 Hello and welcome to Quality of Life. I'm your host Dave Augustine. Today we're going to go into the world of eye care and optometry. And helping us go into that world is Dr. David Kosalik from Kosalik Eye Center. Welcome Dr. Kosalik. Thank you David. Pleasure to be here. Great to have you on the show. In terms of your background in education, could you give us a summary of what you all went through to your current status? I'm a Sheboygan native and I went to North High School. I spent my first year here in this facility at UW Sheboygan and then eventually graduated from Lakeland College a few years ago. I was a biology major and a chemistry minor and wasn't sure what to do with that and I would say maybe my dad was more worried what I would do with that than anything. But then I did attend optometry school. I got my doctorate from the Illinois College of Optometry. So quite a few years ago in 1980 the time flies. I am a board certified optometrist. I am very pleased with that program. It maintains some life long learning to keep that kind of certification. So I've been in Howard's Grove since 1980. My wife and I, we have two girls. Both my girls are out of school finally off the payroll so it's a good feeling and my wife Mary and I continue to live in Howard's. That's where you have your current practice right? Yep. I've been in that practice since 1980. Initially I worked elsewhere for a couple years just as the practice grew but now we've been there in our present location since 2012. Excellent. The world of optometry. I know I've heard different terms or different studies of it like optomology, optometry, the different disciplines so to speak. Could you go in and explain differences between them? I think it is confusing and I think because they're all O's and sometimes people ask me if I'm an obstetrician and I'm not. I don't want anything to do with babies but the three O's in eye care optician would be the person that works on your glasses. You know that cuts lenses, grinds lenses. It's a skill and they go to school for two years and they have ongoing certification for that program. You know there's more to optics than just pop in a pair of glasses on somebody. I think in my practice we are really blessed with some very qualified, very knowledgeable people that do very well with that. You know an optician really gets a two-year technical school degree. An optometrist like myself receives their undergraduate college degree and then pursues a doctorate degree another four years and for me it was in Chicago. Optometrists are trained in primary eye care so we're not surgeons. If you like a patient of my need surgery I'm going to work with a surgeon on that person and their problems that way but we do not do surgery. We do primary eye care be it treat red eyes, glaucoma, we prescribe glasses, contact lenses, that sort of thing. An ophthalmologist is the next step up the ladder let's say and that would be someone that did their four years of undergraduate college bachelor's degree, attends medical school for another four years and then chooses a residency in ophthalmology which is a three year after their MD degree specializing in eye diseases, eye surgeries, that's really the person if you need cataract surgery that's very likely the person that you're going to see. Some ophthalmologists go another step and obtain a fellowship and that would be specializing in a specific area. Some cataract surgeons have fellowships in that area or cornea or glaucoma or retina so you really kind of keep going up the ladder. I mean we can get as specialized as we need to and we're really blessed I think in our area that we have such quality referral people and the glaucoma cataract side of things. It's rare that I need to send somebody to Milwaukee or Green Bay because those specialists are right here amongst us. That's nice to know. In your practice, what's the size of your practice and basically the type of patients that you treat for? You know I would say my practice is we're a busy practice it's myself and Dr. Byersdorf and you know on the average we see 20 people each a day and you know it varies from probably Dr. Byersdorf does more children than I do and maybe I just as I'm older my patient base has evolved has gotten older with me so I probably see more of a little bit more mature population but this morning I was in the office Dr. Byersdorf was doing an infant at a year old and you know I can say I saw someone at 91 this morning so it varies a great deal and some of it is routine and some of it is problem someone has something in their eye this weekend I was in several times for that so You had mentioned you know your patient base stays with you and has grown older with you because they stay with you. What should somebody who's looking for an eye doctor be looking for as far as that patient-doctor relationship? You know maybe I think if I look for another doctor I want someone that's committed to learning to lifelong learning I want to know that the person I'm dealing with is at the peak of their field and maintains that peak so I think I would list that as number one and I would say number two would be trust you know I just think you need to trust that person you're seeking advice from and maybe lastly the ability to communicate you know if you have the best doctor and you can't communicate both ways you know it's not a one way street me telling you it's got to be both ways I have to learn to listen so those would be my items lifelong learning trust and the ability to communicate or