How important is early correction for misaligned eyes or amblyopia in children?

Early correction of eye misalignment (strabismus) or amblyopia ('lazy eye') is critical. If left uncorrected, the brain may permanently ignore the weaker eye, leading to irreversible vision loss or poor depth perception. Interventions typically performed before ages 3-9, and sometimes into young teens, can retrain the weaker eye and realign muscles.

Does too much screen time cause nearsightedness in children?

While for decades, too much 'near work' was linked to nearsightedness, recent exciting studies suggest that the type of light exposure is more critical. Children spending more time outdoors, even if reading, appear to have less progression of nearsightedness compared to those spending more time indoors under artificial light. It's recommended to encourage children to spend time outdoors for broader spectrum light exposure.

What are common risks for eye injuries, and how can they be prevented?

Eye injuries are a significant concern, especially in professions like metal grinding or even during gardening, where debris or fungus can enter the eye. Prevention involves wearing appropriate eye protection such as safety goggles, especially during activities that could cause projectiles or splashes, as eyes are delicate and prone to inflammation and permanent damage.

What is proper eye hygiene for adults?

For most people, tears and blinking keep the eye surface clean, making regular eyewashing unnecessary. However, eyelids and lashes can accumulate dead skin or experience inflammation (blepharitis). For this, light scrubs with dilute 'No More Tears' baby shampoo or specialized eyelid wipes are recommended. For foreign objects, use sterile saline or preservative-free artificial tears to rinse. Occasional eye rubbing is fine but excessive rubbing can be harmful.

What is presbyopia, and should I resist using reading glasses?

Presbyopia is the age-related stiffening of the eye's internal lens, typically starting around age 40, which makes shifting focus from distance to near difficult. While some data on delaying the use of readers is mixed, Dr. Goldberg recommends using them for optimal vision and comfort. Consistently clear vision benefits the retina and brain, and progression of presbyopia is largely fixed and minimally influenced by avoiding readers.

What are the advantages and disadvantages of contact lenses?

Contact lenses can offer superior vision correction quality compared to glasses, especially for higher-order aberrations. However, they can alter tear dynamics and oxygen diffusion, decreasing comfort with age. Risks include severe corneal infections if not cleaned properly or if slept in. Daily disposable lenses are safer, though more expensive, reducing the burden of cleaning.

What's the difference between UV blocking and blue light blocking in glasses?

UV light blocking in glasses is highly recommended and standard, as UV light accelerates cataract formation and can damage the retina. Blue light blocking, however, is a different concept; there's no clear evidence it's helpful and may interfere with circadian rhythm. Most car glass also filters UV light, explaining why transition lenses don't darken in a car.

What causes floaters and eye twitching, and what should be done about them?

Floaters are common as the eye's internal jelly shrinks with age, creating small tissue bits or concretions that cast shadows. They are usually harmless and often resolve or become unnoticeable with time. Eyelid twitching is typically caused by a temporary nerve irregularity and is benign, resolving over a few months. Chronic severe spasms might be treated with Botox, but occasional twitches don't indicate future problems.

Are nutritional supplements effective for eye health?

Yes, with strong clinical trial evidence. The AREDS2 formula (Vitamins C, E, zinc, copper, lutein, zeaxanthin) significantly slows the progression of moderate to severe dry macular degeneration. High-dose Vitamin B3 (nicotinamide) is also showing promising results in clinical trials for glaucoma, helping to protect the optic nerve. However, many other 'eye health' supplements lack rigorous data and should be approached with caution.

Can the eye be used to detect other brain diseases like Alzheimer's or Parkinson's?

Yes, the eye is often called a 'window to the brain.' Early degeneration of the retina and optic nerve is correlated with neurodegenerative diseases like Alzheimer's, Parkinson's, and MS. Advanced imaging techniques can detect these changes, offering a potential non-invasive diagnostic and monitoring tool. Research is ongoing to improve specificity to differentiate between diseases.

What are the main causes of irreversible vision loss worldwide?

After correctable refractive error (needing glasses) and cataracts (surgical solution), the leading causes of irreversible vision loss are glaucoma, age-related macular degeneration, and diabetic retinopathy. These conditions involve degeneration of the optic nerve or retina and often require early detection and ongoing management to slow progression.

What is the recommended screening and treatment for glaucoma?

