May 28, 2025 • 23 mins
Lasik Surgery Cataracts Surgery Eye Surgery Tennessee
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Ask The Experts Atlanta is broadcast live Wednesdays at 10AM ET on W4CY Radio (www.w4cy.com) part of Talk 4 Radio (www.talk4radio.com) on the Talk 4 Media Network (www.talk4media.com). Ask The Experts Atlanta is viewed on Talk 4 TV (www.talk4tv.com).
Ask The Experts Atlanta Podcast is also available on Talk 4 Media (www.talk4media.com), Talk 4 Podcasting (www.talk4podcasting.com), iHeartRadio, Amazon Music, Pandora, Spotify, Audible, and over 100 other podcast outlets.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
The topics and opinions express in the following show are
solely those of the hosts and their guests and not
those of W FOURCY Radio. It's employees are affiliates. We
make no recommendations or endorsements for radio show programs, services,
or products mentioned on air or on our web. No
liability explicit or implies shall be extended to W FOURCY
Radio or it's employees are affiliates. Any questions or comments
should be directed to those show hosts. Thank you for
(00:20):
choosing W FOURCY Radio.
Speaker 2 (00:26):
Welcome to the Ask the Experts Show on W four
CY Radio and Talk for TV, where we bring you
educational information from top local experts in the fields of legal, health,
financial and home improvement. Now sit back and listen to
experts in family law, association, law, hearing laws, business brokers,
(00:47):
home care, along with many other topics. Now here are
your hosts, Spivo and Sophia.
Speaker 3 (00:55):
Hey, Good morning, Nashville. Welcome to another sc expert show
where we bring you the top experts in the field
of legal, health, financial and home improvement. Well, I got
to tell you people, we get so many letters going.
I don't know if you read my email or not.
I read every single one of your emails. And for
(01:18):
a long time, we were getting so many emails, people going,
how come you don't do a show on lay sick
eye surgery, cataracts, and we just didn't have an opening.
We finally got an opening, and we were so lucky
that we got the top ophthalmologist in I say, in
(01:41):
the whole state of Tennessee with the Wang Vision Institute.
And ever since we've added this show, we get so
many letters thanking us for bringing this show. And I
got to tell you our expert today we call them
doctor G. Doctor G. People love the way you explain everything.
(02:07):
Welcome to the show.
Speaker 4 (02:09):
Thank you, Thank you, Steve. I really appreciate it, and
thank you for this platform. I mean, that's that's the
whole point of this, to educate patients and kind of
raise awareness.
Speaker 3 (02:18):
And I got to tell you, you're so busy, and
I sometimes I failed to do this, but we cannot
thank you enough. You take out thirty minutes of your
schedule to sit here and educate people. And I just
want you to know how much our listeners and our
viewers appreciate you, and they love the way you answer
(02:42):
the questions and you don't talk over people's heads.
Speaker 5 (02:47):
Good good, good. I love it. I love it, love it.
Speaker 3 (02:49):
So Wang Vision Institute major clinic, I say in the
state of Tennessee, because we're getting letters from all over
Tennessee about you show tell people about Wang Vision.
Speaker 5 (03:03):
Yeah.
Speaker 4 (03:03):
So Wang Vision Institute was founded by doctor Wang twenty
some years ago, and we are kind of a premiere
refractive cataract surgery group. So I do eight different surgeries
to help patients out of glasses, just depending on your age.
Speaker 5 (03:21):
Your prescription, your goals.
Speaker 4 (03:23):
We're kind of the premiere place that has all the
latest technology. We use a lasers for all of our
surgeries to kind of at an extra level of safety,
kind of access to the newest tools and any kind
of new products that come out. Typically we're kind of
having them first, you know. We prefer any of the
first surgeries in Tennessee.
Speaker 3 (03:45):
Well, I got we got a letter the other day,
people saw that you were coming on one. You know,
do you do any pediatric work.
Speaker 5 (03:54):
That's a good question.
Speaker 4 (03:55):
So ophthalmology, the I is about an inch long, but
that there's over twelve subspecialists where you can train.
Speaker 5 (04:01):
So I trained at Hopkins and Duke and then.
Speaker 4 (04:04):
In a subspecialty and refractive surgery, so kind of a
front part of the eye serger. So just like that,
pediatric ophthalmology is a different fellowship. So just you know,
we do see kids, but typically if they're able to
cooperate with the eye.
Speaker 5 (04:18):
Exam, they're a little bit older.
Speaker 4 (04:20):
So kind of anyone twelve and above we will see
them that anyone younger we recommend going to see a
pediatric optomology.
Speaker 3 (04:28):
Well, we're gonna be talking about dry eye today and uh,
for those of you have been writing us about cataracts,
I was just talking to doctor G about it. We're
going to probably do a show next month on cataracts.
So we appreciate again all your letters. So let's start
off with what exactly is dry eye and what really
(04:51):
what causes it?
Speaker 5 (04:52):
Yeah, good questions, good questions.
Speaker 4 (04:54):
So dry I mean, just to set the stage as
the prevalence it out, there's sixteen million people in the
US that probably have diagnosed dry eye, and probably an
additional six million that have undigosed. So symptoms of dry
eye can range from foreign body sensation in the eyes,
(05:15):
gritty feeling feeling like there's something in there, irritation, redness,
fluctuating vision. Oftentimes when people are tearing, they think, hey,
I can't be dry, but in fact that's actually a
symptom of dry eye. So the eyes get so dry
that the emergencies pump signals of the eyes start to
(05:35):
create some tears, but they're very low quality tears.
