Joel Solano, MD - Cataract Treatments

Transcript

- [Randy] You're watching The Wellness Hour, news that makes you healthier. I'm Randy Alvarez. Today's topic, what you need to know about cataract surgery. With us, we have an expert on the topic, board-certified ophthalmologist, Dr. Solano. Dr. Solano, welcome to the program.

- [Dr. Solano] Thank you for having me.

- All right. Now, for people that don't know your centers, who's the typical patient? And what are the different services you offer?

- So, we're located in the desert. We've actually got offices throughout all of Southern California. My office is primarily in the desert community. So, we do tend to get a lot of, you know, more older patients, more of like a retirement active community. But the nice thing is that under one roof, we're covering virtually any type of problem that can occur with your eye from the front of the eye at the tear

[inaudible] all the way back to the retina.

- So, what are the different services you offer then?

- So, the good news is that there's a lot we can do. The primary reason that people come to see an eye specialist, especially once they hit age 50 or older , is cataracts. You know, that's, that's the number one operation being done in the U.S. It's the most successful operation. So, unfortunately, it does occur a lot. But the good news is that we have very good treatment options for that.

- So, everybody gets it. I mean, if you live long enough, you're going to get a cataract?

- It's true, you will.

- And so, by definition, what is it?

- So, think of the lens which lies inside of the eye, that's a structure that sits right behind the pupil of your eye. When we're born, that lens is nice and clear. The issue is that through exposure to ultraviolet light, and as we age, that lens starts to get cloudy. So, imagine a cloudy lens, blocking the pupil, the light is unable to get through that pupil very well.

And subsequently, your vision gets blurred.

- Okay, I have a lot of questions about cataracts. But, you know, the second part of the show, I have questions about what you could do for dry eye, things like that.

- Yeah, that's a pretty important topic, especially in the desert. You know, the humidity levels are very low so, people tend to come in. What's interesting is they come in with tearing of the eyes, and they say to me, "Doc, my eyes are tearing." And they kind of look at me funny when I say, "Well, it's because your eyes are so dry." They say, "Doc, how can my eyes be dry when they're tearing?" You know, some patients even have the tears running down the face.

It all has to do with the mechanism that the eye has to actually try to rehydrate itself. So, when it gets to a point where it's so dry...

- Starts watering.

- ...it starts watering.

- Is that right?

- Right.

- Is that an easy one to fix, by the way?

- Fairly easy, but especially again, with the community that we see, we tend to get a lot of people with connective tissue diseases like arthritis or lupus, these types of things. And those patients tend to suffer a little bit more than the typical patient will. So, those can be a little bit more challenging. But the nice thing is, we've got a lot of great treatments for these things.

- Okay, good. Let's talk about cataracts for a moment. How big of a problem is for people over 50, 60, 70?

- Pretty much everyone gets cataracts. You know, the problem with that disease is that people tend to put off the treatment too long. And so, they end up getting themselves into a situation where, you know, they're not enjoying the things that they used to. I've got guys that come in and you know, their buddies won't play golf with them anymore, because they can't see the golf ball and they find it, you know, too annoying to be keeping track of the other guy's balls.

- Is that right?

- So, the spouses will come in and tell me, "You know, Doc, you got to fix my husband, because he's staying at home too long and his buddies won't take him out to golf anymore."

- Nobody wants to golf with him.

- Nobody wants to golf with him.

- Because they can't see. So, there's a lot of that, and by the way. Okay, so, is this one of those things where because insurance covers it...

- That's right.

- ...Medicare covers it. And if you live long enough, you're going to get cataracts.

- That's right.

- So, the lens starts to get like wrinkles in it, or...

- Well, it gets cloudy.

- Like cloudy. Okay.

