Disability Talks: Don't Dis My Ability

All Eyes on Vision Health in 2021- Kremer Eye Center

January 08, 2021 Abilities in Motion Season 2 Episode 1
Disability Talks: Don't Dis My Ability
All Eyes on Vision Health in 2021- Kremer Eye Center
Show Notes Transcript

This episode features the expertise of glaucoma and cataract surgeon Dr. Aaron Cohn of Kremer Eye Center in southeastern PA. In this eye-opening conversation, Shelly and Dr. Cohn discuss the importance of regular eye exams and how to take care of your eye health to prevent vision loss and the progression of certain eye diseases like glaucoma. Learn about the “silent disease” that could be stealing sight from your periphery and how glaucoma treatments and cataract surgery change lives by restoring light, clarity, and independence to people of all ages. Dr. Cohn provides insight into the source of his passion for ophthalmology and his vision for better eye health in 2021.

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Intro:

Welcome to Disability Talks, a podcast produced by Abilities in Motion. I'm your host, Shelly Houser. Join us for real conversations and no-nonsense talk from everyday people with disabilities, living their most independent everyday lives. Tune in for the latest news surrounding disability, accessibility, and independence, where conversations aren't dissed and stories that need to be told aren't missed. So let's talk!

Shelly:

Welcome back, listeners. This is your host Shelly Houser, and I am here on Disability Talks. Today our special guest is from Kremer Eye Center, Dr. Aaron Cohn. Welcome, Doctor. How are you?

Aaron:

Hi, Shelly. Great, thank you for having me on the show today.

Shelly:

Absolutely. I know the amazing work that you and your surgeons do there, and I really wanted to bring some eye disease awareness to our listeners as something different. So, Dr. Cohn, can you tell us more about you and why you became an eye surgeon and a little bit of background about Kremer Eye Center?

Aaron:

Of course, yes. Let's just start off with Kremer. Kremer has been around since 1980. It was started by Fred Kremer as a refractive surgery, and other types of surgical procedures and has grown to be, I believe, I think we're at 88 offices nowadays, with about 10 surgeons and 10 other eyecare professionals. Uh, my, my beginning with Kremer started in 2016, but I started in ophthalmology after my, my residency, uh, where, I did in Michigan, back in 2009. And then I did a fellowship in glaucoma, which is kind of my specialty, back in 2010, and I've been working around the area while my wife was finishing her training, and then I moved back to the area in 2012. So my life, I think, as a surgeon began, um, it's hard to pinpoint the exact time, but I like to think it's when I did a rotation in Ethiopia, actually. I did some training there, kind of on a whim cause I actually planned to be an emergency medical doctor and had this extra time in my schedule. And when I went to Ethiopia, it was an eye hospital, and it blew me away the change that can happen when you perform even simple surgery, like cataracts. For me, that was the life changing event. So that's kind of where I got my itch for ophthalmology.

Shelly:

Nice. Ethiopia is a beautiful country and it has wonderful, beautiful kind people. Doesn't it?

Aaron:

It does. I actually saw patient from Ethiopia yesterday. And so awesome to practice my Amharik, and that is great.

Shelly:

Nice. Very nice. So what are the most common eye problems that you personally treat there at Kremer?

Aaron:

Yeah, so, like I said, my specialty is glaucoma and cataracts, but I think my day to day, I see a lot of dry eyes, a lot of cataracts, a ton of glaucoma, and those are my three main things I treat, um, the bulk of my time spent with those main diseases. We have a lot of retinal diseases, diabetes that I see occasionally, but we often have our rental poly a lot on that on a regular basis.

Shelly:

So are most of these diseases, something that grow over time or are they more genetic?

