your i think it was just like a randomly generated one anyway i appreciate that comment uh thanks for listening and watching the podcast

So yeah, I talk a lot about obviously glasses, mostly glasses because I love glasses. They're great. They're safe. I talk about contacts, talk about LASIK. I've talked about that several times over the past few months, but I don't talk about the other potential options. And there's one called ortho keratology. So this is not as commonly used. So ortho keratology, also known as ortho K,

It's still a contact lens, but for a slightly different purpose. So these are rigid gas permeable lenses. Basically the type of lens that people that, that like contacts used to be before we had the soft like dailies, monthlies, they used to be just hard contact. We still have patients that come in wearing hard contacts. There's still a market for hard contacts for different eye diseases, but that's what all contacts used to be as hard lenses.

Well, now you have these specialty hard lenses that are used for ortho keratology. And what it does is these lenses will temporarily reshape your cornea to improve your vision. So kind of like orthodontics for your eyes, like braces for your eyes.

You wear the lenses at night and it reshapes the front surface of the eye. So if you have, these are primarily, I think they're only used for myopia is my understanding. I don't do this. Nobody in our practice does this. So that's why I'm saying it's not as common because there's just better, safer options. And we'll get to why in a second. But these lenses will reshape the front of the eye. And so if you have myopia,

then it'll flatten the surface of the eye, which moves the focal point further back and helps to treat your nearsightedness. So it just flattens the cornea. So you wear it at night, it's flattening the cornea, you take them out in the morning. So obviously, our first red flag with these things is you're sleeping in them. Now,

And that's the biggest, and that's probably the reason that like 99% of ophthalmologists are like, the hell no. Like, I'm not recommending that to my patients because there's other options. We have surgical options. We have non-surgical options, regular contacts and glasses that can treat your myopia. So I'm not wanting to put someone's eyes at risk. Now, I would say there are some patients that this would be okay trying.

The problem is that the biggest market for this type of thing are kids, are young people who are too young, who have myopia. And we're talking like mild to moderate myopia, not high myopes. We're talking like minus two, minus three, who are too young for LASIK.

for something more permanent. And so parents will come in and be like, well, are there any options? Well, ortho keratology is an option. And so you wear these at night and take them out in the day. And then, but it takes, it takes several weeks of using these and the issue with having kids in contact, especially in contacts that reshape your cornea. Do they work? Sure. Yeah, they, they re they do. They reshape your cornea. Now, are they, how effective are they? The studies we have

show that most patients will get to like a 2040 level. And so you may not get the full desired effect of like perfect vision like you would with like LASIK and it's temporary. So that's something in the pro column, I suppose, if you want to just try something out and see if it works. But when you're putting, when kids are using these, you have to be so worried when kids are using any kind of contact lenses, much less ones you can sleep in.

Um, you have to worry about hygiene. Hygiene is such an important part of, of safe contact lens use. And that's what makes me so nervous because that's, who's asking for ortho. Okay. It's, it's the kids. It's, it's the teenagers, uh, who come in with their parents and they're, they're asking about ortho. Okay. I've never, I've never known a single adult using ortho keratology. Um,

I think probably mostly because as you get older, you start to appreciate your mild to moderate myopia. People like being a little bit nearsighted, so they don't want that taken away from them. But, and our eyes just don't tolerate contacts as well as we get older. But it's the hygiene. Like you're putting that kid at risk

at much higher risk of infection than even with like a regular contact lens because they're sleeping in them they're in them for a long time now they're gas permeable which helps right there's still oxygen able to get to the surface of the eye but it still makes me very nervous really to have any like 12 year old in a contact um and so uh but that doesn't mean it's unethical or it can't be done it just requires it's you got to pick the right patients to do it with

And you have to have a lot of counseling, make sure they're doing everything right. Washing their hands, using fresh solution, lens, lens cases, all these things. So anyway, um, but it's, it's the safety issues that I think are, uh, push a lot of eye, eye, eye doctors away from, from doing this type of thing. Also, the other thing that people don't like about it, it's freaking expensive.

I, I, I, I don't know the insurance coverage for something like ortho K, but ortho K prices, it rains. It's usually like a thousand, even up to like four or 5,000, like for the treatment. That's a lot about like those that's LASIK prices right there. Right. So, um, I don't know. I'm just, I'm not a fan for the price, the risk. It's, it's just, I don't know. Just get glasses. Glasses are in now. They're so they're, they're, they're popular. Let's take a break.

