Dr. Joseph Allen: Blue light is overhyped; distance matters

Steven Bartlett 0:00 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.

Dr. Joseph Allen 0:05 So I did research to look into this, and a lot of people don't know this, but it's actually...

Steven Bartlett 0:09 Really?

Dr. Joseph Allen 0:10 Mm-hmm.

Steven Bartlett 0:11 So if I never wanna get bags under my eyes again, what is the natural, easy solution?

Dr. Joseph Allen 0:15 Try this. Dr. Joseph Allen is the board certified eye doctor-

Steven Bartlett 0:19 Helping millions of people understand eye health and unlocking the secrets behind achieving sharper and healthier vision. I really wanna talk to you about your many misconceptions because I don't know what's true.

Dr. Joseph Allen 0:28 Sure.

Steven Bartlett 0:29 Okay, so my vision loss, being inevitable, is that true?

Dr. Joseph Allen 0:32 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.

Steven Bartlett 0:41 And then every once in a while, my eyelid starts twitching. What is that?

Dr. Joseph Allen 0:44 Eyelid myokymia. So that is your threshold of your stress. Get more sleep and stop drinking so much caffeine.

Steven Bartlett 0:50 What about blue light? Is that harmful?

Dr. Joseph Allen 0:52 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%.

Steven Bartlett 1:09 And more people are starting to care about their eye health than ever before, but is our eye health getting better or worse?

Dr. Joseph Allen 1:14 Worse. For example, right now about 30% of the world's population is nearsighted. But by about 2050, we will have about 50% being nearsighted because of our lifestyle.

Steven Bartlett 1:23 So how much screen time, being indoors, reading books up close is okay?

Dr. Joseph Allen 1:27 It depends on age. So...

Steven Bartlett 1:32 Question, if you could sit at a table with any four guests from The Diary of a CEO, who would you choose? Here's a challenge for the entire Diary of a CEO community. If we hit 10 million subscribers by the end of 2024, you will get to pick four guests for your dream conversation, and you can make it weird or you can make it wonderful, and here is the best part. 3,000 of you that subscribe will be invited to join this conversation live, in person, and for free. Subscribe now and let's make this happen together. Who are you,

Steven Bartlett 2:10 what do you do, and I think most importantly of all, why is it so important that you do it?

Dr. Joseph Allen 2:16 I am a doctor of optometry. I am a fellow of the American Academy of Optometry and I'm a diplomat of the American Board of Optometry. So I practice eye care here in the US and I, 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, uh, I also host various, on, on various social media channels, 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.

Steven Bartlett 3:19 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? It... I don't know whether it's just because I'm, 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 i- is our eye health getting better or worse?

Dr. Joseph Allen 3:38 I, I, I wanna say that the r- I think people generally are being more interested in eyes and vision. Unfortunately, part of that is probably 'cause 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, uh, 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, um, that also is reflected with other metabolic diseases like diabetes. Significantly causes damage and leads to potential blindness inside the eye. So there's, there's a lot of factors

Dr. Joseph Allen 4:29 to it.

Steven Bartlett 4:29 What's changing? You know, you referred to some of the situations there as becoming more or worse, et cetera. That would suggest that there's something environmental or within our lifestyle that's having an impact on that.

Dr. Joseph Allen 4:42 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 indoors? All of these things are pushing us to, as a, as, as a society, to have different changes within the eye and increase our risk for diseases and potential vision loss.

Steven Bartlett 5:36 Why does it matter? You know, I ask 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, a, 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.

Dr. Joseph Allen 6:00 Right. (laughs) No, you're absolutely correct, and it's, 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, 'cause a lot of people, they're like, "I see great. I see fine. I don't need to see an eye 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.

Steven Bartlett 6:49 Give me some examples of, of how... Conditions you've spotted by doing an eye exam.

Dr. Joseph Allen 6:53 So patients who don't know they're diabetic, we'll catch diabetes in th- by looking inside the eye 'cause diabetes will cause damage to the blood vessels and we can see bleeding happening in the retinal tissue. 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 'cause just looking inside 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've... I had a... One, 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, 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 is called a Roth spot, and typically we only see Roth spots if somebody has a more serious condition going on.

Steven Bartlett 8:12 Can you show me on that w- where you s- saw it? Sorry.