Aaron:

That's a good question. Uh, I think it varies depending on the disease, obviously for cataracts. I like to tell everybody that no matter who you are, how old you are eventually you're going to get cataract. So generally cataracts showing up on people's exams in their fifties, but they become significant to their vision in a wide variety of ages. I've done surgery on patients for cataracts as young as 18 and as old as 97. So for that, that's a kind of a genetic predetermination to get cataracts, but when they become significant varies based on your lifestyle, how much sun exposure you have, is there inflammatory diseases in your, in your system and things like that nature will make it present earlier. Things like dry eye disease, that can also depend on some genetic predeterminations, um, could be a disease like Ocular Pemphigoid,early cause for, for dry eyes, but people will get dry eyes just from allergies or get environmental triggers, poor diets, a whole host of things can cause dry eyes. And then glaucoma definitely has a genetic determination to it. There's probably 80 to a 100 different genes linked to glaucoma, but for whatever reason, we only have been able to localize that to about 10% of the causes of glaucoma. So most of the glaucoma we see we call secondary glaucoma. We don't have an exact reason for why they have, and it just kind of comes on from, um, probably a combination of genetic issues I c an analyze t he h elping and certain type of age related changes are h appening.

Shelly:

So diet really does seem to play a part in over overall care what happens to our, even our eyes. Right?

Aaron:

I actually think so. Yeah, it's something that has become more and more part of my practice actually from my study of my own family's, kind of, changes in our diet. I think that, um, it's under explored in how we treat diseases these days. You know, oftentimes we'll try to get some quick surgical treatment or quick medical treatment when we ignore people's diets and how their lifestyle needs to be modified to kind of minimize those disease burdens that they have.

Shelly:

Cataracts is in 50 and over, but you said something about it being in younger patients too?

Aaron:

Absolutely. So well, the prevalence is much higher as you get older and the same is true for glaucoma and dry eyes as well. You know, I've seen all the diseases in younger patients and they generally come on for all different types of reasons. There might be trauma related. There might be some genetic predetermination for, or they have a congenital cataract, congenital glaucoma, but it's less common, but not, it's still a huge burden on the patients that in the families where those diseases are present.

Shelly:

Can anything be done to prevent this in younger patients?

Aaron:

Prevention is always the thing want to do and try and maximize prevention and maximize trying, again, I think lifestyle applications is probably the biggest thing a doctor or a physician or anyone in that progression would do because by altering lifestyles, you can actually help people with a disease like diabetes they face. For cataracts, unfortunately, it's kind of something that's going to happen regardless, and unless you're going to live in the dark and don't look at anything and have no sun exposure and anything, it's hard to kind of stop the cataract progression ending. Physically, the congenital ones are there almost from birth or some kids are at a young age. There's nothing you can do to stop those. So treatment unfortunately relies on surgical approaches generally.

Shelly:

Talking about, uh, glaucoma. I think I've read that it's higher in Afro-Americans. Is this true?

Aaron:

Yeah. So there's two main types. There's a lot of technical glaucoma. We talk about glaucoma is kind of a collection of diseases that have like one end point and that end point is the optic nerves. And so that I like to describe it to my patients as, thinking like the eye as this big satellite that takes all the light from the world as has send that light somewhere. And it takes the optic nerve to like kind of channel it or use a cable, I call it, to bring it to the brain. So that cable is where the glaucoma takes hold. So once a disease process occurs that nerve is kind of active theme of thinning or losing its ability to see light. So all the glaucoma is disease around the optic nerve. So having said that, there's kind of opening of glaucoma, we call it, a narrowing of glaucoma, and those kind of relate to kind of the natural brain inside the eye and how well it can move to the outside of the eyes and not raise the pressure. So for opening a glaucoma, that's much more prevalent in Caucasians and African-Americans, and then narrowing of glaucoma is more common in some of our Asian American or Asian population. I think the prevalence is somewhere around 4% to 8% in some studies for African-Americans and then for from opening of glaucoma in about 0.5 to 1% for, for Caucasians. So it's much more prevalent in our African-American population.

Shelly:

And how do you treat that?

