Intro: Duly Noted, a health and care podcast, is the official podcast series of Duly Health and care. Each podcast features physicians or team members discussing groundbreaking topics and innovations that help listeners re-imagine and better understand an extraordinary health and care experience.

Scott Webb (Host): Many of us will experience vision changes as we age, and most of what we experience is totally normal, especially if changes are happening in both eyes. But if we experience a sudden change in one eye, for example, it's probably time to see someone like my guest today. I'm joined by Dr. Shantan Reddy. He's an ophthalmologist with Duly Health and Care.

Dr. Reddy, thanks so much for your time today. I am 55 and so I have noticed some vision changes, though I suspect maybe I just need some new glasses and need to make time for myself and maybe that's true of other folks as well. But great to have you on today to just talk about these vision changes. So, what are some of the common changes that patients experience that we tend to ignore, but really should pay attention to? 

Shantan Reddy: Common changes are, you know, difficulty seeing things up close. We call that presbyopia. It's just a normal part of the aging process. Other common changes are difficulty seeing in low dim light as we age. But the things we want to pay attention to are acute changes in vision. So, a sharp change in your visual acuity from one day to the next.

Other things you want to pay attention to are something we call metamorphopsia, where lines become very wavy or distorted. That can be a sign of something called macular degeneration. You also want to look out for changes in your visual field, so if all of a sudden you can't see a portion of your visual field in one eye and it sticks, it's not something that comes and goes, that's something you'd want to seek urgent care for, because it could be an indication of a retinal detachment.

But you want to separate that from difficulty seeing at night, needing your reading glasses more often as you get older. Difficulty driving at night is a normal part of the aging process. But real distinction is looking for acute changes in vision versus something that's kind of gradual.

Host: Yeah. These sudden changes, as you say, the gradual, if see me where I'm recording here behind my microphone and see how close my laptop actually is to my face, you know, but that has been a gradual process. It used to be further away and it just keeps getting closer and closer. So, let's talk about that then, these age-related changes, you know, how do we distinguish them from potential signs of a serious eye condition? How do we know, you know, since we're not doctors, we're not experts like you are? What gets us to go into the office and say, "Hey, I'm having a problem here"? 

Shantan Reddy: Yeah. It's always good to get it checked, because there's a lot of things we can identify early. It's possible to determine, you know, without looking inside the eye. But just, as a rule of thumb, if things are happening in both eyes together, it's probably more of an age-related process versus if it's unilateral. So if you have a vision change in one eye all of a sudden compared to the next, the eyes usually age, you know, together.

Host: I see, yeah. 

Shantan Reddy: So if there's a quick change or a change in vision in one eye as compared to the other, you'd probably want to get that checked fairly quickly. Metamorphopsia or waviness, so if straight lines are wavy, that is not a normal sign of aging. So, that could be very serious. Visual field changes is not a normal sign of aging, so that could be serious. Those are things you want to look for. You know, driving at night, when you're driving at night, the headlights give you like a starburst, that's quite normal. That's when the eye ages, the cataracts develop, and not everybody develops a cataract as they age. It's just that sooner or later, if you live long enough, everybody needs cataract surgery, but those are normal parts of just getting a little bit older.

Host: I see what you mean. So if we wake up in the morning and we have something in one eye, but not the other eye, and it's sort of sudden and acute, versus, as you say, what I experience is that sort of kind of like halo effect around, lights coming at me at night, that's generally just a sort of, unfortunately, the normal part of aging. So, I think I've got the distinction there. Are there some groups or individuals that are more susceptible to specific eye changes that maybe might warrant closer monitoring over the years? 

Shantan Reddy: In general, eye problems can affect any age, but as you get older, you're more susceptible to more of the diseases, particularly macular degeneration, glaucoma and cataracts. A retinal detachment can occur at any age, again, it occurs more often as we get older, so elderly patients are more susceptible to eye problems, but you don't want to ignore sudden vision changes in one eye at any age.

Host: Let's talk about lifestyle right now. I know I'm always harping on my kids, my daughter's 16, I'm always harping on her about too much screen time as I'm looking at a screen while I'm doing that from the other room, right? So, we all love our phones. We're all streaming stuff like Netflix. We generally spend too much time on our screens and maybe that's a different podcast. But the combination, doctor, of screen time exposure to sunlight, I'm sure there is some impact on our eye health. I know that when I spend too much time staring at my Mac Book during the day, my eyes sort of get crossed a little bit, if you will, where I just need to close my eyes for a while. So, maybe you can talk about that, the screen time and exposure to sunlight, the things that we're doing to ourselves. How does that impact our eye health and just these vision changes? 

