The Diary Of A CEO with Steven Bartlett - The No.1 Eye Doctor: They’re Lying To You About Blue Light! The Truth About Floaters! Turn This Phone Setting On To Save Your Eyes!

Starting point is 00:00:00 There's a lot of misconceptions around how we get bags under our eyes. I always assume it's their stress and they haven't been sleeping. So I did research to look into this and a lot of people don't know this, but it's actually... Really? Mm-hmm. So if I never want to get bags under my eyes again, what is the natural, easy solution? Try this. Dr. Joseph Allen is the board-certified eye doctor.

Starting point is 00:00:19 Helping millions of people understand eye health and unlocking the secrets behind achieving sharper and healthier vision. I really want to talk to you about so many misconceptions because I don't know what's true. Sure. Okay, so my vision loss being inevitable. Is that true? Unfortunately, there are changes that occur with age that will change your eyesight and vision. But there's a lot of things that can help prevent and slow down progression, and we'll go into them. And then every once in a while, my eyelid starts twitching. What is that? Eyelid myokymia. So that is your threshold of your stress. You get more sleep and stop

Starting point is 00:00:48 drinking so much caffeine. What about blue light? Is that harmful? The blue light that comes from your digital screens has consistently shown in research to not increase the risk of aging eye diseases. And research on using blue light glasses shows that it could just be placebo effect. But if you're worried about how blue light's affecting you, just moving your phone back twice as far will decrease your blue light exposure by 75%. And more people are starting to care about their eye health than ever before. But is our eye health getting better or worse? Worse.

Starting point is 00:01:14 For example, right now, about 30% of the world's population is nearsighted. But by about 2050, we will have about 50% of being nearsighted because of our lifestyle. So how much screen time, being indoors, reading books up close is okay? It depends on age. Who are you? What you do? And I think most importantly of all, why is it so important that you do it? I am a doctor of optometry. I am a fellow of the American Academy of Optometry,

Starting point is 00:01:48 and I'm a diplomat of the American Board of Optometry. So I practice eye care here in the U.S., and I see patients for all sorts of eye conditions, whether that be diagnosing, managing, anything from vision problems, simply as like nearsightedness or astigmatism to fitting contact lenses to diagnosing different diseases in the back of the eye and then prescribing medications or therapy to try and prevent that from getting worse or to help treat it. On top of all of this, I also host various, on various social media channels,

Starting point is 00:02:26 a educational website about helping people learn about the eyes, their vision, and finding the best vision products. And that really falls back to my mission of just helping people see their very best today, but also keeping them see their best tomorrow. And when you think about where we are as humans, as it relates to our eye health, like what's the macro picture? Like what's going on? I don't know whether it's just because I'm getting older, but I'm wondering if more people are starting to care about their eye health than ever before. And if they are, why? And is our eye health getting better or worse? I want to say that I think people generally

Starting point is 00:03:09 are being more interested in eyes and vision. Unfortunately, part of that is probably because they're noticing more problems, right? People are starting to notice dysfunctions or more problems with their eye strain. They're noticing more problems with dry eye. Children are starting to become nearsighted faster and to greater degrees. And because of those factors, we're also seeing a lot more eye health conditions in the back of the eye that also is reflected with other metabolic diseases like diabetes significantly causes damage and leads to potential blindness inside the eye. So there's a lot of factors to it. What's changing? You know, you referred to some of the

Starting point is 00:03:59 situations there as becoming more or worse, etc cetera, that would suggest that there's something environmental or within our lifestyle that's having an impact on that. So again, there's many factors that go into it. Certainly just having an aging population, our population, a lot of people are starting to move into older age groups. We also have aftermath of poor diet. A lot of people with diabetes, high blood pressure, and all these other conditions that cause ripple effects down the road. And then our society has changed, especially in the form of lifestyle, beyond diet. Also, what we do throughout the day. How much time do we spend on devices up close? How much of our society is focused on education? And how much time do we spend on devices up close? How much of our society is focused on education? And how much time

Starting point is 00:04:47 do we spend indoors? All of these things are pushing us to, as a society, to have different changes within the eye and increase our risk for diseases and potential vision loss. Why does it matter? You know, I asked that question because I think for people to spend time listening to all the education you give out, they first have to really believe that their eyes matter. And I know this sounds like a bit of a crazy question because we all can understand that seeing things is useful, but sometimes in life, I think we don't appreciate things until we lose them. And I think in your line of work, you must see that more than ever. No pun intended.

Starting point is 00:05:27 Right. No, you're absolutely correct. And it's so frustrating as an eye care provider of how many patients or how many people just come in because they finally notice something's wrong. And usually by the time something's wrong, they notice it. It's already too late. And so one of the best things I can recommend for anybody is to, whether you think you have a problem with your vision, because a lot of people are like, I see great, I see fine, I don't need to see an eye

Starting point is 00:05:52 doctor. It's like, no, you absolutely need to. There's so many different, not only just problems with your eyesight that we can catch, but there's so many, there's over 270 different conditions, systemic and vision conditions, that an eye doctor can diagnose from just one of the simplest non-invasive medical evaluations. And that's just getting an eye exam every year. Give me some examples of conditions you've spotted by doing an eye exam. So patients who don't know they're diabetic will catch diabetes by looking inside the eye, because diabetes will cause damage to the blood vessels. And we can see bleeding happening in the retinal tissue.

Starting point is 00:06:30 We can see high blood pressure, high cholesterol. I've had patients where I've caught that they've technically had little strokes already inside because just looking inside the eye. The eye itself can have a stroke. We can see cholesterol plaques stuck in the arteries within the eye. The eye itself can have a stroke. We can see cholesterol plaques stuck in the arteries within the eye. Autoimmune conditions, we'll catch those from doing an eye exam. Unfortunately, things like brain tumors and conditions like multiple sclerosis, we'll catch those. I had one story I'll share. I have one patient who was, she was young. She was 20 years old, college student. She came in for just getting new glasses, contact lenses. She has to go to school. She has to see well. And during that very routine exam, she has no other problems.

Starting point is 00:07:17 I'm looking inside the eye and I can see a hemorrhage, a blood spot. But there's different types of hemorrhaging that occurs in the back of the eye. This specific type of hemorrhage, a blood spot. But there's different types of hemorrhaging that occurs in the back of the eye. This specific type of hemorrhage is called a Roth spot. And typically we only see Roth spots if somebody has a more serious condition going on. Can you show me on that where you saw it? Sorry. So we, for people that aren't watching and just listening on audio, we have a model of an eye here. So with the model of the eyeball,

Starting point is 00:07:50 during the exam, we of course look through the cornea, through the pupil. Usually we dilate the pupils. If I was to open up the inside of the eye, the orange part that you see here, that's the retinal tissue. And you can see the little red lines.

Starting point is 00:08:05 Those are blood vessels. The retina is really, the eyeball is kind of beautiful because it has a dual blood supply. So it actually has blood that comes through the back and supplies the retina from the backside. But then it has blood vessels that go within the retina and supply nutrients within the retina from the front side. So this type of bleeding spot was occurring just right here in the back of the eye, a little bit off angle, but it was occurring there. And I was like, this should not be there, especially for somebody that was healthy, had no other issues. What sort of age? She was 20-year-old female college student. And usually, again, we see raw spots in more serious conditions, whether somebody's

Starting point is 00:08:45 extremely diabetic or they have HIV. Something's going on. So I said, this is not right. We need to do blood work. So I ended up referring her, basically requested a blood panel. And she didn't have like a family doctor. So I'm like, okay, we need to refer you, but she's heading out to college. So I'm like, I'm going to give you my full report. I need you to go get this done. And then COVID happened. So I didn't hear anything. And so finally, a few weeks later, they finally allowed doctors to go back into clinics for emergency care in case I had an emergency. And I called up that patient. I'm like, I just wanted to check on her, see, hey, what's going on? Did you ever get that blood work? And she's like, you saved my life. And I was like, what? She's like, yeah. A few days

Starting point is 00:09:34 later, I started feeling really tired and not feeling well. So I went into the doctor and I brought your report. They did blood work. They found out I had they they put her in intensive care unit for three days because they were worried she was going to bleed out her platelets were so low that she could she could have just bled there from doing the blood work she had an immunothrombocytopenic purpura so her immune system because probably a virus but her immune system was attacking her platelets. Platelets are the thing that sort of clots the blood, right? Correct. And that ended up manifesting in the eye. So it was one of the few cases where I was like, wow.

Starting point is 00:10:20 Otherwise, if she hadn't come in, what could have happened, right? So I just use that as a good demonstration because there are so many things that we catch on even a daily, weekly basis. There's so many misconceptions around vision in the eye. I think one of the misconceptions I think I found myself living under is that my vision loss is inevitable, really irrespective of what I do. And the minute you start to believe that story, then it kind of disempowers you, but it takes away your motivation to do anything about your vision. Now, is that true? There is changes that occur with age that will change your eyesight and vision.

Starting point is 00:11:00 Some just fundamental facts that you don't really have, like, supreme control over. It's like your hair growing gray. Like, it's going to happen. It's kind of accepted. Yeah, with older age, you're going to have gray hair. With the eye, there's conditions like that, like cataracts, age-related cataracts, eventually will develop. Presbyopia, that's the condition where people are in their 40s and early 50s. They start having

Starting point is 00:11:26 a hard time seeing up close and they have to push things further back and they start wearing bifocals or varifocals. So those sort of conditions inevitably do happen. But there are thankfully a lot of things in our lifestyle that research is paying more attention to that can help prevent, hopefully prevent, and even slow down the progression of more devastating, blinding eye diseases. So there are things you can do and be aware of and happy to go into that. So global eye health and the statistics. One of the really sort of shocking stats I read is that most of us are going to develop nearsightedness when you go into sort of 2050, 2060. Is that true?

