Vetsplanation: Pet Health Simplified
Vetsplanation: Pet Health Simplified
Must-Know Facts: Protect Your Pet's Eyes Today!
Get ready to see eye-to-eye with pet experts Dr. Karen Brantman-Crosetto and Dr. Tyler Sugerman as they share invaluable insights into pet ophthalmology. From deciphering complex genetic conditions to practical tips for detecting early signs of eye problems, this episode is a must-listen for every pet owner. Tune in and empower yourself with the knowledge to give your pets the gift of clear and healthy vision!
What you will learn:
- Understand common eye issues in pets and their breed predispositions
- Learn how to find a qualified veterinary ophthalmologist for your pet
- Explore proactive measures to safeguard your pet's vision health
- Discover the latest advancements in genetic testing for identifying eye disorders
- Gain insights into specific breeds prone to eye problems
- Uncover practical tips for early detection of eye issues in pets
Resources:
Dr. Karen Brantman-Crosetto
AVCO Search - Find a Veterinary Ophthalmologist Near You!
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Did you know that cats can have freckles inside their eyes? Not only that, but sometimes those things that look like innocent freckles could actually be the beginning of something more sinister. Or that certain breeds of dogs are predisposed to certain eye conditions. Join us on this week's episode of Vetsplanation, where we dive deep into what you need to know about your pet. I am your host, Dr. Sugerman, and today we're going to be talking to Dr. Karen Brantman, an ophthalmologist in the Pacific Northwest. Listen in to find out when you might need a veterinary ophthalmologist. Hi, everybody. Welcome back to another episode of Vetsplanation. So I have a super special guest with me here today. So I have Karen Brantman here. She's a veterinary ophthalmologist. So I'm really excited to talk to you today. Yes. So can you tell me, we're going to jump into like.. Just quickly, what is an ophthalmologist?
Dr. Karen Brantman-Crosetto:An ophthalmologist. And this is different from an optometrist. So a lot of people will ask me how I get dogs to read eye charts. And that's actually not something that I do. So your optometrist they can do a couple of diseases, but they fit you for glasses. The ophthalmologist does only medicine. So medicine and surgery really is the big difference there. So I do medicine and surgery of the eye.
Dr. Tyler Sugerman:Nice.
Dr. Karen Brantman-Crosetto:Yeah.
Dr. Tyler Sugerman:And is it just the eye or do you do surgery around the eye as well?
Dr. Karen Brantman-Crosetto:Yeah. So in animals, the ophthalmologist kind of does that whole area. So I will do not only cornea and lens or cataract, and some of us do retinal work.
Dr. Tyler Sugerman:So retinas, the back of the eye.
Dr. Karen Brantman-Crosetto:Retinas in the back of the eye. But we also do the face, so the skin and the eyelids, which in dogs, in particular, and some cats, the confirmation and the way that they're made and put together can be a problem. And so that's something that. I actually work on quite a bit. So in human medicine, you'd have about three or four different people for all of those things.
Dr. Tyler Sugerman:That's how I feel as my job is as well, like for my job, you'd have the emergency doctor and the surgeon, radiologist, and yeah, exactly.
Dr. Karen Brantman-Crosetto:Yeah. Yep. So we wear many hats.
Dr. Tyler Sugerman:You were talking about that you do lots of surgeries and stuff as well.
Dr. Karen Brantman-Crosetto:Yeah.
Dr. Tyler Sugerman:What kind of surgeries do you normally do?
Dr. Karen Brantman-Crosetto:Yeah. So I'm starting with the skin. So there are mostly dogs, I would say that where they'll have malformations. So they may have an eyelid that is flipped inward, right? So now you've got hair rubbing on the eye. That is a common thing we fix depending on, breed and the size of the dog, but I see that a lot. And it can cause a lot of pain, and so fixing those dogs isn't just a cosmetic surgery. It really is for quality of life and for eye health.
Dr. Tyler Sugerman:I can't imagine my, my, yeah, my like lashes touching my eye all the time.
Dr. Karen Brantman-Crosetto:Yeah it, yeah, it would be like your beard flipped into your eye.
Dr. Tyler Sugerman:Yeah, exactly. It'd be terrible.
Dr. Karen Brantman-Crosetto:It'd be a real challenge. Yeah. And so those are big ones that I do. Working our way in. There's also, so you've got an eyelid up here and an eyelid down here, and then there's a third eyelid in dogs and cats. Sometimes there are misplaced glands. And so I'll correct the position of the gland. I do corneal surgery where if there's,
Dr. Tyler Sugerman:Remind me what the cornea is.
Dr. Karen Brantman-Crosetto:Oh yeah. So the cornea is the clear outer windshield of the front of your eye. So it's what you use to see through everything. Your eye is the camera and the cornea is that outer windshield that you're looking through. So the cornea can be punctured, lacerated, infected. So I treat all those things.
Dr. Tyler Sugerman:Lots of foreign bodies in there.
Dr. Karen Brantman-Crosetto:Yeah, foreign bodies. So thorns.
Dr. Tyler Sugerman:Porcupine quills.
Dr. Karen Brantman-Crosetto:Porcupine quills.
Dr. Tyler Sugerman:I've had that. Yeah.
Dr. Karen Brantman-Crosetto:So there are various things that you hope a dog would close their eye and they sometimes don't. And yeah, so if that were something that needed to be removed or repaired, I would fix that for them. Working our way inside of the eye. So cornea, iris, which is the colored part of their eye and the iris constricts and dilates and helps us focus. Behind the iris is the lens, and the lens is where cataract happens. Yeah, so most people are familiar with cataract, it's a cloudy, the lens is supposed to be clear, just like the cornea, so if there's no pacification there, then you can't see through it. Not quite mud on the windshield, but you issues inside the eye, inside the lens. And so people have cataract surgery and we can do that in dogs and cats. So yeah.
