Andrew Huberman - Jeffrey Goldberg

1) Dr. Jeffrey Goldberg answers questions about when and how often people should have eye exams, starting from birth. He explains that every baby should get an eye exam shortly after birth to look for a red reflex, which is an indication of normal eye health. After that initial check-up, it is unnecessary to worry about getting an eye exam throughout early childhood unless certain features present themselves, such as the baby not making eye contact or exhibiting abnormal eye movements. In general, Goldberg suggests that people should have routine eye exams at least every two years, or more often if there are specific concerns.

2) Jeffrey explains the need for regular eye exams in young children, including a red reflex check and an amblyopia screening exam in elementary school. He discusses the importance of correcting any eye misalignment early in childhood to prevent the brain from ignoring it and permanently losing vision. While it was previously thought that correcting eye alignment before age three was fully correctable, more recent studies suggest that kids into their young teens have a chance at correcting amblyopia.

3) Dr. Jeffrey discusses the potential for therapeutic opportunities to reopen critical period plasticity, which declines with age, with a particular focus on the visual system. He goes on to recount his own experience of seeing double after swimming without goggles and how it led to poor depth perception, and he poses the question of whether just a few hours of misalignment of information to the two eyes early in development can permanently rewire the brain.

4) Jeffrey discusses the importance of spending time outdoors to improve eye health, specifically for children to help offset nearsightedness. Although there is a lack of randomized controlled trials with a placebo or control group to determine specific doses for optimal effects, studies show that getting at least one to two hours of outdoor time is beneficial. However, for older people, the premise of light modulation to offset nearsightedness through spending time outdoors isn't as strong since most of the changes in prescription occur in younger ages. Nevertheless, spending time outdoors still has numerous health benefits such as setting circadian rhythm, exercise, and mental health improvement.

5) Jeffrey discusses the importance of eye safety and eye cleanliness. He emphasizes that our eyes are delicate, and even a little bit of trauma to the eye can cause a lot of inflammation and damage. Therefore, there needs to be more education and awareness around eye protection, especially for those working in certain industries or doing activities that pose a risk of eye injury. Additionally, Dr. Goldberg warns against rubbing our eyes excessively as it can lead to dry eyes, eye infections, and other issues.

6) Jeffrey explains how for most people, regular eye washing does not need to be part of their standard routine as the eyes contain tears that help break down bacteria and bacterial toxins, while blinking and tear production are very good at keeping the eyes clean. However, as people age, they may need to develop a light eye scrub routine to remove scurf and inflammation of the eyelashes. In situations where people get something in their eyes, Dr. Goldberg recommends using sterile saline solution or artificial teardrops, as these are completely safe to use and won't hurt the eyes even with occasional rubbing or absent-mindedness.

7) Jeffrey discusses the optometrist's office and the comprehensive screening exam that includes checking the eye pressure, looking at the surface of the eyes, and screening for diseases. He explains that after the age of 40, people start experiencing presbyopia, which results in the loss of the ability to focus the eyes from distance to near, and most people need reading glasses for near. Dr. Goldberg also shares his personal story of experiencing blurry vision early in the morning, and how he uses reading glasses to help his vision.

8) Jeffrey shares his personal experience with discovering his near vision loss and how he became addicted to using reading glasses. He explains that the ability to relax the face and not strain the muscles was a significant factor in his addiction and emphasizes the importance of regular eye exams with optometrists or ophthalmologists for screening for potential eye diseases and maintaining good eye health. He notes that while the dependence on reading glasses may grow, there are limits to how much magnification is needed and encourages people to seek ongoing eye care.

9) Jeffrey discusses the use of readers and corrective lenses to offset vision loss. While there is some evidence that using weaker readers and exercising eye muscles may slow the progression of vision loss, it is also important to give the retina and brain the sharpest visual signals possible. Therefore, Dr. Goldberg advises individuals to use the readers or corrective lenses that work best for them and not to delay their use, even if their prescription may change slightly over time. Additionally, Dr. Goldberg explains that driving at night can be challenging for many individuals due to fatigue and offers insights into the biology behind poor night vision.