Aaron:

So all, all glaucoma is dealing related to kind of taking care of the only model, modifiable risk factor, which is the pressure inside of the eyes. So there's, there's not much I can do to alter someone's genes yet, although that may be coming soon, there's not much I can do to kind of change who their family is or, you know, where they came from. But the prescient idea is we can modify with medications, eye drops, or some oral medications. You can modify with certain of a laser procedures, and then we can modify with surgical procedures and those are treatment treatments for all types of glaucoma.

Shelly:

Do you find that it's a permanent fix or that maybe it needs to be touched up, you know, after maybe 10, 15 years?

Aaron:

Right. So that's a good question too. So, glaucoma once you have it. It's not, doesn't go away. So it's an ongoing disease and there is no quote unquote cure for glaucoma. There are treatments near to reducing the risk for glaucoma. Uh, so some surgeries that we've done, I actually did a study back when I was a fellow, I saw my mentor did a surgery on a patient and like 30 years later it was still work, you know? So it just depends on what type of surgery it is and how severe their glaucoma is. Some patients get, what's known as a selective laser trabeculoplasty, that's an office-based laser procedure. And I've seen them 10 years later and they're still doing great with no eye drops. On the other hand, there's some patients who've had two, three, four surgeries, and they're still struggling with the disease. So there's a great variety in how people handle it and how it deals with the disease.

Shelly:

Well, this is some really interesting stuff, but I think right now we're going to take a short commercial break and we'll be back with Dr. Aaron Cohn.

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Shelly:

And welcome back, listeners. This is Shelly Houser, and we are talking with Kremer Eye Center. Dr. Cohn tell me more about rare eye diseases that you've come across or, or special cases that, uh, Kremer has served over the years.

Aaron:

Yeah. So most of our surgeries today, nowadays are cataracts, LASIK, and glaucoma surgeries, and we do thousands of surgeries a year across all spectrums of the socioeconomic ladder. We've done many professionals or local sports teams as well, but a bulk of our stuff is just local community members who try and help out and see better. You know, the surgery center where we utilize now, we just moved to a wonderful new center over in Wayne. We have our own localized, our own center now, with three OR's and our own laser service there in the center. And it's, I think when--I was thinking about this question, you know, what got me into ophthalmology as I mentioned in the intro was work in Ethiopia. And it was like having these patients again in Ethiopia, walking in with their grandkids or whoever walking or escorting them into the operating room, and then like, they'd stay the next night, and then these patients just walk out under their own power the next day in like, Oh my God, I can see my light again. And I've actually been able to have that experience, unfortunately, too many times here, even in America. It's like at least once or twice a week, I'll be in the operating room and there'll be a patient or what we call a hand motion or life was second cataracts who can't see anything other than the motion behind them. And then the next day they come back in and they can see like almost the way down to the bottom of the chart, and they're blown away. And the expression on their face, you can see it on their face, it'--and uncalculatable how much change you're able to create in that one little instance. And that's what made it important and amazing for me.

Shelly:

Yeah. So it's very life-changing for a lot of folks.

Aaron:

Absolutely. The funniest thing people say to me, and it's like, the next day they'll come in and they're like, I have had one eye done and they'll say, I didn't realize my shower was so dirty or, I didn't realize the color was different on the tiles. And they're like, it's always been yellow, but now it's white. I don't understand. And it's like, they've been living with a cataract for so long, they didn't realize there's more color in the world, so that's awesome too.

Shelly:

That's funny. Speaking of color in the world, is there anything that can be done for persons that don't see color?

Aaron:

You know, I don't know a whole lot about, you know, color deficiencies. Most of those are genetic issues that can't be altered. Nowadays, our technologies and trying to create all the times to improve retinal diseases. There's things called the artist's lens. There's telescopes we can put in people's eyes, but I believe color vision, unfortunately, is not something they're able to adjust yet. I think has to do with the mix of the floater receptors in the retina and how hard it is to kind of figure that out perfectly have a computer chip to reprocess the light.

Shelly:

That's interesting. Yeah. It's something, it's again, some sort of disease that we just don't think about, but yet it's a disability that changes a person's life.

Aaron:

You about 9% of the population, 9% of the male population, has some type of colorblindness, some sort of color deficiency. Half of them don't know, actually.

