Kim
Hello, everyone. I’m Kim Thiboldeaux, and welcome to this episode of NEBGH Voices. I’m glad you’re joining us for a timely conversation recognizing both Healthy Vision Month and UV Awareness Month, where we’ll explore the importance of proactive vision care, prevention, and protecting eye health from environmental risks like UV exposure. I’m pleased to welcome Dr. Brent Finklea, a board-certified ophthalmologist specializing in cornea, cataract, and refractive surgery. Dr. Finklea completed his training at Will’s Eye Hospital, along with additional fellowship training at Will’s Eye and Duke University, and brings extensive experience in patient care and advancing eye health awareness. Dr. Finklea, thank you for joining us today.
Brenton Finklea
Thank you so much for the invitation. It’s a pleasure to be here.
Kim
Well, let’s let’s share a little bit about your background with our audience to start. Can you share a little bit about kind of what drew you to specializing in ophthalmology, particularly in areas like cornea, cataract, and refractive surgery. A little bit about your journey.
Brenton Finklea
Yeah, absolutely. So going way back, I’m from Florida, born and raised, went to University of Florida for undergrad, and then when I went to the University of Virginia for medical school, I was introduced to a whole new world of ophthalmology through an unexpected avenue. I had the opportunity through a public health organization that I worked with to spend a summer working in Ghana, delivering care to a low and middle income population, which really was revealing in terms of the impact of vision health, eye health, and just overall accessibility to quality of life, productivity, and what I saw there really has become the paradigm for how I approach eye care and vision care here in the U.S. as well. And part of actually what I continue to do, my side job is I run the Center for Academic Global Ophthalmology at the Wills Eye Hospital. We have partners throughout the world, particularly in Rwanda, Sierra Leone, Madagascar, and a number of other places. So it’s been just absolutely a pleasure to be able to contribute to this part of people’s lives.
Kim
That’s terrific. You know, I’m a Philly girl, during this time of the semiquincentennial, there was so much conversation about sort of firsts in the country, and Will’s Eye was the first eye hospital in the United States in Philadelphia. So, an extraordinary history there for sure, Dr. Finklea. Since we’re recognizing both Healthy Vision Month and UV Awareness Month, can you just give us a high-level overview of why eye health is such an important part of overall health and well-being.
Brenton Finklea
Absolutely, I mentioned sort of my introduction to ophthalmology and eye care in a location that has very limited access to care. Even in the U.S. we still have large swaths of the population who don’t have this access, and we can see how that plays out in their lives and also in their overall well-being. We know that the productivity of an individual goes drastically down as their vision health goes down. People without high-quality sight have employment rates that are a fraction of that of sighted persons. I’ve seen some numbers quoted as low as 40% of individuals with severe visual impairment who actually can maintain some level of employment. From the overall health and wellness standpoint, the rate and the risk of developing depression, anxiety, other mental health disorders is two, three, even four times that of the average population when you have significant visual impairment. And so, it’s not just about being able to navigate our environment, perform daily tasks. It’s really truly the way that we experience the world and the way that we see ourselves within it.
Kim
Wow, those are some extraordinary statistics, and I think it may be especially interesting for our employers, who I know will be listening, to hear. So, so thank you for sharing that and level setting for us there. You know, when we think about preventative care, I think vision health sometimes gets overlooked, right? We we talk about cancer screenings, and we get our our you know complete blood panel every year, and so so what are the key components of maintaining good eye health over time? What should folks know?
Brenton Finklea
Absolutely, I mean, there’s the big things that we can do at home. You mentioned UV protection; that’s part of what we’re talking about here, but good quality protection when you’re outside-that actually goes along with the risk of trauma. So accidental trauma is a major cause of vision loss in the U.S. If you’re outside working in the yard, if you’re in any places with potential moving objects, very windy environments, you know that’s a significant thing that we should protect against. Diet, general systemic health, or whole body health is of course tied closely to eye health. The eyes are an organ, and just like any other organ is damaged by poor quality general health, the eyes can take a beating as well. One thing which we don’t talk about a lot is contact lens hygiene, even though that’s probably something that impacts most people at the highest level. The number of contact lens wearers across the U.S. is a huge number, and the rate at which we see people contract either infectious illness due to poor contact lens hygiene, sleeping in their contacts, swimming in their contacts is really pretty remarkable. So taking good care of your eyes through good contact lens hygiene is definitely definitely huge. And then I’ll say, if I briefly also can just talk on screenings, there’s a lot of ophthalmic conditions that don’t have a symptom early on in their presentation, and we don’t actually start to notice changes to our vision until the disease process has progressed a long way. And so, a lot of our recommendations for screenings are really based around early identification, early intervention for those illnesses, many of which cannot be reversed once they reach the more advanced stages.
