Eye health and the vision care field
Hey, it's your eye health experts, Prevent Blindness Texas, and welcome to Eyespiring, a conversation about all things vision and life. Hello, and welcome to Eyespiring with Prevent Blindness Texas. I'm Heather Patrick, the CEO and your host for today. PBT is an organization that works to build strong continuum of care in each community we serve so that all children and adults have improved equity to access quality eye care. We know that vision critically impacts learning and development, mobility, independence, and health.
Heather Patrick:We advocate for the necessary attention and solutions to issues surrounding the aging eye and we define success when all individuals who need eye care receive it. Our work improves the health and quality of life for thousands of individuals across the state. So I have been in this business about nonprofit health care business for twenty years or so. And I've been CEO for about eight years. And I think the thing that stands out to me the most is that still there is a disconnect between eye care and overall healthcare.
Heather Patrick:So that's one of our goals through conversations like this and all that we do is to help bridge that gap and really help people understand how important eye health is as part of their overall health. So now I'm excited to introduce Doctor Jane Edmond, our guest for today. So I'm gonna share a little bit about her, and then I'm gonna ask Doctor Edmond to tell us more.
Heather Patrick:She's an ophthalmologist who specializes in both pediatric and neuro ophthalmology. She serves as the inaugural chair, Department of Ophthalmology at the University of Texas in Austin, Dell Medical School. She's the director of the Mitchell and Shannon Wong Eye Institute and Vice Dean of professional practice. She, during her tenure at, UT Dell Medical School, has overseen the construction of two ophthalmology clinics, staff hiring, and the successful launch of a new ophthalmology residency program.
Heather Patrick:She has served in numerous distinguished positions, including the president of the American Association for Pediatric Ophthalmology and Strabusiness, and she which I think is cool, and I want to ask you about this a little bit. She has served as an oral examiner for the American Board of Ophthalmology. She received her medical degree from Baylor College of Medicine. All right, so Doctor Edmond, tell us a little bit about yourself.
Dr. Edmond:Gosh, I'm from El Paso, Texas, and I'm the third child in my family, the last and only girl. My parents divorced when I was two. Mom remarried, but she pretty much raised me as a single mom for several years and worked as a social worker in El Paso, and then as a substitute teacher in Spanish, teaching Spanish. And so I hung out with my maid, Esther, who was my second mom, and grew up speaking Spanish first and English second.
Dr. Edmond:Moved around because my stepdad was in the military. He retired when I was going into high school, so we moved back to El Paso, finished there, and went to UT Austin, and was fortunate to match into Baylor College of Medicine for my medical school internship and ophthalmology residency.
Heather Patrick:Wow, so do you think kind of having that growing up with that social work background has really helped drive you and your connection to the community. Is that one of the reasons you think you have that passion?
Dr. Edmond:Absolutely. I think those early life events, my mom's commitment to the safety net population and then speaking Spanish and me hanging out with Esther really shaped who I am.
Heather Patrick:That's amazing. So what drew you into ophthalmology?
Dr. Edmond:So if there's a phenotype or a look, like if you're real broy and you're very built and muscular and you love sports, what specialty do you go into? What does that look like? Orthopedics.
Heather Patrick:Yes, okay, now that you say that.
Dr. Edmond:Ophthalmologist, so in medical school I rotated for a week, two weeks on ophthalmology. Right now, unfortunately most medical schools, a vast majority, do not have ophthalmology rotations, so if a medical student is interested in ophthalmology, they have to seek that out as a selective or an elective. It's not a standing part of the core education or core clerkships.
Dr. Edmond:But I had my own eye problems as a kid. I wore contacts, which a lot of people do, and I was diagnosed with an optic nerve condition by my wonderful optometrist, Doctor Swick in El Paso, that I had optic disc drusen, and it hadn't caused any problems in my life and still causes a few problems. But having an eye condition also made me a bit more engaged with ophthalmology.
Dr. Edmond:And then when I rotated on ophthalmology, the vast array of conditions and the residents were really cool people. It was like, I want to be in this club. I don't want to be in the ortho club, and I don't fit that.