Dr. Tyler Sugerman:So it's the same thing, right? Cataracts in people is the same as cataract in dogs and cats.
Dr. Karen Brantman-Crosetto:Correct. For the most part. Yep, absolutely. And the techniques that we use are adopted from human medicine. Obviously they came up with the idea first, right? And so yeah, we use a lot of those same techniques and a lot of the same machines. Our instrumentation is a little bit different because of the size of the eye. And it also depends on the species that you're working on. So if you're doing a horse, for example, versus a dog, you would need different sized instrumentation.
Dr. Tyler Sugerman:Yeah. I can imagine doing like my little dog who's eight pounds.
Dr. Karen Brantman-Crosetto:Yeah
Dr. Tyler Sugerman:With the giant stuff that you use for a horse
Dr. Karen Brantman-Crosetto:Yeah, it might not work very well. Exactly. Exactly and then the retina which is all the way back to the back of the eye. The retina is like wallpaper that lines the back of the eye And so there are surgeons who do retinal surgery in animals. Yeah, we see the retina fall off the back of the eye, sometimes it gets torn. So that can be surgically reattached. I don't do that surgery, but there are very special surgeons across the country that will do it.
Dr. Tyler Sugerman:That's pretty cool.
Dr. Karen Brantman-Crosetto:Yeah.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:That's neat.
Dr. Tyler Sugerman:So me as a emergency veterinarian, I can look at eyes somewhat.
Dr. Karen Brantman-Crosetto:Yeah. Yeah.
Dr. Tyler Sugerman:I can remove an eye, but there's not a lot else that I can do. So can you tell me like, when is it appropriate for a pet parent to be able to see you versus come to see me?
Dr. Karen Brantman-Crosetto:Yeah, Good question. And it's tough, I think, because A lot of it has to do with some of the instrumentation that you have. Also your comfort level.
Dr. Tyler Sugerman:Right.
Dr. Karen Brantman-Crosetto:And..
Dr. Tyler Sugerman:Eyes are hard.
Dr. Karen Brantman-Crosetto:Eyes are tough, right? And just being able to you know, at least be able to start some basics. I would say that most signs that a pet parent is gonna notice. All the eye signs fall into one of a few categories. Or a couple of categories. Squinting, discharge, cloudiness or a color change.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:And redness. That's it, right? All of those symptoms
Dr. Tyler Sugerman:I will say there's one other one.
Dr. Karen Brantman-Crosetto:Oh, tell me.
Dr. Tyler Sugerman:Popping out.
Dr. Karen Brantman-Crosetto:Oh yeah, popping out. Yeah. The eyeball has launched itself.
Dr. Tyler Sugerman:Yeah. I've seen that's, I think the majority of what I see.
Dr. Karen Brantman-Crosetto:Oh, that probably is true. So barring the eye, actually called proptosis is what we call it. Barring that. Most of the symptoms are, one of those four things and it could be something, it could be nothing. It could be a big deal. It could be not such a big deal. So a good place to start is always with your primary vet or your emergency doctor. If your primary vet's not available. And I would hope that they would look for a couple of different things. One, they should do tests for glaucoma.
Dr. Tyler Sugerman:Which is doing..
Dr. Karen Brantman-Crosetto:Pressures.
Dr. Tyler Sugerman:Check the pressures of the eye.
Dr. Karen Brantman-Crosetto:And corneal ulcers. So the staining. And I suggest doing tear tests as well. And I would suggest doing all of those tests each time you look at an eye, because even as an ophthalmologist, you really don't know which cases need what until you get pretty far into your training and I'm saying just by looking at them.
Dr. Tyler Sugerman:Absolutely.
Dr. Karen Brantman-Crosetto:So do yourself a favor. Do all of your tests. Know what you're dealing with and then you can go from there and decide okay, which medications am I gonna try? Or I think that's not great. Maybe I should send that.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:And then so that would be I guess the next step is when do you send?
Dr. Tyler Sugerman:Right.
Dr. Karen Brantman-Crosetto:Or when do you say, okay, this isn't something I can do. Glaucoma is an emergency. So high pressure in the eye, but you can always start glaucoma medications as soon as you see these cases. And there's one glaucoma med that is safe to start. It's dorazolamide. And so I would say, if you think there's a pressure increase regardless of the cause that one is safe to use.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:And I wouldn't hesitate. There are other versions, other classes of drugs that might not be safe to use. I always stick with dorzolamide, that's my recommendation.
Dr. Tyler Sugerman:I think that is probably the only one I have ever prescribed.
Dr. Karen Brantman-Crosetto:Yeah, good.
Dr. Tyler Sugerman:That's like the basics of my knowledge of eyes.
Dr. Karen Brantman-Crosetto:Yeah, exactly. And so you can't, you know, do no harm, right? And so get them started on something and then we can send them to an ophthalmologist.
Dr. Tyler Sugerman:Do you always recommend having the pet parent going to an ophthalmologist after being diagnosed with glaucoma?
Dr. Karen Brantman-Crosetto:Oh, good question. It's probably, obviously it's an ideal scenario. There are different reasons for glaucoma occurring. Primary or genetic glaucoma, usually we'll diagnose that based on a breed, right? And exclusion, right? You don't see anything else wrong.
Dr. Tyler Sugerman:Right.
Dr. Karen Brantman-Crosetto:Those cases. There's only so much that I can do. Now, the other scenario is that there's glaucoma as a result of something else going on that could affect overall health or just comfort, in general. Something we might actually want to know more about. Whether there's a tumor or high blood pressure or, something else going on. And yes, it's ideal to send to a veterinary ophthalmologist, but you could attempt to try to manage the pressures and at least try to preserve comfort as best you can. And if you can't keep an eye comfortable and blind, removal is always an option. Assuming overall health is okay.
Dr. Tyler Sugerman:And they do so well.
Dr. Karen Brantman-Crosetto:Oh gosh.