establish that rapport I guess. Okay excellent As far as eye health how often should somebody go and get their eyes checked? I would say like a routine if we looked at maybe some of the American Academy guidelines as far as when should you have your eyes examined I would say a healthy adult I like to see in two years so a routine exam everything is looking good I tell people come back in two years that is you know the routine though for example a diabetic needs to be seen annually there's just issues that develop some medications can affect the eyes maybe six months is appropriate for that I think more often than not we'll see kids sooner because their vision changes you know they're growing their eyes are changing a lot more than your eyes are my eyes that way so maybe in our general idea if you said just routine healthy adult how frequently I would tell you two years but I think that varies people have had surgery people are wearing contact lenses we like to see contact lenses more frequently so it varies a little bit that way okay you had mentioned earlier some of the conditions that people can develop like you know cataracts and such whether some of the diseases that people face nowadays with their eyes or conditions I think of like the three main causes of blindness here in the United States and with listum diabetes would be number one as we get older macular degeneration is the number one cause of blindness and glaucoma would be number three worldwide cataracts is the leading cause of blindness but the reason that is so is because they don't have the ability to correct it you know here if we have a cataract and people start to lose their vision it's a ten minute surgery type thing and we're done with that you know some of the third world countries that ability to correct it just isn't there you know diabetes is an epidemic unfortunately and you know I would say a day doesn't go by that we don't see diabetics in the office and I like to tell my diabetics that the tighter they control their blood sugar that A1C that stays around six or less I don't see eye problems but when that gets away on them they are going to suffer that way so there's a lot of you know as health care evolves and as optometry evolves I think the communication between family doctor optometrist specialists just continues to evolve you know I would say unfortunately a lot of my time is said writing letters you know dictating letters to primary care physicians saying so and so was in and his eyes look great or they don't look so good you know macular degeneration you know if you think of our elderly people nothing would affect retirement like losing your vision, losing your driver's license, losing the ability to read a paper you know just a terrible terrible disease and we're getting to that point in the 30 some years that I practice we finally have some things that they maybe don't sound the best but injections into the back of the eye that can not only prevent the progression or slow the progression actually reverse it and give people their vision back so you know it's been a really exciting area that way. Glaucoma if there's a danger on glaucoma as we talk about the third one it's that there really aren't symptoms you know I can I can tell you if you're diabetic and you're starting to have macular edema you're going to have some visual issues you're going to complain a little bit. Diabetics lose their peripheral vision and by that or I'm sorry glaucoma people lose their peripheral vision and by the time they're aware of it it's a little too late you know that ongoing such an easy thing to catch if we get it early that way but those would be the three that I see day to day that would be concerning for me. Okay just a little bit more definition for our viewers could you go into how does diabetes affect the eye glaucoma, macular degeneration and cataracts other than the car that catwoman drives. Okay. Had a brignette in there it's a little funny come on. We um well diabetes you know in a nutshell maybe and there's nothing simple but the blood vessels inside your eye like to hemorrhage or bleed and diabetes and that causes some swelling in the back of the eye and that causes some loss of vision so you know I think as eye doctors we want helps the primary care person know that their present treatment is good if I can write back and say this looks perfect their insulin is working well or doesn't look so perfect or if there are problems in the retina then to be able to refer to that retinal specialist that fellowship trained person that they can do some aggressive treatment with that to prevent them losing vision you know macular degeneration is uh one of those things that we're not we don't know the cause you know and that's kind of think well if it's a cardiovascular problem you could say well then diabetics are going to have more macular degeneration than otherwise you know than the normal population and that's not true so we used to tell people there were three risk factors in macular degeneration and one of them was getting older the older we get the more problematic that becomes you know secondly it's uh an ethnic problem white people Caucasians are the ones that suffer with macular degeneration than other groups Latinos you know black people that way and lastly smokers have a much higher incidence of macular degeneration than non smokers and they try to cut out all the other variables but I think bottom line if I could tell somebody that's concerned about having a family history of macular degeneration