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Have you had your eyes checked recently? Getting routine eye examinations is vital to maintaining proper vision. Marlene Chang-Brown, MD from WellMed at Mission discusses the benefits of having regular eye exams.
Sept. 25, 2024
Podcast transcript
INTROWelcome to Docs in a Pod, presented by WellMed. Over the next half-hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Tamika Perry and award winning veteran broadcaster Ron Aaron will share information to improve your health and well being. And now, here are Ron Aaron and Dr. Tamika Perry.
RON AARON
Well, hello everybody and welcome to Docs in a Pod. Our Docs in a Pod award winning podcast is available wherever you get your podcast. We're also on the radio in several markets in Texas and Florida as well. I'm Ron Aaron. Today, our co-host and delighted to have her with us, Dr. Tamika Perry. She's an associate medical director at WellMed. Oversees several large clinics in the Optum Care North Texas region. An associate medical director serves as someone who supports providers at those clinics. She also is a physician at the WellMed clinic up near Dallas. Dr. Perry earned her undergraduate degree from Prairie View A& M, went on to graduate from Philadelphia College of Osteopathic Medicine, where she was National Health Service Corps Scholar. She's done a whole lot more, but we won't take the entire show giving you Dr. Perry's bio. Hey, Tamika, good to be with you.
DR. TAMIKA PERRY
Hey, how are you guys today? I'm so excited about today's show. Learning about our vision, maybe she can tell me what's wrong with mine.
RON AARON
Well, we'll kick off then by introducing Dr. Marlene Chang Brown. Dr. Brown chose internal medicine as her specialty because she loves caring for and building relationships with adult patients. Dr. Brown was born and raised in Jamaica and loved caring for animals growing up and pursued a medical career given the absence of veterinary schools in her native country. She earned her degree at the University of West Indies. Dr. Brown moved to the U. S. to complete her internal medicine residency at the Bronx Lebanon Hospital Center in geriatrics, menopause and obesity. Those are some of the many clinical interests she has. Dr. Brown, it's great to have you on again.
DR. MARLENE CHANG-BROWN
Thank you, Ron. It's great to be here.
RON AARON
Now, the three of us, you and Dr. Perry and me, all use glasses. I'm curious, when you think about the importance of getting your eyes checked, I think a whole lot of folks don't go to the eye doctor until they think they have a problem.
DR. MARLENE CHANG-BROWN
Thats not good. There are many conditions that will not be diagnosed. We will never find out that we have them unless we go for a screening eye exam. Thats before we have any symptoms at all.
RON AARON
When you go for an exam, there are MDs, ophthalmologists, and then opticians who are not ophthalmologists. What do you recommend we see?
DR. MARLENE CHANG-BROWN
Well, if you're going for a routine checkup, it's okay for you to see an optician. They are well trained. They just don't have all the same capabilities as optometrists, but they're well trained in diagnosing all the routines of regular medical conditions that affect the eye.
RON AARON
Now I know as people age, one of the issues that many of us have are cataracts. I actually had two removed from both eyes a couple of years ago. Is that just something common that people should expect?
DR. MARLENE CHANG-BROWN
Cataracts are very common. As you age, the likelihood of having cataracts increases. For those patients who are 80 years of age and older, I would say about 50 percent of them have cataracts and these cataracts can significantly impair your vision.
RON AARON
What is a cataract?
DR. MARLENE CHANG-BROWN
Let's go back to the fundamentals before we say what a cataract is. There is a lens in the eye through which all the light enters, and it goes to the back of the eye, making an image. Now, that lens is like, think of it as a windowpane. The normal lens is clear and crystalline, but when there's a cataract, that gets cloudy. Its like a dirty windowpane. You can think of a cataract like that.
DR. TAMIKA PERRY
That's a great description. That's kind of how I describe it to my patients. When they have their cataracts removed I say it's almost like you're going to power wash that window. We're going to wash, blast it all out, suck it away and then your vision is like it was before.
RON AARON
When they do that, they're putting a new lens in your eye.
DR. TAMIKA PERRY
Sometimes they do put a new lens in the eye, but most certainly they take away that dirty cover that's on that lens.
RON AARON
Is that something, Dr. Brown, that you can self-diagnose? If you discover your vision is getting a little blurry, go see the doc and say, Hey, I think I have a cataract.
DR. MARLENE CHANG-BROWN
You can say that, you know, we self-diagnose all the time. You may have an inkling if you notice that your vision is getting cloudy, not just blurry. Some people describe cloudy vision. Some describe problems with more of a glare when they go out in the sun. Also driving at night, when the light hits the lens with the cataracts, there may be some halos that form around the light. So, driving at night may be difficult for people who have cataracts.
