The Silent Killers of Eye Health – Shocking Facts Revealed by Dr. Ashvin | India’s Top Eye Expert

Critical Steps for Children's Eye Health

[00:00] So being an ophthalmologist, what are the critical steps that you will take for a kid's eye health? First, look for any refractive error in the child. Go for an annual checkup, any distance for the devices. Keep a particular distance for the completers, keep a particular distance for the phones and put

[00:20] Make sure your child is doing an outdoor play at least one hour, half an hour a day outside. Please change your glasses in those scenarios. First of all, if you have scratches and if it's an old spectacle or anything, don't wear them, it's not worth it. It's non-benefishing. Because it is putting a strain on your eyes. It's putting a strain on your eyes and it's not allowing the right light to go in.

[00:40] So a patient with high sugar can actually have blood clot in the eye to lead to a complete vision loss. Once the retina is affected by the sugar, it is irreversible. It is irreversible almost. Diabetic retinopathy, glaucoma are too

[01:00] diseases. Once they start affecting the retina, they are irreversible. So, hypertensive retinopathy can happen if the blood pressure is more than 140 or even between 120 to 140, stage 1, stage 2, hypertransmit. Hiberdensive retinopathy can happen even in normal tension.

[01:20] We can talk about cataract. Sure, cataract is very common. So what are the things that we could do to prevent cataract? Please stop smoking. Because no matter what you do, smoking is very detrimental. Overall health, including cataracts. Smoking is directly linked to cataract. Directly linked to cataract. Absolutely. Alcohol? Alcohol occasionally is okay. But

[01:40] Excessively or doing it too frequently can both be harmful to you Hello Dr. Ash, hi again, thank you so much for having me We learned a lot on the previous episode. Okay. So now as extension of the previous eye discussion

When Should You Visit an Ophthalmologist?

[02:00] We want to learn more, especially I want to learn more. That is why I brought you back again. So, right off the bat, I am going to ask you, biggest question in everybody's mind is, when to go to an ophthalmologist? Should we have to go and get it screened even when they do not have any symptoms? What will you say for that?

[02:20] Amazing. So let's break it down to two segments. One is children and then you have the elderly age. The children, 0 to 1. When the child is born, look for two simple things. First, is it a premature or an underweight baby? If it is a

[02:40] premature on an underweight baby, immediately you must start thinking of retinopathy of prematurity. What happens in retinopathy of prematurity is very simple. When the baby is born premature, which is like 3 or 4 weeks prior to the delivery date, 4 weeks prior to the event of delivery date. If it happens

[03:00] If the baby is born premature, the retina is not fully formed. So when the retina is not fully formed, the life support that is required is oxygenation. So the first thing they do is oxygenate the baby in the ICU care. When they oxygenate the baby, it triggers a response

[03:20] that now everything is closed now do not form anymore but the retina is not formed. So the trigger is closed. So the development is stopped. Now there is a trigger of hypoxia. There is an area of no oxygen going to some parts of the retina. That trigger is an abnormal vessel to be formed. I see.

[03:40] These abnormal vessels will cause bleeding or pulling or traction of the retina which will cause retinal detachment. All these is called as retinopathy of permuturity. So in order for your question, between the ages 0 to 1, at least by the time

[04:00] they are 6 months of age, please get one retina investigation done if that is a premature baby or an underweight baby. Underweight is based on the growth chart. Underweight is below 2.6 kgs or 2.2 kgs or I do not know the exact nowadays number.

[04:20] That is the low birth weight. So if you have a low birth weight and if you have premature 4 weeks priority or due date, please check with the retinal specialist between the 0 month to 1 year. 0 to 6 months. 0 to 6 months, please check once. That is the first thing.

[04:40] ages of 2 to 5. Please get two tests done. One is of refractive error. If there is any refractive error brewing, we must know it, acknowledge and put the right glasses or prescription glasses or patching if required to

Optometrist vs. Ophthalmologist: Who Should You See?