I'd say don't smoke you know that would be the big one that macula starts to break down the macula is the central part of your vision so it's the most sensitive so as you look at me right now it's the part that has the most cones so if you have macular degeneration you see a big spot where I am and you can see the fireplace off to your left and my right but you can't see straight ahead so they lose that straight ahead vision you know maybe if we can be reassuring to those people and say well you won't go blind entirely that you will see nothing but realistically you cannot drive a car you cannot write a check you cannot continue at a restaurant you know they're doing some nice things if we get that early diagnosis people that have had macular degeneration for some time that injection is not a cure all if you know I don't want someone to see that and say well I've had macular disease and I can't see and now I'm going to go in and see a retinal person and they're going to fix it because that isn't the case we need to get it early that way so so that's a struggling one you know in glaucoma maybe for some reason the optic nerve dies off and we think it has to do with pressure so a lot of times years ago we had the puff of air test or there's that blue light that we measure the pressure the inside of your eyes of fluid and that fluid is always being replaced you get new fluid going into the eye and old fluid drains away and what often happens is the drainage doesn't work as well so you get this new fluid going in and it doesn't drain like it should that pressure starts to build up and as the pressure builds up it suffocates the nerve and there are other factors but maybe in a nutshell that would be the issue and so what we try to do then is control that pressure and we have drops that improve the outflow you know that make the drainage work better and we have other drops that decrease the production of new fluid or maybe a laser procedure to open up some more ducts or maybe traditional surgery that glaucoma fellow again that can give us the help that maybe we couldn't do with drops what scares me or many about glaucoma is there aren't really symptoms you know it's kind of like you know maybe even when I see a patient then they have a problem it's almost I have to convince them they have a problem if you have a cataract and you come in and you say well I'm not seeing well and I say well it's because you've developed a cataract at least you know you have a problem if I say you have glaucoma and you say well jeez I'm just here because I scratched my glasses you know it's a little bit more of a understanding maybe again going back to that communication you know I have to make sure you understand what we're talking about and why we need to do something and usually that something is very simple I drop once a day and we just prevent you from ever losing vision that way last question or at least I hope I'm still moving in the right direction cataract wise you know cataracts form right behind the iris the human lens like when you and I were children that lens was crystal clear perfect you know and it would be like looking right through a sheet of crystal clear glass but as time goes on that glass hazes a little bit it gets foggy it turns a little yellow that way and if it gets bad enough we start to lose vision on it that way so that lens starts to break down you know a lot of thought about ultraviolet light being a big factor that way some medications can be a factor but probably if you said to me what's the leading cause of cataracts I would say birthdays you know we're getting older and the second leading cause I would say would be ultraviolet light so cataract wise you'd have blurred vision you know you have an issue that way you know sometimes we can correct it with glasses and tell people cataracts aren't an emergency situation you know it's not like well let's take it out now while it's little you know we take it out when it affects the way you live cataract and we say well it's there maybe your vision isn't quite 20-20 but it doesn't really bother you we're just going to watch that and I think that's what I would do for my own eye on the other hand if you said I'm a truck driver and I'm having more trouble with glare at night because of that little cataract I don't know if a surgeon that would say no to you that way we take it and we go okay thank you for clarifying those I've always wondered about you know the differences and how they're affected because I know when I go in and do the test you say oh this looks good that looks good but now it kind of rounds the circle as far as you know what that really means so thank you for that as far as symptoms you know what types of symptoms could someone be experiencing if you know their eyes are starting to you know go in the wrong direction so to speak you know I think for most of us the first kind of red flag out there would be blurred vision you know I think if you and I were sitting here and I'm having some trouble doing far away or up closer so you know that's a good time to come in so I think probably most people that I see have as their chief complaint or the reason they're there is that they have some reason for blur something that changed that way you know things that worry me probably like a new onset of floaters you know probably most of us excuse me most of us occasionally see floaters you know and I would say an occasional floater that's been there for years doesn't bother me a great deal but when people call the office and