Dr. Tyler Sugerman:Just with one eye. Yes. I have two cats with one eye Yes, opposite eyes.
Dr. Karen Brantman-Crosetto:Oh.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:They're buddies.
Dr. Tyler Sugerman:Yeah. Little book ends.
Dr. Karen Brantman-Crosetto:Yeah.
Dr. Tyler Sugerman:That's what we call them.
Dr. Karen Brantman-Crosetto:They animals will do fantastic without vision.
Dr. Tyler Sugerman:Yeah
Dr. Karen Brantman-Crosetto:And without their eyes, one or two. Obviously, it's great if we can try to keep that for them, but they compensate beautifully the vast majority of the time. Always, comfort and quality of life is first, no question. And if that means eye removal, then that's okay.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:Yeah.
Dr. Tyler Sugerman:So with glaucoma, that's usually a medical thing, not a surgical thing. Are there other big medical, like eye things that we should be sending our pet parents over to you for?
Dr. Karen Brantman-Crosetto:Yeah, probably. I would actually say probably the biggest reasons to send things would be if there's some sort of surgical treatment that is recommended because you can always try some medical therapy, right? Even if we think there's an infection, you can try antibiotic drops. If we think there's dry eye, you can try tear production drops. Tear.. What's the word I'm looking for? Stimulating drops.. Yep.
Dr. Tyler Sugerman:Yep. I was thinking of like, like I had, for example, I had a cat who his eye changed color for no reason.
Dr. Karen Brantman-Crosetto:Yeah. Yeah. So a lot of times that might be worth.. If you're not sure about what might be happening. That would be worth sending it. Because there's a couple of things that can cause overall eye color change some of which you want to really stop that process, if you can, and on the other hand, you could be looking at maybe even early melanoma or tumor formation in the eye and having an ophthalmologist help determine when it might be time to remove that eye is probably gonna be very helpful. I would probably recommend that.
Dr. Tyler Sugerman:When you've diagnosed a pet and decided probably the best thing is to remove the eye. Do you usually recommend sending them back over to the general practitioner or the ER vet or do you usually recommend having you guys remove the eye? Yeah,
Dr. Karen Brantman-Crosetto:I am very comfortable removing an eye, which is very important. It's almost like an occupational hazard, which is good and bad news. But is enucleation difficult? I don't think so. I think it's more about how comfortable somebody is doing the procedure and honestly, it probably has more to do with just doing it, than not. And so, you know, I would definitely.. It might be helpful because there are a couple of common mistakes that I see, it would probably be helpful if someone's never done it before obviously, you know make sure you read you know, the book and the described surgical procedure, but it'd probably also be helpful to have somebody there with you who's done it before. Sometimes there's little anatomical things where you're like, is that what I'm looking for and so it might be helpful to have somebody else there.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:Yeah.
Dr. Tyler Sugerman:That's definitely how I learned Yeah, having somebody else there. It's show me.
Dr. Karen Brantman-Crosetto:I think mentoring is a huge part of eye work. That's how obviously I learned as well. You go through your residency and you have somebody right there with you who can teach you so it's yeah, priceless.
Dr. Tyler Sugerman:You were talking about just residency right now. So can you explain to me real quick like how you become an ophthalmologist. Because there's a difference between me and you then. So what is that difference?
Dr. Karen Brantman-Crosetto:Yeah. So a specialist has to go through additional training. And the way that we do it is you have your four years of veterinary school. You need to go through at least an internship, and this internship is general. So you're doing medicine, and you're doing surgery. It's usually a small animal, but some people do large animals. And so you're supposed to have a good foundation in general medicine and surgery overall. From there, you need to complete an ophthalmic residency, but getting the residency is very challenging. It's very competitive. So people will often take extra steps in between their internship and their residency, whether they do a PhD or a masters or other sorts of research, or maybe they do an ophthalmology specialty internship, which is what I did. So I did an ophthalmology specialty internship where I also did more ER work at the same time. I really liked that because I got to work with even more people, right? You see how different people attack different conditions and how that works for them. And then from there you do your residency and that's for me that was a three year program. There are some that are four year programs. I'm glad mine was only three.
Dr. Tyler Sugerman:You've only been in school forever.
Dr. Karen Brantman-Crosetto:Yeah, because otherwise it just feels like forever. And yeah, so it's a bit of a long haul, but I think especially for eyeballs and for those of us who really enjoy it, it's worth it. We love it. But that also, I think it's something to keep in mind that if you don't feel comfortable looking at eyes or don't feel like you quite know what you're doing. Hey, it's okay. It takes most of us five years to get to the point where we can do these things. It's always fine to ask questions and see what people think or things you're not sure about ask somebody, so..
Dr. Tyler Sugerman:That's amazing I can't imagine doing like more schooling than what I did.
Dr. Karen Brantman-Crosetto:Yeah, I know.
Dr. Tyler Sugerman:So what pushed you to not only like you wanted to be a veterinarian but not only that then you want to specialize veterinary ophthalmology, like how did you get to that?.
Dr. Karen Brantman-Crosetto:Yeah. I tend to be a very detail oriented person, so diving deep on one or two topics is a little more interesting or it's a more stimulating for me than trying to do a whole bunch of different things. Plus, I think, different people gravitate toward different things within medicine. Whether that's surgery or this or that or ER medicine, right? And so the other thing about ophthalmology, not only is it for very detail oriented people, but I like medicine and I like surgery so it lets me do both. And I also wasn't sure for a long time whether like initially I wanted to do all exotics and zoo and then I want to do horses and then I wanted to do small animal So this lets me do all of that. And it focuses on one organ in multiple species, which is pretty neat.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:Yeah.
Dr. Tyler Sugerman:And you had mentioned that you can do things like horses and everything. We were talking before about how you got to do a penguin, Hawks..
Dr. Karen Brantman-Crosetto:Yeah.
