Evo Terra (Host): This is Expert Insights with the Carle Foundation Hospital. I am Evo Terra. Today's topic, healthy vision. And I'm joined by Dr. Cherie Oshiro-Johnson, an optometrist at the Carle Foundation Hospital. Welcome to the show, Dr. Oshiro-Johnson.

Cherie Oshiro-Johnson, OD: Hello Evo. Thank you for having me.

Host: Now, I don't normally associate Optometry with hospitals. So, what exactly do you do there?

Cherie Oshiro-Johnson, OD: So basically, we do full eye exams. We treat eye disease. We pretty much have full scope of practicing other than the surgery part. Whatever our comfort level is as far as treating diseases and things, we can do as much as we want. And the good thing is, in a group practice, we have Ophthalmology that's right across the hall. So if there's something that we don't feel comfortable with or something that is out of our scope of practice, we can refer, you know, in-house.

Host: Great, great. Now, since the topic of this episode is Healthy Vision, let's start at the beginning. When should kids have their first pediatric eye exam?

Cherie Oshiro-Johnson, OD: So, that's a million-dollar question. Because if it was up to us and the American Optometric Association, we would like to have all kids come in between six months and a year. Now, when I mention that a lot of parents, they're surprised, why so young? And a lot of the pediatricians right now will recommend a kindergarten exam because that is an Illinois state law. And I'm not sure about any other states, but you have to have a real kindergarten exam by kindergarten. But we find like some of the pediatricians are now recommending about age three, which is fine. That's totally appropriate. But the real, you know, American Optometric Association really recommends between six months and a year.

Host: Wow, that's quite aggressive, I would think as a non-optometry person, obviously. You know, thinking about this, I didn't get my first pair of glasses until I was like in middle school, I think. And I had-- well, I had very, very mild farsightedness. So, thinking of that, should parents or guardians be aware of vision problems that aren't presenting in their child's behavior?

Cherie Oshiro-Johnson, OD: Yes, exactly. That is why we recommend exams so early. Kids, they feel any problem they have with their vision, they feel it's normal. So, either they're going to be too young to complain, or even if they get older, they may not complain, because they feel like that's how they're supposed to see. They don't know what good vision is if they have a problem.

And some of the things that we detect in early screenings are if they have one eye that is a really high prescription, and the other eye's "normal.". Then, that weaker eye can have some amblyopia or just poor vision and they function fine. They walk around fine, they play sports fine, they do their schoolwork fine, because the brain kind of shuts off or suppresses that weaker eye. So when they come in and they have an exam, we try to take vision in each eye. Then, we could tell like they're not seeing well. Or if they're at home and they accidentally rub an eye and they're old enough to tell the parents, "Oh, yeah, now I don't see in this eye," then it can go detected later. But as far as like when they're younger, it may not go detected. And early prevention, early treatment is key to getting that poor eye back to the best level possible.

Host: I can see how you might want to give a kindergartner an eye exam if they can't even do their letters yet, they can do shapes and things like that. But how do you do it on a six-month-old?

Cherie Oshiro-Johnson, OD: So when the infant comes in, or anybody that is not able to read the chart, what we usually do is just to get some kind of level of vision. I mean, obviously, when they're babies, we can't really gauge this. But in a toddler, we might be able to. But basically, we just cover an eye and see if they'll fixate and follow with that eye, a target. If some kids who have poor vision in one eye, they'll let you cover the bad eye, because they see with the better eye. But when you go to cover the better eye, they try to pull away or prevent you from covering that eye. So, that's a sign. So, as long as they can fixate and follow with each eye.

Now, in an infant, a lot of times they won't do that because they don't have the visual development to follow a target. So, what we're looking for is mainly prescription. Do they have a prescription that is abnormal or higher than normal, and we need to follow that infant. Or do we have something that is wrong with their binocular vision? Are they crossing an eye? Are they uncrossing an eye? And then, we dilate their eyes so we can make sure the back of the eye's healthy. When I did my residency, I did a CMV retinitis rotation, and a lot of these babies had scarring in the back of the eye, just in one eye. So, that would go undetected because they would function fine even though they were essentially blind in one eye.

