May 23, 2025 • 30 mins
Nearly 80 million Americans unknowingly live with conditions that can silently lead to vision loss. The National Eye Institute has designated May as Healthy Vision Month, highlighting how routine eye exams can spot early signs of broader health issues. On this episode, we're learning more from Dr. Chantal Cousineau-Krieger, an Ophthalmologist with the National Eye Institute who also spent 3 years as a flight surgeon with the U.S. Air Force.
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Speaker 1 (00:05):
Welcome to Virginia Focus. I'm Rebecca Hughes of the Virginia
News Network. Nearly eighty million Americans unknowingly live with conditions
that can silently lead to vision loss. The National Eye
Institute has designated May as Healthy Vision Month, highlighting how
routine eye exams can spot early signs of broader health issues.
(00:26):
On this episode, we're learning more from doctor Chantel Kuzeno Kraeger,
an ophthalmologist with the National I Institute who also spent
three years as a flight surgeon with the US Air Force.
Welcome to the show. I'm so glad you could come
on today and talk about eye health because that's just
so important.
Speaker 2 (00:44):
Thank you so much for having me.
Speaker 1 (00:46):
So what on't we start by? I mean, people already
know because you know you're an not themologist, but let's
talk about how you got to where you are and
your background so that people understand your qualifications.
Speaker 2 (01:00):
Sure, So I grew up my father was actually a physician,
so I was always interested in medicine, and I went
to medical school at the Uniform Services University that's the
military's medical school. And I was a member of the
Air Force for fifteen years. My first three years I
spent as a flight surgeon, which sounds incredibly glamorous, but
(01:24):
maybe isn't as cool as it sounds by the title, Basically,
you are a general practice person who takes care of
people who fly and maintain airplanes in their families. And
I didn't exactly know what field of medicine I wanted
to specialize in in medicine, and in my intern year
(01:44):
and I finally discovered ophthalmology and fell in love with it,
and so went back and became an ophthalmologist in San Antonio,
did my training down in San Antonio through the military,
and then I spent the rest of my military career
working as a military ophthalmologist.
Speaker 1 (02:02):
Oh wow, Yeah, I will agree. That does sound like
a very glamorous job.
Speaker 2 (02:08):
I know, flight surgeon really does sound awesome, and it was.
It was an amazing job. I loved it.
Speaker 1 (02:13):
Yeah, and you did that for how long? I'm sorry.
Speaker 2 (02:15):
I was a flight surgeon for three years, deployed four
times during that and then yep, and then I did
my residency in ophthalmology after that, and then spent the
rest of my career as an ophthalmologist.
Speaker 1 (02:30):
Okay, and so may is I health or yeah, I
health month or vision month, and so we're talking about,
you know, different things that people may deal with when
it comes to their vision. Why don't you kind of
give us, if you can, if it doesn't take too long,
an overview of different things that might be symptoms that
(02:52):
we need to pay attention to.
Speaker 2 (02:54):
Sure, So you know, I think with I issues, we're
actually lucky if we have symptoms. A lot of diseases
of the eye are asymptomatic. They initially present without a
lot of symptoms. We're sort of kind of grow up
with the thought that well, if it hurts or if
(03:15):
it's not working, well, I'm going to notice. I'm going
to be aware. But especially things that progress slowly or
sometimes not noticed by individuals. We all know if we
get something in our eye or a scratch, it's so
incredibly painful, But the other parts of the eye actually
don't have any pain receptors, so we sometimes don't know
if they're having trouble or if they're in distress. So
(03:38):
that kind of emphasizes the need for routine eye exams
to find these conditions that may or may not have
symptoms in their early stages. But certainly if you're noticing
pain or discomfort, or if you're noticing your vision just
isn't as clear as you think it should be or
as everyone else around yours is, then obviously, go get it.
Go get it examined, get an eye exam.
Speaker 1 (04:00):
Yeah, and I'm glad you said that, because sometimes I
know I have to wear glasses, and sometimes as your
prescription is changing and getting stronger, you don't seem to
notice that you're losing your vision as well as it was,
until all of a sudden you go and you're like, WHOA, Okay,
now I really understand how bad it had gotten.
Speaker 2 (04:23):
Yeah. I still remember the first time that I got glasses,
I was like, WHOA, what have I not been seeing?
Speaker 1 (04:28):
Exactly exactly, very transformative exactly. So have we determined as
a medical community all the different things that can contribute
to I problems? Is it lifestyle? Is it environment? Is
it sometimes within our own body?
Speaker 2 (04:48):
So I don't know that we have determined everything, but
we certainly know some of the things. So there are
certain systemic illnesses such as high blood pressure, diabetes, We
know those things can have effects on our eye health.
We also know that certain things run in families, so
a family history of eye disease like macular degeneration or glaucoma.
(05:12):
Those are things that can contribute, and of course there
are other things that can contribute, like environmental things, what
we eat and whether or not we smoke.
Speaker 1 (05:22):
So really, now, let's explore that a minute, because I
have not heard that before. What we eat or whether
or not we smoke, how do those things affect our
eye health.
Speaker 2 (05:33):
Yeah, so smoking is associated with a lot of conditions
of the eye. It leads to worse outcomes with macular
degeneration and a few other eye diseases like thyroid eye diseases,
diabetic eye disease. It damages a lot of times the
small blood vessels, and that's what provides oxygen and nourishment
(05:55):
to the delicate tissues in the back of the eye.
So smoking can damage those. And then what we eat
matters too. We know that foods that are rich in vitamins,
So your leafy green vegetables and your fruits, eating a
rainbow of colors is healthy for your eyes and helps
give your back of your eyes. The retina, the tissue
(06:16):
that kind of processes images, it helps keep it healthy.
And foods that are rich in omega three fatty acids
like are fatty fish such as tuna, halibit, salmon are
also healthy for our eyes.
Speaker 1 (06:33):
Okay, And of course I've always heard carrots.
Speaker 2 (06:36):
I don't know why, but yeah, you know your mom
was right. Carrots are a really great source of vitamin
A beta carotene. We even have the word carrot built
right in. So, yes, you heard correctly. That is among
that rainbow colored fruits and vegetables that are healthy for
our eyes.
