Curbing street violence; understanding breast cancer; blue light and eyesight: Upstate Medical University's HealthLink on Air for Sunday, Nov. 27, 2022
Upstate social workers Rubina Dhillon and Renee Gregg talk about steering people away from street violence. Kornelia Polyak, MD, PhD, from Harvard Medical School and the Dana-Farber Cancer Institute gives an overview of breast cancer and shares insights from her research. And Upstate ophthalmologist Mark Breazzano, MD, explains how to protect your eyes from blue light.
Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," two social workers talk about how they help people steer their lives away from street violence.
Renee Gregg: ... I just believe that we need to educate our community, our children, on what happens when somebody is injured. They need to know what happens here in the hospital, from the trauma bay to the morgue. ...
Host Amber Smith: A visiting researcher shares her work on the molecular analysis of breast cancers.
Kornelia Polyak, MD, PhD: ... Our immune system tries to eliminate cancer. But cancers figure out mechanisms that makes them able to overcome that. ...
Host Amber Smith: And a retinal surgeon explains how to protect your eyes from blue light.
Mark Breazzano, MD: ... The cornea actually does a pretty good job of filtering out a decent part of the ultraviolet spectrum. ...
Host Amber Smith: All that, along with a visit from The Healing Muse, right after the news.
This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, we'll hear about the promise of molecular analysis of breast cancer from a visiting researcher. Then, an ophthalmologist discusses the dangers of blue light. But first, a pair of social workers explain how they help prevent street violence.
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."
Doctors and nurses and medical technicians at Upstate repair the physical wounds of patients who are victims of street violence. Specialized social workers focus on preventing recurrence of that street violence.
With me to explain the role of Upstate's Violence Education Prevention Outreach Program (VEPOP) are Rubina Dhillon and Renee Gregg. They're social workers at Upstate. Welcome to "HealthLink on Air," both of you.
Rubina Dhillon: Thank you.
Renee Gregg: Thank you.
Host Amber Smith: Upstate University. Hospital is designated as a Level I trauma center, which means it has expertise in caring for trauma patients and people who suffer gunshot wounds or stabbings or assaults.
They often receive treatment at Upstate, so it makes sense that the hospital would have a violence prevention program. Can you tell us how this program began, Ms. Gregg?
Renee Gregg: So our program began in 2015.
We were trying to design something that would stand out, that is policy driven and research based, that works with anyone who comes in for non-incidental injuries. And, in April of this year, we added another program, which is called SNUG: Should Never Use Guns, and Rubina, please tell us about that.
Rubina Dhillon: My program began back in 2009, when 10 cities in the state of New York received funding to work to prevent gun and gang violence.
And then, in 2019, SNUG received additional funding to not only expand but also to integrate a social worker and case manager position. We all know that gun violence is a public health issue, and statistics actually show that 60% of the homicides in the U.S., a gun is the weapon that is being used. And sowhat we try to do is recognize that violence is a learned behavior that can be prevented. So SNUG tries to use a "Cure Violence" model from Chicago in addressing violence reduction.
Renee Gregg: Yeah. And in Syracuse, in 2021, which was last year, we had 31 murders related to street violence.
Host Amber Smith: So it's a known problem and Upstate, it sounds like, has stepped up to try to help solve it.
Rubina Dhillon: Yes, absolutely.
Host Amber Smith: Well, tell me a little bit about what you do as social workers in these programs. Are you located physically in the hospital, both of you?
Renee Gregg: Yes. I'm in the hospital and in the community. I do home visits to our patients' homes, go with them to doctors' appointments and that (sort of) thing, and Rubina is located right here in the hospital.
But what we do is we meet the patient at their most vulnerable point. That's when they come into the hospital emergency room with their injuries. We introduce ourselves, and we try to establish relationships with them so that we can eventually provide life-changing services to them.
Rubina Dhillon: Yes. So we try to provide "trauma-informed" counseling. We like to meet the patient where they're at, assist in advocacy, assistance with filing a victim compensation application -- that is through the state -- and we try to connect the individuals with other services that are either identified or needed. So really we work with survivors of violence, whether, as mentioned, it's gunshot wounds, assault or a stabbing.
But we did want to note that we don't follow self-inflicted or, DV cases,
Host Amber Smith: So you don't, handle the self-inflicted, wounds or domestic violence cases.
Renee Gregg: Nor child abuse or elderly abuse.
Host Amber Smith: OK. Because there's already other programs in place for those things, right?
Renee Gregg: Correct. Correct.
Rubina Dhillon: Exactly.
Host Amber Smith: So I'm curious, I guess the physicians and nurses in the emergency department, they must notify you when they have someone who's been impacted by street violence. Is that how you find (out)?
