Clear vision: How diabetes affects eye health

Podcast transcript

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INTRO
Welcome to Docs in a Pod presented by WellMed. Over the next half-hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Rajay Seudath and award-winning veteran broadcaster Ron Aron will share information to improve your health and well-being. And now here are Ron Aaron and Dr. Rajay Seudath.


RON AARON
Thank you so much for joining us today on the award winning Docs in a Pod. I'm Ron Aaron, along with our co-host who is here today, Dr. Rajay Seudath. We are talking about healthy vision. Dr. Seudath, we are so pleased to have you with us. He is based in Tampa, Florida, and board certified in family medicine. In his work, he loves helping to educate patients. Dr. Seudath received his medical degree from the University of South Florida Morsani College of Medicine, and before his career in medicine, he worked overseas as an English teacher. It's a long and wonderful story on how that led him into the practice of medicine. We'll save that for another day. Or listen to the show we recorded last week, where he explains that in detail. By the way, if you download our podcast, do us a favor and like us and give us a positive review, unless you don't have a positive thought. That will encourage others to tune in and listen to Docs in a Pod. Dr. Seudath, we'll be talking about healthy vision, and I'm assuming because in your practice you see predominantly older people, vision can be a problem.


DR. RAJAY SEUDATH
Oh, absolutely. Vision is one of those things we take for granted. It can affect so many other parts of your life. We talk about falls, balance, and your memory. Vision plays a role in all of those different things. So, that's actually part of the annual screenings that we do when you have your annual physical. Testing your vision should be part of that.


RON AARON
Interesting. Well, let's take a minute and introduce our very special guest today, Candice Moore, who is a nurse practitioner. She's at the WellMed at Park Springs clinic near Arlington. She earned a Bachelor of Science in nursing from the University of Mary Hardin Baylor in 2008. She spent nine years as a cardiovascular ICU nurse, specializing in the recovery of open heart surgery patients. That's pretty cool. She's gone on to earn a master's of science in nursing from Walden University, and has been practicing as a family nurse practitioner in the family and general practice setting since then. Outside of work, Candice is a proud wife of 12 years, a parent to a five-year-old daughter, and the owner of a high-energy, half-Rhodesian dog. She enjoys good food. Who doesn't? Staying active, getting plenty of sleep and giving back to various church activities. Candice, it's great to have you with us.


CANDICE MOORE
Thank you.


RON AARON
Talk to us about your vision and healthy vision as something that you're very involved in with your patients.


CANDICE MOORE
Absolutely. Being in the region that I practice in, our demographic is generally seasoned individuals, and a high volume of our patients also have diabetes. So, not only are we hammering in to go and get your eye exams on an annual basis or people coming in for their regular eye physicals, but also patients who have diabetes. Super important. As we know, it is not just sugar in the blood. It affects all the organs, including the organs that have tiny vessels. And eyes are one of them.


RON AARON
Why tiny vessels? Why is that an issue?


CANDICE MOORE
Yes, sir. With diabetes, sometimes the glucose level can irritate the lining of the eyes. With that being said, inflammation comes. Sometimes the body recognizes that there's an issue. Clots happen, and then sometimes that puts you at risk for stroke and heart attack and even blindness. So, with the eyeball, we need a couple of things. We need our optic nerve to be working, and we need the retina, which is like a light sensitive tissue on the back of the eye, to be working. It's very vascular. So, if we have any kind of inflammation on the vascular level, especially when it comes to eyes, it can affect your eyes, your health, your vision. I think my favorite is when patients tell me that, oh, my eyes are fine. But they haven't been checked out in forever, and when I'm talking to them, they're like, leaning into the paper and holding their phone close to their face. You don't realize that you don't have a vision usually until it's gone. The goal is to be proactive. We don't want you to be blind before you reach out and get assistance.


RON AARON
That's really interesting. You bring up a good point because years ago, while my father was still alive, he didn't have glasses. Never went to the eye doctor, and he finally went for an eye exam, and sure enough, he needed glasses. Really needed glasses. And I remember him saying afterwards, wow, this is opening up a whole new world. I can see stuff I didn't know was out there.


