088 - Modern Keratoconus Treatments with Jen Hodges

[00:00:00] [SPEAKER_01]: Welcome to Dr. Brian Boxer Wachler's health show. Dr. Brian will pull the curtain back on viral TikTok health videos and label them as cap, false or no cap. True. Even if you aren't on TikTok, now is the time to get on board, have fun and join his podcast.

[00:00:16] [SPEAKER_01]: Dr. Brian is a board certified eye surgeon specializing in advanced LASIK, Keratoconus, wider eyes, dry eyes, cataract surgery and reading vision improvement at the Boxer Wachler Vision Institute in Beverly Hills, California. Also, please remember, Dr. Brian is a doctor, but he is not your doctor. He is here to provide general information, not medical advice. So you should always check with your doctor before relying on any information.

[00:00:43] [SPEAKER_00]: Welcome back to the health show. And this is a really exciting episode because for many years of doing this podcast, we've talked about all sorts of areas in medicine. But I just thought, you know what, we should probably have a discussion about one of my core specialties, which is Keratoconus and Keratoconus treatments, because it's much more common than people realize. And I thought, let's have Jen Hodges, who's been with us for many years.

[00:01:13] [SPEAKER_00]: As a patient counselor coordinator, and she's talked to so many people over the years and will have a lot of really great insights to share from her perspective. So Jen, welcome.

[00:01:27] [SPEAKER_00]: Hello, thank you for having me. I appreciate it. Yeah, of course. I'm excited. So Jen, why don't you first share with people the way you describe Keratoconus?

[00:01:39] [SPEAKER_02]: So Keratoconus, it is a progressive eye disease, which was once thought of being much more rare. But nowadays, I believe it's every one in 500 patients that actually has this condition. And unfortunately, it's a lot more common than is thought of. And so a lot of people just don't know what to do, whether it's their local optometrist or the patient themselves.

[00:02:07] [SPEAKER_02]: And it's just brand new. So it's really awesome that patients can still find Dr. Brian, you know, who has been doing this over two decades and it's nothing new to him. But, you know, this condition is something that if you let it go untreated for too long, it can have very profound effects where the patient is having thinning of the cornea, bulging of the cornea into more of a cut.

[00:02:37] [SPEAKER_02]: Tone shape of kind of like a football rather than a smooth rounded cornea. And so it begins to distort the vision because the light is hitting the back of the eye, it's projecting an image that is much more distorted.

[00:02:51] [SPEAKER_02]: And so patients, I mean, we get anywhere from just beginning signs to all the way on the verge of a transplant. And some people have just become so used to their bad vision, they don't really realize how bad it is. And some of them were like wondering how they even function without contacts or glasses where the average person, I mean, they can even see their hand in front of their face.

[00:03:15] [SPEAKER_02]: So it's a very interesting condition because it doesn't have any set rate of progression. It's so unpredictable. So we advise patients to treat it as soon as possible. But I'll let the doctor, you know, prompt me to the next question. How do we treat the condition or what are your next questions that you have?

[00:03:37] [SPEAKER_00]: And I just want to dovetail on what Jen just said. So keratoconus is like a weakening in the cornea, and it's really the collagen that's weak because the cornea is made up of collagen fibers. Imagine like the windshield of a car made up of collagen. That's really how the cornea is. It's like literally the lens of the eye to the world and also on the inside too. It focuses light coming in.

[00:04:04] [SPEAKER_00]: So when that collagen is weak, it bulges. So literally I describe it as being a hernia. But instead of a hernia in the groin, for example, it's actually a hernia on the eye because it bulges out. But here this hernia causes a lot of distortions like Jen was describing. And so we've even had people, you know, when they came to us, they've already lost the ability to be confident driving at night because lights are so bright and so distorted with multiple images or double vision or glare and halo.

[00:04:34] [SPEAKER_00]: And even children, which can affect them being in school, as a matter of fact, can really pose a big problem because we don't want anyone to drop out of school or have their grades suffer because of their vision.

[00:04:47] [SPEAKER_00]: So there's really no rhyme or reason to how it affects somebody. And also it's almost in every decade of life too that we see. And like Jen said, it's much more common than people realize. I know she said it's about one in 500. I think it's now about one in 400.

[00:05:04] [SPEAKER_02]: Yeah, I had a feeling because that was a while back. So yeah, that makes sense.

[00:05:10] [SPEAKER_00]: Our diagnostics are just so good. And it's diagnosed really just taking a quick five second picture of the eye called cornea topography. That's how the diagnosis is made. But not all eye doctors have that cornea topography or cornea mapping test to be able to make the diagnosis.

[00:05:28] [SPEAKER_00]: But one of the things I like to explain Jen to people is how they can know maybe if they do have keratoconus and aren't aware of it, is if they have astigmatism. But if the astigmatism keeps increasing because that's a sign potentially of keratoconus.

[00:05:44] [SPEAKER_00]: Maybe not keratoconus, but that's pretty classic though. But they go back to the eye doctor every year or even a couple times a year and the astigmatism keeps increasing.

[00:05:55] [SPEAKER_00]: So that should be a red flag if anybody listening has that to go to your eye doctor and get that checked out. Anything you want to add to that Jen?

[00:06:03] [SPEAKER_02]: I mean, one of the things that just popped up in my mind though was talking about, you know, you were talking about it being in like every decade.

[00:06:11] [SPEAKER_02]: It's really important because it was something that was once thought of as common knowledge and agreed upon academically that over the age of 40, it would stabilize on its own.

[00:06:24] [SPEAKER_02]: And a lot of optometrists had explained that to their patients. But now, you know, the longer it's gone on, the more research we have, the more data.

[00:06:34] [SPEAKER_02]: And especially our office, you know, we see such a high volume of patients over a couple decades. We have so much data and we can see that's no longer something that is true, that it doesn't stabilize on its own after the age of 40.

[00:06:48] [SPEAKER_02]: And, you know, maybe there's a patient here and there. But what we do see is that, I mean, we've treated as young as eight and as old as someone in their 80s, but can still be progressing much, much older than in their 40s.

[00:07:02] [SPEAKER_02]: So I think it's important that even if a patient is over the age of 40, that they know that it's still good to have it treated as soon as possible.

[00:07:11] [SPEAKER_00]: Yeah, and what I want to do is I want to show a picture of somebody who was told by their doctor, oh, you know, just wait and see what happens. You don't have to get it treated.

[00:07:21] [SPEAKER_00]: So we actually have a information packet that we send to patients, right? It's really designed to provide like one-stop shopping for all the information.

[00:07:33] [SPEAKER_00]: And in it, we have various sections about the procedures and the importance of not taking this wait-and-see approach is such that we actually have one insert here that specifically is called problem with taking a wait-and-see approach.

[00:07:55] [SPEAKER_00]: Because what happens when somebody is diagnosed is you don't just want to wait and see what happens. You want to jump on it and you want to get it treated because what's going to happen very likely is it's going to continue to get worse and people are going to lose more vision when it could have all been prevented had it been treated right in the beginning.

[00:08:17] [SPEAKER_00]: And here's a real patient of ours. So this is where the patient's topography was. I mentioned that's how the testing is done with topography. See, there's just like a little bit of yellow, a little bit of a bulge and I'm just kind of showing the prescription.

[00:08:31] [SPEAKER_00]: Not much astigmatism, less than one diopter, which is actually pretty low, pretty normal amount of astigmatism actually.

[00:08:38] [SPEAKER_00]: And this doctor who the patient had seen after we had seen the patient made our recommendations had said basically, no, you shouldn't do that. Just let's just see what happens. Let's just wait and see.

