SPEAKER_01 0:00

You're listening to I See What You Did There, a Baouch and Laam podcast offering concise conversations on the people, trends, and topics defining modern eye health. Welcome to another episode of I See What You Did There. My name is TJ Crawford. I am the Chief Communications Officer at Baouch and Laam. Most people think of eye exams as one thing. You go there to see if you have good vision or not. And I hate to admit it, but uh it's kind of what I thought before I joined an eye health company. The reality is uh it's one of the most important things you can do for your overall health. I am joined today by Mark Schaefer. He is an Alabama-based optometrist. Uh he is widely known, widely respected in the industry. I would list his credentials, but that would take half of the episode. Uh, Mark, thank you for being with me today.

SPEAKER_00 1:05

Thank you for having me, TJ, and thank you for sparing everybody of my CV. I appreciate it.

SPEAKER_01 1:11

So we'll we'll uh we'll jump right in. So it's a very simple opening question. What is the biggest misconception about eye exams?

SPEAKER_00 1:23

Yeah, and it's really important when we see patients. And for us as eye doctors, we see like 18 to 20 patients per day on average. So for us, it feels very routine. But for you, the patient who come into our clinics every single day, the biggest misconception is this is just a box that I tick, right? This is just something, oh, my vision is fine. Um, we hear that a lot from patients, but fine means a lot of things to a lot of different people. And our jobs as optometrists is to optimize your vision for today and the future, but also to be able to look for things that go undiagnosed inside the eye that you don't know is happening or changing until we've gotten to a point where we have to do some serious interventions systemically and optically.

SPEAKER_01 2:16

Yeah. So you mentioned things happening inside the eye. So the the so what makes the eye, the eye exam unique compared to other exams? And and then again, this is the part when I finally learned this that really interested me. What things, non-eye conditions, you know, outside of pure eye health, what can you identify by a routine eye exam?

SPEAKER_00 2:42

That would take a whole episode too, just listing them. So the AOA has our guidelines, but we can diagnose from a comprehensive exam in the exam lane, the 20 minutes that you spend with your optometrist, we can diagnose somewhere in the neighborhood of 250 systemic diseases. So the big ones that we typically harp on, diabetes and high blood pressure, are really easy for us to see when we have an eye health exam looking at the back of the eye. So whether we're doing an image or we're getting a dilation, some sort of fundus or retina evaluation, we can detect high blood pressure and diabetes. And a lot of times we're gonna be their first diagnosis. So a lot of patients don't know that this is going on, but because the eye has so many pathways within the brain, like 55% of the brain's pathways are dedicated to vision. So anything that happens from front to back in your head can affect your eyes. And because the eyes are innovated by blood vessels that run through and around, anything that affects your blood, your blood vessels can affect how you see and what you see. So we have a lot of patients that come in that are like, my vision is blurry. And blurry means a lot of things to a lot of different people, but we ended up diagnosing them with conditions like diabetes and high blood pressure, things that need immediate attention and things that need a referral to their primary care doctor in order for them to assess that this is what's going on.

SPEAKER_01 4:11

So you you 250 conditions, that's a lot. Um let's let's go into the clinic.

SPEAKER_00 4:19

Yeah.

SPEAKER_01 4:20

The the what what are some of the most um, I guess, surprising things, um, shocking things that that you have um diagnosed um from from a again, from a quote unquote routine eye exam.