Starting point is 00:12:15 What are the stats around that? So a publication came out in 2016, an ophthalmology author of Holden. They looked at the statistics of myopia or nearsightedness. Even going further back, we've known that nearsightedness is progressing. And now, it's estimated that right now, about 30% of the world's population is nearsighted. But by about 2050, we will have about 50% of the entire world's population being nearsighted, but by about 2050, we will have about 50% of the entire world's population being nearsighted. In the U.S. right now, for kids aged 5 to 19, they were already about 42%.

Starting point is 00:12:56 And by 2030, so in just a few years, it's expected in the U.S. will be about that 50% mark. And then other parts of the world, like East Asia, like in Japan, it's closer to 80 to 90% people are already nearsighted. Really? How come? There's certainly genetics plays a role. As more research has come out, we know that genetics maybe only plays maybe up to about 30% of the factor. So if your parents are nearsighted or if somebody's severely nearsighted,

Starting point is 00:13:31 like if your mom's severely nearsighted, you are a much higher risk of developing it. But the key other factors of lifestyle falls down to urbanization, really the fact that if you go outside in a big city that has streets really close to each other, you're not really in an open field, right? You have big tall buildings right next to you. And then you go inside and you're inside of a smaller building, a smaller apartment. Then there's the fact that we spend so much emphasis in our society on education, on being up-close beings, right? Kids now are not only pushed to excel in education and being introduced to education earlier and to spend more time studying and learning, but parents are giving their kids digital devices as the babysitter 2.0, right? So kids are staring at

Starting point is 00:14:26 tablets even from a very young age. And then it's the amount of time we're spending indoors. It's interesting because I don't even think most people realize that the way we live our lives, the things we stare at being indoors can change the eye. I think we all kind of operate under this assumption that our eyes are just our eyes. And we think of muscles as being trainable and exercisable. You know, I can go to the gym, I lift a weight, my muscle changes. But my eye changing is something that I think is quite a surprising concept to most people. How do we know this? So statistically, we've watched and data collected for many decades, watching people gradually become more and more nearsighted.

Starting point is 00:15:15 And there's been those theories of why that could happen. The evidence of what changes physiologically with the eyeball is that the eye, as you grow and go through adolescence and your body's growing, the eyeball actually grows backward toward the brain into the orbit eye socket a little bit. And it doesn't need to change much. The eye growing one millimeter, just one millimeter, will change your prescription for glasses by about three diopters, which is a high amount. So if somebody gets two millimeters of change, that is already into what we classify as severe myopia, which carries a high risk for eye diseases like glaucoma, cataracts, having a retinal detachment where the retina in the back of the eye peels off the back of the globe, and then what's called myopic maculopathy, which is a form of kind of macular degeneration that typically occurs with later age. And that one millimeter or two millimeter growth is linked to lifestyle?

Starting point is 00:16:28 The vast majority of it. How much screen time, how much being indoors, how much reading books up close is okay? Is there like a recommended daily allowance? So there are some recommendations put forth by like the American Academy of Pediatrics. And it depends a little bit on age, especially for young kids. I think for the first few years of life, they don't recommend kids look at screens at all. And then- Why? Why? Because again, there's research showing that not just for eye development, but also neurological development. And I'm not a specialist on that form of pediatric brain development, so I can't really opine on that. But we do – there are recommendations for it. And I encourage anybody who's listening, if you have a young child, if you're thinking about having a child, definitely look into those recommendations because it has impacts on your child's development and growth.

Starting point is 00:17:28 As far as like adults, like you and I are both in our 30s, how much time is spending on like looking up close? Once you're past the age of like 20, 25, the rate of myopia development thankfully slows down. That's nearsightedness. Nearsightedness, correct. Yeah. That does slow down, but about 10% of the population can still develop a stronger and stronger prescription. And part of that, again, is your education and how much time you're spending indoors and on near devices. There have been numerous studies looking at outdoor time and that spending more time outside can offset the onset and progression of nearsightedness. Most studies are quoting

Starting point is 00:18:18 somewhere around 90 minutes to two hours a day can kind of offset all the near work that children are using. So spending sort of 90 minutes to two hours a day outside looking far. That's a part of it. The various studies do look at, you know, are they doing things up close while they're outside? Or is it just being outside? It's not fully understood. Is it sunlight? Is it the brightness of light outside? Is it the specific wavelengths of sunlight that are somehow communicating to the back of the eye to grow or not? There's also the thought that the way the world around us focuses on the retina when we're outside may send a different signal to the back of the eye. Because one of the areas that they've done so much research on in terms of how myopia progresses has to do with how light is focusing on different parts of the retina.

Starting point is 00:19:19 Mm-hmm. I do want to just step back when it comes to all the spending time outside. Again, that research is largely based on surveys, and so they aren't 100% sure how much light outside of our time people are really getting. So now they're utilizing health trackers and giving it to kids for those studies so they can track truly how much light they're getting when they're stepping outside versus not, so they can have a better objective data to really understand the risk of myopia progression based on that. I was wondering if vitamin D plays a role at all there. That's also theorized and looked at in some studies.

Starting point is 00:19:57 Also just athletics and getting more motion in the daily activities. So there's many different studies in those regards. But right now, even a study out of Taiwan, they've been implementing a policy. It's like, hey, you have to get at least 90 minutes to two hours outside every single day. And they have noticed over the last decade, there has been a decrease in childhood myopia development. There's still some debate if it helps slow down progression, because even a more recent meta-analysis said it wasn't statistically significant for the

Starting point is 00:20:37 progression of myopia, but it does delay onset of myopia. Can you reverse myopia? No. Okay, so if I become nearsighted because of my lifestyle or some other reason, I can't then just spend loads of time outside and reverse it and start gazing off into the distance, etc.? So there's the understanding of what true myopia is, and again, that has to do with the elongation of the eyeball. So if you were to somehow find a way to truly reverse myopia, you would have to find a way to somehow shift that part of the eye forward, which we have not been able to do. There are, I know just being in the world of social media, there are people who will claim that they've done this using various things. Usually these people who are claiming this are selling something that is not based on science. And doing

Starting point is 00:21:32 a research study to prove that would be very easy to do. And it just doesn't show. Most people, if they are spending more time outside or they are doing eye exercises of any form to try and reverse their nearsightedness. What's likely what they're going through is that they have something called pseudomyopia, which is where they've overused their eye muscles so much that they're more or less having a spasm. And their muscle is making them think that they are nearsightedness. But then finally going outside, spending more time outside, stop staring at their phone so much, they learn to relax their eye muscles. And all of a sudden, now they can see better again.

Starting point is 00:22:18 Well, this is, you know, in part one of my personal concerns because sometimes, very rare occasions, I'll spend maybe 9, 10, 12 hours in this studio. And I'm doing research on the guest before the guest arrives. And then we're sitting at this sort of distance. And I'm very intently focused. And it's a dark room, et cetera. And then when I walk outside, it's like, I can't see a bloody number play. And I think I'm losing my vision. But from what you're saying there, it sounds like I'm going through a bit of pseudomyopia. You could be. Of course, I haven't done an eye exam on you.

Starting point is 00:22:51 I don't know where you're at. Can I ask, when was the last time you had your eyes checked? Oh, no comment. It was a long time ago, and the reason for that is, again, because I always assume my eyes were fine. So it would have been, gosh, that's such a good question. Maybe seven years ago or something. So it's tough to say. You know, there is possibility that maybe there's a little bit of nearsightedness there.

Starting point is 00:23:15 It could be that you've used your eye muscles so much indoors that you're used to lifting it. Think of it like lifting a five-pound weight, right? You've held it there all day long, and most people can. Eventually, if you hold it there long enough, you can have some eye strain, and people will feel that at the end of the day. But then you step outside, and you're just used to holding it five-pound weight at arm's level.

Starting point is 00:23:37 So you have to learn to, hey, I can relax this and put it back down. So that is a component of the internal eye muscle called the ciliary body, which unfortunately is not the same type of muscle as your skeletal muscle. And so even with eye exercises, you can't strengthen that muscle. So eye exercises don't work? Eye exercises in the form of what's called vision therapy or orthoptics can work, but they're not building the muscle. They are improving really the coordination of your brain, communicating that information to those muscles to work in coordination. And so there's some certain binocular vision disorders, like people have convergence insufficiency.

