When was the last time you had your eyes checked? Ellen Butts, OD, Director of Optometry and Contact Lens Service at the UPMC Vision Institute, explains why it’s important to do so even if you have perfect vision.
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– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider. Both type 1 and type 2 diabetes can have a significant impact on your child’s health. So, what can you do to support them through the illness? Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat Podcast. And, joining us right now is Dr. Katherine Vu-Boast. She’s a pediatric endocrinologist with UPMC Children’s Hospital. Thank you so much for joining us.
Tonia Caruso
When is the last time you had your eyes checked? Why eye exams are more important than you might think. Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat Podcast. And joining us right now is Dr. Ellen Butts. She’s the director of Optometry Services at the UPMC Vision Institute. Thank you so much for joining us.
Dr. Ellen Butts
Pleasure to be here. Thanks for having me.
Tonia Caruso
Okay, so if you already wear glasses or contacts, chances are you go to the eye doctor regularly, and we can talk more about that in a moment. But for adults walking around thinking, “I can see, I don’t have any vision problems. My eyes are perfect.”, why is it still important you say, for them to get an eye exam?
Dr. Ellen Butts
Well, there’s a lot of truth to the old adage, “The eyes are the windows to the soul.”, or in our case, the body. When we look into someone’s eyes, we’re able to see more than, do you need glasses? Do you need contacts? We’re able to pick up on silent diseases like glaucoma or early macular degeneration, diseases that if treated early, can really prevent a lot of vision loss.
Tonia Caruso
How common is it that you would find something like that?
Dr. Ellen Butts
Well, it depends on the age group, of course. So, your post 65 age group is going to have more of these silent diseases. Younger patients, it’s less common. But still, it’s always advised that patients come in every one to two years. And then once you reach that 65 age group, that you’re getting your eye exams every year. I always say that if you’re blessed to live long enough, you’re going to get cataracts. So, that’s one problem we’re always going to find in our patients with more birthdays. So, we’re going to be able to tell patients what level those cataracts are at and what visual blurriness or cloudiness that they can expect from the level of cataract that they can have, and if they’re ready for those cataracts to come out.
Tonia Caruso
I’m realizing I haven’t been to an eye doctor in forever. And normally, you get a physical, you read the chart. This is more than just reading the chart when people come to see you.
Dr. Ellen Butts
Sure, absolutely. So reading the chart, sure, that’s going to tell you if your vision’s poor or not, that 20/20 vision that people hear of. But that’s not telling you if you have any retinal disease, if you are developing early glaucoma, which has no symptoms whatsoever, or if you have a freckle in the back of the eye.
Now the risk of that freckle turning to melanoma is about one in 9,000, but it still exists. So I have had patients come in for routine eye exams and we’ve found choroidal melanoma in them that can be treated. So, that’s eye cancer that can be treated. People are often shocked to hear that you can develop eye cancer, but we can treat that before it turns into something else.
So to answer your question about time period, for adults, typically every one to two years. For children, six to 12 months, you should have an eye screening. And then 12 to 36 months, you should have a comprehensive eye exam. Then before entering kindergarten and every one to two years after that up into adulthood, depending on if you’re a glasses or contact lens wearer or if you just need your regular routine eye exams.
If you’re a contact lens, wearer, Pennsylvania actually requires that you get an exam yearly to get your glasses prescription. And that’s just to protect you, because there’s a lot of risks that come with contact lens wear. So we want to make sure that our patients are checking the health of the cornea, that the contacts are still fitting them well, and that they’re still seeing to the best of their ability.
Tonia Caruso
Right. And so then, how important through all of this to establish a baseline? And why is that important? If you know where a patient starts, how does that then aid in monitoring their eye health?
Dr. Ellen Butts
That’s a great question. So, the optic nerve is what really comes to mind when you ask that. So some people are born with smaller optic nerves, larger optic nerves, just like some people have bigger noses, smaller noses, bigger hands, bigger feet. And if we know what your optic nerve looked like at point A, then we can monitor it as you age.
So sometimes it’s difficult to tell small discrepancies in the nerve size, depending on what your nerve looks like on day one. So sometimes we’ll take a photograph of that nerve and then monitor it. We’ll use that photograph as comparison, which is another reason why if you ever switch doctors, so you’re going to a different doctor, bringing your records is really important.
Because my clinical focus is glaucoma, I’m thinking of the nerve when you ask these questions. So I always say to people, “Glaucoma isn’t a single page, it’s a book. There’s chapters of this book.” So we need different data points to be able to say, “Are you progressing? Are you getting worse? What do we need to do to treat this to get you on a straight line so that we can maintain your visual function?”
Tonia Caruso
Can you briefly talk about glaucoma and what it is and what’s going on in the eye?