Shelly:

Does it come with, uh, you know, you said it comes in males, but does it come in more Asians or more Caucasians, or is it an ethnic thing?

Aaron:

No, I don't, I don't, I don't really know the complete epidemiological breakdown. I think mainly it's like an excellent, I'm sorry, X-linked disease. And so the, it was more common in men because they only have one X chromosome. Um, but I think that's across the board across, across the world.

Shelly:

But I think you and the other Kremer staff and surgeons do is,no pun intended, very eye- opening. And I love the way Kremer gives somebody back their independence to live, to drive, to, to read to, you know, what other things do they do, they find--okay, they can see color again--what other things do some patients notice have changed the most once they have surgery?

Aaron:

Right. So I think that the, the two types of surgeries where that's really most common is like cataracts surgery or LASIK, you know? So new patients would come in for LASIK and that we do both eyes at the same time for LASIK or something called bizien intrapolymer lens. And that's another kind of LASIK light procedure where you generally have younger patients who have very, very large prescriptions in their glasses. Can't see anything without the context of glasses on at all. And then they had this surgery and that same day, they're like, Oh my God, I can see the clock across the operating room. And you're like, but I just did this. And they're like, they can see it right away. And so that is a huge improvement in their independence. You know, I think you hit on that. Exact same thing for cataract surgery. You know, patients generally rely on their family, you know, can't always work during the night times. They can't drive at night because the glare is so bad or they're not able to maneuver around their house. I've had patients tell me they can't walk downstairs because their vision's so bad. Then all that can be returned after cataract surgery or for LASIK patients who are, can now become independent and do everything that most of us take for granted. I think most of us are, what's the term? We're not disabled. We're temporarily abled. Right? Isn't that the term people use.

Shelly:

Yeah definitely. How young do eye surgeons work on patients?

Aaron:

Yeah. Um, so our center we're in patients 18 and over, um, as a fellow and a resident, I worked with patient younger than that and remember, actually a couple of patients in, in Chicago where I did my fellowship. I had a couple children who were a year old who had a glaucoma, And so doing surgery on them was again, life changing for them. And it really opened up my eyes as to like how young patients can get these diseases. If you don't treat the glaucoma at a young age, kids go blind. They never see. And that is just a terrible thing to contemplate. And so it was lucky that these patients end come in to be recognized by his local optometrists and referred to us for care. And we did the surgery and for a year I saw him in beyond that. He was doing great.

Shelly:

And you guys, if you don't have the answer to something or it's a specialty, you guys have a whole network of partnerships across the region. Uh, I guess across several States cause you're in New Jersey as well. So tell me more about some of the partnerships that Kremer's created over the years.

Aaron:

Sure. So we are, especially, our company is Delaware, New Jersey, Pennsylvania, Maryland, I think at this time, uh, and you know, most of our, our, our disease is where the anterior part of the eye cataracts, glaucoma, corneal disease, LASIK, um, there's an amazing group in the area called Mid Atlantic Retina. They work at of Wills Eye Hospital, and they do a lot of the retinal diseases. So we've usually referred most of our retinal diseases--disease treatments to them, other local retina doctors at Scheie Eye Institute. Or we often--Wyomissing in Reading is also great, great facilities up there. So when we see patients who got really bad diabetic macular edema and diabetic disease, we're referring to those retina specialists for care because that is also an ongoing, super specialized treatment that we just don't have enough seats in our company to take care of. But with this partnership, we definitely refer back and forth with them day in and day out.

Shelly:

Um, what can lead to the loss of eyesight besides genetics and, and our health, the way we eat, uh, trauma is one. What else do you see?