RON AARON
Stay with us for a minute. I want to let folks know who may have just joined us, you're listening to the award winning Docs in a Pod. I'm Ron Aaron along with our co-host Dr. Tamika Perry, and we're talking with Dr. Marlene Chang-Brown about issues involved not only in your eyesight, but when you want to see someone to have your eyes examined, how often you should do that, and what are some of the conditions that we do a better job of managing today. Dr. Brown, you brought up driving at night. I know a whole lot of folks, especially as they age, complain about having trouble seeing at night.
DR. MARLENE CHANG-BROWN
Cataracts may be one reason for that, but it's only one. There are other conditions that can affect your night vision. Even lack of vitamins may do that. So, it does not mean that there is a cataract if you're having trouble driving at night. Anyone who has that problem should have an eye exam to see what the cause is.
RON AARON
As a family doc, what are some of the conditions that you can diagnose in your office before having to send someone to a specialist?
DR. TAMIKA PERRY
Some of the common conditions that people come into the office for is a dry eye, but the dry eye has many different etiologies. You can have a dry eye simply because there's a problem with the ducts in the eyes. You can have a dry eye from an autoimmune disorder. You can have dry eye from allergies and consequently allergies can cause the other end of the spectrum when your eyes tear up too much. So, these are symptoms that the patient may tell you other than there's something wrong with my vision. Now, patients like to tell Dr. Brown and I, I know my body. You absolutely know your body. What Dr. Brown and I know is science. We went to school a long time for it, so we take the two clues, and we put them together. Just like she was speaking to earlier, patients may say, it looks like I'm looking through wax paper at times, or I see that halo around rings at night. Even though, the typical primary care doctor doesn't have the equipment in their office to look into the back of the eye or look at the lens of the eye and see the cataract, what we can do is say you have cataracts based on history. We can say probable glaucoma based on history. We can say maybe Sjogren's Syndrome is causing that dry eye.
RON AARON
What Is that?
DR. TAMIKA PERRY
That's an autoimmune disorder in which your immune system might attack certain glands and ducts and you can have dry eyes, dry mouth, dry skin.
RON AARON
How'd she do, Dr. Brown?
DR. MARLENE CHANG-BROWN
She did very well.
DR. TAMIKA PERRY
Oh, thank you.
DR. MARLENE CHANG-BROWN
She spoke about those conditions that can affect the vision, but there are other eye conditions that may not affect your vision that we can diagnose in our offices. Someone may come in with a red eye, we can treat that.
DR. TAMIKA PERRY
Absolutely.
DR. MARLENE CHANG-BROWN
Someone may come with a stye. I know quite a few people who have had stye, so we know how to treat those conditions. Now, if you have eye trauma, we're probably going to send you right on to an ophthalmologist to have your eyes checked, because if there is a laceration in the eye, we have to be very careful. If you have shingles and it's affecting that part of your face, which includes the eye, we want you to go to an ophthalmologist because you might have an ulcer in the eye, which is caused by that shingles virus. Many different conditions can be treated in the office, so it's best first to see your primary care physician and then they will refer you out if it is something that they're unable to handle.
RON AARON
Are there conditions that are as we age that we are more susceptible to in addition to cataracts like macular degeneration?
DR. MARLENE CHANG-BROWN
Macular degeneration. This is quite a common condition. It's estimated that about 20 million Americans who are aged 40 and older have macular degeneration. As you grow older, the chance of developing it increases. You may say, what is that? First, you have to think of what is the macula. I know you're going to ask me that question.
RON AARON
Yeah, we're both laughing because it's exactly what I was going to ask you.
DR. MARLENE CHANG-BROWN
First, go to the back of the eye. That layer at the back of the eye is called the retina. It is where images are formed. The central part of the retina, which focuses those images coming directly into the eye. So, the images from objects directly in front of you, those rays go directly to your macula. So, it's a specialized area of the retina and it focuses on those objects directly in front of you. It's also responsible for color vision for your sharpest for your clearest vision. Without the proper functioning of the macula, we're going to lose detail. We're going to not be able to see stuff that is directly in front of us, as well as objects which are in the periphery. So, that's just a little synopsis of macular degeneration in general.
RON AARON
Can it be treated?
DR. MARLENE CHANG-BROWN
Yes, it can be treated. There are two types. There is the wet type and there's the dry type. I'd rather have the dry type than the wet. Do you know why?
RON AARON
Why?
DR. MARLENE CHANG-BROWN
Because dry macular degeneration tends to progress more slowly. Although if left untreated, it will still result in blindness or it can result in blindness, then you still have a longer lag time before you get to that stage. When you compare it with wet macular degeneration, which can progress quite rapidly. Within a matter of weeks, you could lose your vision. It's not always that fast, but it may happen even within a matter of weeks that you could lose vision from the wet type.