Speaker 5 (05:39):
So those are all kind.
Speaker 4 (05:43):
Yeah, well cause of the cake in kind of the
morning crusting. So what happens the eyes are when the
eyes are dry, all those kind of deposits just kind
of evaporate and kind of clump together on the eye
like that. So anything that's kind of being secreted isn't
really nice and healthy. So we have kind of forty
oil glands at the top of our eyelids, twenty oil
(06:04):
blends at the bottom, and whenever we blink, you know,
those oil blends are secreting oil so that the tears
stand the eye longer. You can imagine if those oil
blands get dysfunctional, there's less oil on.
Speaker 5 (06:17):
The tear film, and the tears evaporate much faster.
Speaker 4 (06:20):
So you know, that's called decreased insufficiency a little bit,
you know, just decreased quality because they're evaporating. So there's
an evaporative component to dry eye. And then there's some
conditions where people have where they just don't produce enough.
So there's what's called aqueous efficiency, so they're not producing
enough tiers. And then there's evaporative dryness where the tears
(06:43):
are just evaporating really fast.
Speaker 5 (06:45):
What causes it, good question.
Speaker 4 (06:49):
So the evaporative component is caused by gland dysfunction. So
those oil glands, what they happen is they start to
get clogged. I don't know if you've ever had a stye,
but it's the same thing that causes sky or silasian.
What happens is those oil glands get clogged, and when
those oil gains get clogged, oil kind of builds up
(07:09):
and then inflammation kind of follows, causing a little bump
causing a sty So it's the same. It's called MGD
Mimobian gland and dysfunction. So that's a big cause. Typically
we can see that in dys natural aging kind of
as we get older, the skin kind of dries out,
face kind of dries out. So the guys, same with
the glands, they can start to do what's called atrophy
(07:31):
and die out. If not taken care properly. Other conditions
like autoimmune conditions, people that are in certain medications diuretics,
those will kind of contribute to drying out, especially people
with conditions like chogrins, which is an autoimmune condition that
causes dry eye, dry mouth.
Speaker 3 (07:54):
So how can someone tell the difference between say, normal
eye irritation and chronic dry eye.
Speaker 5 (08:02):
Good question.
Speaker 4 (08:04):
Oftentimes, and this is a big no no, people use visin,
so you definitely don't want to use vising.
Speaker 5 (08:12):
You know, vizine has something called get the red.
Speaker 4 (08:14):
Out, and the more you get, the more you use
it and you stop it, it can actually cause what's called
rebound redness. So you don't want to use vising to
kind of create dry eye. You know, if you find
yourself using artificial tears, you know, more than three to
four times a day, that's telling you that, hey, maybe
there's something underlying going on here, and it's not just
(08:35):
a transient irritation. What the artificial tears do is kind
of supplement the tears, but it's not treating any cause
of the dry eye.
Speaker 3 (08:45):
Is dry Is dry eye just a innocence or could
it actually lead to more serious problems?
Speaker 5 (08:54):
Good question?
Speaker 4 (08:55):
So dry I I mean the way that I kind
of describe it. It's like trying to look through already
winch you you know, can we do it?
Speaker 5 (09:02):
Yeah, but do we want to do it?
Speaker 4 (09:04):
No?
Speaker 5 (09:05):
You know, the quality of the vision, the.
Speaker 4 (09:08):
Quality of how you perceive things, everything will be degraded,
you know, and if left untreated, in theory, it could
continue to cause what's called cornial scarring cornial hazing. It
can lead to recurrent sties. It could just lead to
the eye looking red angry. It's not going to damage
(09:28):
with like your retina or your optic nerve, but it
does kind of contribute to the overall quality of everything. Similarly,
you know, if you wanted to have any surgeries, whether
that be smile or inventabule, contact lenses or cataract surgeries,
you know, if you have really bad dry eye, it
can affect the outcomes.
Speaker 3 (09:47):
You know. I guess people probably want to know what
types of patients are most would you say, we're at
risk for or dry eyed disease?
Speaker 4 (09:57):
Yeah, you know, so anyone kind of with autoimmune conditions,
anyone with kind of contact use, anyone kind of females
above the age forty with the hormonal changes. They all
tend to be drying out a lot more faster elderly population,
(10:18):
just like the skin and everything kind of dry.
Speaker 5 (10:20):
So did sort of the eyes and again some post
kind of surgical pation.
Speaker 3 (10:26):
We just got our first text in. I'm so sorry
I missed the first part of the show. I really
wanted to see this show. I think I have dry
eye problems. Can you explain the different types of dry
and why that matters for the treatment?
Speaker 5 (10:46):
Good question.
Speaker 4 (10:46):
So, the two types of dry eye are evaporative dry
I have.
Speaker 5 (10:53):
No tear and sufficiency.
Speaker 4 (10:55):
So an evaporative dry eye, what's happening is your body
is not secreting enough oil onto the tier films, so
the tears are rapidting really fast. And then in tear insufficiency,
your body actually doesn't producing enough tears, so you don't
have enough to kind of cover the eye. So there's
different tests that we can do in the office to
kind of determine which kind you have. But in terms
(11:20):
of treatment, there are certain treatments that can be tri
traded to the cause, but oftentimes there's a big overlap,
so oftentimes we use the same therapies for both kinds
of dry eyes.