Dr. Edmond:But they were very interesting people, they seemed to be very satisfied with their career choice, and the difference we make in people's lives, in fifteen minutes you can take a hand motion cataract patient into a twenty-twenty patient, seeing twenty-twenty or perfect vision. That kind of patient satisfaction in a routine sort of procedure, that was really impactful for me also to want to pursue ophthalmology, plus ophthalmology is a very selective field.
Dr. Edmond:You have to be it's very competitive, difficult to get into, and I think that also was a little bit compelling to me, the competitiveness of getting into ophthalmology.
Heather Patrick:So a little competitive, are we? Yeah, possibly. So why isn't ophthalmology part of kind of the general core of education? And is that something you'd want to change? Is that something we advocate for change?
Dr. Edmond:I'm going to reference a CDC statement from maybe ten years ago of the top chronic conditions that needed governmental, federal, state, local, regional attention, and diabetes, hypertension, the common causes of cancer, neurologic conditions, mental health, but ophthalmology was nowhere on that list. But ophthalmology is eyes and vision health are involved in all of those, so many of these chronic disease conditions.
Dr. Edmond:And considering that 65% of our brains are devoted to vision, visual acuity, peripheral vision, visual processing, and eye movements, it just seems that it should be more embedded in our governmental federal focus, plus more focus at the medical school level, and I think maybe ophthalmology got derailed like some of the other otolaryngology, ENT, other subspecialties because of the push to create more primary care physicians, more pediatricians, more women's health.
Dr. Edmond:And so maybe that's how this happened during my long tenure as an academic ophthalmologist, but I'm not sure of the genesis why we've gotten pushed out and why medical students have to seek out an ophthalmology experience.
Heather Patrick:Well, something I think to on the forefront for us to talk about how we could change that and what that could look So kind of leading into that, what legacy do you want to leave in the field?
Dr. Edmond:Well, this position had well, before I became the chair, I think one legacy I was helping to leave was having trained over 60 fellows and over two hundred and fifty residents. You become part of their DNA, and I give a talk on professional identity.
Dr. Edmond:Your personal identity is shaped by your parents and where you grew up and the people around you, but your professional identity is shaped by the people that you encounter in medical school and that you encounter in residency. And you can be a positive role model or a negative role model, and they're both equally important and impactful. So I think I hope I have been a positive role model.
Dr. Edmond:I hear from old fellows that I trained thirty years ago. I remember you told me that never do this in this type of surgery or always do this. I'm like, gosh, I don't remember ever saying that, but I'm glad that worked out. And I remember how you were compassionate to a patient who didn't have bus fare and you provided them bus fare, and how moved you were by a child with a facial deformity and eye problems and were engaged in sort of casework for this family. Those are the kinds of things.
Dr. Edmond:That's inserting, being part of the DNA of the people that you're training, I think is a very important valuable legacy that all of us in academic medicine have that opportunity. But another part of my legacy is establishing this department with a gracious, wonderful, amazing $20,000,000 gift by the Wong family, Mitchell and Shannon Wong, and their spouses, Rose and Betty Wong.
Dr. Edmond:This transfer, it's called a transformational gift, know a lot about it established the Department of Ophthalmology at Dell Medical School where I don't think our inaugural dean was motivated to do that because it's not a core, it's not a primary area of medicine, like neurology, internal medicine.
Dr. Edmond:These are core clerkships, these are foundational educational experiences we must offer medical students and important to the community, right? Ophthalmology is sort of tier two, but I was the first tier two department and one of the only chairs that established a department from scratch.
Dr. Edmond:So built those clinics that you kindly referenced and got very fast tracked into establishing the residency, so I think my legacy in this last chapter of my life is establishing the clinical pillar and hiring faculty and obtaining a contract to care for the safety net population. They were the status of care in ophthalmology was woefully understaffed.
Dr. Edmond:They had very few ophthalmologists that were part of that contract. There were over 100,000 patients with this insurance product from the hospital district that could not get care. Fifty percent of them did not have eye care as a covered benefit.
Dr. Edmond:I got that pushed through by developing relationships with the hospital district and with Ascension, and the stars all aligned, and we obtained that contract, and I hired faculty who are socially conscious and fabulous clinicians and fabulous educators, and then establishing the residency, so it's three per year. Our oldest class is in their third year, including the internship, there's three more years of ophthalmology, so they're about to be senior residents after July, and that's the other legacy that I'm proud to leave.
