Must-Know Facts: Protect Your Pet's Eyes Today!

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Tyler Sugerman (00:00):
Did you know that cats can have freckles
inside their eyes?
Not only that, but sometimesthose things that look like
innocent freckles could actuallybe the beginning of something
more sinister.
Or that certain breeds of dogsare predisposed to certain eye
conditions.
Join us on this week's episodeof Vetsplanation, where we dive
deep into what you need to knowabout your pet.

(00:22):
I am your host, Dr.
Sugerman, and today we're goingto be talking to Dr.
Karen Brantman, anophthalmologist in the Pacific
Northwest.
Listen in to find out when youmight need a veterinary
ophthalmologist.
Hi, everybody.
Welcome back to another episodeof Vetsplanation.
So I have a super special guestwith me here today.
So I have Karen Brantman here.
She's a veterinaryophthalmologist.

(00:43):
So I'm really excited to talk toyou today.
Yes.
So can you tell me, we're goingto jump into like..
Just quickly, what is anophthalmologist?

Dr. Karen Brantman-Crosetto (00:52):
An ophthalmologist.
And this is different from anoptometrist.
So a lot of people will ask mehow I get dogs to read eye
charts.
And that's actually notsomething that I do.
So your optometrist they can doa couple of diseases, but they
fit you for glasses.
The ophthalmologist does onlymedicine.

(01:16):
So medicine and surgery reallyis the big difference there.
So I do medicine and surgery ofthe eye.

Nice.

Dr. Karen Brantman-Croset (01:22):
Yeah.

And is it just the eye or do you do
surgery around the eye as well?

Yeah.
So in animals, theophthalmologist kind of does
that whole area.
So I will do not only cornea andlens or cataract, and some of us
do retinal work.

So retinas, the back of the eye.

Dr. Karen Brantman-Cros (01:43):
Retinas in the back of the eye.
But we also do the face, so theskin and the eyelids, which in
dogs, in particular, and somecats, the confirmation and the
way that they're made and puttogether can be a problem.
And so that's something that.

(02:05):
I actually work on quite a bit.
So in human medicine, you'd haveabout three or four different
people for all of those things.

That's how I feel as my job is as well, like
for my job, you'd have theemergency doctor and the
surgeon, radiologist, and yeah,exactly.

Yeah.
Yep.
So we wear many hats.

You were talking about that you do lots
of surgeries and stuff as well.

Yeah.

What kind of surgeries do you normally do?

Yeah.
So I'm starting with the skin.
So there are mostly dogs, Iwould say that where they'll
have malformations.
So they may have an eyelid thatis flipped inward, right?
So now you've got hair rubbingon the eye.
That is a common thing we fixdepending on, breed and the size

(02:53):
of the dog, but I see that alot.
And it can cause a lot of pain,and so fixing those dogs isn't
just a cosmetic surgery.
It really is for quality of lifeand for eye health.

I can't imagine my, my, yeah, my like
lashes touching my eye all thetime.

Dr. Karen Brantman-Crosett (03:10):
Yeah it, yeah, it would be like your
beard flipped into your eye.

Yeah, exactly.
It'd be terrible.

It'd be a real challenge.
Yeah.
And so those are big ones that Ido.
Working our way in.
There's also, so you've got aneyelid up here and an eyelid
down here, and then there's athird eyelid in dogs and cats.
Sometimes there are misplacedglands.
And so I'll correct the positionof the gland.

(03:37):
I do corneal surgery where ifthere's,

Remind me what the cornea is.

Oh yeah.
So the cornea is the clear outerwindshield of the front of your
eye.
So it's what you use to seethrough everything.
Your eye is the camera and thecornea is that outer windshield
that you're looking through.
So the cornea can be punctured,lacerated, infected.

(04:04):
So I treat all those things.

Lots of foreign bodies in there.

Yeah, foreign bodies.
So thorns.

Porcupine quills.

Dr. Karen Brantman-Cr (04:11):
Porcupine quills.

I've had that.
Yeah.

So there are various things that
you hope a dog would close theireye and they sometimes don't.
And yeah, so if that weresomething that needed to be
removed or repaired, I would fixthat for them.
Working our way inside of theeye.
So cornea, iris, which is thecolored part of their eye and

(04:36):
the iris constricts and dilatesand helps us focus.
Behind the iris is the lens, andthe lens is where cataract
happens.
Yeah, so most people arefamiliar with cataract, it's a
cloudy, the lens is supposed tobe clear, just like the cornea,

(04:57):
so if there's no pacificationthere, then you can't see
through it.
Not quite mud on the windshield,but you issues inside the eye,
inside the lens.
And so people have cataractsurgery and we can do that in
dogs and cats.
So yeah.

So it's the same thing, right?
Cataracts in people is the sameas cataract in dogs and cats.