Speaker 3 (11:30):
Typically'll go ahead it seems like, you know, people just
this is just to them, you know, I'll get over it,
and they do nothing about it. Does it actually get worse? Yeah?
Speaker 4 (11:46):
Yeah, so dry I have left for you. It just
kind of slowly gets worse, you know. That's what we
actually describe the disease as a chronic disease. Truly, even
with dry eye, all the therapies that we do can help
treat the underlying cause, but to fully eliminate it, you know,
and as patients often still have to use some kind
(12:07):
of maintenance therapy. So even after we kind of get
it under control, we recommend kind of high quality artificial
tears kind of like brushing your teeth, you know, kind
of maintain that nice tear film.
Speaker 3 (12:19):
You know, you spoke just ment to go about Vizin
what are some of the over the counter options people
usually to try first and to see if they're effective
or not.
Speaker 5 (12:32):
Yeah, so one you want to check to make sure.
Speaker 4 (12:36):
We typically like what are called preservative free tiers, so
they don't have any preservative in the bottles, meaningless less toxic. Now,
if you're using the tears just three times a day,
the non preservative one is probably okay. But if you're
using anything more than that, you want to get out
preservative free version.
Speaker 5 (12:55):
You know, there are certain brands that we like.
Speaker 4 (12:57):
We like sustain, we like refresh Off, Tase, So a
lot of good options out there that you guys have
probably all seen. You know, recently in the news there
were actually some few eye drops that were recalled. So
one you want always you want to check FDA listings
to see if any of the eye drops have been recalled.
(13:17):
So a lot of ones that were recalled were off
brand ones like the Walmart quit.
Speaker 5 (13:22):
So we recommend using on rand drops.
Speaker 3 (13:25):
You know, I was at a CBS the other day
and I was going down the aisle. I was shocked
how many different types of eye drops there are. There
are so many different hides, and I don't are they
all effective.
Speaker 4 (13:44):
So all the overcounter ones, they're all supplementations for your
te None of the overcounter ones are treating the causes,
but there's something invaporative comp so some some of the
tiers have.
Speaker 5 (13:56):
A little bit more oil, so they lost a lot
of them.
Speaker 4 (13:59):
Some of them were formulated with a little bit of
technology so it lats longer, but essentially all of them
are supplementing the tiers. You know, really depending on your cause,
one may be slightly better than the other. But for
the overall average person that just wants to try something
just using what's called hydration tiers, you sustain hydration or
(14:22):
refreshed tears, those are good ones.
Speaker 3 (14:25):
So let's say someone's using these eyde drops. How long
should you give it before if it's not working, you
should see it specialist at one?
Speaker 5 (14:35):
Yeah, I mean one.
Speaker 4 (14:37):
If you're having any of these foreign bodies insations and
things like that, and now you've tried the tears and
it's not working, that's when it's time to come in.
You know, the earlier you come in, the earlier we
can start kind of treating everything and kind of getting
everything to a good baseline level. You know, you don't
want to just try it for a few months and
then say, okay, this is not getting.
Speaker 5 (14:57):
Better because now you've just suffered for a few months.
You know.
Speaker 4 (15:01):
Typically what we do is if you come in and
you have really bad dry eye and you've already started
artificial tears, there's different options that we can do. You know,
there's lots of prescription eye drops that target the inflammation.
So what happens is when the eye gets chronically inflamed
from the dryness. It's kind of like a positive feedback loop.
(15:22):
That inflammation causes more dryness and the gyness is causing
the inflammation. So all of the prescription eye drops target
that inflammation kind of different receptors, different areas of the
eye to help control the cause. The prescription drops are
things that we could do. We also offer a lot
of procedures in our office, so we're kind of a
(15:44):
dry eye referral center here in Nashville to treat a
lot of dry eye people that have seen other providers
and couldn't figure things out, you know. So we have
devices kind of what's called high locks. You know, it's
a thermal pulsation device, but it does heats up all
those oil glands to secrete all that oil and clog everything.
(16:06):
We have devices called IPL which is intense pulse light therapy.
A lot of plastic surgery offices, dermatology offices also have
them really, so they're used to treat rosation red ness,
kind of provide a skin glow.
Speaker 5 (16:21):
But we have an.
Speaker 4 (16:22):
FDA approved device that we actually used to treat the
eye lids, So the eye lids when we're targeting that
can help control some of the inflammation and stimulate more
oil for.
Speaker 3 (16:33):
This is from pathy. She wants to know. Does the
Wang Vision Institute do any type of eye plastic surgery?
Speaker 4 (16:43):
Eye plastic surgery, so look, we're talking about oculoplastics. Is
the other is another fellowship of ophthalmology. So we don't
do oculoplastics. We refer to a local group.
Speaker 3 (16:55):
Okay, what age group do you normally when it comes
to the quatic dry eye?
Speaker 5 (17:04):
You know, that's a really good question.
Speaker 4 (17:06):
So typically you used to be kind of the females
above forty, the elderly population. But with the advent of
the smartphone and screens, we have seen dry eyes starting
from the twenties the thirties. So what screens do is
decrease your blink reflex by eightfold, So in near work,
(17:26):
looking at screens, looking at phones, just you don't blink
as much, and then you're getting more and more dry.