[05:00] prevent a condition called as lazy eye or cross-eyed as they call it between 2 to 5. If you have a patient with lazy eye between the ages of 2 to 5, you will have a convergent squint because the medial rectus muscle is very strong until

[05:20] It's pulling across. Versus if you have an age group of 5 to 10 with low vision in one eye, it will go for a divergent squint. So the eyeball looks like squint. Now there is a big tab, there is a big myth around this. The myth around this is

[05:40] that people believe that having a squint eye is lucky for you, that kid doesn't believe it's lucky for him. The kid is actually struggling because they are having two different visions of two different eyes. But when you're seeing me, Dr. Pal, are you seeing one of me or two of me? You're seeing me as one.

[06:00] one for now but after call 9 duty 2. But genuinely it is only one. But you have two eyes. So when you have two eyes what is happening? In the brain these two images are fusing to form one. Problem what happens is when you have two different

[06:20] refractive errors in two different eyes which are too despair apart. One image is good and one image is bad. The brain will go through a confusion state. Hey, I do not know what is happening here. Let me shun out or black out this bad image. Let me only

[06:40] keep one image and it will shut down that eye, the bad eye. This is what's happening in lazy eye. So between the age of 2 to 5, please get a check done for refractive error and lazy eye. So this is like a preventive exam. So every kid needs to get this done. Please do it

[07:00] because they will not know. By the time they've gone to school, it's too late. After five only, they are going to school. Then the teacher will come and tell you, he's sitting in the front bench even after I'm asking him to go onto the back bench. So that means there's a very clear indication, I cannot see the board. And this is in today's world, in tomorrow's education

[07:20] system we may not even have boards, we will have only laptops. We never know. So that's where we have to have a huge sense of proactiveness to go and get the checkup done even if there's no issue. Let me ask a very practical question. Maybe it's in the US. Yes, yes, yes, please.

[07:40] there is two different kind of ophthalmology people. One is the ophthalmologist like you. You know, you are a full-blown ophthalmologist where you do surgeries and all those things. The second one is optometrist. They are easy to access. Optomologist appointment is six months from now. You have

[08:00] pain by the time you get an appointment the eye pain will be gone. So people go to optometrist. For these kind of routine checkups optometrist is good enough that's number one. Number two is in India is it the same practice? Not at all. In India an ophthalmologist

[08:20] is very easily accessible in today's world. Maybe few ophthalmologists are more difficult than others, but you will always have an ophthalmologist ready at your beck and call at any point of time. If you walk in, they will not say no to seeing you. That's a very good thing that is happening in India.

Annual Eye Checkups for Adults: What to Expect?

[08:40] Plus, in India we work six days a week, you know that. Versus in the US, you work four and a half days a week. So that's a big difference in terms of timelines. That being said, the regulatory system in India versus in US, it's a lot more flexible in India versus

[09:00] in the US or in Canada where you have to work only this many hours if you cannot work more than a particular number of hours a week. So those aspects have definitely generated a huge sense of dependency on optometrics in the US and Canada and other countries. The dependency on optometrics is not so heavy here.

[09:20] Although that trend could change in the recent or near future, currently ophthalmologists are available for us at any time. Hopefully they should reduce their workload and increase the availability of the optometrist. Yeah, so I think what's happening now is so much incidence on myopia.

[09:40] So much incidence of glaucoma, so much incidence of cataract, so much of corneal issues are increasing on the rise. Dry eyes, so many conditions that are increasing on the rise, we are going to need to extend our arm to optometrist to start serving at different places. Correct.

[10:00] If you look at the ophthalmology, the density of ophthalmologists in the urban cities are extremely high versus the rural cities are extremely low. That being said, optometrists can play a huge role in these rural pockets, at least to kind of bring forth or back the focus on awareness on

[10:20] This is for the Indian community in the US that optometrists are okay. So don't think that union of ophthalmologists get all this refractive error checked with an optometrist. Timing is critical. Absolutely. In fact, I recommend to go to an optometrist because they have the time. They have been guided by the optomologist. They have been told exactly

Optometrist vs. Ophthalmologist: Who Should You See?

[10:40] exactly what to do in which scenario by the ophthalmologist and then refer them only if there is a need beyond a point. Beautiful. So it's a very structured program. Beautiful, beautiful, super, super. So we talked about 2 to 5. So this is a wonderful point that you mentioned that NEK 2 to 5 should be evaluated.

