Sanjeev Grewal, MD - Cataract Treatments

Transcript

- [Randy] You're watching "The Wellness Hour," news that makes you healthier. I'm Randy Alvarez. Today's topic, the good news about cataract surgery. With us, we have an expert on the topic, board-certified Ophthalmologist, one of the busiest guys in the desert, Dr. Sanjeev Grewal. Dr. Grewal, welcome to the program.

- [Dr. Grewal] Hi, Randy. Thank you. Great to be here.

- Now, you know, I said, you're one of the busiest. We were on the phone last week, and it was about like 2 pm. And I said, "Well, how many of these do you do?" You already did 20 that day.

- That's right. That's right.

- So, are there that many people in the desert that have cataracts?

- There are a lot of people in the desert that have cataracts, people in the desert or older people, they're retirees, and these are the people that get cataracts. So, they're here and there's an innumerable number...

- Like, thousands.

- I anticipate thousands of them. Yes.

- Is that right?

- Yes.

- And now another thing that you said, that there's 10s of thousands of them that have the cataracts, and do nothing.

- That's also true.

- And they suffer a poor vision.

- That's also true. Yes.

- Is that right?

- Yeah. It's a shame because people have outdated ideas about what cataracts are and how to treat them. And so, people have a fear of surgery. They don't want to go get it done, when really, this is an opportunity for them to improve their lives and make things actually better than they were before. So, one thing I'd like to, you know, educate people on is that this is an opportunity, rather than something to be fearful of.

- Now, the cataracts, so this is all you do? I mean, in your centers in the desert, is this mainly what you do is cataracts surgery?

- This is the largest segment of what I do right now, and it's cataract surgery. There are some other things that I do. I also do corneal transplantation and ocular surface diseases, dry eyes, various other things that occur there. But the bulk of my practice is certainly cataract surgery.

- Okay. So, in the desert... And I know you don't have an exact number on this, but it's fair to say 10s of thousands have cataracts that are doing nothing.

- Randy, it seems like there's thousands and thousands of people, more than I ever imagined were in the desert, who need cataract surgery. You know, the population of Palm Springs, for example, is 40,000. I would guess there's probably 20,000, 25,000 women who need cataract surgery or are in that age of cataracts. So, there's innumerable numbers of cataracts and patients who need treatment for them. I see hundreds each week and it seems like there's hundreds more the next week.

- So, what age? I mean, what age are people getting cataracts?

- Many people get cataract starting... They actually start to develop, in everybody, around in age 50 or so. But we won't often mention it to people when we see them because it's not bothering them. It's not something that's any consequence to them. Typically, people become symptomatic from them when they're in their mid-60s or 70s. That's when they start to become symptomatic.

- Like, what are the symptoms?

- They get maybe halos around lights at night. They have difficulty seeing things as clearly as they used to, even with their glasses. They have to use a lot more light to read things that they want to read. They can't do the fine things that they like to do, sewing, or playing cards, various things they can't do because their vision is not as good as they would like it to be. Unfortunately, people a lot of time, just chalk it up to old age, "Oh, it's just old, so I can't see as well as I used to."

And this is not necessarily the truth. And it would be an important opportunity for them to come and see an ophthalmologist to be assessed for cataracts because very many of these people can actually improve their vision by having cataract surgery.

- So, cataracts, it's like your lens.

- Right.

- I have a limited understanding of this, but it starts to become cloudy, wrinkled. I mean, what's happening?

- Exactly. Well, the lens in our eye, keeps laying down layers your whole life. So, it starts off when we're children and it's clear. But new layers like onion skins are being laid on this lens your whole life. I mean, actually, there's so many of these layers that the lens starts to become cloudy, and starts just diffract light. You get a lot of glare from things. It also can give a huge of color.

So, things that were blue seemed kind of green now. Things that were white seemed kind of tan colored now. There's dingy. The onset of cataract, Randy, is really slow. It happens over many, many years. So, it's not like one day you'll wake up and not see as well as you'd like to. It's a very slow process.

So, sometimes people forget how well they used to see in the past.

- Yeah. So you were saying in the green room, you say that people don't even know they have them.

- Yeah. Very often they don't.

- They don't even know they have bad vision.

- Yeah. They...

- How is that possible that they don't know.

