Ologies with Alie Ward - Ophthalmology (EYES) with Reid Wainess

Episode Date: August 7, 2018

75% of adult Americans have wonky vision of some kind, your host included. Longtime pal and real-life eye surgeon, Dr. Reid Wainess answers all the questions that you never bring up during appointments. He and Alie chat about how eyes are just little cameras in your skull, glasses vs. contacts, Lasik, why we cry, some boggling ER stories, how marijuana effects eyeballs, floaters, cataracts, eye color, dogs in goggles and more. Also: what happens if you choke under pressure and pick the wrong options in an eye exam? HOW SCREWED ARE YOU?Dr. Reid Wainess's practiceIf you're in LA and and want Dr. Wainess to be your eye doc: 1-800-898-2020More episode sources & linksBecome a patron of Ologies for as little as a buck a monthOlogiesMerch.com has hats, shirts, pins, totes!Follow @Ologies on Twitter and InstagramFollow @AlieWard on Twitter and InstagramSound editing by Steven Ray MorrisTheme song by Nick Thorburn 

Oh, hey, it's your uncle's corduroy jacket that smells like pipe smoke and breakfast sausage. Alley board. Back with another episode of oligies. Okay, so this one's special because your ears are about to get a real mouthful about your eyes. So it's a very multi-sensory affair, like, hey, ears, will you pass this highly informative binder paper note to eyes?

And ears is like, ooh, hell yeah, but I'm going to read it first and it better not talk shit on me. And I'm like, okay, ears, thanks, you're great. One day we're going to do an episode about you, I promise, just not this week. Eyes, all eyes are on you. I mean, all ears are on you. Okay, eye stuff makes your old pod dad a little squeamish. So my goal in doing this episode, I did it intentionally because it was like, I wanted

to get over my eye squeamishness and stop shoving eyes into a corner. No one puts eyes in a corner. Eyes, here's looking at you. Okay, but first, a little business. So thank you to all the Instagram pals. This week, little milestone, we crossed 10,000, I did a very small private dance in an airport alone about it. And I was like, oh, thank you to all the patrons who support the show and submit questions

for the allergies at patreon.com slash oligies. You can support for as little as a quarter a week, 25 cents a week. So this is totally independently published and produced show. It is like, I'm literally recording this in my closet and I record it on the road when I'm working. I just love making it. So thank you for making it possible, literally by your Patreon support. So if you want to find other oligites in the wild, you can pick up oligies shirts and

dad hats and pins and totes and backpacks and such at oligiesmerch.com. Also thank you to anyone who rates and reviews and subscribes. That costs no money, takes a couple minutes and it helps keep oligies up here in the charts for other people to discover. It takes like seconds. Also I'm a known lurker. I lurk. And when I'm feeling like so jet lagged that I want to go live in a hollowed out tree and

talk only to squirrels, your iTunes reviews always remind me that there are folks out there who are listening and cheering me on to keep making more and it helps so much. And to prove it, I read one out loud each week so you know that I actually look. And this week I'm actually going to shout out, I think I'm going to shout out too because they're quick. Okay. Easy On Yellow says, literally life changing, 10 out of 10, this podcast inspired me to pursue my interest in bugs and now I'm working in an entomology lab.

That's so exciting. Thanks Allie. Every episode is super fun regardless of the topic. Listen to them all. Congratulations. That's amazing. Also, Trista Edwards wrote, this podcast is like the manifestation of all of my obsessions. Every episode is like experiencing an auditory cabinet of curiosities.

As a poet, this podcast generates so much creativity and inspires a poem with every episode. Thanks Allie. Soon I may have a whole book of poems inspired byologies. Trista Edwards, hell yes to that. Please keep doing that. We'll buy your book. Okay.

Back to ophthalmology, which is a word that is like a letter party where someone invited too many Hs. Like, oh damn, why can I not spell this word? Just keep adding Hs. That's the secret. In the etymology, if you guessed Russian, you are not correct because it's Greek. It's just Greek guys. Ophthalmolus means I.

Okay. But what does it mean to be an ophthalmologist? Okay. Well, I called upon a longtime pal of mine, a friend who is not only super dedicated to his work, but he is one of the few truly sane people I know in LA. Like he stands out at barbecues because it's like, what's that guy's deal? He seems nice and like he has his life together. It's so weird.

He hasn't taken a picture of himself smoking or mentioned an impromptu. He's also the type of friend that you can text a medical problem to and if it's related to eyes, he'll weather your questions. He'll hook you up. Solid dude. And I just wrote the Yelp reviews for his medical practice. People love him. He's like everyone's favorite super smart cousin.

The reviews are like five stars would get treated for pink eye again. So I sent him a message. He's like, Hey, can I podcast your brain or what? And he was like, sure dude. So I drove the half a mile to his house. Have I mentioned I'm based in Los Angeles? Also it was so hot out. I'm sorry.

And we sat at his kitchen table and had a merry old talk about eyeballs and he helped me face my squeamocity head on. And we talked about why evolution hasn't weeded out bad vision and what to do if you screw up on your eye tests and what to eat to have healthier peepers and if phones are making us maybe a little cross-eyed and maybe very briefly some very bad ocular accidents and what mascara is really made of and marijuana. And do I have eyeball tumors? And we address diabetes and so-called color blindness in air quotes and why we cry and

dogs who wear glasses. So there's so much happening. Please get ready to have a ball with ophthalmologist Dr. Reed Wayness. Let's do this, I haven't, like I said I listen to podcasts every day, I probably listen to an hour and a half with podcasts almost every day. Oh my God. And I literally was listening to a podcast when you walked up the door. Oh my God.

Okay. I've been here like pretend like I'm on the radio now. Yep. It's great. Look at this. We're rolling. All right. Yay.

Okay. Dr. Reed Wayness, you are an ophthalmologist. Yes. I know you get this question. I feel like everywhere like rental car counters, cocktail parties, whatever, what's the difference between an ophthalmologist and an ophthalmologist, I'm sorry, I have to ask you that. It's a question everybody asks. So it's a good one to start with.

So ophthalmatists and ophthalmologists do a lot of, there's a lot of overlap. So they do a lot of the same things, which is examine eyes and treat eye conditions. Okay. Optometry school focuses on diagnostic pathways. So learning to diagnose certain eye diseases, learning to do refractions, which we check patients for glasses and get them seeing well, do vision therapy, like contact lenses and low vision specialties where they really focus on your vision. Okay.

Ophthalmology is more of a disease focused specialty. Yay. Ophthalmology, and you go through medical school. So you're focusing on the diseases and treating the diseases, whether that's medically or surgically. So it is definitely overlap, but ophthalmology is more of the medical side of things. But that's blurred a little bit more in recent years. So optometrists are doing a nice pun, right?

Unintentional ophthalmology pun. So refractions is what you call it when they're just checking to see if you can read the eye check. Yeah. The torturous number one or number two, which is more clear that everybody hates. I just did that. I just had an eye appointment on Tuesday, which I... You didn't see me.

I did not see you. Okay. Can you... But do you do refractions too? I do. I do. Okay. I didn't know that.

I thought you only cut eyeballs open. No, I mean, I can. I don't do it as my mainstay of my work, but usually for friends and family and people I know, I do that. I had no idea. Okay. I thought that... I thought you were the big guns.

Like you go to you and you're like, I think I have cancer in my eye. Well, sure. I mean, for that, you'd probably go to an oncologist specialist, which, you know, you could see me first. If you had cancer in your eye, we'd refer you out to one of those, thankfully, but that's pretty rare. You don't have cancer in your eye. I will say, I didn't realize until I said that, that I have been told I do have an eye

tumor. You're a teridium. I know. I remember. So, side note. I forgot that I'd made Reed look at my gross eyeball like seven years ago. Also, a teridium takes its name from the word pter, meaning wing, and it's this webby wing-shaped film that grows in your eyeballs.

If you move somewhere with bleached, bright light, and you don't wear sunglasses for a few years, the condition varies in severity. Mine's not that bad, but it's also called Surfer's Eye, which is appropriate because it is, clinically speaking, Hellenarnar. Anyway. Yeah. Do I still have them? Well, they don't just go away.

It looks like it do. Yeah. Oh, God. So, I have a benign tumor in my eye right now. It's not really a tumor. It's more of a degeneration of the membrane covering your eye. Okay. It is the medical term for it, but it's just UV damage to the white part of your eye that

causes it to get a little, it loses the elastic portion, so it kind of swells up a little bit and grows a little differently than it normally would. And so, can I use I Have Eye Tumors as an excuse to not go to things? You can do whatever you want, whether, you know, if there's an ophthalmologist or an optometrist at the party, they'll know you're full of something, but, you know, you can pull it off. I'm full of eye tumors. Yeah.

Okay. So, how did old Dr. Waynes, who I'm, let's be honest, I'm just going to keep calling Reed because we're like bros in real life, how did he decide to go to medical school for ophthalmology? I went to medical school not knowing that I wanted to be an ophthalmologist, but just knowing that I wanted to be a physician. Really? So, what convinced you?

At what point during medical school were you cutting into a cadaver and you're like, you know what, eyeballs? So, definitely not when cutting into the cadavers, although that was some fun times as a first year medical student. A few people lost their lunch that first day. I'll never forget that. Really barfed? Oh, yeah.