Starting point is 00:24:28 They can't move their eyes to bring them forward to keep a page in front of them single. Or some people have loss of their accommodative ability, their ability to change focus to keep something up close clear. those type of binocular vision issues can be trained again through the training of the communication between the brain and those muscles Should I be looking for clues as to what the future of my vision is going to be like from my parents because my parents are

Starting point is 00:24:58 they hold everything at like one meter length from their face and I when I was younger used to take the piss out of them thinking like that's so ridiculous and I would show them that I could read from like one centimeter away, and they're reading at arm's length. But I think they're going to have the last laugh when I get to 50, 60 years old. Sure. Because of genetics or whatever. So again, even without genetics, just the way the eye ages, the lens inside of your eye will change. Which is? So if I open up the eye model

Starting point is 00:25:28 here, let me try not to spill everything from the inside of the eye. In the front portion of the eye, you have the cornea. Which is the, is that the very front piece? It's the clear window to the eye. Okay. Behind it, of course, you have the iris, the colored part of the eye. So brown eyes, blue eyes. Behind that, you have a lens. It's called the crystalline lens. And this has got a couple of different pieces. I'll set those to the side. But this crystalline lens is actually about the size of an M&M. I put these together. It's kind of that shape. When you're born, this lens is clear and thin. And so the muscle inside the eye actually pulls on this lens to change its shape. And that's what helps you as a little kid see all the way toward the front of your nose. As you get older, this lens gains an extra layer basically every year of your life. And so as you get older, if you ever look up

Starting point is 00:26:27 on images online, you can actually see rings or these little lines. And it's like looking at the rings of a tree. So you can basically count those and be like, oh, look how old this person is. So by the time everybody's about in their early 40s. There's algorithms that predict this with high accuracy. And in school I had memorized them. I don't really need to use them as much anymore so I haven't thought about it for a while. But these, as this lens gets thicker, it basically gets thicker every year,

Starting point is 00:27:00 it gets to a point where the lens starts to, the crystals within that lens start to change shape. They become more crystallized, rigid. And so even though the muscle inside the eye is still pulling on this lens, it's like pulling on a hard, stiff marble. It doesn't want to change shape anymore. And so that's why people can gradually like, I can't quite keep things as clear anymore. And so it's gradually getting worse and worse. Okay. Eventually, once you get closer to the ages of 50, 60, 70, 80, this lens continues to get thicker, harder, but then the crystals start to change color.

Starting point is 00:27:42 They go from being clear to being more of a faint yellow color to a darker yellow whitish color. And that's what we call a cataract. And so people lose vision because that cataract is such a dense color that light is not filtering, it's not passing through to getting to the retina and the back of the eye anymore. So what did you do? Cut it out? So there is, thankfully, cataract surgery is an amazing surgery. I think it's probably one of the more fascinating surgeries that's out there. What modern cataract surgery does, they either use a laser or they physically have to open up parts of the eye, but they use a procedure called phacoemulsification. It's basically using

Starting point is 00:28:26 ultrasound to shatter the lens into dust. And then they have a small vacuum tube that sucks up all the particles out of the eye. But then a new plastic lens is inserted into the eye into that place. And that new plastic lens can be made to account for any glasses prescription that you need. Okay. And what's fascinating for you and I is that, so this form of cataract surgery has been evolving and getting better and better over generations. But the new lens implants that they've been engineering are just outstanding, even right now. Because now they can make multifocal lenses. They can have lenses that change shape based on how you're using your

Starting point is 00:29:10 eyes. And then it's basically not needing bifocals, not needing glasses as much, in some cases, if at all. And so I keep on thinking like, wow, where this technology is right now, where is it going to be in 30, 40 years when you and I are getting to that point where we might need to think about it? Who knows what we're going to have? I reckon we'll have like cameras. I hope so. Are people working on that kind of thing?

Starting point is 00:29:36 I bet someone's working on some kind of camera, electric eyeball. You know, I did hear of some research maybe about five, six years ago of somebody talking about it. But since then, things have kind of gone quiet. They are probably in the last year, one of the last few years, there's been interest and research into making like augmented reality contact lenses that are quite fascinating. And then there is kind of one of the newest things is the first whole eye transplant.

Starting point is 00:30:08 That was one of the kind of the coolest things that have come up recently. There was an eye transplant? So a gentleman was injured. He was U.S. military, but something happened on the job, electrical damage to his face, his eye. He ended up having partial face transplant and then a whole eye transplant. And at this time, it was the first one ever done. The eye is so unique and so complex that when they finally did this transplant, it's sort of shaken the eye care role a little bit. I just read like a one-year

Starting point is 00:30:48 publication in JAMA that was basically summarizing what it's been like after this last year. And it's amazing because the eye did connect to the optic nerve because the eye, again, is so complex. So they had to not only connect muscles to the eyeball, but they had to connect the optic nerve from the donor tissue to the host. And keeping that, the right amount of blood supply, having it so it didn't reject, is a really tough feat. And what they have now, they find that the last, this last paper I just read, that the eye is still doing well. It's still got blood flow. It's making aqueous humor, the kind of the clear blood within the eye. And through functional MRIs and electroretinograms that we can do in the clinic, they have been able to show that there is electrical

Starting point is 00:31:39 activity going to the patient's brain. Unfortunately, he does not have any eyesight or he cannot detect light with it. But I think just this is the first step of showing like, wow, we actually can try this. We can get it so it actually is safe. So it's pretty fascinating. God, it's only going to be a matter of time, isn't it? You said that the eye is complex. I was reading some stats around the eye that blew my mind. The eye contains over 2 million working parts and is considered the second most complex organ in the body. I guess the brain is the first.

Starting point is 00:32:17 The eyeball is really an extension of the brain. The retina in the back of the eye communicates directly through the optic nerve to many parts of the brain. Your eyes are capable of processing 36,000 pieces of information an hour. Your eyes will process 24 million images throughout your lifetime, contributing to 85% of your total knowledge. And there's a common saying that the eye is a window to your soul, showing how the eyes are so expressive that they can reveal a lot about a person's inner state, which we talked about a second ago. It's just crazy that that particular stat around

Starting point is 00:32:50 85% of my total knowledge will basically come from my eye. When you say it, I kind of understand it because, okay, I'm reading, I'm seeing, I'm learning through my eyeballs, but it is cause for protecting our eyes. And the things you've described there, cataracts and these other sort of eye conditions, cataracts in particular, is that something that I can stave off by making better choices with my life?

Starting point is 00:33:15 So people who do smoke, people who drink more, that increases their oxidation. So the cataract formation mostly occurs due to oxidative stress within the eye. In fact, the most vitamin C in the body is within the eye, and it's in a solution that bathes around that lens and helps prevent it from oxidizing. So best things is try not to smoke, drinking not to do too much. The sunlight does play a role in aging of the lens. And so there's epidemiological studies on age-related eye diseases that have found that people who spend more time outdoors without sunlight protection, without wide-brimmed hats, without sunglasses, they are more likely to develop conditions like cataracts.

Starting point is 00:34:09 There's different types of cataracts. There's one specific type of cataract called a cortical cataract that kind of looks like bicycle spokes. If you were looking in the eye like I do in the exam room, you can see these bicycle spokes, and those have been found to be more related to UV light exposure. And then as far as taking supplements, vitamins, those sort of things, because things like vitamin C are a water-soluble vitamin, once you have enough vitamin C in your body, you just urinate out everything else. So there have been studies on people who are malnourished and don't get enough vitamin C that giving them vitamin C can help slow or delay the onset of cataracts. But if you already are getting proper nutrition, taking additional vitamin C is probably not going to delay your onset of cataracts specifically. I learned something from you actually, from your Instagram, which I think is really going to do me a lot of favors because I'm someone that

Starting point is 00:35:09 spends a lot of time on my phone, admittedly. And you alerted me to the fact that there's actually a feature in the iPhone which will help me stave off my myopia potentially. Perhaps. So thankfully, again, the eyeCare community is not the only people who are aware of these issues with using devices up close. But thankfully, whether it be Apple specifically with their iPhone, but also the other phone manufacturers, people who are making these devices now have software that tracks, hey, you're holding this really close to your face. We want you to push it further back. So thankfully, they do have those sort of notifications that people can turn on. I'll admit that I turned mine on for a while

Starting point is 00:35:49 and I eventually got so annoyed with it that I wanted to push it further back. So I kept it on for a while. I eventually took it off. But maybe I'll have to put it back on again just to serve a good example. So it was a feature release in 2023 and it essentially sends you a notification whenever your phone is, is it 12 inches or

Starting point is 00:36:12 something? I don't remember exactly how close it is, but we do know that on average people hold their phones and devices around eight inches away from their face, so pretty close. And it's important to consider moving things further back. And part of that can be because certainly eye strain relationships, possibly myopia, and then even blue light. I know people get really concerned and interested around the blue light world, especially since COVID. That really blew up at that time. But just moving your phone back twice as far will decrease your blue light exposure by a full 75%. So if you're worried about how blue light's affecting you, it's like, just move your phone back a few inches,

Starting point is 00:36:58 and that's automatically going to decrease your blue light exposure from that device. I don't think most people know that this feature even exists because I don't think Apple really ever announced it or did a marketing campaign around it. But in the settings section of your phone or your iPad, et cetera, it's under screen time. And under screen time, there's a button called screen distance.

Starting point is 00:37:17 And it says, to reduce eye strain and risk of myopia in children, screen distance will alert you to hold an iPhone or iPad with Face ID at a recommended distance. And in the small print, it says screen distance works by measuring the distance between the screen and your eyes. The camera is not capturing images or your face, and the data collected remains on the device. So if I click continue, it then says this is how screen distance works. Screen distance encourages you to move your iPhone and iPad further away to support your vision health.

Starting point is 00:37:47 The next section says vision distance or viewing distance. iPhone or iPad should be held at a suggested distance of 30 centimeters from your eyes. Interesting. Those are recommendations, but how many people actually follow that? No one. Yeah, it's tough. I mean, you'll see people do that, and it just gradually over time gets closer and closer.