Dr. Joseph Allen 8:15 So...

Steven Bartlett 8:16 For we... For people that are watching and just listening on audio-

Dr. Joseph Allen 8:19 Right.

Steven Bartlett 8:19 ... we have a model of an eye here.

Dr. Joseph Allen 8:22 So with the model of the eyeball, 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, those are blood vessels.

Steven Bartlett 8:40 Mm-hmm.

Dr. Joseph Allen 8:40 The retina's really... The eyeball's 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-

Steven Bartlett 8:48 Mm-hmm.

Dr. Joseph Allen 8:48 ... 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.

Steven Bartlett 9:10 What sort of age range?

Dr. Joseph Allen 9:11 She was 20-year-old female college student. And usually, again, we see Roth spots in more serious conditions, whether somebody's 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, um, basically did... Requested a blood, blood, 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 gonna give you my full report, I need you to go get this done." And then COVID happened (laughs) . So I didn't hear anything. And so finally a few weeks later they finally allowed, uh, 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 have her get that blood work?" And she's like, "You saved my life." And I was like, "What?" She's like, "Yeah, I... A few days later I started feeling really tired and not feeling well so I went into the doctor and I brought your, 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 gonna 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 of probably a virus, but her immune system was attacking her platelets.

Steven Bartlett 10:42 Platelets are the thing that sort of clots the blood, right?

Dr. Joseph Allen 10:44 Correct. And that ended up manifesting in the eye. So it's... It was, it was one of the few cases where I was like, "Wow." Like, otherwise if she hadn't come in, what, what could have happened? Right? So I just use that as a good demonstration because there are so many things that we catch on a, even a daily, weekly basis.

Steven Bartlett 11:05 There's so many misconceptions around vision and the eye. I think, um, one of the misconceptions I think I've found myself living under is that my vision loss is inevitable, really irrespective of what I do. And the minute you, you start to believe that story, then it kinda disempowers you, but it takes away your motivation to do anything about your vision. Now, is that true?

Dr. Joseph Allen 11:27 There is changes that occur with age that will change your eyesight and vision, that... Some just fundamental facts that you don't really have con- s- like, supreme control over. It's like your hair growing gray.

Steven Bartlett 11:42 Mm-hmm.

Dr. Joseph Allen 11:42 Like, it's gonna happen. It's kind of accepted. Yeah, with older age we're gonna have gray hair.

Steven Bartlett 11:46 Mm-hmm.

Dr. Joseph Allen 11:47 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 a hard time seeing up close-

Steven Bartlett 12:01 Mm-hmm.

Dr. Joseph Allen 12:02 ... 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.

Steven Bartlett 12:29 Mm-hmm.

Dr. Joseph Allen 12:30 So there are things you can do and be aware of, um, I'm happy to go into that.

Steven Bartlett 12:35 So global eye health-

Dr. Joseph Allen 12:38 (laughs)

Steven Bartlett 12:38 ... and the statistics, um, one of the really sort of shocking stats I read is that most of us are gonna develop nearsightedness when you go into sort of 2050, 2060.

Dr. Joseph Allen 12:48 Mm-hmm.

Steven Bartlett 12:48 Is that, is that true? What are the stats around that?

Dr. Joseph Allen 12:50 So a publication came out in 2016 in Ophthalmology, author of Holden. They looked at the statistics of myopia or nearsightedness. Even going further back, we've known that nearsightedness does... Is, is progressing, and now between around 20, th- uh, and it's estimated that, you know, 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. In the US right now, uh, for kids aged f- five to 19, we're already about 42%, and by 2030, so in just a few years, it's ex- expected in the US 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.

Steven Bartlett 13:47 Really?

Dr. Joseph Allen 13:48 Mm-hmm.

Steven Bartlett 13:49 How come?

Dr. Joseph Allen 13:51 There's... Certainly genetics plays a role. As more researches 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, like if your mom's severely nearsighted, you are a much higher risk of developing it. But the key o- 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, bo- 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 tablets even from a very young age. And then it's the amount of time we're spending indoors.

Steven Bartlett 15:09 It's interesting because I don't even think most people realize that the way we live our lives, h- the things we stare at, being indoors can change the eye.

Dr. Joseph Allen 15:18 Mm-hmm.

