EP 604: Want Better Vision After 50 Than You Had At 20? Call the Eye Institute of Austin Today To Fight Age-Related Vision Loss!

In this episode, Dr. Mistry and Donna Lee are joined by Dr. Todd Smith of Eye Institute of Austin to discuss changes to eye health that patients notice as they get older. Dr. Smith explains that the top 3 age-related eye conditions are cataracts, glaucoma, and macular degeneration. Advances in modern opthamology have led to new and better visual correction treatments. Whether you're interested in cataract surgery that will give you better vision than you had in your twenties or nutritional supplements and retinal therapy for age-related macular degeneration, Eye Institute of Austin can help you achieve clearer vision--call them today to see what you could be seeing tomorrow! 

Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

We enjoy hearing from you! Email us at armormenshealth@gmail.com and we’ll answer your question in an upcoming episode.

Phone: (512) 238-0762

Email: Armormenshealth@gmail.com

Website: Armormenshealth.com

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Transcript

Speaker 1: 0:07

Welcome to the Armor Men's Health Show with Dr. Mystery and Donna Lee.

Speaker 2: 0:13

Hello and welcome to the Armor Men's Health Show. This is Dr. Mystery, your host. Heres always with my incredibly, exclusively funny and thorough. Oh, await. It's me. It's you again. Donna means you though. Sorry. Okay. My mistakes.

Speaker 3: 0:26

What? What the hell's exclusively? I

Speaker 2: 0:27

Don't know. Sometimes that co-host I bring on the other days. Whatever you wish you, wish you wish. You know, sometimes I turn on the radio and uh, you're doing the show with somebody else. Yeah,

Speaker 3: 0:35

Because you're never around

Speaker 2: 0:36

Cheating. Cause

Speaker 3: 0:37

You're always

Speaker 2: 0:37

Books. I'm a men's health expert, a board certified urologist. This is a men's health show,

Speaker 3: 0:41

But I think about you every time I'm with somebody else.<laugh>.

Speaker 2: 0:44

I don't know if that makes me feel any better. You know, we had a patient this week tell us that he really enjoys the show, loves the information, but maybe we need to be more serious.

Speaker 3: 0:52

Oh no,

Speaker 2: 0:53

Mr. Serious. I don't

Speaker 3: 0:55

Care. Oh f that guy

Speaker 2: 0:56

<laugh>. No, no, sir. Thank you so much for being our customer. Don't have that. That this is Men's Health Show. We talk about issues between the nipples and the knees, but today we're gonna go a little higher. Eyeballs. We're a urology place. How do people get ahold of us and how do people know

Speaker 3: 1:08

About us? That's right. You call us at(512) 238-0762. Our website is armor men's health.com. Apparently it's better if I sing it. Armor men's health.com. It is not. Okay. And we're located in Round Rock South Austin. North Austin and Dripping Spring.

Speaker 2: 1:20

And you can listen to this show on News Radio Klbj on Saturdays Ride. I did. We're gonna be tub able. Oh yeah. Hit the button at some point and then can also listen to us. Wherever you get your podcast. Today is one of those awesome days where I get to actually have somebody on the show that's like my own brother. Your friend, Dr. Todd Smith. All right. From I, Institute of Austin is here today. Todd, thank you so much for joining us.

Speaker 4: 1:42

Thank you for

Speaker 2: 1:43

Having me. Now we've known each other for more than 20 years. We did our residency together. You are a Baylor College of Medicine alumnus when it comes to residency, but you call yourself a surgeon, is that right?

Speaker 4: 1:54

Surgical subspecialist.

Speaker 2: 1:54

Yeah. You're a eye surgeon. Mm-hmm.<affirmative>, even though you didn't do a surgery subspecialist like a, like a general surgery internship

Speaker 4: 1:59

Year. It's just delicate. High stakes. Precision work. I

Speaker 2: 2:02

Is that right? Yeah. There's

Speaker 4: 2:03

No blood though. There is blood.

Speaker 2: 2:04

Oh good.