SPEAKER_00 4:34

Yeah. And I can it it lit I literally wrote down like 12 patients that I could rip off the top of my head just so that we could have this discussion. I won't name them because you know, respect that's that would end this podcast individuality. Yeah. But the big ones, like high blood pressure and risk of stroke, um, the number of patients that I've seen that come in for their comprehensive exam, they're seeing 20 better than 2020 on our charts with their glasses, and they're like, yeah, my vision's fine. Their pressure is normal. We take a picture of the back of the eye, we dilate the back of the eye, or dilate and see the back of the eye. And what we can detect are changes due to blood vessels. And so we check their blood pressure in office. It's over 200, um, over 120. So those are stroke-like numbers. And so that patient got a stat referral. Like she went straight from our office to the ER. Um, ended up seeing a family member about nine months later who said, like, you don't know me, but thank you for saving my grandmother's life. And because of you, she got to hold her great-granddaughter, who was born four months ago. And like, that's a story that I'm getting chills. I'm surprised I didn't cry because every time I tell it, it makes me tear up. But that's she came in because she wanted some new glasses and she ended up being able, or we were able to detect a life-altering condition before it happened. Um, same thing with like a 27-year-old who came in with like sudden vision loss in one eye. And when we looked in the back of the eye, everything looked relatively normal except for some changes in her pupils. And so she got a referral for multiple sclerosis. So she had optic neuritis, but it looked healthy. But because of what we know as optometrists and what we can detect from the pathways, now she's living a very different life. Had she not been diagnosed and had she not come in to see us, who knows what could have happened to her eyes and her body. Um, so those are two just off the top of the head, um, things that we have diagnosed, and every optometrist has seen something similar to this in their career. Yeah.

SPEAKER_01 6:55

What and what's the, I'm curious um what the patient reaction is like, right? So you you, you know, do the the the tests and and you say, look, here's the good news. You know, your vision's great. Here's the bad news. You probably have hypertension, right? Like what I I I guess it it's two questions. It's what's the initial reaction, and then what's the kind of surprise level that they get from you identifying this through their again, call it routine eye exam.

SPEAKER_00 7:27

Yeah, I've started calling it a comprehensive eye exam just because routine makes it sound like we're just spinning and grinning behind a rock. Yeah, I didn't mean for you guys.

SPEAKER_01 7:36

I I meant for the patient who just thinks, you know, this is to your point earlier, like this is a box checker for me. I'm just gonna go into this. Certainly.

SPEAKER_00 7:44

I get I'm paying for an eye exam every year. Let me go ahead and use this benefit before it runs out at the end of the year. Right. Um, I think it runs the gamut, right? And I think our patients don't know what they don't know. And I think we as optometrists sometimes don't do a great job of advocating exactly what we can do in that exam. And so I've changed the way that I've spoken during my comprehensive exams for people who don't have any issues and telling them, hey, this is all the things we can see just from what we've done here today, that reaction has been, oh my God, I didn't realize everything you could see from what we've done here. The patients who have issues, it can range. And I think it really depends on the severity and how engaged we are in that care and how concerned we are. And I think if you went to see a doctor and they're like, I'm very concerned with this bleeding and your blood pressure, and I'm worried that something serious is going to happen if we don't intervene today. Um, most patients look at that and go, thank you. Like, I'm so glad that I came in today for what seemed like a common problem of blurred vision. Um, the number of people that we diagnose with systemic conditions continues to rise over the years. And it's just staggering the implications that we have as primary healthcare providers in order for us to see the entire body and not just a set of eyes on a bench.

SPEAKER_01 9:19

Yeah. And I'm I I do want to ask you about um any kind of um trends among your patient population. But I'm curious too, you know, you you mentioned that post-comprehensive exams. Yeah, I switched that. I'm not saying routine anymore. Post-comprehensive exam. Um, you you mentioned that, hey, here's the stuff that we can find, right? So the person's fine, um, but you you tell them what's actually able to happen in their next exam, say, have you noticed a change in behavior among those people who kind of have the aha moment? Are they more likely to make their next appointment? Are they more likely to try to schedule additional appointments? Is that happening?

SPEAKER_00 10:01

Absolutely. I think these patients who you have changed the trajectory of their life. And it's not just with systemic disease. I think visually and ocular health-wise, when we intervene and can change the visual trajectory of their life, um, they're going to continue to come see us as optometrists and more specifically the doctor that diagnosed and took that time and understood the condition and gave them that timely referral if they needed it. But that patient is loyal to getting an eye exam now on the annual basis.

SPEAKER_01 10:41

Yeah. That that I that I get. I mean, that that makes total sense. But but but what about the people you you mentioned, you know, if someone has a normal exam and you say, hey, look, just so you know, this is the stuff that we're actually looking for, right? It's it's more of an education thing as opposed to an intervention thing. Do you notice a change among them as well?