Steven Bartlett 15:19 I think we all kind of operate under this assumption that our eyes are just our eyes, and we, 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, um, an surprising concept to most people. H- how do we, how do we know this?

Dr. Joseph Allen 15:38 So statistically we've watched and data collected for j- you know, for many decades, watching people gradually become more and more nearsighted, and there's been th- 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 the 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, um, macular degeneration that typically occurs with later age.

Steven Bartlett 16:56 And that's, and that one millimeter or two millimeter growth is linked to lifestyle?

Dr. Joseph Allen 17:02 The vast majority of it.

Steven Bartlett 17:04 How much screen time, how much being indoors, how much reading books up close-

Dr. Joseph Allen 17:10 Mm-hmm.

Steven Bartlett 17:10 ... is okay? Like, what, d- is there, like, a recommended daily allowance?

Dr. Joseph Allen 17:15 So there are some recommendations put forth by, uh, like the American Academy of Pediatrics, and it depends a little bit on age, especially for young kids, b- I think for the first few years of life they don't recommend kids look at screens at all. And then-

Steven Bartlett 17:33 Why?

Dr. Joseph Allen 17:34 Why? Because again there's research showing that not just for eye development but also neurological development, and I, 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. The... 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.

Steven Bartlett 18:17 That's nearsightedness.

Dr. Joseph Allen 18:18 Nearsightedness, correct.

Steven Bartlett 18:19 Yeah.

Dr. Joseph Allen 18:19 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. The... 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 somewhere around 90 minutes to two hours a day can kinda offset the... All the near work that children are using.

Steven Bartlett 19:00 So spending sort of 90 minutes to two hours a day look- outside, looking far?

Dr. Joseph Allen 19:05 (laughs) That's, that's a part of it. Uh, 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 indivi- 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.

Steven Bartlett 19:53 Mm-hmm.

Dr. Joseph Allen 19:54 I do wanna just step back when it comes to all the spending time outside. It's, again, that research is largely based on surveys and so they aren't 100% sure how much light outdoor time people are really getting. So now, uh, 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.

Steven Bartlett 20:24 I was wondering if, um, vitamin D plays a role at all there?

Dr. Joseph Allen 20:27 That's also theorized and looked at in some studies. Uh, also just athletics and getting more, um, more motion in, in the daily activities. So there, there's, there's many different studies in those regards. But right now even a study outta Taiwan, um, they've been impleme- implementing a policy that's like, "Hey, you have to get at least 90 to two hour... 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, uh, even a more recent meta-analyis said it wasn't statistically significant for the progression of myopia, but it does delay onset of myopia.

Steven Bartlett 21:15 Can you reverse myopia?

Dr. Joseph Allen 21:17 No. (laughs)

Steven Bartlett 21:18 Okay. So if, if, if I'm... 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, et cetera?

Dr. Joseph Allen 21:31 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... (laughs) 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 or selling something that is not based on science, that is... And, and doing a research study to prove that is, would be very easy to do, and it just... It hasn't... It doesn't show. Most people if they are doing... 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 they've... 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.

Steven Bartlett 22:52 Well, this is, you know, in part one of my cons- my personal concerns because sometimes, very rare occasions, I'll spend, you know, maybe 9, 10, 12 hours in this studio.

Dr. Joseph Allen 23:02 Mm-hmm.

Steven Bartlett 23:02 And, you know, 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 plate 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 pseudo-myopia.

Dr. Joseph Allen 23:21 You could be. Your, uh... Of course I, I haven't done an eye exam on you. I don't know where you're at. Can I ask when was the last time you had your eyes checked?

Steven Bartlett 23:27 Uh, no comment. Um...

Dr. Joseph Allen 23:29 (laughs)

Steven Bartlett 23:29 It was a long time ago and the reason for that is g- again because I just... I always assumed my eyes were fi- were fine.

Dr. Joseph Allen 23:35 Mm-hmm.

Steven Bartlett 23:35 So it would have been... Gosh, that's such a good question. Maybe seven years ago or something.

Dr. Joseph Allen 23:42 So it's, it's tough to say. Um, you know, there is possibility that maybe there's a little bit of nearsightedness there. It could be that you've used your eye muscles so much indoors that you're just... 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 that five-pound weight-

Steven Bartlett 24:09 Mm.

