The Link Between Eye Diseases and Overall Health

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You are listening to Boomers Today with your host Frank Samson. Well, welcome to Boomers Today. I’m your host, Frank Sampson. Of course, each week we bring you a very useful and important information facing baby boomers, parents and other loved ones, and we have another great show for.

You this week as well. I want to first thank everybody for all their support. Many of you listen to the show on Apple Podcasts, Spotify, our iHeartRadio, Audible, or you could just ask the Alexer Siri to take you to the boomers Boomers Today. Some of you go right to our website at boomerstdayradio dot com.

And because of that, many of you are sharing the show or individual podcasts with family and friends. So I want to thank you for that. And because of that we have grown organically to some pretty quite a few listeners. So, and I know why you’re sharing these shows because we have great guests on our show and I’m certainly not going to disappoint you.

Today. We have with us today doctor Robbie Goyle. Goyle, right, is it Goyle or Goyel? Either one’s fine, all right, We’ll go okay. So doctor Goyle is a board certified ophthalmologist and cataract surgeon at Regional I Associates in Cherry Hill, New Jersey.

He serves as a Senior Secretary of OP you you probably pronounced it all the time OP the Malik Practice, and trustee of the American Academy of Ouptomology. A passionate advocate for patient education, he creates optalmology and cataract surgery education content and protecting site dot com. Doctor Doyle is also chair of the a m A Optalmology Section Console and an instructor at Willis I Hospital. His expertise spans optimolo, op all innovation and practice management.

That’s a tongue twister for me by you know. So anyway, doctor Doyle, thank you so much for joining us on Boomers today. Really appreciate it. Frank, I’m delighted to be with you today.

Great. Great, So listen, you know, I’m right in that category where age category where I talk to friends and family, and certainly I’m in the senior care industry, so we hear about it all the time. But a lot of different things going on, you know, with with the eyes. Maybe you could just share with some of the top issues that this generation is facing today.

Frank, I want to thank you for the invitation to join you today. You know, in the in the nineteenth century book, Charlotte Bronte wrote in Jane Eary that the soul fortunately had an interpreter, often an unconscious, but still a faithful interpreter in the eye. And we can find many systemic diseases that have their hallmarks or symptoms or signs in the eye in ophthalmic diseases. So as we as as the as the baby boomer generation is growing older, we’re going to notice that the diseases are going to increase.

For example, you may have about twenty million patients who have vision loss currently in twenty twenty. That’s going to increase about forty million, fifty million by twenty fifty. So over the next twenty five thirty the number of patients who have active diseases that can affect the eye and the body is going to increase, such as Alzheimer’s, you know, Alzheimer’s disease in dementia. There’s an estimate of five million patients who have Alzheimer’s today in Americans, and that’s going to increase to about fourteen million and twenty fifty so all of these diseases, many of these diseases can have signs and symptoms in the eye.

So based on ophthalmic examinations, seeing an ophthalmologist, we can help to guide patients better and help to treat them so that they can live healthier and active lives. Right right, Well, so what are what’s let’s say the top type of disease that you’re that you’re faced with from your patients are what are some of the what’s. The top one? You know, I’d lost the top four as being cataracts, glaucoma, macular degeneration, diabetic retinopathy, and then also dry eye and those sorts of things. So as patients get older, they may have a cataract.

So they’re like, you know, they’re they’re happy, go lucky. Their activities of daily living are okay, but they might notice some glare when they’re driving, some halos when they’re driving, some difficulty reading, some difficult to seeing the TV. Safety issues. So many patients are walking independently, but as they develop a cataract, they may have they may be increased risk for falling, increase risks for stability.

For those are cataracts which cataracts have a bunch of different symptoms. You know, glare, halo’s decrease vision, but it can also plan into depression and happiness homa. I think it was being a silent disease. Lock homa typically, not always typically is what occurs when the pressure in the eye goes higher or there are a bunch of different factors that cause damage to the optic nerve, and gradually that disease can cause a decrease in your sight vision, a decrease in your propyle vision, which can also plan to happiness vision.

You know those sorts of things. So, cataracts, glaucoma, macular generation. Every patient in your every every every one of your attendees has a friend or a family member who’s going to the optalmologists going to the retina specials once a month to get an injection in their eye from their macal generation. Macular generation has two types.

It has a dry type and it has a what we call a wet type YEA, a neovascular type. So macular generation again is another disease process that can cause changes to the central retina and cause you to have difficulties seeing directly, seeing straight ahead. So far as glaucoma can affect your side vision coming to the center. MACLo generation can affect your your your central vision.

Then I think that to top out the big four in my opinion, is diabetes, diabetic, retinopathy. And we know that diabetics in the United States have a rele to be small percentage of the population has diabetes, but they consume over you know, about fifty percent of healthcare dollars and diabetes. You know, diabetes can affect the big three, right. Diabetes can affect the eyes, the kidneys, the feet.