RON AARON
Are they treated the same way?
DR. MARLENE CHANG-BROWN
Not exactly, no. Although there are experimental treatments in terms of injections for the dry, in most cases, it is wet macular degeneration which is treated with injections given in the eye. The dry macular degeneration is mainly treated by other conservative means, such as taking vitamins, vitamin C, vitamin A, vitamin E, these are important for vision.
RON AARON
All right, hold on just a minute. We're going to come right back to you. Dr. Marlene Chang-Brown, our special guest today, along with our co-host. We're delighted to have her with us, Dr. Tamika Perry. I'm Ron Aaron. We are so pleased you're listening to us right here on the award winning Docs in a Pod.
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RON AARON
We are so pleased you were with us today on the award winning Docs in a Pod. I'm Ron Aaron, along with our co-host, Dr. Tamika Perry, and our special guest, Dr. Marlene Chang-Brown. We're delighted to have Dr. Brown with us. We were talking about macular degeneration, Dr. Brown, and wet and dry macular degeneration. Is it curable? Can you get your site back?
DR. MARLENE CHANG-BROWN
No, it's not curable. You can't get back what is already lost, but you can try to preserve what you're still left with. This is the importance of discovering the condition early in its course.
RON AARON
What about retinal transplants? I know we do a lot of shoving other body parts into people. Have we gotten to the point where we can do a retinal transplant?
DR. MARLENE CHANG-BROWN
I have not heard of that.
DR. TAMIKA PERRY
I have not either, Ron. I wish we could, but I have not ever heard of a retinal transplant. I think Dr. Chang makes an excellent point where she keeps talking about prevention and seeing your PCP on a regular basis. Because for things like macular degeneration, we want to know as soon as possible. It's important when you go to your doctor to tell them your vision is a little funny or blurry but quantify that. Is it that you can't see right in front of you? Is it the sides of your vision is, is a little obscured? Is your eye tearing and causing the obscureness? That gives us clues in which direction we need to go.
RON AARON
You mentioned dry eye a few minutes ago. I happen to have dry eye and one of the things that surprised me when my doctor diagnosed it, over tearing can be a sign of dry eye, which intuitively you say, well, how can that be? If I have dry eyes, why do I have so many tears? But it turns out your eye is trying to compensate for that condition. Apparently.
DR. MARLENE CHANG-BROWN
Yes, it is.
RON AARON
Now, what other conditions should we consider as a potential threat?
DR. MARLENE CHANG-BROWN
Before you go to the other conditions, for those who may think that they have macular degeneration, some of the other early symptoms you may notice include if you're looking at, say, the corner of a room, you see the corner where the walls meet, that should be straight. If you're looking at something that's straight and it looks like it's not straight, but it's actually curved, that's one major symptom of macular degeneration. If you have to start using brighter light in order to read or you notice you go to a restaurant and your vision is really poor in the restaurant, it may be a symptom of macular degeneration.
RON AARON
Or maybe they need to turn the lights on.
DR. TAMIKA PERRY
I went to the restaurant the other day and it was exactly like this. Everyone was just looking at the menu and I'm thinking to myself as Dr. Brown is talking, do I have macular degeneration? because everyone was just looking at the menu and I was like, y'all can see it. But then I realized that I was probably the oldest person there.
RON AARON
That's why they put the lights on the phones now.
DR. TAMIKA PERRY
Yes, and I brought my phone out and I just shot the flashlight. I was like, oh, I'm here in life now. This is where I am.
RON AARON
I know, Dr. Brown, one of the issues, of course, is a lot of us as patients use Dr. Google as our reference source. Is it okay, do you think, to try to Google the symptoms you're having or should you not bother with that and just go see your PCP.
DR. MARLENE CHANG-BROWN
It's okay to Google. We are all people who have curious minds, and we all want to be health-literate. So, it's okay, but don't depend on Google alone and decide, I know what it is. I'm going to take care of it. Even if you have an inkling as to what it might be, remember there are many different conditions that may present in the same way and the treatments may be completely different. So, don't rely only on Google. Go see your primary care doctor as well.
DR. TAMIKA PERRY
Right. Not every website is reliable either. I've had patients come in and say something's wrong with my eye. I Googled it. I think I have eyelash cancer. I can almost promise that you do not have eyelash cancer, let's talk about what's going on.
RON AARON
Is there such a thing as eyelash cancer?
DR. TAMAIKA PERRY
No, absolutely not.
DR. MARLENE CHANG-BROWN
It's as rare as rocking horse manure, they say.
DR. TAMIKA PERRY
Right. Absolutely, that rare. definitely see your doctor.
RON AARON
What other conditions should we consider, Dr. Brown?