Dr. Karen Brantman-Cro (05:16):
Correct.
For the most part.
Yep, absolutely.
And the techniques that we useare adopted from human medicine.
Obviously they came up with theidea first, right?
And so yeah, we use a lot ofthose same techniques and a lot
of the same machines.
Our instrumentation is a littlebit different because of the

(05:37):
size of the eye.
And it also depends on thespecies that you're working on.
So if you're doing a horse, forexample, versus a dog, you would
need different sizedinstrumentation.

Yeah.
I can imagine doing like mylittle dog who's eight pounds.

Yeah

With the giant stuff that you use for a
horse

Yeah, it might not work very well.
Exactly.
Exactly and then the retinawhich is all the way back to the
back of the eye.
The retina is like wallpaperthat lines the back of the eye
And so there are surgeons who doretinal surgery in animals.
Yeah, we see the retina fall offthe back of the eye, sometimes

(06:20):
it gets torn.
So that can be surgicallyreattached.
I don't do that surgery, butthere are very special surgeons
across the country that will doit.

That's pretty cool.

Yeah.

Yeah.

Dr. Karen Brantman-Crose (06:33):
That's neat.

So me as a emergency veterinarian, I can
look at eyes somewhat.

Yeah.
Yeah.

I can remove an eye, but there's not a lot
else that I can do.
So can you tell me like, when isit appropriate for a pet parent
to be able to see you versuscome to see me?

Yeah, Good question.
And it's tough, I think, becauseA lot of it has to do with some
of the instrumentation that youhave.
Also your comfort level.

Right.

And..

Eyes are hard.

Eyes are tough, right?
And just being able to you know,at least be able to start some
basics.
I would say that most signs thata pet parent is gonna notice.
All the eye signs fall into oneof a few categories.
Or a couple of categories.
Squinting, discharge, cloudinessor a color change.

Yeah.

And redness.
That's it, right?
All of those symptoms

I will say there's one other one.

Oh, tell me.

Popping out.

Oh yeah, popping out.
Yeah.
The eyeball has launched itself.

Yeah.
I've seen that's, I think themajority of what I see.

Oh, that probably is true.
So barring the eye, actuallycalled proptosis is what we call
it.
Barring that.
Most of the symptoms are, one ofthose four things and it could
be something, it could benothing.
It could be a big deal.
It could be not such a big deal.
So a good place to start isalways with your primary vet or

(07:59):
your emergency doctor.
If your primary vet's notavailable.
And I would hope that they wouldlook for a couple of different
things.
One, they should do tests forglaucoma.

Which is doing..

Dr. Karen Brantman-C (08:11):
Pressures.

Check the pressures of the eye.

And corneal ulcers.
So the staining.
And I suggest doing tear testsas well.
And I would suggest doing all ofthose tests each time you look
at an eye, because even as anophthalmologist, you really
don't know which cases need whatuntil you get pretty far into

(08:36):
your training and I'm sayingjust by looking at them.

Absolutely.

So do yourself a favor.
Do all of your tests.
Know what you're dealing withand then you can go from there
and decide okay, whichmedications am I gonna try?
Or I think that's not great.
Maybe I should send that.

Yeah.

And then so that would be I guess
the next step is when do yousend?

Right.

Or when do you say, okay, this
isn't something I can do.
Glaucoma is an emergency.
So high pressure in the eye, butyou can always start glaucoma
medications as soon as you seethese cases.
And there's one glaucoma medthat is safe to start.
It's dorazolamide.

(09:21):
And so I would say, if you thinkthere's a pressure increase
regardless of the cause that oneis safe to use.

Yeah.

And I wouldn't hesitate.
There are other versions, otherclasses of drugs that might not
be safe to use.
I always stick with dorzolamide,that's my recommendation.

I think that is probably the only one I have
ever prescribed.

Yeah, good.

That's like the basics of my knowledge of
eyes.

Yeah, exactly.
And so you can't, you know, dono harm, right?
And so get them started onsomething and then we can send
them to an ophthalmologist.

Do you always recommend having the pet
parent going to anophthalmologist after being
diagnosed with glaucoma?

Oh, good question.
It's probably, obviously it's anideal scenario.
There are different reasons forglaucoma occurring.
Primary or genetic glaucoma,usually we'll diagnose that
based on a breed, right?
And exclusion, right?

(10:18):
You don't see anything elsewrong.

Right.

Those cases.
There's only so much that I cando.
Now, the other scenario is thatthere's glaucoma as a result of
something else going on thatcould affect overall health or
just comfort, in general.

(10:41):
Something we might actually wantto know more about.
Whether there's a tumor or highblood pressure or, something
else going on.
And yes, it's ideal to send to aveterinary ophthalmologist, but
you could attempt to try tomanage the pressures and at
least try to preserve comfort asbest you can.

(11:03):
And if you can't keep an eyecomfortable and blind, removal
is always an option.
Assuming overall health is okay.

And they do so well.

Oh gosh.

Just with one eye.
Yes.
I have two cats with one eyeYes, opposite eyes.

Oh.

Yeah.

They're buddies.

Yeah.
Little book ends.

Yeah.

That's what we call them.

They animals will do fantastic
without vision.