Renee Gregg: So we have a pager system here in the hospital, which is pretty much like the pagers of old, where they would page you and you just come, you don't know exactly what you're coming to. We report to the trauma bay, so we really meet the patient when they first come through the building.
Rubina Dhillon: Yeah, we'll have the initial contact with them. So really we don't go to the patients. They kind of come to us here, at the ED (emergency department).
Host Amber Smith: So you go to the patient, who also may have family members with them, right? Do you find yourself dealing with family situations, as well?
Renee Gregg: Yes. Unfortunately, COVID has changed a lot of things we do. So we have families ... on one occasion I had 300 people in the parking lot of the hospital.
Host Amber Smith: Wait, 300?
Renee Gregg: (We) had six people come in shot, two people were run over by vehicles at the incident, and there was about 300 people in the parking lot. And I had to run and try to figure out what was going on.
Host Amber Smith: Lots of people that needed your services that day.
Renee Gregg: And many of them didn't really need services. They were just being nosy. But I had to ascertain who was the family member, and who was the nosy one (laughs).
Rubina Dhillon: But a lot of hands on deck, working with not only the survivor, but also the family members, because, of course, you know they're also affected.
Renee Gregg: Yes.
Host Amber Smith: In general, what are the gender and age range of the people that you work with?
Rubina Dhillon: Renee and I have actually both noticed a pattern of working with patients who identify as being males. And the age range varies. I mean, I think last week I was just working with a patient who was in his 50s, but Renee, I think you said you worked with an 11-month-old?
Renee Gregg: Last year now, we had an 11-month-old who was shot three times and eventually died, so I've had an 11-month-old, two (in their) 70s, and ...
Host Amber Smith: Well, that just shows that street violence really affects a wide range of people.
Renee Gregg: Everyone.
Host Amber Smith: So how do you find people are receptive or not to making changes in their lives?
Renee Gregg: When we introduce ourself, we tell them the services we provide, and it's up to them to accept, so they can defer, they can say they don't want it, they can say, We'll talk about this later. Rubina does a good job with following up with people, (in) two weeks?
Rubina Dhillon: Uh-huh. Yep. I'll follow up post-discharge. I mean, there's a lot that goes on when a patient comes in through the ED, right? The medical attention is No. 1 in priority. So we also have to remember that change does start from within, so they may not even be thinking about what sort of resources or needs they'd need addressed post-discharge. And so what we really try to do is, we'll follow up with the patients after a couple weeks and just kind of assess and see where they're at.
Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with social workers Rubina Dhillon and Renee Gregg.
I'd like to understand what can be done to reduce repeated violence. Can you explain how that works?
Rubina Dhillon: As mentioned, we really do try to use a public health approach in reducing shootings and firearm-related deaths. So, what we do is, we use a three-pronged approach to preventing violence.
You know, the first is to interrupt the transmission, and then we try to identify and change the thinking of the highest potential transmitters, and then to be able to help change the group norms that come with that.
Renee Gregg: Yeah. And personally, I just believe that we need to educate our community, our children, on what happens when somebody is injured.
They need to know what happens here in the hospital, from the trauma bay to the morgue. A program in Philadelphia, It's called cradle to grave, and they actually bring the children in and teach them what happens.
But then, the perpetrators need to know what's going to happen to them. And dying is easy. So before you die, understand what your family's going to go through after you die. Education is just imperative in making a change in anybody. And with this public health issue, it needs to be done early and continuously.
Host Amber Smith: For people who agree to sign on and join this violence prevention program, what are the sorts of services that you can provide them? What's the benefit to them joining?
Renee Gregg: For me, the VEPOP social worker, I work with the injured patient, his family and his friends.
And I say "his," because, like we said earlier, it's normally a male, but we have had a lot of women. And we help them to cope with the injury itself, because the extent of the injury can be death, it could be losing a limb, it could be prolonged PTSD, or it could be a combination of those things.
We help them to make sure that they get the follow-up care they need, and to connect them with community resources to promote healthy choices and to avoid street violence. At post-discharge is when I go into the home or into the community, and we provide supportive case management. And it's intense. And we help them to obtain employment, to secure safe housing, to resume or obtain your education, to get hooked up with mental health services, to assist them in navigating the health care field, making sure that they have a PCA (personal care assistant), and that they're keeping their appointments, and also making sure that if they have drug and alcohol use or abuse issues, that they get the support they need.
Rubina Dhillon: So Renee wears a lot of hats at VEPOP, whereas SNUG, we actually have a case manager on site to help address any sort of case management needs.
