 Lakeland Public Television presents Currents with host Ray Gildow, sponsored by Niswa Tax Service, offering tax preparation for individuals and businesses across from the City Hall in Niswa and on the web at niswatax.com. Hello again, everyone, and welcome to Lakeland Currents, where tonight we're going to be talking about something that's important to all of us, our eye health. And my guest this evening is Dr. Seth Docken, who is the doctor at the Staples Eye Clinic in Staples, world-renowned traveler, world-renowned fisherman. I don't know if that's true or not, but one of our really good young doctors in the area, and I'm very happy to have him on the show this evening. Seth, give us a little bit about your background. Where you took your training, and let us know who you are a little bit. I grew up in a little town out in the middle of Niswa called Towner, North Dakota. So I went to school there, and parents live there still. I did my undergraduate at the University of North Dakota in Grand Forks. There I met my wife, my beautiful wife of, I don't know, 12 years now. So I did my undergrad there, and then I went on to graduate school in Chicago. So I went to Illinois College of Optometry in Chicago. All said and done, it was about nine years of school, and graduated there about 10 years ago. My wife, being from Minnesota, wanted to move back to Minnesota, and so we did. We have two beautiful young girls, a kindergartener and a three-year-old, and we live right in Staples, and we bought the eye clinic there about five years ago. And so we do a lot of primary care. I see anywhere yesterday, I think my oldest patient was 97, and my youngest patient was three. Wow. And so there was variability there. So I think when you practice in rural Minnesota, you pretty well get used to seeing everything. Yeah. And that's my background. We're talking a little bit off air about how a doctor, an optometrist, is like a general practitioner, a doctor. Because the eye field is like all the medical fields today getting very specialized. Yeah. What are some of the specialties that are happening in your field? Yeah. So really, within my field, I do, I think of myself as a lot of times a primary care physician for your eye. Because I think on a regularly daily basis, I send patients to all five or 10 different specialists. You have cornea specialists, which deal with different ocular diseases and lasik and those types of things. You have your cataract surgeons, which do that. You have your retina specialists, which handle a lot of your diabetics and macular degeneration type patients. You also have your lid specialists, your blepharoplasty type things where we're doing lid lifts and oculoplastics. So there's just a tremendous amount of specialties. There's specialists in our field. And so I really think of myself as a quarterback where I say, OK, well, we need to do this now. And we get the patient going in the right direction there. And we're going to talk about sort of the three major diseases that people experience. But before we do that, maybe you could talk a little bit. I know you said over the years, you're seeing more and more young people with issues that used to be considered more older people issues, like cataracts. Yeah. What's causing it? Do we have any idea what's causing that? Well, I think that what's causing the cataract stuff is really the success of surgery is driving patients to be willing to get it done a little earlier. That's what's happening in cataracts, I think. You have patients where they've talked to their mom or dad or their spouse or their brother or sister. And maybe they're 55 or 60, a little younger on the cataract side, but they say, gosh, I got done with the surgery. And my eyes are so much better than they used to be. So I think with the success of surgery comes more surgery. The other thing is, is you get into a lot of systemic diseases. There's been an increase in diabetes and hypertensive patients. And so with that increase in diseases, you do get a lot more ocular diseases as a side effect. I think your typical diabetic is going to have cataract surgery probably 10 years sooner than what they would have had it without the diabetes on board. So there is an ounce of prevention possible, at least for that disease. Absolutely. By taking care of yourself, losing weight and not having diabetes. Well, I think as a whole, an ounce of prevention is absolutely it. Not just cataracts, but almost any ocular disease that we look at. There's very much some systemic components where you say, OK, this disease is a little bit more predisposed to having problems with your eyes. How important is wearing sunglasses to the health of your eyes? It's definitely important. In Minnesota, not as important as in Florida. The sun has less power up here. But if you think about your eye, it's really the only organ in your body that's designed to let light in. And we know from our dermatologists and things like that that light is damaging. Light creates problems with your skin, with all those things. And your eye is really the only organ in your body that actually lets light in. So if you don't protect your eyes, they will break down because that light gets in and it really damages some stuff for sure. Well, let's start out with cataracts. And maybe you could help us understand what cataracts are and then how are they treated? Yeah, absolutely. It brought a little slide with a couple of boys so that you can see what you see here is a couple of boys with a soccer ball. One picture is clear. And the other one is kind of a demonstration of what you would see with cataracts. Most of the time it's just very blurry vision. Cataracts is the most common cause of blindness in the world today. It's preventable. It's very treatable. But I think we, as Americans, we fix this stuff all the time, but we don't realize that in the world these are very, very serious problems when