Kim
Wow, it’s really a lot, a lot to take in there, and a lot to think, for people to think about. I’m so glad we’re bringing this topic forward. So let’s talk specifically about UV exposure. What impact does UV radiation have on eye health, both in the short and long term?
Brenton Finklea
The two big places that we see, aside from I’ll say skincare, I’ll leave that to the dermatology group. At the same point, there’s skin around the eyes, and so I got to mention it. There are various skin cancers, squamous cells, basal cells, which can form around the eyelids due to excessive ultraviolet light exposure can actually even get those same cancers forming on the surface of the eyeball itself. So that’s where UV protection comes from on the external part of the eye. Inside the eye, the big thing is cataracts. Cataracts develop from the lens that you’re born with, which is normally clear early on in your life. Chronic UV exposure will slowly change that into a cloudy lens, which you have a hard time seeing through, eventually necessitating cataract surgery, and so that’s probably the most substantial impact. That being said, macular degeneration-we hear a lot about this. It’s the number one cause of major vision loss in the U.S. population over the age of about 60 or so. That is exacerbated by UV light exposure and damage to the macular photoreceptors and and deeper cell layers, and so everything that we can do to protect against those insults will really maintain your eye health at its best possible level.
Kim
Yeah, that’s great to great to hear and know. We hear oftentimes about UVA and UVB rays, and we see it when it comes to sunscreen, or when it comes to eyeglasses or sunglasses. So, can you explain the difference between the two and what people should know about their impact on eye health?
Brenton Finklea
Absolutely. So, UV light is part of the electromagnetic spectrum. I’m going to nerd out really quickly here.
Kim
OK, here we go back to sixth grade science class.
Brenton Finklea
We’re going back. We’re taking a deep dive deeper than anybody wanted, but here it is. So the visible light spectrum, right? Roy Giv. Those are just the primary colors. Visible light. You can see those on the red end. Longer wavelengths. That’s infrared light. On the shorter side, that’s ultraviolet. Once you pass the red, the blue, indigo, violet, ultraviolet. So there are subdivisions of that. We roughly subdivide them into UVA, UVB, UVC. C doesn’t really have a significant clinical impact, so we don’t talk about it. UVA is the biggest contender. About 90-5% of UV light that hits us makes it through the ozone layer is UVA. That’s the slightly longer wavelength of the two. It penetrates deeper into tissues. It can cause more substantial damage. And what we’re really trying to protect against UVB 5% of that radiation that makes it through the atmosphere. That’s shorter wavelength. Doesn’t make it as deeper into tissue, so it’s more skin cancers, all the really superficial stuff that we’re protecting against, but in general, when we’re talking about UV protection, anything that you’re going to get that is dedicated to UV protection will really be protecting against both of those. We’ll just lump it all together and say UV radiation.
Kim
Got it. Okay, so let’s talk about kind of, you know, steps that people can take to protect their vision from that damage. I think, for example, we hear about, you know, polarized sunglasses for protection. Is a polarized lens good? Is it smart? You know, what other things should we be thinking about for protection?
Brenton Finklea
Absolutely. I’m a fisherman. I love polarized lenses. They are great, but polarization does not equal UV protection. They are actually two different things. So there’s UV protection, which you’ll usually see on different types of sunglasses, or even regular just vision glasses, refractive glasses. It’ll say something like UV 400 or it’ll have a sticker that says total UV blocking. That’s to say that we are blocking that short wavelength non visible light spectrum, polarization is actually just blocking out certain angles of light. It doesn’t pretend anything in terms of protection from UV light, but it’s great for reducing glare when sunlight hits flat surface, the roadway in front of you, a lake, river, anything with a reflective top, you’re going to get a reflection in a certain pattern of light, and the polarized lenses are designed to cut out those reflected light waves. And so, it’s great in terms of like quality of vision. It’s great if you’re trying to see through water, right? If you’re trying to look through those reflective layers, and also it’s just great to try to cut down the glare when you’re driving. So, big fan of polarized glasses. Make sure though that it says both.