We also have a social worker, so, as mentioned, I'm the social worker here at the hospital, and then we have a social worker in the community through SNUG and then we also have an outreach team. The role of the outreach team is really just to help respond in shootings to prevent retaliation.
And in order to prevent retaliation, it's done through mediation. We assist family members to those who have been injured or killed, and also just mentor the high-risk youth and young adults that are involved in the program. And, you know, really just try to connect them into goals, in any sort of like job opportunities, educational needs, as mentioned, drug and alcohol treatment, and, overall, to promote positive life skills.
Host Amber Smith: How much of the street violence in Syracuse is related to gang activity?
Rubina Dhillon: That's a tough one. I mean, there really isn't a way to measure that, per se. A lot of the survivors that we work with, you know, oftentimes we'll hear that the incident was "wrong place at the wrong time," so it's kind of hard to pinpoint how much is related to gang activity.
Host Amber Smith: What about poverty?
Rubina Dhillon: Well, I'm all about the research, so research actually does show that communities with fewer resources have higher rates of violence, and it could be for many reasons, right? But I think it's important to remember that violence prevention programs are in place to hopefully help build the community up.
Host Amber Smith: What happens if a victim of street violence feels that they need to move to a different neighborhood to get away from the violence? Can you help them accomplish that?
Renee Gregg: Yes. With funding from New York State Crime Victims (Office of Victim Services), we can help relocate people. We can't pay their rent for a year or anything like that, and they must find their own shelter.
So I moved a family to North Carolina. New York state kept her in a hotel for 30 days, and as soon as she found a place to live and was approved, we sent her first month's rent and her security deposit to that place and provided the movers for her to take her stuff from the storage place to the apartment. After that, she had to use her own resources to pay her rent, and she was lucky she found a job before she found a house, so she was able to just fit herself back into what she was used to doing.
We've moved people, I've moved people, from Butternut Street to Prospect, and that's a very short, distance. But for that mother with three kids, it was just changing location so that she felt that she was in a safer neighborhood. We helped her with calling her landlord and getting another apartment through the same company.
And everything worked out fine. So each month we do a lot of moving, because safety is a big issue.
Rubina Dhillon: And I think it's important to note, too, that VEPOP and SNUG, we don't help with rapid rehousing, but we do have funds to help assist in relocation.
Host Amber Smith: And not everyone, I'm assuming, would want to move or be able to move, and you've got ways to help people stay in their homes and still stay out of the violence, right?
Renee Gregg: Yes.
Rubina Dhillon: And that's where we'll kind of assess for safety and create a safety plan with the patient.
Renee Gregg: And fortunately, everybody is not from a violent community, so we have suburban people who just need to pay their rent because they can't go to work because of their injuries.
So we solicit the crime victims, and they'll help pay mortgages or rent to keep them in their home, in their safe location, while they're recuperating.
Host Amber Smith: So what do you say to someone who's reluctant to sign on and commit to trying to reduce violence in their life? How do you convince them that this is the way to go?
Renee Gregg: I think the best thing is giving information. Information is education. So they'll hear about what we do, and they might not want to be actively involved, but they need a resume because they haven't had a job in a while, and they would like to have a resume. I meet the person where they're at and help them with what they think they need.
I'm not trying to give them my values. I want them to feel comfortable making the changes on their own and always telling them to keep my card or my pamphlet because if they ever need me, they can make that phone call.
Rubina Dhillon: We can provide the tools and the skills, but really, again, as mentioned, the, change has to happen from within, right?
They have to want to make that change and to move forward in a healthy manner, right?
Host Amber Smith: Ms. Gregg, let me ask you, what do you hope to accomplish through VEPOP?
Renee Gregg: My goal is to save a life, or to save lives. And I believe that's done through education and resources. Just making sure people have what they need to have productive, healthy lives.
That's my goal. I believe that's the hospital's goal also.
Host Amber Smith: And Ms. Dhillon, the Should Never Use Guns program: What are you hoping to accomplish with that?
Rubina Dhillon: I've seen a pattern of a lot of survivors of violence that come from various backgrounds. And coming from a cultural background, I want to really break down the cultural barriers and to be able to normalize mental health. I think it's important that we discuss our feelings and move past the saying, "what goes on in the household stays in the household," right?
So that's really a goal of mine, to be able to normalize. If we can take medication daily and why can't we go see a therapist or seek help when needed?
Host Amber Smith: I appreciate both of you making time for this interview.
Rubina Dhillon: Thank you.
Renee Gregg: Thank you.
Host Amber Smith: My guests have been social workers Rubina Dhillon and Renee Gregg from the Violence Education Prevention Outreach Program and the Should Never Use Guns program.