Speaker 4: 2:05

Oh, thank God. Just we don't do it in ccs, we do it in lost red

Speaker 2: 2:08

Blood cells in los. That's right. There's so few. So little blood cells. You count each individual one that you lose, huh? Well good. Some friends that count in the pint. So it's probably, you're probably doing things a little bit better when it comes to eye health. We talk about that a lot on our show. And especially with aging, there's a number of age related eye conditions that you're gonna deal with. Maybe you could tell me what your top three age related eye conditions are that you deal

Speaker 4: 2:29

With. Okay. And I'm happy to kind of go over anything. And if we deviate, that's no problem. But the main things that I address in my practice, even though a child to adult practice, we don't do pediatrics really, but, but we'll see children for just refractive errors and basic things is cataracts, glaucoma, and macular degeneration. Those are the real big ones.

Speaker 2: 2:47

Cataract are a, a kind of fuzzing of the lens so that you don't see as clearly. That's right. About what age do people start having symptoms and well, what are those symptoms gonna

Speaker 4: 2:55

Be? Yeah, so it typically starts the earliest indicator of a cataract. Cataract is when you start having trouble with near vision. That's implying that the lens has lost some of its elasticity and process of accommodation becomes harder and the lens is still clear at that point. But over the next 20 years, once you start having that issue, we'll start to see clouding in the lens itself. And that's technically what a cataract is. Any opacity within the lens. I've operated on patients that are 30 years old with cataracts, but the most common is probably 70 to 80 years old in

Speaker 2: 3:23

That range. And when you're looking through a cataract, a fuzzy lens, are you gonna see halos around lights? Are you gonna have trouble driving at night? What?

Speaker 4: 3:29

Well, what we say is, what Am I gonna know our view in is kind of like their view out. So the patient's aware usually that they have some cataract formation. But yes, the very typical symptoms or glare at night, especially with like the bright halogen headlamps, they're all bothersome. Needing more light to read, not feeling like the Christmas or quality of vision is there. And it occurs very slowly, just like physical appearance. It takes place so slowly. A lot of people feel like it's kinda snuck up on them when it's summates to a point where it's really impacting the vision and causing glare. It's usually been in place for a long

Speaker 2: 3:59

Time. When should patients really consider getting eye surgery? Because a lot of times people are scared of getting their eyes

Speaker 4: 4:04

Operated. But this is what I like to say. I always tell my patients I wanna meet'em halfway. I want them to have some symptoms. I want them to feel like they've had a deterioration in the quality of their life or quality of vision. And I don't like to be aggressive. I don't like to tell a patient, you have a cataract, you need surgery. Generally the patient's gonna know there's been a visual change and there's, patients are at variable states when they want cataract surgery. Some people at the first indication that glare say, I want this fixed and I'd like to have it removed. Other patients wait a little bit longer just for sometimes the, the fact that it's a little scary to go through. And that's the thing about cataract surgery. Modern cataract surgery is it's a very easy process. We do it with just local anesthesia, usually a combination of ED and fentanyl. And we do what's called topical clear cornea surgery. And it's sutureless. So we go within the eye, remove the lens and replace it with a lens. But that, the importance of that is that it corrects the vision most classically and a lot of lens propaganda is out there, but most classically, we implant what's called a monofocal lens that will correct the lens at one point in space, kinda like a contact lens will.

Speaker 2: 5:02

Okay. Okay. And so can you see a cataract on a regular physical exam? Like with one of those lights that you put

Speaker 4: 5:07

Things eye? Yeah. If you shine a a light tangentially it's someone's eye, you can kind of get a sense that there's some clouding within it. What we have is called a slit lamp bio microscope. So we can look at things three to dimensionally. So we look at a cross section of what the lens looks like and you get a sense and you grade cataracts. Most people use a grade of say, one to four, but then within that grade there are different types of

Speaker 2: 5:27

Cataracts. And, And did you use a sutureless cataract repair because Yes. You, you can't tie suture as well as a urologist can.

Speaker 4: 5:33

Well, no, we're better at wound construction. I think that's what it comes down to.