Actually barfed? 100%. So, in his third year of medical school, Reed came to a fork in the road. Will he take medical path or the surgical path? That was me being like a witchy oracle deciding his future. If you're like medical, surgical, what's the difference? Okay. One involves the phrase.

Jerry, hit me a scalpel. So, for me, early on I knew I wanted to do something on the surgical side. I always loved doing model cars and building stuff, so I knew I wanted to do something like that with my medical training. But with alive bodies. Yeah, but with live people, exactly. To me, I'm like the leap between like I like working on like model ships and like, I'll cut into an eyeball.

There's a very large canyon size leap that one makes. How did you do that? So, I don't think it feels that distinct when you're doing it. Like, it just feels kind of like a natural progression of life. More like, I want to be a physician and I always liked working with my hands, so it's like a natural next step for me. And for me, all the surgical specialties just were much more fun. I just enjoyed those things more.

I enjoyed doing things physically to help people be better. Oh, thank God. Yeah. Thank God there are people like you that exist. Oh, thank you. I'm like, I can't cut a raw chicken. And so, thank God that there's someone that's like, yeah, I'll hop in there and do that. Who would fix people's eyeballs?

Yeah, that's what I'm here for. Like no one. So, you were, was it kind of the altruism of it? Like knowing that they're going to come out of the surgery, provided you're not drunk, that they're going to come out of it better? Sort of. I mean, I don't think I've ever thought about it from that perspective. It's an interesting way to think about it.

I mean, I think I just, it felt normal to want to do something to make a difference in people's lives, but I never thought about like, oh, the reason I'm doing this is altruism. It's more about just seem normal. I want to do something where I can help people and it just fit. So for me, it was kind of like, there was never a light bulb moment. It was just kind of, it just always seemed like this is what I should be doing with my life medicine that is, oh, this is what I like. I really like treating eye conditions and helping people see better and it just is enjoyable.

You know what I just realized? You have glasses. I do. How long have you had your glasses? Well, I've worn glasses pretty much since high school. Why? Is it so common? This is my biggest question.

So many people have bad vision. If you put me in the wild or like on survivor and you took out my contacts, I would die in the first like 24 hours. Like I have no chance. I can't see anything without them. So why have we evolved to have such shitty vision? Sure. So that's a good question.

I think a lot of it comes back to what you just said, which is it's evolved. So we didn't necessarily evolve to have that bad of vision. You know, if you go back hundreds of years ago, we probably didn't have people who had minus 10 prescriptions and these super strong glasses and contacts that wasn't as common. We've seen a big boom in myopia, which is nearsightedness of having strong, strong need for glasses in the really the modern world. There's debate about what causes that 100%. You know, we think that being indoors more, a lot of close work, like reading computers,

phones, all those things raise the risk of having a stronger prescription. So when we're at a young age, doing that thing, those things that we all do definitely affects that. So some of it is not about historical evolution of humanity, but kind of our behavioral changes over the last 100 years. So wait, what you're saying is wearing glasses really does mean you're a nerd because that means you were staying indoors, like not getting any sunlight, probably reading, then you're wearing glasses, thus you're a nerd.

So chicken or the egg, right? I don't know. But yeah, probably works that way a little bit. If you're spending more time indoors, you know, playing games and doing things up close, you're probably more likely to wear glasses. You know, one of the treatments they recommend for kids to reduce myopia is to spend more time outside. Really?

Yeah, absolutely. Oh, damn. That's the one thing I feel like we're getting worse and worse at probably. Probably. Yeah. And we're just going the exact opposite direction of that. I guess like your kid reading an iPad outside doesn't cut it, right? Probably not.

So do you think that like dogs and apes and giraffes and stuff have shitty vision? And they're just like, man, I can't read that sign. Some do. I mean, yeah, I mean, you can tell though, if an animal can't function because of their vision, then they're going to be walking into stuff. So you know, again, evolution, I think hits those kind of animals a lot harder than they do us at this point since we're pretty domesticated. But you know, a dog that can't see, we all see dogs with cataracts as they get older

and you can see the cloudiness in their eye and they're bumping into the walls. Most young animals don't have problems like that because just their behavior and evolution over the years hasn't created a situation where they're reading things up close. You know, even if your dog's inside all day, they're not reading the newspaper. Dude, that dog would rule that. Yeah. I mean, Garfield probably would need glasses eventually, but other than that, most pets are good to go.

Quick aside, I needed to see photos of animals and glasses. So I googled animals and glasses and it did not disappoint. I soon found myself on a website called doggles.com, which, as you may have guessed, sells goggles for dogs, just dope as hell, prescription lenses, sunglasses for pups, and for a second, I forgot all about the world's troubles. Also one study found that gorillas, are you ready for this? Need reading glasses when they get older. So what is happening when you get older and you have to hold shit further away from your

face? So the muscles in our eyes, they make it harder to squish our lenses to change focal length. So it's kind of like your hand getting like too tired to work a zoom lens. But I feel like instead of reading glasses for gorillas, they would technically be like lice picking glasses. Okay. How much do you notice eye problems in other people? Like for example, my eyes are garbage.

My eyes are tiny balls of garbage. Like I have teridium, which are, I'm sorry, they're tumors in the eye, I'm telling everyone. My eyes get red when I'm hungry. I don't know why they get red all the time. Like how much are you diagnosing people when you're talking to them? Not that much surprisingly. I'm not just talking to people out in the street and really like looking, oh, do they have a red eye?

Do they have a contact in their eye? Do they have a teridium? Do they have a cataract? No, with the influx, or rather now with the change in policy toward wacky-to-backy. Do you notice a lot of stony eyeballs in Los Angeles and California and also Denver? So I think it's hard to tell because you don't, I think I just assume at this point everyone in Los Angeles is stoned. So I can't tell who's just got red eyes from dryness out there and who's actually stoned.

Why do people's eyes get red when they're stoned? I can't believe that I didn't realize that I meant to ask that. Sure. So we have blood vessels on our eyes and when they're dilated, the blood vessels, they look more red. And when they're shrunken, they look less red. So heads up, it's the THC levels in the wacky-to-backy that lower the blood pressure and then cause blood vessels to just bloom and dilate into something beautifully bloodshot.

But that very decrease in the intraocular pressure is what helps the glaucoma patients. So if you're somewhere it's legal and you want the other medicinal benefits of cannabinoids but do not wish to look like a mugshot, you can go for lower THC products instead of just like buying vizine by the leader jug. You know if you take vizine, it's just a vasoconstrictor, it shrinks the blood vessels on your eye so they don't look as red and that's what vizine is doing to people's eyes or clear eyes and that stuff. I hear that stuff is garbage and so bad for you.

Terrible. Terrible. So it hides the redness but doesn't actually treat the problem and then what ends up happening is your eye gets addicted to it so once you stop taking it, the blood vessels aren't shrunken down anymore, they kind of dilate up really, really big and then your eyes look super red and then you put more in because you're stuck using it and then you're just in a cycle where anytime you don't use it, your eyes get super, super red and you feel like you have to use it every day so it's very addictive so don't use it every day because it's, you know, your

eye is going to get hooked on it and don't use it for dry eyes, use it for occasional redness relief, that's totally cool. Okay, but in general, treat it like a special occasion type of vasoconstrictor. Yeah, exactly. I hear you can use it on zits though and it makes them less red. I haven't heard that. I mean. I will try it.

I've got some samples. I mean you're also talking to someone who's put hemorrhoid cream on their face so don't listen to anything I say. So let's back up and say, let's just back up and look at how does vision work like in a nutshell because it's kind of crazy that we have these eyeballs in our faces. What are they mostly made of? Are they mostly empty? Okay, so this in a nutshell in one paragraph explains like the miracle of vision and it

will change the way you think about your own eyeballs forever. It's crazy. Stay with us. Yeah, so the inside of it's mostly just an empty gel. It's kind of like a watery, gooey, thin jelly almost. Okay. But yeah, your eyes like a camera. I mean, we know how cameras work and well people don't anymore because they're all digital

but we used to know how cameras work with film and all that fun stuff but your eye has a lens that has a retina which acts like the film in the camera. So light hits your eyeball and the cornea, the front surface of your eye and the lens inside both kind of refract or bend the light coming into your eye and help focus it. So light passes into your eye, it gets focused down to your retina and then the retina has the rods and cones and it senses the light and the colors and puts it all together and then the nerves on the retina collate together and send it back through the optic nerve up to your brain where the brain interprets the image.

Okay, I'm just going to repeat that just in case you spaced or like someone in the park was walking a cat on a leash and you got distracted because this is real life. Okay, so the cornea is the clear dome covering the iris which is the colored part which lets light into the lens below and the lens is a biconvex aka that just means M&M shaped jelly blob that works like a camera lens. So light enters, gets bent and then goes through your eyeball jelly to the back of the eye where it hits the retina film which has all the rods and cones to pick up light and color and then your brain, if you're sighted, takes that information and forms a picture you perceive

as a reality. Now just as cameras can have different like mechanical hiccups, so can eyes. So the top few causes of losing sight are cataracts which is a clouding of the lens. There's glaucoma, macular degeneration, diabetic retinal damage and in some parts of the world there's also things like river blindness which is caused by a phallarial worm that hangs out in a black fly. Now those are just some of the top causes. Here in the U.S. a whopping, are you ready for this, 75% of adults need vision correction

which means Reed can change people's lives and also has wicked job security. So you know you've got a lot of cool stuff going on but it's basically just the poor man's camera or camera's a poor man's eyeball I guess on the way around. I guess you don't need much money to have eyeballs which is kind of good. Does the light go through the cornea, through the lens, through the jelly and then hit the retina type of film in the back? And now rods, cones, what's happening? So rods and cones are the sensors inside the eye.