[00:08:52] [SPEAKER_00]: Now this is what happened two years later. So you can see now you've got all that red and it's a much larger area with orange of bulging.

[00:09:01] [SPEAKER_00]: So what happened here is the keratoconus got worse. It bulged out more. The astigmatism increased more and now this patient had four and a half diopters of astigmatism.

[00:09:12] [SPEAKER_00]: And now at this point needed other procedures like intax on top, and we're going to get into the procedures, but needed more treatments that my point is that could have been avoided had they been treated back at this stage.

[00:09:27] [SPEAKER_02]: So do you see that? You hear that a lot, Jen, still from patients that doctors are still absolutely like it used to be a lot more, especially when you know you were the only one doing crosslinking.

[00:09:39] [SPEAKER_02]: And I'm surprised that I still hear it. But unfortunately we do. I mean, we just have patients that, you know, for years they've had the condition and either the doctors knew and they just manage them in contact lenses to mask the symptoms while they're still losing their vision underneath.

[00:10:02] [SPEAKER_02]: Or, you know, the patient it just got completely undiagnosed. I mean, I'm not sure how, but these patients they've lost so much vision, high myopia, very high myopia and high astigmatism, and it was still undiagnosed.

[00:10:16] [SPEAKER_02]: So it's just really important again that you don't wait and see because it's that particular patient. It happened to be a two year span where she got that much worse.

[00:10:27] [SPEAKER_02]: We've seen patients and heard from patients themselves that said, it's been a month. My vision is that much worse in a month. If you can imagine because there is no set rate of progression, no, it's completely unpredictable.

[00:10:43] [SPEAKER_02]: You don't want to gamble with your vision.

[00:10:45] [SPEAKER_02]: You need your eyeballs. We all need our eyeballs to function, to see our loved ones, to do our jobs, you know, I mean to enjoy life. So it's really important that, you know, yes, I understand that it's an eye doctor and maybe it's been a family eye doctor for years and you really want to trust their opinion.

[00:11:05] [SPEAKER_02]: But sometimes going outside of the specialty to an expert, you know, you really want to find the best person, has the most experience and it's definitely Dr. Brian.

[00:11:14] [SPEAKER_00]: So I just want to mention something for parents who have keratoconus, who have now children. It's important to mention this because a lot of doctors just don't ever bother to do this.

[00:11:26] [SPEAKER_00]: But there is about a 15% chance that your child can have keratoconus develop if you have keratoconus.

[00:11:34] [SPEAKER_00]: So my recommendation has been take your child starting around age nine to the eye doctor and make sure they do a cornea topography map, the maps I just showed earlier that's called the cornea topography.

[00:11:47] [SPEAKER_00]: And make sure they do that test every year because if there's any sign of keratoconus starting then they can compare back easily to the previous year and do even a difference map to see if there's a little bulge starting.

[00:12:00] [SPEAKER_00]: So that's why it's really important and it's a simple test. It's non-invasive and it could save your child a whole world of vision hurt, so to speak, by being on top of it because we've certainly seen children whose parents didn't know about that recommendation.

[00:12:15] [SPEAKER_00]: And then by the time they see us sometimes they're already with a lot of vision loss because keratoconus went undetected and they just thought they needed increasing prescriptions, which is not uncommon in children.

[00:12:26] [SPEAKER_00]: But if it's from keratoconus, it can get missed in the process of just it's just a worsening prescription quote unquote when really there was keratoconus behind.

[00:12:36] [SPEAKER_00]: So all right, well, Jen, let's switch to treatments. Let's talk about treatments. I think people are going to be really interested to know like what are the very latest most modern cutting edge treatments for keratoconus that are not cornea transplants.

[00:12:56] [SPEAKER_00]: I originally was because these procedures didn't exist because honestly we hadn't really invented them. So there was only keratoconus treatment by cornea transplant at the time.

[00:13:08] [SPEAKER_00]: And so I was doing cornea transplants in the very early part of my career and I just saw the pain, the long recovery, the complications, even something which is almost like call it the dirty little secret of cornea transplants that transplant surgeons never mentioned.

[00:13:25] [SPEAKER_00]: Is if somebody falls down, hits their eye or gets poked in the eye really strong, they could rupture the transplant open and the inside and I just have to prepare you.

[00:13:38] [SPEAKER_00]: This is gonna be a little graphic, but the inside contents of the eye comes out looks like a squished grape and it's a blind eye at that point and most likely needs to be removed or enucleated as it's called.

[00:13:48] [SPEAKER_00]: I've been called, I used to take call at Cedars Sinai Medical Center here in Los Angeles and there were multiple patients who had transplants.

[00:13:58] [SPEAKER_00]: Not with me but had transplants who had that happen and I had to take them in the middle of the night to the ER, the OR and try to fix this.

[00:14:08] [SPEAKER_00]: And like I said it's a blind eye. So the great news is with these treatments now we're going to talk about they're highly effective at preventing cornea transplants.

[00:14:16] [SPEAKER_00]: So people also get that peace of mind from that too. So Jen why don't you first start about Holcomb C3R and talk a little bit about what that is about, what it does.

[00:14:26] [SPEAKER_02]: Okay so Holcomb C3R was invented by Dr. Brian himself and this was 21 years ago so man it's been a long journey, a couple decades in and this treatment is absolutely amazing and I'm not just saying that because they were trained to do that.

[00:14:46] [SPEAKER_02]: I've been here for almost the whole time that it's existed but I mean I've been able to see the effects of it and how many lives he's changed and been able to save their eyesight and just save their quality of life.

[00:15:02] [SPEAKER_02]: And this particular treatment he invented because it originated in Europe many, many years ago and he's researching keratoconus and he's like why is there no one in North America treating this condition?

[00:15:19] [SPEAKER_02]: And so he really wanted to invent something that was you know the same goal of saving eyesight but didn't want to do it if they were doing it because it was scraping off the outer layer of the cornea and it was very painful.

[00:15:40] [SPEAKER_02]: It opens up to risk for infection, corneal haze and scarring so he developed.

[00:15:45] [SPEAKER_00]: And by the way just to mention that's the kind that was being done in Europe at the time.

[00:15:50] [SPEAKER_02]: In Europe.

[00:15:51] [SPEAKER_00]: Before we did what we did here.

[00:15:54] [SPEAKER_02]: Correct.

[00:15:55] [SPEAKER_02]: And this is why.

[00:15:56] [SPEAKER_00]: Called CXL.

[00:15:58] [SPEAKER_02]: Yes and so the, we'll definitely touch upon that too because we'll talk about the differences but yeah the Holcomb C3R was originally C3R corneal collagen cross-linking with riboflavin.

[00:16:11] [SPEAKER_02]: And riboflavin being the main active ingredient in the solution that he invented.

[00:16:17] [SPEAKER_02]: And this solution is applied to the cornea every few minutes for a period of a half hour both eyes are treated at the same time during that half hour period of time there's a special UV light that patients focus on to activate the main ingredient in the solution that begins to stimulate this collagen growth and like he was saying the collagen has become weakened.

[00:16:39] [SPEAKER_02]: And as the collagen grows these fibers start spreading apart and become thin.

[00:16:44] [SPEAKER_02]: So this solution.

[00:16:46] [SPEAKER_02]: It's, you know, not an instant that second that he does the treatment doesn't like freeze it.