Speaker 2: 5:38

It's a challenge. The cut is so perfect that it just comes back to

Speaker 4: 5:41

Other, No, it's a matter, it's a matter of the size of the incision. So historically we would make a size matter, four to six, exactly four to six millimeter incision and sew it up with three or four sutures. Now we operate through about two and a half millimeter incisions. And the cornea has thickness. Where we make the entry wound is it's the lius, the outer part of the cornea. So we actually make an incision down and then we tunnel in and then we change the angle of the incision to make kind of a Z shaped wound. So at the end of any surgery, of course we're testing that incision to make sure that it's water tight. But I'd say maybe one in a thousand patients undergoing modern topical or clear cornea surgery is gonna need a

Speaker 2: 6:16

Suture. What is the recovery? And do you ever do both eyes at the same time?

Speaker 4: 6:19

At this point in time, we don't. And I feel with something as precious as vision, as a sense, I like the patient to be able to evaluate, have that first eye done, make sure they feel there's been a gain in vision, that they're pleased with their vision, that their experience is great, that they're not having any postoperative dryness or irritation. I like that first eye to be very close to a hundred percent before going and doing the other eye. But generally the patients are real pleased with the quality of vision, the, the color of vision, color, vision that's, that's re achieved the Christmas of the vision, nighttime driving, those kinds of things where they want to have the other one done. And that also helps to kind of balance'em out. And

Speaker 2: 6:52

How much of this is usually covered by insurance and what do people routinely do as kind of add-ons to a

Speaker 4: 6:58

Cataract? Okay, sure. I'll tell you in general, if a patient has a cataract and we diagnose it by looking at the slit lamp and it's causing symptoms, you know, glare, halos, decreased quality of vision, it is, it is covered by insurance. So if you look at the way that it's covered in general, your garden variety cataract that you do a traditional lens in should be very well covered depending on the plan. But that's plan dependent.

Speaker 2: 7:19

It's like when you buy glasses and if yes, the free glasses are really heavy and fall

Speaker 4: 7:23

Off your nose, cataract, you want something light cost you a little bit, is the number one performed surgery in the United States every year. So it's very well covered by most carriers. It's something that their patients are gonna need a service. They're gonna require, if you look at the traditional approach, you're basically paying the surgeons fee, the anesthesiologist to monitor the patient or the CRNA you're paying for the operating room time. So it's that combination of things. And insurances generally do a really good job of covering that for cataract surgery. The additional fees come in when different things occur with the eye of the refractive state of the eye. If there's a stigmatism, we'll use what's called a toric lens to correct for that. If someone says, I'm not comfortable wearing readers, we traditionally will correct both eyes for distance. And then I have patients use readers for near, there are some other lens technologies that we would implant within the eye. They kind of extend the depth of focus or work in a multifocal manner where they have different points of focus where they'll have their distance, intermediate and near vision as well. And those patients have to be perfect candidate. Those advanced technology lenses are very picky about the cornea, the corneal surface, the retina. So things have to look really perfect for me to feel comfortable in planning one of those, what we call advanced technology lenses. And that doesn't mean it's better. It's called an advanced technology lens. It just does things differently.

Speaker 2: 8:34

And those things usually cost patients a little bit out of pocket to be able to get those things. Exactly.

Speaker 4: 8:38

And it's variable. And what, what we've always tried to do is in situations where a patient wants a technology, if they're in a, in a spot where it's gonna be difficult to pay for that, um, do everything we can to, to, you know, waive certain fees that we'd be able to waive to make that happen. But in general, you're looking at traditional cataract surgery being covered. If you're gonna have this toric intraocular lens, I would guess general a thousand to 1500 an eye, if you're gonna have one of these advanced technology lenses in the ballpark of probably$2,000 an I, but that's variable

Speaker 2: 9:15

Now. Do you think it's a little unfair that you get to be old and have better eyes than when you were young

Speaker 4: 9:19

<laugh>? I love it. I love it. And it's

Speaker 2: 9:21

So unfair. It's, it's like, I'm gonna have to suffer for a while wearing these thick glasses Exactly. Until I get the bite on a guy.

Speaker 4: 9:27

Exactly. That, that excitement in general. And nothing's ever a hundred percent, but 99% of patients have cataract surgery. Uh, love it. They're so happy they had it. And their retina is able to see, say you have a 70 year old patient, their retina potential is still just as good as it was when they were 30. So their vision will, they'll often tell me is the best it's ever been in their entire life.

