AMEN Conference 2025: Touched By Grace

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Adventist Medical Evangelism Network (AMEN)

Eye Care

Todd Lang

Vision for Life: How Lifestyle Medicine Protects Your Eyes and Health

Beckner and Amen for inviting me to speak.

It's giving me a chance to share what God's put on my heart and put me in places that allow me to understand the connection between the eye and our systemic health.

When you look at that picture, what do you see?

You see an eyeball, you see a heart, a plant.

And let's start out by identifying the 3 most common eye diseases that are blinding.

Macular degeneration, glaucoma, and diabetic retinopathy.

Those are the 3 and the ones that we'll be talking about today.

So in the Bible, we've all talked about Genesis 129, but this is a verse that I found.

God designed us and then he said, this is what I want you to eat.

Now when you build a car, you put it's built to run on gasoline.

Well, when the flood came, actually after, let's go back farther, after Adam and Eve fell, Sin came into the world and everything changed and So when the flood came There was no vegetation left to eat So God had to come up with plan B.

And plan B was, okay, you can eat this meat but not that meat.

God didn't change that because it was optimal or he would have given us meat to begin with, right?

I mean, as human beings we often feel like we're invincible, particularly when we are younger.

And so The connection between our general health and our eyes is going to become more understandable as we go.

Mitochondria, the powerhouse of our cells.

And so, I haven't thought about mitochondria much at all over my 38 years of practice, but it's become front and center at this point because oxidative stress happens there.

And so we're talking about circulation to the nerve we're talking about the chronic stress to the nerve fibers the axons and why is it vulnerable?

The eye, specifically retinal gang cells and axons, are non-myelinated.

And they take 4 times the energy to transmit the signals as a myelinated nerve.

It's just a short section there, but it is dependent on circulation.

And so what happens is that when people get older, they get hardening the arteries.

And what is often happening around the nerve is poor circulation.

So we have low oxygen, and that creates the oxidative stress.

And we don't have enough nerve, enough of the ability to overcome the demand for oxygen around there.

And so The oxidation overload occurs and begins the damaging cycle around the nerve.

It starts with ischemia or low blood flow.

Then we have the inflammatory process and the oxidative stress.

And then part of what I learned as I studied for this was that there's actually DNA within the cell that has its own DNA.

And so when oxidative stress happens, it damages just the mitochondria itself so that the oxidation becomes even worse.

Because the foods that we're eating are actually creating more oxidation.

So I like to tell patients, you know, your food is either medicine or it's poison.

And the, you know, it's been interesting the conversation with patients over the years in that they just don't understand because they've always eaten a certain way.

And so we're going to keep going here because we have a limited time to cover a lot of information.

And so in macular degeneration, we have lipid deposits, or cholesterol.

Researchers believe it's either cholesterol or inflammation.

Because I didn't know this until just this week that your mitochondria are actually part of the metabolism of fats that are flowing through your blood.

And so, just fascinating how much oxidative stress is a part of our lifestyle and affects these various diseases.

Definition of glaucoma, when I went to optometry school, was high pressure in the eye with a resulting loss of nerve function and And that's that was the path of physiology of glaucoma nowadays You Does anyone know what year they took high pressure out of the definition of glaucoma, the American Academy of Ophthalmology?

And so I take care of 50 to 100-year-olds, and that's what I've done for over 35 years and there is a lot of normal tension glaucoma more than anyone believes and so I have colleagues that still if if the pressure is in the normal range, they hardly look at the nerves I see it quite frequently and then I test them and there is already optic nerve atrophy.

The patient doesn't know they have a problem so That's the time for us to start talking to patients about their lifestyle.

It's part of the what continues to go on.

I'm not an expert on all of the cytokines and the the inflammatory process but there's a lot of biomarkers there that they just get into a cycle.

And those of us who have been treating, we know that once that inflammatory cycle begins, we have to figure out how to stop it.

And usually we're gonna need some medicine.

So the goal is to teach people how to reduce the chances that they'll ever have the inflammatory cycle.