The rods are sensing the amount of light that are hitting the retina or flying into the eye there and the cones measure the amount of the wavelength of the color essentially coming into the eye. So you know you think of ROYGBIV like you know the rainbow, red, orange, yellow and what not. Each of those colors has a different wavelength. And so the cones in your eye are sensing what wavelength that light ray is coming into your eye at and that's how it knows what color it is.

You've got tons of those little rods and cones in the eye and so every little detail in the center of your vision can pick out how much light, how much color and then the brain does all the interpreting once it gets up there. Do you ever just space out and think like it's so weird that we can see anything at all and what if I'm seeing everything in a totally different color spectrum than other people and like what's reality? I think the second half, yes, I think the what's reality like consciousness throws me for a total loop but just the fact that we all have consciousness and thoughts and all

those things, yeah. In my head I assume we all see things mostly the same but obviously we all have different color palettes because there's people with color blindness. I don't know if what I see is red as the white you see is red, who knows. Right. Now are you colorblind? One in 12 dudes, right? Yeah, it's a pretty big number.

I don't know if it's exactly one in 12 but it's something like that. I think it's one in 12 for men and one in 200 for women. Yeah, it's pretty common but again most people don't know that they have a problem, just that's how they experience the world. So real quick, those rods in the retina are for low light vision and the cones detect color. So we have three cones, they each pick up different ranges of light and color vision deficiency tends to happen when one of those cones isn't working right. So the story goes about a decade or so ago while making protective eyewear for surgeons

who worked with lasers, there was a California scientist named Don McPherson and he accidentally stumbled upon some greatness. So he invented glasses that separate certain wavelengths so that the eye can detect differences between like red and green or blue. And so for people who have an issue with their cones, this makes flowers and sunsets and leaves go from muddy because those wavelengths are overlapping to just like acid trip vibrant. Now if you feel like bawling your face off, look up Enchroma glasses on YouTube or Instagram just Google colorblind glasses videos and side note, the more accurate terminology in

recent years is color vision deficiency but people still use the hashtag colorblindness all over the place. So it's a good breadcrumb trail to follow. Now either way, these videos of sometimes these like stoic dad types trying on their special sunglasses, it's just destroys your composure in like the best way. There's this one video, one of the first ones I ever saw posted to YouTube by Aaron Williams-Malay has two million hits and features him. Oh, he's like, he nervously puts on this pair of these like $350 Enchroma glasses.

And with this quiet dignity, just very calmly loses his shit. He seems to almost struggle to keep his balance. He's just like washed over in this orange glow of a Virginia sunset, like the first sunset he's ever seen in full color. Is it very noticeable difference? Oh yeah. 10 out of 10 would weep to any time. I honestly just watched no fewer than 20 of these videos.

My eyes are so swollen, I just kept watching it, just kept crying. I knew what I was doing. I loved it. You just see all the, it's so much. Wow. Yeah, crying. It's like, oh God, it's wrenching. Yeah.

So what kinds of things do you have to treat? Like what's a typical day for you? How often are you like scrubbed in Grey's Anatomy style in the OR? So I'm in surgery one to two days a week, depending on the week. I was in surgery today, but mostly I'm doing cataract surgery. So you know, helping people see who can't see anymore because their cataracts have developed from aging. I'd see a lot of cataract patients, glaucoma patients, people with dry eyes, macular degeneration,

diabetes, all sorts of stuff that, you know, affects their eyes, but I spend three or four days in the office seeing patients. And how many of your patients are stone cold awake when you're operating on them and how many are just knocked the fuck out? So probably 50-50, honestly. Oh. Yeah. So we give people anesthetic to, you know, relax them and IV, you know, that fun stuff

and everybody just responds differently to it. And I always tell people like, we're going to give you just enough sedation that you're comfortable because, you know, the more you give the riskier it is and there's no need to do that with eye surgery because it's pretty quick. Like cataract surgeries take like eight minutes. What? Yeah. It's crazy so fast.

How is that possible? I've waited for smoothies longer than that. How is it? How can you do cataract surgery? Both eyes are one eye. Just one eye. Oh, yeah. Yeah.

Per eye. So most people do one at a time. The surgery is eight minutes, but the whole process is like an hour and a half. So, but the surgery is quick. You just go in and you make a little incision that's like two and a half millimeters. You go in and kind of vacuum out the cataract and you put a new lens implant to replace it and you're done. It's quick.

I don't get that though because the cataract, so do you take out the lens that's there or do you put another lens on top of the lens? You take out the lens. So, yeah, the cataract is the lens itself getting cloudy. Okay. So I would tell people like think of your camera. If you got an old camera with a cloudy lens, you need to replace it with a new lens. That's what cataract surgery is.

It's just a lens replacement. So we take out the old one and put in a new plastic artificial one that's clear so people can see better again. My dad had that surgery done one at a time. Not by me. Not by you. I'm not offended. I'm so sorry.

We had no idea. I should have been like, dad, come down here. But in low light, he has the most shimmery cartoon unicorn eyes. They're just like, they're like, why is that? So the lens is plastic, so you're just catching a reflection off of it when you see it. So what happens in the low light is his pupil gets big, so his pupil dilates, so you can see more of the artificial lens, so you get more reflections off of it. Oh my gosh, so next time you know someone with cataract surgery, just like take a gander.

You'll see a twinkle. Yeah. You'll see like it'll be a light off in the distance and you'll catch that twinkle off someone's eye. And yep, you know they have implants from cataract surgery. Yeah, you're like, what are you, Santa Claus? Like, where did that come in? Just like, honey.

Exactly. So different color eyes, now the iris is the color part. Correct. Okay. So what's the function of that? And also, I heard that everyone who has blue eyes is related to each other somewhere down the line by one person who just had crazy eyes. Well, technically, we're all related if you go back far enough, so probably true.

But the different color eyes, so if you, evolutionarily wise, if you grew up somewhere, your ancestry that was Nordic and there wasn't as much sun, you're more likely to have light colored eyes because it doesn't matter if too much light's coming in the eyes because there's not a lot of light. It's just like having darker skin or lighter skin. It's melanin deposits in the eye. It's the same thing as why we have dark skin versus light skin. If you grew up, you know, your ancestry along the equator, you're going to have much darker

skin because there's much more light and your body needs to adapt to that. And melanin can be blue? So it's not that the melanin is blue, it's the amount of melanin in your eye changes what it looks like. So if you have a really light colored eye, you don't have as much melanin in your eye. So then why are eyes blue or green? Like what's causing those colors? Sure.

Again, it goes back to the wavelengths coming out of your eye. It's like, why is the sky blue? It's that same age old question. It's not because the sky is blue, it's because the light that bounces off the sky is coming at the wavelength that is blue. I'm glad someone explained that to me because I still sometimes struggle with that concept. So side note, the physics of the blue sky is called Rayleigh scattering. And that has to do with the size of the particulates.

But in the eye, in the iris, it's called the Tyndall effect. So it's not that like Frank Sinatra or your neighbor's Cool Husky has blue pigment up in their old peepers, but really a lack of pigment that lets the shorter wavelengths in blues scatter and reflect back. So it's called a structural color. And it's why if the light changes in the room or if one were to wear a different shirt, eye color can appear to shift a little because they're just like freaky translucent bounce boards.

Now, speaking of colors, I did not know that different color lasers can do different things. And Reed mentioned that a red laser can penetrate through different types of tissues than say a yellow laser, which then maybe be like, oh, shit, man, lasers, okay. Have eye lasers been a real game changer? Yeah. I mean, thankfully for me, I haven't had to experience that too much because they were around long before my time. But eye lasers in some capacity have been around for decades.

People use lasers for Lasik and treating diabetes in the eyes and all sorts of other things, which that's been around for many years, 30 years. But there's newer technologies and newer types of lasers all the time and people always trying to figure out new uses for that stuff. When you did your first surgery and you're like, I'm about to work on a live, a living person's eyeball. Were you nervous as hell? So probably, I don't remember it too well now.

It's been a few years. You have somebody sitting with you. It's not like you're just out in the wilderness operating on somebody and, you know, if you're doing something wrong, they're going to say, okay, step aside, let me take over and they'll get things back on course for you. It's not like all of a sudden you're just out on your own trying to operate on somebody and you just hope for the best. That's what I picture.

I picture someone's, it's just like, there's like maybe a nurse and an anesthesiologist in the room and everyone's like, all right, doctor, go for it. And you're just like, shit out of luck. You can't look anything up. Like if you screw up or you're sweat on someone, like it's your own. I just picture you being totally on your own. No. So thankfully, unless you went to some terrible training program, by the time you graduate

and you go out to the real world where you do have to be on your own, you feel pretty confident. But it is still a weird feeling that first time you operate out in private without a teacher with you. It's definitely a weird experience. Anytime you're doing something you don't know how to do well yet, you feel out of your element and you feel like you're pretending a little bit and then you learn and you get better and better until you're really good at it.

All right. I'm about to spill like a thimble's worth of tea about my personal life here. But so Reed and I are like bro buddies now, but before he met his amazing, smart, super badass hot wife, Aaron, years and years ago, friends tried to set up me and Reed. I remember because full disclosure, we've been on a couple of dates. True story. I remember like eight years ago, I remember me being like, how was your day at work? And you said the words ruptured globe and I was like, say no more.