Speaker 2: 9:48

Well, that's amazing. Uh, we had Todd Smith today here with us from Austin Ins I Institute of Austin. I'm Dr. Mystery, that's my real name, joined by Donnel Lee. Donnel Lee. How do people get ahold of us and how do people get ahold of Todd? That's

Speaker 3: 10:00

Right. Uh, Donnel Lee is my real name as well. Well, our phone number's(512) 238-0762. Our website is armor men's health.com. If you have a question for Dr. Smith, you can email us, um, there as well. Yes. Um, armor men's health.com. Awesome. Thank you so much Dr. Smith for joining us. If you wanna reach out to Dr. Smith, it's I Institute of Austin. His number is 5 1 2 4 5 4 8 7 4 4 and his website is institute.com.

Speaker 2: 10:24

I'm Dr. Mystery, your host, Join always with my co-host, Donnel Lee. Donna, I think we need to tell my name more often and your name on the show as we do the, the episodes. Because sometimes people are like, Oh wait, your, your voice sounds familiar. Really? What's your name? I'm like, You don't know my name.

Speaker 3: 10:38

It's a mystery. It's

Speaker 2: 10:39

A mystery.

Speaker 3: 10:40

<laugh>. M i s t

Speaker 2: 10:41

R y. Donna is a, uh, professional comedian. She just got to get back onto the stage. How'd it feel? It

Speaker 3: 10:46

Was nice. It was amazing. And if you didn't go to the show, I was really freaking funny

Speaker 2: 10:49

As far as you know. Oh man. You killed it. I

Speaker 3: 10:51

Killed it. Standing ovation in my mind. In

Speaker 2: 10:54

My mind. It was

Speaker 3: 10:54

Beautiful.

Speaker 2: 10:55

Oh my lord. We are joined again today. Well, uh, just a little a reminder, I'm a men's health expert, a board certified urologist. We started a urology group in town 15 years ago called N AAU Urology Specialist. Mm-hmm.<affirmative>. We're up to four doctors, four mid-levels, two physical therapists, a sex therapist, a health coach, just an amazing holistic approach to your urologic care. Mm-hmm.<affirmative>. And we're joined, uh, once again with one of my really good friends, Todd Smith with I Institute of Austin. Thank you so much for joining us again, Todd.

Speaker 4: 11:23

Thank you, Sonny.

Speaker 2: 11:24

I think after sitting here and talking, we realized why I have such animosity against ophthalmologists. I jealous. And it's because jealous much when you're a resident and you are sitting in Bento Hospital, they run two rooms at night. The orthopedists get one room that runs 24 hours a day. Mm-hmm.<affirmative>, every other surgeon has to share the other room. And if I have a person with a kidney stone or somebody's testicle got caught in a shredder or something like that, I have to put my name in line and wait. And then if somebody falls down and cracks their eye open, guess where they go? Go to the line, the top of the line. The front of the line. So I'll be sitting there waiting for hours and hours and hours for my case to go. And then big old Todd Smith will walk in freshly showered and he's like, hair, hair like flowing. I'm here to fix an eye. And he

Speaker 3: 12:07

Says, I'm here.

Speaker 2: 12:08

Oh my Lord. And they had these really cool little, little briefcases they came with like this. That's fancy equipment. It

Speaker 3: 12:14

Are you saying an eye is more important than

Speaker 2: 12:15

A testicle? I would never say such a thing. I didn't think so. There's, God gave us two eyes, but he only gave us two testicles.<laugh>, thank you so much. We're what we're discussing topics about age related eye conditions. Uh, we discussed, uh, cataracts previously, but uh, my grandfather, he suffered from macular degeneration and it was such a terrible disease for him in which he progressively lost his vision, limited his ability to drive and really took a lot away from him. Tell us what macular degeneration is and maybe how it's evaluated, what symptoms there are, and then we can talk about new and upcoming treatment.