- I'm always amazed myself, quite frankly, because you saw that... And I tried and they can read very few of the letters, and they should be able to. There's no other problems with their eyes that are limiting them. I mean, there are people that have other diseases, even they can benefit from the cataract surgery because this is something that we can fix. You know, there are other conditions that we cannot reverse. Glaucoma cannot be reversed. We can treat it to try and stop it from getting worse, but we can't undo it.

This is actually something that we can fix. We can undo the cataract. We can take it away. Once it's gone, it's cured. It does not come back. It cannot come back. Back to your question about how they don't even know they're developing cataracts and how they don't even know how they used to see.

It's truly amazing. The onset of a cataract is very slow. So, every day there might be a minimal change in their vision. We don't remember things when they happen so slowly of onset. So, we can't remember 20 years ago how clear this used to be. Maybe we weren't looking at this, maybe we lived in a different house where there was different lighting. There can be lots of reasons why we don't know.

It's always dramatic to me, when we take out a cataract from one patient's one eye, they suddenly go, "Wow. The colors are so bright. The...

- Oh, really?

- Yeah. The things are so much clearer. That blue thing is not really blue, it's some other color, or that green wall was actually blue. Then they're like in a rush to get the second eye done because once they've had it done, they realize it's not really that bad. It's not a surgery, in terms of getting a knee replacement or a hip replacement.

- Is there, like, no downtime? I think that's what one of your associates told me, very little.

- There's almost no downtime. I mean, the restrictions that I tell patients are you can't go swimming underwater. You can't lift anything that makes you strain. And you can't play contact sports for two weeks. That's about it.

- Oh, that's it?

- And in this age group, that doesn't include very many people.

- Are you wearing those big giant glasses?

- No, Randy. That's an old idea.

- Oh, really?

- Yeah. We have people wear a clear shield for maybe one day, maybe a couple of nights when they're asleep, so they don't poke themselves when they're sleeping. And that's it. Really, during the day, they can wear some regular sunglasses that they have.

- I'm paraphrasing slightly, but one of the things that sticks out, you say that in one afternoon, their whole life can change, transformed. Elaborate.

- It's amazing. Not only in one afternoon, Randy. These surgeries, take maybe 6 to 10 minutes to do from start to finish.

- Really?

- That's all it takes.

- So, you can do that?

- Yes. Yes. Now, they might be there for a couple of hours. They have to get ready and have their surgery, but the actual surgical time can be just less than 10 minutes for most people. And in that short period of time, we can effect a change that can really change how people live all together. In that short time, you can really effect a change in somebody's life. They can go from not seeing at all to, like, really seeing the things that they enjoy in their life, just in that short period of time, few minutes, maybe 10 minutes is all it takes.

And one of the biggest problems that people face as they get older is social isolation. I have an example of a patient who I had, who really became very socially isolated. He was an older man. He lost his wife many years ago and he lived in a rural area. So, eventually, his vision got so bad that he couldn't drive. And then he became even more isolated. And unfortunately, last year, the fires in the desert, his house actually burned down.

And tragedy, total tragedy, he was forced to move in with his sister, who then brought him in for an assessment. His vision was so bad that he couldn't even see to feed his dogs anymore. His dogs were his beloved creatures. They were like his children, at this point. And so, this is what actually motivated him and his sister to bring him in to get assessed. He had this fear of having surgery. He had some bad surgical experiences before.

Understandably, one could be anxious. It is a surgery. It is something to be a little, you know, anxious about. But once we talked about it, he was willing to undergo the procedure for one eye. So, after the first surgery, he was already dramatically changed within a day. He could see his dogs again. He could feed them.

He was well on the way to regaining his independence. And within a few short weeks, he was moving back into where his home was, to rebuild it. He was taking care of his dogs and he was working on getting his driving license back. Within a month, we were doing his second eye. His life is changed. He now told me that he's dating somebody, actually. He's found a new love.

- Is that right?

- Yes. At age 76, he's found a new love.

- Because 76 in the desert is very young. And so, if you can't see very well, it limits you.

- Absolutely.

- A lot of golfers are in the desert.

- Oh, yes.

- Are they doing this?

- Yes, they are. I have a good example of a golfer too who wasn't able to play golf anymore. He couldn't swing the ball. He was hitting into the pond and all over the place. But he came in, we talked about specific lenses for him.

- Like, what did he ask?

- Like, what's your typical console like, like, with that guy? What do they want to know? What are their fears?