And I remember being like, I would be the worst girlfriend because I would be like, I can't even, I couldn't process like what your job entailed. Like it seemed like a war zone or it was like ruptured globe. Like how does that happen? Was there like a pay ball accident? It was like, oh, like, does this ever affect you? How does it and like, how much of the details of your job? Do you tell your wife?

So you know, when I was in training, I trained at a county hospital. So you saw a lot of crazy stuff like I have some crazy stories. Tell me a crazy story. Oh, sure. I will. I'll get to that. But my wife, you know, I'm in a boring private practice now, so I don't come home with crazy ruptured globe stories too often, but you know, I come home, my wife's like, how was

your day? I was going to wipe kind of stuff. And if something crazy happened, I'll tell her. But usually it's not that, not that gut wrenching these days and my day to day work. So ruptured globe stories, I mean, I got those coming out of the, coming out of the ears. Oh, no. What's a story that you can tell me that I won't throw up in a garbage can right now?

So should I get a garbage can ready? Like do I need to be prepared just in case? I'll throw up down my shirt. It's fine. Okay. The craziest story I've had is I'll tell the story the way I like to tell it because I think you save what it actually is till the end and that makes the, you know, add some drama.

Okay. But so I'm on call. I'm at the hospital and I get a call from the emergency room downstairs and it's getting kind of late in the day. So they call me and they say, we got a guy down in the emergency room. He fell off his bike four days ago and his eyes swollen and red and he can't see very well. One night after the community and they told them he needed to CAT scan.

So they send him here and I said, cool, we'll get the CAT scan and call me back. So this was at like, you know, six, seven PM at night. I'm like checking the radiology program on my computer, like looking to see when this CAT scan pops up and I'm just sitting in the on call room, like hoping I can get to go to catch some sleep soon. I pull up the scan and I see, all right, just please prepare for this. So I was editing this while I was making tea and I didn't know that the kettle was done because in my headphones, my screams sounded the same as the high pitched tea whistle screaming.

Okay. I pull up the scan and I see a picture of a nail that's probably five inches long. I swear to God, going through his entire eye and up into his brain and the frontal lobe of the brain. My God. And I was like, I think I need to run downstairs to the emergency room to see what's going on here. Oh my God.

So the patient had no idea it was in there and I swear to God, so it was the real, he lied and said he fell off his bike when he came to the emergency room, but the real story was he was working construction and the nail gun he was using backfired and it hit him in the face so hard that he passed out. So he didn't know what happened and the nail went, I wish the listeners could see your face right now, but the nail went through the side of his nasal fold and up through the eye and it went through it so fast that you couldn't even see the incision where it went in because it was right on the fold of the nose.

So it was like the perfect angle that he didn't even know what happened. He just knew his eye hurt. My fucking God. So obviously we took him to surgery, took the nail out, he kept his eyeball amazingly, but he's not seeing very much out of that eye because he had a retinal detachment and all sorts of other problems, but he stayed at home for four days with that thing in his eye before he came to the hospital. I'm on the verge of throwing up, but I'm not going to.

I'm swallowing up very a lot. Oh my God. Okay, two questions. Sure. Did it touch his brain? Did he get to keep the nail? So yes and no, it did touch his brain, but he didn't get to keep it. Why didn't he get to keep the nail?

That's a good question. I think that's a question for the neurosurgeon who took it out. Oh, he should have given him the thing. I don't remember him getting to keep the nail. Did it hurt his brain? No, I mean, the frontal lobe is kind of a, you know, it's hard to quantify whether it hurts the brain or not. You know, if you remember back to the story of Phineas Gage, he had like the nail.

Yes. See the 1848 accident in Vermont when a 25 year old railroad foreman had a three foot metal spike blast through and out of his skull and lived for 12 years after, albeit a little less inhibited. Side note, Google image search Phineas Gage and you will pull up like a daguerreotype with sultry lighting of a bizarrely hunky dude and he's just holding this railroad spike like a staff after the fact he traveled with it, he held on to it for the rest of his life.

Also, I realize it's disrespectful because this involves massive head trauma, but the dude could still get it 100% would still hit that in the train spike or whatever it was. A railroad spike went through his frontal lobe and it just changes personality. Like you can live a normal life, but it just like disinhibited him, but this was just barely in his brain. I don't think he probably did much. Oh my God.

What if he's just like so good at dancing and karaoke and it's all thanks to that nail gun? He's just like, yeah. Found out I'm an opera singer. Yeah, he could be painting Picasso's like he could be the best artist in the world now. Oh my God. Was he were you there to deliver the news?

Oh yeah, I was there. We were more at this point just so amazed because he didn't tell us what actually happened that I was, we were like, come on, tell us what really happened. We know you didn't fall off your bike. There's a nail in your eyeball. Oh my God. When you told him, was he in shock? Did he laugh?

Did he cry? He was, yeah, I mean he was amazed. He was amazed. Oh my God. Oh. But obviously not surprised because he knew what actually happened. He's like, yeah, I did get hit in the face with the nail gun. Oh my God.

Full face moments from now on with nail guns, guys. Definitely. Okay, so picture an otherwise normal looking X-ray film with just a giant nail floating in the middle of the brain. Just astonishing survival. And I Googled to see if maybe this particular story like made the news. And you guys, I didn't find it, but I found several other stories of men who had nail gun accidents and didn't know until the X-rays came back.

The wounds were so clean. But nails lodged in their brains. Somehow the stories I read, everyone survived and was fine. I have no explanation for this. But I did ask and read another doctors will always do CAT scans instead of MRIs in the case of any kind of trauma just on the off chance that there's some metal up in your dome, which if you remember from the radiology episode would be very bad scene. Okay, but all those people that I read about happened to survive.

Okay, one more story, but it's very intense and was inspired by just that chill Bible verse about any eye that causes you to sin should be like 86. I'm just going to give you literally the briefest of details. But took two pencils and you can imagine the rest. The pencils did not touch your eyes. Amazing. What? The good news in this story.

Everyone lived bad news. Not with great vision. Have you ever had any close calls with your own a bulls? No, I have not. Okay. Yeah. Oh, you have you ever worn mascara? I haven't.

Or do you ever see eye makeup or beauty treatments and you're like, that is not good for your eye. Don't do it. Oh, all the time. Really? Like what? You know, there's people, you know, we see a lot of patients for dry eyes. People who come in with their eyes are irritated.

They burn. They are tired, all that kind of normal stuff that we all complain about their eyes are teary. And then people come into the office to get examined and I look at their eyes and their tear film has just little black specks of mascara floating all in it because they put so much mascara on that it's just floating in their tears. Like, of course, your eyes are irritated. Your eyes are just sitting in mascara goop all day long.

Oh, no, that makes me want to cry because I think mascara is made of like wood pulp also. Is it really? Yeah. Like part of what we adhere to our eyelashes to lengthen them is like wood pulp. True story. I mean, sort of. So mascara can contain rayon fibers, which are processed cellulose derived from wood

pulp on your eyeballs. Are we batshit? I mean, maybe, but is mascara, is mascara batshit? Well, according to the 2010 episode of the Kid Rock Look and Rat Trapper show, Billy the Exterminator. Guano has been official a man. The number one thing we use back Guano for is mascara. Yes, ladies.

When you use your mascara, you're painting back Guano on your eyes. It's OK. They kill the diseases that goes through a process, but that's all it is. That crap checked into this and mascara does not contain Guano, but rather it has this shimmery substance, guanine, which don't worry. This is simply derived from putting dead fish scales in an industrial blender like a fishy milkshake. Who's hungry?

Speaking of a sugar rush, how does diabetes affect eyes? So that's a really important question because diabetes is like one of the leading causes of blindness in the world. Really? Yeah, absolutely. So what ends up happening in the eyes is the retina, which is where the rods and cones are like the film in the camera. There's a lot of blood vessels through there.

And so the blood's not working properly. The tissues get what we call ischemic when there's not enough blood tissue perfusion. Blood tissue perfusion just means that blood is getting where it needs to go, like no traffic on the 405, all is right with the world. The retina gets damaged from lack of perfusion, of lack of proper blood flow. And then the response is a signal to say, I need more blood vessels. So this isn't working for me. I need better blood.

So all that vege for vascular endothelial growth factor floods into the eye and it kind of floats in the eye and the eye starts making all these new little wispy, crappy blood vessels. And those blood vessels aren't good, healthy blood vessels and they break, they bleed, they scar, they cause all sorts of problems. So if left unchecked, these issues can lead to blindness. So go to the doctor if you can. Now one thing they can do to help is use anti-cancer drugs for it. Like really?

Like what in the Sam hell, how does that work? We actually inject it into the eye and it turns down that signal. So the blood vessels start to shrink down so those new little wispy, crummy blood vessels shrink, disappear and you can reverse some of that. Some of the damage is permanent, but you can reverse some of it. I didn't realize that diabetes and eyesight were so linked. Oh yeah, absolutely. I had no idea, so I'm sure you're seeing more and more in that.

We see tons of it. Yeah. So one of the really important things if you have family or friends or yourself are diabetic. Yearly eye exams are so crucial because if you catch it early, we can treat it with lasers or injections, different things that stop it from happening. So we can really save people from going blind when we treat it early. Speaking again of eye lasers, okay, let's talk Lasik. So many people have gotten it.

