in the all day live program here in seattle washington i'm very fortunate that today is one of the unusual days both because i have a chance to to be with you and secondly because there isn't a cloud in the sky the sun is shining it's in the seventy's and one can't ask for more perfect day in seattle behind us you can probably see the city the space needle and all the other beautiful things that happen in this s research and vision ophthalmology is here with people from around the world to exchange ideas share explore new technologies for improving vision and improving ice people's ability to communicate by but by optics and vision it's a program of over eight thousand posters presentations and even though all of us would love to see more than a hundred we can barely see as many as we can even in our own field but alone going into other fields my field is specifically well coma what is  pressure if the pressure inside becomes too high then the inner structures become damaged and the eye pressure is regulated like a sink in your bathroom there's a fossick that has flow into the sink there's a drain that lets water out if the balance is perfect you have a perfectly level of water to sink and everything works fine and most commonly an opening of oil come on the most common type of girl come on the fossett is working fine for the drains so high pressure damaged three cells that interpret vision damage to the cable that connects the idea of bringing their goal is to be able to accurately measure pressure and find ways to control the pressure research foundation the research foundation is dedicated to progression and advancement in under standing treating and educating the public about the comma the more the public is aware the more that the public can aside vision is often undetected until very late which is why it's very important for screening very similar to high blood pressure we have no idea what your blood pressure is as you sit here with me today but it could be normal it could be it screen here and then treat you if you have a problem you would know same thing with low comma so our goal is to educate the public about the importance of screening especially those groups that are high risk people who have itself we know that there's a larger population of older people the baby boom generation is now peaking in this country and vocal much if it's not found early in in general cases usually starts at the age of thirty five forty so at that time is when we need to be screening for these and baby boomers are now getting forty fifty sixty so there's a large increase in population in that sector which will be identifiable as having low home in addition we're very fortunate now we have better screening devices we can detect club home at an earlier stage so not only will have an increase in the frequency of oh come without notice because of the age generation but will also have an interest for this because we can find it so to answer your question with how do we treat the common the way we treat vocal mic today is either with medications with office lasers bargain the operation in most times in this country the medications are used first if at all possible and save that for the end stages so today we're very fortunate when i first started medicine we had two and medications cipro coma one of the major tired you had to take it twice a day and one of them birger vision for an hour and you sta take that four times so you're very handicapped in order to preserve your vision lunchroom in my training time we developed a four times a day drop to a new drop which is twice a day and now more recently i'm very proud one of my students to be able to fix this problem with people who would adhere to a regimen once a day drops today we have other imaginations in fact the office lasers to lower pressure for a short duration time several years adequate enough to get people onto another stage and we have the lasers part of which i'm very proud of develop our which are basically like lasik of this regular measure of lasik for welcome so imagine a life changing procedure like la years actually probably more than thirty years now and again when i started we had horrible medications horrible options for patients now we're very fortunate that the pharmaceutical industry the laser industry and now the surgical industry is catching up to provide better options for the poor patients i was motivated when i would have a patient like you sitting in my chair in front of me and i would tell them i'm sorry to inform you that you have low coma which could rob you of your vision so i'd like you to partner with me so that we can solve this by in a way that's comfortable for you in a way that you can afford it that you can comply with the requirements of the thirty's and that will keep you seen so you don't lose the opportunity to see the grandchildren growing up so again i was very fortunate to have been involved with people who were forerunners in the now we have tools to treat blood coma so my focus in research is to take those tools and now apply them to my disease as i watched offer you my patient something better approximately twenty five years ago when when working with the team that was developing refractive surgery with lasers i i used this application and started looking at means of applying the same phenomenal  energy to blowing in truck to the pressure to fixing the plumbing in the on what that meant was we knew already where the outflow obstruction was we know where the plumbing was blocked and the way that we let me use an analogy think of your sink being blocked and the one the faucet still running you want to prevent that water from overflowing so in the old days you take a sledgehammer and hit everything underneath the sink remove all the pipes and the water would go away group our goal is to enable the two or three hundred local the surgeons to then adopt this technology into a larger population of five to seven thousand go come in cataract surgeons so that more people can benefit the current technologies available in europe and this is an interesting conundrum although it's been over twenty years since we develop this technology as it was  a an analogue to the refractive surgery refractive surgery became popular because it wasn't a government reimbursed procedure because there was motivation for companies to create devices that people would pay for out of the pockets lasik for  for for myopia basic to eliminate the need for us government reimbursement programs because they are so much more limited in their resources took much longer to develop this procedure e l t has been available in europe for about seven years it's not a real the united states yet unfortunately and i have a conundrum because i had a patent on this technology twenty years ago when we first developed it but twenty years ago i didn't have  so until we were able to learn how to use it and then have a use clinically marketed technology basically in europe there