Yeah

And without their eyes, one or two.
Obviously, it's great if we cantry to keep that for them, but
they compensate beautifully thevast majority of the time.
Always, comfort and quality oflife is first, no question.
And if that means eye removal,then that's okay.

Yeah.

Yeah.

So with glaucoma, that's usually a
medical thing, not a surgicalthing.
Are there other big medical,like eye things that we should
be sending our pet parents overto you for?

Yeah, probably.
I would actually say probablythe biggest reasons to send
things would be if there's somesort of surgical treatment that
is recommended because you canalways try some medical therapy,
right?
Even if we think there's aninfection, you can try
antibiotic drops.
If we think there's dry eye, youcan try tear production drops.

(12:17):
Tear..
What's the word I'm looking for?
Stimulating drops..
Yep.

Yep.
I was thinking of like, like Ihad, for example, I had a cat
who his eye changed color for noreason.

Yeah.
Yeah.
So a lot of times that might beworth..
If you're not sure about whatmight be happening.
That would be worth sending it.
Because there's a couple ofthings that can cause overall
eye color change some of whichyou want to really stop that
process, if you can, and on theother hand, you could be looking

(12:49):
at maybe even early melanoma ortumor formation in the eye and
having an ophthalmologist helpdetermine when it might be time
to remove that eye is probablygonna be very helpful.
I would probably recommend that.

When you've diagnosed a pet and decided
probably the best thing is toremove the eye.
Do you usually recommend sendingthem back over to the general
practitioner or the ER vet or doyou usually recommend having you
guys remove the eye?
Yeah,

I am very comfortable removing an
eye, which is very important.
It's almost like an occupationalhazard, which is good and bad
news.
But is enucleation difficult?
I don't think so.
I think it's more about howcomfortable somebody is doing
the procedure and honestly, itprobably has more to do with

(13:44):
just doing it, than not.
And so, you know, I woulddefinitely..
It might be helpful becausethere are a couple of common
mistakes that I see, it wouldprobably be helpful if someone's
never done it before obviously,you know make sure you read you
know, the book and the describedsurgical procedure, but it'd
probably also be helpful to havesomebody there with you who's

(14:07):
done it before.
Sometimes there's littleanatomical things where you're
like, is that what I'm lookingfor and so it might be helpful
to have somebody else there.

Yeah.

Yeah.

That's definitely how I learned Yeah,
having somebody else there.
It's show me.

I think mentoring is a huge part
of eye work.
That's how obviously I learnedas well.
You go through your residencyand you have somebody right
there with you who can teach youso it's yeah, priceless.

You were talking about just residency
right now.
So can you explain to me realquick like how you become an
ophthalmologist.
Because there's a differencebetween me and you then.
So what is that difference?

Yeah.
So a specialist has to gothrough additional training.
And the way that we do it is youhave your four years of
veterinary school.
You need to go through at leastan internship, and this
internship is general.
So you're doing medicine, andyou're doing surgery.
It's usually a small animal, butsome people do large animals.

(15:01):
And so you're supposed to have agood foundation in general
medicine and surgery overall.
From there, you need to completean ophthalmic residency, but
getting the residency is verychallenging.
It's very competitive.
So people will often take extrasteps in between their

(15:24):
internship and their residency,whether they do a PhD or a
masters or other sorts ofresearch, or maybe they do an
ophthalmology specialtyinternship, which is what I did.
So I did an ophthalmologyspecialty internship where I
also did more ER work at thesame time.
I really liked that because Igot to work with even more

(15:45):
people, right?
You see how different peopleattack different conditions and
how that works for them.
And then from there you do yourresidency and that's for me that
was a three year program.
There are some that are fouryear programs.
I'm glad mine was only three.

You've only been in school forever.

Yeah, because otherwise it just feels
like forever.
And yeah, so it's a bit of along haul, but I think
especially for eyeballs and forthose of us who really enjoy it,
it's worth it.
We love it.
But that also, I think it'ssomething to keep in mind that
if you don't feel comfortablelooking at eyes or don't feel

(16:24):
like you quite know what you'redoing.
Hey, it's okay.
It takes most of us five yearsto get to the point where we can
do these things.
It's always fine to askquestions and see what people
think or things you're not sureabout ask somebody, so..

That's amazing I can't imagine doing
like more schooling than what Idid.

Yeah, I know.

So what pushed you to not only like you
wanted to be a veterinarian butnot only that then you want to
specialize veterinaryophthalmology, like how did you
get to that?.

Yeah.
I tend to be a very detailoriented person, so diving deep
on one or two topics is a littlemore interesting or it's a more
stimulating for me than tryingto do a whole bunch of different
things.
Plus, I think, different peoplegravitate toward different
things within medicine.

(17:15):
Whether that's surgery or thisor that or ER medicine, right?
And so the other thing aboutophthalmology, not only is it
for very detail oriented people,but I like medicine and I like
surgery so it lets me do both.
And I also wasn't sure for along time whether like initially

(17:35):
I wanted to do all exotics andzoo and then I want to do horses
and then I wanted to do smallanimal So this lets me do all of
that.
And it focuses on one organ inmultiple species, which is
pretty neat.