[11:00] by an optometrist or an ophthalmologist for refractive error. And then what is the next age group? Next age group would be between 5 and 12. So the 5 and 12 you have to look again for refractive error for sure. You must look for any myopia progression. If there is myopia there, you can start putting them on myopia contour.

[11:20] control, you can start putting them if there is a lazy eye condition which will come about. Even in 5 to 12, you still have the refractive error that goes into the lazy eye or the cross-eyed because these kids are then when they are entering the schools and that's when usually it is the teacher who calls the

[11:40] parent up and says, hey, the kid's actually sitting in front in the class, they're not going behind because of a particular reason, because they can't see the ball. Or there'll be a school camp, eye camp that's happening and there they will pick it up. Parents are quite busy and we also as parents, myself, we try to avoid thinking about the problems. We kind of

[12:00] focus on other issues. Hey, are you studying well? Are you doing all of that stuff? And we start focusing on that health. So try and focus a little bit proactively on between five and 12 to check for refractive error, check for any progression of myopia. If your child

[12:20] was insulin dependent or type 1 diabetes, please make sure that you can start focusing on that as well. So those are aspects which will come to you. So being an ophthalmologist, what are the critical steps that you will say for a kid's eye health? Amazing. I think those are very pivotal thumb rules I'll give everybody. So the thumb rule is very

Diabetes and Eye Health: The Risk of Retinopathy

[12:40] simple. First, look for any refractive error in the child. Go for an annual checkup. That's number one. Second, any distance for the devices. Keep a particular distance for computers. Keep a particular distance for phones and put protective layers on them if

[13:00] possible. That is true. Third, please go in. Make sure your child is doing an outdoor play at least one hour, half an hour a day outside. This helps the accommodation, helps sunlight and a lot more other aspects which are not happening with the child sitting in the house

[13:20] in playing on their iPads. And the fourth one is limit the screen time. Actually, I would say incentivize the child to limit their screen time and extend their outdoor play. Beautiful. Wonderful. I'm going to tell that to my kid. You must. You must actually.

[13:40] Beautiful, beautiful. So we talked about the 12 years away, right? How about adults? How often they should get a physical exam of the eye? So in adults, it's a very clear nomenclature. Annually get one eye checkup done.

[14:00] What happens in this eye checkup? What are we checking? We are calling you in for an annual checkup? What are we checking? We are checking for first and I am talking about 40 and above. We are checking for cataracts. We are checking for glaucoma signs. This is a silent killer. There will be no symptom for glaucoma but I still need

[14:20] need to check. Glaucomas increase eye pressure. One of the components of glaucoma is an increased eye pressure although it is a multi-organ failure. I see. Although it is a multi-organ failure. Third, I am checking for diabetic retinopathy in case you have diabetes. But if you do not have, I am going to tell

[14:40] you get a diabetic checkup done. Number 4, I am checking for any hypertension related issues. So high blood pressure can also affect eyes. Correct. I am also checking for dry eyes in this. So refractive error, cataract, glaucoma, diabetic retinol,

[15:00] hypertensive retinopathy that is basically your retina checkup and your dry eyes. I'm doing a comprehensive holistic look at your eye and I have to do it really quick. So it can take about one and a half hours to get this whole thing done. But once it's done, you don't need anything for the next one year if everything is checked green.

[15:20] Practical questions. You go there, they give you two options. One is you drop, you put the eye drops, get a dilated exam or without the eye drops using the machine. Excellent question and in fact, today's technology has brought about a big revolution on this aspect alone. A lot of the places still do the dilated exam and that is

[15:40] probably the thumb rule by far best way to do a retinal examination. In today's world, there are devices that even without a dilated exam, you can get instead of 180 degrees, you will get a 160 degree view of the retina. That high. It's very, very high. Wow. There are, I think there are even

[16:00] devices that give close to 180 with one single click. That's a huge time saver. It's a huge time saver because think about it as a practical person going to a job every day. If I come into an ophthalmology clinic and get a dilated exam, it's not just the one and a half hours spent in the hospital. It's

[16:20] Also the 4 and a half hours, 5 hours after that that I cannot see anything, I cannot work, I cannot drive, I have to have an assistant to come and pick me up or an Uber to pick me up. All these aspects have caused a huge drop in productivity at my workplace and so on and so forth. My efficiency has gone down.