So, it just helps us get a baseline. Do we prescribe glasses to infants? Hardly ever. Because there's hardly ever a case where they're so high that we feel like glasses will help their development. But it allows us to maybe follow somebody a little closer every six months, every four months if we're suspecting there could be a problem in the future.

Host: Yeah. And that makes sense. There is a lot of fancy equipment in your office besides that old eye chart that we are all used to.

Cherie Oshiro-Johnson, OD: Yes. And we shine lights, we have bars with lenses on them that tell us what prescription the child has. So, there's a lot of testing we can do, and they don't even have to respond.

Host: That is great. So, I'm thinking about family history. I want to talk about that with you, and I want to understand how important family history is to helping you doctors figure out how kids' eyes can be healthier. So, my parents, both of them now wear reading glasses because they're approaching 80, but they never did growing up. Never had glasses. But I did. So, how much of a factor did genes really play?

Cherie Oshiro-Johnson, OD: Well, it depends on the severity of the prescription. Usually if parents have really high prescription or if they have an eye turn, you know, strabismus or any kind of ocular disease, it definitely makes the risk in a first-degree relative higher. And first-degree relative, we're talking about parents, siblings, children, any of the first-degree puts you at a higher risk. So if two parents are severely nearsighted, chances are the child could be. But environment also plays a role. Nowadays, we have the tablets and the phones where there's a lot of focusing up close and that can cause changes in nearsightedness. So while genetics play a role, it's usually more of the severe prescriptions.

Host: It makes sense. It's summertime. And everybody likes to go outside in the summertime and spend their time soaking up the sun. Now, personally, me, I do not wear sunglasses and I don't wear sunglasses because I will lose them within three minutes of buying them. So, I'm not allowed to buy sunglasses anymore, says my wife. But at the same time, I'm rarely outside without a hat on. So, to block the sun, is there something else that I should be doing to protect my eyes?

Cherie Oshiro-Johnson, OD: Well, I mean, we always recommend sunglasses because, you know, a hundred percent UV protection. You can get UV light damage on a cloudy day. You can get, obviously, UV light damage on a sunny day. But there's macular degeneration, there's cataracts, there's things that the UV light can put you more at risk for developing those things.

Now, cataracts, it's not severe. Everybody gets cataracts if they live long enough, but sometimes the UV light can make it grow faster. And macular degeneration, again, it's predominantly older people, Caucasians, people who smoke, but we always recommend that people try to wear UV protection, especially the people who work outside a lot, that are always outside in the sun, even though they wear a hat, you can still get some exposure.

Host: Yeah. Yeah. I was like, my trick is to just stay inside. I just do that. Just stay inside and I'm fine. Anything else we haven't talked about that you wish to discuss?

Cherie Oshiro-Johnson, OD: No, I mean, the other disease that's fairly common, that can be more at risk if you have a family first-degree relative that has it is glaucoma. Well, there's different kinds of glaucoma, but the most common one is when the pressure gets high in the eye. And the pressure can go very high, and you may not feel it until it's in the 50s, but you can get damage when it's in the mid to high 20s and 30s. So, it's called the silent disease because people don't know that their pressure's high. That's why it's important to get eye exams often, especially when you're an older adult, just your vision's fine, but let's just check your pressure and look at your nerves.

So, African Americans, Latinos, Scandinavian descent people are more at risk. And then, again, you know, if you have family members, it puts you like about 10 times more likely to get it.

Host: Got it. Good. Excellent advice. and all of this has been, Doctor. Thank you very much for all the information today

Cherie Oshiro-Johnson, OD: Absolutely.

Host: Once again, that was Dr. Cherie Oshiro-Johnson, an optometrist at the Carle Foundation Hospital. For more information and to get connected with one of our providers, please visit carle.org. That's C-A-R-L-E.org. Or for a listing of Carle providers and to view Carle-sponsored educational activities, head on over to our website at carleconnect.com.

That wraps up this episode of Expert Insights with the Carle Foundation Hospital. I have been your host, Evo Terra. Thanks for listening.