[00:16:52] [SPEAKER_02]: But over time over the next three to four months on average about three months on a cellular level these corneas become completely rigid and firm with strong corneal fibers kind of like a woven pattern if it's, you know spreads apart it begins to bulge but this

[00:17:09] [SPEAKER_02]: really just tightens up these junctions in three months patients completely have no further progression of the keratoconus of the condition and the UV light that's used.

[00:17:22] [SPEAKER_02]: Do you do you want to explain the study that was done for you and how safe it is.

[00:17:28] [SPEAKER_00]: So when we started first doing this I wanted to make sure it was safe, of course, above and beyond anything else safety first.

[00:17:36] [SPEAKER_00]: So we actually had a donor eye, and we cut out the back of it, and we had it up to the light source and I had a UV meter, which is actually the still meet same meter that we use when we do the procedure because we calibrate the energy level for each patient.

[00:17:53] [SPEAKER_00]: And even each eye.

[00:17:54] [SPEAKER_00]: And we measured the UV and the UV turns out to be about 500 times less UV than if you were outside in the sun in the shade.

[00:18:05] [SPEAKER_00]: So the amount of UV is very, very low so it's very safe.

[00:18:09] [SPEAKER_00]: And like I said if you've been outside for half an hour in the shade without sunglasses which pretty much everybody has, you've already had more UV exposure by 500x than what the procedure is.

[00:18:21] [SPEAKER_00]: So and then we know that interaction of the UV with the riboflavin solution makes the cornea strong and that's really the key.

[00:18:30] [SPEAKER_00]: It doesn't make it so strong, it doesn't feel like concrete or glass when if somebody would touch their eye which you should never do with keratoconus by the way.

[00:18:37] [SPEAKER_00]: It's still soft and supple but it's just strong at the level that makes it bringing it up to a normal cornea essentially for all intents and purposes.

[00:18:46] [SPEAKER_00]: So that's why our stability rate because the whole purpose of this Holcomb C3R crosslinking is to stabilize the cornea by strengthening it.

[00:18:56] [SPEAKER_00]: And our success rate now I think about 22 years in fact that we've been doing it, 99.3% success rate.

[00:19:03] [SPEAKER_00]: So not 100% because there's no 100% in medicine but that translates to the other side of the equation about a 0.7% chance that somebody might need to have a repeat at some point over the years if it acts up again.

[00:19:17] [SPEAKER_00]: But it's still just non-invasive the way it was the first time around because basically this is the first what's called epion crosslinking.

[00:19:25] [SPEAKER_00]: That's what we invented with the Holcomb C3R versus the other kind which is epi-off which is where as Jen was mentioning cornea gets scraped and has a lot of complication potentials and pain and only one-eyed at a time is treated.

[00:19:41] [SPEAKER_00]: And at the end of the day, the long-term results, the stability of results haven't been shown to be the same.

[00:19:47] [SPEAKER_00]: There's a lot more retreatments, a lot more failures and breakthrough progression.

[00:19:52] [SPEAKER_00]: And Jen, do you want to talk about the reasons why the other procedure, the epi-off is not as effective?

[00:20:00] [SPEAKER_02]: Yeah. So there was this controversy and sometimes it's patients say that their doctors consider it a controversy of epion versus epi-off.

[00:20:14] [SPEAKER_02]: So when I was talking about the corneal collagen crosslinking that originated in Europe, that was the epi-off because the epithelium, the outer layer.

[00:20:24] [SPEAKER_02]: So epi is from epithelium and it's just a short abbreviation of the word.

[00:20:30] [SPEAKER_02]: Epi-off is where they scrape off that outer layer and Dr. Bryant's is epion because you're leaving the outer layer intact.

[00:20:40] [SPEAKER_02]: And the reason that when they did the initial clinical trials for the epi-off, the CXL version of crosslinking that is done elsewhere other than our office,

[00:20:53] [SPEAKER_02]: that procedure, the solution was too thick. And so they had to scrape off the outer layer of the cornea to get a profound effect.

[00:21:02] [SPEAKER_02]: So I do want to clarify something because this controversy epion versus epi-off, if you hear someone say or you're researching on the internet, the epi-on is not as effective as epi-off.

[00:21:18] [SPEAKER_02]: That is true only with CXL because in the clinical trials, their epi-on was not as effective as their epi-off because again, the solution was too thick.

[00:21:33] [SPEAKER_02]: However, our epion is completely different than that CXL epion versus epi-off.

[00:21:40] [SPEAKER_02]: So I do want to make sure that people understand that it's clear that the epion has two versions that exist, one that was done in the CXL clinical trials and Dr. Bryant.

[00:21:55] [SPEAKER_02]: And Dr. Bryant is much more highly effective. The retreatment rate as he mentioned is 0.7%.

[00:22:04] [SPEAKER_02]: I mean, since I've been here, there's hardly anyone that's needed a second treatment.

[00:22:10] [SPEAKER_02]: And there is a much higher retreatment rate with the other type of crosslinking that exists.

[00:22:17] [SPEAKER_02]: We do see a lot of patients that come here that have had the other client elsewhere.

[00:22:24] [SPEAKER_02]: And Dr. Bryant's had to do his treatment because of that high retreatment rate for the other crosslink.

[00:22:31] [SPEAKER_00]: So luckily, there's not much of a controversy anymore just because the Holcomb C3R procedure has really stood the test of time

[00:22:40] [SPEAKER_00]: and in fact even predated the existence of the company that is doing CXL.

[00:22:47] [SPEAKER_00]: Actually, they weren't even formed. They weren't even in anybody's mind when we did this back in 2001.

[00:22:55] [SPEAKER_00]: So yeah, so we've been around a long time.

[00:22:58] [SPEAKER_00]: There was controversy when the procedure first came out because cornea transplant surgeons weren't very happy

[00:23:07] [SPEAKER_00]: that we had come up with a procedure and invented a way to stop people from progressing because guess why?

[00:23:14] [SPEAKER_00]: It would prevent people from needing cornea transplants.

[00:23:17] [SPEAKER_00]: So I had found myself in the middle of just like a storm from a lot of medical establishment, cornea surgeons in particular,

[00:23:27] [SPEAKER_00]: because we were preventing their patients from needing cornea transplants and they were losing their patience.

[00:23:32] [SPEAKER_00]: And they were saying all these really terrible things about me just making things up to dissuade patients

[00:23:39] [SPEAKER_00]: because people still fly here from all over the country and the world.

[00:23:43] [SPEAKER_00]: In fact, then they were too and there was a lot of that going on.

[00:23:48] [SPEAKER_00]: And so what ended up happening is, and by the way I gave a TEDx talk about my experience ultimately,

[00:23:55] [SPEAKER_00]: but it wasn't really until our patient Stephen Holcomb, and this is how the procedure is named,

[00:24:00] [SPEAKER_00]: you might be wondering why is it called Holcomb C3R crosslinking?

[00:24:05] [SPEAKER_00]: So our patient was Stephen Holcomb. He was a US bobsled driver and he had cared a conus.

[00:24:11] [SPEAKER_00]: And ever since he was a little boy, his dream in life was to win an Olympic gold medal.

[00:24:18] [SPEAKER_00]: A lot of kids think that, but very few actually follow through with it.

[00:24:22] [SPEAKER_00]: And he was the bobsled driver for the Olympic team and he started to do pretty good.

[00:24:27] [SPEAKER_00]: And then he started really losing his vision and kept it a secret from all of his teammates.

[00:24:31] [SPEAKER_00]: And it got so bad that he just realized he can't drive anymore.