SPEAKER_00 10:58

So I've started applying this into my eye exam last year. So it's interesting now that we're in 2026, seeing those patients come back. Um, I don't have an answer for you, but I do think that the more we educate about the importance of eye exams, whether that's directly of like, hey, it's really important that we check your vision because your vision is how you experience the world, 80% of your sensory input comes from your eyes. Um, so if we harp on the vision aspect, then I think we get that. But I think when the more we educate about how important eye health is to overall health, we're seeing consumers and patients be more um aware and and more um, I guess, just more in tune with their overall health. And so we're seeing them come back more often because they have questions and they have all of these answers that they need and all of these different things that are going on, especially if we diagnose something. But even if we haven't, now they're looking, hey, is this something related to my vision now, as opposed to, oh, it's fine.

unknown 12:09

Right.

SPEAKER_01 12:10

So you you mentioned um you mentioned trends earlier, which is good because I I did want to ask you about that. Um at a kind of macro level, are you seeing or have you seen patterns emerge? Not just, you know, with eye conditions or eye health, big picture health. Are you seeing patterns emerge among your patient population? I have a guess, but yeah.

SPEAKER_00 12:36

The trends for us are we're seeing more systemic disease, we're seeing more medications, more co-management of disease, um, understanding autoimmune conditions, which we're getting better and better at diagnosing exactly what's going on, but seeing those on the rise, things like lupus, rheumatoid arthritis, the unspecified autoimmune conditions, diabetes and high blood pressure are on the rise. Um, even the medications that we're using for weight loss and GLP1s, those have a separate set of things we want to look for in the eye if they're taking those weight loss medications, whether for diabetes or not, um increase in thyroid disease. We're just seeing all of these conditions continue to uptick. And so we have to be, as optometrist, very well educated as far as its implications on the body, not only the condition, but the treatment for that condition as well. So medications that have long-term effects like plaquenil and hydroxychloroquine, which we're using for autoimmune conditions, have a separate set of indications that we need to be very, very careful and watching out for for our patients so that we can make sure that they don't lose vision because of that.

SPEAKER_01 13:52

Yeah. So let's do some some quick hitters here. Um who skips eye exams the most that definitely shouldn't?

SPEAKER_00 14:07

Yeah. If you look at the data, it's actually really interesting because contact lens wearers as a whole generally are more compliant with their visit schedule. And like we recommended annual eye exam, right? Like every year. If you looked at contact lens wearers, they come back on an average every 14 to 15 months. So they're like three months overdue for their eye exam on average. Now, granted, I have a lot of patients that we do a great job of recall. And so they are like, thank you for texting me 92 times because I would have forgot. And I'm like, 91 didn't do it, but the 92nd one, that is the one that did it. Um, but glasses wearers and people who only wear glasses, they come back for their eye exams every 36 months. So they are every three years that they come back. So we're seeing this at an at an earlier and earlier age. We can diagnose these systemic conditions. And so people who are wearing glasses that think their vision is fine, these are patients that are going much longer between exams before they come back for us to make sure their eye health is good. Um, patients who have diabetes and high blood pressure need to have an annual eye exam because we need to be checking the health of the back of their eye. All of their primary care doctors are asking us for those records, and we're sending communication to them because we're an integral part of diabetic management. Um, so those patients definitely skip more than they should. Yeah.

SPEAKER_01 15:38

So you you you you got at this um in that the previous answer. And there's a lot of debate about this from non-eye care professionals, right? For people like me, how often you should actually go and get an eye exam. So you said a year.