Dr. Ellen Butts
Great. Yeah, absolutely. So, glaucoma is when we say pressure is too high for your eye. Now the average eye pressure is 10 to 21, but that doesn’t mean you have a pressure of 22 and you have glaucoma, or you have a pressure of 12 and you can’t have glaucoma. That’s why eye screenings, just checking the pressure and not taking a look at the back of the eye and making sure that optic nerve is healthy, is not sufficient. You need to be looking at that optic nerve as it relates to the rest of the eye.
So when the pressure is too high, it creates pressure on the optic nerve and causes the optic nerve to die. And we can treat that by lowering the pressure of the eye with eyedrops, with lasers, with surgeries. So people shouldn’t be nervous about coming in for their first eye exam because if we do discover glaucoma, we can often treat it with a simple in-office laser procedure if caught early enough. So what really should be scary is waiting to go to the doctor rather than seeing us early on when we can really take care of things early on.
Tonia Caruso
Eye exams, are they covered under medical insurance or do I have to have specific vision insurance?
Dr. Ellen Butts
Sure. I would shout this answer from the rooftops, if I could. If you have any eye problem, dryness, irritation, you feel like you got a contact stuck in your eye, you have a family history of eye problems, you’re on a medication that is high risk for developing ocular side effects or eye side effects, your medical insurance is going to cover all of that. You’re a diabetic, your medical insurance gives you an eye exam. There’s very few instances where we can’t use medical insurance to cover an eye exam.
Really, the only thing a vision plan helps you with or covers is a routine, nothing is wrong with your eyes, you just need glasses and maybe contacts. They don’t even always cover the contact lens evaluation to determine the best fit, the best prescription for you. So if you have medical insurance, you can be seen by an eye doctor. And even if you don’t, UPMC has so many programs that we can get our patients in, we can take care of you.
And another thing, going back to glaucoma, we have a lot of patients on drops, so I always say to them, “Are you feeling like you can afford these medications?” I’m not going to pretend I know what’s affordable to different patients, but, “Can you afford these medications? Is there anything I can help with?” There’s so many programs out there, patient assistance programs from different pharmaceutical programs, using things like GoodRx to get your prescription costs down. There’s so much out there. And you will always hear me say, “If I don’t know there’s a problem, I can’t fix it.” So please always be vocal with your doctors. Let them know what you’re experiencing. We are here to help.
Tonia Caruso
So when someone does go to this eye exam, what are things that we should bring with us to an eye exam?
Dr. Ellen Butts
Sure. So if you’re a new patient, you want to make sure you’re bringing your records, because about that book chapter, not just a single page. And then if you have seen the eye doctor before, it’s still helpful to bring your glasses with you, your contact lenses, as well as the cases. And then if you want to bring your sunglasses, because you will most likely be dilated. But we’ll still give you some really fashionable sunglasses, disposable ones, if you happen to not bring your sunglasses with you.
Tonia Caruso
So what is the purpose of dilating and what goes into that?
Dr. Ellen Butts
So when we dilate your eyes, we’re opening up the pupil or the black center in the colored part of your eye. That allows us to not only see the back of the eye, but also the middle. So we’re able to assess your cataract, we’re able to assess the retina, the optic nerve, the blood vessels, detect diseases like diabetes, hypertension, multiple sclerosis. There’s so much that can be picked up or kind of give us an idea that there might be something else going on in the body, just by looking at an eye exam.
So getting dilated, especially at your first eye exam, is absolutely imperative to determining these diseases. So oftentimes you’ll hear people say, “Well, I got a photograph at my last exam.” But that really misses the center of the eye, so I really do stress the importance of getting dilated. Sure, it’s annoying. No one wants to be dilated. No one likes the way it feels, but it only lasts a few hours. And if you don’t feel comfortable, you can bring someone with you, they can drive you. But most of my patients leave dilated and drive dilated without any issue.
Tonia Caruso
Yeah, that was going to be my next question is can you drive when your eyes are dilated?
Dr. Ellen Butts
Yeah, you can. When I was in school, we got dilated three, four times a week, so I had to drive for all the practice. But if you don’t feel comfortable, like I said, you can bring someone with you at least for the first time, so you know what it’s going to be like. And after that, if you feel comfortable, bring yourself. If you want to have that supports person, there’s nothing wrong with that.
Tonia Caruso
When someone comes to see you and they need to get glasses, are there common things that folks need to get glasses for?
Can I just go to the drugstore and buy a pair of cheaters?
Dr. Ellen Butts
Sure. So, a lot of patients do well with cheaters. And you might find that I say, “Yeah, you can just wear your cheater.” But it is best to determine what the most appropriate, most optimal visual potential is for you in glasses that are personalized to you. So if you are nearsighted, you might only want to wear your glasses for far away and take them off to read. You might decide a progressive is best for you, if you’re also struggling with near vision and you’ve had enough birthdays to get post 40. So, sometimes it’s best to discuss what lens type might be best for your day-to-day activities.