Heather Patrick:I love listening to you. Just the passion that comes through when you're talking about this is just, it's just amazing. You are truly, and I said it last night, but you know, when you're in this business and it is about people, I am always just incredibly inspired and you know being in this business is hard. It's a hard job raising money and serving, right, because the need typically always outpaces the resources. But when you come and you find someone like you that just the passion comes through the commitment to all your patients is just so inspirational.
Heather Patrick:And I think I wish that all healthcare providers looked at it and saw the whole picture like you do because I just think it would revolutionize health care. So what has been one of the challenges of becoming an MD especially as a woman?
Dr. Edmond:Yeah, so I graduated from UT Austin in 'eighty one and entered medical school in 'eighty one, and at that time 24% of my class were female, so now it's over 50%. Sister-in-law, who was a pediatric infectious disease specialist, ten years older than myself, she went to UT Southwestern. They have 200 students in each entering class. There were 12 women. Wow. So the interest, the open mindedness of medical schools and admissions committees to incorporating women was just beginning, and that was a challenge, and you can see here how I pursue challenges.
Dr. Edmond:My mom was a stay at home mom and she loved my mother and my grandmother was stay at home, but so many additional opportunities were being offered to us at that time that it was for someone who wanted to see their life move in a different direction, those opportunities were available, but my mother was not really excited about that, and my grandmother was even less excited about me pursuing medicine. That's not ladylike.
Dr. Edmond:You should go to college, be a Delta Gamma, and get married to a doctor, and that was the extent of the aspirations my mother held for me. And so taking pre med classes and upset that I got a B because that will limit my ability to get into medical school, she was like, I could tell by the end of fifteen minutes on those Sunday calls in between two and four remember there was this window we had half price long distance phone calls?
Dr. Edmond:I would call between two and four and she wasn't really interested in a call outside of Sunday between two and four, whatever that time frame was. And I could tell I'm complaining about my grades and how stressful the class is. That was a little bit of talk to the hand, didn't understand that, wasn't supportive, but over time she became one of my champions, but it was a hard sell initially.
Heather Patrick:Wow, so where did you find that support network then? Because I'm a firm believer, especially going through the course I've taken, it is essential to have that tribe, that support network. So where did you find that?
Dr. Edmond:So it was actually friends from Coronado High School. When I was an undergrad at UT, a couple people, both men, were pursuing pre med, and pre meds get real freaked out when they talk to other pre meds about how well they're doing, what did you write on that test, and I made an A, and I'm like, oh my god, I made it. So you get very you want to limit your tribe actually because it's really stressful to hear about how well everyone else is doing because you're competing for the same spots.
Dr. Edmond:So I had two close friends that helped me get through physics and chemistry and calculus that were valuable, and then in medical school it was easier because we'd all gotten in, and women tend to attract I mean, if I was uncomfortable about something, I would typically reach out to my girlfriends and not a guy. It's like we share genetics, we share two X chromosomes, but certainly men were also in that small tribe, mainly women.
Heather Patrick:Yeah, yeah. So what has been one of the most rewarding things for you as a doctor?
Dr. Edmond:My kids would, I would come home from work and we'd talk about our day and there were stressful parts of all of our days, my days, but at the end I helped people, several or many people every day. How many people can come home from a day of work and say that you've made an impact in people, tangible, palpable impact in people's lives. It's just the most amazing blessing and gift that we're honored with as physicians.
Heather Patrick:That's amazing. So tell me a little bit about kind of like day to day for you what's the most exciting component? Like what now I mean you've accomplished so much, you've set all this into place, what keeps coming back, right? Why do you keep, okay, like even patient after patient and I know that you have, you know, successful patients but then you also have those patients that, right, you can't help them, right? And so how do you one, right, how do you look at that and then two, what like day to day, what's the one thing, that one why?
