Welcome to Orange County Eye Institute

Hi I’m Florence Henderson. When I had cataracts, it was like seeing everything through a hazy film. My doctor said cataract surgery would remove the haze but ordinary cataract replacement lenses wouldn’t fully correct my vision. So, I chose crystal lens. Crystal lens correcting my cataracts and gives my eyes their natural range of vision. Now I can see my phone street signs even the gaps in my car. Some crystalens patients may experience glare and other visual disturbances. All surgical procedures entail some risk and crystalline has the same potential risks as all other intraocular lenses. Many patients hardly if ever need glasses after surgery. Only your surgeon can determine if crystalens is right for you. If you want your vision to go from this, to this, talk to your eye doctor about crystalens find a specialist at crystalens.com crystalens by Bausch Lomb, don’t just see, see better.

I was having more and more difficulty seeing clearly especially street signs you have no idea how many U-turns I could make before I got to my destination if I was in an area that was unfamiliar. So, I consulted with Doctor Salib and he performed cataract surgery on both eyes. As you can see I’m not wearing glasses and I get to my destinations in a very short time. We are located in the saddleback memorial medical towers see well live well.

And welcome back Doctor George Salib is here today with the orange county eye institute and he brought along a pamphlet and we’re going to talk about some of these things. I care facts and myths and I think it’s pretty interesting I looked over your questions and I looked over this and there are a lot of myths, I guess some people might call it old wives tales or whatever it might be, whatever that term may be but you grow up learning about these things you’re hearing them. So, let’s go. You brought along six, six, myths that we’re going to talk about today and the first one is reading in dim lights and that’s something that I remember hearing about as a kid and we got a photo of I don’t know who that is Galileo or Columbus or somebody there reading by candlelight which of course for eons that’s how people read. Yeah exactly this is actually called the young man reading by candlelight by Matthias stone and as you can see yes for centuries people have been reading by candlelight and in dim light because we didn’t have electricity, right. Now that we have great lighting it’s a lot easier to read now of course that basically is a myth it does not harm your eyes to read in dim light. However, it does make it maybe a little more challenging because you have poor illumination which leads to decreased contrast in your paper, so you can’t see the print against the background, you see less, visual details it just makes it overall more difficult to see especially for the 4d and overcrowd, where people tend to lose their focusing ability they don’t have quite the focusing ability. They did when they were younger than that and that’s normal that as you get past the age of 40 your, your, focusing ability decreases because the lens itself becomes a little less pliable the lens that allows you to focus, so good lighting increases what we call your depth of focus, how like the range that you can see things so that’s another challenge. So it makes it more difficult to read but it doesn’t harm your eyes in any way. Okay that makes perfect sense to me because I wear reading glasses obviously and if I’m out in bright sunlight there are certain things I can now read without my reading glasses on right as simple as that I still may need them certain times but that the better light is it makes a little bit easier. Yeah certainly you don’t have to hold the paper quite as far. Yeah and what’s actually nice you know I I read a lot through the, the, kindle app or whatever and of course if you’ve ever seen those apps, you can have a white background with black text black with white there’s like four or five variations that fit your needs the best and it’s, it’s, kind of nice, yes, plus adjust the brightness on the screen. Well let’s look at the next one and this one is I need to wait until my cataract is ripe before it can be removed. I guess that means that it gets to a certain point. Exactly and, and, that is also a myth this is as you can see there’s a cataract on our screen and the cataract is basically the lens of the eye that gets cloudy with time and as the lens gets cloudy it prevents you from seeing well. Now in the past maybe 20 or 30 years ago, this used to be a true statement because we had to wait till the cataract was a certain density or a certain firmness in order to be able to remove it, because they used to make a larger incision, they had to go inside and either freeze the like a special tip called a cryoprobe onto the cataract to remove it or else they would remove the whole lens in one piece, through this large incision, but then again cataract surgery back then was a lot more primitive than it is now, right, you had to stay in the hospital for three days with sandbags around your head. They wouldn’t put a lens in your eye wow and you ended up with these big thick glasses in order to be able to see, versus nowadays it’s an outpatient procedure. It’s about 98 percent successful and done usually within a span of about 15 minutes and it’s done through these micro incisions about two to three millimetres long and you can break up the cataract even before it is ripe. Wow, in fact you can take out a lens of an eye before it develops into a cataract. Now in order for insurance to, to, be able to cover part of your surgery or all of your surgery it has to be a cataract that is visually significant, meaning it’s, it’s, dense enough that it’s causing you to have problems let’s say driving at night because of glare or trouble seeing the fine print but a lot of people even in their late 40s early 50s and on decide to take out the cataract or the lens of the eye before it turns into a cataract, in order to take advantage of the newer lenses now that are available, that allow you to see like far and near at the same time. So it’s, it’s, really changed quite a bit so yes it is a myth that you don’t you don’t you basically do not have to wait till the cataract is ripe. All right, very interesting. The next one we’ve definitely heard over the years and I think  even more so now everybody we got a photo here on a computer, using a computer or watching tv too much or too close, that was as a kid you know you I didn’t we didn’t have computers then but you know the kid was three feet in front of the tv watching their cartoons and sit back and get back it’s going to be bad for your eyes. Yes, I’ve heard that many a time myself and that is also a myth. It doesn’t harm you to sit too close or too long in front of a tv. Now of course there are other health issues we might talk about if you’re sedentary and not moving around because you’re watching tv too much, that can lead to obesity which can lead to problems with the eyes later on but there’s no direct bad effect from just watching tv too long or using a computer for too long or sitting too close. Now a lot of kids will sit closer to a tv because their focusing ability is so well so good that they can focus up close without any difficulty. However, if you see