The pervasiveness of digital devices is threatening the health of eyeballs everywhere. Joseph Stamm, OD, FAAO, specializes in dry eye, which is the most common side effect of screen use. He shares the easy things anyone can do to prevent dry eye and other issues to keep vision as strong as possible for as long as possible.
Welcome to Massachusetts College of Pharmacy and Health Sciences Podcast, the secret to Living to 200. My name is Jennifer Persons and I'm your host. In each episode of this series, we will explore different aspects of health and the factors that allow us to live longer, healthier lives with the help of a thought leader from the university. This year, MCPHS is celebrating its 200th birthday, and what better way to kick off our bicentennial celebrations than with a podcast about longevity and wellbeing. Joining me today is Dr. Joseph Stamm. He is an associate professor of optometry and the chief of contact lens and dry eye service at the Eye and Vision Center at MCPHS Worcester. Welcome. Thank you Jennifer. Glad to be here. We're so glad to have you. Before we dive into our conversation, we'll start with an icebreaker. So my question for you is, if you had a time machine and you could travel 200 years into the future or 200 years to the past, which would you pick and why? I'd probably go back to see what change I could make that would make the future better. That's a wonderful answer. So to start things off, I just want to introduce you to our audience. Tell me a little bit about your professional journey and why you wanted to become an optometrist. Well, I have one of those stories that seems very obvious to everyone. My father was an optometrist and growing up it just seemed like a fun thing to do and I was interested in science and one wound up going to optometry school. So how did you start your career and then what eventually led you to academics? Well, when I graduated optometry school in 1982, I joined practice with my dad. We were in practice together for about 10 years, and then he retired. Something about that's why he sent me to optometry school. Back in that point in time, in the early 1980s, the optometric profession was changing. It was evolving from just glasses and contact lenses to becoming more of a primary healthcare profession for the eye and visual system. What I learned as an optometry student rapidly began to change constantly new responsibilities, new understandings, new things we had to do, and that kind of got my brain back into the idea of learning again, which was very, very enjoyable. Once I was out of practice for about 10 years, I was invited to join the adjunct faculty at the University of Rochester's Medical Center. They had an ophthalmology training program. They needed someone to teach the medical residents and the ophthalmology residents contact lens theory and practice. And I had built the practice into a pretty strong contact lens practice that was very friendly with the docs over there. And that's where I got bid with the academic bug going in and teaching the residents the theory behind contact lenses, having them rotate out to my office to have them shadow me while I was taking care of patients. And eventually I left private practice, joined the faculty of the university full-time and never look back. You mentioned that when you were training and taking over the practice, things were changing so quickly. Can you talk a little bit about the rise of contacts? I feel like nowadays contact lenses are almost a go-to option for people. So what was that transition like to always fitting people with glasses, just fitting people with both to then maybe going to contact straight out of the gate? The evolution of contact lenses is fascinating. Someone who's been around as long as I have remembers the days of hard lenses. There were small pieces of plastic actually made of the same material that screwdriver handles were made out of, which took a lot of getting used to a lot of talent to design and we're not terribly healthy for the eyeball. In the late seventies, soft contact lenses started to come online In the late eighties, early nineties, we started to get into the replaceable or disposable style soft contact lenses, which really are the lens of choice now. And although many people do tend to think, well, I'm going to go contact lenses first, they also have to have a pair of glasses because you can't wear your lenses 24 7, and there are times that you just don't want the piece of plastic on your eyeball. But the technology has grown tremendously and we're getting new technologies every single day. There's very few things that we can't prescribe a contact lens for anymore. And when you think about the entire span of eyecare, really the contacts have not been around that long in the grand scheme of things, and they've already improved so much. It's kind of interesting to think about what could come next. There's always going to be a place for some sort of corrective lens, whether it's a spectacle lens or a contact lens, because to this point, science has not figured out how to keep us from getting older. All of us, no matter how healthy we are, no matter how well we eat, all of us in our mid to late forties will start to need reading glasses, and that's just a fact of life. The lens inside of the eye is aging and it just can't focus as well. That's kind of the brass ring or the holy grail of eyecare is a drop or a treatment that can turn older eyeballs back into younger eyeballs and keep them there. Interesting. Do you think that's actually possible? I think anything is possible. If I look back at the 40 years of my career and what we