welcome to what's going on we haven't seen each other and i don't while in on very glad to be back and to be able to greet today doctors bennett and graham from bennett family  something that i can't imagine it might not affect and as we not you know you may  close it becomes of course that more of a daily question or at least a weekly question and so i'm going to ask you a few questions that i think people would be interested to hear the answers i wonder if you could just tell us how the i was with time we'd be happy to do that thanks i think most people think that we're born able to see but actually children little babies see their mother's best and vision matures in the first six months of life we actually learn how to see and then gradually at about age eight nine eyes grow just like your teeth fall out it's age six well your eyes grow eight nine and ten and the people who are going to become your sighted usually become near sighted about that time and then the eye is fully grown by age twenty twenty one and between twenty and forty of vision is pretty stable when you go to see your eye doctor usually there's not a lot going on but then at forty people will notice all they need longer arms they can't focus as well not that that  focus a close and that's called presby opiah it's a fancy word but it just means you need help reading and then the lens continues to change and that's what brings about cataracts a normal way that the eye ages people often think oh this is a disease no it's a normal way the eye ages because as the lens gets more and more crowded with cells and becomes less and less flexible the cells some of the cells die and they don't and then the vision become the lens becomes cloudy and  then some people have their have cataract surgery to improve their vision some people choose to live with poor vision and change their lifestyle and then of course there are diseases that can occur as we age which we will be talking about i think today  so so it's normal to develop cataracts is what you'll say that's what i'm deaf that's what i'm saying pretty much everybody then develops got around everybody living live long enough that's what i tell patients if you're developing cataracts that means you've lived to be old enough scattering because of that cataract other things that you come in and you can tell us when you go i need new glasses because i can't see any more and i need everything's blurry but you don't need new glasses we can get better the glasses it's a cataracts at that point that are kind of affecting the vision so it doesn't hurt it's just over time it's usually pretty gradual it just kind of gets blurrier and just lots of glare and a lot of license to do i see and do you then perfor surgeons that that are available fortunately in boston we have a lot of choice not exactly a dearth that's right yes we have a lot of choice and we can select a doctor that really perfect for you so that you can have the result that you want and we we know that sometimes doctors have good bedside manners but they're less good surgeons and sometimes surgeons don't have good bedside manners but they're very very good doctors something we try to select somebody who will give the best vision for the patient when they're when they're finished with their cataracts well so how they treated exactly what i mean what puts what happens during cataract surgery they remove the counteract so that's an interesting thing so i was talking about the with the lens i brought this model so that you could see that the lens is located behind the iris and the lens is about the size of an m and m and if you think of that makes it easy to understand so what does an m and m have has that be outside well that's called the capsule and inside where the chocolate is that's where the cells are so when you're young this is like a soft pillow very flexible and easy to focus distance and near then as we get to be  forty those cells of grown very very slowly and we lose the flexibility which is why you need reading glasses and so what happens under cataract surgery is they make a hole in the candy part of the m and m and basically stuck out all the chocolate they make a hole in the capsule and they suck out everything that's inside the lens and they put an implant in where those cells used to be and a good surgeon calculate how long the eye is so that the implant that's placed in the side i allow the patient to either focus for distance or near or everywhere in between depending on whether they choose an implant that's a multi focal ha so does the ability to adjust to distance vision change or do you have to learn how to do that once you've had cataract surgery or will sort of happen most cataract most cataract surgery patients have an implant put in that is not flexible so that then they if they chosen to be corrected for distance they need glasses to see me i and if they've chosen to be corrected here they need glasses for the distance there are multi focal lenses but they do have some side effects and you do have to pay extra to the physician who's putting those in i see well isn't that interesting folks what do you think i mean one would have to sort of give it some thought wouldn't  one and i think guidance is very important in choosing what kind of an implant that that is done and that's done partly by the surgeon but also by you're a public trust because we understand vision very very very well that our thrust of course the health envision they go together and i suppose your lifestyle would have something to do with it and what the inclination would be to be driving can can you drive at night with implants of course you can that's why people often have cataract surgery so that they can go back to driving at night because that's one of things you give up yes and some of the people that have that kind of surgery their vision goes right back to being extremely x and i've had really some people who are seeing better than they ever were before but it does a pen on the person's lifestyle i've had some people who their life is mainly up