Speaker 1 (06:55):
Wonderful. And when you're talking about the blood vessel, the
small blood vessel damage, is that also part of what
leads to things like ocular migraines. I know a lot
of people have that and don't know what it is,
and they just kind of brush it off because, like
you said, it doesn't hurt, doesn't really interfere most of
the time. But are those things related?
Speaker 2 (07:19):
So usually when somebody has an ocular migraine, they actually
have a normal retina eye exam so it doesn't appear
to be from damage to the blood vessels in the
way that we see damage from things like high blood
pressure or high cholesterol, smoking, diabetes.
Speaker 1 (07:38):
Okay, do we know what causes that?
Speaker 2 (07:42):
That maybe is a better question for a neurologist. From
my understanding is that it may be related to spasm
of the blood vessels rather than damage to them.
Speaker 1 (07:51):
Okay, okay, so that goes back to the whole you know,
the stuff that's inside your body that affects your eye
health as well. You said that a lot of conditions
are hereditary. I know you mentioned like cataracts, right, does
that hereditary or can you tell us the ones that are?
Let's just go that way so I don't lead us
(08:13):
down the wrong path.
Speaker 2 (08:14):
Sure, there are some forms of cataracts that do seem
to be hereditary, but those are far less common than
the cataracts that we get simply from aging. So cataracts
are like gray hair and wrinkles. If you live long enough,
you're going to get a cataract. Not everybody develops a
cataract that's bad enough to need surgery, but a lot
(08:35):
of people do. In fact, most of our aging population
will probably end up getting cataract surgery. That has to
do with the lens inside the eye becoming cloudy, So
it's like a dirty window inside your eye. Doesn't matter
what glasses you put on the outside. If the window
inside your eye is dirty, you're not going to get
clear vision, right, So you were asking about other things
that have a family history. So diabetes does run in families.
(08:59):
Are certainly linkages and increased susceptibility to diabetes if you
have a family history of it, as well as age
related Macular degeneration also runs in families, and so does glaucoma.
So those are a few of the eye diseases that
we know have a family family component or likely a
(09:21):
genetic component.
Speaker 1 (09:22):
Okay, And are those mostly discovered later in age or
can some of those be found early in age or
somewhere in the middle.
Speaker 2 (09:32):
So they are typically associated with aging. They are more
common as we age, but they can be seen in
younger individuals as well. Okay, but I far most are
associated with aging.
Speaker 1 (09:44):
Gotcha. That's good to know. So now let me ask
you this, and you probably don't know the specific answer,
but you can kind of speak to it. Who is
the person that I want to punch in the face
who decided that I else should be separate from medical
regular medical health when it comes to insurance?
Speaker 2 (10:04):
And how do we do that? I have no idea
why you know, eyes and teeth are not considered part
of the body. I promise you. I'm not the person
you want to punction in the face of that, right. Well, actually,
it's true that getting things like glasses and contact lenses
is often not covered through insurance, but actually seeing an
(10:26):
ophthalmologist a medical doctor is actually covered by most people's insurances.
So maybe not the glasses, but the eye health part
is covered.
Speaker 1 (10:35):
Well, that's good to know. I don't think that's super
common knowledge, or maybe it is and I'm just in
the dark, but that's really good to know. And if
anybody else didn't know that, I'm glad you said it.
So you know, are there tips and tricks for getting
the best out of our insurance when it comes to
(10:55):
vision or you know, we just stuck with whatever.
Speaker 2 (10:59):
You're talking to Someone spent fifteen years in the military,
I still struggle with navigating my own insurance. Relative Nubie
in here at the and the I. Of course, you know,
at the National Institute of Health, we don't work through insurance,
so I'm probably the worst person you can possibly ask
(11:19):
about insurance.
Speaker 1 (11:21):
Okay, all right, well then let's move on to the
next topic I wanted to ask you about. Obviously, technological
advances have allowed us to have things like lasik surgery.
Are there any other things either in the beginnings or
you know, being worked on on the horizon that may
(11:41):
come to fruition when it comes to vision health.
Speaker 2 (11:45):
Oh gosh, I hope. So, of course, there's amazing research
occurring at the National Eye Institute, a lot of focus
on rare diseases and you know, finding the genetic links
for rare diseases and possibly in the future gene therapy
or gene editing. If you know there's a single bad
(12:06):
copy of a gene, being able to kind of cut
it out and replace it with a healthy one is
a huge field of a focus for you know, future
healthy vision. The retina and the optic nerve and the
back of the eye, they're not tissue that kind of
we can regrow. You know, we're all familiar if you
cut your skin, the skin will form new skin and
(12:29):
maybe you have a scar, but otherwise your skin is
usually intact. But certain tissues in the body don't have
that regenerative capability. So there's a lot of interest in,
you know, how do we get these tissues to regrow
to make a new one. And I'm hopeful that one
day A lot of problems with our eyes will be
(12:50):
solved by regrowing healthy tissue or amending the genetic problem
that caused the disease in the first place.
Speaker 1 (12:58):
Right, right, And so of that thing, I mean, some
of what we deal with could be things like the
increase in computer screens. You know what I'm saying, Like,
I know that puts a lot of strain on eyes.
Can you speak to that and how that might be
affecting you know, generations that have come up in technology
and the ones that are born into it.
Speaker 2 (13:20):
Sure, so I think the pandemic highlighted for a lot
of us screen usage. Right, all of a sudden, our
worlds were shut down, and that's how we went to
work and went to school, and that's how we communicated
was via technology. And so people started to notice the
I think they even coined a term for it, computer
vision syndrome. Your eyes feeling tired or feeling achy. And
(13:43):
the truth is, when we stare at something up close
for a long time, our blink rate just plummets and
you can't remember to blink. That's like remembering to breathe,
and so the eyes tend to get dried, irritated, and
a good rule of thumb is the twenty twenty twenty
Every twenty minutes, take a break and look at something
(14:05):
twenty feet or further in the distance for at least
twenty seconds, and that gives your eye a chance to
kind of relax, the muscles that are focusing inside your
eye a chance to blink and kind of recover a
little bit before we head back to your screen.
Speaker 1 (14:21):
Oh, I've never heard of that before, the twenty twenty
twenty rule. I have to remember that because I'm very
much in front of a screen a lot because of
my job.
Speaker 2 (14:31):
Yeah, I think, I think a lot of us are.