patients get older and get cataracts. Most of my cataract patients come in to me thinking that they need new glasses. I would say at least three quarters of my patients that need cataract surgery come in to me and they say, you know, Doc, I got these glasses two, three years ago and I just, I can't drive at night. I can't read anything anymore without a lot of light. And I take a look at their eyes. I take a look at their prescription and I say, well, you know, all these things are great, but really if you want to see better, it's probably going to take cataract surgery. So technically what are cataracts? Cataracts are a breakdown of the lens inside the eye. So we're all born with a lens in our eye just like a lens in a camera. And with age, usually, it will start to break down and it becomes opaque and blurry. And yellow, I've heard of people describing it as yellowish looking. Absolutely. I see patients one day out of cataract surgery and that's the most common thing that patients will say one day out of cataract surgery is, all my colors are completely different. I had a gal about, I don't know, six months ago or so. She had repainted her house because she didn't like any of the colors in her house and then we had cataract surgery and she had to go back and repaint her whole house again like any of the colors she had selected. So they changed the color. They also dim the vision where night driving is very hard or gosh doc, I can read this but I sure need a lot of light on it and so they dim the vision down and make it blurry is what happens with cataracts. I remember talking in your office one day about how they first started doing cataract surgery and how compared to today how primitive it was. Could you talk a little? I think it was in the Vietnam era, wasn't it? Yeah, from what I understand the first cataract surgery was kind of during Vietnam. There was a surgeon, a patient had damaged their eye and the lens was no good anymore and they used to have glass implants that they would put inside and so obviously with glass you can't bend it so they'd have to make large incisions and they'd have to stitch everything together. In fact, that surgeon, they took away his license. They wouldn't let him practice later in life. They actually put him in the Hall of Fame. But at that time it was pretty radical surgery to take a lens out of somebody's eye and put a new one in and that's really what's happened over the last 20 years I think with cataract surgery is that the implant technology has really improved where we're using these plastic implants and we can fold them and so the incision sizes are nothing and I don't even really remember the last cataract patient that I had that actually had a stitch in their eye so it's all kind of needle driven and laser driven so the outcomes have really improved with that. Well, I've had that surgery in both of my eyes and I remember the doctor saying this will take about seven to nine minutes but it didn't take any longer than that and like you said, the lenses are so small he took it and it was folded and he took a laser and just... I don't even remember the laser doing anything I just remember seeing everything in a room and then all of a sudden I just saw multiple colors in like a little bowl of soup and then all of a sudden it was back in there and he unfolded that in that little slot and that was it. Yeah, so they take the old lens out with what's called a Faco emulsifier it uses ultrasound technology to and I always tell patients it's like a real small shop back it's probably the best way to say they take the old lens out, put the new one in and they unfold it inside the eye and put it in place most patients come back and say I thought they were just going to get started and they said, okay, well, we're done and that's cataract surgery cataract surgery is the most common surgery performed in the United States today and cataract surgery is the most successful surgery performed in the United States today most of my patients, I tell them if you live long enough you will have cataract surgery it's very common but the vast vast majority of patients come out of cataract surgery and say, Doc we should have done that five years ago I just see so much better than what I used to see I think anytime somebody is doing surgery on our eyes it's pretty frightening but I think the bottom line from this debate right now it doesn't have to be that frightening it's a pretty standard surgery but there can be complications what are some of those? there's certainly complications you can have infection that's a very limited risk in fact in the ten years that I've been practicing being a part of several thousand cataract surgeries every year I've seen one you can have lenses that move or displace after the surgery I've seen that happen once are those correctable? they are correctable usually with infection they've got to get some high powered antibiotics on board and try to clear some of that stuff up if the implant moves most often it doesn't really cause any problems it's just if it moves too far it will cause a lot of problems the most common problem with cataract surgery is what we call a secondary cataract where the body puts a little membrane over the top of the implant that happens probably about 30% of the time and so when you get that patient who's had cataract surgery and their vision is great and wow I'm seeing good and then you see them back a year later and they say you know I kind of feel what's happening there is they're getting a little membrane over the top of that implant that they put in and with a laser in about 15 seconds your ocular surgeon can take that membrane rate off and then is that usually done it doesn't usually happen again? doesn't happen again so it's kind of a one time occurrence for 30% of patients that have it 30% but most people have two eyes and so you know a lot of it's not too uncommon to have one eye done