If I Can See Fine, Why Do I Need an Eye Exam

this one is all about eye care, especially related to wellness, because if you can't see, life is a lot more difficult.

Welcome to Wellness in Every Season. We talk all things wellness regarding the environment that you spend a lot of your time in, your physical health, your intellectual health, your financial health, your spiritual health, professional health, your social health, who you have relationships with, your emotional health.

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Today I have with me Dr. Kevin Jackson, and he is an associate professor in preventative medicine and biostatistics...

That was a challenging class for me, PS, at the Uniformed Services University. He teaches and runs the residency year in the Master's in Health Administration and Policy program, and is the director of Med Excellence course. He is a clinical consultant in the medical contact lens clinic at the Walter Reed Eye Institute, and practices primary care optometry at the Naval Health Clinic Annapolis, so he's right in my neighborhood.

He is the founder of the optometry tract of the Military Ocular Trauma Surgery Lab. What haven't you done, by the way? This is amazing. And he has a lot of research and interest in optomic education, which is why I asked him to be on. He's not trying to sell us a book. It's not going to be an infomercial.

This is going to be 30 minutes of you getting questions asked that maybe you haven't even thought to ask. And this is something that matters to me, because I worked for a year and a half as an ophthalmic tech, and it was incredible how many people were coming in not realizing that you should get an eye exam every year, and they were saying they they have diabetes and they haven't been seen in five years, stuff like this.

So for those not watching on the video, Dr. Jackson just gave a, "Oh my gosh" look. So first of all, welcome. I am so glad you're here, and thank you for saying yes to me.

Oh, yes. Thank you. it's always a pleasure to, have an opportunity like this.

And I know that with my reach-out from out of nowhere, you had that, "Okay, you're a real person, right?"

And in the world of AI, I totally understand.

Bots are everywhere,

so. Yeah. let's start with the first question, and this totally goes with what I was just saying, is

if I can see fine, why do I need an eye exam?

Yeah. So, you should know that, when you get an eye exam, you're not just examining your eyes.

You're actually getting a health check as well. and that health check, they, they say the eyes are the windows of the soul. I can't speak to that specifically, but I can say that when we look into your eyes, we can see, the forward projections of your brain. So we can see your nervous system at work.

We can see your circulatory system, so your blood vessels. nowhere else in your body can you see these things, in plain view. And so we have an opportunity to, detect things that, are not just strictly eye-related, but also, can give us a, an idea of how your whole body is working so not just eye health, not just, the clarity of your vision, but also a check for your systemic health.

You reminded me, I have not thought about this in a long time. So I worked for the optometrist back when I was 18. I'm not gonna tell all of you my age. Dr. Jackson, I just told you before we hit record. But I remember this rep, he was very nice, older gentleman. He, By rep, he was a contact lens representative, so I think he worked for Acuvue or, one of the higher name brands.

and he was near retirement, and he had the coolest looking eyes. And I didn't make a comment to him or my optometrist about it, but afterwards he was talking about exactly what you said, how eye health is important and how you need to see the optometrist regularly because you can see so much more.

And he said, "Did you notice his eyes, how he had the extra layer of blue going on?"

Ah.

And I said, "Yeah, I thought the, that was really cool." And he said, "That is actually cholesterol, and he is going to be in trouble if he doesn't get that taken care of." And it just blew my mind.

Yeah. Yeah. So that's, if we can get into the, into the details there.

But your blood vessels get to the edge of your cornea, and obviously the clear part of the front surface of your eye, we don't have blood vessels go through it or we'd see red stripes all the time. and so as they come to the edge, they slow-- the blood slows down and it deposits. And so we have, cholesterol deposits.

If you have high cholesterol, that's easily detectable.

Yeah. So there's so much more there. We can talk for 30 minutes just about that, but I'll go on to the next one.

can someone have 20/20 vision and still have an eye health problem?