Speaker 1 (14:34):
I love that twenty twenty twenty. I'll to write that down. So,
I mean, are there any I mean, do you know
of any research specifically that you're either personally involved in
or familiar with that you could share with us. I mean,
I'm assuming maybe stem cell research or you know, things
of that nature.
Speaker 2 (14:53):
There is a stem cell protocol here where stem cells
from this are grown into a layer of the retina
and then transplanted into the retina of somebody who has
advanced macular degeneration, trying to regain vision that has been
(15:14):
lost from advanced macular degeneration. So I'm that's a colleague
of mind that is working on that project. It's very exciting.
Speaker 1 (15:23):
Yeah, definitely, definitely. So are there ways to I mean,
like with our body, we can do workouts and things
like that. Are there ways to work out our eyes
to strengthen muscles or to strengthen anything about what the
eye does? Uh?
Speaker 2 (15:40):
You know that one is going to be a little
more controversial. There are people who believe that you can
do eye exercises if you have weakening of the muscles.
I don't think that's found as much popularity in the
ophthalmology community as it has with the optometry community. But
there are things you can do to protect your eyes.
(16:03):
One big thing is wearing sunglasses when you're outdoors, when
you're getting bombarded by that UV light. We you know,
we know about the risk of skin cancer and the
importance of sunscreen, but if anybody's ever gotten sunscreen in
your eye, you know how painful that is. So our eyes,
we really need sunglasses. One percent UVA and UVB will
(16:25):
decrease the risk of sun damage to the surface of
the eye. We do see sun damage on the surface
of people's eyes, things like pengueculae or terrigiums are a
result of UV damage and it can advance you know,
aging of the eye. Cataracts may have a role in
macular degeneration and also contributes to wrinkle. So if for
(16:46):
no other reason wear sunglasses for your vanity.
Speaker 1 (16:51):
I like that which had none that years ago to
are there any eye diseases that are actually preventable? And
if so, what do we do to prevent that?
Speaker 2 (17:09):
Eye diseases that are preventable? Well, I'm going to go
with the sun damage on the surface of the eye.
Sure you can. You can prevent that. You can prevent
like basically getting a sunburn on your eye by wearing
you know, sunglasses, So that one, I would say is
probably preventable.
Speaker 1 (17:28):
Okay, all right, are there any others that.
Speaker 2 (17:30):
You know of injury? Like a lot of eye injuries
can be prevented by wearing proper safety glasses. So every
year there are a number of sports related injuries, things
like raquet balls, especially the smaller balls that fit kind
of nicely within the orbit, So wearing protective eyewear for
sports that require it. And then even when you're doing
(17:52):
things like household repair and tasks, wearing protective glasses. So
that anytime you're hammering metal on metal grind, your protecting
your eyes. A lot of eye injuries result from that
true story. You know. I forget what my husband and
I were celebrating, but we were celebrating and having a
bottle of champagne and he went to open it and
(18:12):
he was like, oh, can you get the glasses. I
was like, wait, wait, I'll grab them, and I of
course grabbed the safety glasses. He meant the champagne glasses.
But he just teaches you to think like an eye
doctor is like, here's your eyeglasses, go ahead and open
that champagne bottle right right.
Speaker 1 (18:29):
And I think that is one of those things that
men have a tendency that it's not going to happen
to me no matter what it is. And so yeah,
they're less likely to take those precautions. I think that's
why the God made women.
Speaker 2 (18:44):
We probably do. I'd have to look up the statistics
have less, you know, eye injuries in women than men,
right right.
Speaker 1 (18:52):
What resources would you advise people to check out if they,
you know, are have an some symptoms that they're not
sure about and they're not sure whether they even need
to see a doctor.
Speaker 2 (19:04):
Sure, So I mean, I'm going to toot our own
horn here and talk about our website. So the NEI
has wonderful website with lots of information about common eye
diseases and conditions. So I'm gonna go ahead and give
you that website. It's www dot N E I dot
N I, H dot G O V forwards last h
(19:27):
V M. It's for Healthy Vision Month. And then the
American Academy of Ophthalmology is also another great resource, and
that's a A O DOT O r G and they
have an area for public and patients, so you can
look up some common eye conditions or I symptoms and
get you know, get some guidance. And then of course,
(19:48):
whoever your primary care doctor is, they can direct you
to write resource and they're often you know, they even
if insurance isn't reimbursing it as well, they're they're still
trained on ies, right, they get a little bit of
training on it, and can you know, recognize symptoms that
are concerning or dangerous and get you to the right place.
Speaker 1 (20:07):
Okay, awesome. Now let me ask you this. When people
have children, how early should they start having their children
get eye exams? How early is is there ever a too.
Speaker 2 (20:20):
Early, maybe before they're born. Other than that, No, Actually,
when a child is born, they get an ice cream
immediately at birth. They're looking in the back of the eye.
They're doing what's called a red reflex test. And children
should have their eyes assessed at least twice by age one.
(20:42):
Realistically they should. They're usually checking at every well child check,
and then they should be getting an annual eye check
as part of their annual childhood physical. So and schools
often do a wonderful job of screening for eye eye conditions.
And you know things as well, because as a child,
the kind of nerves inside the brain they're still making
(21:04):
those connections. And it's a condition called amblyopia where for
whatever reason, if one eye is not seeing well, whether
it's got a heavy glasses prescription, or a problem with
its development, or a cataract, any reason, or a droopy eyelid,
any reason why that eye is not seeing well, then actually,
(21:27):
those nerves will never make those connections, and you only
have this narrow window in childhood where you can address
it and strengthen that eye. After about age eight or nine,
that window is closed. And that's why we push so
hard for children to get their screenings so we can
catch things and intervene while we're still within that critical
development window for the eye.
Speaker 1 (21:49):
Okay, that makes a lot of sense. So basically, if
I understood correctly, and I want to say it back
to you so you can correct me if I'm wrong. Children,
as long as there's seeing their regular physician for at
least a yearly checkup once I get a little older,
that should be enough to screen for any eye problems
(22:10):
that might arise. At what point do they need to
actually go see an optomologist or an optimis sure?
Speaker 2 (22:18):
So if they don't pass any of their screenings, or
if they're having any difficulty, you know, they're you know,
not being able to see the you know, I'm going
to say blackboard. Do people even use them anymore if
they're having trouble like making out? Like what do they
call it a whiteboard? Now? Is it all done on computers?