Speaker 4: 12:47

What happens? And first of all, the macula is the central portion of the retina. So we're all of the fine visual acuity takes place looking at details, facial recognition, and it's also the most metabolically active part of the retina. So if you look at it and, and we do studies of the retina, you can see that the majority of the center part of the retina is all made at cones. And cones allow this fine color vision perception. However, when there's a real metabolically active tissue, it requires a lot of oxygen and there's a lot of metabolism to keep the daily functioning happening. What happens with macular degeneration is that those byproducts of metabolism actually get deposited underneath the macula and they show up as kind of yellowish clear deposits we call drusen. And there's an entire spectrum of how someone's impact. The typical age of onset, I'd say is it's not uncommon for me to see some patients in their seventies, sixties to seventies that start to show some of this deposition.

Speaker 2: 13:43

And you can see it on a physical

Speaker 4: 13:44

Exam, you can see it on a physical exam. And really what we're looking for is the health. First of all. We look at what's called the foal light reflex. If someone maintains that, we know that macula's extremely healthy with a patient that is eventually going to develop macular degeneration. We'll look at the exam and I'll say, say I see a 65 year old, I start to look at that layer of the retinal pigment epithelium. You can see some window defects. There's some indicators in this patient that they're likely gonna go on to develop dry macular degeneration. And I'll get into the dry in the wet form in a second. So in that patient, that 65, I'm not perfectly pleased with the exam. I will discuss, of course, dietary approach and multivitamin.

Speaker 2: 14:23

So this is like a condition that's almost like a chronic medical condition that we could have some impact on. I mean, it's not like your eye, your eyes on a one-way train that That's correct. You could maybe change the way you're living to help improve the metabolism of this part of the eye. Correct. And perhaps maybe not reverse, but at least stop the

Speaker 4: 14:41

Progression. Correct. And as an aside or apart from something like retinitis pigmentosa that's heavily genetic, the majority of patients follow a typical course across life. I think macular degeneration, there are some things that you can do to reduce the likelihood of developing

Speaker 2: 14:55

It. Is dry macular degeneration more common in diabetics or smokers or any other particular

Speaker 4: 15:00

Kinda thing? Uh, if interestingly, if you look at the cardiovascular risk factors, elevated cholesterol, hypertension, diabetes, these all play into the risk factors for the development of macular degeneration. There are some trends like typically it's a little more common in farsighted people than nearsighted people. And there's a definitely a genetic theme within it. But I feel strongly, I've had identical twins that were patients of mine that where one had it and the other one didn't.

Speaker 2: 15:26

And so what are the vitamins that you recommend or dietary

Speaker 4: 15:28

Changes? Yeah, so for, to be clear, any vitamins, I, I've never been someone that pushes a lot of vitamins. I would say if a patient is taking vitamins, they need to be on them for a reason. I think you can take too many vitamins, but a study called the eras, the age related Eye disease study was done and it has a formulation of basically a vitamin A derivative called lutein and zaz anin. So it has that in it and vitamin C and vitamin E and then zinc and copper. It has high levels of zinc. So the copper's in there for a few reasons. Nerve function within the retina through the optic nerve, but also to prevent a zinc deficiency anemia.

Speaker 3: 16:06

So let's repeat that cause I'll get a question from a listener. Sure. And this is, what are the four you mentioned? So

Speaker 4: 16:10

Start over. Okay. Before I mentioned, uh, it, first of all, it's the arids formulation. Okay. The ARIDS two formulation, what I mentioned, what's in that is are fo are what are called lutein and xanthin. Mm-hmm.<affirmative>, these are already kind of pre-made by the manufacturer of this vitamin. But the original in, you know, agents would be, um, created as a metabolism of vitamin A. Okay. Uhhuh<affirmative>. Does that make sense? Yeah. So the old formulations used to have vitamin A, this has lutein and zanten,

Speaker 2: 16:38

So it's kind of broken it down already

Speaker 4: 16:39

A little bit. That's right. Lutein is 10 milligrams and zanine is two milligrams.