a child sitting close to a tv or computer all the time then you have to take them to the ophthalmologist in order to determine if they need glasses. They might be nearsighted and they just can’t express that to you. They might only be able to see up close and with glasses they’ll be able to see far away but generally it does not harm your eyes. A lot of people after looking at a computer for a while or a tv their eyes will feel gritty or tired and or even reading a book for a long time, right, and that’s because your blink rate decreases meaning you blink less often when you concentrate on something. So, it’s important to maybe every 20 minutes just take a break have your eyes look far away for about 20 seconds or use an artificial tear to lubricate your eyes and that’ll take care of the problem, but yeah, it’s it doesn’t harm your eyes to, to, watch tv or, or, see a computer for too long. All right well that we’ve heard about since I was a kid when it comes to tv here’s another one that I would hear when I was a kid. Wearing eyeglasses will make you dependent on them and as I, I, said to the doctor before we got on, we all remember his kids maybe a parent or an older sibling had their glasses and you would put them on saying oh look I’m wearing glasses you know and your, your, mom will go don’t do that you’re going to be dependent on those glasses. Right you’ll need those glasses forever and that’s not true. All it is, is, when a person wears a pair of glasses and they’ve never worn one before and if those glasses are fit for their eyes, it’s like going from a regular tv to a high definition tv. All of a sudden, you’re seeing things you’ve never seen before, people’s faces more clearly. Print is much more clear so you want to wear the glasses just to have that clarity of vision. Right, but it doesn’t make you dependent on them and that’s different than let’s say a young child who actually needs glasses to avoid having a lazy eye or to make that lazy eye better so some people really need those glasses in order to prevent that from being a permanent thing. So, kids don’t outgrow lazy eyes you really have to give them the glasses in order to prevent that and in adults it doesn’t make you dependent on glasses. Okay very good. Cataract surgery and we talked about you know the cataract getting ripe. But here we go here’s another one cataract surgery can be done with a laser myth or fact? And that’s true. Here’s your new machine yes this is a laser cataract surgery machine called the lensx laser. If you had asked me that question about three or four years ago I would have said yes that is a myth. Wow oh really that’s short of time, yes, it’s quite near quite recently, interesting, this has happened and now with an video guided precision, we can make laser guided cuts in your eye basically incisions that are tailor-made for your eyes and break up the cataract into smaller pieces allowing us to use less time and energy to remove the cataract. I’m one of few surgeons in this whole area that are able to do this kind of surgery and I was actually the first surgeon in the western US to use the latest software version of this laser. It has really made this surgery even more precise, Wow, and even better, it’s really working, that’s great, the advances are just tremendous. Okay the final one that if you would have asked me before I read this I would have said fact, eating carrots will improve my vision because we’ve always heard that, right or the beta carotene that’s of course in the carrot. Right, right, and I wish that were true but it’s actually a myth. Carrots are an important source of vitamin a and beta-carotene is the form of vitamin a in those carrots. Now vitamin a is, is, important in general because those that beta-carotene is something called carotenoids. It’s a it’s a class of medicate of medications called carotenoids which basically are antioxidants in your body and they’re found in higher concentrations in your eye. So if you eat carrots or if you eat things with beta-carotene such as spinach kale coloured greens then you’ll get more beta-carotene. Now that beta-carotene has been shown in in some studies to decrease the rate of advancement from wet from dry macular degeneration to wet macular degeneration. So, in that regard it is helpful. However, it’s also it also could be harmful for people who are smokers who take extra amounts of beta-carotene because that’s been shown to increase your chances of lung cancer. So you have to be careful in terms of what you do and, and, how much you do it how, how, much of something you’ll take. Carrots are good for you but they’re not going to improve your vision okay all right so well we’ll still eat them but we don’t we won’t go all bugs bunny on the carrots like we used to I guess but they’re all good for you and they, they, taste good so I like this this was a very fun segment. I hope we do this again yes thank you, yeah this was a lot of fun if you want to get hold of Doctor Salib, orange county eye institute there’s the number on the screen 380 eyes or 380-3937 ocinstitute.com nice to see you nice to see you too all right take care we’ll be back in just a moment this was a fun one I liked it

We welcome you back as we continue with our Monday program here on channel six. Our good vision always very important that we all keep our eyes working well and Doctor Salib back with us today to talk about that welcome to the show sir. Thank you. Good to have you with us today’s topic is a unique one. Face it over the years having been here a number of years I’ve had a lot of interviews with medical folks and one of the things that we talk about a lot with you ophthalmologists is cataracts. It just seems to be a reality of aging. For those that have never had that experience or have yet to have it to deal with it real briefly what is a cataract? Well every eye has a lens much like the lens of a camera that allows us to see clearly and focus on what we want to focus. So, with time there’s proteins that aggregate or clump together in the lens and causes clouding of the lens and so a cataract is basically a clouding of the lens that doesn’t allow us to see as clearly as possible and you can see a picture of that up on the screen here where you can see this clouding of the actual lens. And my understanding is it’s a natural occurrence and there’s not much we can do to prevent it correct? Exactly the most common reason people get cataracts is time or age so  if we live long enough we’re definitely going to get cataracts and in fact as we age the incidence of cataracts increases. So, by the time we’re in our 70s about 50 percent of us will have cataracts by the time we’re in our 80s about 70 percent of us will have cataracts that are visually significant. There are other causes as well such as diabetes can increase cataracts, oral steroids can cause cataracts such as prednisone trauma but the most common reason is birthdays. So, for some people it could be in their 40s but for most of us it’s going to be in our 70s or 80s almost for sure that we’re going to have to cope with it. Yes exactly. All right so how do we tell it sounds like it’s something that takes place over years and years and years that gradual change in our vision. Does it have to get to a certain point do the people come to you or do you find it