Joey Wahler (Host): It's something that'll affect us all. So we're discussing protecting our vision as we age. Our guest is Dr. Alejandro Espaillat. He's an Ophthalmologist with PRISMA Health. This is Flourish, a podcast from PRISMA Health. Thanks so much for joining us. I am Joey Wahler. Hi, Dr. Espaillat. Welcome.

Alejandro Espaillat, MD: Thank you, Joey for having me today.

Host: Great to have you aboard. We appreciate the time as always. So first, how does our vision change as we age, and is there an age when most people, all things being equal, will experience that noticeable difference?

Alejandro Espaillat, MD: Absolutely. Vision is central to our independence, safety, and overall quality of life. As we age, we become more susceptible to eye diseases like macular degeneration, glaucoma, cataracts and diabetic eye disease, all of which can dev, can develop silently. The good news is that many of these conditions are preventable or manageable with early detection and the right care.

My goal is to help people stay informed so they can preserve their vision and continue living fully.

Host: And so all things being equal, Doctor, how often should most people be getting their eyes checked?

Alejandro Espaillat, MD: The big four are macular degeneration, glaucoma, cataracts, and diabetes, or diabetic retinopathy. If a patient has been diagnosed with Type 2 diabetes, they need to be seen immediately because they may have had this borderline blood sugar levels for a long period of time, and they have been, they may have been affected by diabetes and diabetic retinopathy for a significant amount of time, therefore, need to be seen immediately.

Patients with Type 1 diabetes, they can actually be seen within five years of being diagnosed. Now, patients with glaucoma, the people who are at a much higher risk are usually African Americans, Hispanics, and Asians. They have a six time higher risk of developing glaucoma than Caucasians.

That doesn't mean that Caucasians won't get glaucoma. Glaucoma can affect everyone, but if you are an African American, Hispanic, or an Asian, you have a six time higher risk of developing one type of glaucoma called primary open angle glaucoma. If you are 40 years old, and you have family history of glaucoma,

you have, you are a smoker, you have been, diagnosed with borderline intraocular pressures, you have diabetes, you have high cholesterol, you have hypertension, you have history of anyone blind in your family, you should have a glaucoma check. In, in essence, everyone at age 40 should have what we call a glaucoma check. Glaucoma screening. Glaucoma can still affect people younger than 40, but, if you are 40 years old, you should have a glaucoma check, which is a determination of the intraocular pressure by your eyecare provider as soon as you can. If you have a history of macular degeneration in the family, macular degeneration usually affects patients 50 years and older, mostly Caucasian patients.

Those patients should be seen by the ophthalmologist and many of them should be started on certain vitamins that have been proven very effective on these type of patients. So, in summary, you have to have an eye exam, as an adult, at least when you reach 40 years old and over.

Host: Gotcha. So what simply put, Doctor is normal or not when it comes to vision changes after 40.

Alejandro Espaillat, MD: You will have normal deficits with your near and your intermediate vision, and that is called presbyopia. So everyone who turns 40 will start to try to extend their arms in order to maximize their vision. That is because the power of accommodation, the power of near vision decreases over time and that power is completely lost by age 60.

So that is not a disease, it's just a part of aging, and that will force patients to need reading glasses. So those are one that's, those are most of the patients that we see at that age. These big diseases that I just mentioned, cataracts, glaucoma, macular degeneration, and diabetic retinopathy, they actually produce no symptoms whatsoever.

You have, you don't feel any of that. And it is sad because many patients either for financial reasons that they haven't been able to get health insurance until they reach the Medicare age, and they get insured by the government or patients who have been blessed with very good vision all their lives, and they think that they don't need to have any eye check.

So by the time they show up to our office when they're 60, they actually, have severe advanced disease and it is very difficult for the provider to actually improve that vision. And the only thing that is left is just to prevent any further vision loss. So many of the diseases that we see early, they are actually completely asymptomatic.

They don't cause any symptoms at all. And that's why the voluntary self check and evaluation and appointments should be made in much earlier age.

Host: So what happens for those that maybe haven't been for a while? What happens during a typical eye exam these days and what are some common problems you are looking for?

Alejandro Espaillat, MD: The eye exam usually requires the testing of what we call the visual acuity. That's the first thing that we do, which is reading the eye chart. The provider's office and his team or her team will also check the intraocular pressure of the patient. They will also go through a medical history, determine if the patient has any potential risk factors for certain diseases they will document a patient's, medications, allergies, and previous histories of previous history of any medical problems or surgical procedures that could be related to certain eye conditions related to the patient's visit at that time.

Then the patient is examined by a professional, either an optometrist or an ophthalmologist. And the doctor will perform a thorough examination from the front part of the eye all the way to the back part of the eye. So it will look at a structures called first the eyelids. Then another section, which is the white part of the eye, the conjunctiva.