Regular, comprehensive eye exams are crucial for glaucoma screening, as high eye pressure often has no symptoms. Lowering eye pressure, whether initially high or normal, is the primary treatment through eye drops, laser procedures (like SLT), or surgery. Lifestyle factors like avoiding smoking and managing cardiovascular health also contribute to prevention.

How can diabetic retinopathy be prevented or treated?

Diabetic retinopathy is a major complication of diabetes, causing damage to retinal blood vessels. Prevention hinges on rigorous control of blood sugar (measured by HbA1c) and blood pressure. Regular annual eye exams for diabetics are essential for early detection. Treatments include injectable drugs to manage leaky blood vessels and new blood vessel growth.

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How to Improve Your Eye Health & Offset Vision Loss | Dr. Jeffrey Goldberg

Andrew Huberman

Science & Technology7 min read189 min video

Jun 26, 2023|4,650,331 views|40,429|1,558

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TL;DR

Dr. Jeffrey Goldberg discusses comprehensive eye health, from childhood exams to cutting-edge treatments for vision loss.

Key Insights

Regular eye exams from infancy are crucial for early detection of eye diseases like retinoblastoma, amblyopia, strabismus, and glaucoma, which are often asymptomatic until late stages.

Spending time outdoors and exposure to full-spectrum sunlight can help prevent myopia (nearsightedness) in children, highlighting the importance of balancing near-work with outdoor activity.

Eye safety, including protective eyewear during hazardous activities and proper contact lens hygiene, is essential to prevent eye trauma and infections.

Presbyopia, or age-related difficulty with near vision, is universal, and while readers are helpful, maintaining eye muscle flexibility may slow its progression; however, providing the retina and brain with clear signals is paramount.

Major causes of irreversible vision loss in adults include glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy, all of which benefit from early detection and consistent management.

Emerging therapies like high-dose Vitamin B3 for glaucoma and red/near-infrared light therapy for AMD show promise, alongside the established ARDS2 supplement formula for dry AMD.

THE IMPORTANCE OF EARLY AND REGULAR EYE EXAMS

Eye health begins at birth with a crucial 'red reflex' test to screen for serious conditions like retinoblastoma. Throughout childhood, regular screenings are vital, especially for conditions like amblyopia (lazy eye) or strabismus (eye misalignment), which if uncorrected, can lead to permanent vision loss due to brain plasticity. Early intervention, ideally before the teen years, significantly improves outcomes. For adults, routine eye exams are essential to detect asymptomatic conditions like glaucoma, where high eye pressure can damage the optic nerve without noticeable symptoms. Annual screenings ensure conditions are caught and managed promptly.

ENVIRONMENTAL FACTORS AND MYOPIA PREVENTION

The environment plays a significant role in visual development. Excessive near-work, common with screens, can contribute to eyeball lengthening, leading to myopia (nearsightedness). Emerging research strongly suggests that spending time outdoors in full-spectrum sunlight is a key preventative measure against myopia progression in children. While specific outdoor time thresholds are still being studied, the consensus points to a dose-dependent benefit. This effect is likely due to the unique light spectrum outdoors, regardless of whether near activities are performed, promoting healthy eye development and potentially offsetting excessive near-focusing indoors.

EYE SAFETY AND HYGIENE ACROSS THE LIFESPAN

Eye safety is a critical, often overlooked aspect of eye health. Wearing protective eyewear during activities like gardening, metal grinding, or woodworking is crucial to prevent trauma. The eye's delicate structures, including the cornea and retina, are susceptible to inflammation and permanent damage from injury. Regarding hygiene, tears naturally keep the eye surface clean, but eyelids and lashes can accumulate debris, leading to blepharitis. Gentle cleaning with diluted baby shampoo can help. For foreign objects, sterile saline or artificial tears are recommended over aggressive rubbing, which can cause micro-abrasions and exacerbate irritation.

UNDERSTANDING CORRECTIVE LENSES: GLASSES VS. CONTACTS

Corrective lenses address various refractive errors. Presbyopia, the age-related hardening of the eye's lens, typically necessitates reading glasses around age 40. While it's debated if using readers accelerates dependence, prioritizing clear vision for comfort and reduced eye strain is generally recommended. Contact lenses offer superior visual quality for many, correcting higher-order aberrations that glasses cannot. However, contact lens use demands strict hygiene to prevent severe corneal infections, with daily disposables offering the safest option due to reduced cleaning requirements and oxygen exposure concerns, especially during overnight wear or with aging eyes.

