eye disease

Like pulling teeth

A couple of months ago, I had the wonderful pleasure of attending the American Academy of Optometry's annual conference in Boston. I had the chance to reconnect with a lot of classmates and friends, as well as visit my school and attend lectures at the meeting. One evening, as we were enjoying a night out on the town, a current 4th year student approached me and said "Harbir, you need write a blog about the importance of regular eye exams!". I told him that I'm sure I've mentioned it a few times already. "Yeah, but why is it that people are willing to go the dentist to get their teeth cleaned every 6 months but they refuse to have their eye health checked every 2 years?!" (Yes, he was both inquisitive and exclamatory all at the same time).

This particular discussion has been a long time coming. I talk about it daily with patients, friends, family, and random unsuspecting people walking down the street who I unwittingly coerce into conversation. But, to this day, I have avoided writing about it because I was afraid that I would end up writing a novel, or it would open up a can of worms, or that all the dentists in the world would hate me and I would never be able to receive adequate oral care (I guess its a good thing I've never had a cavity!). But, with this recent encouragement from the enthusiastic intern, I decided to give it a shot. And I will try to keep it short!

Less 24 hours after being newly inspired, I had the most convenient and fortuitous encounter with friend of a friend who just happened to be a dental student. True story. After restraining myself to allow an appropriate amount of time to become acquainted (maybe 30 or 40 seconds), I jumped at the chance to talk about having my teeth examined bi-annually.

Allow me to summarize.

Harbir: Why do dentists have patients come back every 6 months to have their teeth checked?

Dental student: Because we can.

OK fine, that's not exactly what she said. But, the gist of the story was, dentists have convinced the world that having your teeth scraped with sharp tools and gargling fluoride every six months are absolutely necessary. When, in fact, according to my new acquaintance who now probably hates me, there is no direct correlation between oral hygiene and dental health. Having your teeth cleaned is not the important part. The few minutes at the end of the visit where the dentist pokes and prods around with another sharp instrument, that's the important part. But even that doesn't need to happen every 6 months. Nonetheless, oral care professionals have done an amazing job of convincing people that these regular visits are obligatory.

I'm not mad at them. In fact, I applaud them. I reach out to them and ask them how I can convince my patients to have their eye health examined more frequently.

I know this is a bit crude but honestly, what happens when your teeth fall out? You get new ones. Crowns, or veneers, or dentures. In any case, you can smile and bite and eat again. But what happens when you lose your vision? Nothing. Once its gone, its gone.

But we don't clean or polish. We refract and dilate. Maybe that's not as exciting for patients. Maybe we should start a new division of eye care where we have people come in to have their eye lids cleansed and eye drops instilled every six months. We'll call it ocular hygiene. Maybe then I'll have patients in my chair more regularly so I can check for silent eye diseases like glaucoma that can cause irreversible vision loss in asymptomatic patients. Because convincing people of the latter alone does not seem to be enough.

Snoop Doc and Dr. Dre, OD - Marijuana and Glaucoma

DISCLAIMER: Marijuana laws are a little more lenient now than they were when this blog was originally written... Maybe a little more than a little more lenient, considering there's a medical marijuana "clinic" on every other block in Vancouver these days. Nonetheless, I decided to leave the blog in its original form out of respect for my past self's efforts... or because I'm lazy. Enjoy.

"Got some bubba, give me that. I need it for my cataracts." - Snoop Dogg in "Kush" by Dr. Dre.

While I applaud Mr. Snoop D-O-double-G for his awareness of ocular disease and the potential for using marijuana as treatment, there are some things that we need to straighten out.

Firstly, yes, marijuana can be prescribed for certain medical conditions. BUT! It's use is very limited and strictly regulated. In the medical field, its uses are mostly limited to patients who are being treated for cancer, severe pain, or terminal illnesses. In cancer patients it is used as an anti-emetic (decrease vomiting) and to increase appetite during chemotherapy.

A couple of weeks ago, I received a text from an old friend... "Are there any diseases of the eye that marijuana can be legally prescribed for?" Yes, old friend, yes there are. But, unfortunately, nothing I can help you with :)

The only eye disease that marijuana could be helpful for is glaucoma (not cataracts, Snoop!). Glaucoma is a disease in which the optic nerve (in the back of the eye) is damaged and can result in loss of peripheral vision (and blindness, in severe cases). It usually only presents in older patients, age 55 and up. High intra-ocular pressure is thought to be one of the main causes of damage to the nerve. This is why we do the "air puff" pressure test at every routine eye exam (See the blog "The Dreaded Air Puff Test".

Marijuana can reduce the intra-ocular pressure a little. But in order for it to be effective, a patient would need to smoke very frequently, as much as every 3 hours. While some people may consider that cutting back compared to their daily norm, its not exactly what I would call effective dosing. Especially when one little eye drop once a day can be twice as effective as smoking 4 joints a day. I'm just sayin!