CANDICE MOORE
Imagine that.


RON AARON
All right, stay with us. We're going to come right back. I want to let folks know who just joined us, you're listening to the award winning Docs in a Pod. Our podcast is available wherever you get your podcasts. We're also on the radio in several cities in Texas and Florida as well. We're talking with Candice Moore, a nurse practitioner. Our co-host today is Dr. Rajay Seudath, and we're delighted to have him with us as well. So, Candice, when patients come in for that first exam, they haven't been to the doctor in a bazillion years. Can you tell they've got an eye problem? You mentioned they may be holding papers up close to their face in order to read them. What else do you notice?


CANDICE MOORE
Usually, a good ancient piece is important. Lots of questions.


RON AARON
What's an ancient piece?


CANDICE MOORE
An ancient piece of history and a physical. So, when we come in it's almost like we interrogate you for lack of better words. I'm asking a billion questions. So, as it relates to eyes, I am asking do you have blurry vision? Because some people blink their eyes a couple of times so that it clears. But do you have blurry vision? Do you have double vision? Do you have floaters? Are you seeing halos? Some people don't have any peripheral vision and don't think that's a problem and yet they're out there driving, which is insane to me. But I will say, unless you ask the question, a lot of people kind of normalize a problem that's been a problem because it's been a problem for so long. They feel like, eh, I've always had that issue. It's not a big deal, and it's a huge deal. So, asking questions is huge. I also kind of watch them with their phones. If they're leaning in with their nose scrunched up asking myself a question looking at a piece of paper. Usually I do that as well. As you mature, especially around 40, 45, I really push that. Even if people feel like, oh, I just go to the dollar store and get my readers, it's super important to go at least once and be evaluated because our goal is prevention. We don't want you to be blind before you need assistance.


RON AARON
Dr. Seudath, you mentioned something that's really important. One of the leading causes of injuries and death in seniors is a result of falls. And if you can't see where you're walking, I may be one of those, because my wife always says, Ron, look where you're walking.


DR. RAJAY SEUDATH
That's so true. A lot of people don't understand that your balance is made up of a few things. Your balance is made up of you touching the ground, you knowing where your bones are in space, and then your gyroscope in your ear. That lets you know where you are in relation to gravity. And the last one is your vision. Spatially, where are you? All of those things get lumped together in the bottom part of your brain called the cerebellum. So, if you're diabetic and you have diabetic neuropathy, you can't feel your feet on the floor. That also damages how you feel where your body is in space, your proprioception, where your bones are. And then, if it starts to damage your eyes as well. Now, you've got three of the four knocked out. So, that's why it's very important for people who are diabetic to have their vision checked to look for diabetic neuropathy, because those things come together and they create this perfect storm where a person is very prone to falling.


RON AARON
Candice, how often do you recommend people get their vision checked?


CANDICE MOORE
It kind of depends on what's going on with their health resume, but certainly if they're diabetic, at minimum twice a year. We like to differentiate between going to an optometrist versus an ophthalmologist because they are slightly different.


RON AARON
Well, an ophthalmologist is an MD, medical doctor.


CANDICE MOORE
Yes, sir. But some patients feel like if you can look at the eye with the machine, then you're qualified. We want to make sure that the eyeball is being dilated so that we can make sure your retina is okay. So, I specify that part. They need to know you're diabetic. They need to be dilating your eyes. If they have not dilated your eyeballs, then likely we need to get you to an ophthalmologist who can do that. And then, if there's retinal damage, then we can make the referral to make sure that there's no further damage causing, like macular edema or anything else that could cause visual blindness.


RON AARON
For folks who don't know what dilation is, they put a couple drops in your eye and your pupil grows to about 9,000 ft apart. Right?


CANDICE MOORE
Right. You need special sunglasses when you get out there.
RON AARON
And once that pupil has opened up, Dr. Seudath, you can actually look in and see the retina.


DR. RAJAY SEUDATH
Yes. That's correct. Just for the nuts and bolts. Some insurances will not pay for you to see the eye disease doctor until you've seen the eye glasses doctor.


RON AARON
So, backwards?