Kim
Wow, great advice. And I love to fish, so we’re going to have to talk about fishing one of these days for sure. So, what are some of the most common vision issues or eye conditions you’re seeing today? And tell us about sort of screening, early detection, you know, what’s on the daily in your world?
Brenton Finklea
Sure. Well, I’ll say at large in the U.S. population, refractive error is the number one thing. That means you need glasses, right? Near-sighted, far-sighted. First and foremost, you go to the optometrist, the optician. We’re going to make sure that you get outfitted with a good pair of glasses or contact lenses. In my world, refractive eye surgery, so LASIK, PRK, SMILE, all of these procedures that we do now, we’re doing like implantable contact lenses, different ways to permanently reduce that need for correction. But that being said, medical issues, cataracts, glaucoma, macular degeneration, diabetic retinopathy, those four make up the majority of the rest of the eye issues that the average person will hear about or see over the course of their life.
Kim
Can you say them again?
Brenton Finklea
Yep. Cataracts is the big one. Everybody who lives long enough is going to get a cataract. It’s not genetic. It’s not my my mother had cataracts or my father had cataracts. Everybody gets them. Second thing is glaucoma. That is genetic, high genetic predisposition. So families that carry glaucoma risk factors, you definitely need screenings regularly for that. Glaucoma is one of the big screening things that we’re looking for, the things that we are screening for, because glaucoma has no symptoms early on, and even in the mid levels of glaucoma, many people have zero symptoms. It’s not until the advanced stages that oftentimes are irreversible that people start to lose the peripheral parts of their vision. Macular degeneration-that’s the central part of the vision. Usually, as we’re getting into the 60’s, 70’s, 80’s, that’s when we start to see some changes. Again, early identification, early intervention is key, and diabetic retinopathy. Diabetic retinopathy is just one of those manifestations within the eyes of systemic illness. So, type one and type two diabetes can both cause this. The longer you have it, the more uncontrolled your blood sugars are, the worse it becomes. If you have diabetes, part of your annual screening has got to be an eye exam because not only are we trying to preserve the vision that you have, make sure that you have that till the end of your life, but looking into the eyes is the only place we can actually look at your blood vessels in your body. You can’t see them anywhere else in your body, and we can tell the health of the blood vessels in your kidney, in your heart, in your liver based on how healthy the vessels in your eyes are so that’s why you’re going to see that eye doctor and why they’re communicating with your primary care physician, endocrinologist, or who have you.
Kim
Terrific advice, terrific advice. So it sounds to me, correct me if I’m wrong, but does the risk of eye disease or some of these conditions you’re talking about increase as we age? These are just some naturally, you know, aging processes, or some of them are?
Brenton Finklea
Absolutely the majority of eye conditions are age dependent, and that’s why you know when we talk about screening ages, the frequency and the and also the interval between them starts to get shorter. Say shorter interval, higher frequency, and that’s because they just start to accumulate these risk factors over time. Cataracts happen as we age. Glaucoma, macular degeneration, diabetic retinopathy-all of those can worsen over time.
Kim
And you said glaucoma is the one that we know is genetic or can be inherited, or any of the others related to a genetic risk?
Brenton Finklea
Absolutely, glaucoma for sure. There’s pretty heavy genetic predisposition within families. Macular degeneration is the same. We see a really significant risk profile with family members, first degree relatives who have macular degeneration, and then the diabetic retinopathy. Just because diabetes does have a genetic base to it as well, even though lifestyle factors can play into this. Some individuals just naturally are going to be more susceptible to diabetes.
Kim
Yeah, yeah. Good to know. Good to know. So, Dr. Finklea, are there acceptable or known screening guidelines for our eye health? What? Who makes the guidelines? What do the guidelines say? What should we be doing?