It’s also these are all vessels. There is a vessel issue where you can have sort of leakage of material you from thinning of vessels, and that can cause you know, decreased vision, swelling of the vision, you know, you know, progressive visual laws over time. So canteracts. You know, I know, not personally, but just from experience from my wife and people.

I know it can be corrected, you know. I actually I always I joke around and I say, you know the best thing about getting older is social security and I mean as medicare. Yeah, social Security and canteracts. You know, obviously nobody wants to go on for any surgical procedure, but it it really does work at least I’m sure in most cases.

Can you talk a little bit about that as far as why it’s so effective. Sure. So, first of all, cataracts is has a bunch of different subjects. You can actually have a cataract as an infant, as a baby, something called a congeneral cataract.

And many many of your listeners may have a childhood or a grandchild who or the eye just looked weird when they were when they were when when the when the infant was was was born or was growing older, and they went to an ophthalmologist or a pediatrician, they said, you know, the eyes would look funny, and that patient had a you know, sort of something called a whitening the in the pupil and they had something called a white cataract, or they had a cataract. So you can have a character as a child. You can have a charact in your teen’s, twenties, thirties, you know, with steroid use, injury, poor diabetes, et cetera. But the typical cataract that occurs in patients over the age of fifty or sixty is occurs from gradual changes in the natural lens of the eye.

And you can, and I tell patient all the time, think about the natural lens of your eye as being a peanut minem. If you think about a peanut minem, think about the peanut as being clear, the chocolate is being clear, and the shell is being clear. The peanut is the nucleus, the chocolate is the cortex, and the shell of the of that M and M or something called the post of your capsule. So you can get a cloudiness in any of those three layers of the M and M, the peanut, the chocolate, or the shell.

The good news is that cataract surgery can be corrected with through catarac surgery, through modern catarac surgery. Now, if you go back catarac surgery over the last three thousand years from this ophalmologist you know in India three thousand years ago Calose Sour’s with the you know, they made a large incision. So if you imagine the diameter of the eye being twelve millimeters, they’d make a huge incision, take out the take out the entire penu of eminem as one big object. Or they would actually put sip the P and M M into the retina and they you know, they have to help the vision.

In nineteen fifty, this is the seventy fifth anniversary, Sir Howard Ridley put the first lens in the eye for cataracts, and that has evolved over the last seventy five years so that patients are having more visual freedom and they can walk and drive and read with visual freedom with modern counteractractory in which we can make a two millimeter incision or two point five million your incisions and take out that cataract much more safely. Right, great, Well, so what about you know people who maybe are having some issues. Oh, and I’ll be fine. They don’t think it’s anything serious, but if it’s dragged on and not taken care of, talk to us about some issues people could face could face if they don’t get it taken care of.

Perfect. So I tell all my patients I look at three criteria before I recommend catoc surgery. Number one, does the patient have a cataract? Yes or no? Number two is the vision below a certain level? You mentioned Medicare and vision has to below has to be below a certain level with or without glare before we recommend counteract surgery. Number three, is the patient ready for cataract surgery.

They are they emotionally ready for cateact surgery, they’re ready to have surgery in their eyes. So that I have hundreds or thousands of patients who have a cataract. It’s visually significant, but they’re not ready for surgery. And those patients I see at more frequent intervals because if you let a cataract go longer, that peanut and minem can become thicker, can become harder to take out by the time I need to do surgery, so the recovery time can be longer.

And so that’s why I say, hey, look, if you don’t have some cateach surgery, instead of instead of seeing it a year, I’m going to see you in six months. With three months, I may push you to decide on cataract surgery, because if you let it go too long, you know worst case scenarios, you get a secondary glaucoma where the cataract leaks proteins into the eye and then the body starts to attack the cataract and the pressure of the eye goes up and the vision goes down, and you kind of have the situation where I have to tell the patients you have to stop driving because your visions below twenty fifty and the state of New Jersey you have to see twenty fifty, State of Maryland twenty forty in order to see in order to drive safely. So you know there are alternatives. And I also mentioned look, if you’re in a wheelchair, you have a walker, et cetera, you’re using a cane, there is an increased risk of falling that we can see in patients who let cataracts go too long.

So these are all safety issues and so that’s another reason why I tend to recommend catac surgery. Were also depression. You know where we’re you know, happiness where if the counter gets too big, you’re not enjoying your your food, you’re not enjoying TV, you’re not enjoying your hobbies. So I say, hey, you know, let’s think about contact surgery.

And you know I’ve had I have countless examples of where pages are happier after surgery because they can they finally can see the best complained when they say, hey that I noticed that there’s they’re dulling in the paint to my home. I need to get a house repainted, I need to get the need to get some remodeling done. My wife told me after care like surgery, there were colors actually you know that that are just more vibrant than they were before too. So why do you think people wait just the thought of having surgery in their eye if they know they have an issue they they have, they could risk falls, they could risk a lot of other things.

