Boost Eye Health & Prevent Vision Loss with Jeffrey Goldberg | Huberman Lab Podcast 

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In this episode, Dr. Huberman and Dr. Jeffrey Goldberg discuss maintaining eye health, corrective lenses, contact lenses, LASIK surgery, floaters, dry eyes, sunlight protection, and exercises for better vision. They also cover age-related conditions and strategies for promoting eye health Check out Dr. Jeffrey Goldberg’s profile at Stanford

Host- Andrew Huberman (@hubermanlab)

Every baby should receive an eye exam shortly after birth

The initial eye exam for newborns involves screening for the red reflex, which is the normal reflection of light from the retina Lack of a red reflex could indicate eye diseases, such as retinoblastoma (pediatric eye cancer), although this is rare Apart from the red reflex check, most babies do not require additional eye exams The red reflex check is typically performed by the pediatrician during regular well-child visits

Eye exams during early childhood are typically not necessary However, parents should be careful if their child shows signs such as lack of eye contact, difficulty locating sounds, or nystagmus (rapid flickering eye movements)

By the time most children reach elementary school age, eye exams are usually done at schools The purpose of these exams is to screen for amblyopia, also known as “lazy eye,” which can be caused by refractive errors or misalignment of the eyes (strabismus) Amblyopia is one of the most common eye diseases in children

Children who complain about not being able to see the board or the teacher might have nearsightedness

Eye misalignment: Conditions: convergent eyes, cross-eyes, walleye Symptoms: drifting eyeball, turning in of the eyes

The brain is highly plastic during early development and can change based on the information it receives The brain can become blind to proper alignment if left untreated Permanent vision loss can occur if misalignment persists Parents or photographs can help detect eye misalignment

Even just a few hours of misalignment of information to the two eyes early in development can permanently rewire the brain Corrective measures: patching one eye to balance the information between the eyes

Excessive close-range activities like iPads and phones during childhood can cause myopia (nearsightedness) due to eyeball elongation Recent studies suggest that outdoor lighting may play a larger role in myopia progression than near work alone

We need randomized controlled trials to determine the optimal duration of outdoor time for children to reduce the development of myopia

Outdoor activities with far viewing are beneficial for eye health at any age Spending time outdoors allows the eyes to focus on distant objects, which helps counteract the effects of excessive near work

Eye health do’s: Limit excessive exposure to bright lights Be wary of environmental conditions like toxins, acids, solvents, and foreign objects Wear eye protection when grinding, gardening, and woodworking

Eye health don’ts: Excessive eye rubbing (occasional eye rubbing is ok) Touching the eyes with dirty hands Cleaning eyes with harsh substances

Eyes are delicate – trauma can occur even from minor impact and may result in inflammation and potential long-term damage

Eye cleanliness: Focus on maintaining cleanliness around the eyelashes and eyelids Use mild solutions like No More Tears baby shampoo or eye scrub pads to clean the eyelashes and prevent inflammation (blepharitis) Use sterile saline eye wash or artificial tears for occasional eye rinsing, particularly when there is a sensation of something in the eye

Optometrists have an optometry degree (OD), while ophthalmologists have a medical degree (MD) and surgical training Both can diagnose and treat eye conditions, but ophthalmologists specialize in surgery

Starting from around the age of 40, have your eyes checked every 2-4 years As you get older, increase the frequency of exams: every 1-3 years in your 50s, and every 1-2 years from your 60s onwards After age 40, it is important to monitor eye pressure as it can increase over time

Screening exams can be done at public health fairs or by visiting an optometrist or ophthalmologist Request an eye pressure check during the screening exam

After age 40, people start experiencing presbyopia , which is a natural age-related change in vision Presbyopia refers to the stiffening of the lens inside the eye, making it harder for the eye muscles to relax and reshape the lens for focusing on near objects

The ability to switch focus from distance vision (three feet or further) to near vision (around 14 inches) starts to decline with age The first signs of presbyopia often include the need for reading glasses or a magnifier to see things up close, even if distance vision remains clear

Using reading glasses provides a boost in near vision and helps relax the eye muscles The dependence on reading glasses may increase gradually over time, but it typically stabilizes around +2.5 or +3 strength Readers can be purchased at different magnification levels, such as 0.5, 0.75, 1.0, and so on

Driving at night can be challenging for the visual system, and the use of readers can alleviate strain and improve visibility Optimal vision during nighttime driving requires sufficient contrast and brightness, which can be improved with corrective lenses

Traumatic brain injury can cause deficits in the smooth pursuit of eye movements Recovery protocols for traumatic brain injury: smooth pursuit exercises and pencil push-ups Near-far exercises like pencil push-ups also slow down the progression of presbyopia

Pencil push-ups: Focus on a pen or pencil held at arm’s distance Slowly move it toward the nose while maintaining focus Continue until it becomes blurry, then move it back out Aim for 10 to 25 repetitions, once or twice a day, a few times a week