DR. RAJAY SEUDATH
Well, no. Not necessarily because they can do the dilated screen, the dilated exam, at the eyeglass doctor. Sometimes you have to jump through some hoops to get things paid for correctly by insurance. But that's what your primary care doctor, your primary care office, your primary care providers are all good at weaving through that labyrinthine maze. But that's one of the things that I often tell patients, I do want you to see the eyeglasses doctor. Well, I don't need glasses. I have glasses. I go to the dollar store. I'm fine. No, I need them to also look into your eyes. Now, there are some machines that can do a retinal screen without dilating your eyes. Those are the newer ones. But when you have that done, they will create a report that says specifically no diabetic retinopathy, no macular degeneration. If you don't have something saying that, then I may have to get you a dilated exam.


RON AARON
All right, you stay with me. I'm Ron Aaron along with Dr. Rajay Seudath. We're talking with Candice Moore. You can find Candice at the WellMed clinic in Park Springs, Texas, near Arlington. You're listening to the award winning Docs in a Pod.


AD
Turning 65? It's time for an important choice. Deciding what Medicare coverage is best for you. WellMed can help. When you become a WellMed patient, you can connect our primary care with a Medicare Advantage plan. WellMed doctors and care teams spend quality time with you, listening and learning about your health. WellMed and a Medicare Advantage plan could be right for you. Choose WellMed. Learn more at (866) 433-5048. That's (866) 433-5048.


RON AARON
We thank you so much for sticking with us right here on the award winning Docs in a Pod. Our podcast is available wherever you get your podcast. We ask that if you get the podcast, you take a listen and you like it, like us on that forum, go to Google and give us a review because that will help attract more listeners to Docs in a Pod. In that way, we can increase our reach and help folks across the country and around the world. I'm Ron Aaron, along with our guest, Candice Moore, a nurse practitioner. You can find her at the WellMed Clinic in Park Springs near Arlington, Texas. Dr. Rajay Seudath, who's in Tampa, Florida, at the University of Tampa WellMed Clinic. We're delighted to have him on board as well. Dr. Seudath, we're talking about healthy vision. That's a positive way to look at what can be a problem for a whole lot of folks. Among your client base, how many of your clients, percentage-wise, do you think have vision problems?


DR. RAJAY SEUDATH
I can't give you an actual concrete number, but I would say a vast majority of them. A vast majority of them are simply just the march of time. Getting to the age of 65, there's a large percentage of patients who will develop eye disease. And that is why that yearly exam, whether you need it or not, you need to be getting your eyes screened.


RON AARON
Candice, you mentioned picking up readers from a place like the Dollar Store or elsewhere. Once you hit that 40 mark, presbyopia and difficulty in reading stuff kicks in. That's not an eye disease, is it a fact of life?


CANDICE MOORE
Yeah. A lot of these things do occur because we're aging, and that's okay. We want to age gracefully. So absolutely, you need your eyeballs looked at after 40. I will say also, we're very digital these days. We stare at blue lights all day on our phones or our tablets. Most of us are required to do work on the laptop. So, super important to get your eyes looked at.


RON AARON
What is it with blue light? I'm not sure I understand that.


CANDICE MOORE
So, my glasses actually have like a little bit of a blue light tint, but the light over time can cause issues with your eyesight. A lot of people like to sit at night and in the dark before they go to bed and stare at their phones.


RON AARON
That's my wife.


DR. RAJAY SEUDATH
There was an idea from the past when TVs came out and it’s don't watch TV in the dark. I don't remember if you remember that ad that's a little bit before your time, Candice, but, I'm sure Ron might remember those things back in the day. If you were watching TV, there would be a little PSA that said don’t watch TV in the dark. Part of that was it has to do with glaucoma. Open-angle glaucoma, closed angle glaucoma. And the idea is if you were having closed-angle glaucoma, that could worsen it. That's one of the things. Just to explain what a closed versus open angle is. If you look in your eye, you have a pupil and then you have the colored part, the iris. There's a small sliver between those two that drains from the inside of the eye to the front portion of the eye. So, the idea is if you're watching those types of things in the dark, it can close that slit, and that can cause you to increase the pressure in your eye. So, that's a closed angle. Open angle is usually what we see with diabetes and things like that, and that's a gradual damage of the eyes through intraocular pressure. You see that as your peripheral vision going. First it’s a quarter of your vision, then half of your vision, and then all of a sudden, you can't see anything.