Here's another question. At Julie Rose N2O said, are there different strengths of medications to dilate the pupil? I have been seen by a retina specialist and afterward the dilation lasted for 24 hours and was incredibly painful. I'm so sorry. I've had many eye exams, but that was the worst. Yes, we have different concentrations and strengths of dilating drops. People don't know this. So our go-to dilation,

Like 90% of ophthalmologists are just going to jump to this. This is what we're going to use. We're going to use a medication called phenylephrine 2.5%. That is an alpha agonist. So it activates your, your, your sympathetic nerves, your fight or flight response.

which will help to contract the pupil dilator muscle. It's actually a muscle that helps to open up the pupil. So we attack it from the sympathetic side with phenylephrine, 2.5%. We also do go it from the other way. So we activate the sympathetics with phenylephrine and we block the parasympathetics

with, um, uh, tropicamide. That's our go-to. There's two different concentrations. So if someone comes in and said, I really would like the, you know, something that doesn't dilate my eyes for very long at all. Well, we can use half percent, 0.5% tropicamide, which is, uh, um, uh, it's, it's, uh, anticholinergic. So it blocks the parasympathetics.

So basically it does. So we activate the sympathetic block, the parasympathetics, the parasympathetics help to constrict the pupil like pilocarpine. That's a parasympathetic type medication. It'll, it'll, it'll bring the pupil down. Well, if we block the parasympathetics, it just, that's actually the strongest way of dilating the pupil is with a parasympathetic blocker and anticholinergic, um,

The sympathetic, that is phenylephrine, it doesn't do it. It's not enough. It's weak. It's very weak. But the two in conjunction with each other works really well. So the half percent, that'll get you like a couple hours of dilation, which is great. That works well. It doesn't dilate as well. So for this person, Julie Rose here, who went to the retina doctor. See, retina specialists, especially if they're looking for things like retinal tears, retinal detachments,

You really need a wide open pupil. You want that pupil as dilated as possible. 1% tropicamide and phenylephrine, again, our go-to combination, that'll probably get it. But some people, especially people with much darker irises, it might not give you as big of a dilation as you want. And so you got to bring out the big guns.

So we have cyclopentolate. That's the next step up. If tropicamide doesn't do it, you have another anticholinergic called cyclopentolate. We cyclo them very strong, get you much bigger dilation. We have a 1% cyclopentolate. We even have 2% cyclopentolate. Oh yeah.

We get after it sometimes, especially with cataract surgery. Any kind of eye surgery, yeah, we're going to dilate the hell out of your eye. And with cyclo, it lasts about 24 hours. So you probably did get cyclopentolate, and that's why it lasted about 24 hours. Tropicamide, 1%, gives you four to six hours of dilation. Cyclopentolate,

for 24 hours guess what it gets even worse like we have something called scopolamine so you heard of the scopolamine patch if you put a scopolamine patch on say you're you have a seasickness or something and you you get a you're on a cruise and you want to get a scopolamine patch if you touch it and then rub your eye that scopolamine will get into your eye and you'll have a dilated eye for about a week

scopolamine even stronger and then the strongest we have is atropine so atropine is as big as it gets uh we use that in kids uh for a variety of different reasons um primarily you know the one of them is as a treatment for myopia for amblyopia uh and myopia it's also myopia treatment so atropine that'll keep the eye dilated for like two weeks very very strong very strong

So, um, that's the, that's the rundown of, that's a good question. Rundown of dilating drops. If I had, and I got asked this today, it was like, do you have something that can take the dilation away? If I had an eye drop that could immediately reverse dilation, I'd probably make a lot of money. I, it doesn't exist as far as I know. It doesn't exist.

That would be convenient though, wouldn't it? Just put a drop in. We have things that we can put in the eye at the time of surgery that'll bring the pupil down. I have to imagine though that if you had something like that, it would cause a tremendous headache because to do that, you have to activate your cholinergic system

which also will activate your accommodation. And so your accommodative, you'll get this accommodative spasm with any drop like that, that reverses dilation quickly and can, uh, uh, you get like this horrendous brow ache. I just, I'm pretty sure that's what would happen there. Good question though. All right. I got one more question for you for this episode at Darian.d97.

infection preventionist here. I recently came across a case involving an amniotic membrane transplant graft. Absolutely blew my mind. Could you talk about this type of technology? Are the placenta donors compensated in some way? Great question. You know, there's some things you just don't even like think about. I got to say,

But are a little strange and unusual. And I got to say, I've known about like amniotic membrane grafts. I've used amniotic membrane grafts. I've seen them done and used in dozens of eye surgeries over the years. I've never once really thought about how amazing that is and where it comes from. So I just, I did a little bit of research into it.

Not a whole lot. All right. Sorry. This is supposed to be fun for me. I don't, I don't like doing research. Uh, but this actually was quite interesting. So, um, amniotic membrane is the innermost layer of the placenta. And so it doesn't, and these, these, this layer of this membrane, it's, it's a membrane. It's a very, very thin, right? It's a, it's, it consists of a, the basement membrane and then the avascular stromal matrix.