- That's right. I mean, in the more severe stages, it certainly can get wrinkles. So, the primary reason people aren't seeing well is because that lens inside of the eye where the cataract occurs is getting cloudy. So, it's not really that the lens is getting wrinkly, it's more that the lens is becoming pacified so that the light can't pass through it and reach the other structures in the eye that received the light, what we call the retina, but it's more like the film in the camera.

That's where the light is received. Again, if it's hitting that cataract, the light is scattering and it can't get to that part.

- So if a guy is 50, 60. There's people 50 because that's young today, right? Fiftys and sixtys.

- Yeah.

- People say, "Well, I'm not quite ready for cataract surgery." I mean, is that kind of what goes on?

- I don't know that that's a really fair way of putting it. You know, once you have a cataract, if you're struggling with activities of life, you know, if you're struggling with reading, or your friends aren't playing golf with you, it really doesn't matter how old you are. You've got the disease, and something really should be done about it.

- So, driving at night, is that the tough one?

- Randy, that's a big one. I get plenty of folks that, you know, they won't go to supper after the sun goes down because they're uncomfortable driving at night. You know, they're missing out on dinner parties with their friends, again, because they're just not comfortable driving in the evening because of all the glare and halos that they're getting. And that's really a shame. I mean, this is something that, you know, if you're diagnosed at 50 with it, and you put it off until you're 70, well, that's 20 years that you could have enjoyed life.

And the other side of it is that, not only would you get it done sooner, but the operation is actually easier to do the less advanced the cataract is.

- So, with cataract surgery, I mean, is this true? We talked a little bit on the phone, but somebody it's like a 15-minute procedure if everything goes right, right?

- That's right.

- There's really just about no downtime?

- Right. It's an afternoon, you know, if you were planning to have lunch with your friends, that's about as long as it would take for you to have your cataract addressed. So, it's really...it's a life-changing afternoon.

- So, your patients that get the cataract surgery, is it something that they what...they've been living with bad vision for 5 years, 10 years?

- Well, it's just such a range, Randy. Some people, you know, they'll not see a doctor for many, many years, go in and see their optometrist who very astutely diagnosis cataracts and sends them over right away. But you also have those patients where, you know, they're men, they're stubborn, and they refuse to see the doc.

So, they'll live with it for you know, a decade or two. And again, those are the guys that get drug in by their spouses, typically.

- Okay, so, at what point does somebody need to start taking it seriously? Because we talked. The optometrists, which you work with, all the desert optometrists that they're in a tough position because these people you say, they go in, they've got cataracts, the optometrist told them they have cataracts, they do nothing. And they have to get new vision prescriptions, like every six months or every year.

- Yeah.

- Does that really go on?

- Absolutely. And it's frustrating for, you know, the optometrists and the patients as well. The optometrists feel bad that they, you know, have to keep reminding the patients that there's a reason their glasses are changing, it's the cataracts. But they also at the same time, don't want to be too pushy. And so, it's a fine line that they're walking. You know, they do an excellent job of diagnosing, but it's really ultimately up to the patient to say, "Hey, you know, who else can I see? What more needs to be done?"

- So, everybody, you're of the opinion, they at least know their options, right?

- Absolutely.

- See a board-certified ophthalmologist.

- Yeah, and even the optometrists, particularly in the desert, we've got a handful of just wonderful optometrists that are excellent at seeing patients, diagnosing the disease, and then, you know, depending on what disease they have, getting them referred out to the appropriate specialist. So, it doesn't even have to be an ophthalmologist. It can be you know, any of our primary care providers.

Just get an eye exam so that we figure out what's going on.

- So, people that I guess can't see very well, now they could see, it's life-changing for many of these people.

- Well, it certainly can be, you know. I get folks in all the time with various different stories. From gardening, you know, all the way to reading. I've got one lady that every spring comes in, and she brings me a little bag of cherry tomatoes, you know that she's able to now grow her own vegetables again. She'd stopped gardening because she couldn't see well. And that affects your life tremendously.