and another one done later yeah most people I would say the vast majority of our patient maybe 80 to 90% will have their surgeries within one to two weeks of each other just because they come out of the first surgery and they go holy cow you took my bad eye and made it my good eye so let's fix the other eye too so let's talk about another one of the serious eye diseases, the macular degeneration and what is it? yeah macular degeneration is really a breakdown of the retina inside the eye so that's kind of like the film of the camera it breaks down with age it's called age related macular degeneration and so with life with too many birthdays it starts to come up so there's a couple of different forms of macular degeneration there's a wet and a dry form of macular degeneration macular degeneration affects the central part of the vision so the same picture with those two boys what you'll see is that the side of the boys are clear but that very central part of their faces there is a little bit blurry so the macular degeneration's got just a gray area in the middle just a hole right in the middle so wet macular degeneration is now getting more treatable we actually do do a pretty significant amount of shots to try to take care of some of that blood vessel growth that's growing underneath the retina in wet macular degeneration and dry macular degeneration I think there's some things coming but really prevention is key there we try to tell patients with strong family histories that you should probably be on some type of a multivitamin with lutein good healthy diet with green leafy vegetables regular exercise trying to get more circulation to that retina because really what happens in macular degeneration is that that retina doesn't get the nutrients that it needs and it starts to break apart with age it used to be that people who had that would go blind back in the 60's and 70's and off air I was telling you the story of the person I worked with it's a true story who was diagnosed with macular degeneration and the next day went out in the garage and poured a 5 gallon of gas on himself and burned himself up because he just couldn't imagine living blind and it's not that severe anymore at all it is not macular degeneration is certainly a pretty serious disease but we've really come a long ways over the last 10 years for sure and I think looking out my patients, my young patients I have patients that come in and they're 35 years old and they say well grandpa has macular degeneration do I need to worry about it and I say well this is a long time out and what our profession and I think most of medicine changes quite rapidly so I think there is a lot of hope but really it's about prevention especially for those younger patients and trying not to get to that point where that retina has already broken down and then it's not really fixable the eye is a nervous tissue and so just like spinal cord injuries or various things like that it doesn't really come back and so really with any ocular disease the point is is to catch it early treat it well and you can really save a lot of vision there for sure. What's the more common the dry or the wet? Dry. Dry? Yeah dry macular degeneration is by far more common wet macular degeneration is more treatable now but dry is by far more common than wet. What's the third disease that you wanted to emphasize today? Yeah the three major diseases are cataracts macular degeneration and glaucoma. Glaucoma. Glaucoma is the second leading cause of blindness in the world today cataracts being first and what that is is that's really a pressure issue where the pressure inside the eye is a little higher than it should be and it starts to do damage on the optic nerve in the back part of the eye. Which is why you do that test when you go and have your eyes checked. Exactly so that's why everybody needs a balloon. Exactly so that's the test that we're probably famous for I would say but we're always checking pressure every time somebody comes in it's just like your blood pressure when you go to the doctor it might have been perfect the last ten times but they're probably going to check it every time and so we check pressure a lot what that glaucoma is is where you start to lose side vision so again those same boys where the space in the center is clear but all that peripheral vision starts to go away with glaucoma patients. Glaucoma is I think one of the probably easier diseases that we deal with really it's so treatable you can catch it quite readily with regular eye care almost any practitioner should be able to pick up on glaucoma pretty easily and usually with medications or things like that different types of surgeries you can lower that eye pressure and really most of our glaucoma patients never have any problems with their vision so macular degeneration is the leading cause of vision loss in the United States and especially when you deal with the population up here that kind of European, Caucasian population they're a lot more predisposed so when you get that patient and I try to tell them that up front where they're kind of that blonde hair blue eye, lighter complexed patient you really want to be careful with sun exposure and things like that because that's where you see a lot of macular degeneration is those lighter complexed individuals. Is there anything new happening in transplants with the eye itself is there any progress being made in that field? There is they've started to do a few transplants so where you're taking that macular degeneration patient and replacing that retina a little bit last time I checked they had done 17 in the nation so my patients that come in and say we should do this I saw it on the news it's not quite there yet they've done 17 and from what I understand there was 10 of them that were successful and I think as I look 10, 15 years out there certainly is some hope there with the retinal transplant and stem cell stuff