Transcription:

Melanie Cole (Host): SLUCare ophthalmologists provide comprehensive vision services from regular eye exams, contact lenses, and eyeglass services in our onsite optical shop to the treatment and management of eye diseases and eye trauma. My guest today is Dr. Oscar Cruz. He’s a Professor of Ophthalmology and a Professor of Pediatrics in the Department of Ophthalmology at Saint Louis University School of Medicine. Welcome to the show, Dr. Cruz. Tell us a little bit about the Ophthalmology Department at SLUCare.

Dr. Oscar Cruz (Guest): Well, the Ophthalmology Department at SLUCare is a comprehensive group that encompasses all the subspecialties of ophthalmology, whether it be retina, glaucoma, low vision, cataracts, and neuro-ophthalmology, among some of our specialties. It’s all represented, all in one building, by subspecialty, board certified, trained ophthalmologists.

Melanie: You’re a pediatric ophthalmologist. What is the difference there?

Dr. Cruz: In pediatric ophthalmology, I deal with the issues that are more specific to children—such as strabismus or misalignment of the eyes, congenital cataracts, amblyopia or poor seeing eye, or what is commonly referred to as “lazy eye”—many of the diseases that are just specialized to children.

Melanie: So what can people expect? If they’ve got some eye problems, what would be a symptom of something, Dr. Cruz, that would send them to see you?

Dr. Cruz: Well, it depends on the etiology of their visual loss, but some are just progressively slow loss of vision, which could be in an older patient just the early sign of cataracts; a loss of peripheral vision, which could be a sign of glaucoma; retinal detachment, which is a sudden loss of vision or a sudden increase in the number of floaters and flashes of light. That is one of the few ophthalmic emergencies, sudden loss of vision.

Melanie: If someone has pain behind their eyes, Dr. Cruz, is that a reason for concern?

Dr. Cruz: It depends. Pain behind the eyes is usually not an ocular condition, but it must be ruled out.

Melanie: And then do we still use the standard eye test? What do you do to test somebody’s eyes for any of these visual disorders we’re discussing?

Dr. Cruz: Well, again, yes. We still use the standard eye test at 20 feet to test someone’s vision, but there’s different management tools. For example, if you’re looking for glaucoma, you’d test the intra-ocular or pressure of the eye with specific instruments. There’s visual field test that we use to test people’s peripheral vision. And again, patients with low vision have different needs and different testing mechanisms to be tested.

Melanie: We’re hearing more about macular degeneration. What can people do? Is there anything to do about macular degeneration?

Dr. Cruz: Yes, there is. There’s several different types of macular degeneration. One is called is wet macular degeneration which is leaky our abnormal blood vessels, which can be treated early and should be treated aggressively. The more common form of macular degeneration, which is occurring in our aging population, is what’s called dry macular degeneration, which is just an aging process of the retina. There’s very few treatments available. There are some studies that recommend good Vitamin A supplementation, decreasing the amount of UV sunlight. But the most important thing is to help these patients to optimize their vision to make sure that their cataracts are taken care of, make sure they don’t have glaucoma, and to see a low vision specialist early on so that their lives aren’t compromised or their visual functions aren’t compromised.

Melanie: Let’s talk a little bit about pediatric ophthalmology. Parents, we worry about our children’s eyes. And if our children are telling us something, what would they be telling us? Things like conjunctivitis or pink eye, those are pretty obvious. You see that. But something else that they might be telling us, “Oh, mom, I’m having a little focus problem at school,” or blurred vision, what would the kids be telling us?

Dr. Cruz: Well, that’s interesting because what happens is children don’t complain, and that’s why their disease processes are often caught late. It’s so important that vision screenings occur in pre-school and school ages be done properly and on a regular schedule. The American Academy of Ophthalmology strongly recommends vision screening for all children, because they don’t complain, they don’t know that their vision isn’t supposed to be blurry. They don’t know that their vision has slowly gotten worse if they’re, for example, developing nearsightedness, which is very common around school age, 1st, 2nd grade. And that’s why vision screening in the pediatrician’s office and in school are critical to find and to early-diagnose pediatric ophthalmology problems.