Speaker 1 (22:35):
Right?
Speaker 2 (22:37):
They're having any trouble seeing that? But children don't tend
to complain if they have blurred visions, so that highlights
the it's just how they see the world. I think
I got my first pair of glasses at ten, and
I was like, wow, look at that. Stars don't look
like snowflakes. They look like little points of light.
Speaker 1 (22:55):
Who knew right exactly? And then I'm going to ask
this for my own personal knowledge. I know a stigmatism
is one of the things that can be hereditary. What
causes that?
Speaker 2 (23:09):
So everybody is always very concerned about a stigmatism, and
I think it's just because the word stigma is built
right into the word, making it sound like this terrible disease.
It's actually more common to have a stigmatism than not.
So the front surface of the eye, if it's perfectly
spherical like a basketball, that would be no astigmatism. A
(23:32):
stigmatism means that the curvature is not the same in
every direction. So think about a football where you have
a steep curve in one direction and a flat curve
in another direction, and that's a stigmatism. So the eye
has more than one area that it comes into focus,
and that can usually be corrected with glasses or contact
lenses to get you your best vision.
Speaker 1 (23:53):
Okay, so it's more common than it's not common.
Speaker 2 (23:55):
That's interesting, It's actually really common.
Speaker 1 (23:58):
Well, then let me ask you this. If this is common.
I have three children, and one of them has one
eye that's near sighted and one eye that is far sided.
Speaker 2 (24:09):
Okay, so not a matched set exactly?
Speaker 1 (24:12):
Is that common or is he a unicorn?
Speaker 2 (24:17):
I don't know if he's quite a unicorn. We have
unicorns here at the NIH. The old expression is if
you hear hoof beats, think horses, and you know a
rare diagnosis we call a zebra and a diagnosis. The
NIH is where you find your unicorns. But it's less common.
I would say, you know, only a small percentage of
people don't have similar prescriptions. And it is a bit
(24:39):
of a setup for that condition, that amblyopia, because if
one eye is not seeing as well, if that were
you or me as an adult, we would notice, and
a kid they just pick the eye that has the
better vision and the brain sort of shuts off the
blurred image, and so that I may not develop normally.
And sometimes you need glasses or even glasses and patching
(25:03):
where you kind of take the good eye out of
the equation so that you can strengthen and start using
the eye that isn't seeing as well.
Speaker 1 (25:10):
Okay, And is there ever a time where that doesn't work?
The patching and the glasses, I mean.
Speaker 2 (25:16):
Is a severe case I guess in a more severe case,
or you know, every time I see, you know, a
little kid running around with a patch on the eye,
I want to hug the parents because it is so hard.
I can barely keep pants on my kids, and like,
you know, these people have to do the patching. So
so sometimes it's an issue of like how do you
(25:37):
get the child to actually, you know, wear the glasses
or wear the patch. It can be quite challenging, so
it's not always you know, successful, but it's always worth
the effort. You you know, the vision that you you know,
sort of secure in childhood should be the vision that
carries you through your entire life. And we're working within
that narrow window.
Speaker 1 (25:57):
Right, that's definitely true. Do you know if there are
any changes or updates or upgrades maybe is the word.
I'm looking for innovations in regards to glasses.
Speaker 2 (26:12):
I think the materials are getting lighter, you know, easier
to use. They are making versions of them that kind
of allow you to tweak them and adjust them yourself.
So I think that's kind of nice because you know,
nobody else lives in your body and uses your eyes.
For example, if you have a bifocal and you need
to just dial it up a bit. It's kind of
(26:33):
nice to be able to do that. So I think
that one day our technology is going to, you know,
specifically pay attention to where we're looking, Are we looking
far away, are we looking close, and make those adjustments.
But we're not quite there where it's at every you know,
optical center yet. I do think there's probably going to
be some amazing technological innovations. I mean, glasses have been
(26:56):
around relatively unchanged for a very long time, right, we
definitely do for an upgrade.
Speaker 1 (27:02):
Right right. I know we're coming up close to the
end of our time, but I want to ask you
this question. I'm just really curious, and you're the expert.
Is there anything that the audience needs to know in
regards to vision health, in regards to the National Eye Institute,
or even in regards to healthy vision months that I
(27:23):
did not know to ask you.
Speaker 2 (27:27):
Ah, oh, that's a good question. I'm trying to think
about everything we've already talked about. I think if I
could stress literally one thing that is the importance of
getting screening exams, especially because of the risk of vision
loss that people aren't even aware of a lot of
(27:50):
eye diseases such as glaucoma, macular degeneration. They can rob
you of your vision without you being aware of it
till it's much more advanced. So I this is my
chance to make a plug. Please get in. If you're
over forty, schedule your first eye exam, get a complete
eye exam, and every two to three years after that.
Speaker 1 (28:13):
Yeah, I definitely agree with that. And I know, again
talking about the stubborn part of the population, there's this
thought that I can see just fine, I don't need it.
I'm gonna grab your glasses. I'm gonna put them on.
They're gonna hurt my eyes, and it's gonna prove that
I don't need to go see an eye doctor. But
I think that's also like completely not how that works, right.
Speaker 2 (28:35):
Yeah, that is completely not how that works. And you
don't harm your eyes by you know, getting them in focus.
That's not harmful. You're not you're not weakening your eyes.
And you know, if you're over forty and it's getting
harder to see things up close, you know you're not
harming your eyes by by grabbing those readers. You know,
it's not weakening them. That's that's mother nature. That's normal
(28:58):
eye aging and you're not, you know, leading it down
this road where it becomes dependent on it.
Speaker 1 (29:03):
Right, And if you will plug your website one more
time for me, and then I think we'll probably be good.
Speaker 2 (29:10):
Okay, Sure, it's www dot n E, I dot nih
dot G o V forward slash h v M awesome.
Speaker 1 (29:23):
I really do appreciate your time today. You are a
wealth of knowledge and I have enjoyed so much talking
to you.
Speaker 2 (29:31):
Well, thank you so much for having me. I appreciate it.
Speaker 1 (29:34):
I hope you've enjoyed today's show. Thanks for tuning into
the show on your favorite local radio station. You can
now listen to this show or past shows through the
iheartapp or on iHeart dot com. Just search for Virginia
Focus under podcasts. I'm Rebecca Hughes with a Virginia news network,
and I'll be here next week on Virginia Focus.