The cornea. It will, check the lens of the eye to make sure that there's no opacification and potential cataracts, and it will also pay attention to the nervous layer of the eye, the retina, and the optic nerve, which are the connection of the eyeball with the brain. After that, the doctor will perform, will summarize, his or her findings in an, into an assessment and develop a plan for the patient.

The plan can go from just simple lubricants or artificial tears or prescription glasses or further tests or medical treatments or surgery.

Host: So how about those off the rack readers that we see in stores? When are those recommended as opposed to prescription glasses?

Alejandro Espaillat, MD: Those readers are usually for people who are, they have excellent vision for distance, and they have reached the age 40 or above, and they only need magnification or correction for intermediate or near vision. Usually if people also need glasses for distance, those readers are not going to do the job.

So that is pretty much for patients who are only having what we call presbyopia, which is a deficit on intermediate and near vision.

Host: So how do you know what magnification reader to get and can they hurt your eyes?

Alejandro Espaillat, MD: It is very hard for the patient to determine that by themselves. So they are actually going to try, they don't know which distances they, they should be testing themselves, which is usually extending the prescription to the belly button and checking from there. So ideally, the patient should go to an eyecare provider, and the eyecare provider will inform the patient on the exact number that based on his or her age as well as his or or her condition, should get either for reading only, at a reading distance or at an intermediate computer distance. Or at a distance further ahead. So, it is hard for the patient by himself or herself to make that proper determination and accurately find the correct prescription.

Host: Speaking of computers, which you just mentioned, of course, so many of us Doctor spend much time on various electronic devices, which can strain your eyes. So speaking of glasses as well, do these blue light glasses help in that respect?

Alejandro Espaillat, MD: Well, yes. The screens won't permanently damage your eyes, computer screens, but they can cause digital eye strain, dryness, blurry vision, and headaches. For aging eyes, it can make underlying issues more noticeable. You have to follow the 20-20-20 rule, meaning every 20 minutes you look at something that is 20 feet away for about 20 seconds and that will give you much more relief and less strain to your eyes, and you must also try to use good lighting to reduce the glare around it, which can also be very uncomfortable.

Host: A couple of other things before we let you go. You touched on this, but to go a little further, when we talk about health conditions like diabetes or high blood pressure affecting our eyes, how do they affect them?

Alejandro Espaillat, MD: I want to reemphasize that for adults over than 40, I recommend an eye exam every one to two years, even if you feel your vision is fine. After 60 is often best to have them annually because many eye diseases like the ones you mentioned, have no early symptoms, but can be caught early through routine screening.

Now, to answer your question directly, diabetic retinopathy is one of the leading causes of blindness in the world, especially in non-developed countries or middle developed countries. Diabetes can cause a number of issues inside of our eyes, including increased intraocular pressure leading to glaucoma, decreased sensitivity that you don't get to feel too much on their eye.

It can lead to something called cataracts as well as intraocular bleeding and hemorrhages and retinal dettachment. And finally, loss of vision. If you have diabetes and you developed diabetic retinopathy and you never check it, you will go blind. But thank God we have all the tools, the eyecare providers,

have all the tools needed to prevent that from happening. And even here in the United States, we still see cases of very advanced, poorly controlled diabetic retinopathy as a result of the systemic issues of what diabetes causes, either due to poor diet, lack of exercise, lack of follow up with their primary care providers, poor compliance with the use of their oral medications or maybe financial issues not being able to purchase their insulins for whatever reason. But diabetes is a disease, is a progressive disease that affect the microcirculation, a systemic disease. And the eyes are one of the target organs as well as the kidneys, the brain, and the general cardiovascular system.

So it is a disease that needs to be taken seriously and a disease that I have spent, most of my life, trying to fight against. The good news is that I do believe that within the next 10 to 15 years, we are, we, meaning the scientific community will find a cure for diabetes. I do not believe that diabetes, as it is today, will not be controlled properly within 15 years. But that still requires significant collaboration, not only from the industry researchers, but from the community and the patients themselves.

Host: Wow. Well, that's certainly a message that I'm sure many joining us will be very relieved to hear. Let me ask you in summary here, Doctor, what's your best overall advice for protecting our vision as we age? If people had to keep one thing in mind, what should it be?

Alejandro Espaillat, MD: Well, my final takeaway is that don't take your vision for granted. Do not take your vision for granted. Prioritize your eye health just like you would your heart or your brain. Stay consistent with exams. Make a small healthy changes to your lifestyle and do not ignore the symptoms, if you get symptoms. You only get one pair of eyes.

Take care of them and they will take care of you.

Host: That's very, very well said. Well done. Folks, we trust you are now more familiar with protecting your vision during aging. Dr. Espaillat, keep up all your great work and thanks so much again.

Alejandro Espaillat, MD: Thank you very much.

Host: And for more information, please visit prismahealth.org/flourish. If you found this podcast helpful, please do share it on your social media, and thanks so much again for being part of Flourish, a podcast from PRISMA Health.