Dr. Edmond:I guess there are a lot of why's. So right now I'm 30% time clinical and the rest of the time I'm in my administrative role. So I'll talk about the clinical piece. As neuro ophthalmologist and as a pediatric neuro ophthalmologist, there may be 50 in the country that self identify as pediatric neuro ophthalmologist and at the time I did my second fellowship I was fifteen years into my career as a pediatric ophthalmologist and did this additional fellowship training. At that time there were about 20 people in The US that identified as pediatric neuro ophthalmologists.
Dr. Edmond:Neuro ophthalmologists in general, we often were the last stop of figuring out unusual conditions. We get referrals from optometrists, a lot of ophthalmologists. Often patients have seen two, three, and four eye care providers before they get to us, so solving those problems and taking more time than many offices are allowed to give their ophthalmologist or optometrist. There's a requirement to see x number of patients, and they've got a template, and they can't spend forty five minutes with one patient because their schedule isn't set up that way, so we are, as neuro ophthalmologists, do that.
Dr. Edmond:So solving difficult, making diagnoses that others could not make, and engaging in or initiating treatments, but as Heather, as you point out, a lot of the things that we diagnose are not treatable, but like Prevent Blindness Texas, there are we help patients compensate and deal with the vision they have, maximize their life experience, help them navigate with their vision, and give them the assistive devices and social networking and social care that helps them live their best lives. So that's very rewarding.
Dr. Edmond:And even if we are not able to cure conditions, I saw a fifth grader, the son of an optometrist, and she was quite convinced that her son had vision problems, although he always tested as twenty-twenty, and had seen a lot of eye care providers, and I got the history that there had been significant hemorrhaging at his term delivery, and with diagnostic imaging of the back of the eye and assessing his eye health in clinic and using a lot of additional equipment like an ocular coherence tomography and visual field testing, he had optic nerve damage from this excessive blood loss in infancy or at his birth.
Dr. Edmond:And then his MRIs had all been read as normal, and I pulled up the last MRI and had my go to pediatric neuroradiologist reread the image, and it was a significant amount of white matter damage that is consistent with blood loss in infancy, either low oxygen, much like a preterm infant suffers. This had been not read in two or three MRIs that had been obtained, and so I gave a diagnosis of cortical vision impairment, and although I cannot cure that, I do have resources.
Dr. Edmond:I can recommend additional help for him in school, special seating, and it was giving this family a diagnosis. The mother, you would think it would be upsetting, but she cried with joy.
Heather Patrick:Because she had answers, had a plan to go forward.
Dr. Edmond:She had answer, a diagnosis and a plan to go forward. So in my other administrative life, the most rewarding are when I recruit an amazing physician, either an optometrist or an ophthalmologist or a neurologist into my practice that will improve care in our community, provide care to the safety net population, work with our be a part of our family, train our residents. That's so great.
Heather Patrick:That's your why.
Dr. Edmond:Yeah, that's the why.
Heather Patrick:That is your why. So what has changed over the last decade in the field, and do you think it's been, well, kind of back to the front of the conversation, definitely some challenges I think, but what has changed for you when you look at the field over the last decade and you think, that's been great and wow, we need to fix this?
Dr. Edmond:Right. I think one of the hugest, most impactful changes is the anti angiogenic, anti VEGF injectable drugs into the vitreous or the back of the eye to treat diabetic retinopathy, ischemic or conditions that cause lack of blood flow to the back of the eye, which predominantly is diabetic retinopathy. That has been gigantic. Instead of losing half all of your peripheral vision to a laser, which we did, I did in residency, all of us did in residency to treat diabetic retinopathy, there are now these injections. And more attention.
Dr. Edmond:What's wrong is that we're not focused enough on preventative care. So I think I've been in three you chat to your Uber driver, I take a lot of Ubers in Austin because traffic's awful. I chat with an Uber driver and I think I've been in a car with probably three type two diabetics that are maybe in their 50s who know next to nothing about diabetic retinopathy.
Dr. Edmond:Most of our blinding conditions, diabetic retinopathy, glaucoma are painless and occur at ages when there may not be Medicare beneficiaries that have insurance to cover them to go to the ophthalmologist or optometrist, and their vision loss is slow and insidious. So in these Uber drives, how little these individuals know about eye health and their diabetes, and that is the leading cause of permanent vision loss in our country.