So This slide really is trying to help solidify in your minds these most common forms of loss of vision is about the homeostasis, or imbalance between oxidative stress and the antioxidant system the antioxidants that that work for us are ultimately what we eat and we need to eat more and more of the way more fruits and vegetables than most Americans eat right now.

10 years ago only 3% of Americans were eating enough fruits and vegetables.

Today it's it's about 10% And so there's a lot of room for improvement for our patients and We'll learn that there's other things to do to manage the the cycle of oxidative stress So What are the comorbidities associated with oxidative stress?

It's not just about what we eat either, about how we reverse the chronic systemic diseases that have the same biomarkers that diabetic retinopathy, glaucoma, and macular degeneration have.

So, in lifestyle medicine we learned that Every time someone eats an animal-based fat, it's damaging the endothelium of blood vessels.

Now that, we have to assume, that's happening everywhere in the body Because it's in our blood.

When people eat it, it's in the blood within 45 minutes to an hour.

And so, that is part of the pathogenesis for the vascular diseases that are part of creating this cycle, this pathologic cycle that creates so much damage with people.

Those of us who are practicing have seen that many times on our OCTs.

And the way for it not to get there is for them not to ever get diabetes.

But we don't know if they can stay out of diabetes unless they're doing everything that we know mitigates it.

And so, I like to say it's simple but it's complicated.

And I'll explain that a little bit more later.

Brad, you asked me if there was any studies.

I found 1 yesterday about managing the immune system that Will reduce the risk for that to progress I mean the studies say that just taking the a reds will have reduced the likelihood of progression by like 25% I think and so Why wouldn't it make sense?

For us to add on all of the other pieces of the puzzle that we're going to continue to talk about here.

It's part of the complement immune system.

Even dry ice is associated with autoimmune disease so many times.

I saw 1 study that said that just teaching people...

Jacob Prabahkar Chindrupu

Touched by Grace: Reflecting Christ Through Practical Community Eye Care

So, since then I have been praying, God help me, what I should speak.

And when you think of this topic, touch by grace, I think I must be the maximum recipient of God's grace.

I cannot tell in words how much God has been good to me.

And so, before I could share my experiences, I just thank God for who I am and how He has been gracious to me.

And I've been involved in opening the eyes of people, thousands of them, thousands and thousands of them across the world and he uses us to touch their lives and to change their lives to see Jesus.

It's not just opening the physical eyes but opening to see the life of Jesus.

You know the story when Jesus touched this man who was born blind.

At the end of the story you know that this man was born blind but he heard about him and at the end of the story he says 1 thing I know I was once blind but now I see but he sees Jesus when everyone is telling him was telling him it was not Jesus it was not the Son of God who actually opened your eyes.

But this man says, I do not know about who this man is, but I know for sure, I see, I know I see, I see this man called Jesus who is the Son of God.

Ellen White says Christ's work of physical healing was to illustrate his power to restore the soul.

No matter who you are, when you see a patient, our lives should be able to reflect the character of Jesus in our lives.

When we do a cataract surgery, when you give a spectacle, when you do a diagnostic test on patients, they should be able to see Jesus in our lives.

That's 1 thing I've learned over time in my life, especially when I met It Is Written and I will tell you that story how it all happened.

Before we touch the lives of people in our ministry, I realized that we must experience God's grace personally.

Unless you're touched by His grace, unless you experience His love in our lives, His grace in our lives, it is not possible.

I used to actually do thousands of surgeries, but I never realized until 1 particular time when I know my business is to preach the gospel.

He was a busy shoemaker And people would go to him and ask, what's your business?

And this missionary called William Carey, he would tell them, my business is to preach the gospel.

And so today, If you look at John 1 16, from His fullness, they have all received grace upon grace.

That means His grace is overflowing time and again.

And unless His grace is there with us, especially in the ministry, which we do in my life.

Because it's His grace that touches everybody, hundreds of them, every day when you operate.

It cannot be possible without God's grace.

And when He does that, There is transformation within your own lives.

Unless we are transformed, how can we transform others?

Unless God's grace touches us, that's why the word of God says, if any man is in Jesus Christ, he's a new creation.