Starting point is 00:38:11 And kids probably are even worse because they automatically have smaller arms, right? But then they just bring it right up close, right? They want that phone screen to take up all of their visual field. And so I think it's a good habit. I think it's something. Tell. I think it's something... Tell me, have you turned it on? Has it something that you've utilized? I turned it on when I was in preparation for you coming here today. So I didn't know it existed until I was researching you. And so I've had it on for about a day. Frankly, I haven't actually

Starting point is 00:38:38 got the notification yet, but it's not been on long enough, I don't think, for me to have an opinion on it just yet. But you said it was annoying you, so it's definitely been on long enough I don't think for me to have an opinion on it just yet but you said it was annoying you so it's definitely going to annoy me if it annoyed you. So my challenge was that in the evenings I wear contacts most of the time and I take my contact lenses out in the evening and I go back to glasses and sometimes I'll lay I'll like lay down and I'll take my glasses off because I'm so nearsighted I have to see my, I want to see the screen, but I have to hold the screen just a few centimeters in front of my face because I'm that nearsighted. And then it would just give me that warning the whole time. And it delays. It has like a few seconds of a delay once I pull it back before it actually shows me the screen again. So I was doing it so much. I'm like, I know that I should pull the screen

Starting point is 00:39:25 away and I should just take a break. But it was delaying my productivity. So that's why. But again, to set a good example, I'll probably turn it back on and see how it goes. And if you have kids, you can always, you know, they're not probably doing much that's productive. You can always turn it on their devices, I guess. Yeah, I think so. I think it's also a good habit to lead by example for kids and try to be aware of how much time you're spending on your phone in front of your kids because your kids are going to see that and they're going to probably mimic that same behavior. I want to talk to you about bags under my eyes,

Starting point is 00:40:00 a subject that I know a lot of people are interested in. And there's a lot of misconceptions around how we get bags under our eyes. I think most people think bags under their eyes are because they're tired or something. And is there a difference between having bags under my eyes and having sort of dark circles under my eyes? So when it comes to having dark circles under eye bags, dark circles is something that people are definitely concerned about. It's a huge topic online. I see all the time people ask about it in under eye bags. Dark circles is something that people are definitely concerned about. It's a huge topic online. I see all the time. People ask about it in the eye clinic.

Starting point is 00:40:30 Having dark circles under the eyes is technically different than having under eye bags. But if you have under eye bags, it'll make the appearance of dark circles worse. Okay. So dark circles in the clinic, we think first, what's somebody's skin pigmentation like? Is the dark circle just because they have more pigmentation? And if you're somebody who spends a lot of time in the sunlight, you are more likely to develop darker skin complexion around the eyelids. The eyelids are some of the thinnest, most delicate tissue of skin on your body. And in fact, a lot of people who don't know this,

Starting point is 00:41:04 but having skin cancer on your lower eyelid is actually pretty high. So it's good to be wearing either a wide-brim hat or sunglasses to protect the eyes from sunlight damage. The other kind of components is that if you have vascular changes, so myself, I have a really pale complexion. If I have bad allergies, that can cause the blood vessels around my eyelids to dilate. And so you'll see that color of just the blood vessels coming through the skin a lot easier. And then there's orbital shadow effects. Because some people's orbits, they have more prominent brow. it may kind of cast a shadow onto the lower eyelid. And that's where having under eye bags can also make the eyelids seem like they have kind of dark circles because the eyelids are puffy. And you can have puffiness of the eyelids for multiple reasons.

Starting point is 00:42:00 Allergies are a big one. Salt content of the cheer film, and even in your body can make some of those changes. I know for myself, if I have a cheat day and I eat a bunch of greasy, delicious pizza, the next morning I can feel that my skin and my face is maybe a little bit more puffy. Thankfully, that goes away within a few hours, but that's why a lot of times, even just doing cold compresses, right?

Starting point is 00:42:27 You see people put cucumbers on their eyes. A lot of that is more have to do with just the cooling temperature. Doing a cold compress for 10 at max 15 minutes can bring some of that puffiness down, and that can at least help improve the appearance. So if I have a really salty diet the night before, there's a greater probability I'll wake up with bags under my eyes? Possibly. Okay. I've tried to research this to find any real

Starting point is 00:42:51 publications to see if it's really there. And I couldn't find anything. But I know from just my own anecdotal experience that if I eat a really high salt diet, and I've done over the last eight years, I've really done a better job. I know you have too, of like thinking about my diet, how that affects me, how my body feels after I eat something. And so I've noticed if I have a cheat day, that sort of thing can happen. And where does this, what's the sort of physiological rationale for salt playing a role? So your tear film, for example, your tear, like I know some people will say, hey, if I have a, watch a sad movie and I cry at nighttime, the next morning my eyes are super puffy. So your tears have salt in them. And because if you ever cried and tasted your tears, they taste salty, right? So the challenge is that

Starting point is 00:43:41 when you have salt, it'll draw fluid into the tissues. And so if people cry the night before, the salt remaining in the tears basically get into the tear ducts and sit on the surface of the eye and the eyelids, and then that can draw fluid into those tissues. Does hydration play a role? That's also something that's been looked at in research. It's not really conclusive. I think hydration is still something we need to, I do encourage people to at least be aware of their hydration. For dry eye, there is some research that indicates that people who drink more water tend to have less severe symptoms of dry eye. When I see someone with bags under their eyes, I used to think, well, I still kind of do think that it just means that they haven't slept. That, again, I recently did a live stream where I did research first and tried to

Starting point is 00:44:30 look into this. And they have looked at quality of sleep, time of sleep, and both the subjective and objective appearance of dark circles under the eyes. And they find that it is, if you have not been getting good sleep, objectively, your under eye dark circles do the eyes. And they find that it is, if you have not been getting good sleep, objectively, your under eye dark circles do not change. Really? But your subjective appearance of your own image will go down. Ah, okay. So they find that for both sleep and stress.

Starting point is 00:44:59 So you believe that you've got bigger sort of dark circles or patches under your eyes, but objectively, in reality, you haven't. Yeah. Because they can measure the type of light being reflected off the surface of your skin so they can see how much pigment and what type of light is being reflected. And so they've been able to find, oh, that it's purely just your subjective opinion of your own self-image seems worse when you're tired.

Starting point is 00:45:27 What about stress? Because I'm thinking about people that I've seen that have big bags under their eyes, and their eyes kind of look dark. I always assume it's their stress and they haven't been sleeping, but you're saying that that's not accurate necessarily. So at least in the few studies that I've been able to read that were published in the last five years don't seem to find that conclusive. There are other physiological changes that happen when people don't sleep or are under stress, right? Cortisol releases, inflammation in the body will change, hormones can change. So they may all play a role there.

Starting point is 00:46:01 But right now it seems to have a less effect on the true pigmentation of the eyelids. Okay. And the cucumber and the cold compress and all that kind of stuff, does that stuff work in changing the appearance of dark circles and bags and demise? Because when I filmed Dragon's Den, a TV show in the UK, if I sometimes, it's weird because like sometimes when I'm underslept, I come into the studio and the makeup artist, she won't say anything to me, but she'll just put the cucumber on. And I know what she's saying. She's saying you look like shit, but she doesn't say it. So, and it's always when I haven't slept. So I put two and two together and thought, okay, well, she knows that my eyes don't look great today.

Starting point is 00:46:47 But is it actually doing anything, the cucumber? The coolness effect, I believe, is going to be causing constriction of blood vessels. It's going to be helping the tissue come down and swelling. Just like if you bend your knee or elbow really hard on something, it swells. There's a little bit of inflammation. And so putting cold on there can help momentarily, but I wouldn't do it longer than 15 minutes. The reason why is because if you do it longer than 15 minutes, your blood vessels can go the opposite way and cause more inflammation.

Starting point is 00:47:15 There's other things like eye creams. There's a plethora of different eye creams on the market. Some of those do work to help constriction. Some of those are to help truly remove pigmentation. And a lot of those products can have effect, but it takes months to truly remove the pigment. So you're talking, you're using that two, three times a day for like 14, 15 weeks. But outside of that, if somebody's tried all those other avenues, talked with their dermatologist or an eye care provider of any kind, and things still aren't getting better, there are some surgical procedures that can be done to help people with the appearance of under eye bags and some dark circles. What do those surgeries do?

Starting point is 00:48:03 They either use various forms of light or light therapies to help remove pigmentation. You have to be careful around the eyes when it comes to those sort of therapies, but they do exist. And then there's fillers, like they'll do hyaluronic acid fillers to change the shadowing effects around the eye. And then there's forms of what are called a blepharoplasty, which are true eyelid surgeries. And for that, you would want to see an ophthalmologist who specializes in those type of therapies or those type of surgeries. So if I never want to get dark circles, bags under my eyes again, what is the natural, easy solution? I do still encourage good sleep, eating healthy, staying hydrated. I think all of those things are good habits to have because we know they affect the body in so many other ways.

Starting point is 00:48:53 If somebody is truly struggling with it, then you can look at those various creams. But I definitely encourage people talk to a medical provider or whether a dermatologist or an eye care provider who specializes in that area. What about red light therapy? So red light, there's so much in red light. And this is, I'm glad you brought that up because this is something I've been diving kind of headfirst into, into the research for many things in the eyes. With the eye bag specifically, I'll say that there is some newer publications showing that red light therapy can help with depigmentation around the eyelids

Starting point is 00:49:32 and giving the eyelids more of a youthful appearance. I do wage caution, though, because there's a lot of products that are online that offer red light therapy for various reasons, but they're not really standardized very well. And so there are also publications showing people who've had damage to the eyes because they've used these various forms of red light therapies, devices they bought online.