RON AARON
Peripheral vision, being able to see to the side without turning your head, turns out, Candice, to be pretty important.


CANDICE MOORE
Yeah, absolutely. Especially when people want to remain independent and drive on their own. We make sure they don't harm themselves or others.


RON AARON
What kind of issues do you see in your patients when it comes to problems with their eyes?


CANDICE MOORE
As I mentioned before, we have a huge patient population of those who have diabetes. So, retinopathy is huge. We end up having to spend most of our patients to a retinal specialist because they end up hemorrhaging. Those little tiny vessels are damaged, they start to bleed. Or there's edema, all of which can lead to vision loss. So, that particular one, diabetic retinopathy is the one that we see most commonly, at least here because of our vast diabetic population.


RON AARON
I have a friend who lost vision in one of his eyes because of diabetic retinopathy. It's serious.


CANDICE MOORE
It is.


RON AARON
If you intervene early, can you slow the progress? Can you save your eyesight?


CANDICE MOORE
Yes, you can. Dr. Seudath, if you want to hop in on that one, you're more than one.


DR. RAJAY SEUDATH
Oh yeah, absolutely. There are things they could do, whether it's injections, whether it's laser therapy. There's a lot of different interventions that the ophthalmologist, which is the eye disease doctor, can do. But your primary care provider, wherever you are, they are going to focus on getting your sugars under control and getting your blood pressures under control.


CANDICE MOORE
Yes.


DR. RAJAY SEUDATH
Because those are the two things that we talked about. The blood sugars cause damage to the inside of your blood vessels, and then high blood pressures, which are stretching them out from the inside out. It's like if you have a balloon or a garden hose and you're slowly hollowing out the inside and then cranking up the pressure, at some point that hose is going to bust.


RON AARON
I've seen a big bubble in a hose once in a while and it does bust.


DR. RAJAY SEUDATH
Yes, sir. So, we don't want that to happen inside of the eye.


CANDICE MOORE
That’s a really great analogy.


RON AARON
When it comes to new technology and new treatment for issues of the eye, back in the year 2000, I had laser surgery correcting my vision in my eyes. That was pretty new back then. Now it's commonplace.


DR. RAJAY SEUDATH
Yeah. That's true. Now, that's a little bit different. That can be for cataracts. That can be for your astigmatism. Things that are dealing with the lens. Lasers can help with that. But lasers can also be used for the inside of the eye for further back, like we were talking about with retinopathy. If you have an area that's hemorrhaging, sometimes they can use a laser to stop the hemorrhaging areas. So, there's a lot of interventions, but you have to make the first steps of one identifying the problem, and then two, actually going to see the specialist. Because that in itself can be where a patient gets their hang up. I know I have a problem, I just have to make the appointment and go. There are many different reasons why a person may not do that. They may be in denial about that, they may not have the resources, they may not have someone to drive them to and from while their eyes are dilated because you can't drive when your eyes are dilated. So, those are some of the things. Sometimes we have to work with them to get past those.


RON AARON
The other reason, and I've had friends say this to me, if I go to that specialist, they're going to find something wrong. I may not have a problem, but they're going to find something wrong.


DR. RAJAY SEUDATH
Absolutely.


RON AARON
Both of you are smiling. We do these interviews over Zoom. Our listeners on podcasts and radio can't see this, but each of our specialists today have an ear to ear smile. Dr. Seudath, you've heard that. You're going to find something wrong.


DR. RAJAY SEUDATH
So many times. That's actually what I tell them. Yes, I'm trying to find it early.


CANDICE MOORE
That's right. Early detection.


DR. RAJAY SEUDATH
I want to find it wrong so I can help you so we can help you preserve your vision.


CANDICE MOORE
Yes.


RON AARON
Candice, you had an equally broad smile. You hear that as well?