I'm Amber Smith for Upstate's "HealthLink on Air."
How breast cancer differs from healthy breast tissue -- next on Upstate's "HealthLink on Air."
From Upstate Medical University in Syracuse, New York,
I'm Amber Smith. This is "HealthLink on Air."
Many questions remain to be answered about how and why breast cancer develops.
Today, I'm speaking with Dr. Kornelia Polyak about the research she's doing. Dr. Polyak was invited to come to Upstate to give the annual Baldwin Breast Cancer Research Lecture. She's a professor at Harvard Medical School, and her lab at the Dana-Farber Cancer Institute is dedicated to the molecular analysis of human breast cancer.
Welcome to "HealthLink on Air," Dr. Polyak.
Kornelia Polyak, MD, PhD: Thank you. And thank you for having me here.
Host Amber Smith: Your overall goal is to improve the clinical management of breast cancer patients. What are your priorities for improvement?
Kornelia Polyak, MD, PhD: Well, what we focus on, we and others, focus on is to develop really individualized treatment plans for the patients. That includes studying the tumor, the specifics of the tumor, but we are realizing it's actually not just the tumor that is important for determining the course of the treatment for the whole patients. Many other factors, particularly the immune system, seems to have very important influence on how the patient will respond to treatment and what outcome they have. So really going into, like, understanding the patient as a whole and designing therapies based on that.
Host Amber Smith: Currently, how accurately can doctors predict cancer or its progression?
Kornelia Polyak, MD, PhD: It depends on the cancer. We have many molecular tests that you can run on the tumor to predict who's likely to respond to what kind of treatment. So breast cancer, for example, is not a single disease. We have, like, three major types. One is a hormone receptor positive, so those respond to hormone therapies. Then there is a so-called HER2-positive, which is driven by a gene that's called HER2, (a protein called human epidermal growth factor receptor 2.) And there are many targeted therapies against that particular oncogene that drives those tumors. And then you have the third type, which is called triple negative, just because it's lacking the hormone receptors and HER2, and for that patient's chemotherapy with immunotherapy, which is a new, exciting development, is the usual standard of care. And each one of these have predictions of likelihood of progression, which very much is dependent on the stage of diagnosis. So, you know, the earlier you diagnose a cancer, you have a higher likelihood of successful treatment. Advanced-stage cancers, unfortunately, are more difficult to treat. So that kind of determines what is your prognosis and what treatment would be the best for you to have the best outcome.
Host Amber Smith: Is there a scientific consensus on what causes breast cancer to metastasize, or spread?
Kornelia Polyak, MD, PhD: It's not entirely clear. You know, some of the features of the tumor can make one tumor more likely to metastasize than others. For example, in breast cancer, the so-called triple negative -- which is the one that's lacking the hormone receptors and HER2 -- that's very likely to metastasize, unfortunately, and also metastasize to pretty much all of the organs in the body and even to the brain, which is one of the worst sites for a metastatic disease.
The hormone receptor positive one is less likely to metastasize and more preferentially forms metastasis to the bone. So in some way, the tumor type can determine the likelihood of metastasis and also the site of metastasis. And then we are starting to understand more and more about the role of the immune system. For cancer cells to spread in your body, they have to evade the immune system because our immune system tries to eliminate cancer. But cancers figure out mechanisms that makes them able to overcome that. So, that's an area that's a very intense investigation, to figure out how we can reactivate the immune system and eliminate those disseminated cancer cells in the different parts of the body.
Host Amber Smith: Dr. Polyak, can you tell us about your cancer heterogeneity studies?
Kornelia Polyak, MD, PhD: Yes. So we have been studying tumor evolution and heterogeneity. So in tumors, heterogeneity means that cancers can be heterogeneous among different patients. So that's, we call that inter-patient heterogeneity. But even in one patient, at one time, in one tumor, there are many kind of cancer cells.
So if you have even a small tumor, like a centimeter-size tumor, which is considered fairly small, that's already like 10 to the millions of cancer cells, and they are not all the same. They can be different properties, like different various expression of genes. Even if you think about the location of the cancer within a tumor, like a 1-centimeter tumor, whether it's closer to blood vessels or further away, that all creates heterogeneity because the environment where the cancer cells are selects for a particular type of cancer cell that can survive there. So that's why it's so challenging to cure cancer.