Dr. Joseph Allen 24:10 ... at arm's level. So you have to learn to, "Hey, I can relax this and put it back down."

Steven Bartlett 24:14 Mm-hmm.

Dr. Joseph Allen 24:15 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.

Steven Bartlett 24:32 So eye exercises don't work.

Dr. Joseph Allen 24:34 They... 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 the, really the coordination of your brain communicating that information to those muscles to work in coordination.

Steven Bartlett 24:53 Okay.

Dr. Joseph Allen 24:54 And so there's a... Some certain binocular vision disorders, like people who have convergence insufficiency, 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.

Steven Bartlett 25:24 Should I be looking for clues as to what the future of my vision is gonna be like from my parents?

Dr. Joseph Allen 25:30 (laughs)

Steven Bartlett 25:30 Because my parents are... They, they hold everything at, like, one meter length from their face, and I, 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.

Dr. Joseph Allen 25:40 Mm-hmm.

Steven Bartlett 25:40 And they're reading at f- arm's length. But I think they're gonna have the last laugh when (laughs) , when I get to 50, 60 years old-

Dr. Joseph Allen 25:47 Sure.

Steven Bartlett 25:48 ... because of genetics or whatever.

Dr. Joseph Allen 25:49 So again, uh, even without genetics, just the way the eye ages, the lens inside of your eye will change.

Steven Bartlett 25:58 Which is?

Dr. Joseph Allen 25:59 So wenn I open up the eye model here... Let me try not to spill everything from the inside of the eye.

Steven Bartlett 26:05 Mm-hmm.

Dr. Joseph Allen 26:07 In the front portion of the eye, you have the cornea. That-

Steven Bartlett 26:09 Which is the... Is that the very front piece?

Dr. Joseph Allen 26:12 Mm-hmm. It's the clear window to the eye.

Steven Bartlett 26:14 Okay.

Dr. Joseph Allen 26:15 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. If I put these together, it's, it's kind of that shape.

Steven Bartlett 26:36 Mm-hmm.

Dr. Joseph Allen 26:37 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.

Steven Bartlett 26:49 Mm-hmm.

Dr. Joseph Allen 26:51 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 on images online, you can actually see rings or these little lines, and it's like looking at the rings of a tree.

Steven Bartlett 27:07 Mm.

Dr. Joseph Allen 27:07 So you can basically count those and be like, "Oh, look how old this person is."

Steven Bartlett 27:10 Hm.

Dr. Joseph Allen 27:11 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've, I, I don't really need to use them as much anymore so I haven't, haven't thought about it for a while. But these... As this lens gets thicker, it basically gets thicker every year, 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 wanna change shape anymore.

Steven Bartlett 27:51 Mm.

Dr. Joseph Allen 27:52 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.

Steven Bartlett 27:59 Oh, okay.

Dr. Joseph Allen 28:01 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. 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 so, such a dense color that light is not filtering, it's not passing through to getting to the retina in the back of the eye anymore.

Steven Bartlett 28:36 So what do you do? You cut it out?

Dr. Joseph Allen 28:38 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. They... What, what the 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 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.

Steven Bartlett 29:22 Okay.

Dr. Joseph Allen 29:23 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 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 gonna 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 gonna have?

Steven Bartlett 30:04 I reckon we'll have, like, cameras.

Dr. Joseph Allen 30:06 I hope so. (laughs) Uh...

Steven Bartlett 30:08 Do you really? Are people working on that kind of thing? I bet someone's working on some kind of camera, electric eyeball.

Dr. Joseph Allen 30:13 You know, I did hear of some research maybe about five, six years ago of somebody talking about it. But, uh, since then, the thing, things have kind of gone quiet.

Steven Bartlett 30:22 Mm.

Dr. Joseph Allen 30:22 They are, probably in the last year, one of the...... the last, last few years, there's been s- interest and research into making, like, augmented reality contact lenses that are quite fascinating. And then there is the, kind of one of the newest things is the first whole eye transplant. That was one of the, kinda the coolest things that have come

Dr. Joseph Allen 30:45 up recently.

Steven Bartlett 30:45 There was an eye transplant?