Starting point is 00:50:06 Because what the manufacturer states isn't actually what's being measured when they do it in the research and find out, hey, what type of wavelength is this? How much energy is being produced by the device? Because it's not the specific wavelength. The wavelength is important, but the amount of energy in the red light also is super important. And if you have too much energy, you can go through the eyelid and go into the eye and cause damage. And so I think it's really important. This is still a very early area of research when it comes to the eye.

Starting point is 00:50:37 And so I think I just urge caution to make sure whoever's listening, if you're thinking about red light therapy, you're thinking about getting a red light device specifically for eye care, definitely talk to a specialist who works in that area. Okay. But red light, have you heard much about red light in different areas? I've heard a lot about it. I don't know a huge amount about it. And I have two red light panels at home, which were given to me as a gift um my partner

Starting point is 00:51:08 has when I have one we basically got each other the same Christmas present one year but we we did ask ourselves we sat in front of it one day and said what is this like what does this do in terms of our health and are we allowed to stare at it the devices you come that you got, do they come with goggles? No. Okay. So that is sort of the concern I have is, again, what energy is really not just what wavelengths of light is it emitting, but what's the energy and also how far away from the device are you sitting? What's the recommendations? And specifically with the eye, there is evidence that red light therapy can help with dry eyes, that red light therapy can help with macular degeneration. Which is?

Starting point is 00:51:55 So age-related macular degeneration is one of the leading causes of blindness for older age adults. 50 plus. 50 plus. In fact, if you're over the age of 40 and somebody's legally blind, 50% of them, it's due to macular degeneration. And so probably some of the best research on red light in the eyes is on macular degeneration. In fact, it's currently approved and being used in Europe. It's not approved in the U.S. just yet, but it is going through FDA trials. But that is a form of red light therapy. It doesn't just use red light,

Starting point is 00:52:32 it uses some near infrared light and a little bit of kind of a yellow light. But they shine that in the eye in intervals, and they do it for a few weeks, and then a few months you do it again. And for macular degeneration, they've been able to show that not only can the protein that builds up in the back of the eye in that condition diminish, but they can slow down the progression of macular degeneration, and for some people, even restore eyesight. They can actually help people see better. Using red light therapy.

Starting point is 00:53:03 Using that form of red light therapy. So again, very early research right now. The challenge with all these at-home devices, whether it be for dry eye, whether it be for macular degeneration, there's, again, concern about the power density and about the potential change in temperature within the eye because that could cause damage. There's also red light being utilized and investigated in Asia and in Australia for myopia for children. And so it's something that is really fascinating, and I am looking forward to as more

Starting point is 00:53:48 information comes out. But I personally, when I'm digging into it and trying to understand it, it does make me concerned of how I think there's just not as good a standardization or understanding of really how it works and which devices are safe and which ones are more medically something that you should see a medical provider for. I read in The Nature publication that a 2022 study with 20 participants receiving red light therapy twice a week for three weeks found that they had improved tear reduction. Tear reduction?

Starting point is 00:54:23 And other dry eye symptoms compared to the placebo group. Tear reduction, what does that mean? So dry eye, again, is an area where red light therapy is being utilized in right now. There's several studies on red light on its benefits for dry eye, but the two areas where it's believed to help the most is in helping you produce more of your own natural tears because the red light can shut down inflammation within the tissues and help you produce, basically it helps the cell read more energized. The mitochondria within the cell can be activated by forms of red light. And nitric oxide is also produced, and then you have higher amounts of antioxidants. And so these cellular

Starting point is 00:55:14 components in mice, and then now in humans, they're finding that tear production can be improved. Which helps with dry eyes. Which helps with dry eyes. But then also the red light can help with the meibomian glands in the eyelids. Your eyelids have about 25 to 30 glands, both the bottom and the top part of the eyelid. Can you show me on that? So it's actually in the eyelids, but the eyelids would be... Oh, in front. They're in front, yeah.

Starting point is 00:55:42 So my top eyelids have about 30 meibomian glands in them, and my bottom eyelid has like 25 to 30. And every time you blink, these glands have to release a little bit of oil that prevents your tear film from evaporating. And so there's a lot of implications that go into this, but what happens is as we get older, age is a big factor, but then you also have more we can talk about with device use and the fact that when we're staring at devices, we don't blink as often. And we don't blink as completely when we're staring at a device.

Starting point is 00:56:16 And so for that, along with diet and other inflammatory things, the glands stop producing oil as well. They become inflamed. The oils go from being a clear liquid to being a thick wax. They become yellow, they become cloudy, and they stop releasing oils into your tear film. And so with red light therapy, along with other therapies, but red light has been found to help with getting those oils to produce at least a little bit better. I think the research on red light in meibomian gland dysfunction is still in its infancy. But we have a different form of therapy called IPL or intense pulsed light, which has been even FDA approved for meibomian gland dysfunction in treating dry eye.

Starting point is 00:57:05 Is there any research being done on red light and myopia, i.e. red light and short-sightedness? If I look at those red light panels I have at home, is that going to help with my progressive short-sightedness? So there is research going into red light and myopia. It's being done in children. When it comes to the device you have at home, I have no idea what wavelength that is. I have no idea what power that is. The devices that are being researched and used in research are usually an at-home desk-mounted device that kids will stare into for about three minutes twice a day, morning and then night. And they are showing in those publications that they're able to slow down the rate of progression of myopia. And even for kids who haven't developed myopia, they're able to prevent them from developing myopia, which is really fascinating.

Starting point is 00:57:58 There have been at least, there is at least one study that looked at those devices, and there is some concern that perhaps the power density is too high and could be at risk of causing damage to children's eyes. So again, it's still something heavily in research, and I wouldn't recommend people go and purposely stare into a red light unless their doctor is prescribing it for something. And just because I'm an idiot, the red light is basically stimulating the mitochondria in the cell, which is kind of like the engine in the cell.

Starting point is 00:58:30 And that's making it produce more of the good stuff. Specifically ATP, adenosine triphosphate, which the cell uses for energy. What about gazing at the sun? Because I've been told so many things. When I was younger, it was like, never look at the sun. And then I got older and people are like, no, like stare at the sun. And now I don't know what's true.

Starting point is 00:58:53 Yeah, don't stare at the sun. Even for like a second? Don't. So the challenge is sunlight is good for the eyes, especially early on in the day and, of course, toward the end of the day, just so that you're getting the signals to your brain to, hey, the sun is coming up, the sun is going down, a way to kind of influence your melatonin production. The staring directly into the sun, though, the sun is so powerful, it can very quickly burn holes inside your retina.

Starting point is 00:59:27 And I have a patient right now who she comes in, her vision is not getting to 20-20. We look inside the eye and she has burn holes, a burned hole in her retina that we diagnose as solar retinopathy. And I'm like, have you been staring at the sun? She's like, yeah, I've been sun gazing since I was little. I was in Florida recently, and I stared at the sun. And I was doing this for how many minutes? And now she has permanent blind spots where she cannot see 20-20 anymore. Where in there?

Starting point is 01:00:02 Is that the colored part of the eye? No. So the colored part is the iris, but the light going through the eye is magnified so strongly by the cornea and the lens Inside the eye that ends up focusing on the part of the eye called the fovea or the macula Which is at the back of the it's in the back part of the eye Imagine if we were gonna play darts, we're gonna go to the pub. I'm gonna throw darts the center bull's-eye of the eye, imagine if we were going to play darts. We're going to go to the pub. I'm going to throw darts. The center bullseye of the eye, called the macula, that part is your reason you see so sharply. It's the part of the eye that you're using when you're reading words, when you're studying, when you're looking at your friends and family in the face.

Starting point is 01:00:38 You're using that bullseye in the back of the eye. So when someone looks at the sun, they're putting all of that light energy focused right in that area. And then just a few seconds, you can overwhelm that tissue, causing chemical damage to the retina. Because people, this phrase sun gazing, is this like a spiritual thing? I think I was in Bali and people were like, no, you can, you can sun gaze. You should sun gaze because it's good for you. Sun gazing, what is this term? That is usually in some sort of either religious or spiritual practice, people will gaze toward the sun. Usually, from my understanding, it's people doing it in the early morning

Starting point is 01:01:20 or late afternoon when the sun is largely going down the horizon. And because the light is indirectly being bent, perhaps it's not giving as much energy to cause thermochemical damage to the back of the eye, but there is still a high risk. And so it's always best to not stare directly into the sun or, you know, try to look off center from it. And especially during the high UV times of the day, 10 to 4 p.m. usually, it's good to be wearing UV light protection. Not just because UV can penetrate into the eye, but because UV light damages the skin of the eyelid. It can cause changes to the front surface of the eye. You can get sunburn on the surface of

Starting point is 01:02:02 the eye. Okay, that's good to know. I'm not going to look at the sun. I was being torn because I've got a friend who told me that sun gazing is good for you and you should do it and stuff, but I'll take your word for it. You mentioned blue light a second ago, which is the light that comes off our devices. Is that harmful for my eyes? There's blue light that comes from the sun, really high energy. That could potentially cause aging changes inside the eye. The blue light that comes from your digital screens does not have enough power and has consistently shown in research to not increase the risk of aging eye diseases. It just impacts my sleep potentially. Impacts your sleep.