Dr. Tyler Sugerman:All sorts of cool animals, right?
Dr. Karen Brantman-Crosetto:Yeah.
Dr. Tyler Sugerman:What other animals have you gotten to do surgeries on?
Dr. Karen Brantman-Crosetto:Penguins. Python, that was pretty neat.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:Penguins, python, some medical work on a grizzly bear, which was neat. Small birds, owls, hawks, and predatory birds of prey is the word I was looking for. Chickens.
Dr. Tyler Sugerman:Chickens.
Dr. Karen Brantman-Crosetto:Yeah. Rabbits.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:Ferrets.
Dr. Tyler Sugerman:A fish if I remember correctly.
Dr. Karen Brantman-Crosetto:Oh, fish.
Dr. Tyler Sugerman:A fish. That is crazy.
Dr. Karen Brantman-Crosetto:Yeah, that was really neat.
Dr. Tyler Sugerman:Yeah. So you removed the eye from the fish, right?
Dr. Karen Brantman-Crosetto:Yep, exactly. And the fish did amazing. Yeah, he did amazing. It was a zoo specimen. And I think people have, traditionally, we didn't know how they would do if you removed an eye plus people worry. There's lots of people, including children that come through zoos. Would that be scary? What would happen? And the fish had such a large eye. It was, really protruding out of his head.
Dr. Tyler Sugerman:Sure it's so uncomfortable. It
Dr. Karen Brantman-Crosetto:can't, no, I can't feel good. And so we removed it he did amazing for surgery, very simple surgery. And he healed within, yeah, seven to ten days and he was swimming around. He had zero problems with it. And he looked great.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:Yeah, I have a neat job that I get to help lots of different species and scenarios.
Dr. Tyler Sugerman:And how we met was through a chimpanzee.
Dr. Karen Brantman-Crosetto:Yeah.
Dr. Tyler Sugerman:Who had her eyelid torn.
Dr. Karen Brantman-Crosetto:Yes.
Dr. Tyler Sugerman:I did a podcast with them as well.
Dr. Karen Brantman-Crosetto:Yeah.
Dr. Tyler Sugerman:Yeah. And her eyelid was torn off, and so you had gone back in and repaired her eyelid.
Dr. Karen Brantman-Crosetto:Yes. And so she had already had one repair done. And unfortunately chimpanzees like to pick at things including sutures. So she picked out all of her sutures, and I think she, I think her vet had tried to put it back together a couple of times, and then I went back, and she had, I think I was the third person, and so I tried to use a lot of buried sutures. I got most of it repaired, but there was still an area that she..
Dr. Tyler Sugerman:Picked open.
Dr. Karen Brantman-Crosetto:Picked open. But I..
Dr. Tyler Sugerman:Did you have to go back again?
Dr. Karen Brantman-Crosetto:I didn't. We decided to just let that try and granulate in or heal on its own. Yep, exactly. And she ended up because I got most of it closed. There was only one area right here, so it was a little like this, and then just a little dip, and that was it.
Dr. Tyler Sugerman:It's not bad.
Dr. Karen Brantman-Crosetto:No.
Dr. Tyler Sugerman:Compared to what it was.
Dr. Karen Brantman-Crosetto:Compared to what it was, which was quite open.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:Oh, honeybee.
Dr. Tyler Sugerman:Yeah. So I'm guessing you get called a lot for all these different exotic animals, like asking questions about them and stuff as well, is that right?
Dr. Karen Brantman-Crosetto:I do sometimes not as frequently is I would like. It depends on, the areas where I've worked in in, in, different areas of the country. And one place that I was in, I was their go to person for the zoo. Other places I've worked with rehab centers. Here, there's a few different specialists and I think I might not be the guy who got in there first.
Dr. Tyler Sugerman:I don't know. Maybe if you just put that out there.
Dr. Karen Brantman-Crosetto:Put that out there.
Dr. Tyler Sugerman:I'll see any new zoo animals.
Dr. Karen Brantman-Crosetto:Yeah. Which I would love to do. Yeah. Exactly. Yeah. And I think that you're probably right.
Dr. Tyler Sugerman:Yeah. Yeah. It's Hey..
Dr. Karen Brantman-Crosetto:Yeah.
Dr. Tyler Sugerman:You want an ophthalmologist.
Dr. Karen Brantman-Crosetto:I'm happy to help. Yeah. Absolutely.
Dr. Tyler Sugerman:And then so seeing an ophthalmologist is that a really expensive thing usually?
Dr. Karen Brantman-Crosetto:Yeah, so I think recently in particular we've seen an uptick in a lot of prices in veterinary medicine and we've been affected as well. No question. Yeah I would say that the initial exam, we have a.. There's not many of us and it's really hard to get in. And usually that 1st examination will probably be relatively expensive. The subsequent examinations and follow up care are less but it can be a little pricey.
Dr. Tyler Sugerman:And what should somebody expect on their first examination with you?
Dr. Karen Brantman-Crosetto:Yeah. And price shopping may be something that somebody might wanna do. See what's out there and what places are close to you and what might be more doable than another. But I believe that initial examination, which includes what we call ophthalmic testing. So we're, doing pressures for your animal and tear testing and we're staining the cornea and we're doing all these things. And so anywhere from probably 3 to 500, depending on, where you go and where you live, that, that'd probably be a good ballpark start.
Dr. Tyler Sugerman:Yeah, if somebody had done the tear, staining, and all the testing at their regular vet or at the ER, do you repeat it then?
Dr. Karen Brantman-Crosetto:Most of the time I do. And the reason for that is because it's more about tracking and watching trends. Then it is about oh, I don't believe what they did. Not about that For example, if I see a corneal ulcer and somebody diagnosed that, it might be a day or two or a week or a month since that person had the staining done for their animal. So I want to know is it still open? What does it look like? What are the characteristics because all those things can change?