Welcome to Virginia Focus. I'm Rebecca Hughes of the Virginia
News Network. Nearly eighty million Americans unknowingly live with conditions
that can silently lead to vision loss. The National Eye
Institute has designated May as Healthy Vision Month, highlighting how
routine eye exams can spot early signs of broader health issues.
(00:26):
On this episode, we're learning more from doctor Chantel Kuzeno Kraeger,
an ophthalmologist with the National I Institute who also spent
three years as a flight surgeon with the US Air Force.
Welcome to the show. I'm so glad you could come
on today and talk about eye health because that's just
so important.
Speaker 2 (00:44):
Thank you so much for having me.
Speaker 1 (00:46):
So what on't we start by? I mean, people already
know because you know you're an not themologist, but let's
talk about how you got to where you are and
your background so that people understand your qualifications.
Speaker 2 (01:00):
Sure, So I grew up my father was actually a physician,
so I was always interested in medicine, and I went
to medical school at the Uniform Services University that's the
military's medical school. And I was a member of the
Air Force for fifteen years. My first three years I
spent as a flight surgeon, which sounds incredibly glamorous, but
(01:24):
maybe isn't as cool as it sounds by the title, Basically,
you are a general practice person who takes care of
people who fly and maintain airplanes in their families. And
I didn't exactly know what field of medicine I wanted
to specialize in in medicine, and in my intern year
(01:44):
and I finally discovered ophthalmology and fell in love with it,
and so went back and became an ophthalmologist in San Antonio,
did my training down in San Antonio through the military,
and then I spent the rest of my military career
working as a military ophthalmologist.
Speaker 1 (02:02):
Oh wow, Yeah, I will agree. That does sound like
a very glamorous job.
Speaker 2 (02:08):
I know, flight surgeon really does sound awesome, and it was.
It was an amazing job. I loved it.
Speaker 1 (02:13):
Yeah, and you did that for how long? I'm sorry.
Speaker 2 (02:15):
I was a flight surgeon for three years, deployed four
times during that and then yep, and then I did
my residency in ophthalmology after that, and then spent the
rest of my career as an ophthalmologist.
Speaker 1 (02:30):
Okay, and so may is I health or yeah, I
health month or vision month, and so we're talking about,
you know, different things that people may deal with when
it comes to their vision. Why don't you kind of
give us, if you can, if it doesn't take too long,
an overview of different things that might be symptoms that
(02:52):
we need to pay attention to.
Speaker 2 (02:54):
Sure, So you know, I think with I issues, we're
actually lucky if we have symptoms. A lot of diseases
of the eye are asymptomatic. They initially present without a
lot of symptoms. We're sort of kind of grow up
with the thought that well, if it hurts or if
(03:15):
it's not working, well, I'm going to notice. I'm going
to be aware. But especially things that progress slowly or
sometimes not noticed by individuals. We all know if we
get something in our eye or a scratch, it's so
incredibly painful, But the other parts of the eye actually
don't have any pain receptors, so we sometimes don't know
if they're having trouble or if they're in distress. So
(03:38):
that kind of emphasizes the need for routine eye exams
to find these conditions that may or may not have
symptoms in their early stages. But certainly if you're noticing
pain or discomfort, or if you're noticing your vision just
isn't as clear as you think it should be or
as everyone else around yours is, then obviously, go get it.
Go get it examined, get an eye exam.
Speaker 1 (04:00):
Yeah, and I'm glad you said that, because sometimes I
know I have to wear glasses, and sometimes as your
prescription is changing and getting stronger, you don't seem to
notice that you're losing your vision as well as it was,
until all of a sudden you go and you're like, WHOA, Okay,
now I really understand how bad it had gotten.
Speaker 2 (04:23):
Yeah. I still remember the first time that I got glasses,
I was like, WHOA, what have I not been seeing?
Speaker 1 (04:28):
Exactly exactly, very transformative exactly. So have we determined as
a medical community all the different things that can contribute
to I problems? Is it lifestyle? Is it environment? Is
it sometimes within our own body?
Speaker 2 (04:48):
So I don't know that we have determined everything, but
we certainly know some of the things. So there are
certain systemic illnesses such as high blood pressure, diabetes, We
know those things can have effects on our eye health.
We also know that certain things run in families, so
a family history of eye disease like macular degeneration or glaucoma.
(05:12):
Those are things that can contribute, and of course there
are other things that can contribute, like environmental things, what
we eat and whether or not we smoke.
Speaker 1 (05:22):
So really, now, let's explore that a minute, because I
have not heard that before. What we eat or whether
or not we smoke, how do those things affect our
eye health.
Speaker 2 (05:33):
Yeah, so smoking is associated with a lot of conditions
of the eye. It leads to worse outcomes with macular
degeneration and a few other eye diseases like thyroid eye diseases,
diabetic eye disease. It damages a lot of times the
small blood vessels, and that's what provides oxygen and nourishment
(05:55):
to the delicate tissues in the back of the eye.
So smoking can damage those. And then what we eat
matters too. We know that foods that are rich in vitamins,
So your leafy green vegetables and your fruits, eating a
rainbow of colors is healthy for your eyes and helps
give your back of your eyes. The retina, the tissue
(06:16):
that kind of processes images, it helps keep it healthy.
And foods that are rich in omega three fatty acids
like are fatty fish such as tuna, halibit, salmon are
also healthy for our eyes.
Speaker 1 (06:33):
Okay, And of course I've always heard carrots.
Speaker 2 (06:36):
I don't know why, but yeah, you know your mom
was right. Carrots are a really great source of vitamin
A beta carotene. We even have the word carrot built
right in. So, yes, you heard correctly. That is among
that rainbow colored fruits and vegetables that are healthy for
our eyes.
Speaker 1 (06:55):
Wonderful. And when you're talking about the blood vessel, the
small blood vessel damage, is that also part of what
leads to things like ocular migraines. I know a lot
of people have that and don't know what it is,
and they just kind of brush it off because, like
you said, it doesn't hurt, doesn't really interfere most of
the time. But are those things related?
Speaker 2 (07:19):
So usually when somebody has an ocular migraine, they actually
have a normal retina eye exam so it doesn't appear
to be from damage to the blood vessels in the
way that we see damage from things like high blood
pressure or high cholesterol, smoking, diabetes.