was no doubt now because the u s patent office only lets patterns exist for eighteen to twenty years i have data and no patent so convincing a company to invest in a technology which is proven successful which is proven to eliminate the need for medications is difficult for several reasons number one the pharmaceutical companies reimbursement rate is significantly higher if if you buy a bottle of drops for a hundred dollars it costs the company less than ten dollars to make that they have a huge profit m however if you do a single surgical procedure which eliminates the need for those drops the pharmaceutical companies are disincentive ised to promote you because they're cutting hair or that their their hands off because of they're going to lose the income from their protection another company could come in and say thank you very much we will copy a machine announced its own so it's a sad story to tell people that yes we can fix your disease we can make it cheaper we can make you stable and we can keep you seeing for the rest your life no company wants to support so what do we do we go back to europe where we have the device already in place where there's approval from the government to use it and get more data and eventually ends government systems where outcomes are being evaluated and we will be watched electronic medical records as a requirement after year twenty fourteen so as as much as government watches this procedure which will cost probably two thousand dollars and last forever the crossover point after so many years will enable the government to mandate that the less effect lescott less expensive and more cost effective and humane effective procedure will be required i hope it happens in my lifetime because i'd love to see it adopted when i can still appreciate the fact that i'm able to h right and yes there are there are issues the nice thing to say is for the most part the government is very cooperative and interested in the public's concern sometimes to too great an extent because they become risk averse to new procedures and any time we promote a new procedure or new pharma or something in medicine there's always a risk benefit ratio we have to you have to deal with sometimes you see the risks and complications don't occur in short time david kirk and later time so the government officials that have to sign off are very much afraid if they make the wrong decision that their careers are gone so they're very very conservative about what they want to allow them to approve more so it now more so in united states than in europe so when the united states used to be a technology leader in the last decade plus we're now becoming a follower because the newest technologies are being applied to humans elsewhere so meetings like this in which the europeans can come and show their data and we can share that data i'm sorry europeans and other and other world nations can come to that and it's important to us to to attend such meeting to learn what could we do what should we do and what should we be advising our government to regulate big regulatory people to help us make happen and bring to our people where you're thinking you're thinking outside of the box always thinking outside of the box is is is really a complement is a joy to to be discussing this with you sure because you're looking at the options it's important to do that and yes had approved drug a drug was tested known to be effective and safe now you have a drug a minus which is cheaper it's generic and drug a was made by one company alone is controlled drug a minus is made by five companies sometimes the equivalence is there sometimes the equipment is not there also when you go to refill your medicine you may get patients not getting the same drug and we can't know that until we look at the efficacy and watch the patients what does that do it cost more money it means that patients have to be monitored more often than if they were let to stay on their original known safe event if there switched another issue to is not only is it the drug but some of these drugs respond to the container let's say you have seen you have a half and half cream and you shake it up in a glass bottle it coats the side of the ball now if it's coating the side of the bottle when you shake it how much is going into your coffee cup when most of it stuck in the glass that happens with a lot of these medications the effective part of the medication because the bottle is not the same it's a b or c of the same name drugs may not be as effective not only because it's the drug but it's the delivery system so there are many many clinicians a brilliant scientists and i was thinking about that today because i live right live i had available to me a lot of amenities i needed a laser and in my backyard was a  interested in in helping me develop these techniques were now professors which makes me feel very old and with it with a teamwork that we've had scientists real ability of the equipment financing students and the need for better opportunities to treat our patients these combinations enable better science or medicine better patients better health you think that there's answers there will be more doctors but the question you really need to think about asking is what about the quality of the stuff in it in my day and this is it this is now going to become an issue we were motivated and are motivated both financially and out of our personal self interest for humanity to fix people's lives to go into medicine we wanted to be in a place where we could provide better services provide better therapies provide people better health today the financial reward is gone so people that are going to into medicine now are not the best the brightest that were twenty years ago thirty years there are people who are motivated but there a also disincentive eyes to have one hundred percent that acacia so when i'm teaching at u c l a now years ago i would people would be thrilled to work a twenty four hour shift to be able to to be on call to see an emergency room patient come in at midnight two in the morning because they'd see something that they would never see other walks and see it when you're in training you have someone else watching over you to help you make your decisions to help you make the right decisions how to treat a patient is much better than when you have to see that patient on your own years later without ever having seen that problem before so motivating these people to want to work longer during their training period to see more to learn more guide you advise you measure you and give you the option to make a decision on what you want to do but i also know you because we have a long term relationship what's going to happen and it's happening now is doctors are working eight hour shifts so when you have a problem at night at night you won't be getting me you know you will be getting someone who has no idea who you are they may look at an electronic record and be able to scan a little