SPEAKER_00 15:52

That that's kind of the general recommendation across the board, especially you mentioned for people with conditions like diabetes and and uh twelve, twelve months, annual, just pick a month, make it your your annual month, like May or June, whenever it is, right? Like I'm gonna go get my eye exam every year at the same time. Um it just works. And like, you know, you think about vision as a whole and like what we do in the exam lane, even though it's making clicks and everybody has that anxiety of which is better, one or two. They're like, I hope I made the right choice. Um, you know, that's my job is to give you the right prescription based off of your responses, not your responses are the thing that makes the decision. Um, that's what we as optometrists get the opportunity to do. It's an art and a science. But that 20 minutes that you spend with us is if we're lucky, how you're gonna experience the world for the next 12 months. So how you show up at work, being able to function at eight to 10 hours staring at a computer screen, if your vision is off a little bit, that's gonna cause fatigue and eye strain and just things you don't want to experience. You know, right now we're recording after business hours, right? Like you need your vision to last all day. If you've got kids in sports, you want to see your child hit a home run. If you're not seeing clearly or don't have the right correction, it's gonna affect how you interact with the world. And that's if we're lucky, 12 months of good vision. If your average and glass is only as 36 months of maybe it's not as good as it should be. And I think that's an awesome responsibility that we have as optometrists that we take very seriously, but sometimes it's lost on the patient, like, oh, this is how I experience the world as a whole. So I want to make sure that I get it right.

SPEAKER_01 17:46

Um as you're saying this from doing the math in my head on my last um exam, and I'm feeling a little bit of shame right now. Again, especially it's it's compounded when you work at an iHealth company. Um last of these kind of quick hitters before we get to the uh to the close here. What symptoms should never be ignored?

SPEAKER_00 18:04

Yep. Uh a sharp change in vision. So anything that's acute that, like, hey, my vision was good yesterday. Today it is not good. Um, if there's a big change in that, I mean, I can't tell you the number of patients who come in. You know, my vision's been like really blurry for like three months, and you look in the back of the eyes, there's a retinal detachment, and you're like, I wish you would have come in the first day that you notice symptoms because your prognosis is much higher. I had a patient last week who came in that was like, yeah, my vision's been off for three months. They had a central retinal vein occlusion due to high blood pressure. And so his timeline for recovery and vision coming back is probably in the neighborhood of six months, um, just from waiting as long as we did. So any sharp changes in vision, I think sensitivity, delight, and pain are two other ones that typically are in acute condition. But if you see anything like that, or flashes or floaters or anything that looks like a curtain or veil, those are like the Disney fast pass into an office, right? If you have flashes of floaters and you call an office, they're gonna be like, all right, you hit the lightning lane, we're gonna see you in 15 minutes. Um, those are the types of issues that like you need to be seen that day. Um, I think the next step down, and sorry to take the short answer and make it real.

SPEAKER_01 19:24

This is it's important stuff.

SPEAKER_00 19:25

But optometrists are the best urgent care for eye conditions. And I think that's something that our patients, they'll be like, oh, I went to urgent care on a Friday, and like they didn't really do as complex of a of a of an examination as you do to see what's going on. I was like, Yeah, I have a slit lamp that's a microscope dedicated to this. Urgent cares don't. Like they're looking for one of three conditions, and if it's not, then you're gonna get a very generic prescription. Now, urgent cares are very useful, and I love them. We have patients that go to them and I've used them. But when you're talking about your eyes, your optometrist is best suited to deal with those problems. And so getting in with your optometrist with a red, irritated vision changes, even if it's like sinus congestion and your eyes are red, that's also a reason to see us because we can help your eyes faster, because we have more dedicated um resources and technologies to identify exactly what's going on and get you healed better.

SPEAKER_01 20:30

So I'd like to close these by asking a question that has to be answered in one sentence. So the question for you is if someone has gone years from their last eye exam, what would you tell them?

SPEAKER_00 20:49

Go get an eye exam, comma. Your optometrist probably hasn't had one either. If you want if you want to feel better about it, TJ, I lecture at a national conference like not too long ago. And my new favorite thing to do is I have everybody stand up at the beginning and I go, okay, sit down if you've had a comprehensive eye exam within the last year. And I'm telling you, less than 30% sat down. So you're not alone. We are optometrists that don't take care of yourself ourselves. So don't feel bad. But my message is go get an eye exam. We're not gonna make you feel bad for not going this long. Like we're just glad to see you because you're taking an effort to take care of your own eye health and whole body health.

SPEAKER_01 21:34

Yep. Mark, this was uh very helpful. I think it's gonna be very helpful for a lot of people and uh appreciate you taking the time.

SPEAKER_00 21:42

Thank you so much for having me. I really appreciate it. This is it's always fun to talk about eyeballs. Good to see you. Thank you.