The Monthly Eye Opener: February 2025
The [mis]information age, the rise of severe eye disease in younger patients, and experience testing the Olleyes VR headset
Welcome back to the Health Doko newsletter, where I share my insights on all things healthcare, eyecare and innovation. Over time, we will incorporate reader feedback and refine the format to ensure alignment with our mission of improving the healthcare landscape in the U.S. and beyond.
The Health Doko newsletter is designed for a diverse audience including healthcare professionals, those interested in medical innovation, and most importantly, patients and their loved ones.
February’s Topics:
The [mis]information age
Younger patients, sicker eyes
My experience with the Olleyes virtual reality headset
Healthcare: The [mis]Information Age
The information age started in the mid-1900s, accelerating the distribution of information across the globe. Humanity has benefitted in countless ways thanks to this seismic shift in technology. Sadly, and I would argue inevitably, we are suffering the consequences of near-instantaneous global dissemination of information, regardless of whether or not it’s grounded in truth. Politics aside, one thing we should strive for in this age of misinformation is keeping an open mind with a healthy dose of skepticism. Critical thinking is critical in more ways than one. Just because something is viral or asserted by an authority figure does not make it true. It’s easier than ever to learn about many of these figures’ previous actions, statements, conflicts of interest and ulterior motives. I think at the end of the day, regardless of background and beliefs, most people strive for connection, meaning, respect and happiness. But there are plenty of rotten apples, and they are happy to promise fulfilling those desires as long as you accept their absolute truths. Buyer beware!
Why this matters to patients:
It’s hard to know where to even start with the flurry of attacks on science and medicine these days. We’re seeing the US government gut research funding, erase vaccine schedules/guidelines, threaten Medicaid and end most telehealth coverage by insurance. Researchers and patients alike are being left high and dry. There is no doubt this will dissuade many from pursuing careers in research and force current researchers to abandon their work. Our beacon of innovation is certainly flickering. Short term, we’re looking at worse disparities in health. Long term, we’re looking at potentially fewer scientific breakthroughs and longer innovation cycles. For patients, that could mean the difference between a new treatment option, a cure, or nothing at all.
I see a lot of smart people get swept up in misinformation, and it’s so easy to find false information that supports one’s beliefs, just google it or an LLM will point to what you want. A recent publication in Nature Medicine demonstrated how LLMs are vulnerable to data poisoning. People don’t like gray areas, they like black and white, concrete answers. The problem is that if you spend any amount of time in medicine or science, you’ll learn that’s just not how life works. But in the age of instant gratification and healthcare consumerism, people want absolute truths. Any self-respecting scientist, physician or surgeon will tell you there are no guarantees in life, and not many absolutes. There are probabilities, studies, anecdotal experience and evidence. But patients naturally just want an answer, a magic bullet, and if the doctor doesn’t provide it because it simply doesn’t exist, someone else will be happy to take advantage of this gap between expectations and reality. Yes, I know there are plenty of doctors who have done horrible things, published false data, peddled snake oil to the desperate, etc. This certainly doesn’t help anyone, and it erodes trust in science and medicine. In fact, this Gallup poll observed the following:
Trust in medical doctors has fallen 14 percentage points since 2021. After reaching a historical high of 77% in 2020, doctors’ ethics rating not only returned to its 2019/pre-pandemic level of 65% but, at 53%, is now the lowest since the mid-1990s.
With that said, science and medicine have saved many lives and improved the quality of life for countless more. Sadly, despite our current array of resources and technology, our own culture and lack of public education are causing breaks in the foundation for those pillars to stand on. Look no further than the recent measles outbreak in Texas that has already tragically and needlessly claimed the life of an unvaccinated child - the first death from measles in the US in ten years.
The share of U.S. kindergartners who had received two doses of the MMR vaccine fell from 95% in the 2019-20 school year to less than 93% in the 2023-24 school year. Maintaining measles elimination status requires vaccination coverage to exceed 95%.
There’s no magic bullet for misinformation – the genie is out of the bottle and will continue to threaten our ability to distinguish truth from falsehoods. My suggestion is that whenever you come across a new piece of information, pause. Take time to ingest it, check references, ask people knowledgeable in that field, and do your own research. Even still it can be hard to know what is real, but certainly don’t read a headline while scrolling through your newsfeed and assume it’s true.