Yeah.

Yeah.

And you had mentioned that you can do things
like horses and everything.
We were talking before about howyou got to do a penguin, Hawks..

Yeah.

All sorts of cool animals, right?

Yeah.

What other animals have you gotten to do
surgeries on?

Penguins.
Python, that was pretty neat.

Yeah.

Penguins, python, some medical work on a
grizzly bear, which was neat.
Small birds, owls, hawks, andpredatory birds of prey is the
word I was looking for.
Chickens.

Chickens.

Yeah.
Rabbits.

Yeah.

Ferrets.

A fish if I remember correctly.

Oh, fish.

A fish.
That is crazy.

Yeah, that was really neat.

Yeah.
So you removed the eye from thefish, right?

Yep, exactly.
And the fish did amazing.
Yeah, he did amazing.
It was a zoo specimen.
And I think people have,traditionally, we didn't know
how they would do if you removedan eye plus people worry.
There's lots of people,including children that come
through zoos.
Would that be scary?
What would happen?
And the fish had such a largeeye.

(18:55):
It was, really protruding out ofhis head.

Sure it's so uncomfortable.
It

can't, no, I can't feel good.
And so we removed it he didamazing for surgery, very simple
surgery.
And he healed within, yeah,seven to ten days and he was
swimming around.
He had zero problems with it.
And he looked great.

Yeah.

Yeah, I have a neat job that I get to
help lots of different speciesand scenarios.

And how we met was through a chimpanzee.

Yeah.

Who had her eyelid torn.

Yes.

I did a podcast with them as well.

Yeah.

Yeah.
And her eyelid was torn off, andso you had gone back in and
repaired her eyelid.

Yes.
And so she had already had onerepair done.
And unfortunately chimpanzeeslike to pick at things including
sutures.
So she picked out all of hersutures, and I think she, I
think her vet had tried to putit back together a couple of
times, and then I went back, andshe had, I think I was the third
person, and so I tried to use alot of buried sutures.

(19:58):
I got most of it repaired, butthere was still an area that
she..

Picked open.

Picked open.
But I..

Did you have to go back again?

I didn't.
We decided to just let that tryand granulate in or heal on its
own.
Yep, exactly.
And she ended up because I gotmost of it closed.
There was only one area righthere, so it was a little like
this, and then just a littledip, and that was it.

It's not bad.

No.

Compared to what it was.

Compared to what it was, which was quite
open.

Yeah.

Oh, honeybee.

Yeah.
So I'm guessing you get called alot for all these different
exotic animals, like askingquestions about them and stuff
as well, is that right?

I do sometimes not as frequently
is I would like.
It depends on, the areas whereI've worked in in, in, different
areas of the country.
And one place that I was in, Iwas their go to person for the
zoo.
Other places I've worked withrehab centers.
Here, there's a few differentspecialists and I think I might

(21:03):
not be the guy who got in therefirst.

I don't know.
Maybe if you just put that outthere.

Put that out there.

I'll see any new zoo animals.

Yeah.
Which I would love to do.
Yeah.
Exactly.
Yeah.
And I think that you're probablyright.

Yeah.
Yeah.
It's Hey..

Yeah.

You want an ophthalmologist.

I'm happy to help.
Yeah.
Absolutely.

And then so seeing an ophthalmologist is
that a really expensive thingusually?

Yeah, so I think recently in
particular we've seen an uptickin a lot of prices in veterinary
medicine and we've been affectedas well.
No question.
Yeah I would say that theinitial exam, we have a..
There's not many of us and it'sreally hard to get in.

(21:48):
And usually that 1st examinationwill probably be relatively
expensive.
The subsequent examinations andfollow up care are less but it
can be a little pricey.

And what should somebody expect on their
first examination with you?

Yeah.
And price shopping may besomething that somebody might
wanna do.
See what's out there and whatplaces are close to you and what
might be more doable thananother.
But I believe that initialexamination, which includes what
we call ophthalmic testing.
So we're, doing pressures foryour animal and tear testing and

(22:26):
we're staining the cornea andwe're doing all these things.
And so anywhere from probably 3to 500, depending on, where you
go and where you live, that,that'd probably be a good
ballpark start.

Yeah, if somebody had done the tear,
staining, and all the testing attheir regular vet or at the ER,
do you repeat it then?

Most of the time I do.
And the reason for that isbecause it's more about tracking
and watching trends.
Then it is about oh, I don'tbelieve what they did.
Not about that For example, if Isee a corneal ulcer and somebody
diagnosed that, it might be aday or two or a week or a month

(23:09):
since that person had thestaining done for their animal.
So I want to know is it stillopen?
What does it look like?
What are the characteristicsbecause all those things can
change?

Yeah, I definitely cannot describe like
an ulcer as you can describe anulcer, mine is just like, it's
in the middle.