Heather Patrick:I think that's one of the reasons for me when I think about PBT, it is, we have such an opportunity to make a huge difference just by really connecting those dots, right? And it's for me when I think about, you know, awareness, but it's really education to action. It's really helping everyone understand, right, that connection between overall health and your vision.
Heather Patrick:But then what do you do next, right? And so I think that is why it's so important for organizations like PBT to be here and to partner with the healthcare community because we really can help kind of bridge that gap of knowledge so that people do know how important it is and what the next steps are.
Dr. Edmond:And physicians are reimbursed not so much to prevent disease, but to treat disease. So that's where Prevent Blindness Texas is that filling that gap, that super necessary important. And it has to be communication I wrote a, or it was part of a paper, it was a white paper from the American Academy of Ophthalmology, and it was addressing health disparities, health inequity, ocular health inequity.
Dr. Edmond:And I was in a subtask force that was involved with medical literacy, and I didn't know a whole lot about medical literacy except that the education that we provide patients must be at their understanding level, so that being medical literacy.
Dr. Edmond:But what channel is it best provided? Is it online? Is it on a brochure? Is it in a verbal form? We have language barriers, educational, different levels of education, different cultural values that might alter our approach, so that's where Prevent Blindness could make a huge difference.
Dr. Edmond:But it is a complicated field, like how do you speak to an Asian grandmother who does not speak English, and you need to have a different sort of level of respect when you're in the clinic with this individual and you're maybe using her granddaughter to translate, which makes her very uncomfortable, both of them very uncomfortable, so it's a complicated process. And how much do you hear in a doctor's office? I come out of my own doctor's appointments like, what did she say?
Dr. Edmond:So that's where Prevent Blindness is just really doing a fabulous job.
Heather Patrick:Thank you. So kind of on that note, what patient stories over the years have stayed with you, and one that you wish you could go back and change it, and or one that has made you a better doctor?
Dr. Edmond:Yeah, I call these events light bulb moments. You know, like you see in a cartoon, the little light bulb, like wow, my mind has been blown open. And I came from a middle class background, got into medical school, and I was in the delivery room because we have OBGYN rotation, and I asked an individual who's about to push a baby out, trying to fill out these forms, Are you married?
Dr. Edmond:I'm thinking that surely that's a question here and I've got to check these boxes or fill these boxes in before this baby is delivered or arrives. And the labor and delivery room nurse spun around and said, You do not have to be married to have a baby. And that was humiliating for me, but blew my mind open. Like, there are a lot of different people that I will be treating, and I need to be respectful of where they come from.
Dr. Edmond:I had an interest in craniofacial syndromes. These are genetic alterations, mutations that cause a facial deformity, and it often leads to eye socket abnormalities that leads to a lot of vision and ocular misalignment problems, drying out of the eye, the eyes are very bulge out of the eye socket, hand deformities, neurodevelopmental abnormalities.
Dr. Edmond:So I was seeing a patient with a syndrome like this, and it was a Spanish speaking patient, and my technician was translating for us, but I speak some Spanish but not enough, and she turned to the technician and said, Doctor Edmond, out of all, a lot of doctors are caring for this child, a lot of surgeons and clinicians, Doctor Edmond is the only one that cares for my whole child.
Dr. Edmond:Like asking how they are and how he's doing in school, and that was a very gratifying moment. Developing compassion, you're so focused as a physician on fixing the problem. That's what we're trained to do, we're very tactic oriented.
Dr. Edmond:Yeah, that's what we're supposed to do. But developing the compassion and sitting back and thinking about the condition from the patient and the family's perspective, that takes developing in the professional identity early in our residents' lives. I hope I can do that because I have a, as you can tell, that's part of healing.
Heather Patrick:It is. And honestly, as a patient, you want to know someone's vested in your care, right? And so if you feel that, one, you're more likely to trust your doctor, so you're more likely listen to them, so you're more likely to follow the protocol, but have those conversations. And it is typically those conversations that I think give your doctor the perspective or the wait, we need to go back and look at this, right?