Starting point is 01:02:43 There's also some claims that blue light can affect your eye strain. But again, research on blue light glasses, on using devices, shows that blue light does not impact eye strain. A lot of people will claim that they will. I have a lot of patients who come in and anecdotally are like, oh, my eyes feel so much better from getting the blue light glasses. And that could just be placebo effect. It could potentially be the fact that a lot of blue light glasses will have anti-glare or glare-free protection put onto it. And the anti-glare

Starting point is 01:03:17 is probably improving their focus and they're not having as much glare issues when staring at the device. But right now there's still just no concrete evidence showing that blue light is contributing to eye strain. But then the sleep cycle, we do know that blue light can influence your sleep. What kind of gadgets do you have? I don't know why, but I assume as someone who is an eye doctor, you must have loads of gadgets around your house that you use to, because you know all of the information about eyes and vision and stuff. Is that, am I wrong? I mean, yeah, I have multiple computer screens open.

Starting point is 01:03:54 I have my phone screen open all day. The other day I was texting a friend. I'm like, I've got two laptops open at a coffee shop. You know, I'm like, I'm doubling down on the blue light here. So there's a lot going on there, but yeah. Or practices. Are there any practices that you've been disciplined with because you're aware

Starting point is 01:04:16 of the impacts it will have on your eye? Specifically on blue light? No, all of it. Just your overall eye health. So the biggest things for myself is diet. Okay. Let's talk about diet then. Sure.

Starting point is 01:04:29 What do I need to know in terms of what I'm eating and drinking to make sure that my eye health stays optimal? So they've been looking at lifestyle factors on aging eye diseases for a long time, many decades. The biggest one thing when it comes to diet, and they even have more recent publications. A mentor of mine, Julie Poteet, she's a past president of the Ocular Well Inertia Nutrition Society, which I'm a member of. She even brought my attention to a publication just this year from the American Journal of Nutrition. They looked at the original publication of AREDS, the Age-Related Eye Disease Study. It has a large cohort of people, like 4,000 people. They watched over nine years tracking their diet, tracking their eye health and how things were changing.

Starting point is 01:05:17 And they find that just eating a Mediterranean diet, green leafy vegetables, oily fish, reduces your risk of developing conditions like macular degeneration, specifically slowing down the progression of that condition. In that specific study, this publication that just came out, they showed that just having 2.7 servings of green leafy vegetables in a week, not a day, but just even a week, right? We're supposed to have more than that in a day, but just 2.7 servings or more can slow down your risk of progression of that condition, macular degeneration, by 25% from going from early to more of an advanced stage. And macular degeneration leads to blindness.

Starting point is 01:05:58 It can, yeah. Especially as we get older. Because that condition, and we can go into it, but that condition has a lot to do with your inflammation. It has to do with metabolism and oxidative stress that occur within the eye. But green leafy vegetables, at least 2.7 servings a week, that's that specific study, they find that oily fish, eating two servings of oily fish a week, slowed it down by 21%. And then they found a synergistic effect for people who ate both. It was a 41% reduced risk of progressing in that disease. So, and that's not just the only study. They find that people who eat diets that have more fruits and vegetables, that have oily fish,

Starting point is 01:06:42 reduced risk of developing conditions like macrogeneration, reduced risk of things like diabetic retinopathy. And so I try to focus on eating a good, healthy diet. I mean, the thing that I heard growing up was that you need to eat lots of carrots, and then carrots will help your vision. So carrots, do you know where that came from? No.

Starting point is 01:07:03 It was propaganda started in the UK by Great Britain. From what I understand, I'm sure there's like a historian out there who's just like grumbling at me. But from what I have read and studied is that I believe it was World War II that Britain had – was being attacked by the Germans. And they were worried about German warplanes dropping bombs on them, especially at nighttime. And they had already established radar to detect warplanes coming, but they didn't want Germany to know that. So they put out their own propaganda saying,

Starting point is 01:07:41 hey, our scouts can detect German warplanes better because they eat their carrots, because carrots have beta carotene, which your body can convert to vitamin A, which is essential for nighttime vision and retinal health. Oh, okay. Because I also used to hear that if you ate carrots, you could see in the dark. Yeah. So it's, I mean, it is based on some, like vitamin A is essential for photoreceptors in the back of the eye, but most people are not vitamin A deficient by far. And so it's pretty rare that we see vitamin A deficiency in the eye clinic, unless you happen to live in a place that's pretty malnourished. You mentioned oily fish. I was on your YouTube channel, and I saw that you did an experiment

Starting point is 01:08:29 where you took omega-3 for 90 days, I guess because there's some kind of implications for vision with omega-3? Omega-3 does play a role in the eyes for two rays. That specific video, I was really looking at omega-3s and its relationship to my own dry eye symptoms because there's a lot of studies looking at omega-3 and its dry eye. And the research is still a bit all over the place. Most eye care providers who specialize in dry eye will say that, you know, there is a role for omega-3s in helping reduce inflammation that contributes to dry eye because a lot of dry eye disease has to do with inflammation. And so there is a large belief that it does work. There are some publications, of course,

Starting point is 01:09:15 that say, no, it doesn't. It's just the same as placebo. And so there's still some debate. But omega-3s also play a huge role in the retina in the back of the eye. The photoreceptors in the back of the eye within the retina, again, this kind of orange-pink tissue in the back, that picks up all the light that you see, the colors that you see. It sends those signals through the optic nerve to the brain. So the retoreceptors, about 50% to 60% of the fatty acid content of the photoreceptor is DHA omega-3. And so there have been, interestingly enough, research showing that diets that have more oily fish, those people are less likely to develop macular degeneration,

Starting point is 01:10:02 and they're less likely to have problems with diabetic retinopathy if they happen to be diabetic. But then a lot of the publications on using omega-3 supplements have not seen the same results in terms of this form of retinal health. And there is some insight. They're thinking they've kind of figured this out. And this is still very early research. So there is a transporter called the MFSD2A. This transporter helps transport specific forms of DHA omega-3

Starting point is 01:10:42 through the blood-brain barrier into neural tissue. And they're finding that that same transporter works with a blood retinal barrier as well. And so newer studies looking mainly at Alzheimer's disease, but they're doing it on mice, and they're formulating a specific type of DHA called lyophospholipid DHA called lyphosopholipid DHA that binds to that transporter and helps that get into neural tissue. And the current research is showing that with mice, at least, I haven't found anything in humans, but at least with mice, that the retinal health is improving. They're having better signals through the retina, as well as less risk of things like retinopathy. So still very early research, but... So the omega-3 that I've got in my cupboard at home is probably not going to help,

Starting point is 01:11:30 but the new versions of omega-3 that they're working on probably will. Might. And the reason why the current omega-3s don't seem to have that effect on the retina is because omega-3 fish oils are in the form of what is called a triacyl glycerol, which your body can convert in the liver to get to neural tissue, but it's not very efficient. Okay. There are some forms of, so if you are eating fish, fish, krill, and then like fish eggs. Do you like sushi? Yeah. So fish eggs are often on sushi, fish roe. Those types of like salmon, I've read it has like up to 1 to 1.7% of these phospholipid type of DHA, so not very much. But krill can be up to about 30%. Fish eggs can be somewhere between 35% up to like 70% of these phospholipid DHAs. And your body

Starting point is 01:12:27 is able to either turn those into triacylglycerol, which is similar to the omega-3 fatty acid supplements, or it can turn that into this lysophospholipid DHA, which your body can transport into neural tissue at a better bioavailability. What did you discover when you started taking omega-3 for 90 days as part of that experiment? So that was, again, looking more at dry eye. Yeah. And specifically, I took, first, I just looked at, hey, what's my blood level of omega-3s right now, just by diet. And it was pretty low at that time. It was like 4.7 or something like that, which you want between 8 and 12 percent. Then I started taking, I also did measurements of my dry eye symptoms. My dry eye symptoms, I took dry eye measurements that we do in the clinic to

Starting point is 01:13:15 diagnose objectively what's going on with the dry eye, the dryness components. And then I took it for 90 days. And then I also tested my blood again at the end. And I found that after taking those omega-3s, that specific formula, that it ended up getting to about 9.5% omega-3. It's like more than 100% increase. So it was a dramatic increase in the omega-3 in my blood, and my dry eye symptoms also improved. Now, again, that's just an N of 1. I'm just one person. There's a lot of,

Starting point is 01:13:50 dry eye is really complicated too. What is dry eye? I don't think I've ever had dry eye. So dry eye disease is a disease of the eye. I think everybody can have symptoms of dry eye, just if you walk outside, you know, it's a windy day, maybe you're sitting around a bonfire or something, smoke hits your eye, your eyes can feel a little dry, you blink a few times. But dry eye disease enters a whole different state. And dry eye disease occurs when not only is there a, it could be a reduced amount of production of tears. It could be that your tears evaporate too quickly. That's a lot of people. And then what happens is that there's a little bit of damage on the surface of the eye because the tear film has to stay stable to protect the tissue underneath. If the tears are gone, the tissue underneath gets exposed to air,

Starting point is 01:14:36 and salt content of your tears ends up going up, what we call hyperosmolarity of the tears. That higher salt content irritates the surface of the cells on the surface of the eye here on the cornea. It then has little micro damage, which your body tries to heal. Inflammatory proteins come out to try and heal that. Now, again, if it's just a small episode, you're walking on the street, wind comes up dry, your body heals it. But if it's a chronic condition, you're dealing with dryness all day long, every day, for weeks, months, the inflammatory proteins never go away. And the inflammatory proteins start signaling your

Starting point is 01:15:16 lacrimal gland to stop producing as much tears. The inflammation prevents your eye from healing. And then the inflammation can cause the oil glands of the eyelids to start to basically cause more irritation and stop producing as well. Is there one food in particular that is, in your view, the top food for good eye health? So green leafy vegetables. What about sweet potatoes? Sweet potatoes can certainly help you with things like vitamin A. They've got other nutrients in them I think are really good. Sweet potatoes technically have beta carotene, right?