[00:24:35] [SPEAKER_00]: And he became very depressed and he actually, unbeknownst to anybody at the time,

[00:24:41] [SPEAKER_00]: actually tried to commit suicide. He hadn't told anybody.

[00:24:43] [SPEAKER_00]: Luckily he survived. He finally came clean with his coaches and his teammates

[00:24:48] [SPEAKER_00]: about his care to conus and his vision loss.

[00:24:51] [SPEAKER_00]: And they said, well we'll send you, of course there's going to be treatments.

[00:24:55] [SPEAKER_00]: He went to all these, I think 12 or 14 other eye doctors

[00:24:58] [SPEAKER_00]: and everybody said you have to have a cornea transplant,

[00:25:01] [SPEAKER_00]: which was still going to be a career-ender for him.

[00:25:04] [SPEAKER_00]: So because transplants are very delicate and being in the bobsled is actually very violent.

[00:25:10] [SPEAKER_00]: Steven once told me it was like basically being in a bag of peanuts

[00:25:13] [SPEAKER_00]: and people violently shaking the bag. That's what it's like being in a bobsled.

[00:25:17] [SPEAKER_00]: I've taken a bobsled run, I can attest that's pretty accurate.

[00:25:22] [SPEAKER_00]: So yeah, so having transplants was still going to be career-ending.

[00:25:25] [SPEAKER_00]: So ultimately they came here, we treated him with at the time it was called C3R,

[00:25:30] [SPEAKER_00]: cornea collagen cross-linking with riboflavin. That's what C3R stands for.

[00:25:35] [SPEAKER_00]: And then we followed up with these lens implants called ICLs to restore his vision.

[00:25:40] [SPEAKER_00]: He came out of retirement, he was seeing about 2020

[00:25:43] [SPEAKER_00]: and started driving the bobsled and he won a gold medal at the Olympics in Vancouver.

[00:25:48] [SPEAKER_00]: That was in 2010 and there was so much media attention

[00:25:52] [SPEAKER_00]: because his story was going from blindness to Olympic gold medalist.

[00:25:56] [SPEAKER_00]: It was all over the news and that really quieted a lot of the critics

[00:26:00] [SPEAKER_00]: because now the procedure actually had effectively an Olympic gold medal behind it.

[00:26:05] [SPEAKER_00]: And so he actually ended up writing a book, if you're interested,

[00:26:09] [SPEAKER_00]: it's called But Now I See. It's an amazing book about Steven's journey

[00:26:14] [SPEAKER_00]: just from the very beginning and kind of what I talked about

[00:26:17] [SPEAKER_00]: but in much more detail to being an Olympic gold medalist.

[00:26:20] [SPEAKER_00]: And then the story got the attention of people that organized the TEDx series

[00:26:25] [SPEAKER_00]: and I was selected to give a TEDx talk and then called Fight for Sides.

[00:26:32] [SPEAKER_00]: And then just maybe like within the last year,

[00:26:35] [SPEAKER_00]: I had realized that there's so much more to that story from my perspective as well

[00:26:39] [SPEAKER_00]: that you can't fit into a TEDx talk because they only give you 17 minutes.

[00:26:43] [SPEAKER_00]: That's not a lot of time. There's a lot more to the story.

[00:26:46] [SPEAKER_00]: So I ended up writing a book with all the details about everything that happened in my journey

[00:26:52] [SPEAKER_00]: with Steven, both of our paths basically intersecting.

[00:26:57] [SPEAKER_00]: And there's lots of awesome pictures in here too.

[00:27:00] [SPEAKER_00]: Like when we pranked Steven, we punked him, we made an eye chart at the Olympics

[00:27:04] [SPEAKER_00]: at a press conference and we revealed it and it said,

[00:27:07] [SPEAKER_00]: the night train will win Olympic gold.

[00:27:10] [SPEAKER_00]: And actually it was pretty predictive because they ended up winning gold, right?

[00:27:14] [SPEAKER_00]: So there's just a lot of great pictures and stuff.

[00:27:16] [SPEAKER_00]: So if anybody wants this book, you can just contact our office.

[00:27:19] [SPEAKER_00]: We send it out. It's like complimentary, no charge.

[00:27:23] [SPEAKER_00]: So the staff can help you with that.

[00:27:25] [SPEAKER_00]: So that's really the Holcomb C3R story about stabilizing

[00:27:30] [SPEAKER_00]: and the different types of cross-linking as Jen mentioned.

[00:27:33] [SPEAKER_00]: And the reason why ours is so effective is because of two main reasons.

[00:27:40] [SPEAKER_00]: Number one is when we do the light treatment,

[00:27:41] [SPEAKER_00]: we treat the entire cornea surface, like all the way edge to edge.

[00:27:46] [SPEAKER_00]: The other treatments only treat generally a certain millimeter range,

[00:27:51] [SPEAKER_00]: usually about seven millimeters.

[00:27:52] [SPEAKER_00]: So they're missing a lot of peripheral cornea that gets untreated or uncross-linked.

[00:27:59] [SPEAKER_00]: And the second reason, which is also a really big one,

[00:28:02] [SPEAKER_00]: is we can adjust with our device the energy levels.

[00:28:05] [SPEAKER_00]: So the other device has one energy level. It's locked.

[00:28:09] [SPEAKER_00]: Doctors cannot adjust it, can't adjust it, and it's set and it's relatively low.

[00:28:15] [SPEAKER_00]: So even our lowest energy level is about two and a half times what the other device is.

[00:28:21] [SPEAKER_00]: And that's why higher energy through the cross-linking procedure from that device,

[00:28:26] [SPEAKER_00]: the light device, equals more cross-linking.

[00:28:29] [SPEAKER_00]: And so that's why I think those two factors make our success rate so high.

[00:28:35] [SPEAKER_00]: There's even certain patients that even need a higher cross-linking amount

[00:28:39] [SPEAKER_00]: like somebody who is a child or teenager.

[00:28:42] [SPEAKER_00]: They have more aggressive care to conus.

[00:28:44] [SPEAKER_00]: And somebody who had previous LASIK that got care to conus,

[00:28:47] [SPEAKER_00]: we know that those subgroups need more strengthening than the average person.

[00:28:52] [SPEAKER_00]: And we can adjust it, but no other device here in the U.S. can do that.

[00:28:57] [SPEAKER_00]: Jen, do you want to talk about how we reshape the cornea now?

[00:29:00] [SPEAKER_00]: Some of the options we have for reshaping to actually improve people's vision?

[00:29:04] [SPEAKER_00]: Because we've just been spending a lot of time talking about stabilizing.

[00:29:08] [SPEAKER_00]: But we have lots of options to actually now improve people's vision, don't we?

[00:29:12] [SPEAKER_02]: Right, exactly.

[00:29:13] [SPEAKER_02]: You can see how some patients think we can just save it,

[00:29:17] [SPEAKER_02]: which is obviously the most important thing we need to save our eyesight.

[00:29:20] [SPEAKER_02]: But they're like, oh wow, you can improve my vision too?

[00:29:23] [SPEAKER_02]: Because a lot of patients are, one, very uncomfortable in their contact lenses.

[00:29:31] [SPEAKER_02]: They can also have blurry vision in their contact lenses

[00:29:36] [SPEAKER_02]: and just not getting the optimal visual function from that contact lens.

[00:29:41] [SPEAKER_02]: Or it could be one or the other.

[00:29:44] [SPEAKER_02]: So if they are uncomfortable in contact lenses and not getting the best vision,

[00:29:51] [SPEAKER_02]: a lot of times with care to conus patients, of course, they have that cone-shaped cornea.