So a good example of this is, yes, and 20/20 vision is an important marker for us.

we do use it as one of the metrics of your eye health. However, it's not all inclusive. So for example, you can have glaucoma, and you can have lost all of your visual field down to pinhole vision and still have 20/20 vision. So, it's a necessary and an important, thing, and if you start losing clarity of vision, that's, that's an important marker.

But it is not the whole enchilada

I love that. And actually, maybe this will go with a side question that I'll ask you, because I also used to work for a retina specialist

Ah.

I'm giving you my resume, apparently. And,

how do which eye doctor you should see for what, and where is the overlap, like, between all the specialties?

Yeah. So there's the three O's of eye care. there's, opticians, and if you need, glasses, and the manufacturer of glasses, and, and they do do specialty care for patients who have specific issues. then you have your optometrists. We're kind of the primary care, in the eye field. So, most patients are going to go see their optometrist for primary care.

when you get to the point when you need surgery or advanced disease management, we would refer you, to an ophthalmologist. And, the big bright line difference there typically is that ophthalmologists do surgery, and as I said, they can sub-specialize into, various areas of disease

So what I heard from all of that is start with your optometrist, and they will refer

where you need to go. So you don't even need to try and remember. I love it. Anything that makes my thinking easier, that, yeah, mental load can be a lot, right? Yeah. And that's for all of us. Yeah. We have so much that we're trying to keep track of in our brain. Anything that makes the path easier, This goes with the second part of my second question, of

what conditions can develop quietly before we notice symptoms?

Yeah. So systemically, diabetes, high blood pressure, some issues that relate to multiple sclerosis can be detected through the eyes without a patient really having any symptoms at that stage. so those are three systemic, things. in the eye, from the eye disease standpoint, we can certainly develop, uh, tumors in the eye, which won't necessarily have a, a, an impact until later on, and, and glaucoma, the classic.

so just as I said, you can have 20/20 vision, start significantly losing field. We usually, don't start noticing glaucoma until about 60% of our nerve fiber has, already, disappeared. So, it is important for us to catch that as early as possible.

Which is why that awful puff of air is worth it.

That's right. That's right. Nobody loves it, I can, I can assure you.

I always like being on the other side of the machine and doing it. Don't do it to me. I am the worst. I am such a blinker.

Although I will say, if you ever ask them to just, put your hand there while they do the puff, you'll notice how extremely light the puff is.

It's just nobody likes it right there.

Oh, yeah. I'd still rather have the puff than a needle, but yes. That actually, This is a question I haven't asked, but it re- you totally reminded me of my early training with the optometrist, of

what are the emergency symptoms for your eye?

Okay. So if you, there are a number of things that, are, "Hey, I should get an appointment.

This can wait two weeks, three weeks." and things that fall into that category are kind of the slow, gradual change in your vision, floaters, thing- mild dry eye symptoms, things of that nature. those are kind of just make an appointment. If, however, you have sustained pain in your eye, if you have anything that, uh, causes a loss of vision, so whether that be visual field where it contracts on your visual field, or you have significant loss of clarity of vision that is sustaining those two things are obviously, clear to the doctor.

flashes of light, we can... The back of, back of our eye has no pain receptors. Our retina has no pain receptors. it can only signal the brain through light, signals of light. So we can induce, if you get hit h- hard on the head in the cartoons, you see stars. that can be induced. but if you, without getting hit in the head, if you start seeing stars or little flashes of light, that can be an indication that your retina is becoming unstable.

We need to, evaluate that. So those are some of the primary ones.

I remember him saying the flashes of light and something about a curtain.

Yeah. Yeah. It's a, the curtain coming down. J- Most people don't ignore that one. that's, fairly dramatic. Yeah, it's any loss of your visual field where things are starting to go away, that's quite bad.

Thank you. We

should look at that right away.

sorry for my computer making noise if any of you caught that. That was telling us about the call that we started early, telling me to get on our call that we're on now. So sorry. another side question because I know so many people will play sports. My husband and I are pickleballers, and I'm the naggy wife saying,

"Do you remember how you got hit in the eye?