Heather Patrick:So I think it's just that piece of it of, I mean, all humans want to feel connected and the more connected they are, the more likely they are to trust you and have that kind of relationship. And those relationships I think are what helps patients adhere to treatment and honor that continuum of care and stay in it because they have that relationship with their doctor.
Dr. Edmond:As part of the joy of medicine is developing those patients' relationships. We're not just technicians. I mean, this is still a calling in my opinion. Last night, a woman came up to me and said, Are you Doctor Edmond? Yes, I am. You took care of my daughter, Tiana, who's sitting right over there. She's 24. You started caring for her when she was three.
Dr. Edmond:Highly nearsighted. I gave her glasses. There was eye alignment issue. Then we went into contacts, and these are how simple is that, right? Glasses and contacts, this is not a very complex situation, but I made a huge difference in this child's life and the family's life, and because of the type of care rendered or my attention to the family, who gets to do that other than people in health?
Heather Patrick:Yeah. So what do you wish more patients knew?
Dr. Edmond:I wish more patients knew more about their eye health and empower them to ask questions and to be in the clinical setting with their eye care provider, and if that wasn't understood, ask it again. Please explain it in different terms and how I can maintain my eye health or improve my eye health, or this plan's not working for me, or this medicine is too expensive, it's not covered under my insurance, or I'm self pay.
Dr. Edmond:Low vision, patients with vision impairment. I wish ophthalmologists knew more about that warm handoff. Like what do we do with this individual who's stopped driving, who has lost their job, who's isolated at home, are they depressed, are they a suicide risk, what can we do to help this individual be more satisfied and more productive and live a happier and healthier life with their vision impairment. I wish physicians, eye care providers, knew more about that and patients as well.
Heather Patrick:So do you think that's a gap that an organization like PBT could step in and fill is to kind of bridge that communication and education between even like mental health providers and eye providers, being able to say, look for these signs, right? And to help, you know, have that communication and relationship so that it is they know exactly if they start to see these things outside of what their specialty is, right? But they know what the next step is for their patient and how to get them there.
Dr. Edmond:That is a gigantic gap that would be prime for PBT to step into. Think about your average retina clinic. So that's 30 to 50 patients in a half day. Many are getting injections for their diabetic retinopathy. They may have retinitis pigmentosa as well, but lots of age related macular degeneration, so not peripheral vision but central visual acuity.
Dr. Edmond:If you're seeing that many patients a day and treating that many patients a day with this gigantic tsunami of individuals with age related macular degeneration that need injections and diabetics that need injections. There's not going to be the time required to ask or provide a survey, PQH9 is what we use, about suicidal ideation, and do we need to refer this patient to somebody, a low vision specialist, or orientation and mobility, or workforce, Texas workforce.
Dr. Edmond:Those conversations, it's possible that the eye care providers don't even know about these and don't have the time to have that conversation. So that would be a really important gap to fill.
Heather Patrick:So I wanna go back to talking about you wish more patients basically would advocate for themselves more effectively, right? How do we help them do that, right? Especially we had this conversation last year when I interviewed you specifically, right? I think women are less likely to push back on if they don't understand something or they feel like they need more information. So how do we help that?
Heather Patrick:How do we fill that gap so that patients do feel more comfortable asking questions and advocating for their health? How do we help close that gap?
Dr. Edmond:I think it would be another prime opportunity for PBT because physicians aren't going to do that. With declining reimbursements over the last decade or more, that forces all physicians, all providers to see more patients, which decreases the amount of time that on the schedule is spent with a patient, so there are external factors that push physicians and academic and in private practice to see more patients, so that's less conversational time, but that's the patient's right, and they are for top priority.
Dr. Edmond:I know we need to make money to keep our clinics and offices open, however, our leading number one to 10 priority is our patients, and that education should be provided, or, and empower the patient. Hopefully you can empower the patient. I'm not sure how we as physicians, I certainly would be happy to do that, but it's not going to be a dominant conversation in most providers' offices.
Heather Patrick:Yeah, yeah. So what are you passionate about outside of medicine? Like what fills that bucket outside of medicine for you?