Dr. Tyler Sugerman:Yeah, I definitely cannot describe like an ulcer as you can describe an ulcer, mine is just like, it's in the middle.
Dr. Karen Brantman-Crosetto:Yeah. Yeah. Yeah. Yeah, and there are certain things that I'm looking for when I stain. So I will stain the cornea and then I look at the cornea with a microscope. So I'm looking for specific patterns and the way the cells handle that stain and all of that.
Dr. Tyler Sugerman:That's usually not something that we have, we don't have.
Dr. Karen Brantman-Crosetto:Oh, yeah. Yeah.
Dr. Tyler Sugerman:To see those things, which is why it's great for you to be able to see those things.
Dr. Karen Brantman-Crosetto:Exactly. And it does also take.. People say that using, it's called a slit lamp. That's the handheld microscope that I use. And people say that for doctors to learn how to utilize it often takes three, four or five years. So it's it's not something that most people can just pick up and do. Unfortunately, you have to get used to it and practice with it.
Dr. Tyler Sugerman:Yeah I remember when I tried to do that, like in school and I was like, I don't know, I don't understand what I'm looking at.
Dr. Karen Brantman-Crosetto:Exactly. And there are some schools that don't even have their students look through slit lamps. People that I train or work with, I try to have them all look through it and know what it's like and see things up close because I think you have a different understanding when you're using that instrument to look at that particular organ. It's not like other. It's not like a kidney or something.
Dr. Tyler Sugerman:Yes. Yeah.
Dr. Karen Brantman-Crosetto:It's different.
Dr. Tyler Sugerman:Exactly.
Dr. Karen Brantman-Crosetto:Yeah. And I was going to say things like, I think I would say the biggest thing with repeating those tests too is because really they are just like blood work. It's a snapshot in time and so much can change with the eye. Even within 12-24 hours. So when they come to see me, I need to know where things stand currently to be able to help.
Dr. Tyler Sugerman:You mentioned that about blood work. I talk about that all the time. People always be like I got blood work done six months ago. Like how much could have changed? I'm like, everything actually, everything could have changed.
Dr. Karen Brantman-Crosetto:Yep. And one way I explain it, like with eye pressure is like how your blood sugar goes up when you eat. Your eye pressure can go up at different times of the day and that's normal. Those are normal variations, just..
Dr. Tyler Sugerman:Different, like stress and all sorts of things.
Dr. Karen Brantman-Crosetto:Yes, absolutely. Absolutely. So it's worth to make sure we're doing everything correctly and treating correctly. It's good to repeat these things.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:Yeah.
Dr. Tyler Sugerman:Good. Yeah, because I know a lot of people will ask if we did the testing then they're not going to repeat the test? I'm like, actually, most likely will repeat the testing. Yeah, so it's really good information to know that, why? Because it's a snapshot, not because you don't trust what I'm doing.
Dr. Karen Brantman-Crosetto:Exactly. I'm looking for the trend. And even for my current patients, I'll have, I like to have six months plus, even three years of tears and pressure measurements. Cause I like to see, when I did something how did that affect things or how did things change? Last time I did surgery, what happened here? And so it helps me manage, I feel like the care better.
Dr. Tyler Sugerman:Yeah. Yeah. And how often do you have them usually recheck with you?
Dr. Karen Brantman-Crosetto:It depends. If it's a new, current disease process, that we're trying to get a handle on. I might see them more frequently. If it's an infection, maybe even weekly for a couple of weeks. But once things slow down, depending on what it is, I like to say some people actually graduate, right? So I'm like, come back if you need me, see you later. And that's probably the best recheck follow up plan anybody gets or recommendation. But I would say most eye diseases, unfortunately are, a lot of them are managed. You can't make them go away. So younger animals. I'll at least see them annually, usually, if they're controlled. Once I have pets getting up into 13, 14, 15, 16, which I see. I usually prefer to see them at least twice a year because at that age things can change even faster.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:Sometimes I see them every four months.
Dr. Tyler Sugerman:Do you have certain diseases in cats more than dogs or certain breeds more than other breeds?
Dr. Karen Brantman-Crosetto:Yeah, I would say cats probably one of the biggest things that I'm seeing or that I try to manage is iris tumors. So we worry about, melanoma of the iris and we worry about it spreading to the rest of the body.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:So that's why we try to track it so closely.
Dr. Tyler Sugerman:I think it's really important too to like showcase how like you had to do your internship with learning all about the body because people think that the eye is very isolated.
Dr. Karen Brantman-Crosetto:They do. Absolutely.
Dr. Tyler Sugerman:But it is really connected to almost everything else in the body.
Dr. Karen Brantman-Crosetto:And that would be. Of the two things that I would have people know about the eyes. It's eyes are wonderful and fantastic, but you can live without one, right? And they can do great and they compensate and they're okay if they can't see so that's one thing. And then two the eyes are connected. Just like your brain is connected to the rest of your body. So are your eyeballs and there are certain diseases of the body where the only thing we see is a sign in the eye, or maybe that's what people notice first, right? Because falling down the stairs or bumping into a chair is not expected and really noticeable.
Dr. Tyler Sugerman:Or that color change. Those are the things you can like..
Dr. Karen Brantman-Crosetto:Really notice. Yeah. Yep. Where you, and you can say to yourself I don't think that's right. And so for cats, I would say watching for the iris tumors and the other thing for cats is blood pressure.
Dr. Tyler Sugerman:Can you tell me what the iris tumor looks like?
Dr. Karen Brantman-Crosetto:Oh yeah. The iris melanoma type tumors. I should back up.
Dr. Tyler Sugerman:Okay.
Dr. Karen Brantman-Crosetto:So irises, particularly in cats, we see it in dogs, but in cats, we worry about it more where they can develop little brown spots. And the brown spots can be just that, little focal spots, or they can be webby patches. Sometimes they can even go all the way around the iris. You can have freckles. It can be just a freckle, just like a mole on your skin can be benign. These can be benign..