DR. MARLENE CHANG-BROWN
I would think of glaucoma. It's quite common. This is a group of eye diseases in which pressure builds up in the eye, and this pressure affects the optic nerve. So, your optic nerve is what will translate the images formed on your retina to your brain so you can actually see. What happens when your optic nerve gets damaged is that you lose vision. It's different with glaucoma as opposed to macular degeneration. They have lots of peripheral vision, so they can see straight ahead very clearly. What do you think that causes? They pick up their condition later than those who have macular degeneration because they're looking straight ahead, and their vision is clear. They're not noticing the periphery. They're not looking out here, they're looking directly there. So, they will discover their visual problem later. Many people who are diagnosed with glaucoma have already had significant amounts of visual loss.
RON AARON
Now, I know when I go see my ophthalmologist, they always do a pressure test. In the old days, it used to be with a little puff into your eye, which I hated, everybody hated that. They now have more sophisticated tests. Is that something that could be done in a PCP's office?
DR. MARLENE CHANG-BROWN
There are some PCPs who have the equipment to do the test. I don't have that in my clinic. I usually send the patients out. It's a very good idea to send patients out once every 2 years at least if they have no other medical conditions and they're not having any eye problems. It is good, especially once you get to age 60 and above to go have your eyes tested at least every two years, looking for these conditions that may creep upon you insidiously.
RON AARON
If you're diagnosed with glaucoma, is there a treatment for that?
DR. MARLENE CHANG-BROWN
Yes, there definitely is treatment for glaucoma. There are eye drops, and there is surgery also.
RON AARON
Is it effective?
DR. MARLENE CHANG-BROWN
Oh yes, very effective, especially if you're compliant with your treatment.
RON AARON
You say that with a smile, meaning as a patient, are you doing the drops when you're supposed to?
DR. MARLENE CHANG-BROWN
Right.
DR. TAMIKA PERRY
Now, there are other conditions that affect your vision that we have to watch out for, like, most common diabetes. Dr. Brown, tell us what diabetes potentially can do to your vision.
DR. MARLENE CHANG-BROWN
Oh, diabetes is real bad when it comes to the eyes. If you get diagnosed with diabetes today, you probably already have eye disease. As long as you have not been testing your blood in the past, say, 3 to 5 years, you may have had diabetes and you may not even have known it, believe it or not. Diabetes can accelerate the growth of cataracts. That's one thing. Diabetes can cause diseases of the retina. The retinal disease is classified in two parts. There are proliferative changes and non-proliferative changes. Non-proliferative would be conditions like a little swelling of the retina, some microaneurysms, areas of the blood vessels that balloon out but they haven't ruptured. Those are some changes that can occur in diabetes. At that stage, the condition is reversible with good control of diabetes. But if diabetes is not well controlled, then it progresses to what we call proliferative retinopathy. Proliferation of the blood vessels at the back of the eye. Multiple blood vessels growing. These blood vessels are not as strong as the originals. They're thin, they're easily ruptured. You can rupture these. Blood fills the back of your eye. You immediately lose your vision. It's something to speak about the diabetic eye. It's very complex.
RON AARON
I have a friend, also a broadcaster, who had untreated diabetes for several years. He knew it. He just figured he could manage it on his own and he has ended up blind in one eye, ended up losing a part of a leg and is losing his sight in his other eye and he's now on kidney dialysis. All due to untreated diabetes.
DR. TAMIKA PERRY
This is what we call in diabetes, end organ damage. So, it damages the organ at the end point, like Dr. Brown so eloquently described the different types of retinopathy and what you in essence described is the peripheral vascular disease that happened from the diabetes. Diabetes is a scary entity, but it can be controlled with diet, exercise, medication, lifestyle changes.
RON AARON
It gets to that one-word Dr. Brown used earlier, if the patient is compliant.
DR. TAMIKA PERRY
Correct.
DR. MARLENE CHANG-BROWN
Diabetes may also cause swelling of the macula. So, it causes water to seep into the macula and the vision gets blurry because of that. There are injections available for that, but every treatment for the diabetic eye is always combined with improving the control of diabetes.
RON AARON
Now, before we let you go, Dr. Brown, as someone who may be 65 and over, you're recommending they go to their PCP annually to be sure that all of their various body parts are working.
DR. MARLENE CHANG-BROWN
Yes, I do recommend that. Go and have a yearly physical. This is not for people who are feeling ill. This is for people who are feeling healthy. You think everything is going well. You don't know. You need to go and get yourself checked.
RON AARON
Thank you so much. Really appreciate you being here, Dr. Marlene Chang-Brown. We thank you very much for being here and our co-host, Dr. Tamika Perry. I'm Ron Aaron. We will be talking soon right here on the award winning Docs in a Pod.
OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.
DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.
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