Shantan Reddy: Yeah, sure. This is a pretty common question. There's been a lot of hype about blue blocking glasses, because they're worried about the UV light coming from screens and damaging the eye. And recent studies have shown no benefit in the blue blockers. So, it's really not the UV light from screen that's harmful to the eyes. So, we have a lot of parents come in, trying to get us to tell their kids not to be on the screen. Obviously, it's not good for the brain. But with the eye, it really doesn't structurally change or harm the eye, excessive screen time. What it does do is produces a lot of digital strain on the eye. So, you can get headaches, a little blurriness that's transient.

So, if you're on the screen a lot, we often recommend something called the 20/20/20 rule. So if you're on the screen for 20 minutes, you want to take a break for about 20 seconds and look 20 feet ahead of you. So, it kind of relaxes the ciliary body, which is the muscle in the eye that causes the pupil to constrict. And that's what gives people headaches when they're looking up close for too long.

 UV light in general, it can be harmful over extended periods of time, so it's always good to wear sunglasses. And again, like, more expensive sunglasses are better than the cheaper ones you get, you know, at the Dollar Store, because they all block the appropriate amount of UV light. But it's good to wear sunglasses just as you wear sunblock outside. It can decrease risks of cataract, macular degeneration over the long term. But with regards to the screen time, it's not going to physically alter the eye, but it can produce some digital strain.

Host: Yeah. That's good to know and that's definitely what I experience, is that strain. And I've heard that 20/20/20 before and I try to follow that. I try to take that 20 seconds off and sort of look into a dark space in the room, just get my eyes off the screen. Besides sunglasses, is there anything else that we can do? Do you recommend folks maybe wearing hats when they're in the sun, that kind of thing? Like, anything we can do to protect our eyes? 

Shantan Reddy: I mean, hats are probably an overkill, because, again, it's long-term exposure over years may increase risks of cataracts. The best thing to do for your eyes are you know, entertaining diet rich in, you know, maybe green leafy vegetables. Obviously, don't smoke. Smoking is the biggest environmental risk factor for age-related macular degeneration, which is the leading cause of blindness in the elderly. So, the best thing you can do is not smoke. But if you want to eat healthy, you get a lot of green leafies in there, where they had zeaxanthine, which is an antioxidant that can protect the macular portion of the retina. Just live a healthy lifestyle, keep your blood sugars controlled. Those are the best things to do for your eye. I

Host: Yeah. And that's just our eyes, of course, right? So, eating healthy, living healthy, not smoking, a lot of benefits for our eyes in basically, you know, the rest of us, of course. This has been really good stuff here today, doctor. As we wrap up here, just want to have you explain the importance or stress the importance of regular eye exams in detecting some of these early eye problems. 

Shantan Reddy: Regular eye exams are crucial because we want to detect disease early in the eye. Because systemic diseases can affect the eye like diabetes, high blood pressure, but a lot of the early changes aren't noticeable by the patient. So, we want to identify that disease or those changes early and it can be treated sometimes before patients become symptomatic.

 Regular eye exams, you know, if they can identify conditions like cataracts, glaucoma, which can be silent in its early stages before it produces irreversible vision loss. And then, diseases like diabetic retinopathy, which is the leading cause of blindness in the working age population can be identified before you have vision loss with regular eye exams. So, early intervention can prevent vision loss, and maintain the overall eye health in patients.

Host: Yeah, that's awesome. Early intervention, early diagnosis. As you say, there are some of these silent things that we don't even realize are happening and, if you catch them early, can prevent the vision loss, prevent blindness perhaps. So, doctor, thank you so much for your time today. You stay well. 

Shantan Reddy: Sure. Bye.

Scott Webb: That's ophthalmologist Dr. Shantan Reddy. And for more information, go to dulyhealthandcare.com.

Host: And if you found this podcast helpful, please share it on your social channels and check out our full podcast library for additional topics of interest. This is Duly Noted, a health and care podcast from Duly Health and Care.