And I like to use the analogy of: imagine you have a bucket, and the bucket is filled with different colored balls. Each one is a different color, but on top of that, imagine that those are those flashing balls, you know, they're flashing with a light, that they're changing colors. And then you're trying to treat the red ones, but then the red ones turn green, and that keeps happening over time in the tumor. And then, when they become metastatic, then the different colors can metastasize to different organs. And then they will, again, keep changing. And that's why it's been so challenging to very effectively treat cancer, especially the more advanced stage it is, because then you have even many more different varieties of cancer cells. So even if you have, like, 1% of the cancer cells that don't respond to treatment, that's enough to regrow the tumor. And that's one of the challenges we have, and we and others have been studying. And we are trying to understand what drives this heterogeneity and also how we can come up with combination therapies to treat the heterogeneous tumors more effectively.
Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Kornelia Polyak. She's a professor at Harvard Medical School, and her lab at the Dana-Farber Cancer Institute focuses on the molecular analysis of human breast cancer. She was invited to Upstate to give the annual Baldwin Breast Cancer Research Lecture.
I wanted to ask you about the life span of a breast cancer cell. Are you saying that these breast cancer cells change shape or size during their life span?
Kornelia Polyak, MD, PhD: Yes. It's not always the same cancer cell, but then they have a progeny like the cancer cell give rise to another cancer cell. Then when they divide, then those properties can change. And we think that most tumors actually take many years to develop, and some cancer cells can proliferate or give rise to many more progeny. And many times cancer goes undetected until either you go for a screening or it becomes symptomatic. But usually by that time it's a reasonable size, meaning, like, 0.5 to 1 centimeter size is usually what we can detect with the current technologies. But maybe it was already there for many years, and we just haven't been able to detect it. So, they can have many years of living, not necessarily always the same cell, but the progeny of the cells.
Host Amber Smith: How many times might a cancer cell divide in its life span? In other words, how many additional cancer cells might it create in its life span?
Kornelia Polyak, MD, PhD: That depends on the tumor, but in general, one of the features of cancer cells is that they have an uncontrolled cell division. So they divide many more times than normal cells would divide. And they also don't respond to the kind of inhibitory factors that would limit their ability to divide. So that's one of the features of cancer, is the uncontrolled division. The actual number of divisions, it's hard to count, again, but it's certainly many more than a normal cell would divide.
Host Amber Smith: Now, your lab is focused on identifying the differences between normal and cancerous breast tissue. Can you tell us what is known so far?
Kornelia Polyak, MD, PhD: Well, cancers generally have mutations, which means that there are some changes in the DNA that lead to some abnormal function. Normal cells obviously don't have that, so that's one of the very important features of cancers, that they have some genetic alterations which are inherited, and they basically have this very high degree of heterogeneity. And that enables the selection of cancers with different properties. And then, as I mentioned also, the cancers don't respond to normal controls to divide or not divide. They just take on and become much more independent. They are more likely to be able to spread and go to different parts of the body. And then I mentioned at the beginning that one of the important features of cancers is to evade the immune system, meaning like being able to shield themselves from the immune cell attack that normally would eliminate cancer. And the cancers that can grow have some way of overcoming this immune recognition and immune elimination that's very important for tumor growth.
Host Amber Smith: Considering the immune system's role or potential role in cancer, does that have any effect on whether you would recommend radiation or chemotherapy for a patient who has breast cancer?
Kornelia Polyak, MD, PhD: So actually the immune system plays very important roles to respond to treatment. Even chemotherapy is much more effective in patients whose tumor has more immune cells because the immune cells are important to eliminate the cancer cells. So the chemotherapy induces killing of the cells, but then you need the immune cells to eliminate them. And similar with radiation. Radiation can cause an inflammation of the tissue, which can activate the immune cells. So the immune cells play an important role in treatment response, even when it's not an immunotherapy because radiation and chemotherapy activate the immune cells, in a way, and that's usually beneficial, to help with more effective treatment.
Host Amber Smith: What can molecular analysis reveal about cancer? And can you give us some examples of how that information might be used in patient care?
Kornelia Polyak, MD, PhD: Breast cancer, again, is one of the best examples that based on the molecular analysis of the tumor. So every patient, when they are diagnosed with breast cancer, the pathologist will run a test to look at the estrogen receptor, the HER2 protein that I mentioned. That's very important to determine what treatment they get, because if you have the hormone receptors, then you are going to get endocrine therapy, hormonal therapy. If you have the HER2, then you get the HER2-targeted therapy.
And other cancer types, nowadays it's more routine that they are sequencing the mutations, like what are the genes that are abnormal in a cancer. In some cancers, there is a very specific targeted therapy based on the mutations they find. For example, in lung cancer, the people who develop lung cancer who are non-smokers very commonly have a mutation in a gene called EGFR, and there are very specific inhibitors for that gene. So that's how we are becoming more and more able to design the treatment specific for the tumor based on knowing the molecular features of that particular tumor. And that's true in breast and many other cancer types as well.