THE IMPACT OF LIGHT: UV, BLUE LIGHT, AND PHOTO THERAPIES

UV light is detrimental to eye health, accelerating cataract formation and potentially damaging the retina. Most modern eyeglasses and car windshields filter UV, and sunglasses or brimmed hats are recommended for outdoor sun exposure. Blue light blocking, especially during the day, lacks strong scientific support and may interfere with circadian rhythms. Conversely, specific red and near-infrared light therapies show promise for neuroprotection in age-related macular degeneration and could reduce myopia progression. While research is ongoing to define optimal protocols, these non-invasive phototherapies represent an exciting frontier in eye care, potentially mimicking benefits seen from natural outdoor ambient light.

LASIK SURGERY: ADVANTAGES AND CONSIDERATIONS

LASIK is a highly advanced surgical procedure that reshapes the cornea using a laser to correct refractive errors, often achieving vision better than 20/20. Benefits include freedom from glasses and contacts, particularly appealing to athletes or those with severe prescriptions. The technology, especially wavefront-guided LASIK, offers precise, individualized corrections. However, it's not ideal for everyone. Patients with pre-existing dry eye may experience exacerbation of symptoms. It's generally contraindicated for children and young adults whose vision is still changing, as stable prescription for several years is crucial for long-term success of the procedure, which can last for decades.

DRY EYE SYNDROME: CAUSES AND MANAGEMENT

Dry eye is the most prevalent eye condition, characterized by insufficient tear quantity or quality, affecting millions. Tears consist of a saltwater component (from lacrimal glands) and essential oils (from meibomian glands in the eyelids), which prevent evaporation. Aging, screen use (leading to reduced blinking), and environmental factors like allergies contribute to dry eye. While artificial tears address the saltwater deficit, effective replacement or rejuvenation of the oily tear component remains an unmet need. Preservative-free artificial tears are recommended for frequent use to avoid irritation from preservatives. Advanced cases might benefit from serum tears, derived from a patient's own blood serum, rich in growth factors.

MAJOR CAUSES OF IRREVERSIBLE VISION LOSS: GLAUCOMA

Glaucoma is the leading cause of irreversible blindness worldwide, a neurodegenerative disease affecting the optic nerve. It's often asymptomatic, silently degrading peripheral vision first. Risk factors include increasing age and high eye pressure. Early detection via comprehensive eye exams, including pressure checks and optic nerve head examination, is critical. Treatment focuses on lowering eye pressure through eye drops, laser therapy (like selective laser trabeculoplasty), or surgery, even in cases of normal-pressure glaucoma, as a sustained reduction slows disease progression. Adherence to treatment is vital despite the lack of immediate symptomatic relief.

MAJOR CAUSES OF IRREVERSIBLE VISION LOSS: MACULAR DEGENERATION (AMD) AND DIABETIC RETINOPATHY

Age-related macular degeneration (AMD) is a common cause of vision loss in older adults, particularly Caucasians. It targets the macula, responsible for central and color vision. Dry AMD involves slow degeneration of photoreceptors and support cells, while wet AMD, a more acute form, is characterized by leaky new blood vessel growth. Treatments for wet AMD include anti-VEGF injections, which have revolutionized care. Exciting new treatments for dry AMD are emerging, showing promise in slowing progression. Diabetic retinopathy, a complication of diabetes, also damages the retina through leaky and new blood vessels. Strict control of blood sugar and blood pressure, along with annual eye exams, are crucial for prevention and management.

NUTRITION AND SUPPLEMENTATION FOR EYE HEALTH

Opthalmology has a strong history of rigorous clinical trials for nutritional supplements. The AREDS2 formula (Vitamin C, E, zinc, copper, lutein, and zeaxanthin) is a proven recommendation for individuals with moderate to severe dry age-related macular degeneration, shown to slow disease progression. High-dose Vitamin B3 (nicotinic acid or nicotinamide), a known NAD+ precursor, is currently undergoing large-scale clinical trials for its neuroprotective potential in glaucoma, with early results suggesting improved retinal function. Other supplements like Ginkgo biloba lack robust evidence for eye health benefits, and patients are cautioned against unproven therapies, especially if they deter adherence to established treatments.