- They're afraid of surgery. They don't want to go under anesthesia. A lot of people think that you have to be under general anesthesia for surgery. You don't. This is really done with local. We put eyedrops in to numb your eye, and that's all most people get.

- Is that right?

- Actually, that's all they get. Yeah. And you don't feel the pain. It's over before they know it. A lot of people tell me, t the end of the surgery, "Gosh, that's it? You're done. That's not even as bad as getting my teeth cleaned." I mean, it's really not anything that people... Then they go, "Well, I'm ready to get the second eye done."

After it took them five years to get them to commit to do the first one, they want to do the second one in a day. It's probably the most common question I get. When can I do the second one?

- Now, I interrupted you, but the golfer, so the golfer comes in and he asks those questions, the guy couldn't see the ball, what happens?

- So, the golfer, he wanted to be able to follow his ball as it went out, as he struck the ball on the golf course. And he wanted to be able to read the menu when he got to the 19th hole to see what cocktails were on special or what he could have to eat that night. These were the things that were important to him. This is a guy who's always depended on glasses.

- Like, for readers, for reading, kind of a thing.

- He had two pairs in his pockets this whole time. He had one pair to see distance and a different pair to see reading. He didn't like bifocals. He couldn't adjust to them. So, he'd always be carrying these two glasses around and losing them, and spending more money on glasses. It was very frustrating. But there came a point when even the glasses weren't serving him well.

Even with the glasses, he couldn't see to do the things he wanted to do. That's what brought him in the door. So, we looked at him, we talked about what his goals were. And we decided that, for him, the best lens was a multi-focal lens, kind of like a multi-focal glasses They let you see far away and they let you see up close. This met his needs of seeing the golf balls that went off, sometimes into the water, unfortunately, and also to be able to read the menu when he got to the 19-hole, and not have to worry about these glasses in his pockets.

He was uncluttered. He felt liberated from all these things. And, you know, when your life is based around something like golfing because you've earned that by working your life hard, that really changed his life. He was such a happy man. He always came in with a smile.

- Now, did they ever say, like, "I should have done this years ago?"

- All the time.

- Is this one of those things?

- All the time.

- Like, "Why didn't someone tell me earlier?"

- Well, there's a lot of old information out there.

- What does that mean?

- People think that cataracts have to get ripe. This is kind of an old concept.

- But isn't that true? I mean, for insurance to cover this, you have to be at certain level of cataract.

- Well, to some extent, you're right. But the concept of ripe is old. Ripe used to be because the surgery was not that good.

- Right. So, ripe meaning, like, they're not ready to do surgery yet.

- They would be filling they're way around the house. Yeah. These are people who... They were only ready for cataract surgery when they completely could not see. They couldn't see, you know, the door in front of them. They couldn't walk around. You could see white things in your pupils when you looked at them.

That's really an outdated idea. The surgery wasn't that good back then. So, we waited until people were really disabled to do it. Now the surgery is so much better, that we actually are improving people from where they were before. People who always have worn glasses don't have to wear them anymore.

- Oh, really?

- People who maybe never have seen really good, can see really well now. It's really a dramatic change. It's actually not just making things as good as they were before, which is what we do in a lot of surgeries. If you break your hip, you want to get a hip that works as well as your old one did. We actually can see people who were dependent on glasses or contacts or couldn't see anything, and now they can actually function without that. They have better vision than they'd ever had.

- So, with cataract surgery, okay, so you're giving them like a contact lens. I'm calling it a contact lens, but you're getting a new lens with, like, a little bit of a bifocal and also correcting their... What about astigmatism, things like that? Can that be done at the same time?

- Absolutely, Randy. There's lots of choices available just now People who have had astigmatism, which means that they have distortions in their vision that cause images to be smeared out, kind of. That's the best explanation that I can give.Those requires special kinds of corrections in your glasses or contacts. We also need to have those available for the lenses that we implanted after cataract surgery. so we can correct somebody astigmatism so they don't have to wear glasses or contacts to correct that.

It's pretty dramatic. And we can also do that with multi-focals. So, if you have astigmatism and you want to see near and far, you can get the whole shebang and get everything taken care of.

- You call them multifocal lenses.

- Multifocal.

- So, you got the cataract surgery.

- Yes, sir.