[16:40] by technology becoming better and I am able to do this retinal investigation through just a single click even through not dilating. It's a huge game changer. Nice, nice. Thank you for that. You saved my time. Absolutely. I hope I can save a lot more. I get checked every year.

[17:00] I get checked every year and there is not significant change in the power. But they always say something about astigmatism and it can change. And how about glasses? Should we have to change that every year if there is no change in the power? No, not at all. In fact, if I check in

[17:20] your eye and if somebody else checks your eye, there will be a 0.25 difference every time and that's okay. Yeah, so when there's an interpersonal difference, will be there if I check in your check because it will be a subjective check test, right? So what happens in that scenario is only when there is a progression for a

[17:40] year over 0.5 and you are symptomatic to it. If you are saying I can see better with these new glasses, I cannot see the old, that is the only time I have changed. If you are saying I am able to see the same even though it shows me a 0.5, it is fine. Go ahead, do not worry. One other practical question because I wear glasses all the time. Yes, please. Cleaning the glasses.

[18:00] glasses. I have seen many people not do it at all. Cleaning the glasses, scratches on the glasses and then they will say I cannot see. Obviously you cannot see because the whole glass is scratched. Please change your glasses in those scenarios. First of all if you have scratches and if it is an old spectacle or anything, do not wear them. It is not worth it. It is not beneficial.

[18:20] is putting a strain on your eyes. It's putting a strain on your eyes and it's not allowing the right light to go in. I see. It's when diffracted scattered light is going in. So you're obviously going to see a lot more glare and you'll be like I can't see very clearly. That is the cleaning the glasses, please do it regularly but use the right cloth. Sometimes the cloth itself is the one that

Understanding and Managing Glaucoma

[18:40] causing the scratches. I see. So they always give you that in the box. Please use that one, it always good for you. Practical question again. How often you care you should use the microfiber cloth. My microfiber cloth looks like a kitchen cleaning cloth now. Change the cloth. At least annually once you can change

[19:00] Okay, annually once is more than that. So when you are going to the optimology for your annual checkup, bookcloth. Okay, beautiful. See all these practical questions. Very important question. No, no, people tend to neglect our own, we all neglect our own health. We worry about our family, we worry about everybody else, but we do not worry about ourselves. Somebody else

[19:20] has to worry about us by the time it's too late. So let's start worrying about ourselves and taking care of ourselves. See, make yourself a priority. Make yourself a priority. Super beautiful. So one most important thing that you touched upon is my topic very near and dear to my heart is diabetic retinopathy.

[19:40] So as you know, insulin resistance is rampant and many people are being diagnosed with prediabetes and diabetes. One thing I want my audience to understand is that diabetes is a multi-system disease. It's not only your pancreas that is not secreting insulin properly, it is affecting right from your head all the way to your toes. One of the most common

[20:00] common thing as you know is it is causing small small clots in the blood vessels. We call it as microthrombosis in these capillaries. The most common organ that is getting affected is your nerves. We call it diabetic neuropathy and if it affects the kidneys we call it diabetic nephropathy and

[20:20] most important thing for you is when it affects the eyes it is called diabetic retinopathy. Question to you is if you are a diabetic how often you should be checked for diabetic retinopathy? How do we know whether it is being effective? First of all Dr. Pal that is such an important

[20:40] question, it is the third or maybe the fourth biggest problem in the world. Diabetic retinopathy, the retina of your eye is the first organ where diabetes starts showing up. So if you're going to find

[21:00] a sign somewhere. First it will be the eye. If you ever have gone to a diabetologist, the first thing they will say, the minute they see your borderline or above, go and get an eye examination done. They will ask you for a retinal investigation done.

[21:20] Why? Because before it reaches the nerves or before it reaches the kidney, those micro-aneurysms as you call it, thrombosis in the kidney is aneurysm in the eye. Those micro-aneurysms have already started happening in the retina. So diabetic

[21:40] has a very strong link to the eyes. So in the annual checkup that we talked about, let us say the patie