Dr. Tyler Sugerman:And benign means..
Dr. Karen Brantman-Crosetto:Not a cancerous tumor that we worry about spreading or causing damage to other organs. But the problem is that some of these can be what we call melanoma or cancerous malignant tumors. And we think that these can spread to the body with a pretty high percentage. Some of our understanding of these tumors is influx, right? Just so many things with medicine. But we think that they can spread really willingly and really fast before we get a chance to even get in between these things and the rest of the body. So we watch them and we look for things that might suggest that they're more sinister. Like a big nodule or a really dark brown patch, something that changes really fast. Or if the eye seems like not only is it got brown coloring, but maybe it's not working right. The pupil doesn't look right. And they say those are probably the biggest things. Yeah.
Dr. Tyler Sugerman:Yeah. And then what do you see? What do you think people with dogs should look for more?
Dr. Karen Brantman-Crosetto:Dogs. Oh my gosh. Dogs get so many things. So if I, I would say probably two of the biggest things well, can we do three?
Dr. Tyler Sugerman:Yeah. Oh, yeah, you choose your..
Dr. Karen Brantman-Crosetto:Okay, so the first thing with dogs and cats will get this too. They'll get corneal ulcers. They're squinting. They're red. You put your stain in you diagnose a corneal ulcer and..
Dr. Tyler Sugerman:It'll show up as a little a green spot.
Dr. Karen Brantman-Crosetto:Yep. Exactly and then we use an antibiotic to prevent infection while that heals. That's a relatively straightforward one. I would say the other two that I see are dry eye. So low tier production. And the reason why that's a big kind of a I would put that in the big three is because one you can rule it out or rule it in by testing for it.
Dr. Tyler Sugerman:Easily, like we can do it in ER or GP. Yeah.
Dr. Karen Brantman-Crosetto:Two, it's a huge contributor, if not the main contributor to chronic discharge and redness it contributes to vision loss via scarring. It can just do a, it can't feel good. It's irritating and it can cause vision loss and we can pretty easily figure it out and potentially treat it.
Dr. Tyler Sugerman:At least manage it.
Dr. Karen Brantman-Crosetto:At least try. Yeah. At least try and do what we can. So that's why that goes in also the big three. And then probably the last one would be glaucoma. And the biggest thing with glaucoma, elevated intraocular pressure inside the eye. Is it hurts. It's like a headache. So you may not see them squint. They usually, there's only a handful of breeds that will come into the ER like this with a high pressure. Usually..
Dr. Tyler Sugerman:Those are the Chihuahuas.
Dr. Karen Brantman-Crosetto:Yeah. Or Shiba Inus, but they're screaming already anyway. Or teeth gnashing, or, a lot of times glaucoma, you may notice, this, or maybe the third eyelid is up a little, but more than that, usually they might not want to. It's like a headache. So they might not want to eat as much or they might sleep more. The way I think of it is you know when you have a headache, you still go to work, but maybe you just don't feel great or you still eat, but you just don't feel great.
Dr. Tyler Sugerman:I feel like the other thing I see commonly with glaucoma is they're more snappy.
Dr. Karen Brantman-Crosetto:Yeah.
Dr. Tyler Sugerman:A little more aggressive and people like, I just don't know. They just are like, they're more weird about me touching on their face.
Dr. Karen Brantman-Crosetto:I think that is probably true. And I think that a lot of eye disease, in general, I will see that. Where initially, because I think sometimes, especially if you have a little dog, who might be snappy in general, you try to go toward the head and they're snapping at you and you might think, oh, that's... that's just my dog. When in actuality it's more about they don't want to be touched. And sometimes the signs can be really subtle like on one side I'll touch and they're like, oh, it's okay. And then on this side, they might do something as simple as.. That. So it's not necessarily biting, but I think, but I do see that. Absolutely. And as dogs come in and I'm getting their condition controlled, it's actually a neat process because maybe an animal is aggressive or painful when they come in and then each visit they get easier and easier to handle and then maybe actually even enjoy coming in, which is pretty fun to see that you're helping.
Dr. Tyler Sugerman:Yeah, exactly.
Dr. Karen Brantman-Crosetto:It's pretty neat.
Dr. Tyler Sugerman:Very cool. Yeah. It's just so interesting. I've always found eyes very interesting. We don't get a lot of training in it, I feel like. Yeah.
Dr. Karen Brantman-Crosetto:Yeah. And I wish, in, in human medicine, I think it's the same thing except if they're at a hospital, they're just saying to the ophthalmology resident, can you please come down?
Dr. Tyler Sugerman:I don't have that.
Dr. Karen Brantman-Crosetto:You don't have that option. Yeah.
Dr. Tyler Sugerman:Can you come down here real quick?
Dr. Karen Brantman-Crosetto:Yeah. One thing I'm interested in looking at and that I think is really neat is doing tele consulting with. ER clinicians or primary that just general practitioners where you don't necessarily, if you have somebody, you can send a case to great, but there are areas where there's nobody. I'm number 491 in my college. That's how many of us there are. Not that many. Yeah.
Dr. Tyler Sugerman:And that's over like. I don't even know how many..
Dr. Karen Brantman-Crosetto:North America.
Dr. Tyler Sugerman:But that's like over what? I don't even know when ophthalmologists'started'.
Dr. Karen Brantman-Crosetto:That's since the eighties and nineties, I'm number 491 having finished in 2013 and there's..
Dr. Tyler Sugerman:Really not a lot.
Dr. Karen Brantman-Crosetto:There's not a lot of us, and reaching some of those rural spaces or just the ER clinicians overnight. I think would be a really neat option and something I'd like to leverage.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:I think it'd be really cool.
Dr. Tyler Sugerman:Yeah. That'd be really cool. Because there's so many times that I've said like, or people who can't get out to you.