The other thing that exasperbad it was during COVID masks actually,
you know, so with hope, when you were wearing all
those masks, the air is kind of flowing up and
kind of contaminating the eye a little bit. Causing a
(17:48):
little bit more dry eye. So we've been seeing a
lot more dryness even in patients in the twenties and thirties.
So for anyone that spends a lot of time on
computers and screens, we recommend what's called the twenty twenty rule.
For every twenty minutes of screen time, you want to
look at something twenty feet away for about twenty seconds.
Speaker 3 (18:07):
Interestingly, never heard that before. I've heard of something called
punktal plugs. Yes, yes, how do they help with dry eye?
Speaker 4 (18:18):
Yeah, so there's what we call four punkum. Punkdum are
essentially tier ducks that drain the tears. So we have
two at the upper lid, two in the lower lid,
and the tears drained through them. So when we do
what are called punktal plugs, we look, we put a
little dissolvable plug in two of the pump and punk tem.
(18:38):
So what that does is it slows down how fast
the tiers evaporate, and the tiers stay on the eye
longer and kind of helping with the drying. So it's
a we we like to use the dissolvable ones. Some
people also use the permanent plugs, and in fact that's
a procedure that's even covered by insurance.
Speaker 3 (18:56):
And might just want to know, do the prescription I
that help treat the root cause of dry eye, not
just the symptom.
Speaker 4 (19:05):
Correct, So the prescription eye drops treat the inflammation associated
with the dryness, so it can help kind of control everything,
fight off the inflammation, then just kind of rebuild your
tear film. The cleaning procedures that we had talked about,
kind of like the eye locks and the il those
(19:26):
more directly attack the glands themselves.
Speaker 3 (19:30):
Can the treatment actually make dry fully go away? Yes.
Speaker 4 (19:37):
Oftentimes when we're doing treatment, you know, the goal is
to kind of get to them to either a drop
the stage so where they don't reliance any drops, or
they just need to use artificial tears two to three
times again. So that's kind of the treatment goal that
we ty trate to here. So we're starting with prescription
eye drops. I'll tell patients to use the prescription eye
(19:58):
drops for about two months and then just stop it.
Speaker 5 (20:01):
See how you do.
Speaker 4 (20:02):
You know, it's not like one of those medications where
if you stop it it comes back.
Speaker 5 (20:06):
You know, it is one of those where you used it.
Speaker 4 (20:08):
Now the inflammation's kind of gone and now you just
want to kind of maintain it.
Speaker 5 (20:13):
Same thing with the procedures that we do.
Speaker 4 (20:15):
We have patients that come in every six months or
so to get those procedures done. It's kind of like
a deep clean when you go to the dentist stuff.
So it just really cleans up everything, kind of provides
a nice basal tear foam level.
Speaker 3 (20:29):
In your office. Doctor g you offer IPL and I
looks treatments out of those work and who are they
use the best for.
Speaker 4 (20:38):
Yeah, so both of these treatments are used for the
people with the glandiest functions, so I lucks. What it
does is it heats up all those oil glands and
then expresses them, so it actually pushes out all the
oils and does removes all the blocking just so actually
for the first day, patients might feel a little bit
(20:58):
more dry because we've just expressed everything, but starting the
day after, everything just kind of flows much nicer, helping
patients with their symptoms almost immediately.
Speaker 5 (21:10):
With IPL, it's intense pulse light.
Speaker 4 (21:13):
Therapy BBL, other terms that people may use for it.
It's actually it provides two purposes. It actually has also
a cosmetic component to it. That's why a lot of
plastic surgery offices and dermatology offices have them. And what
it does is it helps control the redness of the face, skin,
things like that. But for the eyes, we have a
(21:36):
device that who could actually use to treat the eyelids directly.
So it's done over a period of four sessions, and
what it does is it stimulates all the vessels deep
to the eyelids that are contributing to the inflammation and
the dysfunction. And it can actually even help regenerate some
of the oil blends that you've lost.
Speaker 3 (21:54):
You love what you do, don't you.
Speaker 5 (21:57):
That's right, That's right.
Speaker 3 (21:58):
It's so tell people how they can reach the clinic.
Speaker 5 (22:03):
Yeah, there's you know, multiple ways. Our website is playing
Vision Institute dot com.
Speaker 4 (22:08):
Or you can always call us at six one five
three two one eight eight eight one.
Speaker 3 (22:14):
Uh someone just ask can they actually request you? Yeah? Sure, yeah,
Because there's a lot of doctors in your office, right.
Speaker 5 (22:23):
Yes, there are, there are.
Speaker 4 (22:25):
So we have we have two surgeons, it's me and
there's another surgeon, doctor Jones, and then we have two optometrists.
So they don't do surgeries, but they'll see medical patients
and help kind of assists with some of the evaluations.
So typically I'm in a lot with the surgeries and
the procedures. But hey, I see anyone that requests me.
Speaker 3 (22:44):
So beautiful, Doctor Gee. We love having you on the show.
You'll be back again with this next month. Thank you
so much for taking the time today, and I can't
wait for next month's show.
Speaker 5 (22:57):
Thanks doctor, Yes, thank you, Steve. Take care of guys.
Speaker 3 (23:00):
That's doctor Duro Wang Vision Institute. We just call them
doctor g. We're going to go to a quick break.
