Sleep Apnea and Glaucoma | Driving with Dr. David Richardson Ep 03


Good morning. I’m Dr. David Richardson. I’m a cataract and glaucoma surgeon that practices
in Southern California. One of the things I mentioned in the first
video was sleep apnea. So, I’d like to discuss a little bit about
sleep apnea. And let’s get going and chat. The first thing is to address some misconceptions
about sleep apnea. Sleep apnea is not just an issue with bad
snoring. Sleep apnea is, essentially, a condition where
someone during sleep is unable to breathe for a period of time or rather just stops
breathing. And there are multiple potential mechanisms
of this we don’t really need to get into but point is that for a period of time which can
be an extended period of time there is no breathing occurring. and if there is no breathing
occurring there is no oxygenation of the tissues in the body including the retina, optic nerve,
and other ocular or eye-related tissues. now it’s of interest that the retina is considered
to be one of the most metabolically active structures in the body and what that means
is that it requires a lot of energy in order for it to function well. So what this means is that the retina is essentially
a sports car of the eye. just as you would not attempt to drive a sports
car using low octane fuel or at least not expected to perform well, one cannot expect
that the retina is going to perform well if it does not have a good blood supply or is
not getting oxygen in the blood because oxygen is the fuel that our tissues need. Now, you might be wondering, “well what
does the retina have to do with the optic nerve?” we’re talking about glaucoma. glaucoma is a condition of optic nerve pathology
well the optic nerve is made up of axions from cells which are in the retina these cells
are called the ganglion cells and it’s important that these ganglion cells get the oxygen they
need in order to perform the metabolic activity or functions that are going on. so all of this is just to state that you need
to have good oxygenation as well as good perfusion as we talked about in the last video so you
need to have a blood supply but the blood itself has to be oxygenated both of those
things are critical and in those with sleep apnea there is not good oxygenation during
the night. So all of this is just to point out that sleep
apnea again it’s not just an issue of snoring, it’s not just something that makes people
tired the next day… it’s a condition that actually slowly destroys the tissues in the
body. the eye being one of them and in particular
the ganglion cells and associated optic nerve. So although it can be quite challenging and
annoying and inconvenient to obtain a workup for sleep apnea and a treatment an effective
treatment for sleep apnea it really is worth the effort. there are a couple of types of glaucoma in
particular where it seems to be worth the effort so although I recommend for all of
my patients who have symptoms of or who at risk of sleep apnea and what are some of the
risks—well obesity or doesn’t even have to be obesity it just can be extra tissue
around the neck or within the oral pharynx so basically the back of the mouth the tongue
the the mouth the back of the mouth all these things which can be addressed from weight
loss to special devices that are placed in the mouth to orthodonture. I mean so there really is a full range of
potential treatments. I do recommend that any of my patients with
glaucoma who are at risk for sleep apnea get worked up for it, and those that have it documented
actually be treated for it. There is a subsets of patients that have what
is called normal tension glaucoma (sometimes called low tension glaucoma) in which they
have all of the signs and symptoms of glaucoma in terms of the typical loss of nerve fiber
layer a loss of visual field but their pressures are fine or at least every documented pressure
has been fine. in these patients it really is felt that the
problem is not primarily with the intraocular pressure but rather perfusion of the optic
nerve or oxygenation and these patients tend to be particularly susceptible to damage from
sleep apnea so anyone who has normal tension glaucoma and is at risk of sleep apnea or
developing sleep apnea in my view really needs to be worked up and treated for it
So I think that’s enough on sleep apnea, today. Again, I’m not going to get into all of the
methods of how to diagnose and treat it. That’s for another specialist to discuss. I’m sure there’s some video out there on that,
as well, online. But I did want to pay particular attention,
today, to that element of a holistic approach to glaucoma. Eventually we’ll get to intraocular pressure—but
not yet. All right, so have a great day and I’ll see
you on my next commute.