Dr. Karen Brantman-Crosetto:No.
Dr. Tyler Sugerman:My wife is a nurse and RN and she has a lot of patients that she sees that are homebound.
Dr. Karen Brantman-Crosetto:Yes.
Dr. Tyler Sugerman:And there's no way for them to get to you. Yeah. They have to send somebody else to usually send them to me. So some really nice neighbor has brought them to me.
Dr. Karen Brantman-Crosetto:Or a family member. I have that as well.
Dr. Tyler Sugerman:Exactly. And then I'm like, Hey, you're going to have to go see an ophthalmologist. Cause I, I can't give you an answer. And that's even harder.
Dr. Karen Brantman-Crosetto:Yes, exactly. Yeah. There's a couple of new.. It sounds kind of hokey to say it, but it really truly is a couple of different ways of reimagining veterinary care and bringing care to people or pets that wouldn't necessarily have it otherwise all through video and teleconsulting. And I can, granted, not to put less emphasis on the stuff that I can do in person because obviously there are things that, that help me out a lot when I'm looking at an animal in person, but I can do a lot to start care by looking at photos, videos, the way the animal moves, how they're holding themselves in consult. Yes. And in consultation with someone else who's got feet on the ground. I can do a lot. So I'd like to do more with that.
Dr. Tyler Sugerman:Yeah, it'd be so helpful, I said like this, we just don't get a lot of ophthalmology work. So it's really hard sometimes for us to be able to do those things unless somebody's been like really diligently studying those things.
Dr. Karen Brantman-Crosetto:And also, I think, whereas you see a lot of eyes throughout a year, right? But I see 20 pairs of eyes every day. But you're probably seeing 20 pairs of eyes maybe probably in a month. So it's a little different. I mean you're seeing it, but it's not all the time.
Dr. Tyler Sugerman:Right. Exactly. Very cool. And can you tell me like if we do want to see a veterinary ophthalmologist? How do we find a veterinary opthalmologist?
Dr. Karen Brantman-Crosetto:Yeah, so a great way to do it is to probably.. one of two ways, Google veterinary ophthalmologist. And then when it asks you to click, in your area, you say yes, and so that is one option you would want to look for an actual ophthalmologist, someone that's labeled as an ophthalmologist.
Dr. Tyler Sugerman:I do see like when I've Googled it sometimes, a general practitioner will pop up.
Dr. Karen Brantman-Crosetto:Correct.
Dr. Tyler Sugerman:I know this is...
Dr. Karen Brantman-Crosetto:Correct. Exactly. So you want to see ophthalmologist either after their name or in their job description title, or even in the clinic title. So that's one way to do it.
Dr. Tyler Sugerman:What are the letters after?
Dr. Karen Brantman-Crosetto:Oh, good. That's a great question. So the letters after my name are D A C V O. Diplomate of the American College of Veterinary, which is, everybody has that, and then ophthalmology. O at the end. And our college, so the college of veterinary ophthalmology has a website for people to go through specifically to look up somebody near them.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:And you can put in a name, you can put in a city or a state or a zip code. You can look within a certain mile radius of whatever location you want to. So that might be a really great way for people to look up.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:People.
Dr. Tyler Sugerman:And I know it's so hard to get into an ophthalmologist. I do usually tell people call multiple.
Dr. Karen Brantman-Crosetto:Yeah.
Dr. Tyler Sugerman:Whoever has the first opening, you take that one.
Dr. Karen Brantman-Crosetto:Yeah. I would say that would probably be the best way to go, especially if there's something worrisome or that's concerning, you should really take the first one that you're offered just for the health of the pet.
Dr. Tyler Sugerman:Yeah. Absolutely.
Dr. Karen Brantman-Crosetto:I would say if, there are certain breeds that tend to be more predisposed to eye problems where even if nothing is wrong. Or you think nothing is wrong, You may want to have an ophthalmologist in your contact list. Just so that, make that appointment, make a non urgent appointment so that you're already in the patient base And that way when you do have an emergency, you can call your ophthalmologist directly.
Dr. Tyler Sugerman:And what kind of breeds are those?
Dr. Karen Brantman-Crosetto:Yeah, Boston Terrier. I would say Boston Terrier is one of the top breeds. They have just about all of the issues and many of them have multiple issues. Cornea, tear problems, cataract, glaucoma, all the things. I have several Boston terrier parents who they have experience with it now, so they get a new puppy and they just bring it in when it's one or two years old and get it checked out.
Dr. Tyler Sugerman:Nice.
Dr. Karen Brantman-Crosetto:Yeah. Pugs would be another one. English Bulldogs.
Dr. Tyler Sugerman:I was going to say Bulldogs is my number one.
Dr. Karen Brantman-Crosetto:Yeah. Yeah. Yeah. And I like to tell people any dog with a smooshy face is at risk for having eye issues, just like they're at risk for so many other health issues. But Boston Terriers, Pugs, English Bulldogs, and then the one other one that I would say you might want to get checked out, even if you think everything is okay, is a little bit different. It's a Golden Retriever. And the reason is because we have relatively recently, detected a really serious disease for these guys which..
Dr. Tyler Sugerman:Another one?
Dr. Karen Brantman-Crosetto:I know. And it is a genetic disease.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:And so the breeders are breeding, but you don't detect it as a baby. You detect it when they're older and it's insidious, meaning, that they can have it and you don't know it until it's bad. So it's a disease that causes inflammation and glaucoma in the eye. So they can go blind, they can be painful, and trying to start treatment early we think can help. So if you have a golden retriever, probably having an eye exam every one to two years starting at four years old would be wise. And once they're six to seven, I'd probably say every year.
Dr. Tyler Sugerman:Yeah. Wow.
Dr. Karen Brantman-Crosetto:Yeah.
Dr. Tyler Sugerman:Poor guys.
Dr. Karen Brantman-Crosetto:I know.