Vision performance centers, like Stanford University’s, explore the difference between normal and supernormal vision The goal is to understand how to train individuals to move from normal vision to above-normal performance

Athletes use specialized tools like goggles with intermittent vision blackouts to improve visual reflexes and performance Vision is now recognized as a crucial factor in optimizing athletic abilities

Vision measurement: 20/20 vision: standard, reads smallest letters at 20 feet Degraded vision: numbers like 20/25, 20/40, or 20/200. Severe degradation: measurements like 2,400 or 2,800, difficult tasks Legal blindness: typically 20/200 or worse, affects light perception

Better-than-normal vision: Achieving vision beyond 20/20, like 20/15 or 20/10 Seen in athletes, fighter pilots, LASIK surgery recipients Visual acuity usually consistent between both eyes for healthy individuals Newborn babies have initially poor visual acuity, improving gradually Hawks and owls have naturally better visual acuity, often 20/10 or 20/8

Visual acuity distinction: Visual acuity primarily focuses on the central area of vision, known as the “hill of vision.” Peripheral vision has a lower resolution but contributes to overall visual perception and detecting motion Looking around and using eye muscles helps fill in gaps and obtain a higher-resolution view of the surroundings

Contact lenses alter tear dynamics and decrease oxygen diffusion onto the eye’s surface Most individuals tolerate polymer gel soft contact lenses well Contact lenses offer advantages in correcting eye shape and higher order aberrations for better vision quality

Dos and don’ts of contact lens wear: Daily disposable contact lenses for convenience and reduced risk Follow recommended cleaning routines and use guidelines Avoid sleeping in contact lenses to prevent infections Improper use or cleaning of contact lenses can trap bacteria or fungus, leading to corneal infections Infections can cause corneal scarring and blurred vision Be aware of the low risk of bacterial infections and take precautions

Contact lens tolerance may decrease with age Dryness and discomfort may occur after shorter periods of wearing Adjust usage and reduce wear time if necessary Regularly monitor eye health and consult an eye care professional

UV light can have adverse effects on the eyes and skin Blocking UV light is important to prevent eye damage and skin problems Most eyeglasses and contact lenses have UV-blocking features Wide-brimmed hats and sunglasses can provide additional protection against UV light and help prevent skin cancer

The use of transitions lenses that react to UV light is another option for UV protection Blocking UV light is recommended, the impact on eye health and cataract development may not be significant in the long term

Blue light and “blue blockers”: Blue light exposure at night disrupts melatonin production and sleep Blue blockers can help reduce nighttime blue light exposure Wearing blue-blocking glasses or lenses all day may not be necessary Bright natural light during the day is crucial for regulating the circadian rhythm

Light sensitivity & eye color Light-colored eyes, like blue or light green, may be more sensitive to bright light The iris muscles and nerve impulses play a role in light sensitivity differences People with light-colored eyes may struggle to constrict their pupils in bright light, causing discomfort or squinting

LASIK is a type of eye surgery that reshapes the cornea to correct vision problems

LASIK is usually performed on individuals who want to reduce the dependence on glasses or contact lenses It can also address regular and higher-order aberrations, improving overall vision quality

Dry eye may be a possible side effect, especially for those who already have dry eye It is not typically recommended for children or young teenagers due to potential changes in eye shape and prescription

Long-term benefits of LASIK: Reduce dependence on glasses or contact lenses Safe and comfortable outcomes for the majority of patients Clear vision without corrective eyewear for up to a decade

Dry eye- common eye condition with millions of sufferers Underlying cause: deficiency in lacrimal gland production

Tears consist of salt water and essential oils Wet part of tears can be replaced with artificial tears Oils prevent evaporation and hold tears on the eye surface The industry needs to find solutions for replacing the oily part of tears

Tips to beat dry eyes: Preservative-free artificial tears are recommended for regular use to avoid irritation For severe dry eye, use serum tears, derived from blood serum Standard drops are ineffective for severe cases Eyelid cleaning and reducing inflammation

Further research is needed to evaluate the efficacy and safety of new treatments like PRP (platelet-rich plasma) and serum tears in ophthalmology

Major Causes of Vision Loss: Refractive error: correctable with glasses; affordability and access can be barriers in some regions Cataract: normal aging process; cataract surgery is an effective solution, but access to care is limited globally Glaucoma and optic neuropathies: a leading cause of irreversible vision loss; a neurodegenerative disease affecting the optic nerve

Glaucoma risk factors: Increasing age: more common in adulthood and the elderly. High eye pressure: regular screenings to monitor and manage eye pressure

Treatment options for glaucoma: Medications: eye drops to reduce eye pressure Laser procedures: used to lower eye pressure Surgeries: provide controlled outflow for fluid and normalize eye pressure

Access to glaucoma therapies and early detection remain significant challenges globally Peripheral vision loss is often unnoticed until the disease progresses

Age-Related Macular Degeneration (AMD): Risk factors: more common in the elderly, populations with larger Caucasian/white populations Two forms: Dry AMD (slow degeneration of rods, cones, and support cells) and wet AMD (growth of new leaky blood vessels) Treatment options for wet AMD: injections of antibodies into the eye to counteract new blood vessel growth Recent advancements: successful trials for a treatment for the dry form of AMD in phase three clinical trials.