Do you think maybe you should wear your goggles that you now pack in your bag?" What do you have to say about this as an optometrist because I know this sport is taking off, and there are so many pe- other people who are in sports that maybe should wear eye protection and don't?

Yeah, so we actually, we see lots of eye injuries as a result of, sports.

And, sometimes in sports that you wouldn't even think because they're allegedly non-contact like basketball. but there's still flying fingers and, you can easily get significant, injury. One of the things that I would say about this is military, for years made eye protection that looked Pretty, pretty terrible.

And so, compliance with using them was very, very low. One of the things that, the major things that we learned in the war on terror was that, if we outsource that to the Oakleys and the Wiley X's and companies like that, they made eye protection that was very slick and, and, cool. And all of a sudden people started wearing eye protection.

So if you are, if you should be wearing eye protection and you probably do, if there's any suspicion, you probably should be wearing eye protection. invest in something that you would, you would feel comfortable wearing, as a, as a cool, device as opposed to, going and getting the $5 pair that you're gonna pack in your bag but not put on.

Yeah. I'm already going through that. I have, I actually think they're Oakleys, shh, but I get the fog and I've started taking them off and it's, "Okay, I need to upgrade," but the next upgrade is quite a jump in price and it's "I don't really wanna spend that." So, thank you. You'll, you'll push me over that ledge.

I'll

show you my case study that'll change your mind.

And it reminds me of what my grandmother said. So when my family came back, on my dad's side of the family it's, almost Mayflower time period of wh- when that s- side of the family came here to the United States, all the men were in the military, so very military family on my side.

And I remember her joking about how my grandfather was very attractive when he was younger, still attractive older man, he's since passed away, but when he came back from basic training, he had birth control glasses. So it just made me remember her joking about that. She even gave him a look and he was chuckling too, and they're normally very stoic people so, this was, top level joke for them.

but-

I, ...

she made sure to show me pictures too.

Yeah, that's probably a bad idea on our part. we do issue in the military very unattractive glasses, to, particularly to our basic training folk. and it's a bad idea because really some of them end up, in the drawer, instead of being worn. but they are nicknamed our birth control glass.

Yep. That's funny though. But it's also the parenting standpoint, right? Prove that you can take care of these and I'll get you something better. Who knows?

Yeah. Yeah.

Yeah. So, okay, back to my questions of, Let me get my microphone out of the way. This one. I already kind of answered it, so I'll ask you the second half of it as well, of

how often should adults and children actually have comprehensive eye exams?

And that means, like, the full thing. And who needs to be seen more frequently because of age, family history, medications, or other risk factors

Yeah. So, I mean, as a default, you-- like you said, if you wanna make it simple, an annual eye exam is probably the simplest thing to, to remember. One of the things that people don't really think about is generally it's a good idea for, six-month-old children to have their, their, vision, or their eyes taken a look at.

generally we say six months before starting school. Usually before first grade is, is about the right time. And then once you, y-your eyes are changing rapidly, like most things in childhood, so we should be looking at the, at children's eyes on an annual basis, because they're actually growing and significantly, changing in as far as their potential need for glasses.

And kids are notorious for not really understanding that they have a vision correction issue. and so they can go for long periods of time, years, without noticing that they have blurry vision because that's just the way they are. so that's a, that's a important one. Generally, Your eyes stop growing in the early 20s.

Usually we can move to about every two years up until age 60 or so. however, there are a number of things that would, that, would move you back to at least annual. And that, as you mentioned, are things like, systemic diseases like diabetes being a principal one. Any family history of glaucoma. So you don't even have to have the disease, just family history would bump up your risk factor.

If you're a contact lens wearer, that certainly is something that, uh, we need to keep an eye on and be seen annually. so those are three primary things that, would drive you back to the clinic at least on an annual basis. but again, if you go on an annual basis, you're less likely to forget.

folks who are doing every two years, it usually ends up being every four years because, you don't really track it at that point. So, if you're going every year around your birthday or some other set date, it generally helps people to, stay on track.