in the in the exam room? Well usually if they haven’t felt anything or seen anything I’ll sometimes see it in my exam room and I’ll tell them well you have the beginnings of cataracts. When people come to me and tell me you know I can’t see as well please change my glasses, I’ll change their glasses and they come back a month later I still can’t see well out of my glasses that’s a common sign that you have a cataract, if you’re frequently changing glasses. Another thing people tell me is they have difficulty for instance doing things such as driving at night. Maybe it’s a little darker or they can’t see quite as well because of the lights flashing in their eyes. The lights cause scattering of, of, the light they see halos. So that’s often also a common reason people will come in or they sometimes just say they can’t see quite as clearly in general whether they want to read, if they can’t see the golf ball the tennis ball you can see here a picture of a normal eye on the left where you see a clear image because you have a clear lens through which you’re seeing. On the right you can see the cataract and the cataract eye scatters the light so that the retina which is the back of the eye doesn’t get a clear image and you see it blurry. I guess the problem is it takes years and years for this to develop so we sort of accommodate everyday activities whether it’s driving or playing with our grandkids or whatever might be sort of just over time and eventually but of course getting an annual eye exam you can spot this maybe before it becomes real problematic. Well we know that for years they’ve been dealing with it I understand that it’s actually in England I think after world war ii or around world war ii they found that some of the pilots had little, little, chips of Plexiglass where the bullets had hit the plexiglass and on the airplanes and little pieces that stayed in their eye, so that the eye will tolerate to some extent some foreign things in it on a permanent basis. That’s kind of how they developed the lens inside the eye is that correct? Yeah exactly they found that for the fighter pilots, they found that that that material didn’t really cause much damage so they decided to try and develop a lens that you could put in the eye for that for the person to see. They used to just take out the cataract and then you’d have to wear those big coke bottle glasses in order to be able to see. So they put the inner the lens in but I guess part of the procedure is getting the old fuzzy part out so to speak and my understanding is you’ve got some new techniques using a piece of equipment you’ve used for something else for years you’re now able to use that to help get that old lens out of there. Right exactly so in the traditional method of taking out a cataract we use blades and bent needles basically to do the incisions in the cataract itself in the cornea in order to get at the cataract and then we use something called phacoemulsification which is the machine that actually breaks up the cataract using ultrasonic energy and then we put in the new lens. So now we’ve been using a technology called femtosecond laser technology where we’ve been using that for all laser LASIK where we create the flap, but now we can use that same precision to do the incisions for the cataract surgery and the circular opening in the front of the cataract called the capsulotomy and we can even soften the cataract itself to lessen the amount of energy that we use during the cataract surgery. Why do you feel that’s better than the shall we say the standard way of removing that capsule? Right, well while you know a seasoned surgeon is very good and he has nice steady hands he can never be quite as precise as a laser. So, with this new laser technology we have video assisted technology where we can actually see the layers of this the eye on the screen through something called optical coherence tomography and then with that that, basically gives a good map of the eye. We can precisely tell the laser where it we want it to cut how big the incision we want it to make it to make and exactly how big the capsulotomy we want to make, which is that opening in the front of the capsule of the cataract and we can actually break up the cataract. They’ve done a study where they found that out of 250 patients 43 percent of the time they had a 43 decrease in the amount of energy used to break up the cataract, once they broke it up with a laser and actually were able to do it in 51 percent less time and also in terms of the capsulotomy, the manual way of doing it compared to the LASIK the laser method only about 10 percent of the time were we able to achieve the same  precision as with the laser. So even though the doctor is well trained and skilled the equipment can help and modern technology we’re seeing so much of that arthroscopic surgery these days lasers being used in lots of ways but obviously for the eye as well. Are all patients’ good candidates for this or are there some people that would do better than others in this particular procedure? Right well with every case in terms of surgery we have to look at the individual case but certainly this can benefit a lot of people. It especially helps those people who have astigmatism. So astigmatism just means that the front of your eye is not completely round it’s kind of like if you look at a spoon and you look at your image in a spoon you’ll see how your image is a little distorted. That’s astigmatism. So, this laser is great for that because we can actually plan the astigmatic incisions in the cornea with the laser instead of doing it by hand and on top of that this is especially good technology for those people who choose those lenses that are not the standard lens. For instance, the what we call the lifestyle change, the focus lenses focusable lenses, yes the multifocal lenses the torque lenses all those lenses achieve the best results when you have good astigmatism, astigmatism, correction. Good sounds like something you folks would want to ask about if your doctor was saying to you hey your cataracts are coming out you need to get those dealt with this might be the next technology and something that might be helpful to people that want to find out more, they can contact your office for if they want to get that exam taken care of, sure, and they also can of course get taken surgery as well 770-1322 they can give you a call and find out more. I understand also with 250 clubs here meeting all year long, they always are looking for guest speakers I understand you’d be available to speak some of our clubs. Yeah certainly I’d be happy to come out to your club and give you a talk about any eye topic you choose. I am always interested in educating and talking to the residents of this town. Sounds good so if you would like to find out more again you can give Doctor Salib’s office a call and his staff will get you scheduled in between laser surgeries and cataract removal he’ll try and come and speak to your Cleveland organization thanks for joining us today good to have you with us thanks for having me see you back here in a few weeks thanks for joining us today. Doctor George Saleem again topic today laser cataract surgery very interesting new technology. We’ll be coming back with more guests as our Monday program continues for you stay with us.