And this is a lady that uses gardening as exercise and was no longer able to do that because she couldn't see well. You know, you come in and one afternoon later, she's back to doing the things that she loves. So, yeah, I think absolutely it's life-changing.

- If this is such a predictable procedure, cataract these days, cataract surgery, why aren't they all doing it? I mean, what they live with this for like 10, 15 years 20 years sometimes?

- Randy, think of it like your hearing. You know, when people start to lose these things, it's a gradual decline. It's not something that changes overnight . And so, the vision is the same way. If these cataracts aren't progressing rapidly, if they're changing slowly, sometimes they may not notice that they're no longer driving in the evening, or they're not, you know, reading their scriptures anymore, or going out to dinner with their friends.

These are all things that, you know, maybe if they happened overnight, they would notice them, but it changes so slowly that oftentimes they miss it.

- And when they get it done, how soon do they see better?

- Well, the next day.

- And what do they say to you?

- Well, usually I get a lot of hugs. So those are my favorite clinic days, is the post-operative days they come in and it can be a, you know, a heartwarming day for me in the office. Those are some of my favorite days. I had a lady that came in for her afternoon post-operative appointment, the next day, and she said, "Doc, I didn't realize that I wasn't seeing The Prices is Right anymore." And it may seem like a little thing, but it's really not.

You know, if your primary source of enjoyment is, you know, watching television or interacting with friends or seeing your grandchildren's faces, and you can't do those things anymore, that's a big impact that it makes on your life. So, absolutely this thing can really change your life around.

- Now, because you're replacing, what, the lens, is that correct?

- That's correct. So, the lens, think of the lens as that structure that's right behind the pupil. And that's precisely where the cataract is. So, the entire cataract needs to be removed in order for us to be able to get you to see better.

- So, what's the holdup then? Is it just the fear of surgery or it's called surgery?

- Perhaps, Randy.

- But if it's a 15-minutes procedure, there's really no downtime. You tell them to take it easy for about a week. They see better immediately.

- Yeah.

- So what is it? Is there a misconception about this?

- Yeah, perhaps. I don't know that people come in and necessarily tell me that they're afraid of the operation. You know, plenty of people have had it, they've talked to their friends, they realize that it's not a difficult thing to go through. Again, I think it's maybe just the progression of the disease is so slow that they may just not realize it.

- How old can you be? I mean, there must be a cutoff age - No cut off. I have one lady who's 102 years old.

- Why would a 102-year-old want to go through this?

- Oh, that's...again , she wanted to see her grandchildren's faces, you know, she's had great-grandchildren at that point. And these are important things to people. You know, again, if it's such a gradual change and a slow change, you might not realize it until the day after surgery. She's seeing her grandkids for the first time.

- Back to the lenses, are there tinted lenses? I mean, are there...

- Yeah, so, we've got a lot of great options for lenses nowadays. That's something that really has to be tailored specifically to the patient. So, when they come in for their evaluations we'll get all the measurements that we need, do the examination and then we'll talk about the lenses that are specific for that patient's eye health and what their eye is really going to tolerate well.

- Now, what if they have poor vision, and they have the cataract, right? They have some vision problems and a cataract. Can you do two procedures on the same day?

- Yeah, absolutely. And, in fact, we do that pretty often, especially those like us out there that are you know, certified in multiple different specialties. I get plenty of patients that come in that have glaucoma and cataracts at the same time, they've got crummy vision, they're struggling with their life. And literally, we can take care of all those things with one trip to the operating room.

Instead of before, it would be multiple trips.

- Okay, so they have glaucoma, and they have cataracts, and you could...is the downtime, much different for that?

- It's really no different.

- Really?

- The operation itself might take 5 to 10 minutes extra minutes. So, that's a little bit of extra time in the operating room. But the downtime is really the same as it is, you know, for the recovery of just the cataract operation.

- So they're not walking around with patches over their eyes?

- We do or I do like to keep their eyes protected overnight.

