Dr. Calvin Roberts Talks about Glaucoma on The Dave Nemo Show, SiriusXM Road Dog Trucking Station

Dr. Calvin Roberts talks about Glaucoma — screening, prevention, and current treatments — on The Dave Nemo Show, SiriusXM Road Dog Trucking station. Road Dog Trucking keeps over a million professional drivers and industry stakeholders informed of current and pending issues affecting the trucking industry, ranging from transportation legislation and technology to health and wellness. 

Podcast Transcription

Announcer: Live from the American Gulf Coast it’s the Dave Nemo show.

Nemo: We are really thrilled and I mean that sincerely to welcome back to the program 

Doctor Calvin Roberts. He is the President and CEO of Lighthouse Guild, the leading organization dedicated to providing exceptional services that inspire people who are visually impaired to attain their goals.

And of course, Dr. Roberts, as I mentioned a little earlier is a clinical professor of ophthalmology at Weill Cornell Medical College and he was formerly senior VP and Chief Medical Officer of Eye Care at Bausch Health Companies, where he coordinated global development and research efforts across their vision, care and pharmaceutical and surgical business units. And, I could go on and on and on, but we’ll run out of time if I keep going and I don’t want to embarrass him too much. Doctor Calvin Roberts. Good morning.

Roberts: And good morning, and as many times I’m on the show as as many times as you mispronounced Weill…

Nemo:  I know, and I meant to ask you that.

Roberts: Like once in a while.

Nemo: Well, you know what I was gonna do was say “Veill”, and then I didn’t know if that was right. And then I chickened out.

Roberts: Good morning to you.

Nemo: Good morning and happy New Year here too. You know you and I were talking about the origin of the word glaucoma and I didn’t realize that it goes back to Hippocrates himself back in 400 BC or so, and the word glaucoma comes from the Greek word glaukos that basically means it’s a color. It’s blue-green, and it was considered to be the color of the sea, and Hippocrates says once the pupil has the color of the sea, eyesight is destroyed and you will often find that the other eye is also blind.

You know the way that’s written, I don’t know. It’s like you don’t know if the other eye is blind until you know that the other eye is blind. But in any rate it we we’ve known this was a problem for a long time, didn’t know what caused it, but they were on it in ancient Greece. So here we are now in 2024, starting a new year, we have national glaucoma month and it’s critically, eye sight, as you well know, and that’s why we can’t tell you how much we appreciate you being with us on the program because our listeners, of all of the things are the absolute most important eyesight for the truck driver.

Roberts: Absolutely. Yeah. No, absolutely. So, glaucoma is such a scary condition, not only just for obviously people have it, but for doctors because of the fact that it has no symptoms until you get to the very, very, very last stages. So here’s what’s going on.

So, your eyeball is just as it is, it’s a ball and like a basketball or a like a football, it has a pressure inside. It has an inflation pressure. So you know, if you squeeze a basketball, if it’s too hard, it feels rigid. And if the basketball is too soft, it’s it’s all squishy.

That’s how it is with eyes. Eyes should have a normal pressure to it in which it’s full, but it’s not hard. And what happens in glaucoma is that the pressure inside the eye gets high and the eye actually gets hard. And what you’re talking about that blue-green with the Greeks is that when the pressure in your eye gets really, really high the color of your iris, the appearance of it, may change its its color. 

So, if the pressure in the eye is high, what happens is that your normal circulation of blood is your blood flowing everywhere within your body, it flows into your eye. If the pressure in your eye is too high, the eye stops the blood, it can’t get in. So the pressure in the eye is higher than the pressure in your blood. And so it just doesn’t come in. The blood doesn’t come into your eye. The nerves in your eyes starve.

And then when they starve, they die. When they die, you lose your vision. So that’s  what glaucoma is. And so because of the fact that, again, you only have symptoms after this has been going on for years and years and years, the only way you find out about this is actually to go and get your eyes checked and get the pressure in in your eyes checked. There is no way around that.

Nemo: So what I’m hearing you say here in terms of the pressure and the ability of the eye to receive blood, is that it doesn’t really matter so much what your overall blood pressure is when you take it on your arm and you know the blood affects all of your organs, it’s the eye itself that accepts or rejects.

Roberts: Right. So, your blood pressure could be something like 120 / 80 type of thing. But but if the pressure in your eye is higher than than that then the blood isn’t going to flow when it gets to your eye and so consequently you need a situation in which the pressure inside the eye is lower than your blood pressure so that the blood can flow in and flow out.

Nemo: OK, so we know, we can pretty well find out pretty easily. I’m looking at a blood pressure cuff right here in my studio I keep one in here. But what I’m getting at is that only you can look to see if – Can you tell how high the blood pressure is in the eye or you just be able to say it’s high or it’s low or it’s normal?

Roberts: No. So, you actually can measure it and there are instruments that measure it, two types of of measurements. One sometimes people will go into into the into the doctor’s office and they’ll feel a little puff of air. And so that’s called a puff tonometer, meaning a instrument that measures pressure 

And so, what happens there is the air will bounce against your eye, and if your eyes hard then the puff of air won’t push your eye in a little bit. It’s able to quantify what the pressure of your eye is. Another way is there’s actually a machine that actually touches your eye, and that one can also measure exactly what the pressure inside your eye is.