Host Amber Smith: If a woman has a mammogram, and the mammogram detects a suspicious lump, but then that lump is found to be benign and not cancerous, what assurances are there that that will not turn into cancer later? Or does a lump like that still need to be treated?
Kornelia Polyak, MD, PhD: Well, it depends on what type of a lump it is and what is the histology. They always do biopsy, and the biopsy will determine what is the definition, but if it's a benign fibroadenoma or even some other benign hyperplasias, those don't become cancer. But if you have such a lesion in your breast, that means that you are generally at higher risk of having the cancer. It doesn't mean that that particular lesion will become the cancer, but it's kind of a mark that you have some higher likelihood to develop cancer in some other part of the breast. So, fibroadenomas never become really breast cancer, but they do indicate that you may have higher risk.
Host Amber Smith: Well, Dr. Polyak, I really appreciate you making time for this interview. Thank you.
Thank you so much. My guest has been Dr. Kornelia Polyak, a professor at Harvard Medical School with a research lab at the Dana-Farber Cancer Institute. She's in Syracuse to give the annual Baldwin Breast Cancer Research Lecture. I'm Amber Smith for Upstate's "HealthLink on Air."
Next on Upstate's "HealthLink on Air" -- protecting your eyes from blue light.
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."
The largest source of blue light is from sunlight, but we're also exposed to blue light from flat-screen televisions, computer monitors, smartphones, LED lights, fluorescent lights ... ophthalmologists are concerned because of how much time many of us, including children, spend exposed to blue light because it can affect our vision.
Here to explain is Dr. Mark Breazzano. He's a retinal surgeon and clinical assistant professor of ophthalmology and visual science at Upstate. Welcome back to "HealthLink on Air," Dr. Breazanno.
Mark Breazzano, MD: Thanks so much for having me, Amber. It's a pleasure to be back.
Host Amber Smith: So, can we start with, can you give us a definition of what blue light really is?
Mark Breazzano, MD: Absolutely. So blue light is also known as short wavelength light. It's in the visible light spectrum, and it's about 400 to 500 nanometers in wavelength. And basically the way that light works is, a longer wavelength means less energy that it holds, based on its frequency. This is one of the physics formulas. We could go much more into detail if we like, but essentially, blue light is relatively higher energy with its higher frequency and lower wavelength than other types of light. And with this short wavelength light has been of interest for a number of reasons.
Host Amber Smith: Why is blue light used in electronics?
Mark Breazzano, MD: Well, blue light is part of that visible light spectrum. So it's in sunlight. It's in electronics. And it's variably higher in certain electronics, including LEDs and other devices, as you alluded to. And it's just part of the spectrum that is emitted from these devices. And so it's something that we're becoming more and more attuned to.
Host Amber Smith: Is the blue light from the sun, is that different than the blue light in our cellphone?
Mark Breazzano, MD: Well, it's different in that the amount of radiation that's given off by any particular source can vary, and it certainly is different from the sun compared to these other devices. And there's obviously other factors involved in terms of anything else in between that can pick up the radiation and absorb it before it reaches us. And in terms of radiation, visible light is one of those things. There's certainly other types of radiation as well on the electromagnetic spectrum that are far outside of what visible light is. But obviously that's a different discussion.
Host Amber Smith: Well, can you talk about the benefits of blue light, because we need it, right?
Mark Breazzano, MD: Yeah. It's a very interesting topic because there has been a lot of hype around blue light recently. There have been some studies that show that blue light in particular has the ability to influence physiologic change within our own body compared to other types of lights. So specifically, some investigators have actually looked, monochromatic lights, so basically just a single blue light wavelength exposure over an extended period of time for several hours can actually induce these responses moreso than green or yellow wavelength that was tested in an artificial setting. And notably one of them is melatonin, which we know is an important regulating hormone for sleep. And it actually suppresses that sleep more than these other wavelengths do. But it's important to keep in mind that this is a very artificial setting. This is isolating one particular wavelength. And in the normal, natural, or even the way we go about our lives, we are constantly exposed to more than just blue light. So you'd have to be in a very specific situation to really replicate that scenario where you're going to have, "Oh, I'm getting blue light specifically, and no other type of light."
Host Amber Smith: So what are the risks of too much blue light? Why are ophthalmologists concerned about this?
Mark Breazzano, MD: I think there is a little bit of -- concern might be a little strong in some ways, and especially now that what we're finding is that there's actually some mixed evidence in a lot of aspects of blue light.
So there's three main concerns that people have brought up regarding blue light. One is direct phototoxic effects of blue light, given its higher energy and the way it's absorbed in the back of the retina, for developing disease and conditions like age-related macular degeneration, which is one of the leading causes of blindness in the developed world.