Well part of good health of course is good vision and our next guest is an expert in keeping everyone’s eyes working well. That’s Doctor Salib from the orange county eye institute welcome back to the show. Thank you thanks for having me. Good to have you with us today, you know pretty much anytime you visit almost any doctor these days one of the things they want to do is wrap this black thing around your arm and squeeze this little bulb and check your blood pressure, right,  and obviously that’s very important to have normal blood pressure but from an ophthalmologist standpoint you’re concerned about if you will high blood pressure, hypertension in the eye? That’s right yes hypertensive eye disease is what we call and basically it’s high blood pressure of the body affecting the eye and most of the time it affects the back of the eye called the retina, which is the inner lining of the eye that allows you to see and you could see on these on the screen that basically on the left is a normal retina which is how it normally would look with the, the, disc which is the white thing and the blood vessels there but in high blood pressure, you’ll start to have hardening of the arteries and thickening much as you would in the body and then you’ll start to get haemorrhages leakages in the in the back of the eye. You can get optic nerve swelling even retinal detachments and with that comes of course loss of vision and it can influence other types of diseases of the eye such as even macular degeneration, where people with high blood pressure tend to have a higher rate of the wet kind of macular degeneration compared to those that don’t. So, it’s quite a devastating disease if you let that blood pressure progress and is uncontrolled in the eye. So, when the doctor is checking that thing on your arm, it actually also can impact your vision because they’re concerned about your cardiovascular system but obviously your eyes are fed by that system as well so, exactly you can see how it relates I guess that the only way to tell if you have high blood pressure is to test for it is the, the, squeezing on your arm thing. Right, right, the blood pressure cuff is very important. So, it’s imperative that you visit your general doctor and see if you have high blood pressure and if you do then you should definitely go to your ophthalmologist to get checked. I have diagnosed a lot of people with high blood pressure even though they’ve never had it before just by looking inside their eye and looking at their retina. In fact, about 30 percent of the people that have high blood pressure don’t even know they have it until they come to the eye to their regular doctor and determine that. So, it’s very important to get regular check-ups to see that. How common is this? It’s extremely common in fact about a quarter of the population in this whole country has high blood pressure about 23 and as you age you have a higher percentage or higher risk of having high blood pressure so that by the time you’re about 60 about half the population has high blood pressure and by the time you’re 75 about three quarters of the population have high blood pressure. The scary thing is that once you know you have high blood pressure only about half the people who have high blood pressure are adequately controlled for it. So, and about 20 to 25 percent of people who have high blood pressure develop eye disease associated with that. So, it’s a huge number of people in this country that have these problems. The I guess the common treatment is they start off with exercise and diet control, salt I think is a big factor of what I’ve heard. Yes, so some of those dietary changes maybe weight loss exercise and then there’s medication I guess if those things aren’t as effective as they want them to be and there’s I guess a range of medications that they can prescribe as well. Right, right, it’s a multi kind of faceted approach to treating hypertension or high blood pressure. So, as you said leading a healthy lifestyle, decreasing your salt intake increasing you know the amounts of fruits and vegetables you eat, increasing the amounts of foods with let’s say calcium magnesium and potassium not smoking losing weight, all those things are very important and then once you have high blood pressure that affects the eyes, then you might need other treatments. For instance, if you have swelling in the back of the eye you might need injections or laser treatments into the eye and in rare cases you might need some surgeries depending on the complications you might have with that high blood pressure. So it’s obviously important that we see our family doctor on a regular basis as well as our ophthalmologist on a regular basis and I guess good communication from us as the patient to our doctor and to you as well would be to say hey by the way last time I was in my blood pressure was elevated and, and, you, you, would probably already have observed that if it’s serious enough you would have seen that in the eye exam. Yeah that’s exactly right we all we have to really work with the patient and work with the other doctors to just ensure that your overall health is good, just because we’re only examining the eyes doesn’t mean we can’t remember the rest of the body. So, if the patient has high blood pressure they should let us know and then I’ll be looking for that and looking for any changes in your eye. I’ll be looking for it anyways and as I said I’ve diagnosed some people with diabetes high blood pressure or other diseases just by looking in your eyes. They’re kind of the portal to the rest of your body what do they say the eyes of the window to the soul but also maybe the windows to the rest of your body for your, for your health concerns as well, yes, well it’s an important subject and again some of the things you need to share with your doctor. I would imagine probably if somebody is taking medication for example for high blood pressure, you probably want to know what medications they’re taking because those some of those could be interacting with some things you want to do with the eye as well. Sure, anytime a patient comes into our office we ask about all of their medications in general some medications have some effects on the eyes and we like to know just their general overall history. So certainly, systemic medications can have effects on the eyes that people might not realize but we definitely look for that. Some doctors I know that we’ve had on have said that there are vitamins you can take that assist in your eye is that something that you sometimes suggest? There are certain vitamins that are helpful especially with people who have moderate macular degeneration. Those that’s the most commonly prescribed reason the reason that we would prescribe a vitamin. It hasn’t really been proven to be helpful in other people for instance mild macular degeneration or just people who have no eye problems, but I always think that once we develop the technology to find out if it does help, we’ll eventually find out that these vitamins do help so I often will prescribe it even for people with mild degeneration. Right again good communication whether it’s your family doctor or your ophthalmologist that’s always very important. Well speaking of good communication, I understand that you’re willing to come and communicate to our over 200 clubs here in the community if they’re looking for a guest speaker you’d be interested in speaking to them at no charge? Yes that’s quite right I’m very happy to come by and speak to your group to just educate anyone about eye disease and be happy to answer any questions you might have, I’m always willing to do that. That’s great well if you want to find out more information we’ve got the doctor’s phone number there on your screen. You can give them a call at 770-1322 the orange county eye institute and as we say Doctor Salib interested in maybe coming to your club or your group and sharing some of this important information with you thanks for joining us today we’ll see you back in a few weeks thank you good to have you on the program today. Doctor George Salib again that’s the orange county eye institute and if you want to find out more give them a call 770-1322 we’ll continue on with more of what’s happening around your busy community.