CANDICE MOORE
I do, and I think a lot of us people are afraid. They don't know what they don't know. They had a friend who had sisters, brothers, aunts, cousins who had the same problem and they bled to death on the table. I think a lot of it has to do with education. I think we can kind of calm some of the nerves if we can remove some of the myths for some of these patients. A lot of them just have white coat syndrome and they're afraid. So, we also talk about making sure they take someone that they know they trust because some of these people don't understand what's being said, and they're afraid to ask the physicians to please don't use medical terminology. So, I do try and make sure that when I speak to them, I use layman's terms because it can be intimidating on top of they don't know what's going on, and now you may as well be speaking a different language.


RON AARON
That's a really good point. Dr. Seudath, I pleaded guilty to being educated. I've got a law degree, I got a lot of education. But I'll come home from the doctor and my wife will say, so what did they say? And I will say, I have no idea.


CANDICE MOORE
Oh no.


DR. RAJAY SEUDATH
Oh, that's horrible. I'm going to go into apoplexy after hearing that.


CANDICE MOORE
Oh, geez.


RON AARON
But what Candice said is good advice. Bring someone with you and make sure the provider understands you want them in the room with you.


DR. RAJAY SEUDATH
Absolutely.


CANDICE MOORE
Yes.


DR. RAJAY SEUDATH
I always say it's nice to have a second brain.


CANDICE MOORE
For sure.


RON AARON
What about recording that session so you can play it back later?


DR. RAJAY SEUDATH
That's a little bit different. I know there are medical legal issues when it comes to recording those. So, I don't think that's allowed for multiple reasons. Instead of doing that, what I would say is bring a list of things you want to talk about. Bring someone to help. Remember those things, and write down the things that you are going to remember, and ask for your provider to write down the things they're talking about.


CANDICE MOORE
Absolutely.


DR. RAJAY SEUDATH
At your end of visits summary, I always tell my patients or I tell my front staff, hey, make sure you print out the end of visit summary because I have things written for them on their plan section and it has, you know, do this, do that, do this, do that. And when they come back, I'm going to quiz them. Did you do this? Did you do that? I want them to know what I'm having them do.


CANDICE MOORE
Absolutely.


DR. RAJAY SEUDATH
But one thing I just wanted to touch on before we lose time here because we're getting to the end is there are things in your diet that do promote vision. So, things that have lutein in them, zeaxanthin, those types of food are going to be green leafy vegetables. Tuna, mackerels, fruits like oranges and strawberries, vegetables. There are lots of supplements like present vision, those kinds of supplements. But those are rather expensive. You can get a lot of those same things through a healthy diet. So, I just wanted to touch on that before we run out of time.


RON AARON
My mother always used to say, eat your carrots, you'll see better.


DR. RAJAY SEUDATH
Absolutely. The carotenoids, those are the same things that our eyes use. So, cones and rods have carotenoids and things like that in them.


RON AARON
Cones and rods are what's in your retina?


DR. RAJAY SEUDATH
Yes. That's correct. Those chemicals that are found in carrots and other green leafy vegetables are what our body uses to maintain those parts of the retina. So, it's important to have those in your diet.


RON AARON
So, when Bugs Bunny chewed that carrot and said, what's up doc?


DR. RAJAY SEUDATH
He was right.


RON AARON
All right, Candice, in summary, we're flat out of time now.


CANDICE MOORE
No problem.


RON AARON
Pay attention to your vision, right?


CANDICE MOORE
Absolutely. If you feel something is wrong, don't be afraid to say something because being proactive is key.


RON AARON
There you are. If you don't see it, say something. If you see it, say something. Thanks to both of you. I appreciate you being here today and the award winning Docs in a Pod. Thank you, Candice, you did a great job. I'm Ron Aaron, we'll talk with you soon on Docs in a Pod.


OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.


AD
Turning 65? It's time for an important choice. Deciding what Medicare coverage is best for you. WellMed can help. When you become a WellMed patient, you can connect our primary care with a Medicare Advantage plan. WellMed doctors and care teams spend quality time with you, listening and learning about your health. WellMed and a Medicare Advantage plan could be right for you. Choose WellMed. Learn more at (866) 433-5048. That's (866) 433-5048.


DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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