Dr. Edmond:Well, I used to paint. Both my parents were artists, but actually I don't have a lot of, it's sad to say, a lot happening outside of medicine. So I work about six days a week. I take a day off. I love going to our ranch with my husband, which is about an hour outside of Austin, and it was my mother's ranch, it's not large, but when I walk in that house, I channel her spirit and it makes me happy.
Dr. Edmond:I love being with my adult kids, they love being with us, which is like a blessing, And we see them several times a year, I should visit them more often, but there'll be a day for all those things.
Heather Patrick:So here do you see eye health and vision care in five years?
Dr. Edmond:I think we'll have, so the injections for wet macular degeneration and diabetic retinopathy, they happen on every four or six or eight week basis. I foresee longer acting injectable drugs so patients don't have to return to the retina surgeon as frequently, and maybe there are devices that are implantable that elude the drug, that that can like maybe a yearly fill up of that device that eludes the drug.
Dr. Edmond:Inherited retinal disorders are there are a few gene therapies that have been discovered that restore not normal sight but bring back some sight to these some blinding from birth, Leber congenital amaurosis, one genetic mutation that causes that, a condition of blindness at birth.
Dr. Edmond:I see on the horizon more gene therapies for inherited retinal disorders, which can be present at birth or, like retinitis pigmentosa, manifest later in life. Also, bionic vision, I think that's on that's already been discovered but has not evolved to being like a mainstream go to device.
Dr. Edmond:Also brain based vision impairment, that's harder to create a bionic vision device. Hopefully with stroke patients you turn on their, somehow turn on the visual field deficit. I think those would be really exciting things in the future and not too far off.
Heather Patrick:Technology. The good and the bad of technology, what about, do you think at some point in the future we'll be able to screen someone's eyes and be able to really understand what their risk is for heart attack or heart disease or giving some kind of that, a more in-depth concrete health risk assessment?
Dr. Edmond:Yes, and so AI has been able to look at a photograph of our retina and determine with a high degree of accuracy if you are male or female. And we have no idea how it does that.
Heather Patrick:I mean, that's kind of cool and very scary at the same time.
Heather Patrick:Well, exactly. So you are spot on, Heather. These AI with big data and tons of images have been able to predict dementia risk, Alzheimer risk, cardiovascular death and morbidity and mortality risks, so that can be very informative.
Dr. Edmond:There's a lot of regulatory federal patient privacy hoops, FDA hoops that have to that are very expensive and add a lot of time, delays to get things like this to market, so those types of utilities of AI in those spaces, the only AI device that has or devices in the AI space that have been FDA approved are diabetic retinopathy.
Dr. Edmond:Predicting I think they have to use Sympolitically Correct. It's predictive of diabetic retinopathy and only a human can make that diagnosis, but there's a very high degree of accuracy for the AI to diagnose diabetic retinopathy, and then that type of screening can be done in the primary care space. You don't have to see a doctor two times a year or once a year.
Dr. Edmond:That's in an otherwise individual that has glasses and can see just fine, and it's just for a diabetic check, this has saved so much healthcare dollar, better patient experience if these cameras are available in the primary care office. That's just terrific for patients and the healthcare dollar.
Heather Patrick:So do you think that would help drive prevention or at least a larger infrastructure for prevention?
Dr. Edmond:So looking at the back of your eye with fundus photography that's gone through AI or maybe OCTA or some other diagnostic imaging, your risk of cardiovascular complications in five years is eighty percent. Well, that would change that individual's compliance with their hypertension meds, change their diet.
Dr. Edmond:So yes, I think that would scare the bejeebers out of people and get them to hopefully change their behavior and compliance to meds to improve their health. But what about this scenario? So in ten years you have a ninety percent chance of dementia, of which we have no cure. That would not make me very happy.
Heather Patrick:Yeah, there's the pro and the con to it, right? As with almost anything, right? Yeah, so I think it comes back to how do we utilize it effectively but to the ultimate benefit of the patient. Right?
Dr. Edmond:And balancing physical health with psychological health.
Dr. Edmond:Absolutely, absolutely. Okay, one last question question around eye health. What's the one thing, if our listeners take nothing else away, what's the one thing you want them to remember?
Dr. Edmond:Be good to your body, because good physical health will convey good ocular health. So much of our health you would think that your health status was significantly dependent on where you live and your access to a quality physician, but that's only like 20%.