Eyecare: Younger patients, sicker eyes
I recently had to send two young women to the ER from my clinic for high grade papilledema. The first patient was in her thirties with a history of type 2 diabetes mellitus, high blood pressure, and obesity. After seeing the papilledema on exam we checked her blood pressure and it was around 170s/110s. The second patient was in her early twenties and had noted double vision on her drive between home and college. She had already gone to another ER and got a CT scan of her brain, which was reportedly normal. On exam she had an abduction deficit in left gaze consistent with a cranial nerve VI palsy. One of the causes of papilledema is something called idiopathic intracranial hypertension (IIH) or pseudotumor cerebri. Oddly enough, just the day prior to me seeing these two women, one of the other doctors in my practice saw a nearly identical presentation of a young woman with headaches, cranial nerve VI palsy, papilledema, and an opening pressure of around 60 cm H2O on lumbar puncture (about 3x normal). You could say it’s coincidence, but this retrospective study in Wales found the incidence and prevalence of IIH increased significantly from 2003 to 2017, which is really no surprise given the near-global rise of obesity and the strong association between IIH and obesity. Additionally, I seem to be seeing more young patients in their 20s-40s being referred for shingles outbreaks near their eyes with concern for eye involvement. There are a few theories why the incidence of shingles amongst younger people has increased over the last few decades, including more public awareness and higher stress levels.
Why this matters to patients:
While it was highly unusual for so many young patients to present to our clinic with such severe findings on exam in such a short window of time, I see plenty of young people with severe eye disease and vision loss present to my clinic. A lot of these presentations stem from the basic killers like high blood pressure, high cholesterol, diabetes, and obesity. It’s scary to see people my age or younger who are already suffering potentially irreversible damage to their vital organs from preventable diseases. When people think of complications from these diseases, naturally they think of things like heart attack and stroke, and for good reason. But people need to know that all of these diseases can cause severe damage to your eyes and irreversible vision loss. It’s tragic when I see a young man on dialysis with proliferative diabetic retinopathy and severe vision loss in both eyes from sequalae of the disease. Or a college student with NAION and an inferior visual field defect likely related to his optic nerve anatomy and microvascular disease secondary to previously undiagnosed hyperlipidemia. Then of course there are the traumas like a globe rupture from a nail that ricocheted back into a young woman’s eye. Or severe bacterial keratitis from improper contact lens use. To me, nothing is more heartbreaking than an irreversible disease state that could have been prevented. I hope readers remember, you have one body, so take care of it as best you can. Simultaneously, don’t be so quick to assume others suffering from these diseases brought them onto themselves. Many are born and raised in conditions that practically guarantee they will enter adolescence or adulthood with one or more preventable diseases, through no fault of their own. That’s what happens when society does not invest in health infrastructure and education up front. But there are beacons of hope in the US that prove changes can be made and communities can improve their overall health with the right guidance – more on this in a future newsletter!
Innovation: the Olleyes virtual reality headset
My practice recently tested the Olleyes virtual reality headset and it was pure fun for an eye nerd and someone who loves efficiency and improved patient experience. By and large, patients had a positive experience and preferred using it over the standard Humphrey visual field test we normally use for visual field testing. In addition to visual field testing, it can perform a variety of tests including visual acuity, color vision, contrast sensitivity, pupillometry, extraocular muscles, and phoria/tropia testing . The headset was comfortable and the device was intuitive. The on-screen avatar gives clear, easy to understand directions and the findings are reported in a clear, easy to interpret format. I believe you can choose from multiple languages too, which is great. We’ll be testing out the Oculus Easyfield VR as well to see how they compare before potentially incorporating them into our clinic.
Why this matters to patients:
Any frequent flyer of eye care practices knows we often have to subject patients to numerous tests in order to determine how best to approach their care. This can be extremely time consuming and very resource intensive from a practice management standpoint, as a technician must chaperone patients from one device to another, get the patient positioned properly, type in the patient’s information, potentially have to repeat tests until acceptable quality scans are obtained (if possible), and frequently have to transmit those images to viewing software for the doctor to then review and interpret the findings. I think every eye care practice dreams of a single device that can do it all in under a second. While that day will likely never come, the pace of innovation has been incredible and the technology just keeps getting better. Testing can be performed more quickly, more comfortably, and often times match or exceed the quality of former testing devices. Exciting times indeed. This means a better patient experience in practices that are able and choose to invest in these exciting new technologies.
Blake Hampton, MD
Thank you for reading February’s The Monthly Eye Opener! We welcome your feedback and look forward to continuing the conversation on the future of healthcare.