close so they are on the computer all the time and they'd rather have be able to do nothing but then put on glasses to talk about what your lifestyle is because you know we have very active most people are seniors that have them cataract surgery so some people are very very active and other people are more well i'm i do near work and that's the thrust of what i want to do so it's looking at two my father's had cataract surgery but my mother has not partly it's because of her health and her choices she doesn't want to see  we age well diabetes of course that this november is national diabetes month and diabetes can happen significant effect on your eyes so i always say to patients diabetes is a blood vessel disease and and the eyeball is the one place in the body we can actually see your blood vessels without cutting you up that's why this model will show you that when we look in and we can see all the blood vessels of your eye so we can tell how well your diabetes is being taken care of and if we see  that are bleeding or leaking we know that's probably happening in your kidneys as well and of course that's not healthy for your eye not healthy for your kidneys certainly diabetes and then we have macular degeneration  those straight lines to get wavy and a lot of times you know especially if it's fluid you can kind of cause those areas to kind of break down and kind of die away where you're missing parts of your vision so when that happens to your most detailed central vision you can see around but that part that gives you the best vision that you have is just kind of going away and it is a very very big kind of problem for people where they can become like legally blind from this there's lots of ways to kind of help and terms of prevent it not really help it you know doing things basically living healthy kind of doing things like wearing sunglasses eating good kale spinach leafy green  vegetables not smoking lots of things can kind of help prevent it what's in the leafy green vegetables that that kind of helps and yes in leafy green vegetables there's lots of different vitamins and also like antioxidants are in there to of help the cells almost kind of break down in the right way get taken away like they're supposed to so generation it's a heart disease because once it starts up it's very hard to do anything about it it's more about preventing it and living a healthy lifestyle and more in the beginning of life and throughout your life and then there's other diseases as well but we think that you know for macular degeneration this isn't something that we find in our older age but it's something that basically is cumulative over your rates and then actually you know talking about eating well i mean popeye knew what he's talking about spinach really does make a difference and it's a lutein in spinach that really makes a difference in get up now we get to think about the inside of the eye as a piece of your brain once a piece of your brain dies it's not coming back so the first thing is prevention yet there are two basic types of macular degeneration we're only going to talk about two there are lots of little outliers but we'll stick with that one is dry and that ninety percent of people have drive macular degeneration and that's what the lutein and all those things and the other ten percent is wet in the past w much more detrimental to your vision because there was no treatment basically the cells drowned but today there are injections that we can do into the eye that can dry up some of the blood vessels that are leaking that can save vision  even while we're talking about saving it what's gone is gone and it's not coming back so it's preventive of the that's right but the injections to treat wet are have sensationally improved unfortunately it's not just one shot at the shot every month six weeks two months and think about that now do you want to have a shot in your eye not really but if it's a matter of going blind or not people could do it and you folks do that no that's another way that we refer those patients to to a retinal specialist a person who only looks at retina so you do the nice thing of course  the work that specialists do so we know which are the good ones and which ones to avoid  eye pressure is normal doesn't mean you don't have glaucoma ha but you're right the test for your eye pressure yes which is different from blood pressure is one of the ways one of the many tests that are done to see if you have glaucoma so on a regular visit to your eye doctor they should they would definitely check your pressure they will look at your optic nerves to make sure it's healthy they will check peripheral vision your side vision and then just look at the way that the structure of the eye is dr graham is getting ready to point out that it went on for a camera this time and so the optic nerve is kind of back here it's almost like this kind strand back here literally is kind of what's helping connect the eye to the brain so it's the pathway from the eye to the brain so when that area optic nerve is kind of getting hurt by pressures or by something else that's what's kind of causing that disease  and sort of noninvasive yes but but but go on the coma is a progressive disease so if you go to your physician and you have high blood pressure and put you on blood pressure medication do you have to go back and see him  again because sometimes the medicine stops working and that's the same thing with glaucoma we can lower your pressure if it's high or if it when it's low we lower further because it's too high for you but then we have to keep monitoring to make sure that it's still working there are multiple we're live in wonderful times when there are multiple different kinds of medicines to that different i drop medicines that can actually help to preserve vision and glaucoma as i say to people our job is to make sure your eyesight lasts as long as you do you just have to tell us how long that's going to be hopefully very very little mean you go for a long long long oh my my my so diabetics and vision when you want