Yeah.
Yeah.
Yeah.
Yeah, and there are certainthings that I'm looking for when
I stain.
So I will stain the cornea andthen I look at the cornea with a
microscope.
So I'm looking for specificpatterns and the way the cells
handle that stain and all ofthat.

That's usually not something that we
have, we don't have.

Oh, yeah.
Yeah.

To see those things, which is why it's great
for you to be able to see thosethings.

Exactly.
And it does also take..
People say that using, it'scalled a slit lamp.
That's the handheld microscopethat I use.
And people say that for doctorsto learn how to utilize it often
takes three, four or five years.
So it's it's not something thatmost people can just pick up and
do.
Unfortunately, you have to getused to it and practice with it.

Yeah I remember when I tried to do
that, like in school and I waslike, I don't know, I don't
understand what I'm looking at.

Exactly.
And there are some schools thatdon't even have their students
look through slit lamps.
People that I train or workwith, I try to have them all
look through it and know whatit's like and see things up
close because I think you have adifferent understanding when
you're using that instrument tolook at that particular organ.

(24:39):
It's not like other.
It's not like a kidney orsomething.

Yes.
Yeah.

It's different.

Exactly.

Yeah.
And I was going to say thingslike, I think I would say the
biggest thing with repeatingthose tests too is because
really they are just like bloodwork.
It's a snapshot in time and somuch can change with the eye.
Even within 12-24 hours.
So when they come to see me, Ineed to know where things stand
currently to be able to help.

You mentioned that about blood work.
I talk about that all the time.
People always be like I gotblood work done six months ago.
Like how much could havechanged?
I'm like, everything actually,everything could have changed.

Yep.
And one way I explain it, likewith eye pressure is like how
your blood sugar goes up whenyou eat.
Your eye pressure can go up atdifferent times of the day and
that's normal.
Those are normal variations,just..

Different, like stress and all sorts of
things.

Yes, absolutely.
Absolutely.
So it's worth to make sure we'redoing everything correctly and
treating correctly.
It's good to repeat thesethings.

Yeah.

Yeah.

Good.
Yeah, because I know a lot ofpeople will ask if we did the
testing then they're not goingto repeat the test?
I'm like, actually, most likelywill repeat the testing.
Yeah, so it's really goodinformation to know that, why?
Because it's a snapshot, notbecause you don't trust what I'm
doing.

Exactly.
I'm looking for the trend.
And even for my currentpatients, I'll have, I like to
have six months plus, even threeyears of tears and pressure
measurements.
Cause I like to see, when I didsomething how did that affect
things or how did things change?
Last time I did surgery, whathappened here?

(26:18):
And so it helps me manage, Ifeel like the care better.

Yeah.
Yeah.
And how often do you have themusually recheck with you?

It depends.
If it's a new, current diseaseprocess, that we're trying to
get a handle on.
I might see them morefrequently.
If it's an infection, maybe evenweekly for a couple of weeks.
But once things slow down,depending on what it is, I like
to say some people actuallygraduate, right?
So I'm like, come back if youneed me, see you later.

(26:49):
And that's probably the bestrecheck follow up plan anybody
gets or recommendation.
But I would say most eyediseases, unfortunately are, a
lot of them are managed.
You can't make them go away.
So younger animals.
I'll at least see them annually,usually, if they're controlled.

(27:14):
Once I have pets getting up into13, 14, 15, 16, which I see.
I usually prefer to see them atleast twice a year because at
that age things can change evenfaster.

Yeah.

Sometimes I see them every four months.

Do you have certain diseases in cats more
than dogs or certain breeds morethan other breeds?

Yeah, I would say cats probably one of
the biggest things that I'mseeing or that I try to manage
is iris tumors.
So we worry about, melanoma ofthe iris and we worry about it
spreading to the rest of thebody.

Yeah.

So that's why we try to track it so
closely.

I think it's really important too to like
showcase how like you had to doyour internship with learning
all about the body becausepeople think that the eye is
very isolated.

They do.
Absolutely.

But it is really connected to almost
everything else in the body.

And that would be.
Of the two things that I wouldhave people know about the eyes.
It's eyes are wonderful andfantastic, but you can live
without one, right?
And they can do great and theycompensate and they're okay if
they can't see so that's onething.
And then two the eyes areconnected.
Just like your brain isconnected to the rest of your

(28:31):
body.
So are your eyeballs and thereare certain diseases of the body
where the only thing we see is asign in the eye, or maybe that's
what people notice first, right?
Because falling down the stairsor bumping into a chair is not
expected and really noticeable.

Or that color change.
Those are the things you canlike..

Really notice.
Yeah.
Yep.
Where you, and you can say toyourself I don't think that's
right.
And so for cats, I would saywatching for the iris tumors and
the other thing for cats isblood pressure.

Can you tell me what the iris tumor looks
like?

Oh yeah.
The iris melanoma type tumors.
I should back up.

Okay.

So irises, particularly in cats, we
see it in dogs, but in cats, weworry about it more where they
can develop little brown spots.
And the brown spots can be justthat, little focal spots, or
they can be webby patches.
Sometimes they can even go allthe way around the iris.