And it's actually used in different surgical specialties. But in ophthalmology, we primarily use it when we need to reconstruct the surface of the eye. There's a number of reasons why we need to do that. Like if we do a teresium surgery, teresium is where you have this scar tissue type, basically the white part of the eye, the conjunctiva, starts to grow abnormally onto the surface of the cornea. And we have to remove all that

abnormal tissue and it leaves a bare spot on the sclera where you don't have conjunctiva because you have to remove the abnormal conjunctiva. Well, you can put an amniotic membrane graft right there in its place and it just helps to form, it acts as a scaffold for new tissue to grow over it.

It can also be used as a bandage for people that have neurotrophic keratopathy. A neurotrophic cornea is when the cornea, which is supposed to be the most sensitive part of the body, and is normally, loses its innervation and that causes the epithelium of the cornea to slough off and it can't heal itself. You have this

what's called a neurotrophic ulcer, where you have an epithelial defect, basically a corneal abrasion that just won't heal. It can't heal. The cornea doesn't have those nerves and those nerve growth factors to help it heal. That's a big problem because that invites thinning and atrophy of the cornea. It invites infection in the cornea.

Big problem. Well, sometimes we can use amniotic membrane to just help provide some of those growth factors, some of that tissue that helps establish a better environment for the cornea to heal itself. So it's all ocular surface stuff. That's what we're talking about.

And, um, um, but where does it come from? That was the, that was the question, right? Where's the, this amniotic membrane come from? Um, and the way they do it is during elective C-sections. So to get, to harvest amniotic membrane, you get informed consent from a patient undergoing an elective C-section. And then, um, they, the thing I don't know, because I've never seen this process is exactly how much of the placenta they take.

I imagine they have to take, they, they take some of it or maybe all of it. I'm not sure. And they have to section it to get the thin amniotic membrane that they need for, for transplant. Um, and then they, uh, they screen it for infections, obviously that like they do with any organ, uh, that's being transplanted and then it's cryo preserved. So the way it comes to us is,

Is it comes in like a little sheet and like a, I'd say like a, a small, like a dollar bill sized container here and you just open it and it's, it's, it's frozen and you, you thought out and then you just, you, you, you take it out and you can just lay it. You can suture it onto the eye. You can just lay it on. You can cut it into smaller pieces. If you need a smaller section of it, really easy.

amazing, amazing thing. And the question, one of the questions here was, what is it? Oh, are the placenta donors compensated in some way? I don't think they are. I don't think they are because it's probably just like it would be any kind of organ donation. You can

because I'm nobody in my family has ever gone through a c-section so I'm not sure how this process someone could should it would be great if you could enlighten me um it's probably just a question that's asked like are you okay with donating your placenta um so I would imagine it's not something that you'd be compensated for um because it's it is tissue that's

is, is going to be, be discarded otherwise usually. Right. I think some people want to take their placenta with them. Um, but, um, I imagine it's not. So anyway, I'd love to hear, hear from someone who has actually gone through that or knows a little bit more about this than I do, obviously. Um, okay.

You know what? Let's stop there. I didn't get to, you know, I'm going to tease, I'm going to tease you guys with a little something. So I learned about a TikTok trend that I'm not, I'm not too thrilled with. It involves people like trimming, cutting off their eyelashes, like taking like clippers and just cutting their eyelashes. Why? I don't know. But I think next time, next episode, I'm going to talk about a bit about

eyelashes let's talk about like how long does it take them to grow what kind of diseases cause you to lose your eyelashes is there anything you can do to regrow your eyelashes just all about eyelashes I've talked about fake eyelashes and everybody knows my disdain for fake eyelashes don't like them never not a fan

Uh, but we're, we're going to talk a little bit more about eyelashes, including I'm going to, I'm going to do a little bit more research about this trend. I'm going to watch a couple of tech talks. So what exactly people are doing with their eyelashes? Why on earth they would trim them. I don't know. Like this, why, why?

People would kill for long eyelashes. They probably have killed for long eyelashes. Anyway, so I'll save that for next episode. Thank you all for listening. Again, all these episodes, you can get them any place you get your podcast, but also they're posted on YouTube. You don't have to watch me. If you don't want to watch my look at my face, that's fine. You don't have to watch me, but if you have a question or you want me to shout you out, if you have a good comment, anything, story,

Great stories. I love great stories. You guys know. Hi. We love stories over there. Or just anecdotes. I guess those are the same thing as stories. What am I talking about? Or topics you want me to cover, comment on the YouTube channel. Subscribe, too, while you're there. I really appreciate it. And I'll try to get to as many as I can.

So thanks again for listening. I'm your host, Will Flannery, also known as Dr. Glock and Flecken. Executive producers are Will Flannery, Aaron Corny, Rob Goldman, and Sean T. Brick. I guess I'm kind of a producer of my own podcast. I'm producing this podcast for you right now. Our editor and engineer is Jason Pardeser. Our music is by Omer Binzvi. Knock Knock Eye is a human content production. Thank you all. We'll see you next time. Bye. Knock knock. Goodbye. Human content.