to say about this take care of your diabetes it's so important i think that people are often say that they would rather be dead th blind so we really you know taking care of their diabetes is the number number one thing diabetics can do they do in fact there is a possibility of doing injections into the eye if those blood vessels leak as i was talking about earlier but the best case for diabetics is that can prevention is get that diabetes under control and come for your annual exam so that's a huge thing and a lot of primary care doctors do seem to try to get people to get their exams and then with a loss you next is you know do you feel that i mean my background is enough practitioners in internal medicine i don't ever remember in the course of our education and i must say in my practice having this first and foremost in my head to have patients take away with them after a visit so many other things sort of came to mind but i think it's  essential really well it's really don't have people remind and it's not like it's a whole other part of some small sum of it's part of who you are right your vision well as you may know that there's been a lot of changes in medicine especially recently and there are some things called meaningful use that doctors are all over the nation are putting into effect and one of the critical parts about taking care of diabetics for primary care doctors is to make certain that patients have their eyes examined once a year and have their retina thoroughly examined so that diabetes is picked up the effects of diabetes are picked up earlier because as i said the physician can't look in your kidneys but we can look in their eyes and tell them what is happening in the case now would you say though that without the medical diagnosis of diabetes the stress on reminding people to have a vision check up every year is less important or just as important does is something we should have been doing all along in people's progression through life absolutely will the thing too is that even if you haven't been diagnosed with diabetes someone will be the first to see things so we can look and just like you know that's been a saying we look and we can see kind of almost inside your body basically because we can see inside the eye so we can pick up things like high blood pressure first we can pick up  diabetes even things like multiple sclerosis things like that we can pick up signs of things so if you kind of are coming to us every year sometimes we'll be the first ones of you sending you off to your primary care doctor and going  that we've just mentioned all these different i diseases and the main take home message is there none of them going to painful we haven't talked about anything that's really hurts people say to me i don't need to come for my exam nothing hurts i don't i can see fine everything that we talked about is painless there are no pain sensors in the retina so there's nothing painful so you don't have a clue what's going on except for if of course you can't see but those patients will automatically know they come in but  even well actually i can't say that i just examined somebody the other day with that came in because he thought he was having problems with his vision and it turned out he really couldn't see anything out of his other right but you do realize that until we cover one it's not unusual all and the only way you know is this it's not like you're you know you just don't think about it even ones like glaucoma that was a really hard one because because you use it you're losing your side vision you've really won't notice it until it's gotten to a very severe point so a lot of people won't come in for you know ages they'll come in ten years and then they'll think everything's fine and they'll test the visual field and they're seeing not seeing anything until we're like right here you know i mean you don't really notice those kinds of things especially don't drive or anything like that so that's a that's a huge one that's very hard to find by yourself but we always you know optometrist in general always kind of test for the field so make sure things are nice and full so what about dry eyes that's a big thing is it yes yes i think dry eyes were is coming into its own as far as there are so many so many people that have it and there are lots of new treatments that are coming along to treat it of course there's artificial tears that most patients and you may have heard the commercial for restasis around which it plays over and over again so there's lots of different ways of treating dry we're coming especially now that going into november in that dry eye season we live in a very very dry environment here and in massachusetts in the wintertime and we turn on and then we heat we turn on the heat and the air is even dryer so dry eye is just a it's not only affects your comfort but it affects your way you see because the tears are the first thing that light passes through as it enters your eyes so if your eyes if you look at a lake and it's flat c you can see the fish swimming underneath but if you look at a lake that's wavy like dry piers you don't see you can't see those fish right so the same things do i can affect the way you see and it also can affect the way you you feel and it is one of those things that it does tend to affect your woman more and general i really yeah yep and awful we drive absolutely we drive we got lucky that way and then as we get older basically i'd like to ask an insurance question for people who might stay away from having their vision checked with the frequency they ought to is medical insurance covering adequately eye exams absolutely ok in fact with the new obama health care all children are it's part of the a palm up care that all children but before the age of eighteen are eligible under your health insurance for an exam every year you know i only have thirty five more questions to ask you but i'm afraid we're going to be running out of time so maybe we'll have you back some time if that's ok with you we would love to and so the bennett family