were able to do, not just as eye doctors, but as healthcare providers in general 40 years ago, I mean, yeah, it absolutely is. That would be just incredible. So I want to talk about dry eye. You specialize in it. Yep. And I think when the general public hears that phrase, a lot of us can remember those Ben Stein commercials with the drops for dry eye. Yes. Those commercials were not necessarily the best They were funny. I mean, very, very funny. Dry eye is something that has been around forever to a degree. It's grossly misunderstood. People don't really know what that means because it's a very subjective thing. But dry eye is becoming, it's approaching epidemic proportion in our world today. Oh wow. We should define dry eye. There is a layer of tears that coats the front of the eyeball, and that layer of tears protects the eye. It keeps the eye comfortable, it lubricates the eye as we blink. It's really the first focusing element of the system of the eye. And if something about that tear film is unstable, you're not producing enough tears, your tears are evaporating too quickly, it can cause discomfort. It can significantly impact visual comfort, fluctuations and vision. And what's fascinating about use of digital devices and how pervasive it is right now is that we don't blink when we're looking at a digital device sitting in conversation, people will blink 12 to 15 times a minute, and that frequent blinking keeps the surface of the eye moist. It keeps it healthy, it keeps it comfortable, it allows you to see clearly. Multiple studies over the years have shown that when you are doing something visually intensive, reading a technical document or adding a multiple columns of numbers, and especially using digital devices, that blink rate drops by 75%. Wow. So where people say, oh, I've been staring at my computer all day. They've been staring at their computer all day, and you can't get away from it. It doesn't matter what you do for a living. If you're a student, obviously like our students are on their digital devices all day long, people who work in offices or on digital devices, jobs that in the past you might have thought were more manual labor, not visually intensive. Everybody who's working in a warehouse right now is on a digital device. So it really has brought to the forefront the fact that although we love our technology, we're using our technology right now as we talk. And how would we get by without our technology? It can influence the health of the eye and it can have both short-term and long-term negative effects for the patients. So as a contact lens doc, when I teach my students and my introductory contact lens courses, I tell them that the tear film is the foundation that the contact lens house is built upon. So if you have a poor tear film, if you have a marginal dry eye, you are not going to be a successful contact lens wearer. So although they sound like different things, they really are one and the same. So that by identifying these patients earlier and not just saying, oh, use whatever artificial tear you see advertised by Ben Stein on TV with a complete examination with a professional evaluation, our students are leaving here knowing how to find these problems before they become major problems. And we try to teach them to be proactive as opposed to being reactive when it comes to dealing with these issues. Sure. Can you describe some of the other options than artificial tears? The lack of blinking starts to induce changes in these glands. They don't produce the normal amount of oil and the tears evaporate. So we have treatments ranging from things as simple as using a warm compress and the massage to get the tears to flow. We have high technology where we can clear those glands out, multiple medications on the market to stimulate tear production, to stimulate oil production. A couple of years ago we got a nasal spray, which stimulates natural tear production. In the past six weeks, three new medications for treatment of various forms of dry eye have been approved by the FDA. Wow. So it's a very exciting time to be in this field. We have things we can treat as the root cause as opposed to treating the symptom, which is all artificial tears do. What kind of things can we do to prevent symptoms of dry eye from forming? It's really remarkably simple. Get your eyes off that screen periodically during the day and blink. I mean, it sounds foolish. We eye doctors always talk about 2020 vision. Well, we've been working with this 20 20 20 rule for about 10 years now that every 20 minutes get your eyes off the screen for 20 seconds and look 20 feet away. Now, that can be hard to do because people have bosses who don't want them every 20 minutes walking around the office or looking out the window. But we counsel our patients who are using digital devices, whether it's the gamer at home in the evening or the accountant at tax time who's got 14 hour days that multiple times during the day get your eyes off the screen and consciously blink, close your eyes gently for two seconds, squeeze tight for two seconds, open for two seconds, and do that five times multiple times during the day. And people's blink rates actually will start to increase subconsciously. So it doesn't have to be fancy. It doesn't have to be real, real high tech. It can be as simple as remembering to blink your eyes. I think as we're talking about it, I'm blinking more good for you, which is a good thing. And I hope the same goes for listeners. You hear the word blink, you're like, oh yes, I need to blink. But sometimes that doesn't always work. Yeah. Getting into see your eyecare professional, whether Letting