Well today’s health topic is brought to you by the orange county eye institute and it’s very important that you’ve treat your diabetes but a lot of people probably don’t realize that it also affects your vision and Doctor George Salib is joining us today with the orange county eye institute. Thanks for joining us today. Thanks for having me. There’s a lot of talk about diabetes but I don’t think people realize that it actually affects your vision you know quite a bit. Yeah indeed in fact, a lot of people go by and they have diabetes and then they don’t realize that what’s affecting their vision then all of a sudden, they start to see blurred images and then they figure out well what’s going on. Right, so diabetic eye disease really affects people who have diabetes, right, and diabetes is basically a disease of blood sugar. So, the elevated blood sugars which are caused either by insulin lack of insulin or a resistance to insulin, starts to cause damage to the vessels inside your eye that line the retina and once you get damage to those vessels, they can start to have little out pouching’s little micro aneurysms they call it, haemorrhages. Similar to what we see here on the screen? Exactly you see on the left you’ll see a normal retina, what this is what I’m looking at when I’m looking inside your eye if your eye is dilated. So, you have the, the, nerve surrounded by all these blood vessels on the left and everything looks kind of clean there. On the right you could see that there’s a haemorrhage there so you can get large haemorrhages and bleeding inside the eye as well as even retinal detachments and even certain types of glaucoma and fluid leakage and that’s all as a result of that sugar affecting those blood vessels and making them weak. How can the person tell that diabetes is actually the effect of these things could it you know could it just be a coincidence or is it usually you can tell and narrow it down that diabetes has caused this effect to their vision? Right, well that’s a very good question you have to look at their overall history that’s why when we take a patient into our clinic we will ask them a bunch of questions to see what is their past medical history and if they have high blood pressure for instance or diabetes or kidney disease or high cholesterol, we take all those factors into consideration to look at what might be causing that disease in your eye and there’s certain patterns that are more familiar or more characteristic of certain diseases and we take that into consideration. Now a person with diabetes will have a vision that looks similar to this slide how gradual is that before something like that happens. Well it’s a great question because in fact in the beginning you might not notice anything. You might not notice that your vision is blurry if the blood spots for instance inside your retina are not exactly in the centre of your vision but once it starts to get into you’re the centre part of your vision called the macula and you start to get leakage of fluid there, that’s when you’ll start to get these blurred and distorted images and even blind spots and even blindness if you get a huge haemorrhage or detachment. How common is that for people that suffer from diabetes that they’ll actually have this effect on their vision? You know it’s, diabetes is the leading cause of new blindness in the united states in ages 25 to 74. So, it’s a huge problem. In fact the CDC estimated about 26 million people in this country alone have diabetes and about three times that have pre-diabetes. Worldwide you could see this graph basically  in the beginning like now we have about 177 million people in this country alone in the in the world, 171 million who have diabetes and that’s thought to more than double by the year 2030, Wow, so it’s a huge problem the scary thing is that half of the people that know they have diabetes, they never seek eye care or they don’t get the appropriate eye care and it becomes a huge burden not only for themselves but on society in terms of health care costs. Now this affects people of all ages because we talked just briefly during the break, right, it’s not for 50 plus you know people as you age you kind of go through this process you have children that actually can suffer from this as well. Exactly there’s a couple of types of diabetes type one in type two. So, kids they have a lack of insulin production and so they can get them you know in the early years, you know, five six seven eight years old.  However, and then type two diabetes is usually as a result of a lack of insulin receptors or a downgrading of those receptors so that you don’t have so much response to the insulin and that’s as a result of obesity or lack of leading a healthy lifestyle and that the length of time that you have diabetes affects whether you get diabetic retinopathy. So usually after about 15 years about half of the people will have some changes in their eyes as a result of diabetes. So what kind of treatments do you have available for someone like this that’s suffering from that? Well always the best treatment first is prevention. So, you have to lead a healthy lifestyle as much as you can eat right exercise don’t smoke all those things are important to try to minimize your chances of developing diabetes and the next step once you have diabetes if you get diagnosed with that is to have good access to health care going to your doctor regularly and to make sure that you get treatment for that if necessary. Now what can we do for treatment? You could see on the left there’s an eye that has lots of little white spots. So laser is a very good treatment. So all those little white spots is where the laser actually hits the eye if you have a lot of leakage in your eye. On the right you could see an image of an eye being injected with a medication that actually helps to decrease the amount of leakage by decreasing the amount of blood vessel growth in your eye, that comes as a result of diabetes. So basically, these remedies are trying to get that vessel to kind of constrict and get back to its normal shape and function compared to this