We'll be right back.
Speaker 2 (23:10):
Thanks for tuning in today to the Ask the Expert
Show on W FOURCY Radio and Talk for TV. Tune
in next week and every week to hear more from
our experts on personal injury, insurance, air condition repairs, estate planning, medicare,
and many other topics in the areas of legal, health,
(23:31):
financial and home improvement. See you next week.
The topics and opinions express in the following show are
solely those of the hosts and their guests and not
those of W FOURCY Radio. It's employees are affiliates. We
make no recommendations or endorsements for radio show programs, services,
or products mentioned on air or on our web. No
liability explicit or implies shall be extended to W FOURCY
Radio or it's employees are affiliates. Any questions or comments
should be directed to those show hosts. Thank you for
(00:20):
choosing W FOURCY Radio.
Speaker 2 (00:26):
Welcome to the Ask the Experts Show on W four
CY Radio and Talk for TV, where we bring you
educational information from top local experts in the fields of legal, health,
financial and home improvement. Now sit back and listen to
experts in family law, association, law, hearing laws, business brokers,
(00:47):
home care, along with many other topics. Now here are
your hosts, Spivo and Sophia.
Speaker 3 (00:55):
Hey, Good morning, Nashville. Welcome to another sc expert show
where we bring you the top experts in the field
of legal, health, financial and home improvement. Well, I got
to tell you people, we get so many letters going.
I don't know if you read my email or not.
I read every single one of your emails. And for
(01:18):
a long time, we were getting so many emails, people going,
how come you don't do a show on lay sick
eye surgery, cataracts, and we just didn't have an opening.
We finally got an opening, and we were so lucky
that we got the top ophthalmologist in I say, in
(01:41):
the whole state of Tennessee with the Wang Vision Institute.
And ever since we've added this show, we get so
many letters thanking us for bringing this show. And I
got to tell you our expert today we call them
doctor G. Doctor G. People love the way you explain everything.
(02:07):
Welcome to the show.
Speaker 4 (02:09):
Thank you, Thank you, Steve. I really appreciate it, and
thank you for this platform. I mean, that's that's the
whole point of this, to educate patients and kind of
raise awareness.
Speaker 3 (02:18):
And I got to tell you, you're so busy, and
I sometimes I failed to do this, but we cannot
thank you enough. You take out thirty minutes of your
schedule to sit here and educate people. And I just
want you to know how much our listeners and our
viewers appreciate you, and they love the way you answer
(02:42):
the questions and you don't talk over people's heads.
Speaker 5 (02:47):
Good good, good. I love it. I love it, love it.
Speaker 3 (02:49):
So Wang Vision Institute major clinic, I say in the
state of Tennessee, because we're getting letters from all over
Tennessee about you show tell people about Wang Vision.
Speaker 5 (03:03):
Yeah.
Speaker 4 (03:03):
So Wang Vision Institute was founded by doctor Wang twenty
some years ago, and we are kind of a premiere
refractive cataract surgery group. So I do eight different surgeries
to help patients out of glasses, just depending on your age.
Speaker 5 (03:21):
Your prescription, your goals.
Speaker 4 (03:23):
We're kind of the premiere place that has all the
latest technology. We use a lasers for all of our
surgeries to kind of at an extra level of safety,
kind of access to the newest tools and any kind
of new products that come out. Typically we're kind of
having them first, you know. We prefer any of the
first surgeries in Tennessee.
Speaker 3 (03:45):
Well, I got we got a letter the other day,
people saw that you were coming on one. You know,
do you do any pediatric work.
Speaker 5 (03:54):
That's a good question.
Speaker 4 (03:55):
So ophthalmology, the I is about an inch long, but
that there's over twelve subspecialists where you can train.
Speaker 5 (04:01):
So I trained at Hopkins and Duke and then.
Speaker 4 (04:04):
In a subspecialty and refractive surgery, so kind of a
front part of the eye serger. So just like that,
pediatric ophthalmology is a different fellowship. So just you know,
we do see kids, but typically if they're able to
cooperate with the eye.
Speaker 5 (04:18):
Exam, they're a little bit older.
Speaker 4 (04:20):
So kind of anyone twelve and above we will see
them that anyone younger we recommend going to see a
pediatric optomology.
Speaker 3 (04:28):
Well, we're gonna be talking about dry eye today and uh,
for those of you have been writing us about cataracts,
I was just talking to doctor G about it. We're
going to probably do a show next month on cataracts.
So we appreciate again all your letters. So let's start
off with what exactly is dry eye and what really
(04:51):
what causes it?
Speaker 5 (04:52):
Yeah, good questions, good questions.
Speaker 4 (04:54):
So dry I mean, just to set the stage as
the prevalence it out, there's sixteen million people in the
US that probably have diagnosed dry eye, and probably an
additional six million that have undigosed. So symptoms of dry
eye can range from foreign body sensation in the eyes,
(05:15):
gritty feeling feeling like there's something in there, irritation, redness,
fluctuating vision. Oftentimes when people are tearing, they think, hey,
I can't be dry, but in fact that's actually a
symptom of dry eye. So the eyes get so dry
that the emergencies pump signals of the eyes start to
(05:35):
create some tears, but they're very low quality tears.
Speaker 5 (05:39):
So those are all kind.