Speaker 2: 16:44

Okay. And then you have zinc and

Speaker 4: 16:45

Copper. Okay. Then you have zinc and copper, and then vitamin C and vitamin E. Oh,

Speaker 2: 16:50

Okay. That is amazing. And exactly. And

Speaker 4: 16:52

It's r And if you're doing, if you're gonna split it out, if you just get the Arabs formulation, you have it, but you want crick oxide. That's, that's a very important factor from what I've been told in my training.

Speaker 2: 17:02

I think that we need to put that on our Facebook thing. Maji?

Speaker 3: 17:05

I do. How do you spell s

Speaker 4: 17:06

Uh, arids. A r e d s a r. Age related eye disease study. Perfect.

Speaker 2: 17:11

So, so now if, if things have gone beyond this, this part with dry macular

Speaker 4: 17:16

Degeneration and, and just to be, I wanna be real clear, I only advise that when I see changes. Understood. I, I don't like preventative. I don't feel it's a bad idea, but it's a, you know, the vitamin doses are pretty high in that Arabs formulation. So the only patients I convert to that are those that I foresee macular degeneration based on exam findings or that have preexisting macular degeneration when I see'em.

Speaker 2: 17:37

So if they already have it and are starting to lose some of this fine vision and the central area vision, Yes. Now what am I, am I just kind of destined to not being able to drive.

Speaker 4: 17:47

So in that case, you will have regular follow ups. We can do a very fine cross section of the back of the eye called an O C T. And that O C T is just like a CAT scan, but of the maculate itself. And we're able to see the individual layers of the macula. We're able to see the amount of drusen that's accumulated. We're gonna compare that across time. We know with dietary alterations in the arids formulation, there's less of a likelihood of the accumulation of that drusen accelerating or increasing. So a patient that says, I want the diet that would be preventative for, um, the development of macular degeneration, that's gonna be the traditional kind of Mediterranean diet, uh, rich and dark green leafy vegetables like spinach, kale, arugula, uh, cruciferous, uh, yes. Broccoli. That's a big word. Yeah. Broccoli is, is another one. And if you're, if you like salads, uh, pick up the romaine instead of iceberg because it has a little bit more of those necessary micro nutrients and vitamins. The, um, cold water fish, wild salmon and Alva cortina halibut. You, they have to have the wild salmon, which is a little more expensive, but it's known to have that health benefit through the omega3 fatty

Speaker 2: 18:59

Acids. Mm-hmm.<affirmative>. And so if, if somebody progresses to the point where there really are having Yes. Significant problems Yes. For dry macular degeneration. Yes. Are there surgeries and medicines and

Speaker 4: 19:09

Things like that can be done. Yeah. And, and unfortunately with dry macular degeneration, all we notice suggest is the dietary, even studies are being done now, but all we notice suggest is the dietary alteration or modification and the arids formulation. Um, multivitamin.

Speaker 2: 19:25

I really can't think of a, of a kind of a more frightening thing for someone to go through then this slow progressive loss of uh,

Speaker 4: 19:33

Central vision. Vision. Fine vision.

Speaker 2: 19:35

I mean, especially if you were a woodworker or a knitter or something that was using or you know, even a urologist or per yes. No perverts. Look at things, big things. Everything's fuzzy on the television anyway. That's true. It's probably helping the world out,

Speaker 4: 19:49

But yes honey, and that is the dry macular degeneration. This kind of comes in and out. Is that still working? Fine. Okay.

Speaker 2: 19:56

So and so, uh, I think we're only gonna have time today for the dry macular generation. Okay. Would you come back and talk to us about wet macular generation at some point? You are just so informative and just, it was so eyeopening. I, I think this is the most information. Hey, I<laugh>, this is the most information I've ever had on macular generation and although the bad news of no real cure, the good news that we have some capability, uh, within us to, to make a change. That's correct. Todd, thank you so much for joining. Welcome. This is Todd Smith, Dr. Todd Smith with I Institute of Austin. Donna, how did they get ahold of him? You

Speaker 3: 20:29

Can reach out to him@iinstitute.com. His number's 5 1 2 4 5 4 8 7 4 4. And you can check us out at armour men's health.com.

Speaker 1: 20:37

The Armor Men's Health Hour is brought to you by Urology Specialist. For questions or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at armor men's health.com.