[00:29:57] [SPEAKER_02]: And so there is a tiny little plastic segment, tiny, tiny.

[00:30:02] [SPEAKER_02]: It's like the tip of my fingernail.

[00:30:03] [SPEAKER_02]: And it is just this little segment.

[00:30:07] [SPEAKER_02]: The doctor will create a tiny little channel within the cornea.

[00:30:12] [SPEAKER_02]: And wherever the cone is most pronounced, he'll customize this for each patient.

[00:30:17] [SPEAKER_02]: And he'll just slip that little segment in.

[00:30:19] [SPEAKER_02]: It's less invasive than even Lasik.

[00:30:21] [SPEAKER_02]: There's no cutting with Lasik.

[00:30:25] [SPEAKER_02]: You move over the flap and then treat the area.

[00:30:29] [SPEAKER_02]: I hope it seals back perfectly with this.

[00:30:33] [SPEAKER_02]: It's just a tiny little incision.

[00:30:35] [SPEAKER_02]: You don't need stitches or anything like that and very little downtime.

[00:30:39] [SPEAKER_02]: And it's removable if need be.

[00:30:42] [SPEAKER_02]: Dr. Brian has been doing this since 1999.

[00:30:45] [SPEAKER_02]: So it's very, very common for him to treat.

[00:30:49] [SPEAKER_02]: And that's one thing that can address the cornea.

[00:30:53] [SPEAKER_02]: There's a few other things.

[00:30:56] [SPEAKER_00]: Actually, let me just dovetail about the intact.

[00:30:59] [SPEAKER_00]: So, yeah.

[00:31:00] [SPEAKER_00]: So as Jen said, we've been doing intact since hard to believe 1999,

[00:31:04] [SPEAKER_00]: back when I was a brunette.

[00:31:07] [SPEAKER_00]: And 25 years ago.

[00:31:09] [SPEAKER_00]: And I've even done them on my family members.

[00:31:12] [SPEAKER_00]: My sister-in-law has carotid conus.

[00:31:14] [SPEAKER_00]: And I've done it on my brother-in-law as well.

[00:31:17] [SPEAKER_00]: About probably over 20 years ago.

[00:31:19] [SPEAKER_00]: And they still talk to me, by the way.

[00:31:22] [SPEAKER_00]: So they're doing great.

[00:31:24] [SPEAKER_00]: And we know that the intact is made of a material

[00:31:27] [SPEAKER_00]: that the original cataract lens implants were made out of.

[00:31:30] [SPEAKER_00]: So it's totally biocompatible.

[00:31:32] [SPEAKER_00]: There's no allergic reaction.

[00:31:34] [SPEAKER_00]: They don't degrade or break down.

[00:31:36] [SPEAKER_00]: You don't feel them.

[00:31:37] [SPEAKER_00]: It's like having a dental filling in your tooth

[00:31:40] [SPEAKER_00]: where you have a little implant in your tooth for a filling.

[00:31:42] [SPEAKER_00]: After you add a cavity, you don't even know it's there or feel it.

[00:31:46] [SPEAKER_00]: Intact is just like that too.

[00:31:48] [SPEAKER_00]: So they're very user-friendly for patients.

[00:31:51] [SPEAKER_00]: It's a one-day recovery.

[00:31:53] [SPEAKER_00]: Seven-minute procedure.

[00:31:54] [SPEAKER_00]: We use a numbing gel.

[00:31:56] [SPEAKER_00]: And if people are nervous, we have Valium to relax them.

[00:32:00] [SPEAKER_00]: So that part's really easy.

[00:32:01] [SPEAKER_00]: And it flattens the cornea.

[00:32:03] [SPEAKER_00]: That's the whole purpose of Intax.

[00:32:04] [SPEAKER_00]: They flatten the bulge.

[00:32:07] [SPEAKER_00]: And depending on the stage of the bulge,

[00:32:09] [SPEAKER_00]: we now may use something different,

[00:32:11] [SPEAKER_00]: what I call like a biologic Intax.

[00:32:14] [SPEAKER_00]: So Intax come in certain thicknesses.

[00:32:16] [SPEAKER_00]: And we can only use a certain amount of thickness

[00:32:18] [SPEAKER_00]: to still keep the cornea healthy.

[00:32:21] [SPEAKER_00]: Now what we do for more advanced care to conus,

[00:32:25] [SPEAKER_00]: where we need to get more flattening

[00:32:26] [SPEAKER_00]: than Intax are capable of,

[00:32:28] [SPEAKER_00]: I use what I like to just call a biologic Intax.

[00:32:31] [SPEAKER_00]: In other words, a collagen implant.

[00:32:35] [SPEAKER_00]: It's made of cornea collagen,

[00:32:36] [SPEAKER_00]: but it can be much thicker than an Intax.

[00:32:38] [SPEAKER_00]: So the thicker the segment, the more flattening.

[00:32:41] [SPEAKER_00]: That's the way the mechanics work.

[00:32:44] [SPEAKER_00]: So this is called CARES, K-A-I-R-S, biologic Intax.

[00:32:48] [SPEAKER_00]: So now we use that for more advanced cases.

[00:32:52] [SPEAKER_00]: And I've even had, Jen, you know,

[00:32:54] [SPEAKER_00]: we've had people come back who've had Intax,

[00:32:57] [SPEAKER_00]: and now we can do CARES.

[00:32:58] [SPEAKER_00]: We can take the Intax out and put the CARES in

[00:33:00] [SPEAKER_00]: and get even more effect.

[00:33:03] [SPEAKER_00]: Actually, I just saw somebody today

[00:33:04] [SPEAKER_00]: who came in for their three-month post-op,

[00:33:06] [SPEAKER_00]: and they're doing contact lenses,

[00:33:08] [SPEAKER_00]: but they're doing great in Contax.

[00:33:10] [SPEAKER_00]: You know, seeing better than they've ever seen before

[00:33:12] [SPEAKER_00]: because we got more additional flattening

[00:33:14] [SPEAKER_00]: from the biologic Intax.

[00:33:16] [SPEAKER_00]: Yeah, which was great to see.

[00:33:19] [SPEAKER_00]: So yeah, so those are,

[00:33:20] [SPEAKER_00]: that's kind of how the implant world works

[00:33:22] [SPEAKER_00]: for keratoconus, for the flattening effect.

[00:33:25] [SPEAKER_00]: But Jen, you want to talk about

[00:33:26] [SPEAKER_00]: some of the other things we do?

[00:33:28] [SPEAKER_02]: Yes, so I was just a little excited.

[00:33:31] [SPEAKER_02]: So I was about to talk about CK.

[00:33:36] [SPEAKER_02]: CK is conductive keratoplasty,

[00:33:39] [SPEAKER_02]: originally approved for presbyopia,

[00:33:42] [SPEAKER_02]: the natural aging of the eyes.

[00:33:44] [SPEAKER_02]: But Dr. Bryan, many, many years,

[00:33:47] [SPEAKER_02]: has been using CK in conjunction with Intax

[00:33:53] [SPEAKER_02]: a lot of times to help reshape the cornea even more,

[00:33:57] [SPEAKER_02]: give an extra boost division

[00:33:59] [SPEAKER_02]: than just the Intax by itself,

[00:34:01] [SPEAKER_02]: where patients have more astigmatism

[00:34:04] [SPEAKER_02]: and he deems them to be a candidate.

[00:34:06] [SPEAKER_02]: He can use these customized little heat spots.