I'm going to let you know, so many people I know who have gotten it and had crappy experiences and I'm scared of it. That's too bad. And I'm sure there are so many people I know that have gotten it and just said nothing and it's only the vocal people who are like putting on Facebook that their eyes are bleeding or whatever. But what happens with Lasik? How safe is it?

So let's start with the number one thing is it's very safe. So like anything, you hear the bad stories, you don't hear the good stories. So everybody who has a bad result is going to talk about it. The 99% of people who have a perfect result are just going with their lives and are happy. So the loud people are the people who are unhappy and of anything, medical procedures included. How come you haven't gotten it? So I don't mind wearing glasses.

I have a small prescription. So I'm happy wearing glasses. Like I think I look dapper with glasses. I'm happy with them. It's a good look and also it's on brand for you. Exactly. There you go. I might say that for Dr. Waynes, the glasses have full.

So Lasik is basically reshaping the eye to build your prescription into your eye. So your glasses work by bending light. So the way your eye works right now is we talked about this earlier, the cornea and the lens bend the light coming into your eye and it focuses on the retina. So if you don't need glasses at all, it means that's focusing in the right place. It's focusing right on your retina. If you're nearsighted, it means your eyeball is too long. So that focus is actually happening, the image is actually focusing on the middle inside

of your eyeball and not making it all the way to the back of the eye to where it's supposed to be. No way. So I got long eyeballs. You got long eyeballs. No way. I never realized that's my vision. How did I not ask that earlier?

So that's the more nearsighted you are, probably the more elongated or longer your eye is. Oh my God. So the average eye is like 23, 24 millimeters long. I have a patient scheduled for surgery that has an axial length or a length of their eyeball of 31 millimeters. So they're really, really nearsighted. Wow. Yeah.

So the longer your eye is, the higher your prescription. So anyways, so the way your glasses work or contacts is they bend the light into a different way. So the light coming into your eye is bent. It's hitting the focal point in the wrong spot. So the lenses that you put in front of your eye just change the way that light is bending so that it focuses on the correct place. Wow.

So Lasik is doing the same thing. You're reshaping the cornea to change the way the light comes into your eye so it bends and focuses in the right place. But you're not changing the length of the eyeball. Correct. Okay. You can't change that. So with Lasik, they flatten or they steep in the angle of that cornea, that dome that

covers your iris. And that changes the way that the light bends before it hits your little jelly lens inside. And so why does it not work for some people? Or can your body grow it back to whatever bad shape it was to begin with? No. So your eye is not going to change. Your eye does change. So if you laser your cornea to a different shape, it's not going to regress back to the

old shape it was in because they actually remove layers of the cornea and they're gone. So that's what the laser does. The laser is ablating or destroying layers of your cornea to flatten it out. So it's pretty crazy stuff when you actually think about what's actually happening, but it's really amazing that it works and that people figured it out. And it doesn't hurt. It doesn't hurt. No, you numb the eye.

You put a little eye drop on there and it numbs it so it'll burn for like five seconds when you put the numbing drop on and it doesn't hurt at all. And then when our eyes get worse and worse every year, is it because our eyeballs getting longer or what's happening? Most of it is the change in the lens inside of your eye, the cornea inside the eye. All right. Let's talk about eyes and phones. Okay.

I feel like I worry that my phone is making me cross-eyed or giving me like one wonky eye. Do I have a wonky eye? You don't have a wonky eye. Are you lying to me? I'm not lying to you. Okay. And if I was, I wouldn't know which eye to look at.

Oh, no. No. I feel like in pictures sometimes I'll look and I'll be like, where are my eyes looking right now? Yeah. You might have just not been looking at the camera. Okay. That's possible.

PS. I was taking a selfie on his porch for Instagram after we recorded and sure enough, I was just looking at the screen of my phone instead of the actual camera lens and my eyes looked weird and he was like, my God, what a dipshit. But our phones doing terrible things to our eyes. So yes and no. I mean, they're not doing anything that bad. They're making our eyes more dry because when it ends up happening, anytime you stare

at something really intently, like your phone or computer, even a newspaper, you don't blink as much and so your eyes get drier and drier and the tears have different layers in them and we have oil that comes from our eyelids and we know that doing a lot of close up work and using screens makes that oil production not work. Properly at least. It doesn't work properly. It works, but it just doesn't work as it's supposed to. So we get blockages of the oil glands in our eyes.

So it's very common. We see people in our office, I look at their eyelids and I can see their oil glands are all plugged up. Really? Yeah. And you literally just put heat on it and that helps. So you put hot compresses on the eyes or nutritional supplements like Omega 3 fatty acids.

That kind of stuff helps. How can you tell? Are there little bumps? There are. My bomean gland. Sure. You'll see tons of Google images of people's my bomean glands and you'll see these little white dots right at the base of every eyelash pretty much.

And in somebody with blockages of those, they kind of look big and bulgy. So it's like a pimple. I mean, it looks like, you know, tiny little pimple. It's like a little ball of white goop that's kind of stuck there where the oil is not flowing out properly. Yeah. Okay. So I didn't look this up and oh God.

So if you've completely desensitized yourself to Dr. Pimple Popper and you're looking for like a stronger barfier fix, feel free to saunter into the dark underworld that is a YouTube search for my bomean gland expression. Wherein a doctor just gently wedges a metal paddle into your eye and then presses your lid into it, erupting what appears to be butter in a linear fashion, like the Bellagio Fountain in Vegas, only tiny, oily and out of your eyeballs. So that's what you're doing to your eye when you're staring at your phone. You're making it dry.

You're disrupting the oil mechanism of the eye. You're not like causing yourself to go blind. You're not going to cause any permanent problems, but you are just irritating your eye. Oh God, I had no idea. But it's not going to be something permanent. No. I mean, some of it, you know, it's permanent in that you're not going to give up your phone. So I don't think we're going to have a purge and I'll get rid of technology and maybe we

will. I feel like the apocalypse is an eye. It's possible. I mean, not in a good way, but just start over. So side note, Reid had also told me that the puff test at the doctor is measuring your intraocular pressure. Like if the air flattens it, not enough pressure, but if it barely budges, you might have a bulge issue, like possibly from glaucoma.

So contrary to common beliefs, it's not merely a tool to scare the shit out of you and deliver perverse joy to eye doctors. Also, are tears different depending on if they're tears of joy, tears of sadness? Have you seen that thing going around? Tears are different. So I don't know about the emotional component of the tears, but there are definitely different proteins in your tears for different things. So we all have tears that are on our eyes 100% of the time.

And when we cry, we make a totally different type of tear. So if you looked at it under a microscope, they would look totally different. Really? Yeah. I think it holds true for different emotional states as well. So side note, a few years back, photographer Rose Lynn Fisher released a series of dozens of microscopic images of dried tears. And tears, apparently, there are three types.

There are basal tears. Those are the everyday ones that our eyes use just to stay moist. There are psychic tears caused by grief or laughing or frustration. And then there are reflex tears, which could be caused by like onion vapors or dust. So Rose Lynn Fisher collected over 100 samples from herself and from volunteers. And they all dried in these really beautiful and wildly varying patterns. And they look like land from an aerial view, kind of like a stark black and white satellite map.

And so she called the project Topography of Tears. Now some of the variation can depend on the drying conditions and the salinity, but psychic tears, the emotional ones, do contain more of a protein-based hormone that acts as a painkiller. So when you're out there like having a good face rain, watching a dude having a face rain, wearing color vision deficiency glasses, your body is like, this much beauty. This much beauty. It hurts me.

Make it stop. Humans are so cute. Also, we get befuddled a lot, for example. But people always get really confused because they come to the doctor and they say, my eyes are watering and I'm like, you have dry eyes. And they're like, no, I don't. I have wet eyes. And it's like, well, no, your eye is crying because the tears that are supposed to be just

sitting on the eye all the time, which are different type of tears, aren't there. That's so funny because if your page would be like, I don't look at how wet my whole face is wet. So you're tearing to fix the fact that your eyes are dry with a different type of tear that's not doing what you really need. Oh my God. Okay. Okay.

So quick aside, Reid started telling me another story about his days in the trenches as an emergency eye doctor and a 16-year-old patient he saw. And I'm going to redact most of it and I'm just going to let you visualize the rest. But... Firework wasn't working. Homemade firework, of course. It's always a homemade firework. Yep.

Okay. That's all you need. Let's just say he has one glass eye now. Or does he? He was like an inspirational kid, you know, just like got him an artificial, you know, fake eye and he was happy and looked good and lived a normal life. How did those glass eyes work? So they're not glass eyes.

Okay. So glass eyes is like maybe 100 years ago, people use glass eyes or I don't know when. But nobody uses glass eyes now. So basically you take out the eye and you put a ball in there, it can be like a silicone implant ball or like a little porous implant. And basically you cover it with the membranes that normally cover the eyes, so you actually remove the eyeball itself, but you leave all like the membranes around it. The whole eye would just be white, like your eye is now.

So it would just look white across the whole thing. And then they get a little prosthetic shell that's like a giant contact lens and it sits on top of that. And they paint it to match your other eye. So you probably have interacted with people that you don't even know have a fake eye because it's painted to look exactly like their other eye. What's that job like? Is it like an artisan?