- Okay.

- Again, because people when they're awake, they know better than to be scratching their eyes, or they know better than to rub it. But when you're asleep, you know, they could accidentally feel something and want to scratch it. Or maybe they'll lay on it. So, I do have them just protect it overnight. But during the daytime, they don't have to wear these patches.

- They can wear their regular glasses or sunglasses or whatever?

- Or sometimes nothing at all.

- You don't need the big plastic?

- You don't need plastic glasses. You can certainly wear those if you're having some light sensitivity, you know, in the desert, we get a lot of sunshine. So, if you want to wear the big dark glasses, absolutely no problem with that. But they certainly don't have to.

- So, what should you look for a doctor that's going to be doing your cataract? And I want to ask you questions about dry eye coming up in a moment. But what should you look for in a doctor that's going to do your surgery?

- I think primarily you want a doctor that you're comfortable with. You want a doctor that's going to explain things in terms that you understand. The reality is that doctors are all very well trained, we all do a good job. But I think that connection is what's so important, so that they feel comfortable telling you, "You know, these are the symptoms that I have, doc. What are my options to get these symptoms addressed?"

- Now, what about lasers for cataracts? You're doing that now?

- That's right. Probably about 20% to 25% of surgeons in our country are now using lasers at the time of cataract surgery. The problem with laser surgery is that Medicare doesn't cover that cost. So that's an additional cost that needs to be passed on to the patient.

- All right.

- But absolutely, it's making our operation safer, more reliable. It's taking all of those incisions that used to be in the surgeons' hands and putting them in the hands of the laser which, you know, I don't care how good your hands are the laser is perfect.

- There's a term... I guess to be covered by insurance, your cataract has to be a certain level, right?

- Yeah.

- And they call it being ripe. And they want to know if their cataracts are ripe enough for surgery. What does that mean?

- Yeah, I get a lot of patients that come in and they say, "Well, Doc, I waited to this point, you know, I can no longer read, I'm not enjoying the crocheting anymore. But I just thought they weren't ripe enough." And the reality is that if you have a cataract, the time to fix it is when you can't do the things that you enjoy doing. So, it's my job to tell you you have a cataract. It's your job to tell me when it's affecting your life. The minute it starts affecting your life and you're no longer you know, driving in the evening, or hiking or skiing, doing things that you enjoy, that's the time to fix it.

- Get something done.

- Get something done.

- So, if you're driving and what are the cataract symptoms, just what, flares, what is it?

- Glare and halos. Those are the big ones. So, blurry vision, glare, and halos. Those are the three things that I hear every single day in the office.

- And that goes away, right after the surgery?

- Goes away with it. You know , if the cataract is responsible for those symptoms, you remove the cataract those symptoms go completely away.

- Okay, back to the premium lenses for just a moment. So, what are the other options to do this?

- So, you know, nowadays we've got a lot of options with cataract surgery. It used to be that we would remove the lens or the cataract of the eye and we just had one standard lens that we could put in there, you know, the so-called government issued standard lens. Nowadays, we've got a lot of really great options for lenses that help people see better, not only because you've removed the cataract because the lens is actually doing part of the work for their eye.

So that lens can address things like astigmatism or address issues like having really thick glasses. All of these things make people a lot less dependent on glasses and gets them you know, active again and doing the things that they miss doing.

- So in these lenses, they can have like a bifocal kind of thing, is that right?

- They can. You know, one of the things that we evaluate when they come in for their consultation is to make sure that their eye is healthy enough and is a good candidate for the various different type of lenses. One of the options is what we call a multifocal lens, which allows people to see out in the distance and also up close. But again, we' got to make sure that these people are screened properly and make sure that they're not buying a lens that maybe isn't going to give them the satisfaction that they really deserve.

- Okay, we talked in the green room. But you know, I guess some of these premium lenses that like have a bifocal for example, they're not covered entirely by insurance.