Brenton Finklea
Right, I’ll say every organization related to eye health has their own guidelines, and they’re all slightly different. But if I could try to give a practical summary of them, kids under one year of age will usually have them screened in the hospital at the time that they’re born, and then at well-child visits over the first year of their life. Age one to 17, most kids are going to be getting screened either at their pediatrician’s office or in school. Most schools have a screening program, so they’ll be able to pick up any vision disturbance. Once you hit 17, and if everything is copacetic at that point, a baseline screening as you hit about 20 is good, and then every two to three years is appropriate until about age 40. Once you hit 40 to 45 is when the need for more frequent screenings starts to occur. If you’re a healthy person with no genetic predispositions, healthy family members, still probably every two years is okay for the most part. But some organizations do recommend annual screenings, whether it be 40 years old or 50 years old as the starting point. Annual screenings thereafter. I do tend to feel that because of the risk of glaucoma, macular degeneration, and these things that have very limited symptoms early on, they really only picked up on screenings. So an annual screening is a great idea. It’s really hard to remember to do something every other year. Like I don’t remember what I did last week, much less if I went last year to see the eye doctor. So just it’s more so for consistency.
Kim
And can’t you get all these medical bodies together and get them to have the same set of guidelines that could be our bible for this? That would be great.
Brenton Finklea
I will. I will dub somebody the Queen of Eye Care, and they can put all those together.
Kim
Let them know. Make it a little easier for us. I mean, we we’ve gotten pretty good with the cancer screening guidelines and agreement there. So so that’s terrific. I I think I know an issue of real interest to a lot of folks is nutrition. We focus a lot. Our employers are investing in programs around nutrition and healthy lifestyle in terms of overall health, and dealing with some of the conditions like we’ve talked about, diabetes, obesity, but what do we know about the relationship between diet and eye health? And are there specific foods, vitamins, supplements that can support healthy vision? What does the science say?
Brenton Finklea
Yeah. So the big things that we’ve looked at, actually, in large scale population studies, we’ve looked at the risk of macular degeneration. That’s probably our most robust study. And so, looking at that, the AREDS study and the AREDS II-it’s the age-related eye disease study. Those looked at what supplements are most likely to reduce the risk of progression of macular degeneration in those individuals that already have some baseline level of it, but I think that you could, you know, pull from that the benefit across the population. But that is looking at things like lutein, zeaxanthin, beta carotene, all of these, which we know are beneficial to the layers of the retina, photoreceptors. Now, what normal dietary components will have these – so we don’t have to go and all start taking supplements – dark green leafy vegetables is the big one, right? They say carrots for eye health, but that’s actually a little bit of a misnomer. Dark green leafy vegetables is the big one. Beyond that, there’s also a handful of studies looking at dry eye and more ocular surface, the outside of the eye health, and we have good data that omega-3 fatty acids supplementation or just fish oils components of the regular diet, omega-3s do support dry eye health and the oil gland function of the eyelids. So those two recommendations: dark green leafy vegetables and omega-3 fatty acids, either part of your diet or supplemented, both can contribute meaningfully and with known significance to your eye health,
Kim
And we get that omega 3 from things like salmon, mackerel, walnuts…
Brenton Finklea
Absolutely.
Kim
All kinds of natural sources. Yeah, great.
Brenton Finklea
That’s perfect.
Kim
Great, great, great. We know that many of our employees spend long hours on screens, whether it’s the computer, whether it’s the phone, also obviously our young people are spending an increasing amount of time on screens. What do we know about digital eye strain, and how can people better manage that?