It's cool. It's an ocularist. Reed told me that this job is called an ocularist. And Casey needs someone, Dr. Steven Haddad in LA, one of the best in the world. And wouldn't you know it? It was Friday night and I just found myself like 17 photos deep on this ocularist's website. They have a patient gallery. And I'm just, I am genuinely thrilled to report that it is extremely unsatisfying.

Just a bunch of photos of totally garden variety, nice looking people, nothing out of the ordinary. Everyone just looks healthy and happy. So good job. There's just amazing artistic people that do phenomenal work. So, so under over the implant is your is actual your tissue? Yeah. So if you think about most people don't really understand the anatomy of the eye, but the eye, the white of your eye is the sclera.

But then there's the conjunctiva, which is the membrane that covers it. So you've actually got different layers there. So you can remove the eye, but leave the conjunctiva. Oh, so the sclera would be gone. Because the eyeball itself is removed. But the membranes that kind of sit on top of that, those can be closed back up. So you put a fake eye behind it and then you close those membranes on top of it. And then how often do you have to put in that kind of covering?

So most people wear it all the time. You can, depending I think on the person's comfort level, it's like a giant, huge contact lens. But they give you like a little plunger so you can pull it out like a contact lens and everything. And then. So some fun celeb trivia. So Sammy Davis, Jr. and Peter Falk, who played the detective Colombo, both had eye implants. And even cooler than that is that you've probably met a ton of people in real life who have them. But ocularis are such skilled wizards.

You just never know. It's like no biggie. OK, onto one more thing that you don't know. OK, are you ready for rapid-fire rounds? Yeah, let's do it. OK, now you've looked at these questions. I cheated, yeah. I saw you became a patron and I was like, number one, it's fine if you want to become

a patron to look at your questions. But you don't have to give me five bucks a month. You can do it for a dollar a month. That's OK, I support you. I was like, you could have gotten in for a lot less. No, you asked me to do this podcast and I started listening and now I enjoy the oligies. So I'm a patron now. OK, all right.

But I was like, you didn't have to come in following so hard. I don't know. I can I can handle five dollars. OK, well, if you need to drop it down to one, if for some reason you don't like it. Yeah, we need to start a college fund or something for the baby. Drop it down to one. We'll drop it to one. Colleen Thompson, I love also that if anyone hears any munching

or bull scraping, that's your little pup. We are pup who has cataracts. He definitely does. He's 16 years old. He's an old little guy. Do you ever want to do cataract surgery on your dog? I don't. I don't know much about operating on dogs.

And also, people are much easier to anesthetize and keep still than a dog. That's a good point. I can't even brush my dog's teeth because he's a spaz. So the thought of the thought of operating on his eyeball does not excite me. I just love that he's like he's like a living demonstration of what cataracts are. OK, so rapid fire questions. Here we go. We're going to try and get through as many as we can.

We'll see. Do it. But before we take questions from you, our beloved listeners, we're going to take a quick break for sponsors of the show. Sponsors, why sponsors? You know what they do? They help us give money to different charities every week. So if you want to know where allergies gives our money, you can go to alleyword.com

and look for the tab, Allergies Gives Back. There's like 150 different charities that we've given to already with more every single week. So if you need a place to go donate a little bit of money, but you're not sure where to go, those are all picked byologists who work in those fields. And this ad break allows us to give a ton of money to them. So thanks for listening and thanks sponsors. OK, your questions. Colleen Thompson asks, can you really get a weed card for glaucoma asking for a friend?

It me. Well, thankfully, you can pretty much get a weed card for anything. So you just have to tell them I have anxiety and they'll give you a weed card. So marijuana, it's actually a common question about marijuana and glaucoma. So marijuana does help glaucoma. Glaucoma is a disease where the nerve in your eye gets damaged. And the way we treat that is by lowering the eye pressure and smoking marijuana or ingesting marijuana lowers your eye pressure.

However, it does it for a very short period of time. So we have medications that work much, much better. You put an eye drop in your eye one today and it's going to lower your eye pressure for 24 hours. You smoke a joint, it's going to lower your eye pressure for maybe an hour. So we don't prescribe it for that because it's not as good of a treatment as the other treatments we do have. Got it. But also it gives you feathery, feathery eyelashes, right?

The glaucoma medications. The drops do, yeah, absolutely do. That's what lethises, too. So it's the same thing. So if you ever go and buy lethies, you're just buying a glaucoma medication. So the reason they came up with lethies is the glaucoma patients were getting thick eyelashes. So people were taking these medications, they noticed their eyelashes were growing and getting thick. And so they were like, well, hot,

we could make some real cheddar off this. That's what I'm guessing they said. Also, April Farr asked, how does lethies work? I thought you just painted it on your eyelid skin to make the hair grow thicker, but a listed side effect is possible darkening of your eye color. Should people be fooling around with this for the sake of spidery lashes? It can be true. Yeah. So the medication, it doesn't on most people, but it can.

So the lighter your eye is to begin with, the more likely it is to happen. So the medication has been shown in people with glaucoma, same thing. So it's a risk if you're taking it as a tease, because it's the same medication that it does get into the eye. That's how it treats your eye disease. And it can change the melanin in your eyeball and your iris and it can darken the color of your eye. So if you have brown eyes to begin with, it's not going to lighten your eyes.

It's not going to change them. Patients, so it is rare, but you can have people with blue eyes kind of get darker eyes while they're taking that medication. So from glaucoma can happen. If you're using it with lethies, it can happen as well. With lethies, you're applying it more on the eyelashes. So it's probably less likely to happen if you actually think about it because you're not soaking your eye in it.

Right. But it absolutely is a risk. I mean, I've looked into it. It's so expensive. It's like $100 a month. And that's why it's nice. I get samples of the glaucoma medication. So if my wife wants it, I can just bring her home some samples. Literally, we have lots of people who do that. Like you'll have technicians who in our office who take a bottle home

and just put it on a mascara dropper and then rub it on their eyelashes. Yeah. A lot of the reps do it. All the reps for the glaucoma medications do that. Really? Yeah. Absolutely. And I hear that it's way more expensive when it's lethies versus when it's a glaucoma medication. Well, of course it is. But yeah, they obviously when they're selling anything for cosmetic purposes

are going to jack up the price. On the topic of this, Susan Curie wants to know how bad are lash extensions for your eyes professionally done? So probably fine most of the time. Again, what anything can do that to foreign body or foreign substance throughout the eye is it can cause irritation. So it's not going to cause you to go blind, but you can have an allergic reaction. I've had people come in with lash extensions with super swollen eyelids

and itchy, burny kind of just a allergic reaction. If you've had them multiple times and you've never had a problem, it's not going to cause any problems. OK, it's so weird to be like, oh, we're just going to glue some human hair on our eyeballs. Yeah, I think most people will do fine. So I wouldn't worry too much about it. Jessica Baumgartner and someone named Liz both said my eyes are green, but sometimes I think they change to blue or gray, depending on what I'm wearing.

Is that bogus or is the color really bringing out my eyes? As far as bringing out the eye color, your eyes not changing. So your eyes the same. So if you wear a different color shirt, it's going to bring it out because of the contrast between the different colors or it might be reflecting off something. So you catch it in a different light, things like that. Your eyes can look different.

Again, it comes, it's not you sense the color based on the light bouncing back to you, not what the color actually is. So you could see the same item in two different lights and it looks a little different because different colors come out differently when they're refracted by different amount of light. So it's like when I turn the lights off in this room, this table gets darker. Yes. Is the table getting darker? No, it's no. OK, got it.

One day we're going to have chromatophores like octopuses and we'll just we're going to be able to change them at will. That'd be pretty cool. One day. Yeah, I like it. The Latisse people are going to get on that. Anna Thompson wants to know, do contacts make your eyesight worse over time? Or was that just something my parents told me

so I would get glasses and some contacts in high school? People do what's called ortho keratology, where they wear hard contact lenses overnight while they sleep and it actually flattens your cornea out. So when you wake up, you don't need glasses the next day. What? Yeah, I swear to God. So it's actually a big thing in the Asian population, especially like in Los Angeles. And we have small offices out in like Roland Heights in San Gabriel,

which are big Chinese and Korean populations. And it's really big out there. So a lot of these patients, their kids are 15, they are near sighted and they don't want to be. So instead of having to wear glasses or contacts during the day, they sleep with these ortho keratology contacts and then they wake up the next day and they can see. And then if you don't wear them for three days,

you're going to lose your you're going to go back to being near sighted again. But as long as you wear them every night, your eye kind of stays up and stays flattened out the cornea so you can see well. It's like a retainer for your eyeball. Yeah, I like that analogy. It's like a waist trainer. It's like a Kardashian corset. P.S. before you go Google these old school corsets

that are racking up all kinds of new money, please note that a year or two ago, the ones that Kimmy Kay and the crew endorsed got sued for false claims and for misleading consumers and they lost the lawsuit. So don't squeeze your organs into an elastic vice because you're fine the way you are and social media is a lie. OK, bye. I can't imagine it's comfortable, but whatever. Julie wants to know or no, actually, Laura Egret Crow wants to know how can you keep the whites of your eyes super white,

like what causes them to be yellow and dingy and bloodshot? Sure. So your eyes are white on the sclera. But then as we talked about, there's little membranes that cover it like the congenitiva, those blood vessels that flow through all that. Those blood vessels are red. So when the eyes are red, it's those blood vessels getting dilated. And that could be because they're irritated. It can be because you ingested a drug that makes your blood vessels dilate.