10) Jeffrey discusses the benefits and utility of pencil push-ups, which are exercises designed to improve and strengthen one's eyesight and eye muscles. He notes that they can be especially useful for those who have trouble turning their eyes properly and those with convergence insufficiency. Additionally, he discusses the potential use of these exercises in the recovery from concussions and traumatic brain injuries, where they have been shown to help restore smooth Pursuit eye movements. Overall, the exercises are not harmful and can generally be used by anyone without adverse effects.

11) Jeffrey discusses the potential of training one's vision to move from normal to supra-normal performance. Evidence shows that it can be done, with athletes utilizing special goggles to practice catching a ball with only fractions of visual information available. Dr. Goldberg highlights the opportunity to dig into how this can work, especially for driving at night, reducing accidents and other benefits for everyday people. Dr. Goldberg also touches on the definition of 20/20 vision, degraded vision, and above-normal, which fighter pilots may have.

12) Jeffrey discusses the pros and cons of wearing contact lenses. While contact lenses can provide better vision correction than glasses, they also change the eye's tear dynamics and decrease oxygen diffusion, which could negatively impact the cells and tissues on the surface of the eye. As we age, we also have less tear film reserves, which could make contacts less tolerable. Additionally, improper cleaning of contact lenses can cause corneal infections, which are rare but can lead to scarring and blurred vision. To prevent this, Goldberg recommends using daily disposable contacts and avoiding sleeping in them.

13) Jeffrey discusses healthy contact lens use and the importance of properly cleaning and storing them to avoid bacterial infections. He recommends following the instructions given for the recommended use and cleaning of contacts to avoid any trouble, especially in the younger decades when people can tolerate them well. As people age, they tend to become less tolerable. Dr. Goldberg also notes that UV light is very harmful and can lead to eye and skin damage, so blocking UV light is essential in any pair of eyeglasses, and most glasses filter UV light nowadays.

14) Jeffrey speaks about the importance of blocking UV light and how it can be achieved through sunglasses or transition lenses that react to UV light. He suggests that people who do not wear corrective lenses can wear wide-brimmed hats to reduce direct light entering the eyes or wear sunglasses outside, even if they do not have corrective lenses. While wearing UV-blocking sunglasses may not make a significant difference in eye health, a wide-brimmed hat can help reduce the sun's impact on the face and prevent skin cancers.

15)Jeffrey discusses the suitability of LASIK for children. He advises avoiding the procedure on kids or young teenagers because the shape of their eye and prescription requirements are still evolving, meaning that LASIK may lose its effect within a year or two, forcing the persons to wear glasses again. Dr. Goldberg also talks about dry eye, the most common eye disease, and explains that there are two major elements to tears: saltwater and oil parts. While the eye drop industry has solved the problem of replacing the saltwater part with artificial tears, the oil part is still an issue, especially for people who spend more time on computers.

16) Dr. Goldberg discusses the causes and effects of dry eye, which is a major unmet need in the medical industry. He explains that people blink less while looking at screens, causing a lack of oil in the tear film, which can be problematic. Although the wet part of the tears can be replaced using over-the-counter artificial drops, the oil part cannot be effectively replaced by the industry, and it is aging like the rest of the body. Thus, Dr. Goldberg recommends treating eyelids to rejuvenate oil glands and maximize tear production. For patients with severe symptoms, low-dose steroid eye drops and anti-inflammatory treatments or serum tears rich in growth factors are suggested to regenerate and rejuvenate the nerves and cells under the tear film's surface.

17) Jeffrey discusses the different types of optic neuropathies, with glaucoma being the most common optic neuropathy. The two major risk factors linked with glaucoma are increasing age and increasing eye pressure which can lead to permanent vision loss. Screening is important to detect and diagnose glaucoma, with treatments available to lower eye pressure. However, in some parts of the world, affordability and access to treatment are limited. Glaucoma affects peripheral vision, making early diagnosis difficult, which is why regular check-ups are recommended.