Brenton Finklea
I’d say nothing terrifies me more than my weekly screen summary, screen time, and you know it’s just part of life. It’s part of how we communicate with each other, and so it’s not practical to say spend less time on digital devices. And so we have to figure out how to be more healthy about the ways that we interact with them. And so there’s a few recommendations that have now been made. I’d say from the standpoint of what is the problem, and then we can talk about solutions. The big problem is number one, dry eye is a big issue with screen time. We’ve done studies where we see people actively reducing the rate of blinking as they’re focusing on the screen in front of them. That significantly will impact their eye comfort. You can also have fluctuating vision as the eyes dry out. The other thing is that you’ll actually get some eye strain. You get this sort of heaviness feeling-we’ve all felt that that tension around our eyes, the orbital area-that’s due to what we call accommodation. So when we’re on our phone, when we’re on the screen in front of us, we are focusing on something that is much closer than what we normally might look at across the room. And so when that happens, you have three different components of this reflex, we call it the accommodative reflex. Your pupils get smaller, muscles constrict. Your eyes converge, muscles contract by the nose, and then most importantly, this muscle inside the eye constricts, allowing the lens or the cataract to change shape and focus the eye, and that is where you get a lot of that strain sensation from. So I like to use the analogy: if you go to the gym and you pick up two one-pound weights, you hold them with your arms flexed, and you walk around the gym for an hour at first, no problem, totally fine, arms feel great. After about 30 minutes, actually, honestly, probably a lot faster than that. But after a while, your arms are really going to start feeling it. It feels a lot heavier than that one-pound light weight that you had picked up. This is what’s happening inside your eyes when you’re focusing on the screen in front of you. Your eyes are constantly flexed, as if you’re holding these little one-pound weights. You’re straining them, and then you can think of what happens if you held these one-pound weights for an hour, and then you drop them. Now your arms are sore, and you almost have to sort of stretch the muscles to make them feel more comfortable. And so, the way that we drop the weights in our eyes is we look at an object that’s far away. Ideally, more than 20 feet away. That’s why where that term 20/20 comes from. We use 20 feet as sort of a reference point in the eye world because that is when we’re not converging or accommodating at all. So, we’ve come up with the 20-20-20 recommendations, which is every 20 minutes you should take about 20 seconds and look at something about 20 feet away from you, and that will give your eyes enough time to drop the weights, start to relax, shake it off, and then you can go back and you pick the weights back up and get back to your task. But being purposeful about those brief interval of distance vision activities, along with that, also gives you a moment to let your eyes rehydrate, maybe even blink them a couple times, eye drops if you need them, if you’re experiencing a lot of dryness, and then you can get back to your work. And those few simple steps really can make a meaningful impact to your quality of comfort and overall your vision health long term.
Kim
Terrific! Great tips! I love that 20-20-20 rule. That’s great. You know that we are an employer led coalition, employer driven. So, do you have any thoughts about the role that employers can play in supporting better vision health among their workforce? I mean, things about, you know, coverage policies or other things that they can do to, you know, making sure they’re covering those those screenings and things like that.
Brenton Finklea
I think that’s the most important thing by a significant margin. The biggest issue that we see, and this is on all areas of healthcare, is when we feel good, we don’t seek general healthcare, and we wait until something bad happens and we feel bad. And at that point in time, usually the disease burden on our body is much more substantial. It requires a higher cost intervention, and it really is then a more significant burden on your your workforce, on your individual even, and so if we can support individuals and even try to push them a little bit to have the annual screenings at the appropriate interval relative to their age and their overall health, that would help us to identify those disease processes early enough that the burden disease is not substantial and that we can intervene while their vision is still good and they’re healthy. Nothing hurts my heart more than the individuals who come in at 60 years old or 65 years old, and they said, “I’ve had perfect vision my entire life. This is the first time I’m ever seeing an eye doctor,” and they have a very substantial level of either glaucoma or macular degeneration, and they just never identified it early on when it was treatable and when we could have gotten ahead of it, so I think that’s the big thing. And then there’s always just the little campaigns. Don’t forget good UV protection, eye protection when you’re outside doing any sort of sports. We do more and more racket sports as pickleball becomes popular. Also, racquetball these high velocity small little objects that can very easily fit right into the orbit or around the eye. Make sure people are wearing proper eye protection during all these things. That’s a very easy recommendation that can be pushed out to everyone.
Kim
And I think a lot, like you said, also a lot of the tasks that we just do around the house, around the yard, around the, I know we just had some bad storms in the Northeast. I see people out with chainsaws and with – so I think some of that, but but I do think employers have an important role around that awareness, around that education, and around making sure that they have good coverage policies for screenings and for treating eye conditions. I think that that that makes a lot of sense. We’re getting towards the end of our conversation, which makes me a little sad because I have a lot more to ask you, but are there any emerging trends, technologies, treatments in vision care that you’re excited about? Are you seeing cool things happening with AI and vision care? You know, talk to us about that a little bit. What’s on the horizon?