And when you are a new person in Jesus, you would want to do everything that Jesus does.

Our mission should first begin with transformation within.

And when you depend on Him, the Word of God says, My grace is sufficient for us.

Sometimes when you find the work is so overwhelming, sometimes situation is so difficult, sometimes you have no materials, you have no time, you have no skill, you find that you're So insufficient when the work is so large But the word of God continues to keep encouraging his children his people my grace is Sufficient for you that includes everything that you need My strength is made perfect in weakness.

Therefore, transformation by His grace is a journey, not once, but daily and continuously through self-surrender, through walking with Jesus and trusting in him depending on God's Guidance Even though sometimes you don't have assurance.

There's no assurance whatsoever things will be all right for you, but God's grace is sufficient for us.

As we continue our presentation today, I want to share some quick stories.

I'd like to quickly finish up whatever I have to say, and I believe that these stories that I'm going to share will inspire us in our lives, in our journey to be an inspiration to others.

Actually, it was because of God's grace that I'm here today.

I should say we are 8 siblings, father and mother, 1 day at a time.

How can you ever think of becoming a physician in a nation like India, still trying to be a Seventh-day Adventist?

All of the institutions are secular institutions.

It's a Monday to Saturday, working days, impossible to go to a medical institution that gives you sabbaths, that takes care of your financial burden.

Unless by God's grace, coming from a poor family, you want to aspire to be a physician.

But with God, all things, all things are possible.

And so today, I'm here, I was praying God, give me an opportunity.

I want to go back and serve the people in India and across the world if it's you will make me a physician But with nothing No way of getting into the gates of the medical school.

My church pastor, an Adventist church pastor, saw some potential in me.

And so he put me in a small Adventist school from LKG, from low KG, till 10th standard.

I was in this boarding school, absolutely nothing.

I used to work during summer months to earn my scholarship.

I went to do canvassing, selling books 7 summers to earn my scholarship, to earn my fees.

I'm praying, God, please help me to go to a medical school.

But lo and behold, God makes things possible for you, even in the difficult situations.

He makes openings for you so that you can never ever believe.

And so lo and behold, when I finished my grade 12, there was an opening.

There was an agreement between Loma Linda University, the Southern Asia Division of Seventh-day Adventist, the church that I come from in India, and the medical school which I was going to go to.

There was a trilateral agreement that the Kasturba Medical College which I was going to go to will offer 5 seats for Adventists.

And we will get Sabadovs, 5 medical seats just that very year.

And that is the most expensive medical school in India.

A poor child like me is going to be admitted in the most expensive medical school, paying nothing.

And then I went to 1 of the admitted medical schools, medical hospitals, and served there for 2 years.

It was by my desire to work as a, to become a general surgeon.

Please allow me to join a residency program, because I want to do lots of surgeries.

I went to the admissions director and asked him, sir, I want to do general surgery.

Can you give me a residency program in general surgery?

He looked into my eyes and said, why didn't you take up ophthalmology?

Aldo Espinoza

Ocular Emergencies: How to Share Hope and Grace in the Midst of Trauma

Well, my talk is a little bit more didactic, a little bit more informational about things pertaining to our specialty, and then at the end we'll go over empathy as well.

So for those of you who don't know me, what Todd just said, I was born in Peru.

I went to Southern for undergrad, Loma Linda for medical school, and then residency for ophthalmology in Georgia at MCG.

And I have 3 kids and my beautiful wife who's here with me today.

So the the program will have the financial disclosures there and also the objectives which many of you already have seen.

There's different kinds of ocular injuries.

So there's urgent, emergent, and then routine.

We're going to focus on mostly the emergent and urgent ones, but we'll kind of briefly touch on all of these as well.

So for those of us who are not eye care providers, some of these images may be a little shocking.

If you like eyes, then you're gonna like this too.

Brief overview, we'll go over the orbital anatomy.

We'll do cases first from the, I had an excess with the front of the eye, the eyelids and so forth, and then I move interiorly.

This is a lady who's a 70 year old female who came in with worsening eye pain and swelling, blurred vision and double vision.