You know, whatever it may be, if your blood vessels are big, you're going to have red or eyes. The yellow is usually little fat and cholesterol deposits in there as well. And that stuff just kind of comes out when your eyes are tired or dehydrated because, you know, there's less fluid around there and things kind of stand out a little bit more. Really? The best thing you can do to control that stuff is to make sure your eyes aren't dry.

So try putting in artificial tears, not the redness removers, lubricating the eyes, you know, refresh, sustain any of those artificial tears that you see when you go to the drugstore and there's like a wall of eight billion different products that you have to decide which one's going to work for you. But any of them that say artificial tears to lubricate the eyes will help. I can't believe that the yellowness is like fatty deposits. That's gross. It's not that gross.

It's a little gross. I mean, thinking of like just having like chicken fat under there. Well, it's not chicken fat. It's like Eishmals. Yeah. I mean, a little bit. A little bit. Who knew? OK, so hydrate. Yeah, hydrate is good. But again, it's not just about diet plays a big role, too.

So it's not just about how much water you drink. It's about like what vitamins you're eating. So you know, American eyes, Western eyes, diet is very low in omega three fatty acids, for example. And we know that having a high dosage of those things can help dry eyes. Oh, the next question on my list from Julie is what habits or foods can the average human do to extend their eye health? Thank you, Julie, for that wonderful segue.

But, you know, eating healthy obviously is important for the health of everything in our body, but the eyes work just like everything else does. So, you know, vitamin A, for example, is good for the health of the retina. And that's why they say eat your carrots, because carrots have vitamin A. Eating things that have green leafy vegetables, which are have high antioxidant levels in them are very important for the health of the eye. So diseases like macular degeneration. Macular degeneration, by the by, tends to affect more folks over 60.

And it's when the central portion of the retina, remember the film in the camera at the back of the eye deteriorates. It kind of looks like the center of your vision blurs. And I started looking up images of simulations. And then I started thinking of grandmas and grandpa's not being able to see their own birthday cakes or trees or their grandkids. And then I started having these painkillers, saltwater things come out of my lacrimal glands.

So how can we prevent this? We know that antioxidants are really important. So whenever somebody comes in and is diagnosed with macular degeneration, we put them on an antioxidant supplement. Oh, like eat more blueberries for God's sake. Well, we give them a pill, but that's important, too. So yeah, eat blueberries, eat raspberries, eat green leaf vegetables. All that stuff is really important for, you know, the aging health of your eye.

Studies have come out that have showed that you're more likely to get a cataract if you have a diet that's low in vitamin C. Really? All this stuff, just eat healthy. That's really what it comes down to. There's no magic bullet. Just eat healthy and your eyes will be given the best chance you can. And, you know, sometimes you have genetic diseases that you can't control. But, you know, the healthier you eat, the better you're going to do.

You know, I did have, I had a makeup artist I worked with who had really lovely skin and she was telling me that she, she just takes a lot of vitamin C and it helped her skin a lot. And I was like, oh, I never thought about vitamin C being helpful for anything other than colds. Oh, yeah. You know what I mean? It's good. It's good stuff. Well, I mean, think about it.

You didn't have vitamin C, people would get scurvy. That's like where scurvy came from. Like it's so important for the health of your body. I only think about it when it comes to being like, oh, I got a cold. I'm sorry, vitamin C, for just booty calling you when I'm sick. Here is Karl asks, semi-serious question. When will eye doctors get equipment that can automatically detect what your vision is? So you don't have to go through those nerve-wracking questions about, which is better?

So number one, number two. Good news, Karl, we already have it. What? Yeah. So I had to go through this two days ago. Well, here's the problem. It's not as accurate. So we use that as a starting point and then we fine tune it. OK. So you can go on a machine that will spit out your, what it thinks is your exact prescription for your glasses. It's going to be pretty close to perfect.

So sometimes you'll do that and you put that in the little machine, which is called four-opter, where we do the one and two. And you don't have to make any changes and it's right on the money. Wow. But sometimes you do. Yes. OK. So Brianna Faust wants to know, what is happening when you're saying better one, better two? And also for me, and I thought I was the only person about this way, but every single time I'm like, what if I'm saying the wrong thing and I can't tell?

Yeah. So one or two, what we're doing is we're comparing two lenses. So we're flipping little dials inside that machine. So basically we're just playing hot and cold. That's what we're doing. Yeah. We're going higher and lower with the numbers till we kind of get to where we know you are. And if you think you're wrong, we double check. So you don't have to worry.

So yeah. So you're not going to. I mean, if you're like really, really bad at it, you could screw it up. But ninety nine percent of people, like you say one and then we test it again. And then you say two. We're like, OK, this person needs like some triple checks, quadruple checks. Oh, my God, I have no idea. Yeah. So if you know, sometimes we'll see what's called going around in circles on the dial, so we'll be spinning the dial and you'll go right past where you

started and you'll just keep going. And we know, OK, this person needs a little more help to figure out where the prescription is because they're struggling to tell the difference between these numbers. So essentially, if you're like a train wreck about it, they'll discreetly keep asking without you knowing. So, you know, we do things to figure all that out. So you don't need to stress about it because we know that it's not as easy as it should be. Do you ever see a certain temperament that's worse at making that call?

No, not a temperament. I think the older you are, the harder it is sometimes. Oh, it's so scary. Every time I'm like, what if I'm what if I just was spacing and gave them the wrong answer? What's the worst case scenario? Your glasses aren't right in there. We make them like, oh, I don't know. I know, I know, but it's not the end of the world.

And then sometimes I'm like, am I there's this little part of me that's like, did I say it wrong and I'm going to offend them? And they're going to know what's worse is when I go one or two and the patient goes, yes, that happens all the time, all the time. That's funny. Yeah, all the time. No, you're like, it is a binary question, but it's not a true or false. Yeah, yeah.

True. Zach Mardalucci asks, is it true that your eyeballs are the same size throughout your whole life? It is not. Oh, my God. OK, so your eyes do grow over the first few years of your life. They're pretty much fully grown at some point in your childhood. OK. But yeah, they definitely grow after you're born.

But apparently we are more likely to take care of a baby if it looks like it has big eyes, because it's cuter. That's probably why I believe that. Here, do you know the human head with a pound? Why are babies with glasses the best? I think anytime you see something that's out of the norm of like what you're expecting, it's just adorable, like a dog with glasses would be adorable. Also cute.

I mean, once again, doggles.com, kill in the game. Aki wants to know why is looking at the sun a bad idea? Is it worse to look at the sun during a solar eclipse? Are we just looking at the sun more during a solar eclipse? So it's easier to look at a sun during a solar eclipse because it's not a strong feeling, but the light rays hit you just as hard. So that's the problem with a solar eclipse. Normally, if you go try to look at the sun, it's going to really hurt and you're going to turn away.

So it's really, really bad for the eyes. Like looking at the sun for a few seconds can blind you. Oh, my God. And it literally just torches the center of your your phobia, the center of your retina, where you have like this really dense layer of rodent cones where you can see everything. So you lose like just the center of your vision. You wouldn't go blind completely, but the center of your vision would be torched. Oh, my God.

So what ends up happening, obviously, during an eclipse is everyone's like, oh, let's look at the sun and then people try to look at it. And because it's not as bright feeling, you look at it even harder and that can cause problems. And then people buy glasses on Amazon. They don't realize our counterfeit and then look at the sun and damage their eyes that way, too. And then you had like, you know, videos of the president staring up at it without glasses at all, which was hilarious. Even the president saw it, but in a move that is not a complete surprise,

he looked directly at the sun without any glasses, perhaps the most impressive thing any president's ever done. So that was a real clip from, shoot, what network was it? Where are my notes? Oh, yeah, it was Fox News, right? He's that strong. He's that strong. It's impressive.

It's impressive. I wish I was that strong. Stare straight into the sun when told not to over and over again. That's true. He showed us Hillary Mazer wants to know, why do some newborns' eyes change color in the first few months? Is it always blue to brown or can other things happen? So it's usually blue to something darker.

OK, but essentially it comes back to the Mount of Mellon in the in the Iris. So they're just still growing Mellon and producing Mellon in when they're a baby. My son came out with blue eyes and they're they're kind of like a brown and chasal, but still a little blue. They've definitely changed eight months old and they've changed. Oh, crazy. So they're just you're just you're populating it with Mellon and as you grow. Exactly.

Oh, I didn't know that. Ariel Belk wants to know, I always get these painful styes in my eyes. What's that about? She asks, sure. So that's a good question and very common. So we have these little glands in our eyelids called the Mybomian glands, which we talked about earlier, a little bit when we talked about dry eyes. But basically oil comes out of those glands and sits on top of your tears.

So your tears have layers and the oil is the outer layer that kind of protects them from the world. So your tears don't evaporate. So, you know, we all remember from cooking oil and water don't mix. So the oil is there as like the final barrier for your tears to protect them. So that oil comes from your eyelids, because it's kind of on the outer part of your eye. Those oil glands can get plugged. And when that happens, they back up with oil and they form a sty.

So it's basically just a ball of that oil that's just kind of formed and gotten stuck in there and can't drain out. So the number one way to treat that is heat. So if you feel that starting, put hot compresses on your eyes like crazy, the more the better and give it a chance to kind of melt that stuff out so we can drain out a little bit. Oh, that'll help it get out of the hole. Correct.