Nemo: Wow, that is amazing. So, circling back to the fact that you can have it, OK, cataracts and you were with us for a national cataract month, too. So you know, so the cataracts pretty much start the day after you’re born from what I understand and they just slowly, slowly, slowly grow. If we all live long enough where we all wind up with glaucoma at some point or even if we have to live to 120?

Roberts: Yeah, no, fortunately, no. So some people are going to get glaucoma. Some people aren’t going to get glaucoma. Interestingly, glaucoma does tend to run in families.

There is a racial component to to glaucoma. Highest in this country, in Hispanics. Less so in African Americans, less so in Caucasians, but that’s not an absolute. So there are a lot of Caucasian families that get a lot of glaucoma, but I’m always concerned with my Hispanic friends and patients because the incidence is higher in the Hispanic population.

Nemo: Do we know why?

Roberts: Well, you know I think at the end of the day, it’s all gonna be about genes. It’s all going to be genetic. Alright, so either you have some kind of a gene that’s going to say, Oh my gosh, you’re going to get it and you’re going to get it early or you have a gene that says, Maybe depending upon how long you live and what else goes on in your life. At the end of the day, I  think everything is in the genes.

Nemo: I would imagine we don’t have it at the moment, but are we working on coming up with a test to discover whether or not you have that gene? There are some, I think, in the world of like breast cancer, I believe that they can get the markers and a lot of ladies are doing, you know, preemptive surgeries. Because of their numbers. So, we’ll find out how that works with us. Hey, if you got some questions about glaucoma or eyes in general, give us a call. Take advantage of the expertise of our good friend Doctor Calvin Roberts. 

<<Break>>

Nemo: It’s Highway to Health. Doctor Calvin Roberts is with us in Glaucoma Awareness Month. President and CEO of Lighthouse Guild. If you go to radionemo.com, just Scroll down to touch past the pictures and you’ll see  Dr. Roberts’ link there for Lighthouse Guild.

So, we all need to stay up and and in the trucking industry, obviously vision is you know the corner piece of of everything. So we have our eye exams yearly. Everything’s going, we see our numbers and is there a point along that number scale that pressure number scale Doctor Roberts, is there a point to where you say we got to do something about glaucoma.

Roberts: Yeah, so, the pressure in your eye is a number and usually the number 20 is the point where you start getting concerned, so anything under 20 is usually fine. Anything between 20 and 25 gets you a little bit uncomfortable. Over 25, those people need to get treated and treatments for glaucoma are primarily the use of eye drops.

And so you put a drop in your eye maybe once a day, sometimes even twice a day. Not anything that hurts or stings, but just becomes part of your routine just to put a drop in every morning when you get up. And usually that’s going to be enough to to lower your pressure, keep your pressure in that normal range, and so that you’re safe and you don’t have to worry about losing your vision.

Nemo: Got it. You and I had a little private conversation about the blood pressure during the news. I guess I got some free medical advice. I’m sorry to do that to you.  But one of the things you said, you know, you can kind of get used to medicines and after a while they kind of lose their effects. You kind of get some new meds. Will those eye drops do you forever, or do you kind of get a little resistant or do you have to have stronger? In other words, how does the eye drop regimen actually work?

Roberts: Usually the the drops that you’re on last last year for a long time now, one of two things can happen as you say, you can develop a little resistance to the drop over many years or your condition, the actual glaucoma, could get worse and and so that you need a little stronger medicine, or sometimes take two medicines in order to keep your pressure under your control. It’s only rare, and in these in these days with better medicines, it’s really rare that someone would actually need an operation or some surgery to correct glaucoma. But these days just drops alone work really, really well and keeps keeps you safe. And you know that you’re fine.

Nemo: So overall, it’s one of the most critical conditions you can have because you’re going to lose your sight and never get it back, but at the same time, it’s one of the easiest to treat with a few drops a day.

Roberts: Exactly, exactly. And that’s why the screening for glaucoma is so important, because if you can catch people in the early stages when their pressure is just starting to go up, it hasn’t caused damage and you can treat it just with a simple painless drop in the eye every day and just make sure that person is going to live their life with great vision. So that’s why that’s it’s so common. It’s one of those things that that so many people have. I think we’re over 3 million people in this country have glaucoma. And so it’s important that  people get screened for it. Really important.

Nemo: Boy, indeed, indeed. One of the things that we, well the ancient Greeks, they had no measurement devices, they had no microscopes or anything like that. So they did visual observations and they saw that color and everything, the glaucoma color, the blue-green. But, we now basically are looking at it from a completely different standpoint in terms of the medical possibilities, so technology can help us, but it can also hurt us.

Are there things we do to our eyes that can cause glaucoma to rare up in the sense like  I’m looking at screens. How many screens are in front of you at the moment, you know. Are some of the modern technologies that we’re tied to the phones, the screens, everything. Is that having an effect? Are there outside influences on glaucoma, I guess I might ask.