Brenton Finklea
There, one of the wonderful things about eye care is it is a very technologically driven field. And we are constantly seeing turnover of what’s available to us and what we’re able to offer to our patients. And that’s one of the exciting things about it. And so, I’d say at large, what’s going to impact the most people is number one, it’s lens implants. So we are getting better and better at cataract surgery. We truly do have it down to a science. But what is unique about the future is that the implant that has to be placed at the time that cataracts are removed, they just get better and better with time, and that improves individuals, not just quality of vision at certain ranges, but the overall range of vision, the quality of vision that they’re getting is really unbelievable. It’s it’s quite remarkable, and I think that’s the thing I look forward to each year is what’s next year’s new lens going to be? Because they do get better and better. In my world, part of what I do is corneal transplantation, and so that’s replacing part or all of that clear window on the front of the eye. And so we have some really exciting new transplantable tissue options that are about to come to market. We’re actually in our final phase three trials right now. Our office is one of the ones that’s going through this, but these are injectable cell lines that will repopulate the inner layers of the eyes that have been either damaged by disease, by surgery, by trauma. Where historically we would have to actually remove the cornea and replace it with a new cornea or part of a cornea. Now we’re just basically growing cell lines that can be injected. It’s a very low, low burden intervention for individuals, and so we’re super excited about that.
One of the things which, ear to the ground, I think is going to be really important in the next decade is we’re looking a lot at myopia prevention. So myopia being nearsightedness. Over the last few decades, there has been a worldwide epidemic of myopia, or nearsightedness, for many reasons. There’s less time being spent outside. There’s more time being spent on studious, up-close bookwork. People doing that accommodative, looking up close and flexing the muscles of the eyes that are really driving our children more and more towards nearsightedness, and there’s a number of different interventions that are being trialed right now, and that are slowly coming to market that can prevent these bigger issues later on down the road. And so, I think in the next five to 10 years, we’re going to learn a ton about which one of these therapies is the best and how we can try and stop this because nearsightedness is actually it’s a big problem for a lot of people, especially the levels we’re starting to see. I will make one other comment on that, which is we’ve spent a lot of time talking about UV prevention, and UV prevention is important in the we’ll say 20s, 30s, 40s, 50s. But that being said, there is a benefit to UV light exposure for kids because one of the things that happens is UV light hardens tissues, as we see, and we don’t like that later on. But early on, that is one of the things that we see that can prevent some of these pathologic changes in the eyes as kids are spending more time inside, more screen time, more up close work, and driving themselves towards nearsightedness, being outside, sunlight exposure, distance vision activities, playing sports-that is something that I just don’t think that we can replace with medical interventions. We still got to get our kids out there.
Kim
Wow, terrific! Good to know. Good to know. So, as we wrap up, Dr. Finklea, when our listeners are thinking about their own eye health, give us a couple tips as we part ways that you want them to remember from today’s conversation. What are some things that they should be thinking about right now, especially our, you know, working age folks who are in the workforce?
Brenton Finklea
All right. The the three big ones that I’ll give you. Number one, eye protection. So that’s not just UV light, but UV light is important. But eye protection when you’re doing any activity that potentially could have accidental trauma to the eyes. I worked in an Eye ER for years. Please protect your eyes. The second thing is good, just general health. Eyes are an organ. Take care of your body. You’re taking care of all the components of that. Most importantly, in in my opinion, is taking care of your eyes. And then the last thing is, though it may seem unnecessary when you are seeing well and you’re feeling well to go and get screenings, you don’t have to see the eye doctor every year. But having intermittent eye screenings every two to three years, depending on those intervals that we talked about earlier, really can be helpful in preventing that late presentation of disease. So do your do your eyes and yourself a favor. Make sure you’re getting those those conditions screened for, and you’ll have a long life of excellent vision.
Kim
I love that. Great tips, great advice, Dr. Finklea. Thank you so much for taking the time to be with us today and for sharing your expertise on vision care and prevention. And we hope our listeners come away with a clearer view of how to support their eye health and their overall well-being. I just had to get some kind of pun in there.
Brenton Finklea
So many puns, so many eye puns.
Kim
I know there are so many eye puns. I had to get one in. So I appreciate you being with us. I’m Kim Thiboldeaux. This has been NEBGH. Thank you for listening today, and as always, we wish you wellness.
Closing Voices
And I am one of the voices. And I am one of the voices.
Brenton Finklea
I’m Dr. Brenton Finklea, and I’m one of the voices of NEBGH.