(29:35):
You can have freckles.
It can be just a freckle, justlike a mole on your skin can be
benign.
These can be benign..

And benign means..

Not a cancerous tumor that we worry
about spreading or causingdamage to other organs.
But the problem is that some ofthese can be what we call
melanoma or cancerous malignanttumors.
And we think that these canspread to the body with a pretty
high percentage.

(30:05):
Some of our understanding ofthese tumors is influx, right?
Just so many things withmedicine.
But we think that they canspread really willingly and
really fast before we get achance to even get in between
these things and the rest of thebody.
So we watch them and we look forthings that might suggest that

(30:27):
they're more sinister.
Like a big nodule or a reallydark brown patch, something that
changes really fast.
Or if the eye seems like notonly is it got brown coloring,
but maybe it's not workingright.
The pupil doesn't look right.
And they say those are probablythe biggest things.
Yeah.

Yeah.
And then what do you see?
What do you think people withdogs should look for more?

Dogs.
Oh my gosh.
Dogs get so many things.
So if I, I would say probablytwo of the biggest things well,
can we do three?

Yeah.
Oh, yeah, you choose your..

Okay, so the first thing with dogs and
cats will get this too.
They'll get corneal ulcers.
They're squinting.
They're red.
You put your stain in youdiagnose a corneal ulcer and..

It'll show up as a little a green spot.

Yep.
Exactly and then we use anantibiotic to prevent infection
while that heals.
That's a relativelystraightforward one.
I would say the other two that Isee are dry eye.
So low tier production.
And the reason why that's a bigkind of a I would put that in

(31:43):
the big three is because one youcan rule it out or rule it in by
testing for it.

Easily, like we can do it in ER or GP.
Yeah.

Two, it's a huge contributor, if not
the main contributor to chronicdischarge and redness it
contributes to vision loss viascarring.
It can just do a, it can't feelgood.
It's irritating and it can causevision loss and we can pretty

(32:15):
easily figure it out andpotentially treat it.

At least manage it.

At least try.
Yeah.
At least try and do what we can.
So that's why that goes in alsothe big three.
And then probably the last onewould be glaucoma.
And the biggest thing withglaucoma, elevated intraocular
pressure inside the eye.
Is it hurts.
It's like a headache.

(32:39):
So you may not see them squint.
They usually, there's only ahandful of breeds that will come
into the ER like this with ahigh pressure.
Usually..

Those are the Chihuahuas.

Yeah.
Or Shiba Inus, but they'rescreaming already anyway.
Or teeth gnashing, or, a lot oftimes glaucoma, you may notice,
this, or maybe the third eyelidis up a little, but more than
that, usually they might notwant to.
It's like a headache.
So they might not want to eat asmuch or they might sleep more.

(33:13):
The way I think of it is youknow when you have a headache,
you still go to work, but maybeyou just don't feel great or you
still eat, but you just don'tfeel great.

I feel like the other thing I see commonly
with glaucoma is they're moresnappy.

Yeah.

A little more aggressive and people like,
I just don't know.
They just are like, they're moreweird about me touching on their
face.

I think that is probably true.
And I think that a lot of eyedisease, in general, I will see
that.
Where initially, because I thinksometimes, especially if you
have a little dog, who might besnappy in general, you try to go
toward the head and they'resnapping at you and you might
think, oh, that's...

(33:54):
that's just my dog.
When in actuality it's moreabout they don't want to be
touched.
And sometimes the signs can bereally subtle like on one side
I'll touch and they're like, oh,it's okay.
And then on this side, theymight do something as simple
as..
That.
So it's not necessarily biting,but I think, but I do see that.

(34:17):
Absolutely.
And as dogs come in and I'mgetting their condition
controlled, it's actually a neatprocess because maybe an animal
is aggressive or painful whenthey come in and then each visit
they get easier and easier tohandle and then maybe actually
even enjoy coming in, which ispretty fun to see that you're

(34:38):
helping.

Yeah, exactly.

It's pretty neat.

Very cool.
Yeah.
It's just so interesting.
I've always found eyes veryinteresting.
We don't get a lot of trainingin it, I feel like.
Yeah.

Yeah.
And I wish, in, in humanmedicine, I think it's the same
thing except if they're at ahospital, they're just saying to
the ophthalmology resident, canyou please come down?

I don't have that.

You don't have that option.
Yeah.

Can you come down here real quick?

Yeah.
One thing I'm interested inlooking at and that I think is
really neat is doing teleconsulting with.
ER clinicians or primary thatjust general practitioners where
you don't necessarily, if youhave somebody, you can send a
case to great, but there areareas where there's nobody.

(35:25):
I'm number 491 in my college.
That's how many of us there are.
Not that many.
Yeah.

And that's over like.
I don't even know how many..

North America.

But that's like over what?
I don't even know whenophthalmologists'started'.

That's since the eighties and nineties,
I'm number 491 having finishedin 2013 and there's..

Really not a lot.