And that’s why I always say that a good expert optician is really key. There’s so much more that goes into a pair of glasses than just the numbers that I’m going to give someone. The front curvature of the glasses matter, the lens type matters, the material. There’s certain materials that some patients, it’s not necessarily an allergy, but they don’t adapt to it. They get a lot of what’s called, chromatic aberration. So they’ll see a lot of speckles and lights, if they have certain types of lens.
Dr. Ellen Butts
And an optician is the best person to determine, based on the frame that you choose, what the distance between your eyes, where the glasses need sit on your face, where your pupil sits in the glasses. All of this matters for the optimal visual potential in a patient. So, it’s not just our numbers. So having an expert optician, I will always stress, is so important to having the best glasses for you.
Tonia Caruso
Right. Let’s talk about contacts for a minute. And are there times where contacts can be more beneficial than glasses? And do they do the exact same thing? Tell me a little bit about that.
Dr. Ellen Butts
So, that’s a great question. So there’s a lot of corneal issues, so front surface of the eye issues, that contacts are actually better than glasses. And in those cases, oftentimes your medical insurance will actually cover your contact lenses.
Say you have an infant and they had cataracts removed at a young age, or maybe they were born without a lens inside their eye. So there is a condition called, aphakia, where you’re born without a lens. Those patients, those infants actually benefit from contact lenses. It’s a beautiful thing to see a baby get sight for the first time, see their mom, see their dad. So in those cases, contact lenses are actually covered by medical insurance.
There’s also a corneal or front surface of the eye disease that can happen in your teenage to 20 years called, keratoconus, which means that the front surface of the eye thins out, juts out at the bottom portion, sometimes causes a lot of shadowing, distortion. And glasses really can’t give you optimal vision, so contact lenses are key in that. So those are called, medically necessary contact lenses. And they’re a specialized type of contact that optimizes visual potential.
Tonia Caruso
And I want to go back, ’cause I think someone listening to this is like, “Wait, what? Babies can wear contacts?”
Dr. Ellen Butts
Yeah.
Tonia Caruso
Tell me about that.
Dr. Ellen Butts
So, sometimes we have the patients come in and have their parents learn how to use the contacts. Sometimes we have our providers put in the contacts and then remove them at specific intervals. But giving those babies vision is just such a beautiful thing.
Tonia Caruso
That is amazing to me. And as children grow, you have a conversation with the parents about would glasses be better or contacts? And talk about some of what goes into that decision, not only which is more beneficial, but in terms of responsibility of the child, et cetera.
Dr. Ellen Butts
Yeah. So typically, I always start kids out with glasses just so that they can experience it. But if a patient’s highly motivated and they really want to learn and the patient tells me, or the parents tell me that their son or daughter can be hygienic about wearing the lenses, then I think it’s a great option. I always like kids to be in daily disposable lenses, just because it’s easier than having to worry about, “Is the case clean? Are they cleaning the lenses?” Less risk for infection. And there’s so many different options for contact lenses now, affordable categories, depending on what patients are able to afford.
Tonia Caruso
How did you choose this as an area of medicine? I mean, we can tell you love your job.
Dr. Ellen Butts
I do.
Tonia Caruso :
Smiling ear to ear, as we discuss this all. How did you choose this area?
Dr. Ellen Butts
So I think eyes are absolutely fascinating, but specifically the moment of realization that this was what I needed to do came when I was 12 years old and I was at my grandma’s house in Canada. And there was a Reader’s Digest article that, on the front, had an image of the back of the eye and it said, “Look what your eye doctors can see when they examine your eyes.” And it showed the optic nerve and the blood vessels. And I just thought, “Lights and lenses, and that’s all we need to be able to image both the optic nerve and blood vessels and tell so much about what’s going on in the rest of the body. It’s just absolutely fascinating.”
And then on top of that, getting to care for the gift of sight, it’s just such a privilege. I have fun every single day that I’m at work. I love it. And I hope that my patients also have fun when they come in, because while we may not be a dentist, ’cause I know people really don’t like going to the dentist, it’s still not fun to have bright lights in your eyes. But we try to make it as enjoyable as possible. And I always try to use each examination as a learning experience.
So if my patient is motivated to learn, I would be happy to teach them about anything they want to know about eyes. So we often, if we don’t take pictures of their eyes that day, we’ll pull up pictures of someone on the internet that is similar to them and say, “This is what we’re seeing in your eye. This is why we’re watching it. This is what it looks like now.”, and kind of go from there.
Tonia Caruso
As we close, your last minute pitch to everybody about why they should get an eye exam.
Dr. Ellen Butts
You should definitely get an eye exam so that you know you’re seeing your best, but also that we’re able to pick up on other issues in your body and be able to take care of you early on. Because prevention is key, but also early detection is key.
Tonia Caruso
Well, Dr. Ellen Butts, thank you so much for coming in and spending time with us today. Some really good information. We appreciate your time.
Dr. Ellen Butts
My pleasure. This was really fun. Thank you.
Tonia Caruso
You’re welcome. I’m Tonia Caruso. Thank you for listening in. This is UPMC HealthBeat.