Starting point is 01:15:53 Same thing as carrots. If you're deficient in vitamin A, your body will convert that beta carotene to vitamin A, which is good. But mainly in green leafy vegetables, you can not only get things like beta carotene, but you can get lutein and zeaxanthin, which are amazing for eye health in many ways. Not just eye health, but also brain health. What about sugar? What impact does it, because you mentioned diabetes earlier, I think. If I'm having a lot of sugar in my diet, will that have an impact on my eye health? It can. For patients who don't, or for people who are diabetic or have elevated blood sugars,

Starting point is 01:16:32 when you have too much sugar in your blood, it can enter into the eye. It can cause the lens inside the eye to swell. And so with that swelling, you can see a refractive change. Your power of your glasses, contact lenses, that can shift. And so that can sometimes be a tip-off. If you were to see me in the clinic and I noticed your prescription suddenly changed like two steps, I'm like, why is it making this big of a change? It may be a tip-off that, hey, maybe the blood sugar's off.

Starting point is 01:17:00 We have to send you in for like a diabetic workup. Do people with diabetes suffer more with their vision? They can. Diabetes is devastating for the health of the eye. Because with diabetes, when your blood sugar is elevated, it causes damage to the endothelium of the blood vessels and the arteries in the back of the eye. The things at the back of those things there. Yeah, because the back of the eye is one of the most highly vascularized area of your body. Because you have blood vessels, again, on the inside of the retina. You have blood vessels on the backside of the retina. And so

Starting point is 01:17:34 when people have damage to those blood vessels, the vessels can start to hemorrhage. They can start to have little aneurysms. They start to bleed in the back of the eye. And then the function of the retinal tissue is the retinal tissue is not getting the nutrients, the oxygen and the nutrients it needs to stay alive. And so then people's vision can deteriorate. You can have a swelling in the back of the eye in the retinal tissue itself. We call macular edema. And ultimately, if people unfortunately are diabetic, they don't know it, or they're poorly controlled, they can bleed so much in the back of the eye that fibrous scar tissue starts to form, and it can even pull on the retina and create a retinal detachment. Let's pause for a minute and talk about today's sponsor,

Starting point is 01:18:26 Whoop. What do you have planned for the next 31 days? If this month is shaping up to look similar to the last month, I want to challenge you to try something new. This October, Whoop is encouraging all of its members to embrace sobriety. They want you to experience all of the mental and physical changes that come as a result of abstaining for just 31 days from drinking and I firmly firmly firmly believe that this is a good thing I haven't drunk for more than a year now I quit drinking because of whoop I firmly believe in the power of information and the agency it gives you to make better informed choices in your life especially ones around your health so if you're already part of the whoop community keep your eye on the app this month for the Sober October Challenge. If you haven't joined yet, now's a great time to join.

Starting point is 01:19:08 Just head to join.whoop.com slash CEO to start your free trial today. That is join.whoop.com slash CEO. Now is the time to transform your life. Every once in a while, my eyelid starts twitching. What is that? Eyelid myokymia. Is that what it's called? That's the medical definition for it. Twitching eye, I call it. Twitching eye.

Starting point is 01:19:32 Twitching eyelid, like the eyelid starts going... What is that? So that is your threshold of your eyelids to blink, is your level of stress. You're like holding really tight muscles. And so they find, and this is historically, even in textbooks, they call it basically the medical student twitching eye because it's usually people who are stressed out, people who are not sleeping very well, they're fatigued. And then people are drinking way too many stimulants, like drinking

Starting point is 01:20:03 caffeine. So I have a lot of patients who come in, they're like, I'm having my eyelid twitch, and I look over on the counter and they, sure enough, have an energy drink with them. And I'm like, okay. So that is largely what it is. Some people can have a true blepharospasm, where the eyelids close involuntarily. And that's more of an advanced medical condition. So I think if people are having just a little flutter on their eyelids, it's usually not a concern. It's just get more sleep, stop drinking so much caffeine, try to look at your stress levels. And that's a tough thing because even myself, I remember in

Starting point is 01:20:44 college, I remember in college, I remember saying the same thing to my eye doctor. He's like, you're just too stressed. And I'm like, I'm not stressed. I'm doing great. And then I go home and I start making a list of everything I'm trying to control in my life. I'm trying to control this for grades. I'm trying to do this and excel in athletics. I'm trying to do this at home. I'm trying to manage this with my friends. And halfway through, I look at the list. I'm like, whoa, there is so much going on in my life. No wonder I actually am stressed. I've just come so accustomed to it.

Starting point is 01:21:13 I didn't realize it. I haven't been that self-aware. Glycoma. Now, glycoma is something that people over 60 typically get, from what I've understood. Is that preventable at all, or is that just a consequence of aging? And what is glycoma? So glycoma is where the nerve, the nerve in the back here that connects the eyeball to the brain. So this thing here? Yes. So the nerve that all of the retinal cells converge onto the ganglion cells, which are essentially sending the information from the eye to the brain.

Starting point is 01:21:46 And so glaucoma, there's different types of glaucoma, but the nerves die for some reason. So the nerves at the back here? Mm-hmm. Okay. Those nerves go send the information back toward the brain so that you can see. The challenge is that that nerve, if it gets damaged, the nerves die off. And when they die, you can't get them back. So glaucoma, again, there's different types of them. The most common one that people think about is what's called primary open angle glaucoma.

Starting point is 01:22:21 And this is where pressure inside of the eye builds up. And if you think of a bike tire, if you fill that full of air and it gets to a point where it's so filled, the weakest part of the bike tire blows out. And that basically happens with the eye. But the weakest part of the eye is the nerve in the back. So that increased pressure pushes on the nerve and slowly pinches it, each of the ganglion cells, to a point where it starts to die off. That's not reversible, is it? Unfortunately, no. It doesn't sound reversible.

Starting point is 01:22:56 When you lose the ganglion cells, they die. We know that pressure plays a role in it, the internal pressure of the eye. And so most treatments right now for glaucoma are focused on treating the pressure. But more publications and research right now are also going into how do we better support the health of the nerve in the back, whether that be through blood flow. Is it better for us to have some sort of nutrients getting to the optic nerve to give it more of a robust health and structure to withstand the pressure. So there's more research going into it. And the other thing that I heard about when I was researching your work is this term eye floaters. I'd never heard about this before.

Starting point is 01:23:38 What is an eye floater? So floaters inside the eye are... so many people have these issues. And do you see them at all? Do you see little black specks when you look left and right? Do you see little things? Probably... I'm going to say that maybe sometimes, but I can't recall a time. As we get older, floaters do naturally start to occur. These are the gel inside the eye called the vitreous, the vitreous humor. So opening up the eye again, this large area that holds the shape of the eye, this is the vitreous humor. And it's mostly water,

Starting point is 01:24:16 collagen, and a little bit of hyaluronic acid, but it's like a jelly. But as we get older, this gel starts to break down and the collagen begins to clump. And it sits there suspended in whatever's gel or fluids left. And so when people go outside, it's a bright sunny day. They look at the computer screen. It's a bright backlight. They'll see these little specks floating around. And they'll shift their eyes left and right and you'll see it continue to drift.

Starting point is 01:24:43 And it gets really annoying. It's like looking at a gnat or a little bug flying around. And really what's happening is the light is just hitting those collagen clumps, it's casting a shadow on the retina and you see those floating spots. The concern is that some people develop suddenly a whole bunch of floaters. And if you have a whole bunch of floaters, that could be because the gel, which is attached to the retina in the back of the eye,

Starting point is 01:25:10 that gel can tug on the retina and create a small tear, or it can create a full detachment of the retina. It can pull the retina off from the back of the eye. Usually, though, if you ever have symptoms of a flash of light, like a lightning bolt is going off somewhere in your vision that no one else saw, or you're having a dark shadow coming down from the top of your vision or rising up from the floor or from the side, that would be an indication that perhaps a sudden change has happened and you should see a doctor as soon as possible. But otherwise, the development of those small little floating spots, those

Starting point is 01:25:50 gradually occur with age. And is there a way to treat them? So there are two surgical procedures to try to get rid of them. However, most surgeons won't want to do them because there's always a higher risk of causing damage or other complications in the eye. How many people are likely to experience these eye floaters in their lifetime? Basically, every decade of life, you gain another 10% chance of having these floaters. Okay, so most people. Yeah, by the time you're 80 years old, you have an 80% chance of having these floaters. Most people that I see coming in because of a complaint of floaters are usually in their 40s, 50s. I've heard you talk

Starting point is 01:26:30 about pineapple helping to cure floaters. So there is a study that came out several years ago that looked at using a type of supplement called bromelain, and that's found in pineapple. And that was a study that looked to see if people eating pineapple could reduce their floaters. That study was not the best study ever done. They did—it was kind of a—I think it makes me excited that at least there's researchers looking into, hey, is there a way we can get rid of these floaters? Because they can be really annoying. If they're really large, they can obstruct people's vision. A more recent publication from 2021 looked at a different formulation of different enzymes and vitamin supplements that include vitamin C, L-lysine, zinc, these can help preventing the glycation of collagen,

Starting point is 01:27:30 and specifically within the vitreous of the eye. And they did find after six months of supplementation that people's symptoms of floaters reduced. It's only one study, and I want to see more. But that right now is probably the only supplement on the market that has probably the best research behind it, being it was a placebo-controlled trial. The pineapple study was in 2019 in the Journal of American Science. And the study said that people who had three slices of pineapple a day had a 75% eye floater improvement. But you're saying that that study was not super robust? The medical community, the eye care community,

Starting point is 01:28:06 we don't look at that with having the most scientific validity. We do want to see more research in that area. Anecdotally, I've had people certainly message me on email and on YouTube and on Instagram saying that it did help them, but it's hard to say if it's truly placebo or not I think it's helpful, I get my doses at one and one half, yeah I just one day saw it

Starting point is 01:28:34 come in what you need to do is get the pineapple what is it there, do you have it constantly I remember one day I came in and I was really freaked out didn't know what it was I thought I was getting some sort of disease or something, I came in and it really freaked me out. I didn't know what it was. I thought I was getting some sort of disease or something. I went

Starting point is 01:28:47 online and it was quite normal. But yeah, I came in and it had come and I kind of shifted around. I kind of looked at it and like shifted around by looking in a certain direction. But it's not there all the time. It just all suddenly just drifted into my side. I think if somebody even,

Starting point is 01:29:03 especially for anybody who's having floaters or seeing a spot like that, I think it's still really important to have it evaluated because there is a chance, it's not a huge chance, but it's like a 5% that you could have a small tear or a hole in the far edge of the eye when the gel separated.