Speaker 1 (07:38):
Okay, do we know what causes that?
Speaker 2 (07:42):
That maybe is a better question for a neurologist. From
my understanding is that it may be related to spasm
of the blood vessels rather than damage to them.
Speaker 1 (07:51):
Okay, okay, so that goes back to the whole you know,
the stuff that's inside your body that affects your eye
health as well. You said that a lot of conditions
are hereditary. I know you mentioned like cataracts, right, does
that hereditary or can you tell us the ones that are?
Let's just go that way so I don't lead us
(08:13):
down the wrong path.
Speaker 2 (08:14):
Sure, there are some forms of cataracts that do seem
to be hereditary, but those are far less common than
the cataracts that we get simply from aging. So cataracts
are like gray hair and wrinkles. If you live long enough,
you're going to get a cataract. Not everybody develops a
cataract that's bad enough to need surgery, but a lot
(08:35):
of people do. In fact, most of our aging population
will probably end up getting cataract surgery. That has to
do with the lens inside the eye becoming cloudy, So
it's like a dirty window inside your eye. Doesn't matter
what glasses you put on the outside. If the window
inside your eye is dirty, you're not going to get
clear vision, right, So you were asking about other things
that have a family history. So diabetes does run in families.
(08:59):
Are certainly linkages and increased susceptibility to diabetes if you
have a family history of it, as well as age
related Macular degeneration also runs in families, and so does glaucoma.
So those are a few of the eye diseases that
we know have a family family component or likely a
(09:21):
genetic component.
Speaker 1 (09:22):
Okay, And are those mostly discovered later in age or
can some of those be found early in age or
somewhere in the middle.
Speaker 2 (09:32):
So they are typically associated with aging. They are more
common as we age, but they can be seen in
younger individuals as well. Okay, but I far most are
associated with aging.
Speaker 1 (09:44):
Gotcha. That's good to know. So now let me ask
you this, and you probably don't know the specific answer,
but you can kind of speak to it. Who is
the person that I want to punch in the face
who decided that I else should be separate from medical
regular medical health when it comes to insurance?
Speaker 2 (10:04):
And how do we do that? I have no idea
why you know, eyes and teeth are not considered part
of the body. I promise you. I'm not the person
you want to punction in the face of that, right. Well, actually,
it's true that getting things like glasses and contact lenses
is often not covered through insurance, but actually seeing an
(10:26):
ophthalmologist a medical doctor is actually covered by most people's insurances.
So maybe not the glasses, but the eye health part
is covered.
Speaker 1 (10:35):
Well, that's good to know. I don't think that's super
common knowledge, or maybe it is and I'm just in
the dark, but that's really good to know. And if
anybody else didn't know that, I'm glad you said it.
So you know, are there tips and tricks for getting
the best out of our insurance when it comes to
(10:55):
vision or you know, we just stuck with whatever.
Speaker 2 (10:59):
You're talking to Someone spent fifteen years in the military,
I still struggle with navigating my own insurance. Relative Nubie
in here at the and the I. Of course, you know,
at the National Institute of Health, we don't work through insurance,
so I'm probably the worst person you can possibly ask
(11:19):
about insurance.
Speaker 1 (11:21):
Okay, all right, well then let's move on to the
next topic I wanted to ask you about. Obviously, technological
advances have allowed us to have things like lasik surgery.
Are there any other things either in the beginnings or
you know, being worked on on the horizon that may
(11:41):
come to fruition when it comes to vision health.
Speaker 2 (11:45):
Oh gosh, I hope. So, of course, there's amazing research
occurring at the National Eye Institute, a lot of focus
on rare diseases and you know, finding the genetic links
for rare diseases and possibly in the future gene therapy
or gene editing. If you know there's a single bad
(12:06):
copy of a gene, being able to kind of cut
it out and replace it with a healthy one is
a huge field of a focus for you know, future
healthy vision. The retina and the optic nerve and the
back of the eye, they're not tissue that kind of
we can regrow. You know, we're all familiar if you
cut your skin, the skin will form new skin and
(12:29):
maybe you have a scar, but otherwise your skin is
usually intact. But certain tissues in the body don't have
that regenerative capability. So there's a lot of interest in,
you know, how do we get these tissues to regrow
to make a new one. And I'm hopeful that one
day A lot of problems with our eyes will be
(12:50):
solved by regrowing healthy tissue or amending the genetic problem
that caused the disease in the first place.
Speaker 1 (12:58):
Right, right, And so of that thing, I mean, some
of what we deal with could be things like the
increase in computer screens. You know what I'm saying, Like,
I know that puts a lot of strain on eyes.
Can you speak to that and how that might be
affecting you know, generations that have come up in technology
and the ones that are born into it.
Speaker 2 (13:20):
Sure, so I think the pandemic highlighted for a lot
of us screen usage. Right, all of a sudden, our
worlds were shut down, and that's how we went to
work and went to school, and that's how we communicated
was via technology. And so people started to notice the
I think they even coined a term for it, computer
vision syndrome. Your eyes feeling tired or feeling achy. And
(13:43):
the truth is, when we stare at something up close
for a long time, our blink rate just plummets and
you can't remember to blink. That's like remembering to breathe,
and so the eyes tend to get dried, irritated, and
a good rule of thumb is the twenty twenty twenty
Every twenty minutes, take a break and look at something
(14:05):
twenty feet or further in the distance for at least
twenty seconds, and that gives your eye a chance to
kind of relax, the muscles that are focusing inside your
eye a chance to blink and kind of recover a
little bit before we head back to your screen.
Speaker 1 (14:21):
Oh, I've never heard of that before, the twenty twenty
twenty rule. I have to remember that because I'm very
much in front of a screen a lot because of
my job.
Speaker 2 (14:31):
Yeah, I think, I think a lot of us are.
Speaker 1 (14:34):
I love that twenty twenty twenty. I'll to write that down. So,
I mean, are there any I mean, do you know
of any research specifically that you're either personally involved in
or familiar with that you could share with us. I mean,
I'm assuming maybe stem cell research or you know, things
of that nature.