haemorrhage that’s now developed in your eye? Right, the idea is to really try to get those blood vessels to not grow and proliferate as much and blood vessels tend to grow when you have a lack of oxygen and if you have blood vessel damage there’s a lack of oxygen which causes that blood vessel growth. So really strict blood sugar control is very important and it’s been shown in a study here in the united states and in the UK that strict control can actually decrease the rate of progression of diabetic changes in your eye by about half. So that haemorrhage is that when we saw that blurred vision slide is that the haemorrhage that’s actually causing that kind of block? It could be the haemorrhage itself blocking it, it, could also be a leakage of fluid into the actual retina and that cause it’s like looking through water, right, if you have that leakage and that’s all as a result of that sugar affecting that blood vessel making it weak. Very interesting. So obviously some very important information that for anybody that’s suffering from diabetes and if you’re not suffering from diabetes I, I, probably would guarantee that you either have a family or friend that has some kind of diabetic condition, right, so it’s important that they see you and you also speak to clubs and organizations as well regarding some of these topics. I do, I’m always available to speak to that. I love educating about these topics I’m always available to give any lectures if necessary about this and other topics, and the most important thing too for someone like this is, is, nutrition like we talked about and your lifestyle right, exactly, yeah nutrition is extremely important remember what goes into our body makes up our bodies. So we really should think twice about what we eat and try to decrease those complex carbohydrates and eat a healthy meal. Right, well if you’d ever like to have the doctor speak at one of your clubs especially even the vision impaired club that we have here in our community give them a call at 770-1322 or visit them on the web that’s the ociinstitute.com and they’ll get you any information you may have and of course very important information especially if you suffer from diabetes. Thanks for joining us this morning. Thanks for having me. That’s Doctor George Salib he’s with the orange county eye institute give them a call at 770-1322 for any more information regarding your vision or if you’d like to have them speak at one year organizations we’ll be back with more the channel 6 NewsHour right after this.

Helping you folks to retain your good vision is the goal of our next guest on the program back with us today Doctor George Salib from the local eye group and he’s with us today to talk a little bit about what’s going on out there some cutting edge no pun intended. Right, way to correct your vision we’re talking about something called LASIK today and I’m assuming those letters stand for something. Exactly LASIK stands for laser-assisted in-situ keratomileusis and it’s just a fancy name for saying that we create a flap of tissue in your cornea, we lift it and we do the laser treatment.  In fact, it’s one of the really the most exciting innovations in ophthalmology in the last you know 15 or so years. What we do for a patient is we have them come to your office to the surgery centre basically have them lie down. We put a few drops in their eyes. We create a flap of tissue in the cornea which is the very front part of the eye. We use a cool laser to shape the cornea in order for you to be able to see and then we replace the flap. I usually ask my patients to go home and relax and close their eyes maybe take a nap and then by the next morning, they have a whole new world in front of them. I’ve actually had LASIK in my own eyes. That was about 10 years ago and I thank god every day for having had it. Waking up in the morning being able to see the alarm clock without putting on glasses not having to worry about glasses and frames and contact lenses and the associated possible risk of infection. I’m so happy that I don’t have to worry about that. Well I might say I’ve had it as well I’ve had a little bit longer I had it almost 16 years ago now and obviously the techniques and technology has improved since then, but yeah that was the first thing that when I woke up in the middle of the night that first night actually early morning the next morning, turned over and could read the digital alarm clock without having to fiddle for glasses. So yeah, it’s, it’s, amazing and it is life-changing for many people as well. Certainly, is it something for everybody, can anybody have LASIK or is it not appropriate for some people? Well that’s a great question the main thing that you have to really take into consideration is you have to come to the office, so that we can do a full evaluation. We offer complimentary consultations for LASIK and what we do when you first come in is we first get a full medical history. We examine your eyes in detail. We take lots of measurements with a bunch of fancy machines to determine if your eyes are good candidates and if you are a good candidate. The first thing you have to be able to the first thing that’s important is you have to be at least 18 years of age preferably 21 because if you’re too young then your vision is still changing and if we do the laser you’ll just have to repeat it later on as your vision changes. Right, your, your, vision correction parameters have to fall within the parameters of the laser machine itself. We have to make sure that your corneas are suitable for it like you don’t have something called keratoconus where your eye is abnormally curvy and a little bit thin and then certain medical conditions preclude you from having LASIK as well. So, we have to look at that your medications that your whole medical history to determine your suitability. I know a lot of people know that their vision is down distance wise they’re having a hard time seeing the signs on the freeway. For a lot of people their distance vision may still be okay and acceptable at least good enough to, to, keep getting that driver’s license renewed