18) Jeffrey discusses the two forms of macular degeneration and how they cause a slow degeneration of the rods and cones in the retina. He explains that the dry form can convert to the wet form, which causes new blood vessels to grow and leak fluid into the retina, leading to acute vision loss. Injections can be used to treat wet macular degeneration, and there is now a successful treatment for the dry form. Dr. Goldberg also discusses retinitis pigmentosa, which is an inherited form of macular degeneration that can affect vision early in life, and diabetic retinopathy, which is a major complication of diabetes that causes damage to the retina inside the eye.

19) Jeffrey discusses how to prevent diabetic retinopathy, which is primarily through controlling diabetes and keeping blood sugar under control. He notes that high blood pressure can also damage the retina and that keeping blood pressure under control is important. Lifestyle changes like improving diet, exercise, and weight loss can help with controlling blood sugar and blood pressure. Diabetic retinopathy can be treated with drugs that can be injected into the eye. For glaucoma, it is important to get a comprehensive screening exam with an optometrist or ophthalmologist to detect if there is any damage.

20) Jeffrey discusses the different treatment options available for glaucoma, including eye drops, lasers, and surgery, but also mentions that even with all of the treatments available, around 10-15% of patients will still lose significant functional vision, and 5-15% may go blind. He emphasizes the importance of regular eye exams and taking prescribed medications consistently, as compliance can be difficult for patients who do not feel or notice a daily difference in their symptoms. Additionally, he stresses that smoking and vaping nicotine, as well as excessive alcohol consumption, are major risk factors for both glaucoma and macular degeneration, and encourages patients to reduce these behaviors to protect their eye health.

21) Jeffrey emphasizes the importance of a healthy lifestyle, including a balanced diet, exercise, and no smoking or vaping, to support eye health. For glaucoma patients, he acknowledges that cannabis can lower eye pressure but highlights the negatives of smoking as it causes lung inflammation, dry eyes, and can be high in THC concentration. He recommends not using it as a primary approach but acknowledges that the edible form, used in select cases, can help lower eye pressure during the night when it is highest. He expresses excitement about developing long-acting eye-specific drugs to help with glaucoma.

22) Jeffrey discusses the relationship between sleeping positions and eye pressure, particularly in patients with glaucoma. While sleeping with the head elevated has been shown to lower eye pressure, it is important not to interfere with a person's overall sleep quality. There has also been research regarding whether sleeping on a particular side affects glaucoma in one eye more than the other, but this has not been definitively proven. Furthermore, red and near-infrared light therapy has shown promising results in protecting against degenerative eye diseases, including macular degeneration. While more research is needed to determine the optimal dose and wavelength, Dr. Goldberg finds this approach to be very compelling.

23) Goldberg explains that in most cases, eye floaters are harmless and will eventually go away on their own. He advises patients to be intentional about ignoring them and reassures them that it's not worth putting them at risk by intervening. Dr. Goldberg also discusses the causes of eye twitching, which usually stem from a nerve ending misfiring, and that in most cases, it is not a cause for concern, lasting only for a few months. Regarding nutrition and supplementation for eye health, Dr. Goldberg notes that ophthalmology has been exploring this area for some time and that there have been many studies conducted. There are some supplements like Vitamin A and omega-3 fatty acids that have been shown to have a positive effect on eye health, while others, like lutein, don't have strong scientific backing.

24) Jeffrey discusses the results of the Age-Related Eye Disease Study (AREDS) and AREDS II, studies that researched the use of supplements in slowing down the progression of age-related macular degeneration (AMD). AREDS used vitamin C and E, zinc and copper, and beta-carotene, while AREDS II replaced beta-carotene with the carotenoids, lutein, and zeaxanthin. The study showed that the formula used in AREDS II was better at slowing dry macular degeneration in the moderate to severe population, and the effect was even stronger if patients are not already taking a multivitamin or eating a diet that is naturally rich in lutein or zeaxanthin.