Dr. Joseph Allen 30:48 So a gentleman was injured in a m- he was, uh, US military, but he, 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, it's sort of shaken the eyecare world a little bit. The, they just, I just read, like, a one-year, a publication in JAMA that was basically summarizing what it's been like after th- this last year, and it's amazing because the eye did connect to the optic nerve 'cause 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 to the, from the donor tissue to the host. And keeping that, the right amount of blood supply, having it so it didn't reject is, 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 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, it's pretty fascinating.

Steven Bartlett 32:36 God, it's only gonna be a matter of time, isn't it?

Dr. Joseph Allen 32:37 (laughs)

Steven Bartlett 32:38 Um, you said there that the eye's complex. I was reading some stats around-

Dr. Joseph Allen 32:41 Mm-hmm.

Steven Bartlett 32:41 ... the eye that blew my mind. The eye contains over two million working parts and is considered the second most complex organ in the body. I guess the s- the brain is the first.

Dr. Joseph Allen 32:51 And the eyeball is really an extension of the brain.

Steven Bartlett 32:54 Right.

Dr. Joseph Allen 32:54 The, the retina in the back of the eye communicates directly through the optic nerve to many parts of the brain.

Steven Bartlett 33:01 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. But it's just crazy that, you know, the, that particular stat around, um, 85% of my total knowledge will basically come from my eye. Th- when you say it, I kind of understand it because okay, I'm reading, I'm seeing, I'm, you know, I'm-

Dr. Joseph Allen 33:32 Mm-hmm.

Steven Bartlett 33:32 ... learning through my eyeballs. But it is, um, 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?

Dr. Joseph Allen 33:49 So people who do smoke, people who drink more, uh, that increases their oxidize, um, oxidation. So their 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 bathes, 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. There is a specific, there's different types of cataracts. There's one specific type of cataract called a cortical cataract that kinda looks like bicycle spokes. If you're do, if you're 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.

Steven Bartlett 35:13 Mm-hmm.

Dr. Joseph Allen 35:13 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 pre, um, delay the onset of cataracts. But if you already are getting proper nutrition, taking additional vitamin C is pro- probably not going to delay your onset of cataracts specifically.

Steven Bartlett 35:36 I learned something from you actually, w- from your Instagram, um, which I think is really gonna do me a lot of favors because I'm someone that spends a lot of time on my phone admittedly and y- you alerted me to the fact that there's actually a feature in the iPhone which will help me stave off my myopia potentially.

Dr. Joseph Allen 35:54 Perhaps. Uh, so thankfully, again, the eyecare community is not the only people who are aware of these issues with using devices up close.

Steven Bartlett 36:03 Mm-hmm.

Dr. Joseph Allen 36:03 But thankfully, whether it be Apple specifically with their iPhone, but also just 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.

Steven Bartlett 36:16 Mm-hmm.

Dr. Joseph Allen 36:17 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 and I eventually got so annoyed with it- (laughs)

Steven Bartlett 36:25 Really?

Dr. Joseph Allen 36:25 ... that I wanted to push it further back. Uh, so I, I kept it on for a while, I eventually took it off. Um-But maybe I'll have to put it back on again just to-

Steven Bartlett 36:34 (laughs)

Dr. Joseph Allen 36:35 ... be a good, just to serve a good example.

Steven Bartlett 36:37 So this, it was a feature released in 2023, and it e- essentially sends you a notification whenever your phone is... Is it, what, 12 inches or something?

Dr. Joseph Allen 36:46 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.

Steven Bartlett 36:56 Mm-hmm.

Dr. Joseph Allen 36:57 So pretty close. And it's important to s- consider moving things further back. And part of that can be because certainly eye strain relationships, possibly myopia, and then even blue light. Uh, I know people are getting really concerned and, um, 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 tw- like a full 75%. So if, if you're worried about how blue light's affecting you, it's like just move your phone back a few inches and that's automatically gonna decrease your blue light exposure from that device.

Steven Bartlett 37:36 I, I don't think most people know that this feature even exists because I don't think Ap- 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.

Dr. Joseph Allen 37:47 Mm-hmm.