the doctor know what you do for a living, reviewing medications, having them perform the exam. I'm a huge fan and have always been of being more proactive. Sure. Don't wait until something is bad because it's much more difficult to fix. Do you have any thoughts or opinions on blue light glasses? That is a question I get all the time and I will go on record as saying, and the professional organizations have gone on record as saying there is no evidence at all to support blue light glasses to relieve computer eye strain. So the amount of blue light that you get from a digital device is kind of over-hyped. You'll get more blue light from the sun now where people talk about blue light glasses helping the sleep cycle. Well, what can really help the sleep cycle is put the digital device down an hour before you go to bed. I have an iPhone, so it has that night mode where it kind of turns everything a little bit yellow, reducing the amount of blue light. And that has been shown to help with sleep. But it isn't so much the lack of blue light, it's dimmer, it's not as bright, and the brightness confuses our brain. It thinks, Hey, I'm still up. I still should be doing things. So again, there are people who believe in this, but my students ask about it all the time and we teach them, here's the scientific literature. It says it doesn't do anything whatsoever. So as we're talking about health and longevity, you mentioned that in our mid forties it's pretty much inevitable. Our eyes are going to age, we're going to need help reading. In addition to what we've talked about with blinking and reducing device screen times, is there anything that we can do as part of our daily lives to keep our eyes healthy and to maintain our quality of vision as we get older? A lot of it is the same thing that an internist will tell you when you ask them, what can you do to keep yourself healthier, longer? Don't smoke, limit alcohol consumption, eat well, get your sleep. The eyes are not separate from the body. One of the first things that we teach our students is that eyeballs will never walk in your exam room by themselves. They're attached to the body. So everything that is universally accepted to be good for us is good for the eyeballs. Would you say that the options are also there for older people who might be on Medicaid Medicare because that's not true of every specialty? Absolutely. Routine eyecare, if all you need is a pair of glasses that is not covered by Medicare, there has to be some sort of medical diagnosis to go along with it. Medicaid, in virtually every state that I know of, mass health here in Massachusetts covers a routine eye exam. One of the joys of being here at M-C-P-H-S is that we have our clinic right here in the building out here in Worcester, and we see patients who fall through the cracks in the system every day. It doesn't matter whether they have insurance coverage or not. We're providing care to the community because that's our mission to care for others. It's a great message. For anyone listening out there who hasn't been to the eye doctor in a while, consider going to see one. Even if you think everything's fine, let us get a look at your eyes. Let us make sure there isn't something that we can find now to keep you functioning because we do need our vision. And fortunately, lifespans are increasing and eyes are not necessarily designed to last as long as they used to, but we need them. Visual impairment is very, very disruptive to the life. And fortunately, we're at a level of technology now where if you come in, we can find these problems before they become a big problem. Thank you so much, Dr. Sam. This has been a wonderful conversation. Absolute pleasure, Jennifer. We've come to the part of our show called Red's Rapid Fire. So I'm going to ask you a short series of questions and the goal is to answer them as quickly as possible. So are you ready? I am ready, but I've never been known to answer anything quickly. You might surprise yourself. Okay, here we go. What is your favorite animal? Favorite animal's? Got to be dogs. I'm a dog person. Coffee or tea? Coffee. Hands down. Straight up black. What do you do for fun? I like to take pictures. I've been a photographer since I was in high school. Which birthday has been your favorite so far? My favorite so far has to have been my 50th because where I was practicing at the time, we had a list of birthdays in the break room. And on my birthday in September, one of the techs said, Dr. Stam, do you mind if I ask you how old you are? And I said, Tina, this is my 50th birthday. And she said, wow, you don't act your age. If you could have any Superpower, what would it be? I'm going to be real, real corny is just get to the people who need the care. Did you ever want to be anything other than an optometrist? If I had it to do over again and someone dropped a ridiculous amount of money on me, I would go to cooking school. What is one thing you think is an underrated quality? Oh life in central Massachusetts? People don't realize how great this part of the state is. What game show do you think you could win? Oh, I'm a jeopardy person. I have more trivial information in my brain than I know what to do with. Name something on your bucket list. Take a month, rent an rv, and just travel the national parks out West. And my last question is, what's one piece of advice you would give your younger self? Slow down. Be patient. It took me a long time to figure out how to be patient. Thanks again, Dr. Stamm and thank you for listening to this episode of The Secret to Living to 200. We hope you'll join us next time. And as always, stay curious Cardinals.