There's not a lot of us, and reaching
some of those rural spaces orjust the ER clinicians
overnight.
I think would be a really neatoption and something I'd like to
leverage.

Yeah.

I think it'd be really cool.

Yeah.
That'd be really cool.
Because there's so many timesthat I've said like, or people
who can't get out to you.

No.

My wife is a nurse and RN and she has a lot
of patients that she sees thatare homebound.

Yes.

And there's no way for them to get to you.
Yeah.
They have to send somebody elseto usually send them to me.
So some really nice neighbor hasbrought them to me.

Or a family member.
I have that as well.

Exactly.
And then I'm like, Hey, you'regoing to have to go see an
ophthalmologist.
Cause I, I can't give you ananswer.
And that's even harder.

Yes, exactly.
Yeah.
There's a couple of new..
It sounds kind of hokey to sayit, but it really truly is a
couple of different ways ofreimagining veterinary care and
bringing care to people or petsthat wouldn't necessarily have
it otherwise all through videoand teleconsulting.
And I can, granted, not to putless emphasis on the stuff that

(36:54):
I can do in person becauseobviously there are things that,
that help me out a lot when I'mlooking at an animal in person,
but I can do a lot to start careby looking at photos, videos,
the way the animal moves, howthey're holding themselves in

(37:17):
consult.
Yes.
And in consultation with someoneelse who's got feet on the
ground.
I can do a lot.
So I'd like to do more withthat.

Yeah, it'd be so helpful, I said like this,
we just don't get a lot ofophthalmology work.
So it's really hard sometimesfor us to be able to do those
things unless somebody's beenlike really diligently studying
those things.

And also, I think, whereas you see a
lot of eyes throughout a year,right?
But I see 20 pairs of eyes everyday.
But you're probably seeing 20pairs of eyes maybe probably in
a month.
So it's a little different.
I mean you're seeing it, butit's not all the time.

Right.
Exactly.
Very cool.
And can you tell me like if wedo want to see a veterinary
ophthalmologist?
How do we find a veterinaryopthalmologist?

Yeah, so a great way to do it is to
probably..
one of two ways, Googleveterinary ophthalmologist.
And then when it asks you toclick, in your area, you say
yes, and so that is one optionyou would want to look for an
actual ophthalmologist, someonethat's labeled as an

(38:27):
ophthalmologist.

I do see like when I've Googled it
sometimes, a generalpractitioner will pop up.

Correct.

I know this is...

Correct.
Exactly.
So you want to seeophthalmologist either after
their name or in their jobdescription title, or even in
the clinic title.
So that's one way to do it.

What are the letters after?

Oh, good.
That's a great question.
So the letters after my name areD A C V O.
Diplomate of the AmericanCollege of Veterinary, which is,
everybody has that, and thenophthalmology.
O at the end.
And our college, so the collegeof veterinary ophthalmology has

(39:07):
a website for people to gothrough specifically to look up
somebody near them.

Yeah.

And you can put in a name, you can
put in a city or a state or azip code.
You can look within a certainmile radius of whatever location
you want to.
So that might be a really greatway for people to look up.

Yeah.

People.

And I know it's so hard to get into an
ophthalmologist.
I do usually tell people callmultiple.

Yeah.

Whoever has the first opening, you take that
one.

Yeah.
I would say that would probablybe the best way to go,
especially if there's somethingworrisome or that's concerning,
you should really take the firstone that you're offered just for
the health of the pet.

Yeah.
Absolutely.

I would say if, there are certain
breeds that tend to be morepredisposed to eye problems
where even if nothing is wrong.
Or you think nothing is wrong,You may want to have an
ophthalmologist in your contactlist.
Just so that, make thatappointment, make a non urgent

(40:15):
appointment so that you'realready in the patient base And
that way when you do have anemergency, you can call your
ophthalmologist directly.

And what kind of breeds are those?

Yeah, Boston Terrier.
I would say Boston Terrier isone of the top breeds.
They have just about all of theissues and many of them have
multiple issues.
Cornea, tear problems, cataract,glaucoma, all the things.

(40:48):
I have several Boston terrierparents who they have experience
with it now, so they get a newpuppy and they just bring it in
when it's one or two years oldand get it checked out.

Nice.

Yeah.
Pugs would be another one.
English Bulldogs.

I was going to say Bulldogs is my number
one.

Yeah.
Yeah.
Yeah.
And I like to tell people anydog with a smooshy face is at
risk for having eye issues, justlike they're at risk for so many
other health issues.
But Boston Terriers, Pugs,English Bulldogs, and then the
one other one that I would sayyou might want to get checked
out, even if you thinkeverything is okay, is a little

(41:27):
bit different.
It's a Golden Retriever.
And the reason is because wehave relatively recently,
detected a really seriousdisease for these guys which..

Another one?

I know.
And it is a genetic disease.

Yeah.