- And it's just a different kind of a lens. That's kind of custom-made, like, a contact lens. -Exactly. It's kind of like a contact lens, Randy, but instead of going on your eye, it goes inside your eye, which means, you don't have to take it out. You don't have to clean it. It doesn't feel uncomfortable. You don't have to change it.

Once it's in there, it's yours to keep - How long are they supposed to last?

- These will outlast all of us. Once it's in your eyes, it's permanent.

- So, if you're 80 and you live to be 106...

- Your lens will outlive you.

- You're gonna be able to see very nice?

- Absolutely.

- These are old people. You know, I've had doctors on the show. We talk about fall prevention, the pain management physician, Dr. Reinhardt in the desert. A lot of people fall.

- Absolutely.

- And a lot of it is because they can't see?

- Absolutely.

- I mean, does that happen?

- Sure. Pavement is uneven, curbs to step off of, stairs to go up, up, ramps. There's all these things, poorly lit areas where people fall. A fall when you're 90, can be really devastating. That can be the beginning of the end for you because you break your hip and then you end up in hospital. You get an infection. It's a downward slope for many, many people.

But we can prevent that if you can see, if you can be safe around your house. You can walk over the edge of the rug. You can see where the step is. You can find the incline and be safe. So, if you can see better and function better, you may not end up having any of these other problems.

- So, HMO Insurance covers this, PPO Insurance covers this, Medicare covers this.

- If we can document that somebody is having some problem with their ability to function, it will be covered by insurance.

- Like, at my age, if I legitimately am driving and I'm starting to see halos, which I don't, but I know people my age with a lot of halos going on.

- Yes, sir.

- Those people would be candidates and insurance would cover, even though they're not so-called "ripe?"

- That's right. That's right.

- Or it's not progressed enough.

- As long as we can document that there's some visual impairment, that they're having some functional disability, they can't drive at night safely. They can't do some things they need to do for self-care. They can't read the bottoms of their medications. These are important things for people. So, insurance will cover it if we can document that there's some functional disability. Now, having said that, these premium lenses do cost extra.

Your insurance will pay for the cataract surgery still, and they'll still pay the cost of the basic lens implant. If you want to have one of these other choices to improve your life, to make things better, they're available to you. You just pay the difference in cost.

- It's not that much money, by the way. I know the fee. It's not that much money, for even at the highest end, you can get this done. And since we're talking about the vision here.

- I agree with you, Randy. I think a lot of people sell themselves short.

- Sell themselves short?

- Yeah. Sell themselves short. They're 75 years old and they say, "Well, I don't wanna do this for me, it seems like it's too much. It's too much expense, I shouldn't do it. I'm not worth it. I'm not gonna live that long. I'm an old person and I shouldn't be doing these things for me.

This money should go to my grandkids," whatever it is, okay. They don't realize now that they have 25 years left of their life. Thirty years left, they should be functional. I mean, the better you see, the better you can do all the things that you require your vision. I mean, what things do you do without your vision in a day? I use my vision all day long. How about you?

- Yeah. Yeah.

- Everything we do is based on vision.

- So, if you're lucky enough to live to be 80...

- Which is many, many people these days.

- Right. I mean, people are going to live to 100 now, all the time.

- Yeah. Absolutely. Yeah. The people come in and say, "Well, I'm 70, what am I gonna do this for?" And I'm like, "Well, we've got 30 years left, you don't want to see? You want to see and you want to see better." And once they get around that and they say, "Yeah. I am worth it.

And this is very important to me. And this is gonna affect all aspects of my life," then they understand it. And also, the economics of it makes sense. You're not spending this money for a one-year improvement. You're spending this for maybe 30 years of better vision, 30 years of better function, 30 years of independence. It's very important to sort of re-assess our constraints that we have.

- So, I mean, you're one of the busiest in the desert. In fact, you're the third-largest ophthalmology group here in the United States. Now, you work with optometrists, local optometrists in the desert, all over the desert. So, they'll still keep their optometrist.

- Yeah. If you have a good relationship with your optometrist, you should keep that relationship. It's important to have somebody that you can go to when you have a problem, if you need some new sunglasses, if you need to be tested for glaucoma. All of those things can be done by your optometrist still. But if they decide that you have cataracts, you can come and see us, we can take care of that. We can help you to see better and you can still retain the relationship you have with your current optometrist.

- Numbing eye drops.

- Numbing eye drops.

- Numbing eye drops for most people...