Dr. Edmond:20 to 30% is based on behavior. Smoking, good diet, taking your medicines, a small percentage, 20% on your genetics, social determinants of health, do you live in a food desert, are you eating highly processed foods? I would say attend to your general health and that will serve your eyeballs well.
Heather Patrick:I was in an integrative health coaching program last year for six months through the University of Houston, and I think one of my largest takeaways from that was, I've been in the healthcare industry, so I should know those, but true the impact stress has on our well-being at every level. I don't think we've done enough to really talk about how that impacts each part of our body.
Heather Patrick:I think we've done a good job of talking about how stress impacts our mental health, but the physical impact it has and how that plays into if you have diabetes and what that means for you if you're carrying all that stress. And so the class was amazing and really life altering for me in many ways, but that really stuck with me of how do we help tell that story to even with your eyes, right, how important it is to manage our stress.
Dr. Edmond:When you figure that out you tell me okay.
Heather Patrick:Yeah, I mean, I think one is being aware. I think it really is truly understanding what stress does to your body at all different levels, right? And then what that does to you physically too. And I just don't think we, I don't think enough people understand that because we talk about self care and all of that and I absolutely believe in that.
Heather Patrick:But it's more than that. It really is I think understanding how detrimental stress is at all levels, but especially physically the impact it takes on your body.
Heather Patrick:And I think being able to really, again, I think so much of it comes back to the bridging the knowledge, and then really helping people understand what actions they can take even if they're small actions, right? Small steps lead to big outcomes. So I think being able to, kind of back to the earlier point, right, with the mom once you kind of know what the issue is, how to make the plan for it. So I think that's an important component.
Dr. Edmond:And there's a lot of, you know, wellness has become very important in the workplace and that may be due to COVID and the rise of suicide and the isolation that COVID led us all to suffer. So the workplace can play a role in stress reduction by attending to wellness.
Heather Patrick:I agree, 100%. Okay, so you got connected with PBT about five years ago. We've been on this journey together, so what would you tell our listeners? Why get involved with PBT?
Dr. Edmond:It is that it's filling those gaps in between the public and the eye care providers. It's the social outreach, it's the social consciousness that I want to teach my residents, that I learned as a youngster that I want all of my patient care, the patients I treat, to understand the broader community, not just the patients that are in front of me.
Dr. Edmond:So I think physicians, we advocate for our patients inside the clinic or the Operating Room, but if we don't advocate for our patients in the community, regionally, federally, we're not doing half our jobs. I think that's where PBT comes in, because they do that part of our job in caring for our community, our people, our citizens.
Dr. Edmond:So that's why PBT is so important and that's why I've engaged in this conversation and why I donated a bunch of money last night, because of the great work that PBT does.
Heather Patrick:Thank you, thank you. So I love that social consciousness. I think that is really, that's a key. So thank you so much for being here and being our guest.
Heather Patrick:So back to Doctor Edmond's point, if you would love to get involved with us, we would love to have you. There are many different ways to get involved with PBT from serving on a committee to becoming a trained and certified screener to being a donor.
Heather Patrick:We are always happy if you reach out, we're happy to talk to you. So please let us know if interested. You can always reach us through our website, call us, email us. We are happy to have and watch the PBT family grow.
Heather Patrick:And of course, we are always open to donations as well because I think you said it earlier, right? We have to have the money to make the mission move. So thank you so much. Any last minute advice before we go?
Dr. Edmond:No, I'm just so honored to have been your visionary awardee, and PBT is such an incredible organization. Giving money is one thing, that's very important, but the volunteer aspect and how gratifying it is to be with a group of individuals that are like minded and giving back to the community, those of us who are able and have time, retirees or if you're in your working ages, how it makes our souls healthier to give back and volunteer. So I encourage the listeners to do just that.
Heather Patrick:We are called to serve. So thank you so much for listening and making sure that make sure you subscribe to Prevent Blindness Texas Eyespiring. Have a great day. Thank you. Oh, and our last question always for our audience. Let us know what your vision is.
Dr. Edmond:Thank you Heather.
Heather Patrick:Thank you.