FLOATERS AND EYE TWITCHING: COMMON CONCERNS

Floaters are common, especially with age, and result from the natural shrinkage of the eye's vitreous jelly, causing collagen fibers and tissue bits to become visible. While often frustrating, they are usually harmless and tend to diminish over time as the brain learns to filter them out. Surgical intervention to remove floaters carries risks and is generally not recommended. Eyelid twitching, or myokymia, is typically caused by a minor nerve fiber misfiring, often exacerbated by fatigue or stress. Most twitches resolve spontaneously within a few months and don't indicate serious underlying conditions. For persistent, severe spasms (blepharospasm), treatments like Botox injections can be effective.

THE EYE AS A WINDOW TO BRAIN HEALTH

The eye, a direct outgrowth of the brain, offers a unique, non-invasive window into neural health. Advanced retinal imaging can detect subtle degenerations associated with brain diseases like Alzheimer's, Parkinson's, and Multiple Sclerosis. While current retinal markers may not always differentiate specific neurodegenerative diseases with high specificity, they offer invaluable insights into disease presence and progression. Groundbreaking research using cellular and subcellular imaging of the retina is uncovering novel structural changes, such as those found in MS patients, which could lead to a new generation of highly specific biomarkers for early diagnosis, tracking, and personalized treatment of neurodegenerative conditions, advancing the field of

Mentioned in This Episode

●Supplements

●Products

●Software & Apps

●Companies

●Organizations

●Studies Cited

●Concepts

●People Referenced

Eye Health & Vision Care Checklist

Practical takeaways from this episode

Do This

Ensure all babies receive a red reflex eye exam at birth.

Encourage children to spend time outdoors daily to reduce myopia risk.

Wear safety glasses or goggles for gardening, metal work, or wood shop to prevent eye trauma.

Clean eyelids and eyelashes with dilute No More Tears baby shampoo or specialized scrubs for blepharitis.

Use sterile saline solution or preservative-free artificial tears to flush eyes if a foreign object enters.

Get regular comprehensive adult eye exams, especially after age 40, to screen for glaucoma and presbyopia.

For presbyopia, use reading glasses (readers) as needed to ensure comfortable clear vision.

For contact lens wearers, prioritize daily disposable lenses or maintain strict cleaning protocols for reusable ones.

Remove contact lenses overnight to reduce infection risk.

Wear sunglasses and broad-brimmed hats outdoors for UV protection, especially when the sun is high.

If you have diabetes, get at least annual comprehensive retinal exams.

Control blood sugar (HbA1c) and blood pressure to prevent diabetic retinopathy.

If diagnosed with glaucoma, consistently use prescribed eye drops or consider laser treatment (SLT) as directed to lower eye pressure.

Consider high-dose Vitamin B3 (nicotinamide) supplementation for glaucoma, in consultation with your ophthalmologist, especially in advanced cases.

Sleep with your head elevated (e.g., on a couple of pillows at a 30° angle) if you have severe glaucoma and can tolerate it, to reduce nighttime eye pressure.

Avoid This

Ignore any signs of eye misalignment in children; seek early correction.

Over-rub your eyes excessively, as it can be detrimental in certain conditions.

Rely on prisms as a sole correction for eye misalignment in children; prioritize exercises to yoke eyes straight.

Assume good vision means healthy eyes, as conditions like glaucoma can damage peripheral vision without symptoms.

Smoke or vape nicotine, as it is a major risk factor for macular degeneration and glaucoma progression.

Rely solely on cannabis to lower eye pressure for glaucoma, as its effects are temporary and smoking carries other risks.

Self-diagnose or self-treat serious eye conditions with unproven supplements or therapies without consulting an eye care professional.

Common Questions

Every baby should have an eye exam at birth, typically checking for a 'red reflex.' A normal red reflex indicates healthy retina reflection, while a whitish or gray reflex could signal serious conditions like retinoblastoma. Typically, only a pediatrician's check is needed through early childhood unless specific symptoms arise.

Topics

Health & Longevity Neuroscience & the Brain Eye Health Light Therapy Nutritional Supplements Medicine & Clinical Vision Correction Cataract Surgery Pediatric Eye Care Adult Eye Care Diabetic Retinopathy Nearsightedness Prevention Dry Eye Treatment Eye Safety

Mentioned in this video

Concepts

Glaucoma

A neurodegenerative disease of the optic nerve, a leading cause of irreversible vision loss, often associated with increased eye pressure and aging.