Dr. Tyler Sugerman:They just get everything.
Dr. Karen Brantman-Crosetto:I know. I know. The worst.
Dr. Tyler Sugerman:They're so nice.
Dr. Karen Brantman-Crosetto:I know. They're such nice dogs.
Dr. Tyler Sugerman:Geez, isn't there another one? I could be wrong. Because again, I'm not great at eyes. I feel like there's like huskies had some sort of genetic eye problem.
Dr. Karen Brantman-Crosetto:The biggest, one of the biggest genetic, are you thinking of, are you thinking of collie eye anomaly? Yeah. So that's an interesting one. Which one of the whole reasons the college started and eye certification exams for breeders started was because of collie eye anomaly. Yeah. So these dogs are born with congenital malformations and they can be mild or they can be severe and the mild ones aren't that bad. But if you keep passing those genes on, then you could have a dog that gets severely affected. And those dogs are blind and all of that. When those dogs are young, you bring them in to the ophthalmologist and you take a look, and you can know, hey, maybe I'll breed this dog, but not this dog. So if they have a lesion early in life, it can be easy to know and a lot of that disease has been stamped out because of what we've done. Which is great.
Dr. Tyler Sugerman:It's amazing.
Dr. Karen Brantman-Crosetto:Yeah, I mean if you think of you know of all the diseases, that's really cool.
Dr. Tyler Sugerman:Right.
Dr. Karen Brantman-Crosetto:Problem with a disease like the golden retriever. It's called golden retriever uveitis. Couple of different names for it now. Is if they get it late in life, you don't catch it on my certification exam.
Dr. Tyler Sugerman:Yeah.
Dr. Karen Brantman-Crosetto:There's also some genetic testing that can be done these days.
Dr. Tyler Sugerman:Oh, cool.
Dr. Karen Brantman-Crosetto:For various diseases.
Dr. Tyler Sugerman:Do they have one for the golden one?
Dr. Karen Brantman-Crosetto:There is, I think there's a gene that has been identified. I don't know if there's testing available yet for it. But that's a great question. But some of the inherited retinal degeneration or lens diseases. And of course, we haven't identified all the genes, but so many of the conditions are genetic. And we've identified a few so that breeders can know, hey, should I breed this one or not?
Dr. Tyler Sugerman:Do you usually send the testing to like UC Davis for those things? Or will you tell people to do the Embark or?
Dr. Karen Brantman-Crosetto:Yeah. So there's a couple of different options these days. It used to be OptiGen was one. I think Embark does actually, if I recall correctly..
Dr. Tyler Sugerman:Yeah, I can't remember if it's the Wisdom Panel or Embark, but one of them.
Dr. Karen Brantman-Crosetto:Yeah. And they can do. An entire, not just eyes, there's just many body systems. And so I have a breeder for one of my dogs and she was telling me all about it and I was really impressed with all of the things you can test for.
Dr. Tyler Sugerman:Right, I had mentioned Addison's to one of my pet parents and they're like, oh let me show you her genetic testing.
Dr. Karen Brantman-Crosetto:Oh yeah.
Dr. Tyler Sugerman:And I was like..
Dr. Karen Brantman-Crosetto:Yeah. And I will have some dogs that come in to me now. Every now and then when a pet parent may say, I think this is happening for my dog. Here's the genetics testing that she had. Is this what she has? And then I can, confirm or..
Dr. Tyler Sugerman:Yeah, it's just like another piece of the puzzle. Which means yes, this does fit.
Dr. Karen Brantman-Crosetto:Yeah, it just fits with everything. Exactly. Yeah. It just helps us keep our dogs even healthier if we can avoid some of those things.
Dr. Tyler Sugerman:Yeah. Very cool.
Dr. Karen Brantman-Crosetto:Yeah.
Dr. Tyler Sugerman:So where can we find you at?
Dr. Karen Brantman-Crosetto:So I am probably best searched for either Google, you can do my last name. But you can also..
Dr. Tyler Sugerman:Which is actually hyphenated, by the way.
Dr. Karen Brantman-Crosetto:Oh, yeah.
Dr. Tyler Sugerman:I don't know if it says on there. So I just want to make sure it's like my name is hyphenated. So not everybody finds me.
Dr. Karen Brantman-Crosetto:Oh, okay. And if you put in Brantman, that should be sufficient. And I believe on our college website, the ACVO website you could probably find me under Brantman.
Dr. Tyler Sugerman:Okay. Yeah, with mine, like you can look up Sugerman. People get confused because they're like there's another last name on there, so is this the correct Sugerman?
Dr. Karen Brantman-Crosetto:Yes. And so the married name is Crosetto. Yeah.
Dr. Tyler Sugerman:Perfect. Was there anything
Dr. Karen Brantman-Crosetto:else you want to share with us? No, I think we covered it. Perfect.
Dr. Tyler Sugerman:Thank you so much. Like I, I learned so much just from what we were talking about just now. So I'm really excited about that. So thank you.
Dr. Karen Brantman-Crosetto:My pleasure.
Dr. Tyler Sugerman:Perfect. Yeah.
Dr. Karen Brantman-Crosetto:It was really great talking with you.
Dr. Tyler Sugerman:Great. Yeah, thank you. All right. Thank you guys. Make sure to keep your pets happy, healthy, and safe. We'll see you next week. Thanks. I wanted to give a huge thank you to Dr. Brantman. I learned so much about ophthalmology on this podcast, and just about how cool her escapades are in general. She's a pretty awesome lady, and I can't wait to have her back on to talk more about eyes. Also, thank you as always to Shawn Hyberg for editing the podcast and answering all of my technical questions, and Kelly Reopelle, sorry if I messed that up, Dwyer, for always helping me with my website. You guys are amazing. Make sure you catch our future episodes on pet first aid kits and are cats actually nocturnal? Thank you to everybody for keeping your pets happy, healthy, and safe.