Uh, why do you why do you think their reason is? What’s the reason to wait? Well things, First of all, I got to tell you that that the artists clawed. Monnet had cataracts, and you can see the changes in the color of his paintings as his cataracts got more progressive then, you know, and he was he was in the last entry. But you know, patients wait for a variety of reasons. Often it’s other medical issues.

You know, they have they have high blood pressure, they have diabetes, they have a family member who has who’s going through medical issues, you know, cancer treatment, chemotherapy, et cetera. I had a patient recently who said, you know, I want to have my cataract surgery. First I need chemotherapy for whatever condition. I stepped back, I said, no, you need to go get your chemotherapy done.

You need to become medically stable. I don’t want to operate on you until you’re medically stable and you meet their criteria. But you have time, you can still drive safely. So we let’s let’s hold off on catactrac tree.

You know, patients, you need to have us a social network. You need to have a you know, family member at my surgery center. Why I operate at the Walesye Hospital in New Jersey, a family member or somebody has to be with you for twenty four hours after surgery. You can’t uber to the surgery center and uber home by yourself.

So it is there are very difficult issues in terms of family social networks in order to do cataract surgery safely, and a lot of it is the preoperative care and the post operative care. So they also say people often say, oh, I hear character surgery is easy, you know, et cetera. But you know, it becomes it. You know, I’ve been doing catecter surgery for more than twenty five years, you know.

And so someone says, oh, it only takes fifteen minutes. I say, it takes twenty five years and fifteen minutes to do it. To do to do a great surgery so you definitely want the experience, but I think that patients wait because of fear. I think you know, thankfully cate surgery is uh, it is medically.

You need to meet those criteria for it to be medically you know, covered under traditional Medicare. If some of the Medicare advantage plans will sort of play games on the pre authorizations and stuff suggestions. You have two family caregivers or professional caregivers that you’re taking care of the person, things that maybe they should be looking out for and and and making recommendations. Well, absolutely, I think that you know, we know that the biggest risk of falling is in someone’s home, right, so we I think you need to do a home assessment sometimes.

I once did a you know, I don’t do a lot of house calls, but if you’re an established patient and you go you become bedroom, I will do the occasional house call and and the spouse that, you know, my husband can’t see the TV. I did a house call. Yeah, that you can’t see the TV because the TV is across the room and at an angle. So you want to make sure that the you know, that that what they’re using if they’re watching TV, that they get that it’s convenient for them if they’re reading a book.

Lighting is very important. We talked about the old Halligen lighting and now new LED lighting. So if somebody you know needs those, uh for caregivers, they should do a home assessment. They do do a personal assessment.

They should see are they happier, are they less happy? How are they walking? Do they need a cane and they’re using a cane? Hey, mom, you know, like your dad, like you know, you might want to think about counteract surgery because you’ve become less I’m noticing that you’re that you’re you know, three dimensional spacing you know, you know, as they’re viewing objects is a little bit off. Or you know, are they enjoying their food as much as they used to? Are they having trouble seeing their food when they’re eating. I think that’s a big issue. So I think that you know, especially among my readers, you know, they if you can’t read it can it can lead to a lot of depression, I think.

And when this is something we can, you know, we can the ophthalmologists can you know, typically take care of pretty It’s pretty straightforward, Zach, But we’re. Going to take a real quick break just to recognize our sponsor. We come back on a you know certainly have you shop information about your practice and where people could find people like yourself around the country. And then I would like to talk a little bit more with the time we have left about glaucoma and macular generation a little bit all right, and so do you know anyone who may be concerned about an older driver? While senior care authorities.

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And uh, we are now back with doctor Robbiegoyle who is optalmologists in New Jersey. So I know you’re in New Jersey and uh, people listening to this said, you know, maybe I should give him a call. So certainly, uh, you know, share with us any information that you’d like to share with our listeners and and how they can maybe learn about finding the right type of doctor like yourself in other parts of the country maybe well find up. Thank you very much, so you again.

My name is Robbie Gollam, a comprehensive optomologist and counter I surgeon in Cherryo, Old New Jersey with regional Associates. I’m also a voluntary instructor at the Will’s Eye Hospital. I have a you know, they can they can type in just protecting site dot com, which you’ll get to my blog, or they just type in my first name, last name, an M, D, Robbie R A V I G O E l MD dot com that’ll get to my get to my blog, my personal website, and they can find me on my practice website. Also, the best way to find out a an ophthalmologist is to go to our national specialty, the American Academy of Ophthalmology AAO dot org.

That’s AAO dot org. I happen to be a trustee of the Academy, but that has thirty thousand members worldwide, twenty thousand ophthalmologists in the United States. Ninety four percent of ophalmologist in the United States or members of the Academy. And you know, we are you know, colesial group that creates content.