- That's correct.

- But you told me how much it is. It's not that much more to do it out of pocket, letting insurance pay for some of it.

- That's right.

- Then get the lenses.

- The nice thing is that insurance will pay for the operation itself. They just won't pay for these additional technologies. They look at a cataract like a disease. So they'll pay for you to have the disease fixed, but they don't cover the additional technologies that go into making these specialty lenses.

- So there's probably tens of thousands of people in the desert, Palm Springs, Palm Desert, the whole Coachella Valley that have cataracts, have Medicare, or insurance. HMO, PPO doesn't matter. and they're doing nothing.

- That's right . And it's...

- It's got to be the fear of the surgery.

- Well...

- It's my take, but you know, I do obviously.

- You know, that may be a small portion of it, but again, I think that it's such a gradual onset disease that I think people are probably living with the cataracts and not knowing just how different their lives could be if they got it fixed.

- If you had a family member, 50 years old, and the optometrist told them, "Well, you've got the beginnings of a cataract." Would you say, "Get it done immediately to one of your family members? Like at what point ?

- Yeah, I would say at the point where somebody tells you, you have a cataract, you probably should see a surgeon that can at least put things in perspective for you and explain to you what your options are. You know, that surgeon might see you and not recommend that they get fixed, but at the very least you owe it to yourself to go and get that second opinion and make sure that at least you're aware of what your options are.

- Okay. Dry eye. Let's talk about dry eye for a moment.

- Yeah, we see a lot of that here in the desert. You know, the desert, there's no humidity, a lot of sunshine. So, we get folks that come in and they've got the tears running down the face and they say, "Doc, why are my eyes so teary?" And they just look at me like I'm crazy when I tell them that they're dry. You know, it's one of these stories, that just doesn't make sense. But what happens is that the eyeball gets so dry, that the reflex mechanism to the lacrymal gland is to secrete a lot more tears.

So, sometimes they'll come in and the tears are running down their face, and they'll say, "Doc, how can you tell me my eyes are dry when I've got the tears running down my face?

- So, what's the answer? What's the fix for that? And is it easily treated?

- Well, it is pretty easily treated. In fact, for the patient that doesn't want to see the doctor, that's as easy as going to your local pharmacy and getting some supplemental artificial tears to help your eye, you know, rehydrate. So that the tearing goes down. For folks that have tried these measures and aren't getting, you know, the results that they'd like, then absolutely come see us. We've got plenty of treatment options for the dryness - Give me a few of these treatment options.

- One of my favorite treatment options is to actually block the drainage system of the eye. So, what happens with tears is they get secreted from the lacrymal gland which sits kind of on the outer portion of the eyebrows, that tear gets accreted onto the eye and then subsequently drains into the nose. One of the things we can do is to actually block that drainage system so that the tear doesn't escape into the nose and that the tear can stay on the eye and bathe it longer.

The big one that I get with dry eyes is that people come in and they're trying to read and they get these collections of tears in their lower eyelid. And when they blink, the tear gets splashed on to their glasses so that then you know they can't see the book that they're reading. So, again, it's as simple as using more artificial tears, or coming to see one of us to you, know, talk about the other options for getting those eyes rehydrated again.

- And what about those people that they've already had cataract surgery, and they're still not seeing well, what are their options?

- Well, when you think about how the eye works, you know, the light comes into the eye, and it actually goes through three structures before it gets to the film in the back of the eye. So, the first thing it's going to go through is the tear film. We kind of alluded to that a little bit earlier that your eyes have to be well hydrated for you to be able to see well. The next thing that the light goes through is the cornea. And then the final thing is that lens.

So, if you've already addressed the dryness, which is on the tear film and the cataract, really the next place to look is the cornea. So, that's where we get a lot of patients in with what's called Fuchs' dystrophy. And oftentimes that gets missed at the time of their initial consultation. Again, maybe supporting the fact that that you know, getting a second opinion or maybe seeing a cornea specialist to make sure these things don't get missed is important to the patient so that they get the outcomes that they really want.