Roberts: Yeah, very, very few. So, I think glaucoma is just one of those things that we talked about, it’s just in your makeup. It’s in genes and it’s not one of the things that either reading or driving or watching TV or even rubbing your eyes, is going to make a difference with. So fortunately, it’s not one of those things where we need to change people’s behavior in order to help them. All we need to do is just have them take these special eye drops and then they’re going to be fine. 

Nemo: Boy, when you don’t have to change people’s behavior, that’s about 99.9% of the battle, it seems.

Roberts: It’s interesting. So, the only situation, and I remember this patient so well. So, I had this patient, great guy, just a great guy, but he was overweight and just the way he was type of thing and his glaucoma was getting worse and worse and worse. He lost the weight. And he must have lost, you know, big amounts of weight, 50 pounds, 60 lbs. Whatever. Comes back after losing the weight, the glaucoma is gone.

And since then I’ve seen this again and again. So, if there is only if there was one thing that I would say that could behavior-wise affect glaucoma would be to lose weight. And this is for people who are, you know, really, really heavy.

Nemo: Wow, that’s amazing. Yeah, that is amazing. But now those drops are not going to cause you to lose weight though, right? That’s the next thing you’ll see on TikTok or something.

Roberts: Yeah, right.

Nemo: OK, so you know I’ve circled back to the ancient Greeks to make a point and I’ve lost my train of thought. But what I wanted to do is kind of talk to our listeners out there right now. When they were listening to the Tim Ridley show, and in fact, let’s see, it’s just kind of becoming daylight out on the West Coast right now. So driving at night, colored halos around lights, a lessening of peripheral vision. There are some warning signs and it’s a pretty good laundry list, too.

Roberts: There sure is. And so, what happens is that when the pressure in your eye goes up your ability to focus actually decreases, and so you will get some blurry vision. You will get the halos. Oncoming headlights become hard to see. You notice that you just getting a lot more glare than you’re used to. You’re wondering why is it that I’m putting sunglasses on when I drive at night. Why am I happier with sunglasses when I’m driving?  It just helps you with the glare. 

I think those are the type of symptoms that shouldn’t be ignored. And so that glare, halos those type of things, oncoming headlights that just seem different than they were before. Those should be the signs that you should go and get your eyes checked for sure.

Nemo: Don’t let it stop with the glasses.

Roberts: Don’t let’s stop with the classes, absolutely.

Nemo: You’re talking about difficulty in ifocusing and things like that. In terms of difficulty in focusing, do you mean that it takes you longer to focus or that you never can really focus or or a combination?

Roberts: It just seems like things just aren’t as sharp. You know, it used to be that I could that I could see those signs. Those street signs. Just a lot sooner. Now, I have to wait until I get so much closer till I see it. Now that I got my glasses changed and even with my new glasses it just seems like the signs just aren’t as clear as as they used to be, and that could be a warning sign to you. There’s something’s going on here that’s really worth the getting checked out.

Nemo: Yeah, because there are no symptoms. But there are plenty of warning signs, and there’s a difference there. But if you can’t get a symptom, go for the sign.

Roberts: Right, right. So, it’s not something that did your eyes are going to hurt or something like that. No, that’s not what’s going to happen. And again even those signs are really more in the later stage. So that in the earlier stages, the first couple of years it’s going to be causing damage to your eyes and it’s not even going to give you those warning signs, and that’s why for glaucoma in particular, I say don’t wait until you’re noticing something going on, please just go in. Get your eyes checked. And particularly if there’s someone in your family who has had glaucoma because we talked about that, this could be a genetic part to it. 

So if it’s somebody in your family who you know has glaucoma, my gosh, please get your eyes checked.

Nemo: And the onset of glaucoma, as you mentioned and emphasize, is that it it’s a very, very slow process that you’re not really even going to notice it on your own until it gets noticeable. But, it’s going to take a long time for that to happen. 

I want to kind of drop the eye drops back into the conversation. We just got about a minute left Doctor Roberts. OK, so you catch my glaucoma, you give me the drops. I’m doing them every day. Everything’s wonderful.

Is it only going to be as good as the day I come in and get the drops. In other words, if I have glaucoma and I’m at like the six month stage, I I know there’s no six month stage, I’m going to kind of get a good relief. But if I hold on for a year or two years and you give me the drops. I’m not going to go back to the six month stage, right? I’m going to stay where I am. Or will the drops help me to regain?

Roberts: No. So you’re never going to regain what you’ve lost. So, you’re not going to regain the vision. You’re not going to regain that health of of your eye. What you want to be able to do is stabilize it so that your eye doesn’t get worse and that you retain the health that you have and the vision that you have.

With glaucoma, what we want to do is treat you early so that you don’t lose vision, and if you have lost vision, we don’t want you to lose any more.

Nemo: Doctor Roberts, Calvin Roberts, thank you so much for being with us here, helping us get a good look at glaucoma on Glaucoma Awareness Month. That’s going to be Highway to Health.