say I have a new I'm seeing spots out of one eye and maybe sometimes they're seeing lightning bolts or so that's an emergency if you ever want to get into an eye doctor in a hurry you tell them you're seeing floaters or flashes and if they don't see you that day you don't want to go there anyway okay got you so floaters that change are a scary thing blurred vision always makes us think double vision is double vision is if you said to me what are the leading causes of double vision and I would tell you diabetes and thyroid disease those are the two if someone comes in and says I'm watching TV and I see two TVs at night those are the ones that come to the top of my list I mean it could be other things you could have a stroke there could be a tumor things like that but number one and number two are going to be diabetes and thyroid disease that way okay oh cold sorry I'm glad it's you not me in today's world what are some of the corrective measures that are available to patients you know to correct their eyesight I mean there's glasses there's contacts there's lacy you know I guess what's all out there when do you recommend and it's funny glasses have been the standby for a long time and I would say they continue to be the standby for most people you know and even in glasses some of the things they've done with no line bifocals and anti-reflective lenses and lenses that illuminate ultraviolet light you know they've really done some nice things glasses wise that has evolved you know just amazingly even in the 30 years that I've practiced that way contact lenses you know it used to be well you can't wear contact lenses because you have a stigmatism or you have dry eye and again contact lenses have evolved so much or when I started wearing lenses I had those little boiling units you know we used to boil the saline in a little bubbler and you know now it's one day throw away you know the technology has evolved refractive surgery is for the right person just a blessing you know a miracle essentially I remember a patient that said to me they had a very strong prescription and she said that she was afraid to go to a hotel because if there was a fire and she couldn't get her glasses she'd never get out you know I'm nearsighted and I have a prescription but I never had that thought my prescription wasn't that strong but for her the peace of mind that refractive surgery gives her is you know was worth every nickel she spent on it that way you know some of the things that we're talking about with macular degeneration how about cataract surgery like we talked about you know what sure what used to be like when I was in school wearing these big thick coke bottle glasses after cataract surgery you know people the day after their surgery will say I haven't seen this good in 50 years you know just the technology has been so exciting you know it's kind of you wonder where it's gonna go next you know it's just been quite alright I think back to when I first went to an eye doctor Imigmeyer and Wall in Sheboygan and you know they had the lenses and they were probably like six frames we could pick from and three of them were brown and three were black and that was about the extent of it and they were stylish and they were all six of them were very stylish and I think five of those six have come back again you know that retrofit looks very good again funny you should mention that I started out I've had glasses since I've been in first grade since I was in first grade and I started out with Dr. Schott actually I had eye surgery when I was really young and then went to Imigmeyer and Wall so on and so on now I'm with your establishment as well and throughout the years I've had glasses I've had contacts and then finally a few years ago I had the Lasik surgery which I know we didn't agree at first but to me it turned out really well as far as how my case went you know as far as that goes and to me it's a blessing what the Lasik you know as far as I can see because I'm always active outside or hunting and first thing my glasses would always steam up or whatever you know sitting there and whatever else so I mean to me it really helped again Imigmeyer going back to any individual it does you know everything is limited including glasses and contact lenses and refractive surgery there's you know I can't say there's the perfect correction you know nothing we have is quite as good as perfect let's say but you know to approach any of those including refractive surgery and say well I'm willing to have surgery and continue to use reading glasses is certainly you know for that right person again for that female patient of mine to give her the comfort to go to a hotel room you know I mean that's just you know I think it's harder to do certain corrections just be you know at one point we only did near-sightedness in refractive surgery that was all it was done and then they started to do far-sightedness and then we started to do near-sighted and astigmatism and then finally the far-sighted and astigmatism issues and you know at some point you know we'd be foolish to say that we won't be able to get rid of the reading glass issue you know at some point to say that option should be there and we're just not quite there yet that way when I first had it everything was crystal clear I could read the serial number on the dollar bill but as the age kept up you know here we are I've got them as well so there they are you know as far as that goes and that's the biggest thing I've noticed but even still if I have to wear cheaters that