- Okay, so this Fuchs' dystrophy, so they go in, they're getting a cataract evaluation. They get the cataract surgery, but they had this underlying or additional problem, this Fuchs' dystrophy.

- That's right.

- Which is what, and what are you doing to fix it?

- Yeah. Good question. You know, Fuchs' dystrophy is a disease of the cornea, which is the clear part of the eye. With Fuchs' dystrophy, people's corneas tend to swell up because they don't have enough of the cells that are responsible for removing the fluid from the cornea. And actually, it's a pretty common problem that goes undiagnosed because you really have to spend extra time doing the examination to make sure that patients don't have that.

But as many as 10% of people that hit age 60, can have the disease. And again, if it's missed at the time of your cataract surgery, you can actually make the disease worse.

- So, if you're going to get cataract surgery, do you actually ask your doctor, "Could you check me for this Fuchs' dystrophy?"

- Yeah. Absolutely. And you should. So, anytime you're seeing your eye care specialist and you're struggling with your vision, yeah, absolutely, you want to say, "You know, Doc, do I have cataracts? Do I have Fuchs' dystrophy? How's my dryness? These are, you know, three of the big things that really inhibit people from seeing as well as they should.

- So, if you're at the exam, the optometrist can also check for this Fuchs' dystrophy?

- Absolutely. Especially, if you know that maybe one of your parents had it, these are things that you should be actively asking for. The optometrist very easily can just take the extra time to do that portion of the examination and make sure that you're not one of the folks that falls into that 10% of people that, again, once you hit age 60, that's the prevalence of that disease, is about 10% of folks will have it.

- And you could fix it?

- That's fixable.

- In less than an hour, right?

- Yeah. So that requires quite a bit more than just cataract surgery. But if that disease has progressed to the level where it does need, you know, surgical management then, luckily, nowadays, we have treatments that are very effective for treating both at the same time. Downtimes are a little bit longer than just having cataract surgery, but the surgery itself can be done, you know, at the time of the cataract operation, and again, get you home by later that afternoon.

- Okay, good, so, dry eyes, cataracts, what about glaucoma? Just for a moment. We have a few minutes.

- Yeah. Glaucoma is a, you know, big problem in our country. If you talk to enough of your friends, absolutely, you're going to hear somebody using eye drops for glaucoma. One of the things that we can do at the time of cataract surgery is to address the glaucoma, as well, in an effort to try to reduce the number of drops people are using, and oftentimes, maybe even get them off of their eye drops. So, again, if you've got glaucoma, that's another thing that really your optimologist needs to know when you go in for your consultation so that you're given all the options that you deserve.

- So, you can take somebody that has glaucoma, maybe stop it, or slow it, or reverse it, take care of their cataracts, maybe give them a premium lens, so they don't need glasses to read. Is that right?

- Yeah, you know, again...

- Am I overstating this? Because it sounds good to me, right?

- It is a good thing. You know, the nice thing about practicing medicine today is that we've got such great options for people. And we don't want to simplify it and make it sound like, "Boy, you're going to come in and walk out seeing like an 18-year-old again." Because certainly, if you've got advanced glaucoma or corneal diseases, things like this, you know, we might not be able to get you to see like you were seeing at age 18.

But we'll try to optimize things so that you see at your visual potential, so that you can see as good as you're actually capable of seeing.

- And patients give you gifts. I think I heard you say that in the green room.

- Yeah, I do frequently get, you know, doilies. These are patients that their lives have transformed. You know, they're crocheting again. They're bringing in doilies. They're bringing in, you know, tomatoes from their garden. These are things that people come in to show their gratitude for something that, really, they didn't realize was so bad.

- So, somebody that's about 85 years old, which is also young in the desert, but if they've never had cataract surgery, they probably need it. Is that true?