- That's all they need for most people.

- ...you do the surgery 6 or 9 minutes, they walk out, pretty much no downtime.

- Exactly.

- One day, maybe stay out of the Sun, you can't swim underwater. But you're back seeing great.

- Absolutely.

- Did they report that, "Yeah, I see really well," right away?

- Absolutely. A lot of people will see immediately well, within a few hours. Some people may have a little bit of swelling, it may take a few days. But that's a small price to pay for improved vision over many, many years yet of your life. So, it's really a very little downtime for people.

- So, you know, I mentioned this in the green room, my father's 82 years old, right? And he goes, "I've never had cataracts. My vision is fine." But he's driving at night, and I'm worried about it.

- Sure. Sure. Sure. So, would you say everybody has a little bit of cataract or some cataracts at 82?

- Actually, Randy, it's true. Most of us will develop our cataracts starting in our 50s. Now, we will see them when we look at people, but if you're not having a problem, if you don't say to me, "I can't see well," we're not going to maybe mention it to you. There's lots of things that go on in the body normally over time, and this is kind of one of those aging processes. I like to think of it really not as a disease, but more like a normal aging process. So, basically, I tell people, "If you live long enough, you're going to need cataract surgery.

- So, everybody gets cataracts?

- Everybody will get cataracts.

- If you live long enough.

- Absolutely. Yes, sir.

- Okay. Is it more women getting treatment than men because men tend to put things off?

- You know, us guys, we don't like to go to the doctor, so it's true. Men like to not go to the doctor. They think that things can be put off. It's true. So, a lot of times, they'll be coerced by somebody, their daughter, their granddaughter, who says, "Hey, papa. Why don't you go in and have these looked at? We can take care of this for you. We'll drive you to the doctor. We'll take care of it." So, they'll come in reluctantly, and we'll have a talk, and figure out what their goals are. And 9 times out of 10, they're very impressed and want to go forward with it.

- So, this 70 plus, is that close to an average age of the people getting cataract surgery?

- Yeah. I would say that most people are in their mid-60s or higher.

- Okay. And of those people, and I know we don't have exact numbers on this, I don't think you do, that these people probably had eight, nine years of bad vision before they finally get it done?

- That's also true because the onset is so gradual. It's not like you wake up one day and you can't see. It's a very gradual sort of reduction in clarity.

- Is it like hearing? You know, the say that with hearing, you lose it so slow, you don't even know you can't hear.

- It's very similar. It's a very similar thing. You just lose it very slowly. So, you don't have a comparison. You don't remember what your vision was like 20 years ago. I can't remember what things were like 20 years ago. Can you, Randy?

- Not the way I saw.

- So, the onset is so slow that we don't have this comparison. They do have the comparison, however, when we take one cataract out and they can compare how they seen the other, they go, "Wow. I didn't realize things were so bright or these colors were so wonderful, or I could see things so well." A lot of times the wives will say, "Thank heavens. I can turn those [inaudible] lights off that we have all over the house." They can bring it back down to a regular.

- Oh, I see.

- Because these guys are asking for more and more light all the time, so they can read or do the things they want to do.

- Is it common that one person will go in, they get it done, they see well, and then they bring their partner, drag their partner in?

- But it's less of a drag the second time because they know that there's not a lot of downtime. They know that it's a quick recovery and they know the results are good. So, actually the second person is easier to bring in than the first.

- Is that right? Because they're kind of sold on the whole idea.

- Yeah. Absolutely.

- Now, this premium lens thing, where you can get people that wore glasses, they're 75, and they've been wearing glasses since they were 10 years old. Are there cases where those people are glass-free?

- Yes, there are. Absolutely.

- Really?

- Yes, sir. Because when we're taking your cataract out, we're taking the lens that was in your eye out. So, we now can put a lens in of any power we choose. So, we use some calculations to come up with the power that you need to do the things you want to do. So, if you want to see near and far, we can figure out...

- So, somebody is in their 30s wearing glasses, you know, they did their LASIK, but they still have issues or whatever, could they get a premium lens or it's not indicated for that?

- Well, I mean...

- Is that the future?

- It might be. There is a process called clear lens extraction that some people do, do. The risk benefits are still being weighed on that. So, there's not a clear conclusion on that one.

- Okay. But cataracts, over 50...

- Over 50, clouding of the lens that we see.