every few years, but for a lot of people you know the, the, joke is their arm’s too short you see him doing this in church with a handbook or you see him doing you know with the with the newspaper getting out the magnifying glass, so they can read the newspaper. Right, if somebody has good or at least normal acceptable distance vision but is having that near vision, issue does LASIK work for them as well. Well it depends how old you are. So up until the age of about 40 to 45 if you have had LASIK before then you’ll be able to see well at all distances. Now whether you had LASIK or you didn’t usually by the age of 45 you need some reading glasses, unless you were very nearsighted before then. So, if you get LASIK in your 40s 50s or 60s for instance then what you have to consider is you want to be able to see up close as well to try to get rid of all glasses or do you would you mind wearing reading glasses. If you want to get rid of glasses then what I would suggest is having one eye corrected for distance and the other eye corrected for near. I believe that that that is something that gets done as well with people that have contact lenses and often the doctors don’t tell them that they’ve your left eye is the strong eye or whatever and I understand. You test for which is the stronger eye or which eyes better to be your distance eye and your close-up eye. Exactly that’s called your dominant eye there’s a special test we do to determine that we usually have you try it out with contact lenses first to make sure you like that and that’s called blended or monovision and if you like that then we can certainly do that with LASIK. Is there a I know as a kid I can always remember anytime I got a new pair of glasses because they were very strong I was very nearsighted as a kid, I’d always get a headache for a couple of days. Right, is that normal and LASIK because you’re seeing different now but you’re not wearing glasses does that headache situation become a reality?  Actually, no most people don’t experience a headache at all I had LASIK in my eyes as you know and I and I didn’t experience that at all. Okay, you’re saying that your procedure is all laser.  Which says to me that not everybody is all laser. Tell us the differences? Right there’s two main parts to having LASIK one is the creation of the flap and the other is using the cool laser to shape the cornea so that you can see. The first part which is the creation of a flap is either done with a laser or with a knife basically a blade and that’s called a microkeratome. I used to do it with a microkeratome and that’s how most people started out and now we have a femtosecond laser that can be used to actually create that flap in a very precise and easy way in order to re lift that flap and do the laser so that’s what all laser LASIK is. Let’s talk about success rate. Obviously, you’d like to be able to say its 100 percent all medical procedures have some perhaps small amount that that aren’t successful. How about LASIK how successful is it? You know LASIK is incredibly successful I’d say about 95 to 98 percent of people have great success with it at least nine out of 10 people can see 20 over 20. In fact, I’ve seen some studies up to 98 of people seeing 20 over 20 with this procedure. So, there it’s a very successful procedure and most people are extremely happy with it. What about length of lasting is is it going to change as somebody say somebody gets it done in their, in their 50s or 60s by the time they’re 75 or 80, is it going to have changed will they be back to glasses will they be back to contact lenses or do they need a laser tune-up? Well you know how early you get your LASIK depends on how long it lasts. So, when you get into your 60s 70s or 80s then you have to start worrying about cataracts and then that of course will change your vision and at that point we’ll have to remove the cataracts and we can put in all these new lenses that allow you to even see without glasses. So, at any stage of your life there’s always a good option so if you’ve had LASIK you are not precluded from getting your cataracts dealt with if that’s the case in the future? Oh, not at all I routinely consider cataract surgery and do it on patients who have had it. When you do an eye exam on somebody and you’re say a new patient and they haven’t given you a lot of information about their eye history can you tell if they’ve had LASIK? In most cases yes sometimes the laser scar is so faint it’s hard to tell. So, I usually ask and I’m pretty direct about that. Right and finally obviously like a lot of medical procedures there may be some insurance coverage but maybe not how about paying for this obviously this is a procedure that maybe not all insurance companies are ready for yet? Right some will cover that some don’t most don’t so there’s different ways of paying for it you can either have a sell like a health savings or flex account where you take that money out of your pay check  without interest, I mean without taxes and then you use that for the LASIK or you can use it you can do financing with the company such as care credit which allows you to pay overtime without interest we actually pay the interest by contracting with a company for you so there’s a lot of very good. Affordable options for that, and your staff is good at explaining all those options I’m sure. I’m very proud of my staff. Speaking of explaining if you have a club or organization here in the community and you’re looking for an interesting topic maybe you want to find out more information about LASIK or something else with eye care. Doctor Salib tells me he’s available to speak to your club or organization as well. I’d be happy to. That’s great the office number there on the screen give them a call 770-1322. You can find out more about well taking good care of your eyes but also maybe if you’re looking for a speaker for your club or organization as always thanks for joining us good to have you on the program today see you back here in a few weeks and we’ll see you folks in about two minutes with more news and more guests as our program continues for today.