- It would be hard for me to imagine that if you've lived to 85, that those cataracts aren't affecting your vision to the point where if we fix it, you wouldn't notice a substantial difference.

- Is that right?

- That's right.

- And that's a common theme throughout, is the patients, when it's all done, they say, "I should have done this years ago?"

- Not just in the desert, throughout our whole country.

- So, your center, Acuity Eye Specialists, is a unique center, you say?

- It is a unique center.

- How so? You know, it's not that common to have so many specialists under one roof. The nice thing is that if people come in and maybe they're seeing a cornea specialist, and I find out that they've got maybe some macular degeneration, we've got all of these specialists in the same office. So, the nice thing is patients, you know, they know where the office is, they know what the parking is like. They know that, in that building, they'll be able to see an excellent group of surgeons and doctors that can address really, whatever eye disease they have.

- I mean, we haven't talked about a lot of things, but you guys do everything.

- Yeah, pretty much. If you're an adult, we do all adult eye care.

- So, there are people that will go to maybe, the glaucoma person, surgeon and then they'll go to the person that does the cataracts, two different offices. And you do it right there. So, are you trained in both of those things?

- Yeah. So, I actually did fellowship training, in not just cataracts and glaucoma, but also cornea. So, it's a little bit unusual. And I do admit that it was a lot of time in school to learn to do all these things, but I think the patients appreciate seeing one person that can address all these different things. You know, explain things to them in terms that they'll understand and go over the real risks and benefits of what they're getting themselves into.

- Okay, good. And the consultations, they get to see you?

- Yes.

- Because I know you have a bunch of people but they could see you as well.

- We do. In particular, you know, if you've seen one of my colleagues and you know, you've been told that you've got Fuchs' dystrophy or cataracts or glaucoma and you want to see me, it's just as simple as going to the front desk and scheduling an appointment.

- And with glaucoma there are a lot of people with glaucoma as well?

- Well, a lot. That's a disease that tends to worsen as we age. So, we do tend to see a lot more of it you know, in the retirement communities.

- The things you can do for glaucoma, just so I understand this correctly, is what? Slow it, stop it?

- Yes, stop it is our main goal. We can't get rid of glaucoma. And hopefully, they've been told, you know, that, that the disease can't go away by whoever's taking care of them. But we can certainly stop it, you know, slow it down or hopefully, stop it entirely.

- Through surgical?

- Eye drops, laser surgery, operating room surgery, all these different things are, you know, methods that we can use to address glaucoma.

- But the lasers for cataracts, and I'm skipping around here a little bit, but I wanted to ask you this. So, I guess there's a big learning curve. You know, I talked to one of the founders of your company, and that you have a lot of the training with the lasers.

- Yeah, I don't know that you can get any more training, Randy. I've spent a lot of time in school learning how to do these things. And I enjoy what I do. And, so, it makes it very, very easy for me to do and very pleasurable.

- Well, thank you for coming on the show. It's good. So, talk to your optometrist then about this.

- Absolutely. If you've got any type of visual complaints, any dryness, any issues that you'd like addressed, see your optometrists, get an eye examination, you know, ask for them to look for these things. And if ever you need a second opinion, please, please come see me.

- By the way, do they have to see the optometrist first? or could they go directly to you?

- They certainly can come directly to me. I prefer the people to continue to see you know, their regular doctors because they've got a history there. Honestly, the patients that do the best are the ones that see their optometrist. And then, if their optometrist feels they need to see me then I work together with their optometrist to make sure that that individual patient is given the best care that they need.

- And if they've been...so, if they're updating their prescription with their...if their vision is changing, like every year, and they're aging, and they've been told they may have cataracts, they need to do something about it. You probably should do something about it.

- Okay, good. All right. I'm going to thank you for coming to the show. Good stuff.

- My pleasure. Thank you.

- You are 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] ♪