just like you've seen news stories where this person with a spinal cord injury is all of a sudden walking again so we're starting to get to a point where we can affect nerves but at this point in time it's not a very common procedure that we do and where is that research being done for the most part? Is it all over scattered sort of? Yeah it's kind of scattered but most of it is at your big major hospitals your Dukes and John Hopkins and those types they're the cutting edge places for that the cutting edge research facilities Harvard's and yeah well let's talk about something near and dear to my heart floaters what is a floater? I suppose if you're 20 years old or 25 years old you've not heard about floaters although they can be a floater is a breakdown of a gel inside the eye called the vitreous and it's common with age it breaks down on almost everybody and you start to notice these little bugs floating around your vision I in fact have one in my right eye which is my shooting eye that bothers me a little bit when I'm out duck hunting but it breaks down and very common for the most part and I tell most of my patients the vast majority of floaters are very benign and they're their best left alone there are some surgeries to take them out but those surgeries are inherently a little risky compared to leaving the floater where you want to be careful as if you have a sudden onset of floaters with a lot of flashes where you're getting these lightning streaks kind of coming through the vision and you start to feel like you're losing some peripheral vision because as those floaters break off they can take the retina with them and that's where you get into the retinal tears the retinal detachments those types of things this fall the Vikings coach had that issue and more than one time it's not an uncommon problem is it not uncommon we certainly have you know several patients every year or every month probably that we're sending down to retina specialists to get laser down or to have a retinal detachment repaired any sudden onset of new floaters should really be looked at pretty quickly I know in our office our staff knows that if somebody calls up and says hey I have a new floater they say well how does noon work or how does 8 o'clock tomorrow morning work you try to get them in right away the vast majority when you see that new floater patient are benign they don't cause any problems but they're just irritating they are irritating yes absolutely they are irritating and you know we do have some patients that go through the surgery to take them out if they get irritating enough but the vast majority we just try to like you said that's a pretty high risk surgery too it is you know I mean it's not a most surgeries nowadays are pretty successful but the consequences in eye surgeries tend to be very very high so even floater surgery which tends to be you know pretty successful I mean if something goes wrong you do have a patient that might not see anymore and so the consequences with what we do and that's what you were saying it's pretty high and people get nervous about doing any sort of eye surgery how about another common issue and that's seeing flashing lights yep flashing lights is when that retina is getting a little tension on it so the retina is about the thickness of saran wrap so it's very very thin and so anything that pulls on it you will get a little flash and flashes again just like floater should probably be investigated usually we say within 24 hours but they are often not serious too are they again just like floaters often very very benign and so they the vast majority of the time there's nothing going on but you do have situations where we are taking just like the viking said coach and he's having an emergency retinal surgery see the retina if it detaches has to be reattached very quickly wow that's gotta be really fine night surgery it is you know I think some of the retina specialists that we work with are the best surgeons in the world really and you know when you start to try to take saran wrap and put it back together it's tough it's difficult so not all retinal surgeries come out great but the vast majority would do so well we're down to about the last minute but let's talk about one more issue that I know that I've experienced and I know it's pretty common too those ocular headaches could you explain what that is yeah when you get like an ocular migraine yeah ocular migraines are very common and what that is is that's a little bit of a hiccup to the blood supply go into the eye and you get that same kind of where it gets blurry in your eyes once that blood supply comes back usually I will restore back to normal but a lot of times we have Ziggy, Ziggy little things is what I've seen on the top and I have only experienced it maybe a couple of times in my life but it makes you a little nervous and we are always investigating in those situations you know how is your blood pressure how is your blood sugar because a lot of times it is kind of little hiccups in the blood supply going up to your eyes actually is what causes a lot of those and again the vast majority of time they're pretty benign but you're going to want to get any new changes investigated pretty quickly so so how do people get a hold of you Seth yeah you can call our office the Staples Eye Clinic our phone number is 218-894-1331 we also have a website stapleseyeclinic.com which is a good place and a Facebook page which is run by my wife because I'm not super Facebook compatible but so yeah those are probably the best ways to get a hold of us and certainly welcome new patients and we love to see new faces and try to give them the best care possible for their eyes well thanks for jumping on a show with us we appreciate it very good information sounds good thank you you've been watching Lakeland Currents and we're talking about what you're talking about I'm Ray Gildow so long until next time