No. 2 is its effect on circadian rhythms and our ability to sleep.
No. 3 is eyestrain, problems with these electronics getting to be able to use them long term, and are they actually contributing to our ability to work and use these devices unhindered?
And so there's basically three main issues that have been raised with concerns about blue light, and they each have a varying level of evidence to actually support these concerns.
Host Amber Smith: Are children at greater risk than adults?
Mark Breazzano, MD: So especially now with the toys and sort of entertainment that's easily at our disposal for allowing them to have additional screen time. Maybe in schools they're using screens more than we typically used. There is certainly that concern, is there a new introduction of potential harm that wasn't there before? And this is one of those things where we obviously need to learn a little bit more about.
But what's interesting is, in terms of eyestrain, there have been several studies looking at prolonged exposure to participants in terms of primary outcomes related to that blue light. And there actually wasn't really a noticeable difference in those that used blue light blocking lenses, for example, compared to non-blocking lenses. And one of the main reasons or explanations for this is that it's a very multifactorial problem.
You know, getting strained from using the computer can often be explained by several different issues. Dry eye syndrome, for example, is very common among people. The tear film is incredibly important on the surface of the eye. And anytime we're using the screen, the blink rate can actually go down by half. And so when that happens, it actually can evaporate more and just become more dry from that standpoint. So really just lubricating the eyes with preservative-free artificial tears can be helpful, is often what I tell my patients. Or just taking a break from the computer, if you can do that. You know, a lot of us, especially with remote work and the pandemic and afterward and a lot of office work requires a lot of screen time. And so there are very conservative measures to help improve this.
There are other aspects too. Just simple ergonomic things with sitting at the desk or the computer, making sure maintaining good posture, and these musculoskeletal components to eyestrain or just general comfort can certainly influence us as well.
Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with ophthalmologist Mark Breazzano from Upstate about how to protect our eyes from blue light.
So let me ask you about digital eye strain. How would someone know that they have that? Are there symptoms to be aware of?
Mark Breazzano, MD: Yeah, and like we were discussing, some of these symptoms can be very hard to tease out from other aspects that affect the eye, including dry eyes.
Sometimes there can be other aspects, ocular motor issues as well. So anyone with a history of a lazy eye as a child or strabismus (misalignment of the eye) that may have been corrected with surgery at some point. These things can be a little bit exacerbated with prolonged screen exposure.
And I think one of the other important points to keep in mind is, screen exposure introduces a lot of light, and so there are things that can be done including blue light blocking lenses, which sound really fancy and can be great and certainly can reduce that blue light exposure.
But really, you look at the American Academy of Sleep Medicine, and they recommend discontinuing any kind of screen exposure for at least 30 minutes before bedtime. That's the best thing you can do for your sleep hygiene. And then after that, if you think, "Well, I really don't want to give that up." OK, then maybe the blue light blocking lenses can be helpful to some degree. And there's mixed evidence on that. There's a few studies out there that show some benefit in sleep quality, but there are others that didn't really show much of a difference.
Host Amber Smith: When we talk about the screen time, how long is prolonged? Because you mentioned taking breaks, but how often do you need to take breaks?
Mark Breazzano, MD: Every person is a little bit different, but if you can do it at least maybe 20 minutes or so. That's been suggested and proposed by others. But I don't think there's really a hard and fast rule yet. And it's still early to know exactly is there really problems or is there really detriment to this?
Host Amber Smith: Are there long-term impacts to the retina? I wonder, as a retinal surgeon, if you ever see patients whose retinas are damaged by excessive exposure to blue light?
Mark Breazzano, MD: Yeah, it's a great question, and it's one of the main three points I think brought up with this whole blue light discussion. We worry about, again, the age-related macular degeneration and the potential detrimental effects from that. The blue light, as we know from a lot of preclinical studies on several different animal models in the retina, that can create through the blue light, these reactive oxygen species, and A2E is actually a byproduct of this process that can be detrimental to the retina, and it's been shown to in these experiments.
And so this has actually led for the basis of these concerns. But it really hasn't been proven yet, at least, with normal everyday life. And the thought is, is because in these experiments they use higher intensities of that wavelength, and it is just one wavelength, and so they're sub-threshold, meaning not quite the intensity level that we would normally expect. And they're actually a higher level. And then obviously throughout our everyday life there's potentially prolonged exposure compared to the experimental setting. So we have a chronic sub-threshold amounts of it compared to what was done in these experiments, and that may explain why we're not seeing it yet clinically.