Speaker 2 (14:53):
There is a stem cell protocol here where stem cells
from this are grown into a layer of the retina
and then transplanted into the retina of somebody who has
advanced macular degeneration, trying to regain vision that has been
(15:14):
lost from advanced macular degeneration. So I'm that's a colleague
of mind that is working on that project. It's very exciting.
Speaker 1 (15:23):
Yeah, definitely, definitely. So are there ways to I mean,
like with our body, we can do workouts and things
like that. Are there ways to work out our eyes
to strengthen muscles or to strengthen anything about what the
eye does? Uh?
Speaker 2 (15:40):
You know that one is going to be a little
more controversial. There are people who believe that you can
do eye exercises if you have weakening of the muscles.
I don't think that's found as much popularity in the
ophthalmology community as it has with the optometry community. But
there are things you can do to protect your eyes.
(16:03):
One big thing is wearing sunglasses when you're outdoors, when
you're getting bombarded by that UV light. We you know,
we know about the risk of skin cancer and the
importance of sunscreen, but if anybody's ever gotten sunscreen in
your eye, you know how painful that is. So our eyes,
we really need sunglasses. One percent UVA and UVB will
(16:25):
decrease the risk of sun damage to the surface of
the eye. We do see sun damage on the surface
of people's eyes, things like pengueculae or terrigiums are a
result of UV damage and it can advance you know,
aging of the eye. Cataracts may have a role in
macular degeneration and also contributes to wrinkle. So if for
(16:46):
no other reason wear sunglasses for your vanity.
Speaker 1 (16:51):
I like that which had none that years ago to
are there any eye diseases that are actually preventable? And
if so, what do we do to prevent that?
Speaker 2 (17:09):
Eye diseases that are preventable? Well, I'm going to go
with the sun damage on the surface of the eye.
Sure you can. You can prevent that. You can prevent
like basically getting a sunburn on your eye by wearing
you know, sunglasses, So that one, I would say is
probably preventable.
Speaker 1 (17:28):
Okay, all right, are there any others that.
Speaker 2 (17:30):
You know of injury? Like a lot of eye injuries
can be prevented by wearing proper safety glasses. So every
year there are a number of sports related injuries, things
like raquet balls, especially the smaller balls that fit kind
of nicely within the orbit, So wearing protective eyewear for
sports that require it. And then even when you're doing
(17:52):
things like household repair and tasks, wearing protective glasses. So
that anytime you're hammering metal on metal grind, your protecting
your eyes. A lot of eye injuries result from that
true story. You know. I forget what my husband and
I were celebrating, but we were celebrating and having a
bottle of champagne and he went to open it and
(18:12):
he was like, oh, can you get the glasses. I
was like, wait, wait, I'll grab them, and I of
course grabbed the safety glasses. He meant the champagne glasses.
But he just teaches you to think like an eye
doctor is like, here's your eyeglasses, go ahead and open
that champagne bottle right right.
Speaker 1 (18:29):
And I think that is one of those things that
men have a tendency that it's not going to happen
to me no matter what it is. And so yeah,
they're less likely to take those precautions. I think that's
why the God made women.
Speaker 2 (18:44):
We probably do. I'd have to look up the statistics
have less, you know, eye injuries in women than men,
right right.
Speaker 1 (18:52):
What resources would you advise people to check out if they,
you know, are have an some symptoms that they're not
sure about and they're not sure whether they even need
to see a doctor.
Speaker 2 (19:04):
Sure, So I mean, I'm going to toot our own
horn here and talk about our website. So the NEI
has wonderful website with lots of information about common eye
diseases and conditions. So I'm gonna go ahead and give
you that website. It's www dot N E I dot
N I, H dot G O V forwards last h
(19:27):
V M. It's for Healthy Vision Month. And then the
American Academy of Ophthalmology is also another great resource, and
that's a A O DOT O r G and they
have an area for public and patients, so you can
look up some common eye conditions or I symptoms and
get you know, get some guidance. And then of course,
(19:48):
whoever your primary care doctor is, they can direct you
to write resource and they're often you know, they even
if insurance isn't reimbursing it as well, they're they're still
trained on ies, right, they get a little bit of
training on it, and can you know, recognize symptoms that
are concerning or dangerous and get you to the right place.
Speaker 1 (20:07):
Okay, awesome. Now let me ask you this. When people
have children, how early should they start having their children
get eye exams? How early is is there ever a too.
Speaker 2 (20:20):
Early, maybe before they're born. Other than that, No, Actually,
when a child is born, they get an ice cream
immediately at birth. They're looking in the back of the eye.
They're doing what's called a red reflex test. And children
should have their eyes assessed at least twice by age one.
(20:42):
Realistically they should. They're usually checking at every well child check,
and then they should be getting an annual eye check
as part of their annual childhood physical. So and schools
often do a wonderful job of screening for eye eye conditions.
And you know things as well, because as a child,
the kind of nerves inside the brain they're still making
(21:04):
those connections. And it's a condition called amblyopia where for
whatever reason, if one eye is not seeing well, whether
it's got a heavy glasses prescription, or a problem with
its development, or a cataract, any reason, or a droopy eyelid,
any reason why that eye is not seeing well, then actually,
(21:27):
those nerves will never make those connections, and you only
have this narrow window in childhood where you can address
it and strengthen that eye. After about age eight or nine,
that window is closed. And that's why we push so
hard for children to get their screenings so we can
catch things and intervene while we're still within that critical
development window for the eye.
Speaker 1 (21:49):
Okay, that makes a lot of sense. So basically, if
I understood correctly, and I want to say it back
to you so you can correct me if I'm wrong. Children,
as long as there's seeing their regular physician for at
least a yearly checkup once I get a little older,
that should be enough to screen for any eye problems
(22:10):
that might arise. At what point do they need to
actually go see an optomologist or an optimis sure?
Speaker 2 (22:18):
So if they don't pass any of their screenings, or
if they're having any difficulty, you know, they're you know,
not being able to see the you know, I'm going
to say blackboard. Do people even use them anymore if
they're having trouble like making out? Like what do they
call it a whiteboard? Now? Is it all done on computers?
Speaker 1 (22:35):
Right?
Speaker 2 (22:37):
They're having any trouble seeing that? But children don't tend
to complain if they have blurred visions, so that highlights
the it's just how they see the world. I think
I got my first pair of glasses at ten, and
I was like, wow, look at that. Stars don't look
like snowflakes. They look like little points of light.