Why do they get plugged in the first place? So again, we think it comes back a lot to some dietary issues as well. But some people are just prone to it. Just the enzymes that live kind of on your eyelid aren't doing what they're supposed to, all the proteins on the eyelid aren't doing what they're supposed to. And again, we know that it's staring at a screen all day. More it makes this more likely. Some people have bacteria that lives on their eyelashes that grow way more than

they're supposed to, or they can get little mites on their eyelashes that grow all sorts of gross stuff. But that stuff all causes inflammation, which causes that to happen. Do you ever see mites on people's eyelashes? Are they so you see them? Well, you don't see like the literal bug crawling around. OK. But you know what they look like. They look like little giant clumps of dandruff, like in a little cylinder on

the base of the eyelash. Really? Yeah. If you took them and put them under a microscope, you'd see the little bugs. But we know what it is when we see it. And it's pretty common. It's very common. I love that we're never alone. Like you have mites just hanging tough out there. Your entire gut is just filled with bacteria and that are with you all the time. I know. You're never alone.

We've got we've gotten a lot of these, which is awesome. Hillary Blake wants to know, was there anything in your training that stood out for you like gave you that? Yep. This is what I'm here for a moment. Definitely. I think the best thing about ophthalmology is when you take someone who can't see and you make them see again. Oh, my God. The happy feely story here. So I was a second or third year in my training as a resident and I did cataract surgery on this woman and we have her in the office the day after

her surgery to take her patch off. So we set her home with a patch over her eye and she had really bad vision. I think she was legally blind from her cataracts, if I remember correctly. And sitting in the exam room with her, we take off her patch and she starts crying. And I'm like, well, what's something wrong? Like what's going on? And I'm like, are you OK? And she's like, I've never seen my grandson's face before.

Oh, my God, I'm in the right. And like seriously, I was like, this is the best. This is why I'm doing this. Like nothing felt better than that. And I still have those experiences today. I have people that just like come in so happy because they can see again. And that's the best part about being an eye doctor is you can literally with a 10 minute surgery, take someone from blind to having normal vision.

Oh, my God. That's just like I can just already picture the montage of moments that you could put together to just make people ball their faces. Oh, definitely. One more question, because I know I'm peppering you with a million, but this is a question that we got from Colette Ayers, Melissa Cowan, Dan Engler, Bob Carlson, Tom Tarmot, Toycanon, Kira Litchfield. So many people are like, what are floaters?

Why do we get them? Should we can be concerned about them? Give us the scoop on floaters. So sometimes you should be concerned about them, but most of the time, no, thankfully. So a floater is just a little piece of the gel inside of your eye, causing a shadow. So our eyeball is big and it has to be filled with something to stay, you know, big, but otherwise it would just deflate if it didn't have anything inside of it.

Weird. So, yeah, like if an eye has really, really low pressure, it can actually kind of get a little mushy. If it's really, really at high pressure, like from glaucoma, for example, it'll feel really firm. So again, we need something to fill that space to hold it from deflating. So there's a thick gel inside there. As we get older, it kind of breaks apart, it becomes more watery.

So you think of it like a kind of thick jelly. And then as we get older, it becomes more and more watery. And so little clumps of it break apart. And those clumps cast shadows onto your retina, where you see light. So light comes into your eye and there's a little stringy, floaty thing inside of that gel where a little piece of the gel broke apart and it casts a shadow, which is what you're seeing. And then as we get older, you can get the big floater or a big series of floaters.

And that's because that jelly, when we're younger, is like really thick and attached to the wall of your eye. And it detaches from the wall of your eye at some point as we get older. So it's pretty normal, unless it's not. So if you start to see like rando disco lights and you are not in a disco, call the doctor. And so if you see like flash bulbs go off in the corner of your eye and there's a giant new sea of floaters, you need to get checked because you may have a tear in your retina, which could lead to a full detachment.

Mary M. and also Anna M. McDavid asked, what's the deal with detached retinas? Why do they happen? Can they be prevented? Sure. So a detached retina is think of the retina like wallpaper. And wallpaper, if you get water behind it, it's going to detach, right? It's going to kind of pull off the wall. So inside the eye, the retina is attached to the wall of the eye and it's held in place by that gel, the vitreous gel.

And as the vitreous pulls on it, it can cause a tear. And if that tear forms, fluid gets behind it. And just like your wallpaper with water going behind the wallpaper, it can pull it off the wall. If water goes behind the retina, it separates it off from the wall of the eye and it detaches. So if we see a hole or a small tear, we laser it closed. So we put like a tack it down with a little ring of laser to hold it in place.

Whoa, God, that's crazy. You can just shoot a laser and be like, all right, I glued it back. Yeah, you're literally just tacking down the retina with laser. Yeah, like lasers in your eyeballs is like it's it's crazy that this is the world that we live in. That's pretty cool stuff. I mean, what now? OK, what about your job sucks? Like, what is the worst thing about your job? The overhead, dealing with doom with insurance companies, pharmacies,

all of those things that are just not why anybody went into medicine. So it's just such a pain, no matter what your political beliefs are, affiliations, even if you think we have the best system in the world, the worst system in the world, it sucks. So we talked about how shitty the business side of medicine and insurance was for like 17 more minutes. But, you know, episodes can only be so long and I don't want to make any of you shed any psychic tears.

OK, what is the best thing about being an ophthalmologist? The best thing is just helping people see again. Honestly, it's it's amazing when somebody comes into your office and they come back to see you and they're better. I mean, it's like any field of medicine when you can make someone better in a tangible way. It's awesome. But the instant gratification of having people come to me every day

happy because I made an immediate impact on their lives is awesome. Well, thank you for fixing so many people's visions. Oh, I love to do it. You don't need to thank me. I thank them. I hope I am never under your knife. But if I have to be under a knife in my eyeballs, I will let you know. If you want those trigiums removed, you know where to find me. Can I get them cut off?

No, you don't need to get them cut off. Just because they're there, you don't need to remove. You get them removed when they're like causing severe irritation or blurring your vision. They look bad. No, they're barely noticeable. OK. I only know they're there because I'm an eye doctor. Oh, God, thank you for being on.

Yeah, I'm a pleasure. It's been it's been a lot of fun. My favorite ophthalmologist. Oh, am I the only one you know? Yes, but you're my favorite. So to gently stalk your new favorite ophthalmologist, if you're in the LA area, you have an eye ish. You can find him at acuityigroup.com.

I'll put the link in the show notes. You can call if you are you ready for this dad pun. Get this, their phone number 1-800-898-2020. I'm literally proud of him for that pun of a phone number like way to go. You can also Google Dr. Reed Waynes, his Yelp comes right up. I'll link it in the show notes too. So take care of your eyes.

Don't be afraid of them. And if yours don't work so great or at all, I'm really sorry. And if they work even a little bit, well, ding, dang, boy, howdy, that's something to appreciate. So if you're having any kind of bad day, just, I don't know, take a sec, like pick a sense, whether it's vision or hearing or smell. And just go, whoa, dude, that works. And I'm just a big lump of bones and water and carbon molecules

who experience stuff and has secret thoughts and eats bananas and gets to dream. So that's cool. Senses are cool, whichever ones you have, let's appreciate them. And remember, ask smart people super questions because they have incredible, crazy stories and no question is actually stupid. And our time here is short, so whatever. Now, thank you to Aaron Talbert and Hannah and River Lipo for moderating the very great group of folks in the Facebook group.

And special thanks go to Gage Martin this week, who posted something in the Facebook group asking why we didn't cover the HIV AIDS epidemic and last week's epidemiology episode. And I read that and like literally hit my own forehead being like, oh my God, I'm so sorry. So I just want to say I'm so, so sorry that we didn't. That was a huge oversight on my part. I had a Patreon question selected about it, but we went too long in the interview and I rushed the rapid fire.

So I'm so sorry I didn't address it in an aside because HIV awareness and research is a cause I've been committed to personally. My omitting it really disappointed me. I really fucked that up there. Thank you Gage for being so cool and asking. And we had a really nice chat about it on Facebook Messenger. Anyone can check out this podcast will kill you's episodes on HIV and AIDS. They're well researched and great.

Also on Instagram, I posted a photo of the CDC's tick-laden muffin and y'all lost your shit, just barfing in the comments. And for that, I am not really sorry. I'm just not. I did it because I loved you. Be careful of ticks. Also, thank you, Bonnie Dutch. Happy birthday. And Shannon Feltis for helping run the merch site,ologiesmerch.com.

Thank you, as always, to the man, the mustache, Steven Ray Morris, for editing these episodes together. I would be screaming into the void were it not for him. Nick Thorburn of the band Islands wrote and performed the theme music. And if you listen to the very, very end of the show, you know, I tell a secret at the end of each episode. And this is both relevant and timely and kind of gross. But literally I'm writing and recording this episode.

I wake up with a sty in my eye. I haven't had one in I swear to God, like a decade. And I was like, are you kidding me with this episode? So I looked in my super up close mirror, the one that is like horrifyingly informative, and then I had to take a Q tip and kind of like swab at it. Very gratifying, but also really bizarre timing. Like, is this how manifesting works? Did I use a secret to get an eye pimple?

What is life? OK, bye bye. Medirology, nephropology, nephrology, seriology, cellulogy. No, not the beast! Not the beast! I'll live my eyes! Eyes! Oh, no.