[00:34:09] [SPEAKER_02]: It's not a laser.

[00:34:11] [SPEAKER_02]: It's not like putting.

[00:34:12] [SPEAKER_02]: It's a gentle heat probe,

[00:34:14] [SPEAKER_02]: and he will customize these spots

[00:34:16] [SPEAKER_02]: to help elevate the tissue in certain areas

[00:34:18] [SPEAKER_02]: that are too flat.

[00:34:20] [SPEAKER_02]: So a lot of keratoconus patients,

[00:34:22] [SPEAKER_02]: you know, lopsided cornea,

[00:34:25] [SPEAKER_02]: the Intax has steepness

[00:34:27] [SPEAKER_02]: where maybe it's like a mountain,

[00:34:29] [SPEAKER_02]: and then this section here is like a valley.

[00:34:32] [SPEAKER_02]: And if you push down the mountain here

[00:34:34] [SPEAKER_02]: with the Intax,

[00:34:36] [SPEAKER_02]: if you were to push down the other side of this

[00:34:38] [SPEAKER_02]: to fly, you still have a lopsided cornea here.

[00:34:41] [SPEAKER_02]: So these little heat spots

[00:34:43] [SPEAKER_02]: will help elevate the tissue some

[00:34:46] [SPEAKER_02]: so that it's more uniformly shaped.

[00:34:48] [SPEAKER_02]: And you're trying to normalize the shape

[00:34:51] [SPEAKER_02]: with the cornea as much as possible

[00:34:53] [SPEAKER_02]: because there is a lot of distortion

[00:34:55] [SPEAKER_02]: and those astigmatism spots in the prescription,

[00:35:00] [SPEAKER_02]: just it adds a lot of nighttime vision problems,

[00:35:05] [SPEAKER_02]: more difficulty in fitting contact lens.

[00:35:08] [SPEAKER_02]: So these things are all helpful

[00:35:11] [SPEAKER_02]: in improving the quality

[00:35:13] [SPEAKER_02]: and the clarity of the vision.

[00:35:16] [SPEAKER_00]: And just to help everyone understand visually

[00:35:19] [SPEAKER_00]: what's happening and transpiring here,

[00:35:21] [SPEAKER_00]: I'm going to hold that map up again.

[00:35:24] [SPEAKER_00]: So remember this was the map from before.

[00:35:26] [SPEAKER_00]: And this is the steep spot.

[00:35:29] [SPEAKER_00]: So the Intax, I will customize,

[00:35:31] [SPEAKER_00]: it's a U-shaped segment,

[00:35:34] [SPEAKER_00]: and it goes under the surface,

[00:35:35] [SPEAKER_00]: and I'll customize the location

[00:35:38] [SPEAKER_00]: to where the bulge is.

[00:35:40] [SPEAKER_00]: So that's one thing that a lot of experience

[00:35:43] [SPEAKER_00]: will enable a surgeon to do

[00:35:44] [SPEAKER_00]: is put the Intax in the right place,

[00:35:47] [SPEAKER_00]: first of all,

[00:35:48] [SPEAKER_00]: because you want to target the steepening.

[00:35:51] [SPEAKER_00]: And in a code of conduct like this

[00:35:53] [SPEAKER_00]: is I would be using one segment,

[00:35:56] [SPEAKER_00]: not two,

[00:35:58] [SPEAKER_00]: because the doctor puts in a segment

[00:35:59] [SPEAKER_00]: also up above and below.

[00:36:02] [SPEAKER_00]: They're going to cause this blue area,

[00:36:04] [SPEAKER_00]: which is flat, to get even flatter.

[00:36:06] [SPEAKER_00]: And that's going to be counterproductive.

[00:36:09] [SPEAKER_00]: So in this case,

[00:36:10] [SPEAKER_00]: this is going to be where we'll want to use one segment.

[00:36:13] [SPEAKER_00]: And by the way, I've seen patients that had two

[00:36:15] [SPEAKER_00]: and we can take one out

[00:36:17] [SPEAKER_00]: to help reverse that unnecessary flattening

[00:36:19] [SPEAKER_00]: in the flat area already.

[00:36:22] [SPEAKER_00]: But that's the area we're going to want to now do the CK.

[00:36:25] [SPEAKER_00]: So we use the heat probe here.

[00:36:29] [SPEAKER_00]: By the way, CK is for conductive keratoplasty,

[00:36:31] [SPEAKER_00]: not Calvin Klein,

[00:36:32] [SPEAKER_00]: in case anybody was curious.

[00:36:34] [SPEAKER_00]: But we'll do the little heat spots in the blue area.

[00:36:37] [SPEAKER_00]: And the eyelid is covering part of that,

[00:36:39] [SPEAKER_00]: but it's all going to be blue up here.

[00:36:41] [SPEAKER_00]: So we do the heat spots in the blue area

[00:36:43] [SPEAKER_00]: because that's going to lift it.

[00:36:44] [SPEAKER_00]: So we actually want to lift the blue

[00:36:46] [SPEAKER_00]: and flatten the red down below.

[00:36:50] [SPEAKER_00]: That's why the CK can be a very good procedure

[00:36:53] [SPEAKER_00]: in conjunction with the Intax

[00:36:55] [SPEAKER_00]: to maximize the reshaping process.

[00:36:58] [SPEAKER_00]: And there's only about a seven-minute procedure as well.

[00:37:01] [SPEAKER_00]: So it's quick, it's painless.

[00:37:03] [SPEAKER_00]: We do it right after the Intax.

[00:37:05] [SPEAKER_00]: So it doesn't add really much recovery.

[00:37:08] [SPEAKER_00]: People might just feel a little scratchiness

[00:37:10] [SPEAKER_00]: for a day or two, but not bad at all.

[00:37:13] [SPEAKER_00]: Jen, why don't we talk about Visian-ICL?

[00:37:16] [SPEAKER_00]: When would people consider the Visian-ICL lens procedure?

[00:37:20] [SPEAKER_00]: And why don't you describe what it is?

[00:37:21] [SPEAKER_02]: So I always get really excited about this procedure

[00:37:26] [SPEAKER_02]: because this particular procedure

[00:37:28] [SPEAKER_02]: is for the high myopia patients.

[00:37:32] [SPEAKER_02]: That otherwise, in text alone,

[00:37:35] [SPEAKER_02]: they may still have a lot of residual prescription.

[00:37:39] [SPEAKER_02]: And this particular lens is specifically

[00:37:41] [SPEAKER_02]: for high myopia, so the near-sighted patients.

[00:37:45] [SPEAKER_02]: But it is an insurmountable lens.

[00:37:47] [SPEAKER_02]: It is based behind the colored portion of the eye,

[00:37:50] [SPEAKER_02]: the iris, and in front of your natural lens.

[00:37:53] [SPEAKER_02]: You have a natural lens in the back of that.

[00:37:55] [SPEAKER_02]: So it's placed in front of that.

[00:37:57] [SPEAKER_02]: So it's going to give a greater and enhanced vision

[00:38:01] [SPEAKER_02]: than if you were to, say, wear a contact lens or glasses.

[00:38:06] [SPEAKER_02]: The closer a lens is to the back of the natural lens

[00:38:09] [SPEAKER_02]: in the back of the eye,

[00:38:10] [SPEAKER_02]: the greater the enhancement of vision.

[00:38:11] [SPEAKER_02]: So that's why you get better vision with contacts

[00:38:14] [SPEAKER_02]: than you do with glasses,

[00:38:16] [SPEAKER_02]: which sit out here on your face.