Speaker 1 (22:55):
Who knew right exactly? And then I'm going to ask
this for my own personal knowledge. I know a stigmatism
is one of the things that can be hereditary. What
causes that?
Speaker 2 (23:09):
So everybody is always very concerned about a stigmatism, and
I think it's just because the word stigma is built
right into the word, making it sound like this terrible disease.
It's actually more common to have a stigmatism than not.
So the front surface of the eye, if it's perfectly
spherical like a basketball, that would be no astigmatism. A
(23:32):
stigmatism means that the curvature is not the same in
every direction. So think about a football where you have
a steep curve in one direction and a flat curve
in another direction, and that's a stigmatism. So the eye
has more than one area that it comes into focus,
and that can usually be corrected with glasses or contact
lenses to get you your best vision.
Speaker 1 (23:53):
Okay, so it's more common than it's not common.
Speaker 2 (23:55):
That's interesting, It's actually really common.
Speaker 1 (23:58):
Well, then let me ask you this. If this is common.
I have three children, and one of them has one
eye that's near sighted and one eye that is far sided.
Speaker 2 (24:09):
Okay, so not a matched set exactly?
Speaker 1 (24:12):
Is that common or is he a unicorn?
Speaker 2 (24:17):
I don't know if he's quite a unicorn. We have
unicorns here at the NIH. The old expression is if
you hear hoof beats, think horses, and you know a
rare diagnosis we call a zebra and a diagnosis. The
NIH is where you find your unicorns. But it's less common.
I would say, you know, only a small percentage of
people don't have similar prescriptions. And it is a bit
(24:39):
of a setup for that condition, that amblyopia, because if
one eye is not seeing as well, if that were
you or me as an adult, we would notice, and
a kid they just pick the eye that has the
better vision and the brain sort of shuts off the
blurred image, and so that I may not develop normally.
And sometimes you need glasses or even glasses and patching
(25:03):
where you kind of take the good eye out of
the equation so that you can strengthen and start using
the eye that isn't seeing as well.
Speaker 1 (25:10):
Okay, And is there ever a time where that doesn't work?
The patching and the glasses, I mean.
Speaker 2 (25:16):
Is a severe case I guess in a more severe case,
or you know, every time I see, you know, a
little kid running around with a patch on the eye,
I want to hug the parents because it is so hard.
I can barely keep pants on my kids, and like,
you know, these people have to do the patching. So
so sometimes it's an issue of like how do you
(25:37):
get the child to actually, you know, wear the glasses
or wear the patch. It can be quite challenging, so
it's not always you know, successful, but it's always worth
the effort. You you know, the vision that you you know,
sort of secure in childhood should be the vision that
carries you through your entire life. And we're working within
that narrow window.
Speaker 1 (25:57):
Right, that's definitely true. Do you know if there are
any changes or updates or upgrades maybe is the word.
I'm looking for innovations in regards to glasses.
Speaker 2 (26:12):
I think the materials are getting lighter, you know, easier
to use. They are making versions of them that kind
of allow you to tweak them and adjust them yourself.
So I think that's kind of nice because you know,
nobody else lives in your body and uses your eyes.
For example, if you have a bifocal and you need
to just dial it up a bit. It's kind of
(26:33):
nice to be able to do that. So I think
that one day our technology is going to, you know,
specifically pay attention to where we're looking, Are we looking
far away, are we looking close, and make those adjustments.
But we're not quite there where it's at every you know,
optical center yet. I do think there's probably going to
be some amazing technological innovations. I mean, glasses have been
(26:56):
around relatively unchanged for a very long time, right, we
definitely do for an upgrade.
Speaker 1 (27:02):
Right right. I know we're coming up close to the
end of our time, but I want to ask you
this question. I'm just really curious, and you're the expert.
Is there anything that the audience needs to know in
regards to vision health, in regards to the National Eye Institute,
or even in regards to healthy vision months that I
(27:23):
did not know to ask you.
Speaker 2 (27:27):
Ah, oh, that's a good question. I'm trying to think
about everything we've already talked about. I think if I
could stress literally one thing that is the importance of
getting screening exams, especially because of the risk of vision
loss that people aren't even aware of a lot of
(27:50):
eye diseases such as glaucoma, macular degeneration. They can rob
you of your vision without you being aware of it
till it's much more advanced. So I this is my
chance to make a plug. Please get in. If you're
over forty, schedule your first eye exam, get a complete
eye exam, and every two to three years after that.
Speaker 1 (28:13):
Yeah, I definitely agree with that. And I know, again
talking about the stubborn part of the population, there's this
thought that I can see just fine, I don't need it.
I'm gonna grab your glasses. I'm gonna put them on.
They're gonna hurt my eyes, and it's gonna prove that
I don't need to go see an eye doctor. But
I think that's also like completely not how that works, right.
Speaker 2 (28:35):
Yeah, that is completely not how that works. And you
don't harm your eyes by you know, getting them in focus.
That's not harmful. You're not you're not weakening your eyes.
And you know, if you're over forty and it's getting
harder to see things up close, you know you're not
harming your eyes by by grabbing those readers. You know,
it's not weakening them. That's that's mother nature. That's normal
(28:58):
eye aging and you're not, you know, leading it down
this road where it becomes dependent on it.
Speaker 1 (29:03):
Right, And if you will plug your website one more
time for me, and then I think we'll probably be good.
Speaker 2 (29:10):
Okay, Sure, it's www dot n E, I dot nih
dot G o V forward slash h v M awesome.
Speaker 1 (29:23):
I really do appreciate your time today. You are a
wealth of knowledge and I have enjoyed so much talking
to you.
Speaker 2 (29:31):
Well, thank you so much for having me. I appreciate it.
Speaker 1 (29:34):
I hope you've enjoyed today's show. Thanks for tuning into
the show on your favorite local radio station. You can
now listen to this show or past shows through the
iheartapp or on iHeart dot com. Just search for Virginia
Focus under podcasts. I'm Rebecca Hughes with a Virginia news network,
and I'll be here next week on Virginia Focus.
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The official podcast of comedian Joe Rogan.
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Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Special Summer Offer: Exclusively on Apple Podcasts, try our Dateline Premium subscription completely free for one month! With Dateline Premium, you get every episode ad-free plus exclusive bonus content.