Melanie: For pediatric ophthalmology problems, what kind of treatments are out there for some of the ones that you’ve mentioned before?

Dr. Cruz: Again, strabismus or misalignment of the eyes. Many times, this is treated surgically. Sometimes this is treated typically with glasses. Nearsightedness is very easily treated with glasses early on, contact lenses as the child progresses in age. Amblyopia or poor vision in one eye from a variety of causes is treated by patching the dominant or good eye several hours a day to increase the function and vision in the poor seeing eye.

Melanie: You mentioned contact lenses as a child gets older. What age do you see, if children are wearing glasses—and we’ve seen the little children with real thick glasses on—what age can they start wearing contact lenses?

Dr. Cruz: Contact lenses vary on maturity of the child and the needs of the child. We have some children who are intense, where the parents are obviously responsible for putting in and removing the contact lenses for children who are born with congenital cataracts. But elective contact lenses for things such as just nearsightedness, it depends on the maturity of the child. Girls tend to be a little bit more advanced than boys and a little bit more willing to put the contact lenses, but I tell the parents that when the child is ready to take care of the contact lenses themselves—which can vary about age 10, 11, or 12—then they’re probably ready for the contacts if they’re motivated. But some children require contact lenses at an earlier age.

Melanie: So tell us, Dr. Cruz, about refractive surgery. People are looking at LASIK Surgery and all of these things we’ve heard about for the last 20 years. What’s new, and what’s really advanced in this world today?

Dr. Cruz: Refractive surgeries have become very refined and very predictable. That’s what’s probably changed over the last 10 to 15 years is the predictability of the outcome and how close they are to getting people to not using glasses at all. But advances still need to be made. There is nothing for what we all face as we become older. The need for reading glasses, there is no current treatment for that other than just reading glasses. The advances in refractive surgery haven’t been made there, and they haven’t made for farsightedness or the opposite of nearsightedness. The majority of people are nearsighted as they become older, and that’s the basic population that has very successful outcomes with refractive surgery. But for presbyopia, the aging need for reading glasses, currently, there are no current treatment either with refractive surgery or any other types of surgery that effectively treat that condition on a regular basis.

Melanie: Do you recommend something like multifocal lens implants? If somebody is sick of switching from one type of glasses to the reading glasses, and then now with computers, Dr. Cruz—and people aren’t quite sure which glasses to put on when they’re sitting at a computer or if they have to work with one—what are we looking at for implants that people can use to sort of read and see far away and even looking at the computer?

Dr. Cruz: The multifocal lenses have advantages, as you just stated, for having a variety of focal lengths to see things. For example, reading is a different distance in people’s computer than the distance. But there are so many options, and that really needs to be individualized by that patient’s cataract surgeon. Again, there’s usually an additional charge for these lenses because of the technology and the surgical requirements to place the lenses, but there are many options to choose from depending on people’s need. Some people prefer seeing at near preferentially than distance. Some people prefer their computer distance. But people do have the option of having all their refractive needs met.

Melanie: So just tell us in the last minute or so, Dr. Cruz, why should people come to SLUCare for their Ophthalmology treatment?

Dr. Cruz: Well, thank you. Well, we have a multidisciplinary team, and I guess what we can offer that not many other places can offer is that all subspecialties are represented in the same building. So if a patient with a cataract has a neuro-ophthalmology problem, we have that subspecialty represented here. The contact lenses, optical shop are all here; vitreoretinal surgery, glaucoma, pediatrics. And we have our own operating room, all housed within the same building, so all your care is encompassed in one site.

Melanie: Thank you so much, Dr. Oscar Cruz. You’re listening to For Your Health with the physicians of Saint Louis University, SLUCare Physician Group. SLUCare is the academic medical practice of Saint Louis University School of Medicine. For more information, you can go to slucare.edu. This is Melanie Cole. Thanks for listening.