bit  paper record will ever have the same equivalence as a touchy feely doctor patient relationship so you can call me at night o'clock at night and i know what you have i know what you  you call somebody else who doesn't know you and they have no idea what to do with you that's what's going to get it so the eight hour handoff three times a day you can be seeing a different doctor how do you feel about seeing a different doctor three times a day depending on what time your problem happens versus having a single person who you have a relationship with and can talk to and knows what you need in an instant how do you feel about that if that's what's going to be happening and we're going to have to learn to live with that  unless we opt out unless the government allows us to opt out which they don't care to have a relationship with a fee for service and not a proscribed relationship system which is the current medicare system history and my patients are all my friends you can't have that when you're looking forty patients for an eight hour shift and you know at the end of it in her shift the next i was going to hear the patient so you just hope that the last guy who did work on the patient went and and you get a patient back to mess things up but the relationship if if we're going to team if i'm going to ask you to do something on a regular basis to improve your health like in this case asking you to not smoke if we don't have a team if you if you don't relate to me and relate to the fact that i care i will watch and i'll help you not to be  so why would someone just say i just got a phone call from one of my neighbors back home who has a style of his own and i've just given him some advice on what to do until i get home because i relationship with bush and what he trusts me so i can get him to start a fair and he will comply and fix it probably before i ever need to see me because we have this relationship how can you do that with someone you never saw before you don't know who doesn't know you that's my concern about what's going to happen when i and when you are in the hospital god forbid in ten twenty years and you need someone to watch over us who's going to be there i try because i am teaching these kids to have compassion to understand that when they're passing off a patient or not passing off person in bed five they're passing off a person who happens to be sitting  that's something that the people have to come in with to understand month many of them do not all do and they have to also go it's a hard training it's a better selection process before they come into medical school to find the people that want them want to have those relationships and hopefully then they'll become educated to know what to do with those skills required of the other students that you're hoping to teach i had a really nice compliment today in a text that was sent to me from some brazilian students that i happened to meet here at the meeting and they they were appreciative that a professor could care about their welfare could motivate them to want to both have a life and not be a doctor in boxing and to still care about patients and also to still be productive and inventive and offices are in los angeles big mccomas to beverly hills is is at cedar sinai medical center across the hospital and is obviously one of the premier diagnostic and there puting centers for glow coma in los angeles problem if they're concerned about what to do and do they want a second opinion where there is it possible that we could plan future all their life roles where we could scrape you in and maybe building to this is what's going on it's sad that we don't have as much public introspection to what goes on at meetings like this to how we interact to how much we appreciate  where if someone calls for second opinion to me we know where they're coming from is a coming from here in fact we're such a close family that's what we usually know where they're coming from from around the world so we can exchange these ideas we can share our thoughts we can help our colleagues saturday and ends today ok it's it's almost a weeklong conference because as i say there are many thousands of issues being discussed and information being can't possibly stay current in all those fields and more because the knowledge is expended so much so i rely on my other experts around me to share with me what they've learned and i share with them what i've learned again flush out all of it like i doubt i'll ever but you know that also opens up the door to more study needs to be done on this so we can make it legal to the rest of the country a qualified condition enough times to make it make them a call five patients so they do need good medicine even though they don't consider it medicine because before i was diagnosed with m s i had medicine my whole life since before i was even born my parents were hippies it was just something recreational live wasn't just the way it was and when i realized i had a mass i realized the quality of medicine needed to be higher for it to affect me better as make conditions cop worse and then that was when i was diagnosed i realized that yeah i have a disease now i can label it but i didn't realize that cannabis was being a medicine to me the whole entire time i didn't know i had it i was using i was gravitating towards something that was helpful for me without giving the side effects of the pharmaceuticals and if he would do it and i wrote a letter so sometimes officials will wait till the last minute so i do have the spots open for those last minute many people like you to tell me these important people and that's why i gathered scouters and i've been asked so you know what i can ask him i can go home type a letter out now ask him and he's got a couple days final segment of tonight's show on all the life will be with a party named rich and with professor gizmo well known neil throughout the world especially with his notoriety for being at the what we call the occupy here in seattle that was quite something he was filmed in almost every newspaper in the world were hunted have helped have professor gizmo helping us tonight on this program discussing sprint broadcast about the g m oh no on the protest was that day and the twenty fourth of may by the way it was beginning of folk life here in seattle so i hope that you enjoy this program we've got parts of folk life we missed the actual march so we try to catch up with it but we didn't but we did our own little march ourselves we got some insight from some great people it's discussing this about the fact that it is a major detriment for us and i speak a lot to have a means by which we have choice and labeling and that's the major corporate foods which are actually refining a to kill us and do something about it so we can feed ourselves and not be let's say something to be destroyed by major corporate interests something to think about see all the light show thank you for watching i hope you enjoy this