Speaker 4 (05:43):
Yeah, well cause of the cake in kind of the
morning crusting. So what happens the eyes are when the
eyes are dry, all those kind of deposits just kind
of evaporate and kind of clump together on the eye
like that. So anything that's kind of being secreted isn't
really nice and healthy. So we have kind of forty
oil glands at the top of our eyelids, twenty oil
(06:04):
blends at the bottom, and whenever we blink, you know,
those oil blends are secreting oil so that the tears
stand the eye longer. You can imagine if those oil
blands get dysfunctional, there's less oil on.
Speaker 5 (06:17):
The tear film, and the tears evaporate much faster.
Speaker 4 (06:20):
So you know, that's called decreased insufficiency a little bit,
you know, just decreased quality because they're evaporating. So there's
an evaporative component to dry eye. And then there's some
conditions where people have where they just don't produce enough.
So there's what's called aqueous efficiency, so they're not producing
enough tiers. And then there's evaporative dryness where the tears
(06:43):
are just evaporating really fast.
Speaker 5 (06:45):
What causes it, good question.
Speaker 4 (06:49):
So the evaporative component is caused by gland dysfunction. So
those oil glands, what they happen is they start to
get clogged. I don't know if you've ever had a stye,
but it's the same thing that causes sky or silasian.
What happens is those oil glands get clogged, and when
those oil gains get clogged, oil kind of builds up
(07:09):
and then inflammation kind of follows, causing a little bump
causing a sty So it's the same. It's called MGD
Mimobian gland and dysfunction. So that's a big cause. Typically
we can see that in dys natural aging kind of
as we get older, the skin kind of dries out,
face kind of dries out. So the guys, same with
the glands, they can start to do what's called atrophy
(07:31):
and die out. If not taken care properly. Other conditions
like autoimmune conditions, people that are in certain medications diuretics,
those will kind of contribute to drying out, especially people
with conditions like chogrins, which is an autoimmune condition that
causes dry eye, dry mouth.
Speaker 3 (07:54):
So how can someone tell the difference between say, normal
eye irritation and chronic dry eye.
Speaker 5 (08:02):
Good question.
Speaker 4 (08:04):
Oftentimes, and this is a big no no, people use visin,
so you definitely don't want to use vising.
Speaker 5 (08:12):
You know, vizine has something called get the red.
Speaker 4 (08:14):
Out, and the more you get, the more you use
it and you stop it, it can actually cause what's called
rebound redness. So you don't want to use vising to
kind of create dry eye. You know, if you find
yourself using artificial tears, you know, more than three to
four times a day, that's telling you that, hey, maybe
there's something underlying going on here, and it's not just
(08:35):
a transient irritation. What the artificial tears do is kind
of supplement the tears, but it's not treating any cause
of the dry eye.
Speaker 3 (08:45):
Is dry Is dry eye just a innocence or could
it actually lead to more serious problems?
Speaker 5 (08:54):
Good question?
Speaker 4 (08:55):
So dry I I mean the way that I kind
of describe it. It's like trying to look through already
winch you you know, can we do it?
Speaker 5 (09:02):
Yeah, but do we want to do it?
Speaker 4 (09:04):
No?
Speaker 5 (09:05):
You know, the quality of the vision, the.
Speaker 4 (09:08):
Quality of how you perceive things, everything will be degraded,
you know, and if left untreated, in theory, it could
continue to cause what's called cornial scarring cornial hazing. It
can lead to recurrent sties. It could just lead to
the eye looking red angry. It's not going to damage
(09:28):
with like your retina or your optic nerve, but it
does kind of contribute to the overall quality of everything. Similarly,
you know, if you wanted to have any surgeries, whether
that be smile or inventabule, contact lenses or cataract surgeries,
you know, if you have really bad dry eye, it
can affect the outcomes.
Speaker 3 (09:47):
You know. I guess people probably want to know what
types of patients are most would you say, we're at
risk for or dry eyed disease?
Speaker 4 (09:57):
Yeah, you know, so anyone kind of with autoimmune conditions,
anyone with kind of contact use, anyone kind of females
above the age forty with the hormonal changes. They all
tend to be drying out a lot more faster elderly population,
(10:18):
just like the skin and everything kind of dry.
Speaker 5 (10:20):
So did sort of the eyes and again some post
kind of surgical pation.
Speaker 3 (10:26):
We just got our first text in. I'm so sorry
I missed the first part of the show. I really
wanted to see this show. I think I have dry
eye problems. Can you explain the different types of dry
and why that matters for the treatment?
Speaker 5 (10:46):
Good question.
Speaker 4 (10:46):
So, the two types of dry eye are evaporative dry
I have.
Speaker 5 (10:53):
No tear and sufficiency.
Speaker 4 (10:55):
So an evaporative dry eye, what's happening is your body
is not secreting enough oil onto the tier films, so
the tears are rapidting really fast. And then in tear insufficiency,
your body actually doesn't producing enough tears, so you don't
have enough to kind of cover the eye. So there's
different tests that we can do in the office to
kind of determine which kind you have. But in terms
(11:20):
of treatment, there are certain treatments that can be tri
traded to the cause, but oftentimes there's a big overlap,
so oftentimes we use the same therapies for both kinds
of dry eyes.
Speaker 3 (11:30):
Typically'll go ahead it seems like, you know, people just
this is just to them, you know, I'll get over it,
and they do nothing about it. Does it actually get worse? Yeah?