Yep. I'm the scheduler of that, and it's before we leave the office.

And for my husband, because he has some of the banker's holidays off where the optometrist is still there, I schedule that so he doesn't have to off work, and it makes it a lot easier. And, you mentioned contact lens. Because some people are a little more naughty like me.

I know the boundaries because I used to work for an optometrist But I'm still learning. There are still things that I was doing wrong that my new optometrist was "Hey, did this?" So-

Yeah ...

can you give us some of those things? if you're a napper and you're in contacts, do this. give us some of those hints.

Yeah. So one thing, that, we don't like anybody to sleep in their lenses generally. Okay? And the reason for that is because when you're, when you're asleep, you actually don't produce a tear, which is practical 'cause otherwise you'd wake up with a wet face. and so our tears contain kind of an antibiotic in order to protect our eyes, and so in the absence of that, it's much more likely that we'll develop, problems overnight.

So we typically don't like the, patients wearing, w- wearing their contact lenses while they sleep. If you fall asleep for 15 or 20 minutes during the day, generally that's not going to be, enough time to make it, a problem. If you're a consistent daily napper for an hour or two, generally I would take your lenses out.

but, certainly, if you're catnapping, you can probably get away with that, but generally we want to see them out if you're doing any significant amount of sleeping. the other thing that I've r- reinforced is that, a few years ago, they came out with, the marketing came out with no-rub solution for contact lenses.

If you are wearing lenses that are not daily disposable and you're wearing them, more than one day for the lens, then cleaning them is super important. you have to keep in mind that this, when you put a contact lens in your eye, you're putting it in your body, and that is sitting up against your mucus membranes inside your eye, for as long as you're wearing those lenses.

And so you want them to stay clean and be clean. and so do spend the time and do, when you get your new box with the, with the, the bottle and it comes with a new lens case-

This is

what you- Please switch out- ...

educated me on

Yeah. Switch out your lens case. Don't get, there are a lot of things in this world that are precious to us.

A lens case should not be one of them. so do switch those out. Well, I don't

switch out until the my contact's already in the case and the solution empties, so yeah. It's now a I need to put the new case next to the old one so in the morning I'm throwing away the old one, or it's a, maybe I should just switch the whole thing.

And actually, that brings me to another question that goes along with this. If you are

Getting over a virus Yeah ... what's the you should do and shouldn't do for this part?

Yeah, so any upper respiratory tract infection, there is a chance that, that, particular bug can also grow in the eye.

And we do tend to, sneeze and, touch our face a lot during that time period. So you just have to be extra cautious. You are, i- if you're someone who can't... I treat patients who, if they don't have their contact lenses because of a corneal disease, they basically can't see.

so in those cases, you can make, you can just be exceptionally careful. if you don't have a good backup pair of glasses for your contact lenses, please make sure you get some because, you should be able to take a day or two off if you need to in order to, and still be able to function in society, so.

Yeah. And that reminds me of something else I was taught earlier on, is you need to make sure you're having a break from your contacts during the day, like when you first wake up, before you go to bed. I'm not the best when I first wake up, I put my contacts right away. But I make sure at night, and I notice, so if any of you feel like your contact lens solution, you don't like it, switch around Because I notice that I'm more sensitive to some than others, and I'm also one of those, yay, I produce extra calcium in my tears.

So I love Clear Care because it has the peroxide. But if you use that, make sure you are not putting in your contacts in too early, because otherwise you have the nice peroxide burning in your eyes. That's not fun. Yeah. But there is so much there with eye health, and we could talk for probably not even hours, days about this.

So,

what is your last soapbox moment? And then the, what, let, rest of the questions, I'll pick a couple and send them to you to answer through email.

Okay. Yeah, so, just keep in mind that, your eyes obviously are... We, we live in a very visual world, much more so than 1,000 years ago, more than 100 y- years ago, and more than 20 years ago.