- So, if you're 60, you probably have cataracts.

- Oh, yeah.

- Period.

- And also, Randy, there are younger people who develop cataracts. People who have had injuries, people who've been on steroids medications. They can develop cataracts in an earlier age. So, they can have them and they can be real, and they can really have visual impairment, just the same as their grandfather or their grandmother does. And the surgery that we do for them is the same. But those people have an even longer period of time to live with these lens implants. So, even more reason for them to think about getting these better lens implants that give them a lot more freedom, near and far vision clarity without glasses.

- Now, I've talked to one of your founders, and you have more than 42 locations across the country at acuity. And Tom Chang pretty much says he is kind of.. I'm paraphrasing but, like, he scoured the U.S. to find some of the best surgeons in the country.

So, for people that don't know your company. You guys have this, where you do everything under one roof, like, many, many specialists.

- Yeah. Our goal is to kind of be the one-stop shop, so that people who have eye problems, can get them all taken care of here. We can do everything from dispensing glasses to doing refractions, defeating contact lenses to treating glaucoma and doing cataract surgery, and taking care of retinal problems. There's the whole spectrum of things that we have.

- Sure. Retina specialist, cornea specialist.

- Absolutely.

- Everybodys...

- In fact, our founder is a retina specialist, a very well-known and renowned one for various problems in the eye. We also have our own optometrist. So, if somebody doesn't have an optometrist, they can come and see us for refractions and glasses, and contact lenses, and all those things as well. So, we have a great group of people, really great knowledge base, lots of good skills available, and you only have to come to one place to get all of that.

- And you can do 20 of these in a day?

- Absolutely.

- What's your record? Do you have a record?

- A short day. My record is 26, 26 in a day.

- Twenty-six. And that's not rushing at all.

- That's not...

- It's just because it doesn't take that long.

- I have downtime between the cases. I'm doing other things, lasers or taking notes or things like that between cases.

- Who is more stubborn, the 80-plus crowd or the person that's just phobic about surgery?

- Wow. Phobic people are very difficult because sometimes it's hard to convince people differently than the set of beliefs they already have. So, they either have to have somebody close to them who had it, that they can see that this is better or, you know, they come and observe, watch a video, learn things. It takes a little while to change people's fixed ideas about things.

You know, they may base their fear on something that their grandmother had or some lady down the street may have had. And, sure, people can have bad outcomes. But overwhelmingly, the outcomes of cataract surgery are positive, and people do see better afterwards.

- That's one of the few things, surgically, where you told me they're better off than they were when they walked in the door.

- There are very few things where you end up better off after surgery than you were before. Most of the time we're attempting to give you back what you lost. This time, we can have an opportunity to make things better than they were even before you developed the cataract, so by not having to wear glasses for near or for far.

- Is this the new aging gracefully? I mean, if your 70s, 80s which is young today.

- Sure. Sure. Sure. I think it's part of it, you know. I do hear complaints sometimes when people get their cataract surgery, that they can now see the bags under their eyes and the wrinkles on their face, so they want to go out and have those dealt with. But it's nice that people are... Self-care is ...

- So, they realize they don't look so good after all.

- Yeah. Absolutely.

- Because now they can see clear.

- Randy, I've had the opportunity to go abroad and do mission work in the third-world. And one of the most interesting cases was this gentleman who was blind in both eyes and was unable to hear his family. And so, it was in the Phillipines.

- Blind because of cataracts?

- Because of cataracts, which is actually one of the leading cause of blindness in the world, overall, if you can believe it. And there are still people in the United States who go blind from them because they fear, fear of cataract surgery or because they don't know that it can be fixed. So, this gentleman, we did cataract surgery in his first eye, and we took the patch off on the first day, and he looked and he said, "Who's this old woman across the room?" And it was his wife and he hadn't seen her in so many years.

- Oh, my goodness.

- I know. That was not good.

- Oh boy.

- We gave him a mirror. He looked in the mirror, he saw that he wasn't so young anymore, too.

- So, you ended up doing both eyes?

- We did. Yeah. Yeah. In a short period of time. And he was able to actually regain functionality and not be a burden upon his family. You know, in the third world, when you can't see, that means that, not only are you and unable to do the things you need to do, but usually a child is to take care of you during the day. So, they're also not able to go to school and learn, and do all those things.