Speaker 4 (11:46):
Yeah, so dry I have left for you. It just
kind of slowly gets worse, you know. That's what we
actually describe the disease as a chronic disease. Truly, even
with dry eye, all the therapies that we do can help
treat the underlying cause, but to fully eliminate it, you know,
and as patients often still have to use some kind
(12:07):
of maintenance therapy. So even after we kind of get
it under control, we recommend kind of high quality artificial
tears kind of like brushing your teeth, you know, kind
of maintain that nice tear film.
Speaker 3 (12:19):
You know, you spoke just ment to go about Vizin
what are some of the over the counter options people
usually to try first and to see if they're effective
or not.
Speaker 5 (12:32):
Yeah, so one you want to check to make sure.
Speaker 4 (12:36):
We typically like what are called preservative free tiers, so
they don't have any preservative in the bottles, meaningless less toxic. Now,
if you're using the tears just three times a day,
the non preservative one is probably okay. But if you're
using anything more than that, you want to get out
preservative free version.
Speaker 5 (12:55):
You know, there are certain brands that we like.
Speaker 4 (12:57):
We like sustain, we like refresh Off, Tase, So a
lot of good options out there that you guys have
probably all seen. You know, recently in the news there
were actually some few eye drops that were recalled. So
one you want always you want to check FDA listings
to see if any of the eye drops have been recalled.
(13:17):
So a lot of ones that were recalled were off
brand ones like the Walmart quit.
Speaker 5 (13:22):
So we recommend using on rand drops.
Speaker 3 (13:25):
You know, I was at a CBS the other day
and I was going down the aisle. I was shocked
how many different types of eye drops there are. There
are so many different hides, and I don't are they
all effective.
Speaker 4 (13:44):
So all the overcounter ones, they're all supplementations for your
te None of the overcounter ones are treating the causes,
but there's something invaporative comp so some some of the
tiers have.
Speaker 5 (13:56):
A little bit more oil, so they lost a lot
of them.
Speaker 4 (13:59):
Some of them were formulated with a little bit of
technology so it lats longer, but essentially all of them
are supplementing the tiers. You know, really depending on your cause,
one may be slightly better than the other. But for
the overall average person that just wants to try something
just using what's called hydration tiers, you sustain hydration or
(14:22):
refreshed tears, those are good ones.
Speaker 3 (14:25):
So let's say someone's using these eyde drops. How long
should you give it before if it's not working, you
should see it specialist at one?
Speaker 5 (14:35):
Yeah, I mean one.
Speaker 4 (14:37):
If you're having any of these foreign bodies insations and
things like that, and now you've tried the tears and
it's not working, that's when it's time to come in.
You know, the earlier you come in, the earlier we
can start kind of treating everything and kind of getting
everything to a good baseline level. You know, you don't
want to just try it for a few months and
then say, okay, this is not getting.
Speaker 5 (14:57):
Better because now you've just suffered for a few months.
You know.
Speaker 4 (15:01):
Typically what we do is if you come in and
you have really bad dry eye and you've already started
artificial tears, there's different options that we can do. You know,
there's lots of prescription eye drops that target the inflammation.
So what happens is when the eye gets chronically inflamed
from the dryness. It's kind of like a positive feedback loop.
(15:22):
That inflammation causes more dryness and the gyness is causing
the inflammation. So all of the prescription eye drops target
that inflammation kind of different receptors, different areas of the
eye to help control the cause. The prescription drops are
things that we could do. We also offer a lot
of procedures in our office, so we're kind of a
(15:44):
dry eye referral center here in Nashville to treat a
lot of dry eye people that have seen other providers
and couldn't figure things out, you know. So we have
devices kind of what's called high locks. You know, it's
a thermal pulsation device, but it does heats up all
those oil glands to secrete all that oil and clog everything.
(16:06):
We have devices called IPL which is intense pulse light therapy.
A lot of plastic surgery offices, dermatology offices also have
them really, so they're used to treat rosation red ness,
kind of provide a skin glow.
Speaker 5 (16:21):
But we have an.
Speaker 4 (16:22):
FDA approved device that we actually used to treat the
eye lids, So the eye lids when we're targeting that
can help control some of the inflammation and stimulate more
oil for.
Speaker 3 (16:33):
This is from pathy. She wants to know. Does the
Wang Vision Institute do any type of eye plastic surgery?
Speaker 4 (16:43):
Eye plastic surgery, so look, we're talking about oculoplastics. Is
the other is another fellowship of ophthalmology. So we don't
do oculoplastics. We refer to a local group.
Speaker 3 (16:55):
Okay, what age group do you normally when it comes
to the quatic dry eye?
Speaker 5 (17:04):
You know, that's a really good question.
Speaker 4 (17:06):
So typically you used to be kind of the females
above forty, the elderly population. But with the advent of
the smartphone and screens, we have seen dry eyes starting
from the twenties the thirties. So what screens do is
decrease your blink reflex by eightfold, So in near work,
(17:26):
looking at screens, looking at phones, just you don't blink
as much, and then you're getting more and more dry.
The other thing that exasperbad it was during COVID masks actually,
you know, so with hope, when you were wearing all
those masks, the air is kind of flowing up and
kind of contaminating the eye a little bit. Causing a
(17:48):
little bit more dry eye. So we've been seeing a
lot more dryness even in patients in the twenties and thirties.