Aaron:

So for diseases like cataracts and glaucoma or glaucoma, specifically, there can be many types of secondary causes to them, and these are more common in younger patients. So inflammatory disease is the big one that I see a lot. So we have a term on uveitis, which can related to autoimmune diseases like lupus or rheumatoid arthritis. Um, there can be in stash diseases where you have a bacterial viral infections inside the eyes and then lead to inflammation, which then cause glaucoma. And then even patients who have certain type of, um, you know, neoplastic or these cancer like diseases, they can also affect the eye in a very real way. So diseases in the back of the eye, like ocular melanoma, which is basically like a melanoma in the back of the eye, that can be pretty traumatic experience for patients, but even types of cancers inside the iris itself, you can create glaucoma and other vision loss, uh, from that. If you have inflammatory diseases, the treatment is often medically related. Initially, if you have a loss of the angle or the natural drain, like I was talking about before, then you need to have surgical approaches to treat the glaucoma from inflammatory diseases, but people can lose eyesight from all sorts of things. Even dry eyes itself, if left untreated, can cause blindness here, you can get a ton of deterioration of the cornea. And without that, you can't sleep, you lose the window to the world.

Shelly:

So the takeaway is to really, if your eyes are acting off and you have floaters or light in your eyes, or they're not seeing an adjusting correctly to light or dark, take it seriously and go see a surgeon or an eye doctor. Right?

Aaron:

Absolutely. I mean, with glaucoma specifically, we say 50% of people with glaucoma have no idea they have the disease because there's this silent loss of vision generally in the periphery and they don't notice that until it's kind of affects the central vision. So, you know, routine eye screening at least once a year from your local eye doctor's is essential. You know, being aware of any changes you've noticed in your day-to-day life is essential and just being, you know, being aware. And that's always the hardest thing for people to do these days, especially during this coronavirus crisis, where so much else is going on, you lose track of what's right in front of you sometimes We were open even during the pandemic for emergencies from May on, and so we were there when people needed us and we're still going to be there.

Shelly:

Were you able to do surgery after a few months and getting back to normal? Yeah. Funny word now, right?

Aaron:

Yeah. Um, so from the initial shutdown from, I think it was early in March to like, May we were completely shut down from any elective surgical procedure. We still did a few emergency procedures. I know I did. And we saw emergency patients on a day-to-day basis as they came in. But once Governor Wolf lifted the elective surgery restrictions, we were doing surgery beginning in May and have been since.

Shelly:

Ok. So, it's really hasn't affected you too terribly.

Aaron:

No, no. Not us.

Shelly:

Yeah. Because some surgeries really just need to be done, and it's, if you don't get it done in time, it could get worse and, and blindness or whatever happens.

Aaron:

Actually, there was one patient. I just remembered now, who I saw right before the shutdown. Yeah. He was a young guy. He was like 48, 50 years old, and he had massive cataracts in both eyes and he couldn't work, you know, and he was trying to get back, back to--back to his job. And he, like, we were going to sign up for the cataract surgery, but it got canceled because he was signed up for March, and so I had to kept putting it off, putting it off. And this poor guy, I was finally able to do his first eye like, I start actually trying to get his emergency surgery, but they wouldn't let me do it. So I had to wait until May, the first week in May, to do a surgery. And once he did that, he was like, his whole world opened up again. He could go back to work, he could go back to driving and doing everything he needed to do.

Shelly:

It was within a week. Yeah, and typically it's like within a few days to a week until they're healed enough to go back?

Aaron:

Yeah. So what we tell patients for, you know, recovery you expect within a day or so, you can tell me, drive yourself around the next day or the day after. Usually you say there's a week where you can't do any heavy lifting. And I tell patients to hold of changing their glasses, or prescription, for about two to three weeks after cataract surgery. But for this gentleman, yeah, he was able to drive himself in the next day to be seen for his follow- up visit.

Shelly:

I think that's one thing that surprises me, that I wanted our listeners to know--that the surgery really is in and out, is completely safe. I've seen amazing work done at Kremer, and, um, and it seems to be such a short amount of healing--return back to life, you know, everyday skills, in a very short turnaround.