And what's also interesting is cataract surgery is one of the most common surgeries performed in America. And one of the big things is, with cataract surgery, after the cataract is taken out, an intraocular lens is placed in its place. And these often are blue blocking. And numerous studies have actually looked at the effects of these blue blocking intraocular lenses. There has not been, it has not been shown to my knowledge yet that there has been an increase or decrease in age-related macular degeneration based on having a blue blocking intraocular lens or not. So it is very interesting that it has not been shown yet, and despite the effort to introduce these blue blocking type of lenses.
Host Amber Smith: So it sounds like there's a lot still to learn about this. Does it seem like if there's damage to the eye from blue light, can that be reversed?
Mark Breazzano, MD: Unfortunately, when there's damage to the retina in many ways, phototoxic effects, not too uncommonly we will see injuries from laser pointers, which is called laser pointer maculopathy actually, A lot of the damage from this can be irreversible. Some might improve slightly over time, but there can be permanent damage. And the shorter the wavelength, the higher the energy, the more damage, typically, that we see. So, as a public service announcement, these blue lasers definitely more dangerous. Every laser pointer can be dangerous, but blue is definitely more, higher intensity, more severe than green, and then by red. So we're talking sequentially, increasing wavelengths, lower energy, less danger, relatively speaking, but we always need to be cautious around any of these devices.
Host Amber Smith: Does the damage from blue light always cause the person some sort of symptoms where they'll have dry eyes or blurry vision or some sort of symptom? Or could people have damage to their retinas without even knowing it's happening?
Mark Breazzano, MD: Well, if we go even shorter on the visible light spectrum, and we're going to the ultraviolet side of things, the cornea actually does a pretty good job of filtering out a decent part of the ultraviolet spectrum. And so glass blowers and those types of injuries with that kind of radiation at that extreme of the visible spectrum, or just beyond the spectrum, can actually lead to problems with the tear film and cornea that way. And depending on how severe the injury is, it can cause severe issues, but hopefully, and usually it can be milder than that.
Well, Dr. Breazzano, I appreciate you making time for this interview.
Mark Breazzano, MD: Thank you so much again, Amber. It's been a pleasure.
Host Amber Smith: My guest has been Dr. Mark Breazzano. He's a retinal surgeon and clinical assistant professor of ophthalmology and visual sciences at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."
Here's some expert advice from Dr. Vincent Calleo of the Upstate New York Poison Center. What should a parent do if they suspect their toddler has ingested acetaminophen, or Tylenol?
Vincent Calleo, MD: One of the first things the parents should do is to remain calm. A lot of the ingestions that occur with pediatric patients or acetaminophen, which is commonly known as Tylenol, do, fortunately, tend to be nontoxic.
Now with that being said, if a parent notices a child gets into any amount of acetaminophen, one of the first things they should do is call the poison center toll free at 1-800-222-1222. And there, they will be connected with a specialist in poison information who can go ahead and help to provide recommendations based on the amount of medication that the patient may have taken and help to provide guidance for whether or not that child can safely be managed at home, or whether or not they should go to the emergency department to seek further treatment.
Host Amber Smith: You've been listening to Dr. Vincent Calleo from the Upstate New York Poison Center.
And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.
Deirdre Neilen, PhD: Physician and poet Tai Wei Guo gives us a portrait of a young girl in the hospital, reflecting on the sounds and sights all around her, as she tries to be brave.
Here is "Brave":
Machines in the hospital can cry, but brave little girls do not.
Little girls who cry startle doctors who ask "what's wrong?"
Doctors feel like they have to fix everything.
When your bones are broken, they fix your bones;
and when your bones are dislocated, they locate them.
When your pancreas is broken, they excise the tumor;
when your spirit is broken, they try to exorcise the fear.
Meanwhile, machines in the hospital sing all day of apocalypse:
Air in line, occlusion downstream, air in line, infusion complete.
Machines in the hospital are actually metronomes
because they count every lonely second with you.
Lub-dub pa-chik lub-dub pa-chik lub-dub pa-chik lub-dub --
Brave little girls whittle away at time watching Van Helsing.
Brave little girls read books like Dawkins and know there is
no use crying over statistics: someone had to be unlucky.
Brave little girls know refusing morphine is a sign
of strength and refusing faith is a sign of science because
refusing pity is the highest sign. Bravery is being content
watching ships outside the window barging downstream.
Except it doesn't feel brave to watch your mother crying.
Here is the secret: brave little girls are just
little girls because they never chose to be brave.
What else is there to be, with half a pancreas
and a line of staples holding their guts together.
Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. Next week on "HealthLink on Air," a medical mission trip to Ukraine.
If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org. Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel. This is your host, Amber Smith, thanking you for listening.