We welcome you back to the program and we’re welcoming back as well Doctor George Salib, good to have you back on the program. Thanks, good to have you come by today. So, something to hear a lot about and I guess as we age more and more of us or our family and friends have to deal with something called cataracts. I know it’s a something that you’ve studied for years in medical school and now in your practice working on it, but for our people that maybe aren’t up on all the latest medical briefly what is a cataract. A cataract is basically a clouding of the natural lens of your eyes. So, as you age mainly the proteins within the lens kind of like the lens of a camera that allows you to focus the proteins within the lens start to clump together and form a clouding of the lens. So you could actually see on the  on this picture over here that on the left image you can see the eye in a side view with the lens focusing the light very clearly onto the back of the eye which is the red part of the eye called the retina, and so you have a very clear image, right, on the right side of the screen the cataract the cloudy lens scatters the light and doesn’t allow for a clear image and usually by the time we’re in our 70s about half of us will have significant cataracts and by the time we’re in our 80s about 70 to 75 percent of us will have cataracts and they can impact our life greatly by blurring your vision, it makes it difficult to drive at night for instance because of the glare from headlights, even during the day from the sunlight you might have trouble reading or seeing the television or the print on the television, right, so it’s a natural occurrence and you could have good health and healthy eyes otherwise but develop that strictly through the aging process. Yes exactly, but I would imagine there may be some rare cases where maybe something happens and it happens sooner at a younger age I guess you’ve had some cases younger than 75 or so oh yeah sure if you had for instance some trauma in your eye if you have diabetes or if you’ve taken oral steroids such as prednisone for another medical condition certainly you can develop cataracts earlier so you remove the, the, lens the cloudy lens and I guess back in the day in the ancient days that was all they did and they gave you the real thick glasses so you could, could, cope right exactly so we’re taking out the natural lens of the eye which has gotten cloudy and we have to replace it otherwise you won’t have a lens to focus and that’s when you get those big coke bottle glasses nowadays we have really exciting ways of taking out the cataract we have the standard method which is with something called fake emulsification where we break up the lens with this machine and then we suck it out and we put in a new lens inside your eye which is called an intraocular lens or IOL the other option now we have is laser cataract surgery with a laser machine and we’re always staying up on the latest of technologies I’m actually very proud to announce that last Friday I was the first surgeon in the western united states to use the latest software advancement for the latest lens x laser and the cases really went beautifully I know you’ve been using lasers for years for other types of procedures with the eye LASIK and some of those corrective procedures right so is this the same laser or a different diff different type of laser well there’s two types of laser for instance used to do LASIK there’s one that creates the flap and ones that does the correction this is the same type of laser that creates the flap okay so you’re using similar technology that you’re somewhat familiar with already with this new procedure yes I guess the lens you replace it with I think people that have worn contact lenses it’s is it a soft material is it a hard material what’s the actual replacement lens made of it’s usually a soft material made with a plastic called acrylic or it could be made with silicone it’s very small and it fits right into the eye not on the surface of the eye but inside so it goes behind where that lens where that cloudy lens was removed you replace it with a new type of lens and I guess again they went from the coke bottle glasses to a for those of you in photography a fixed lens a specific millimetres of lens and usually that was for normal vision and then you’d correct with glasses for reading and distance and all of that right well there’s several types of lenses there’s the standard monotonal lens which is actually shown here has a nice clear  central portion through which you see but you’ll need glasses to see the different distances because it only focuses at one distance there’s got some new technology now that’s focusable exactly there are many new technologies now  there’s one lens that here for instance called the torque lens which has some hash marks that allows us to dial it in exactly to correct for something called astigmatism now astigmatism the easy way to understand that is if you look at your image inside a spoon your face will be distorted that’s what astigmatism is if it’s not perfectly round it distorts it a little bit so this torque lens allows us to fix that problem and then there’s other lenses such as the multifocal lenses let’s like the restore lens or the teknis multifocal which have these little concentric rings in the centre of the of the lens which allows us to focus at different distances allowing us to see far intermediate and near those of us that are used to doing  tv lighting or stage lighting maybe with a Fresnel lens this looks similar to that with the rings yeah it’s a very similar concept right and it allows us to split light at different levels to allow us to see different distances and there’s also another lens called the crystal lens which is similar to that and it has hinges which allows that single optic to move back and forth also allowing us for a broader range of vision if somebody has been using glasses for years or contact lenses in a substitute for glasses they develop cataracts you say well the bad news is you have cataracts I have to take them out the good news is I can replace it with a lens that allows you to focus is there some training has our eye gotten lazy wearing contact lenses or glasses  well it depends if you for instance have the crystal lens your eye and depending on how old you are you might have to go through an adjustment period to be able to focus that lens back and forth the other one with the rings you don’t need that because it naturally splits the light with those rings so how do you make a decision to which one to recommend it looks like you’ve got four or five here that you like to use right how do you make that recommendation to the patient well that’s the thing you know I don’t want the patient to think you know that you’re the only one that has to research this and figure out which lens is best for you we take you throughout the whole process we examine your eye I determine what is the best lens for your eye depending on the anatomy of your eye and what you like to do and what your goals are after surgery well the good news is that you can do a lot of great things with the other side of that is obviously anything medical is going to cost some dollars let’s talk about the insurance aspect either private insurance Medicare or Medicare supplement is cataract surgery covered cataract surgery yes is covered by insurance as long as you have trouble seeing if you’re not having trouble seeing but you still wanted to take advantage of the lens then it might not cover it but for all people who have trouble seeing yes it would now the lenses themselves  the standard lens is covered the other lenses you might have to pay a little bit extra to get that extra technology and you’ll just pay the difference there I understand  that we all like to hang on to our money and not dump it all at once you have something called care credit which helps people maybe kind of finance that process if they need to yeah exactly you can take between a year and a year and a half to pay off these lenses without interest and it makes it much more affordable to get that best lens inside your eye all right sounds like some unique technology if you want to find out more if this is appropriate for you give their office a call 770-1322 and by the way if you are the program director for a club or organization I understand you’re available to come give them a free lecture and deal with some of these topics or anything that might be of interest as far as I care yeah I’d be happy to go over these topics in much more detail at your clubs all right again if you want to find out more give the doctor’s office a call 770-1322 Doctor Salib, thank you for coming by interesting topic thanks for having me good to have you on the show today we’ll be coming back with more as our Monday program continues here on channel 6 tv