Transcription:
Eye Health and The Importance of Annual Eye Exams

Melanie Cole (Host):  Your eyes are so precious. Periodic eye and vision examinations are such an important part of preventive healthcare. My guest today is Dr. Evan Kaufman. He is a board certified optometrist at UVA Health. Welcome to the show, Dr. Kaufman.  How often should people have an eye exam? Are there some red flags that would signal that it’s time to get in and have your eyes checked?

Dr. Evan Kaufman (Guest):   Thank you very much, Melanie, for having me on the show. When we talk about eye health and how quickly you should get in, it’s usually a good idea to have a complete or routine eye exam once a year. What I tell most of my patients is that sometimes we are not even consciously aware of our vision and if it’s getting worse. That’s why we suggest eye exams once a year. I compare it to watching a child grow. If you see the child every day, you don’t see them grow an inch or two inches or three inches but if you see them at six months or every year they grow like weeds. Just like our vision on a day to day basis, we don’t really see the small visual changes that occur in our eye but if you get your eyes examined every year, an optometrist, ophthalmologist or an eye care provider can track those changes. I also compare it to high definition TV. I did not want to get high definition TV myself but just like the rest of America, we did get a high definition TV. When I look back at the analog I think my eyes are blurry. People’s perception of vision is what they see every day. Sometimes, when we can make micro changes in a person’s prescription or identify a pathology, we can heighten the person’s vision by changing their prescription.

Melanie:  Dr. Kaufman, how important is patient history when you’re giving somebody an exam?   

Dr. Kaufman:  As a primary care provider the history is one of the things that I spend the most time on. It’s kind of one of those things where I want to know what your daily routine is, what your visual needs are. Somebody sits in front of a computer doing a data analization has a different visual need than somebody that might be outside and doing some manual labor versus someone that might be a surgeon and has to look at something that’s at an arm’s length away has different visual needs. The first thing I ask is, “Tell me about what you do in daily life. Are you reading 10 hours a day? Are you on the computer 10 hours a day?” What are the visual needs? The second thing is, is I want to know that the old prescription is or if they’ve ever worn glasses before because that kind of gives me where we’re starting from. If a patient says, “I’ve never worn glasses. I’m coming in because my primary care doctor says I need to have an eye exam” and their acuity, let’s say, is in the 20/40 range, which is just about where the DMV wants you. Anything less than about 20/40, the Department of Motor Vehicles doesn’t like that too much and can restrict your driver’s license. If the patient says, “But I don’t have any problems” maybe they are not consciously aware that they could see better. Or, maybe they are not consciously aware that they could have some type of ocular pathology. Understanding A, what a person’s visual needs are and, too, what their previous history with glasses, contacts, any systemic history is very important, especially a history of diabetes. Diabetes is one of the leading causes of blindness in the United States today in adults over the age of 40. Diabetic screenings once a year is crucially important because diabetic retinopathy or damage to the eye due to high blood sugar can start before a patient is actually aware that they are losing vision. They come in and they say, “I’m seeing fine.” But, we look in the back of the eye and say, “Oops, there is some leakage of blood vessels or there are some early ventricular changes which is what we call early cataracts. These are all things that we want to know about and then we can communicate back to a patient’s primary care provider to maybe either get better blood sugar control or maybe change the medication.

Melanie:  Dr. Kaufman, is there a genetic component to what goes on with our eyes?

Dr. Kaufman:  It depends on who you talk to. In my opinion, yes. A lot of people say, “My parents wore glasses so I will probably have to wear glasses.” That’s not necessarily true. The latest research is that if you are going to be far-sighted or near-sighted it is “programmed into your DNA” but it’s multi-factorial which means that some of the signal comes from one gene and another one comes from another gene. It has to be a combination of multiple genes in order for them to illicit the trait. Basically, the environment that you put yourself into can illicit whether you are going to be near-sighted or far-sighted. There are some really interesting studies that are going on right now – I was just at a meeting – where they were dealing with how much light is in a classroom. If there is more light, maybe people will not be so near-sighted when they are in class and working on assignments in their class. This is out of Southeast Asia. The study hasn’t been conclusive yet, so I don’t want to say that it all has to do with one particular component but there is a trend to think that there is a genetic component to being either far-sighted or near-sighted but we haven’t mapped it down. We can’t test your DNA and tell you if you are going to be near-sighted or far-sighted because it comes from such a complex, multi-factorial component.

Melanie:   Dr. Kaufman, there is so much information. We could speak for an hour about this. Now, tell us about the tests. People hear that you are going to dilate their eyes and they get nervous that they can’t drive afterward. What tests do you do? Are you taking pictures of our eyes or blowing air into our eyes? What are these tests that you’re doing to see what’s going on with our eyes?

Dr. Kaufman:  In a standard routine exam, the first thing that we do is something called a refraction. A refraction is where we use a multitude of optical lenses in order to focus an image on the back of an eye at the retina. That can tell us if a patient has normal vision or not. People say, “Do I have normal vision?” 20/20 is really what we call standard vision but just because you don’t have 20/20 vision doesn’t mean that it’s not normal. It’s just kind of where we put the standard. A refraction will tell what the best possible vision a patient can get. If a patient does not have 20/20 vision and it’s worse, then we look for components of disease such as cataracts, glaucoma, macular degeneration, a variety of conditions. The best way that we do that is by dilating the eye. When we dilate the eye, we give medications in the eye that is just temporary that numb the iris, or the color part of the eye, in order to make it very large. It does not constrict. The reason that we want to make it large is that we want to look in the back of the eye through a window not a keyhole. If a patient’s not dilated, looking through a keyhole is very difficult. We can only see what directly passes in front of that keyhole versus that if we do a dilated exam, the pupil dilates and then we have a much bigger window to look up and down and left and right in all parts of the eye. No type of pathology escapes the provider.

Melanie:  In just the last few minutes--what great advice – there’s so much that we could cover, Dr. Kaufman. Give your best advice for people to maintain their eye health.

Dr. Kaufman:  First of all and foremost, yearly eye exams is probably the most important and that is because nothing sneaks up on you such as diabetic retinopathy or any type of refractive error. The second thing is a healthy a diet is important with eye health. I tell my patients that Omega 3 fatty acids, which is found in fish, is very good for the retina and it is also good for dry eyes that a lot of people suffer from. Those are the two things that I would do is have yearly eye exams and eat healthy.

Melanie:  Why should someone come to UVA ophthalmology for their eye care?

Dr. Kaufman:  UVA ophthalmology is unique because we are a multi-diverse department. We have everything from neuro-ophthalmology that deals with people who have neurological problems with the eye to corneal problems which is people who have infections and ulcers of the eye, to glaucoma and retinal specialists for diabetic retinopathy. In addition to having that, we also run a clinic for specialty contact lenses which deals with people that can’t wear glasses; that have to wear contact lenses. We also have a very large primary eye care clinic where people can just come and get their routine care. It is a very complete package of a department. If you had a condition that needed multiple specialists, we can manage that within the department without having to outsource any care.

Melanie:  Thank you so much for being with us today, Dr. Kaufman. You’re listening to UVA Health Systems Radio and for more information you can go to UVAHealth.com. That’s UVAHealth.com. This is Melanie Cole. Thanks so much for listening.