doesn't bother me you're still hunting and all the rest without it yeah exactly maybe realistic expectations you know maybe as a primary care person to say that something that we need to make sure people have those you know not to sell anything but to make sure to make a good informed choice that way respect the eye care and eye health is there something that people can do to help promote their health you know like you go to general physician obviously say keep your weight down so the blood pressure is down and diabetes does that all apply to your eyes as well or is there other things that people can do to help promote you know their eye health I think what I like to tell patients is that what's good for your heart is good for your eyes so if you think of anything diet wise that's good for your heart and your cardiovascular system it's good for your eyes as well and I wish I had a magic vitamin you know I wish I could say if you take vitamins such and such that is going to be the best thing for your eyes but unfortunately that has not been established that way you know they've done some really nice studies on multivitamins and you'll see a lot of vitamins in you know at Walgreens in the drug stores that way and all market eye health and you know the people that have early macular degeneration it's been proven that they benefit from a multivitamin and a set regimen and that was called the arid study the age related eye disease study and that so maybe in my part I keep those vitamins and they buy them at Walgreens it's not something we sell they get them anywhere that way but those people if you have the start of macular disease the studies have said a multivitamin will slow or halt the progression of the disease and that same study took other people and it looked for cataracts and so well if we put a patient that has the start of a cataract will that slow or halt the progression and the answer was no and they took healthy individuals and they looked that had no sign of macular degeneration and so well would this individual or would these people benefit down the road if they took a multivitamin and the answer was no so at this point on my patients I tell them if you have the start of macular disease I want you to take these vitamins and if you don't there's nothing I'm recommending other than what's good for your heart is good for your eyes. Okay well it's good sound advice basic common sense. One of my favorite vitamin stories and maybe I'm getting off on a tangent but you know I still get people that'll come in and talk about billberry tea and they drink billberry tea because it improves their night vision and I think that's a very interesting you know concept and I you know there's not a lot of research behind it but during World War II the British pilots were always drinking billberry tea before they would go up on their night missions over Germany and the British pilots had an outstanding success rate and the British Secret Service essentially sent this propaganda out that why their pilots did so well was because they drank so much billberry tea when in reality the British had developed radar and they had a very nice system of getting these enemy planes out of the air and it had nothing to do with billberry tea but that that that rumor or you know that thought persists to this day that billberry tea helps your night vision so go that to the British Air Force I guess. Nice. Well today's medicine is based on you know the cures of years ago where you all you had was roots and herbs and whatever else I mean that's where today's medicine has come from. You know and we're learning as we go to you know I don't argue with people that want to take billberry tea you know I think or vitamins in general because I think next year it may say a whole different thing you know we're learning just like you said I think it's really interesting that medical schools many medical schools now have in as part of their curriculum food you know as in food being a drug you know and this is just as much a drug as your licinopril or your meevacor or whatever that way but what we eat has got a lot more to do with things than what we ever realized possible that way. Excellent. If someone wants to learn or research more about you know optometry, eye care what are some good sources to go to? You said I could give myself a little plug here. Absolutely. You know I think we have a nice website KosellicEyeCenter.com and maybe the issue on that would be more so the links. You know the American Optometric Association is a good link. The National Eye Institute a government group you know again a good link on eye diseases that way. There's a website out there called thinkaboutyoureyes.com and again it's a coalition of optometrists, opticians, ophthalmologists that have just kind of pushed eye education essentially not bias to one group or the other but just what's good for the public kind of thing. So those are three really good sites that I would recommend that I think were enjoyable and informative. Excellent. I know we're out of time so I'd like to wrap and say thank you very much Dr. Kosellic for joining us on our show. It's been a pleasure David. I really appreciate it. Thank you for making me feel comfortable. You bet. It's been very educational if anybody has any questions regarding today's show or other topics they'd like to see you can visit our website at www.wscsheboygan.com and then contact us there again for quality of life. On behalf of Dr. David Kosellic I'm Dave Augustine. Thank you for watching.