So for anyone that spends a lot of time on
computers and screens, we recommend what's called the twenty twenty rule.
For every twenty minutes of screen time, you want to
look at something twenty feet away for about twenty seconds.
Speaker 3 (18:07):
Interestingly, never heard that before. I've heard of something called
punktal plugs. Yes, yes, how do they help with dry eye?
Speaker 4 (18:18):
Yeah, so there's what we call four punkum. Punkdum are
essentially tier ducks that drain the tears. So we have
two at the upper lid, two in the lower lid,
and the tears drained through them. So when we do
what are called punktal plugs, we look, we put a
little dissolvable plug in two of the pump and punk tem.
(18:38):
So what that does is it slows down how fast
the tiers evaporate, and the tiers stay on the eye
longer and kind of helping with the drying. So it's
a we we like to use the dissolvable ones. Some
people also use the permanent plugs, and in fact that's
a procedure that's even covered by insurance.
Speaker 3 (18:56):
And might just want to know, do the prescription I
that help treat the root cause of dry eye, not
just the symptom.
Speaker 4 (19:05):
Correct, So the prescription eye drops treat the inflammation associated
with the dryness, so it can help kind of control everything,
fight off the inflammation, then just kind of rebuild your
tear film. The cleaning procedures that we had talked about,
kind of like the eye locks and the il those
(19:26):
more directly attack the glands themselves.
Speaker 3 (19:30):
Can the treatment actually make dry fully go away? Yes.
Speaker 4 (19:37):
Oftentimes when we're doing treatment, you know, the goal is
to kind of get to them to either a drop
the stage so where they don't reliance any drops, or
they just need to use artificial tears two to three
times again. So that's kind of the treatment goal that
we ty trate to here. So we're starting with prescription
eye drops. I'll tell patients to use the prescription eye
(19:58):
drops for about two months and then just stop it.
Speaker 5 (20:01):
See how you do.
Speaker 4 (20:02):
You know, it's not like one of those medications where
if you stop it it comes back.
Speaker 5 (20:06):
You know, it is one of those where you used it.
Speaker 4 (20:08):
Now the inflammation's kind of gone and now you just
want to kind of maintain it.
Speaker 5 (20:13):
Same thing with the procedures that we do.
Speaker 4 (20:15):
We have patients that come in every six months or
so to get those procedures done. It's kind of like
a deep clean when you go to the dentist stuff.
So it just really cleans up everything, kind of provides
a nice basal tear foam level.
Speaker 3 (20:29):
In your office. Doctor g you offer IPL and I
looks treatments out of those work and who are they
use the best for.
Speaker 4 (20:38):
Yeah, so both of these treatments are used for the
people with the glandiest functions, so I lucks. What it
does is it heats up all those oil glands and
then expresses them, so it actually pushes out all the
oils and does removes all the blocking just so actually
for the first day, patients might feel a little bit
(20:58):
more dry because we've just expressed everything, but starting the
day after, everything just kind of flows much nicer, helping
patients with their symptoms almost immediately.
Speaker 5 (21:10):
With IPL, it's intense pulse light.
Speaker 4 (21:13):
Therapy BBL, other terms that people may use for it.
It's actually it provides two purposes. It actually has also
a cosmetic component to it. That's why a lot of
plastic surgery offices and dermatology offices have them. And what
it does is it helps control the redness of the face, skin,
things like that. But for the eyes, we have a
(21:36):
device that who could actually use to treat the eyelids directly.
So it's done over a period of four sessions, and
what it does is it stimulates all the vessels deep
to the eyelids that are contributing to the inflammation and
the dysfunction. And it can actually even help regenerate some
of the oil blends that you've lost.
Speaker 3 (21:54):
You love what you do, don't you.
Speaker 5 (21:57):
That's right, That's right.
Speaker 3 (21:58):
It's so tell people how they can reach the clinic.
Speaker 5 (22:03):
Yeah, there's you know, multiple ways. Our website is playing
Vision Institute dot com.
Speaker 4 (22:08):
Or you can always call us at six one five
three two one eight eight eight one.
Speaker 3 (22:14):
Uh someone just ask can they actually request you? Yeah? Sure, yeah,
Because there's a lot of doctors in your office, right.
Speaker 5 (22:23):
Yes, there are, there are.
Speaker 4 (22:25):
So we have we have two surgeons, it's me and
there's another surgeon, doctor Jones, and then we have two optometrists.
So they don't do surgeries, but they'll see medical patients
and help kind of assists with some of the evaluations.
So typically I'm in a lot with the surgeries and
the procedures. But hey, I see anyone that requests me.
Speaker 3 (22:44):
So beautiful, Doctor Gee. We love having you on the show.
You'll be back again with this next month. Thank you
so much for taking the time today, and I can't
wait for next month's show.
Speaker 5 (22:57):
Thanks doctor, Yes, thank you, Steve. Take care of guys.
Speaker 3 (23:00):
That's doctor Duro Wang Vision Institute. We just call them
doctor g. We're going to go to a quick break.
We'll be right back.
Speaker 2 (23:10):
Thanks for tuning in today to the Ask the Expert
Show on W FOURCY Radio and Talk for TV. Tune
in next week and every week to hear more from
our experts on personal injury, insurance, air condition repairs, estate planning, medicare,
and many other topics in the areas of legal, health,
(23:31):
financial and home improvement. See you next week.
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