- Now, one of the things I'm picking up on because these are people in their 80s that maybe walk a little slower, they're a little less active because they can't see very well. So, you give them back a clear lens in 6 or 9 minutes, it takes you to do it. And they start walking faster?

- Absolutely.

- Do you see their mannerisms are different?

- They walk slow because they can't see things. They're worried about falling or tripping over something that they can't see. When you can see it again, you gain more confidence and you can then be more mobile. My mother always tells me, "If you don't use it, you lose it as you get older." So, she likes to be very active. She's in her 80s. And my mom and dad went to Machu Picchu recently and climbed up, you know, in the mountain.

- So, they have new lenses?

- They actually do. Both my mom... I do.

- Did you do it?

- I did not. No.

- You didn't do it?

- I did not. Yeah. So, it's very important as you get older that you keep using your facilities, all, you know, your muscles, keeping them active. So, if you're not going out because you have fear of not seeing something, and tripping, and falling, it's not good. Once you have confidence, you can see those hazards and navigate them safely, you become more active and you can go out, and walk around, perhaps even hike. You can go golfing. You can walk on the golf course.

You can do all these things that maybe you didn't feel comfortable doing before. So, it can really affect everything in your whole life. It can really snowball into a big improvement for you.

- We're short on time. But what's your oldest patient to get this surgery?

- Randy, this is a fond memory of mine because a lot of people come in and think they too old for cataract surgery. Well, the oldest patient I was operating on is actually 101 years old.

- Why would they want to go through that?

- Because he couldn't see anymore. He couldn't see his grandkids. He wanted to see his grandkids, so we did cataract surgery for him. He was able to see his grandkids and he actually lived to be 106 years old. So, he had five more years of life that he could see and function, in which... That's kind of stuff moves me.

- And his vision will stay as long as he stays?

- Yes, indeed.

- Premium lenses, as a recap, there's options. So, cataract surgery is covered by insurance, period?

- Yes.

- Medicare, even VA?

- Absolutely.

- I guess you are working with VA people.

- We do have some VA patients. Yes, indeed.

- Okay. But the premium lenses cost a little bit more.

- Exactly.

- These are the ones where they could get a prescription like a contact lens.

- Correct. Yeah. We can give them freedom, independence from glasses or contacts.

- And you have financing for that if they need it?

- Yeah. Absolutely. If the number seems too high for people, you don't have to pay the whole thing at once. We have ways that they can pay over time and enjoy this benefit for the rest of their lives, really.

- The people that get the premium lenses, are they the happiest group? That means the people that now they don't have to wear glasses. They don't have to wear readers at dinner or have a flashlight.

- They're very happy, Randy.

- So, really, no flashlight, like, at dinner?

- I mean, you know, some of these restaurants are pretty dark.

- That's true.

- I need a flashlight sometimes, maybe. Yeah. But, I mean, people who are well-selected and are good candidates for this, their lives are better. They're very happy. And I very rarely hear people say that they regret it or, you know, wouldn't recommend it.

- Yeah. Do they need a referral from their optometrist to see you?

- Well, some do and some don't. But if you're not sure, you can come in and see us and we'll figure it out. We'll get a prior authorization from your insurance. We'll take care of all that. That's what we do.

- How long does it take? If somebody wants to go, they're in their 60s, because you say most 60-year-olds have a little bit of cataracts, they go in, how long before you say, You're a candidate, you have cataracts?" - Usually, we'll know it on the first visit. We'll see them. You can see that that's the cause that their vision is not as good as they'd like it to be. And that's something that we can treat, so we can talk to them about cataract and get the ball rolling for them.

- We are out of time. I want to thank you for coming on the show. Final message. Somebody, they're 55-plus, their vision is starting to go, especially, if they're 60-plus, what's your advice?

- First thing is, don't be afraid. Second thing is, don't conclude that this is just because you're getting older because a lot of times this is something that we can fix. You can come in, we'll see you, we'll diagnose you with cataract. You can discuss the lens options that are available to you and we have the potential for improving your life for the rest of your life.

- Okay. Good. I want to thank you for coming on the show. Excellent stuff. Thanks.

- Thank you, Randy.

- You've been watching "The Wellness Hour." I'm Randy Alvarez. For now, I wish you good health.

- [Man] Thanks for watching "The Wellness Hour," the leader in "Medical News," with your host, Randy Alvarez, the authority on health issues. ♪ [music] ♪