Steven Bartlett 37:47 Um, and under Screen Time there's a button called Screen Distance 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." Um, 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 of your face and the data collected remains on the device." So if I click Continue, it then says, "This is how Screen Distance works. Um, Screen Distance encourages you to move your iPhone and iPad further away to support your vision health." V- Um, the next section says, "Vi- Vision Distance or Viewing Distance. iPhone or iPad should be held at a suggested distance of 30 centimeters from your eyes."

Dr. Joseph Allen 38:29 Mm-hmm.

Steven Bartlett 38:30 Um, interesting.

Dr. Joseph Allen 38:33 Those are recommendations, but how many people actually follow that? It's-

Steven Bartlett 38:39 Uh, no one.

Dr. Joseph Allen 38:40 Yeah. (laughs) It's tough. I mean, you'll see people do that and then it just gradually over time gets closer and closer. And kids probably are even worse because they automatically have smaller arms, right? But then they just, they just bring it right up close, right? They want that phone screen to take up all of their, their visual field. And so it is, I think it's a good habit. I think it's something... Tell me, have you, when, have you turned it on? Is it something that you've utilized?

Steven Bartlett 39:04 I turned it on when I was, uh, in preparation for you coming here today. So I, 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 got the notification yet, but-

Dr. Joseph Allen 39:13 Okay.

Steven Bartlett 39:13 ... um, it's not been on long enough, I don't think, for me to g- have an opinion on it just yet. But you said it was annoying you, so I'm, it's definitely gonna annoy me if it annoyed you. (laughs)

Dr. Joseph Allen 39:21 So my, 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 'cause I'm so near-sighted I have to see my, I wanna see the screen, but I have to hold the screen just a few centimeters in front of my face-

Steven Bartlett 39:43 Wow.

Dr. Joseph Allen 39:43 ... because I'm that near-sighted. 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.

Steven Bartlett 39:54 Ah.

Dr. Joseph Allen 39:54 So I was doing it so much, I'm like, "I know that I should pull the screen away and I should just take a break." But it was, it was delaying my productivity. (laughs)

Steven Bartlett 40:04 Ah, yeah.

Dr. Joseph Allen 40:05 So that, that's why. But again, to set a good example, I'll probably have to turn it back on and see how it goes.

Steven Bartlett 40:10 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 on their devices, I guess.

Dr. Joseph Allen 40:16 Yeah, I think so. I think it's also a good habit to, um, 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 gonna see that and they're gonna probably mimic that same behavior.

Steven Bartlett 40:30 I wanna talk to you about bags under my eyes.

Dr. Joseph Allen 40:33 Mm.

Steven Bartlett 40:34 Um, 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. Um, and is there a difference between having bags under my eyes and having sort of dark circles under my eyes?

Dr. Joseph Allen 40:51 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 the eye clinic. 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.

Steven Bartlett 41:13 Okay.

Dr. Joseph Allen 41:14 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, uh, people who don't know this, but, uh, under, having skin cancer on your, on lower eyelids 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, 'cause some people's orbits, they have more prominent brow, it may cos- k- kind of cast a shadow onto the lower eyelid.

Steven Bartlett 42:18 Mm-hmm.

Dr. Joseph Allen 42:18 And that's where having under eye bags can also make the eyelids seem like they're, uh, have kind of, uh, dark circles, because the eyelids are puffy. And you can have puffiness of the eyelids for multiple reasons. Allergies are a big one. Salt content of the tear film, and even in your body can make some of those changes. I know for myself, w-If I have a cheat day and I eat a bunch of greasy, delicious pizza, the next morning I'll probably feel... I can feel that my skin in my face is maybe a little bit more puffy.

Steven Bartlett 42:53 Mm-hmm.

Dr. Joseph Allen 42:54 Uh, thankfully, that goes away within a few hours. But that's why a lot of times, even just doing cold compresses, right? You see people put cucumbers on their eyes? A lot of that is more has 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, help improve the appearance.

Steven Bartlett 43:14 So if I have a really salty diet the night before, I'm, there's a greater probability I'll wake up with bags under my eyes?

Dr. Joseph Allen 43:22 Possibly.

Steven Bartlett 43:22 Okay.

Dr. Joseph Allen 43:23 I've tried to research this to find any real publications to, to see if it's really there and I couldn't find anything. But I know from just my own anecdotal experience that, yeah, if I eat a really high salt diet, um... 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, if I have a cheat day, that sort of thing can happen.