We have meetings and we stay on the cutting edge of ophthalmology and vision care. And our mission is protecting site and empowering lives and so that that they have a find a doctor h tool on the website where patients can they can they can find find an enthomologist. Or often if I have a patient who moves to another area, I tell them to call their call their new internist or you know, and and ask ask that professional who the ophalmologists they would recommend seeing in their local community. So I think those are those are the best way I think those are the best ways to find uh, find an ophalomologists locally.

Great. So you know, we don’t have much timeline. We’ve got about five minutes left here and certainly this subject matter deserves more time. So hopefully maybe you’ll come back and we could talk more about glaucoma and macular degeneration.

But uh, you know, catteracts, we spoke about that that fortunately in most cases is curable, uh and actually could end up having much better vision that you’ve had since you’re probably a kid. But talk to us more about glaucoma macular degeneration. Are those curable diseases? And again what are symptoms? And you know, to just educate our listeners more about those two diseases. Sure, but you know, glaucoma is the second leading cause of blindness worldwide after cataracts, and is a major public health issue and a major public health concern, particularly in some ethnicities such as African Americans, Asians, you know, et cetera.

So glaucoma is typically an asymptomatic they don’t have symptoms until it can be advanced, and it causes something called visual field loss as I mentioned, where the side vision your your your side vision can become can become can become more difficult. So what I recommend is that all patients should have a baseline exam of the age of forty and then they have an exam every year or two. By the time the patients in their sixties sixty five, they should be seeing an ophthalmologists every year and they do screening tests looking for glaucoma. Glaucoma is not just pressure, it’s how the optic nerve looks.

You know, the optic nerve and the retina. They are sort of you know, parts of the brain. You know, you know, that’s why, that’s why you know. Alzheimer’s research, et cetera.

They can use they can look at the retina to look at how how how how Alzheimer’s the brain can get affected in the retina. But glaucoma is the second leading cause. Macular generation is another great is another significant public health concern. When I was a resident in two thousand and one, there was no therapy for MACLA generation.

The macular generation and reactions that have come out, Something called anti VEGEP therapies came out in two thousand and five, two thousand and six. Now it’s revolutionized ophthalmology, it’s revolutionized retina care. It’s revolutionized the patient’s ability to lead healthier life, eyes, to live independently, to have great vision. So those are a couple of entities.

I think that I think the easiest way is it’s hard to go to a screening, you know, and you know, at the local mall. I mean, you really need to see, like you need to see an optomologist to get a great eye exam, because there are you know, it’s a it’s almost like looking at a camera, you know. I mean many of your listeners remember sending something out to York Films, you know, thirty years ago to get processed. And now the eye is really like a camera.

We’re trying to get the We’re looking at the lens and the film and the processing, et cetera to get the great product. So you need an eye exam. Yeah, you know, I know a little bit about mancular generation because of a family member. But is the dry and the wet as you said earlier, but it’s the wet that you may need injections for, not the dry or am I incorrect in that.

Sting well before two years ago, yes, but now there are injections for dry MACL generation. They have something called geographic atrophy, so uh so so that sort of revolutionized MACL generation care. Retina specials have become the primary care doctor. You know, a typical patient see the retina specials more than they see their primary care guy guy or gal.

So. So, I think that so so used to be just that the wet need injection. Now there are Now you can have geographic atrophy in some forms of dry macro generation, which which can use injections. The good news is that you can use vitamins.

And there are a bunch of different modifiable factors. You can’t cure macro generation. But you know we’re sunglasses. Don’t smoke, eat green leafy vegetables, eat salmon, you know, you know, while you know, wildfish once or twice a week, or use something called the A reds too.

The National Institute came out with a great study twenty twenty years ago which showed that you know, these vitamin supplements can help patients who have moderate maclar generation are worse and you need to see an ophthalmologist locally to guide you properly. Great, great, well, uh, unfortunately, where we are out of time, but I’ll give you a moment just to just any words of wisdom that you may have to our listeners and talking about a lot of these issues. Frank, my only same move to sea to say thank you. I know that there are a lot of unsung heroes among your listeners who are caring for an elderly patient or they’re caring for an elderly family member, and you know, there were all the same team.

We’re trying to help our elderly patients family members leave happy, healthy lives and the the the eyes really are a great window to the body and to the brain. And so I think that, you know, getting a baseline examination and periodic periodic examinations can help our patients lead happy, healthier lives. Right Meacher Robbie Goyle, thank you so much for joining us. Got to have your back.

Thank you, and I want to thank everybody out there for joining us as well. Please please, he says, and we will drop to everybody scream. You’ve been listening to Boomers Today with Frank Sampson. To learn more about today’s show, visit Boomerstodayradio dot com and join us next time for another edition of Boomers Today.