Okay? And so you really need to, be invested in protecting your eyes, because a lot can happen to them. And so as a, as we talked about, eye protection, super important. It only takes a split second for you to have, an eye injury that will have implications for the rest of your life. as well as, routine maintenance is a good idea.

So coming in to, to ensure that nothing else is going on, is generally, like we said, a good way of maintaining your health. and for, you had mentioned something about dry eye before. one of the things that we, we neglect, you clean all of your skin, 'cause it has oil glands in it and can get dirty, and, things, we can get clogged glands.

We also have oil glands in our eyelids that help coat your tear film and prevent, your tears from evaporating. Heat and mild pressure on your eyes is your friend here. So generally when you're bathing, make it part of your shower routine or whatever, even if you're not having any issues with, dry eye, to help prevent that, going forward, because it'll help flow through your oil glands, which will help protect the surface of your eye.

Oh, I love this so much. thank you. And let me read, because of where he works, I have to read this, and honestly, this should be in every podcast episode. let me find it really quick. My microphone is in the way

There we go.

Okay, so the opinions and assertations expressed herein are those of Dr. Jackson and of Autumn Carter, and they do not reflect the official policy or position of the Uniformed Services University of the Health Sciences-- sorry, my microphone's in the way, of the Health Sciences or the Department of War But these are things that are s- researched and that are, if you stop to think about it, common sense.

But we are in such a go, go, go society that we don't stop to really think through things, like me, of, hey, just because I use Clear Care that has peroxide that turns into water within six hours, it, I should still switch out my contact lens case. Duh. Right. But I'm not stopping to think that. I'm, "Okay, these are out.

What's the next thing on my evening list?" And usually I'm taking out my contacts when the kids are going to bed because then automatically I'm getting a couple hours with glasses on. Right. So they're usually, "Mom, Mom, Mom," while I'm taking out my contacts and doing the what with one contact in and one out and...

Right? Stop to think about things. If things don't feel right with your body, who do you need to see?

Very good. Well, that's why the importance of the, podcast, I

think.

Yeah. Keep us reminded.

And then if we want more eye care- Data, news, where should we look for this? Because obviously you're not one of those where you're an influencer that, is on social media.

Where should we go to have factual knowledge about our eye health, besides, obviously, our optometrist?

Yeah. So, obviously those appointments have a certain, length. so you can go to either the, uh, American Optometric Association puts out, public health bulletins, as well as the American Academy- Academy of Ophthalmology has a s- a nice site that has information that, And the National Eye Institute. These are three very reliable and, well-researched sources.

And the first one you mentioned, and I wanna put this in the recording so I'm not editing this part out, is that is how I found the surgeon here in Maryland that did LASIK surgery for my husband, because he was on the same board as the retina specialist that I worked for.

So I went to the retina specialist and said, "Hey, my husband wants this. Where should I go?" And he said, "Actually, I know someone who's on the same board as me." Okay. We had just moved here to Maryland. I didn't know anything. My husband had talked about as soon as he graduated from college he wanted to do this, and then he was gonna put it off as soon as he graduated 'cause he's doing something for himself.

Perfect. If somebody is on that board, they are a go-to. And for resources, thank you for mentioning all three of those sources, because with the field that you work in, the best sources. So thank you for sharing that with us. Welcome. And thank you for your time.

All right. Thank you very much, Yeah.

Thanks a

lot.

Thank you so much for joining our discussion. If you enjoyed this, please like, subscribe, most of all, share the love with others. Please share this episode so that we can help other people really recalibrate every aspect of their lives so they can be the best version of themselves, and I will see you in the next episode.

I want to have my quick disclaimer here that this is not a one-size-fits-all. If you want one-on-one coaching, let's talk, and we will make sure what wellness means to you is really put into your life, put into practice. I am using my undergrad in applied health and my life coaching experience to bring this podcast to you