Aaron:

You look at the history of cataract surgery. Actually, I gave a lecture on this a year or two ago, like in the old days, before 1950 people would be stuck in the hospital for 10 days, waiting for their cataracts to heal. They'd be supine, laying down with sandbags over their eyes. You know, it wasn't till modern techniques came around in 1970, 1980s that people could actually stay in the hospital and they wouldn't, but nowadays our surgeries are so efficient, and I don't say risk-free free, but there's less, definitely less risk to it. They're there in the hospital or in our surgery center for about two hours at the most, and they go home the same day.

Shelly:

One final thing I want to talk about with eye care is what is the best way we can care for our eyes either during the summer months or the winter months with snow and sun glare.

Aaron:

So there's, there's, um, you know, special glasses that will take care of certain types of ultraviolet rays. So you want to have sunglasses that block UVA and UVB sunlight, and then some patients really appreciate that's what is known as a blue blocker light that helps out with certain technical glare. I know I have those for when I'm driving sunglasses and probably the best way to protect your eyes during the sun and in the snow, it's the same time thing. If you're a skier or snowboarder or snowshoer, you need to have goggles that have certain types of filters on them to block out those sun rays.

Shelly:

And it is especially like early in the morning, we hit that sun glare driving to work, and the snow glare is just as bad.

Aaron:

Absolutely. I hope we get snow this year. Last winter, there was no snow here, which-

Shelly:

-Yeah, I didn't get to take a snow day off myself. I get that.

Aaron:

I think snow days are gone, and with how people are taking care of their work at home. We're not going to have snow days anymore.

Shelly:

Yeah, that's what the kids in high school are worried about that, too, now.

Aaron:

Yeah, they're done.

Shelly:

So how can our listeners find, uh, Kremer Eye Center and you and your office?

Aaron:

That's a great question. Yes. So we have a pretty wide, um, social media presence. We're on Facebook and Instagram, Twitter, um, LinkedIn, so if you ever need us, you can look on there at Kremer Eye Center. We have our own website, if you want look at it as well its kremereyecenter.com. U m, we have, u h, offices throughout the area, tri-state area. I currently work in the Limerick office, Springfield office, King of Prussia office i n Center City. And we, we just opened up a new main center for us in the King of Prussia area just behind t he Valley Forge Casino. But it's this nice, new, beautiful building, all i n one floor, so it's very accessible to patients with disabilities, y ou k now, wheelchair accessible, all that good stuff. There's no stairs at all, so t hat makes it very nice for our patients who are r elying on walkers and need assistance.

Shelly:

That brings up a question that I just had you talking about accessibility. How do the surgeons accommodate a person with a walker or a wheelchair that needs to lay back for surgery?

Aaron:

Yeah, it's not a big issue actually for the surgery. Cause we have special surgical operating tables that can articulate itself up and down. So the patients, and all of our patients, when they come in, if they walk in or a wheelchaired in, they have their own chairs. They then go into a wheelchair from our pre-op area to, to surgery. No matter if you walk or don't walk, we want you sitting down and relaxed and comfortable so that we can kind of guide you there, not worried about you slipping or falling. There's some specific case session I can think of on my path I've had operate standing up a couple of times, which is not our normal. Usually we're sitting down in a microscope and we have our feet on two different pedals, and so we have to use all of our limbs to kind of do the surgery, but I had a couple of patients who just couldn't lie back because of, um, spine issues or breathing issues, and they had to be essentially 45 degrees articulated and, you know, doing that surgery was a challenge, but we were able to accomplish it, so we can accommodate most patients in that way.

Shelly:

Oh, that's good to know. Thanks for letting our listeners know that because you know, so many times a facility is not accessible for us and we need it. We can't have the healthcare that we need. So it's important for our listeners to understand that you truly are accessible in, in every way. Well, Dr. Aaron Cohn, thank you so much for being here and informing our listeners of all the things that we need to really pay attention to. And even in these times of, COVID not be laxed with our eyecare because it is the windows to our world. So thank you so much for all this information. It's been a joy and quite a pleasure to have you and Kremer Eye Center on the show today.

Aaron:

Thank you for the time. We're in this together.

:

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