Strabismus

A condition where eye muscles and brain control fail to keep both eyes looking straight ahead, leading to images falling on different parts of the retina; can cause amblyopia if not corrected early.

macular degeneration

A common age-related disease causing degeneration of the light-collecting cells (rods and cones) and their support cells (RPE) in the macula, leading to vision loss.

Nystagmus

Rapid, flickering, alternating eye movements in babies that, if noticed by parents, should trigger an eye exam.

Presbyopia

Age-related stiffening of the eye's internal lens, which gradually diminishes the ability to focus on near objects and typically starts around age 40.

myopia

A condition where the eyeball lengthens, causing the visual image to fall in front of the retina, making distant objects blurry. Sunlight exposure can help prevent or reverse it in children.

amblyopia

A condition where strong connections from one eye to the brain fail to develop fully due to unequal vision or misalignment, often correctable if intervened early in childhood or even young teens.

Retinitis Pigmentosa

An inherited form of macular degeneration affecting photoreceptor cells and support cells in the retina, leading to early vision loss.

Cataracts

Occlusions a blurring of the lens inside the eye, typically due to aging or UV exposure, which can block vision but is treatable with surgery.

Latent Hyperopia

A condition where the eye's optical system is naturally focused beyond infinity, requiring constant muscle strain to achieve distant focus, often revealing itself as fatigue in dim light or with age.

Dry Eye

A very common eye disease where tear quantity or quality is deficient, causing discomfort, irritation, and potential vision interference. Untreated dry eye is a major unmet need in ophthalmology.

Retinoblastoma

The most common pediatric eye cancer, thankfully rare, which can be screened for in newborns by checking for a white or gray reflex instead of a red reflex.

Critical Period Plasticity

A period during early development when the brain is highly plastic and can form strong connections. In the visual system, correcting issues like amblyopia during this period is crucial for full visual recovery.

Products

Maui Nui Venison

A sponsor of the podcast, offering nutrient-dense venison protein products like bone broth, ground venison, and steaks.

LASIK surgery

A surgical procedure that reshapes the cornea using a laser to correct refractive errors, often resulting in better than 20/20 vision.

Companies

Eight Sleep

A sponsor offering smart mattress covers with cooling, heating, and sleep tracking capabilities to optimize sleep temperature.

Athletic Greens

A vitamin, mineral, and probiotic drink covering foundational nutritional needs, used by Dr. Huberman since 2012 for gut health and overall nutrition.

InsideTracker

A personalized nutrition platform that analyzes blood and DNA data to provide insights and recommend interventions for health goals.

LMNT

An electrolyte drink offering sodium, magnesium, and potassium without sugar, important for proper cellular and neuronal function.

Drugs & Medications

Botox

A treatment for blepharospasm and chronic muscle spasms, in which it prevents certain nerves from causing specific muscles to spasm.

People

Andrew Huberman

Host of the Huberman Lab podcast and Professor of Neurobiology and Ophthalmology at Stanford School of Medicine.

Jeffrey Goldberg

Guest on the podcast, Chair of the Department of Ophthalmology at Stanford University School of Medicine, clinician, MD, and PhD laboratory scientist focusing on mechanisms and cures for eye diseases like glaucoma, retinitis pigmentosa, and macular degeneration.

Organizations

Stanford School of Medicine

The institution where Andrew Huberman is a professor and Dr. Jeffrey Goldberg is the chair of the Department of Ophthalmology.

Supplements

Vitamin B3

A high-dose vitamin B3 (nicotinic acid or nicotinamide) that has shown promise in limited clinical trials to improve retinal function and protect the optic nerve in glaucoma, possibly by boosting NAD+ pathways.

NAD

A critical molecule in cellular metabolism involved in oxidative stress regulation and energy regulation, whose synthesis pathway is influenced by Vitamin B3.

Studies & Research

AREDS2

A large randomized clinical trial that tested supplemental mixtures of vitamins C, E, zinc, copper, lutein, and zeaxanthin, finding them effective in slowing the progression of moderate to severe dry macular degeneration.

Software & Apps

Pencil Push-ups

An eye exercise involving focusing on a pen or pencil moving from arm's length towards the nose, used to strengthen eye muscles and improve focusing ability, particularly for convergence insufficiency or concussion recovery.

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