So this is the differential when you see something like this.

And with common things being common, the most likely cause of something like this is what we call orbital cellulitis.

And the thing that will tip us off to know whether it's preorbital, preceptal, or orbital is the pain with the eye movements.

So that's kind of the main differentiating factor because a lot of people can have swollen eyes, redness, swelling of the conjunctiva, but when there's pain with eye movement, that's more indicative of being an orbital process that's post-septal.

There's a different classification system for the different kinds of orbital salitis.

Type 1 is just pre-septal, type 2 is post-septal.

Type 3 is when there's an abscess forming into the cone of the orbit.

And then type 4 is when the abscess is extending into the periosteum, so the bone around.

And then type 5 is the most dangerous 1, which is a cavernous sinus thrombosis.

So why it's important to know is because there's different mortality rates with the different types and they can progress.

So type 1 can go to type 2, then type 3, then type 4.

And so you want to kind of know what you're dealing with when you're going through these.

There's different causes of orbital cellulitis.

So you can break them out based on where they're coming from.

The most common cause is a sinus infection.

So people have a sinus infection, get a cold, head cold, and then it spreads because all around are sinuses or our eyes.

Then you can also have, you know, lacrimal sac inflammation, dacrosis thytus, dental infections that can spread to the orbit.

And then also people can get it from trauma or surgery or endogenous causes if they have bacteremia or septicemia.

So the good thing about ophthalmology or eye care that we do, sometimes we don't even have to have a patient be very verbal for us to know what's going on, we just look at their eyes and we can kind of figure out from there.

And the same thing usually goes with this too, where part of the workup is the eye exam, which is the most important.

You don't have to get a CT scan to diagnose an orbital cellulitis.

If you do the right exam and you do the right questioning, you can know whether it's preceptor or post-septal.

You know, if they're having pain with eye movement, if they're having double vision or decrease in vision, it's probably not preceptor.

But nowadays we order imaging just about on everybody for everything.

So the most appropriate imaging to do is the CT orbits with and without contrast, including the sinuses, because that's kind of where they usually come from.

And then you also want to do a blood work to see if their white count is elevated or where the infection is coming from with the blood cultures.

So this is an interesting patient, sees a 77 year old who I saw, who presented with sudden onset vigit loss.

And so most of us who know eyes will see this and say, oh, that's the retina, there's a retina problem.

And so 1 of the optometrists that I work with sent her to a retina specialist.

The problem is 3 days later, she'd look like this.

So for those of us who know eyes, when you see something like this, you're thinking more like a retinal artery occlusion or something like that.

You would not imagine it turning into an orbital cellulitis.

And so unfortunately this lady developed panopsomitis.

So this initial presentation was actually retinal ischemia, as you can see with the vessels of the retinal arteries and veins there.

And there was actually bleeding related to the ischemia and not an actual embolic event.

But she was immunocompromised, and that spread to the front of her eye and unfortunately she ended up having have it nucleated.

There's different kinds of a protocol and things how to appreciate these when they're children.

So it's a different kind of algorithm that we go through.

With children obviously you want to be a little bit more attentive to what's going on and the first kind of branch point there that you see is chemosis, proptosis, and pain.

So the problem is sometimes kids don't tell you that they're in pain they just show that you're there in pain, right?

They're just crying, they're uncomfortable.

But if there's none of those symptoms, and it's probably just preceptal cellulitis.

So as you can see there, if they're older than 1, they can be treated outpatient.

But when they're younger, you have to admit them to the hospital to get IV anesthesia.

If they do have signs of orbital cellulitis when they're that young, then there's a different protocol to go through, whether you do all the blood work and the CT scan.

And then if it shows orbital cellulitis, those usually have to be treated inpatient with IV antibiotics.

So here's another summary slide for the difference between the 2.

1 can be more common at certain age groups.

So preceptal is usually more common younger in life.

Postseptal is more common older in life and the different kind of bacteria that are associated with there, like we discussed.

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Eye Care

Vision for Life: How Lifestyle Medicine Protects Your Eyes and Health

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