And so the breeders are breeding,
but you don't detect it as ababy.
You detect it when they're olderand it's insidious, meaning,
that they can have it and youdon't know it until it's bad.
So it's a disease that causesinflammation and glaucoma in the
eye.
So they can go blind, they canbe painful, and trying to start

(42:11):
treatment early we think canhelp.
So if you have a goldenretriever, probably having an
eye exam every one to two yearsstarting at four years old would
be wise.
And once they're six to seven,I'd probably say every year.

Yeah.
Wow.

Yeah.

Poor guys.

I know.

They just get everything.

I know.
I know.
The worst.

They're so nice.

I know.
They're such nice dogs.

Geez, isn't there another one?
I could be wrong.
Because again, I'm not great ateyes.
I feel like there's like huskieshad some sort of genetic eye
problem.

The biggest, one of the biggest
genetic, are you thinking of,are you thinking of collie eye
anomaly?
Yeah.
So that's an interesting one.
Which one of the whole reasonsthe college started and eye
certification exams for breedersstarted was because of collie
eye anomaly.

(43:09):
Yeah.
So these dogs are born withcongenital malformations and
they can be mild or they can besevere and the mild ones aren't
that bad.
But if you keep passing thosegenes on, then you could have a
dog that gets severely affected.

(43:31):
And those dogs are blind and allof that.
When those dogs are young, youbring them in to the
ophthalmologist and you take alook, and you can know, hey,
maybe I'll breed this dog, butnot this dog.
So if they have a lesion earlyin life, it can be easy to know
and a lot of that disease hasbeen stamped out because of what

(43:53):
we've done.
Which is great.

It's amazing.

Yeah, I mean if you think of you know
of all the diseases, that'sreally cool.

Right.

Problem with a disease like the golden
retriever.
It's called golden retrieveruveitis.
Couple of different names for itnow.
Is if they get it late in life,you don't catch it on my
certification exam.

Yeah.

There's also some genetic testing that
can be done these days.

Oh, cool.

For various diseases.

Do they have one for the golden one?

There is, I think there's a gene that
has been identified.
I don't know if there's testingavailable yet for it.
But that's a great question.
But some of the inheritedretinal degeneration or lens
diseases.
And of course, we haven'tidentified all the genes, but so
many of the conditions aregenetic.

(44:45):
And we've identified a few sothat breeders can know, hey,
should I breed this one or not?

Do you usually send the testing to like
UC Davis for those things?
Or will you tell people to dothe Embark or?

Yeah.
So there's a couple of differentoptions these days.
It used to be OptiGen was one.
I think Embark does actually, ifI recall correctly..

Yeah, I can't remember if it's the
Wisdom Panel or Embark, but oneof them.

Yeah.
And they can do.
An entire, not just eyes,there's just many body systems.
And so I have a breeder for oneof my dogs and she was telling
me all about it and I was reallyimpressed with all of the things
you can test for.

Right, I had mentioned Addison's to one of my
pet parents and they're like, ohlet me show you her genetic
testing.

Oh yeah.

And I was like..

Yeah.
And I will have some dogs thatcome in to me now.
Every now and then when a petparent may say, I think this is
happening for my dog.
Here's the genetics testing thatshe had.
Is this what she has?
And then I can, confirm or..

Yeah, it's just like another piece of the
puzzle.
Which means yes, this does fit.

Yeah, it just fits with everything.
Exactly.
Yeah.
It just helps us keep our dogseven healthier if we can avoid
some of those things.

Yeah.
Very cool.

Yeah.

So where can we find you at?

So I am probably best searched for
either Google, you can do mylast name.
But you can also..

Which is actually hyphenated, by the way.

Oh, yeah.

I don't know if it says on there.
So I just want to make sure it'slike my name is hyphenated.
So not everybody finds me.

Oh, okay.
And if you put in Brantman, thatshould be sufficient.
And I believe on our collegewebsite, the ACVO website you
could probably find me underBrantman.

Okay.
Yeah, with mine, like you canlook up Sugerman.
People get confused becausethey're like there's another
last name on there, so is thisthe correct Sugerman?

Yes.
And so the married name isCrosetto.
Yeah.

Perfect.
Was there anything

else you want to share with us?
No, I think we covered it.
Perfect.

Thank you so much.
Like I, I learned so much justfrom what we were talking about
just now.
So I'm really excited aboutthat.
So thank you.

My pleasure.

Perfect.
Yeah.

It was really great talking with
you.

Great.
Yeah, thank you.
All right.
Thank you guys.
Make sure to keep your petshappy, healthy, and safe.
We'll see you next week.
Thanks.
I wanted to give a huge thankyou to Dr.
Brantman.
I learned so much aboutophthalmology on this podcast,
and just about how cool herescapades are in general.
She's a pretty awesome lady, andI can't wait to have her back on
to talk more about eyes.

(47:28):
Also, thank you as always toShawn Hyberg for editing the
podcast and answering all of mytechnical questions, and Kelly
Reopelle, sorry if I messed thatup, Dwyer, for always helping me
with my website.
You guys are amazing.
Make sure you catch our futureepisodes on pet first aid kits
and are cats actually nocturnal?

(47:49):
Thank you to everybody forkeeping your pets happy,
healthy, and safe.

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