Starting point is 01:29:20 And in those cases, then if it's needed, they can use a laser to just zap it and tack it down so that you don't develop a retinal detachment because if you get a retinal detachment it's an urgent procedure where they need to repair the retina and get it back into place because it can otherwise lead to permanent vision loss you know when you get something in your eye and it gets annoying i had it the other day when i was in bed in L.A. I had something in my eye and I could just feel it.

Starting point is 01:29:50 And, you know, you look in the mirror and you can't see it and someone tries to blow in your eye and get it out and that doesn't work either. And you can feel it for maybe like 30 minutes, an hour. What's the best thing to do in that situation to get rid of that feeling, in your opinion? And is it like a hallucination? Because I can't see anything there.

Starting point is 01:30:07 So the eyeball, it has some of the most nerve endings on your body. So even just something small, a piece of dust gets on your tear film, you can feel that and it can really irritate the eyes. Some of the easiest things to do are using eye drops. You know, get even just over-the-counter eye drops, using those to rinse the eye. If somebody gets a chemical in the eye, then you really want to rinse the eye really good with just even tap water. You want to get water to flush it out. You know, if some, you know, obviously you're at a workplace, they have wash stations for those sort of things.

Starting point is 01:30:40 So that's going to be the most important. If the eye remains red, irritated, the body will produce more mucus to try and fix the problem. And so a lot of people, if you get a little irritation, it just never seems to go away. It's because somehow there's inflammation developing on the surface. Your body's producing more mucus. Your body can sense that there's more swelling there. So the best thing to do is rinse it out and go see the eye doctor, especially if it's not getting better. So how often do you think I should get my eyes tested? Yearly. Every year? You should. I say that because they've had multidisciplinary

Starting point is 01:31:17 of different eye care professionals, not just eye care, but different medical professionals in different fields look at the statistics. And again, it's the fact that it is one of the easiest, least invasive medical procedures you can do to detect the most medical conditions that can potentially prevent you from having more serious comorbidities later in life. Dr. Joseph, what's the most important thing we didn't talk about that maybe we should have talked about today? I think probably one of the biggest things that I personally really like to reflect on,

Starting point is 01:31:58 we've touched on diet a little bit, but I think diet and lifestyle, paying attention to how much, not only what you eat, how much you eat, exercise, sleep, hydration, focusing on these sort of things can have a ripple effect on the eyeball, but so many other parts of the body. And the eyes are an extension of your brain. And what's good for the eyes is also good for the heart. It's also good for your brain. And so I think we need to be really aware of that and how important the eyes are for your learning, for your development, for your risk. If you have poor vision, your risk of developing dementia and Alzheimer's in later years is greater. That vision and eyesight is really important for the development for children and their minds.

Starting point is 01:32:51 And so we need to be aware of how all of that is connected and how our lifestyles on devices all the time and being indoors so much can also have an impact. So seeing an eye doctor on a regular basis is really important, even if you feel like your vision is great and you see fine. You don't want to lose that. We have a closing tradition on this podcast where the last guest leaves a question for the next guest not knowing who they're going to be leaving it for. And the question that has been left for you is, what is your most important early memory that you've ever had, ever? One that does impact me on a regular basis is just making friends.

Starting point is 01:33:43 When I was a kid, I didn't have many friends. And I remember finally making friends from sports and just having people over to play, have sleepovers, and finally feeling like I had companionship of some kind, I think it kind of proved that I was, that I mattered, that I had value. It was just, or being seen, being that I had a role in this world beyond just me being on my own did your childhood tell you otherwise

Starting point is 01:34:31 i have a memory that i've shared mainly with my therapist where i was in trouble i was grounded to my bedroom i didn't feel safe leaving my bedroom because my older brother bullied me at that age. And I felt that I course of my life, that feeling that I needed to perform, excel, was the only way for me to get attention to prove that I had value and worth. And so I think that's driven me to excel in academics,

Starting point is 01:35:37 to excel in extracurriculars. It was a very subconscious thing, something I was not aware of. And I only recently in the last year have come more to terms with those early experiences in my life and how they maybe have driven me. And it goes through a lot of work to reflect on those experiences and make friends with that part of your life and come to terms that like, no, I've grown up. I do matter. I do bring value. I am worthy of friendship and love. Those are tough, real things that I think internally we battle and sometimes don't even realize it. How much of that early experience inspired you to pursue the line of work that you do? Now, I know that you said it pushed you to excel, but specifically,

Starting point is 01:36:35 focusing on the eyes. Somewhat connected. When I was a kid, again, I was lonely. I was an indoors kid. I played a lot of video games, watched movies. My brother, he was the fisherman outdoors kid. When I turned 13, entering into junior high, my mother wanted me to pick a sport. And so I did the manly thing. I want to play football. You know, American football, I'm going to tackle people. It's hard to play tackle football with thick glasses on.

Starting point is 01:37:07 You had thick glasses. I was a nerdy kid. Sat inside all day. Again, I was inside, had thick glasses because I was myopic. I went to the eye doctor, got fit for contacts. And being fit in contacts changed me because suddenly I could play sports, making friends for the first time in a long time, to having self-confidence because of that. And having that level of self-confidence, I started to attract the attention of the opposite sex. Girls start paying attention to me. And at age 13, that was like the most important thing in the world.

Starting point is 01:37:51 And so continuing to grow up, I was always fascinated with eyes, with contact lenses. And I knew in later high school when people were like, hey, what are you going to do when you grow up? What are you going to do for college? I'm like, I don't really know. But when I see the dentist, I don't like that guy. He pokes and prods and makes my gums bleed. But when I see the eye doctor, that guy's cool. Every part of the eye exam is like black magic. I thought, you know what? I could be that guy. And so that definitely influenced my, that amazing experience

Starting point is 01:38:26 influenced me. And I think most eye doctors have some experience like that where their life was changed by what an amazing eye doctor they had before. And they just want to pass that on. I want to help people have an amazing experience with their eyesight and experience the world and have more freedom in their life to pursue education, to experience and see just the beauty of color, nature, really to experience the world. And so I really want to just give that as a gift to as many people as I can. And I guess the confidence that it gives those people as well, as it did for you at a young age, isn't to be underrated. Well, thank God you did, because, you know, you've helped many millions of people with a wide variety of eye-related issues and

Starting point is 01:39:17 conditions and helping them understand both the more superficial elements of their eyes, but also the more sort of deeper progressive diseases that might risk taking away their freedom in the way that you've described just there. But I just want to say a big thank you for, let me think of a nice eye-related pun, allowing me to see more clearly as it relates to the subject of eye health and vision and everything that's interconnected.

Starting point is 01:39:44 So thank you so much, Joseph. Thank you, Stephen. Appreciate you, man. This is great. I don't know how to say this in a way that you're going to understand, but Perfect Ted is banging. I'm an investor in the company.

Starting point is 01:39:58 I drink here every day. The whole team drinks Perfect Ted every day. We have a Perfect Ted fridge in the office. Here's why I like Perfect Ted. Typical energy drinks used to give me these crashes. And as a podcaster, the last thing you want to do is be crashing in a conversation.

Starting point is 01:40:09 The founders of Perfect Ted wanted to create an energy drink that wouldn't create that horrible crash cycle that many of us go through. So they used matcha as the energy source. And somehow they also made it really, really delicious. They've just come out with this new flavor called Juicy Peach.

Starting point is 01:40:22 And it is banging. If you try Perfect Ted's Juicy Peach and it's not banging, feel free to get in my DMs and cuss me out. You can pick it up at Tesco's or Waitrose or you can get it online. And here's a secret that you've got to keep to yourself. I'm going to give you 40% off Perfect Ted just so you can try Juicy Peach yourself. Go to perfectted.com and at checkout put in the code DIARY40. I'm going to leave that up for some time, not forever. That's perfectted.com and then use code DIARY40 at checkout. in the code diary40. I'm going to leave that up for some time, not forever. That's perfectted.com and then use code diary40 at checkout. When you try it, make sure you tag me on Instagram and say, Steve, you were right. It's banging. Thank you.

The Diary Of A CEO with Steven Bartlett - The No.1 Eye Doctor: They’re Lying To You About Blue Light! The Truth About Floaters! Turn This Phone Setting On To Save Your Eyes!

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