[00:38:18] [SPEAKER_02]: And the contacts are also customized for each patient.

[00:38:22] [SPEAKER_02]: So this is even more customizable.

[00:38:26] [SPEAKER_02]: I mean, we even do an ultrasound

[00:38:27] [SPEAKER_02]: to measure the chambers of the eye

[00:38:29] [SPEAKER_02]: because everyone has different size

[00:38:31] [SPEAKER_02]: on the insides of their eyes as well.

[00:38:33] [SPEAKER_02]: But this is for patients.

[00:38:36] [SPEAKER_02]: Now with keratoconus, of course, it depends on the stage,

[00:38:38] [SPEAKER_02]: but the goal is typically to get patients out of contact lenses,

[00:38:44] [SPEAKER_02]: to either eliminate contact lenses

[00:38:47] [SPEAKER_02]: or eliminate the dependency on contact lenses.

[00:38:52] [SPEAKER_02]: And it just changes their whole lives.

[00:38:55] [SPEAKER_02]: I mean, this can be for patients

[00:38:56] [SPEAKER_02]: that don't even have keratoconus

[00:38:59] [SPEAKER_02]: and have high myopia

[00:39:00] [SPEAKER_02]: and are looking for vision correction options

[00:39:02] [SPEAKER_02]: and maybe they're not a good candidate for, say,

[00:39:06] [SPEAKER_02]: LASIK because of dry eye or thin corneas.

[00:39:09] [SPEAKER_02]: This is an amazing procedure.

[00:39:12] [SPEAKER_02]: If you see someone that has the thicker Coke bottle glasses,

[00:39:15] [SPEAKER_02]: you usually kind of know,

[00:39:17] [SPEAKER_02]: oh, I bet you they might be a good candidate for ACL.

[00:39:20] [SPEAKER_02]: So a lot of the patients that have keratoconus that come in

[00:39:24] [SPEAKER_02]: because before pre-op testing,

[00:39:26] [SPEAKER_02]: they can't wear their contacts for a week.

[00:39:28] [SPEAKER_02]: So they're like, oh, man, I have to wear my glasses.

[00:39:30] [SPEAKER_02]: I know they get upset

[00:39:31] [SPEAKER_02]: because they're the ones with those thick Coke bottle glasses

[00:39:34] [SPEAKER_02]: and they don't want to wear them around work and stuff.

[00:39:38] [SPEAKER_02]: But it's great because then they get to eliminate that

[00:39:41] [SPEAKER_02]: and not ever have to worry about them again.

[00:39:43] [SPEAKER_02]: So it's just a really exciting procedure.

[00:39:46] [SPEAKER_02]: Even Steve Holcomb was highly beneficial for him

[00:39:51] [SPEAKER_02]: because it improved his vision so much.

[00:39:54] [SPEAKER_02]: It was so crystal clear that it was like a distraction at first

[00:39:59] [SPEAKER_02]: after he first had it, right?

[00:40:01] [SPEAKER_02]: Remember, he was seeing the ice and everything.

[00:40:03] [SPEAKER_02]: He wasn't used to seeing all of these things.

[00:40:06] [SPEAKER_02]: They were so tiny before.

[00:40:08] [SPEAKER_02]: I mean, of course, he ended up wearing gold.

[00:40:09] [SPEAKER_02]: And of course, it was very beneficial to the whole US even.

[00:40:15] [SPEAKER_02]: But yeah, just it's so wonderful, Chris, clear vision.

[00:40:18] [SPEAKER_02]: What would you like to say about that procedure?

[00:40:21] [SPEAKER_00]: So I really liken it to the keratoconus procedures

[00:40:24] [SPEAKER_00]: we've been talking about up until this ICL

[00:40:27] [SPEAKER_00]: we're now discussing lens is what I would call part one.

[00:40:31] [SPEAKER_00]: And then the ICL is part two

[00:40:33] [SPEAKER_00]: that people can come back for part two.

[00:40:35] [SPEAKER_00]: We want them to wait three months

[00:40:37] [SPEAKER_00]: for everything to settle down and stabilize

[00:40:39] [SPEAKER_00]: from the first keratoconus procedures.

[00:40:43] [SPEAKER_00]: And some number of people don't need an ICL

[00:40:46] [SPEAKER_00]: because their near-sightedness isn't that high.

[00:40:48] [SPEAKER_00]: But for people who want to improve their vision

[00:40:52] [SPEAKER_00]: without their contacts, it's not so blurry.

[00:40:55] [SPEAKER_00]: ICL is really something that can be life changing

[00:40:58] [SPEAKER_00]: because of treating the high level of near-sightedness or myopia.

[00:41:02] [SPEAKER_00]: And some people may still wear lenses afterwards.

[00:41:05] [SPEAKER_00]: It just depends on where they are to begin with

[00:41:08] [SPEAKER_00]: when we do that evaluation for ICL.

[00:41:10] [SPEAKER_00]: So I'll counsel everybody specifically.

[00:41:12] [SPEAKER_00]: Or if people send records in from out of town,

[00:41:15] [SPEAKER_00]: we can review those and give people an idea as well.

[00:41:19] [SPEAKER_00]: As well as the first time too.

[00:41:20] [SPEAKER_00]: A lot of people will send their records

[00:41:21] [SPEAKER_00]: for the first time for the keratoconus assessment.

[00:41:24] [SPEAKER_00]: And I'll review the records and say maybe it's Holcomb C3R

[00:41:27] [SPEAKER_00]: and maybe Intax or maybe Intax and also CK.

[00:41:30] [SPEAKER_00]: So we do that for that stage, phase one, but also for phase two.

[00:41:36] [SPEAKER_00]: We can evaluate for ICL as well

[00:41:39] [SPEAKER_00]: and give some realistic expectations.

[00:41:42] [SPEAKER_00]: When people file out here, then after we get our measurements,

[00:41:45] [SPEAKER_00]: then I can really be specific about the expectations.

[00:41:48] [SPEAKER_00]: If people don't need to wear contacts or glasses

[00:41:50] [SPEAKER_00]: most of the time after the ICL

[00:41:52] [SPEAKER_00]: or maybe they still will benefit from it,

[00:41:54] [SPEAKER_00]: but when they're waking up in the middle of the night,

[00:41:56] [SPEAKER_00]: they at least can see.

[00:41:57] [SPEAKER_00]: Or maybe they just need them part time during the day

[00:42:01] [SPEAKER_00]: or maybe just at night time.

[00:42:02] [SPEAKER_00]: So it just depends.

[00:42:04] [SPEAKER_00]: I like to always be really specific with my recommendations

[00:42:07] [SPEAKER_00]: when I evaluate people

[00:42:08] [SPEAKER_00]: so that they know realistically what to expect from the procedures.

[00:42:12] [SPEAKER_00]: But it's also about a one-day recovery too.

[00:42:15] [SPEAKER_00]: ICL now takes about seven minutes.

[00:42:17] [SPEAKER_00]: We also do it in our office.

[00:42:19] [SPEAKER_00]: If it's both eyes, we do them one right after the other.

[00:42:22] [SPEAKER_00]: And then they just rest and then the next day,

[00:42:24] [SPEAKER_00]: typically already seeing huge improvement the very next day.

[00:42:27] [SPEAKER_02]: I think that's a great thing about our curatoconus procedures.

[00:42:31] [SPEAKER_02]: There's just a very quick recovery time for patients.

[00:42:36] [SPEAKER_02]: Even the cross-linking,

[00:42:38] [SPEAKER_02]: if it's just the cross-linking procedure,

[00:42:40] [SPEAKER_02]: patients can wear their contacts the next day.