Retinitis Pigmentosa: An inherited form of macular degeneration that affects rods, cones, and support cells in the retina Various genes can contribute to retinitis pigmentosa, leading to vision loss early in life Less common overall compared to AMD but can be more severe due to early onset

Diabetic Retinopathy: Complications of diabetes, more prevalent with the increasing cases of type 2 diabetes Damage to the retina caused by leaky blood vessels and new vessel growth Importance of early screening and regular eye exams for people with diabetes Control of blood sugar and blood pressure is crucial in preventing diabetic retinopathy Treatment options: injections and laser treatments to manage retinopathy

Glaucoma leads to the death of retinal ganglion cells, which connect the eye to the brain and cannot be replaced at this point

To determine if you have glaucoma, undergo a comprehensive screening exam: Check eye pressures Examine the optic nerve head for characteristic signs Additional tests may include imaging and peripheral vision testing

Lowering eye pressure: Slows glaucoma progression Important regardless of the initial pressure level Treatment options: Eye drops (first line) Safe laser treatments like selective laser trabeculoplasty (SLT) Surgery if necessary

Glaucoma management challenges: Vision loss or blindness still possible despite treatment Compliance with prescribed eye drops can be difficult due to the lack of immediate effects and potential side effects

Aging is a risk factor for glaucoma, along with smoking and alcohol consumption To reduce the risk of glaucoma and macular degeneration: Drink less alcohol and smoke/vape nicotine less

Maintain a healthy lifestyle: Eat a balanced diet Take a multivitamin Exercise regularly

Cannabis has the potential to lower intraocular pressure (IOP), which may benefit glaucoma patients However, the effect is typically temporary and limited to the duration of being “high” from cannabis use Smoking cannabis also worsens dry eyes Edible forms of cannabis may be a viable alternative

Further research is necessary to develop more effective, eye-specific drugs derived from cannabinoids

Consider the position you sleep in sleeping with your head slightly elevated above your feet may help lower eye pressure, especially for individuals with glaucoma

Glaucoma can often affect the eyes asymmetrically, with one eye experiencing more damage than the other Sleeping on different sides does not appear to have a significant impact on this asymmetry Even if you have a preference for sleeping on a particular side, people naturally toss and turn during sleep, so both eyes receive a similar amount of time in different positions

Consider red and near-infrared light exposure into your routine a few times a week, preferably in the morning, at a distance of approximately two feet from the light source

Potential neuroprotective effects: Enhance mitochondrial function in photoreceptors Reduce reactive oxygen species Neuroprotective benefits for conditions like macular degeneration and optic neuropathies

Other light therapies: Violet light and other end-of-the-visible spectrum light therapies Potential for preventing nearsightedness in children

Sunlight exposure: Light therapies may mimic the natural effects of sunlight Consider the potential lack of outdoor exposure in modern lifestyles spent indoors and in front of screens

Floaters in the eye are caused by the shrinking of collagen fibers and gel in the eye as we age Most floaters go away on their own without treatment Ignore floaters and they will eventually become less noticeable

Eye twitching is often due to a malfunctioning nerve cell or muscle in the eyelid Eye twitches usually resolve on their own within a couple of months Chronic eyelid spasms can be treated with Botox injections Consult a healthcare professional if twitching persists or is severe

Carrots benefit vision because they contain vitamin A, although vitamin A deficiency is rare in developed countries

AREDS2 formula to slow down the progression of macular degeneration: Vitamin C, vitamin E, zinc, copper, lutein and zeaxanthin Even individuals with mild macular degeneration can benefit from these supplements

If your diet lacks sufficient amounts of lutein and zeaxanthin, these supplements can be even more effective

High-dose vitamin B3 is being studied for its potential to protect against glaucoma Initial trials have shown it to be safe and potentially improve retinal function Large clinical trials are underway to gather more evidence

Use caution with other supplements and alternative therapies for glaucoma (especially online) Supplements are not a substitute for prescribed treatments

The retina, located in the back of the eye, is part of the brain and can be imaged to detect neurodegeneration Imaging the retina is easier and quicker than scanning the entire brain, making it a useful tool for diagnosing and tracking diseases like Alzheimer’s and Parkinson’s Retinal degeneration is often associated with degeneration in deeper brain structures

New imaging techniques, such as cellular and subcellular resolution, are allowing the discovery of specialized structures in the retina linked to diseases such as multiple sclerosis

These discoveries may lead to the development of new biomarkers for diagnosing and tracking the progression of diseases