[00:42:44] [SPEAKER_02]: With the CXL, the epi-off version,

[00:42:47] [SPEAKER_02]: not only is it super painful,

[00:42:49] [SPEAKER_02]: but they're not able to resume normal activity as quickly

[00:42:53] [SPEAKER_02]: or wear contact lenses the next day.

[00:42:56] [SPEAKER_02]: They're just shocked usually

[00:42:58] [SPEAKER_02]: once we do start to describe the procedure and the recovery time.

[00:43:03] [SPEAKER_00]: We've always really been on literally the cutting edge

[00:43:05] [SPEAKER_00]: and figuratively for these curatoconus procedures.

[00:43:10] [SPEAKER_00]: It's great to be of service to people

[00:43:13] [SPEAKER_00]: and to help them achieve their goals.

[00:43:15] [SPEAKER_00]: That's what we've been doing pretty much from the beginning of my career,

[00:43:19] [SPEAKER_00]: is wanting to help people achieve what they want to out of life.

[00:43:22] [SPEAKER_00]: For people with curatoconus,

[00:43:25] [SPEAKER_00]: we feel very honored to have that sort of hallowed position in somebody's care

[00:43:31] [SPEAKER_00]: to be able to do something where they really can't get these treatments anywhere else

[00:43:35] [SPEAKER_00]: with that level of expertise too.

[00:43:38] [SPEAKER_00]: We definitely don't take it for granted that people fly here

[00:43:40] [SPEAKER_00]: from literally all over the United States and from other countries

[00:43:43] [SPEAKER_00]: for the last 20 plus years.

[00:43:47] [SPEAKER_00]: We really appreciate that.

[00:43:49] [SPEAKER_00]: We know we're doing something really special.

[00:43:51] [SPEAKER_00]: We feel very fortunate to be in that position as well.

[00:43:56] [SPEAKER_02]: Yeah, because we do offer a lot of different types of procedures

[00:44:00] [SPEAKER_02]: that can help patients in other ways.

[00:44:04] [SPEAKER_02]: Of course, those are amazing procedures that we have as well.

[00:44:08] [SPEAKER_02]: If patients go to our website, boxerwockler.com,

[00:44:11] [SPEAKER_02]: we have so many types of procedures.

[00:44:13] [SPEAKER_02]: I think this one is the most nearest and dearest to our hearts

[00:44:17] [SPEAKER_02]: because we're so ultra passionate about saving the eyesight

[00:44:22] [SPEAKER_02]: because improving the vision is really important as well.

[00:44:26] [SPEAKER_02]: But being able to really look into the future and know how to predict it

[00:44:33] [SPEAKER_02]: because you've seen what has happened to other patients,

[00:44:36] [SPEAKER_02]: and you can just stop it just by educating patients

[00:44:40] [SPEAKER_02]: and showing them that kindness and care that you truly care about

[00:44:44] [SPEAKER_02]: what happens to them I think is really, really important for people,

[00:44:48] [SPEAKER_02]: especially that don't have any clue about the condition.

[00:44:51] [SPEAKER_02]: And we're either their first stop or maybe they've talked to someone before

[00:44:56] [SPEAKER_02]: but didn't really truly understand the urgency of it.

[00:44:59] [SPEAKER_02]: It's just amazing that we can help people in such a profound way.

[00:45:03] [SPEAKER_00]: That's the reason why to get word out, educate people.

[00:45:08] [SPEAKER_00]: I've published four books now on care to conus over my career,

[00:45:11] [SPEAKER_00]: more than anybody because we want to provide more information, not less.

[00:45:16] [SPEAKER_00]: That's always been my philosophy,

[00:45:18] [SPEAKER_00]: which is why on our website we have so much information.

[00:45:20] [SPEAKER_00]: We have videos.

[00:45:22] [SPEAKER_00]: Even if somebody's a skimmer,

[00:45:23] [SPEAKER_00]: they'll be able to hit the high points if somebody wants to dive deep.

[00:45:27] [SPEAKER_00]: They'll get under the hood and really learn as much as possible

[00:45:31] [SPEAKER_00]: because we just like to provide the information and educate people.

[00:45:35] [SPEAKER_00]: And the staff are great.

[00:45:36] [SPEAKER_00]: So if you call the office, if you have care to conus,

[00:45:38] [SPEAKER_00]: you want to learn more.

[00:45:40] [SPEAKER_00]: You can even set up a Zoom call with the staff or in person face to face.

[00:45:45] [SPEAKER_00]: They can discuss your situation with you.

[00:45:48] [SPEAKER_00]: So our office phone number is 310-860-1900.

[00:45:55] [SPEAKER_00]: And our main website is just the last name, BoxerWalkler.com,

[00:45:58] [SPEAKER_00]: or the care to conus website is care to conusinserts.com.

[00:46:02] [SPEAKER_00]: This information will be in the notes for the podcast.

[00:46:07] [SPEAKER_00]: So you'll have all that there in the website links too.

[00:46:11] [SPEAKER_00]: Well, Jen, thank you very much for joining us here

[00:46:13] [SPEAKER_00]: and sharing information for people

[00:46:16] [SPEAKER_00]: and helping to educate people about what's the latest and greatest

[00:46:19] [SPEAKER_00]: in care to conus and the most modern treatments that are out there now.

[00:46:22] [SPEAKER_02]: You're welcome.

[00:46:23] [SPEAKER_02]: Anybody feel free to contact me too,

[00:46:26] [SPEAKER_02]: and I'll be more than happy to help you.

[00:46:28] [SPEAKER_02]: I'm really excited to do so.

[00:46:31] [SPEAKER_00]: Great.

[00:46:31] [SPEAKER_00]: And then we'll be up with new episodes coming shortly

[00:46:35] [SPEAKER_00]: on the health show here.

[00:46:38] [SPEAKER_00]: So stay tuned.

[00:46:39] [SPEAKER_00]: Don't forget to subscribe if you haven't

[00:46:41] [SPEAKER_00]: and share with your friends too.

[00:46:43] [SPEAKER_00]: And of course, if you know someone with care to conus,

[00:46:46] [SPEAKER_00]: feel free to send this episode to them too.

[00:46:47] [SPEAKER_00]: They'll be very grateful, I'm sure.

[00:46:50] [SPEAKER_02]: Then you can help them too.

[00:46:52] [SPEAKER_00]: Okay.

[00:46:53] [SPEAKER_00]: Thank you, Jen.

[00:46:54] [SPEAKER_01]: You're welcome.

[00:46:55] [SPEAKER_01]: Bye.

[00:47:07] [SPEAKER_01]: And visit nocaphealthshow.com.

[00:47:10] [SPEAKER_01]: Don't miss another episode and subscribe to the show

[00:47:12] [SPEAKER_01]: on Apple podcasts, Spotify, or wherever you listen to podcasts.

[00:47:17] [SPEAKER_01]: Also make sure to follow Dr. Brian on TikTok

[00:47:20] [SPEAKER_01]: at Brian Boxer-Walker MD.

[00:47:22] [SPEAKER_01]: And remember, Dr. Brian is a real doctor,

[00:47:25] [SPEAKER_01]: but he is not your doctor.

[00:47:27] [SPEAKER_01]: He is here to provide general information,

[00:47:29] [SPEAKER_01]: not medical advice.

[00:47:31] [SPEAKER_01]: So you should always check with your doctor

[00:47:33] [SPEAKER_01]: before relying on any information.