Steven Bartlett 43:50 And where does this... What's the sort of physiological r- rationale for salt playing a role?

Dr. Joseph Allen 43:55 So your tear film, for example, um, 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... 'Cause if you've ever cried and tasted your tears, they taste salty, right? So the challenge is that 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.

Steven Bartlett 44:30 Does hydration play a role in it?

Dr. Joseph Allen 44:32 That's also something that's been looked at in research. It's not really conclusive.

Steven Bartlett 44:35 Okay.

Dr. Joseph Allen 44:36 I think hydration is still something we need to... I do encourage people to at least be aware of their hydration. Um, for dry eye there is some research that indicates that people who are... drink more water tend to have less severe symptoms of dry eye.

Steven Bartlett 44:52 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.

Dr. Joseph Allen 44:59 That... Again, I d- recently did, uh, a live stream, but I did research first and tried to 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 not change.

Steven Bartlett 45:23 Really?

Dr. Joseph Allen 45:23 But your subjective appearance of your own image will go down.

Steven Bartlett 45:29 Ah, s- okay.

Dr. Joseph Allen 45:30 So you're... Both... They find that for both sleep and stress.

Steven Bartlett 45:33 So you believe that you've got bigger sort of dark circles or-

Dr. Joseph Allen 45:37 Mm-hmm.

Steven Bartlett 45:37 ... patches under your eyes, but objectively, in reality, you haven't.

Dr. Joseph Allen 45:41 Yeah. 'Cause 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, 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.

Steven Bartlett 46:01 What about stress? 'Cause I'm thinking about people that I've seen that have like big bags under their eyes-

Dr. Joseph Allen 46:06 Mm-hmm.

Steven Bartlett 46:06 ... and like, th- you know, their, their eyes kind of look dark. I always assume it's their stress and they haven't been sleeping, but you're sa- saying that that's not accurate necessarily.

Dr. Joseph Allen 46:14 So at least in the, the few studies that I've s- 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, um, but right now it seems to have a less effect on the true pigmentation of the eyelids.

Steven Bartlett 46:43 Okay.

Steven Bartlett 46:44 And the, 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 under my eyes? 'Cause when I filmed Dragon's Den, a TV show in the UK, if I... sometime... It's weird 'cause 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.

Dr. Joseph Allen 47:08 Mm-hmm.

Steven Bartlett 47:09 And I know what she's saying. She's saying, "You look like shit," but, 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." Um, but is sh- is it actually doing anything, the cucumber and the...

Dr. Joseph Allen 47:24 The, 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.

Steven Bartlett 47:30 Mm-hmm.

Dr. Joseph Allen 47:30 Just like if you bang your knee or elbow really hard on something, it swells.

Steven Bartlett 47:33 Mm-hmm.

Dr. Joseph Allen 47:33 There's a little bit of inflammation. And so putting cool- cold on there can help momentarily, but I wouldn't do it longer than 15 minutes. The, the reason why is 'cause if you do it longer than 15 minutes, your blood vessels actually can go the opposite way and cause more inflammation.

Steven Bartlett 47:46 Weight gain, yeah.

Dr. Joseph Allen 47:47 The... 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 true- truly remove pigmentation. And a lot of those products can have effect, but it takes months to truly remove the pigment.

Steven Bartlett 48:12 Mm-hmm.

Dr. Joseph Allen 48:12 So you're talking you're using that two, three times a day for like 14, 15 weeks. But, uh, o- outside of that, if somebody's tried all of those other avenues, talked with their dermatologist or, or an eye care prev- 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.

Steven Bartlett 48:35 What do those surgeries do?

Dr. Joseph Allen 48:37 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 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 wanna see, uh, an ophthalmologist who specializes in those type of therapies, or, or those

Dr. Joseph Allen 49:06 type of surgeries.

Steven Bartlett 49:06 So if I never wanna get dark circles, bags under, bags under my eyes again, what is the natural easy solution?

Dr. Joseph Allen 49:14 I do still encourage good sleep, eating healthy, uh, staying hydrated. I think all of those things are good habits to have 'cause we know they affect the body in so many other ways. If somebody is truly struggling with it, then you can look at those various creams-

Steven Bartlett 49:34 Mm-hmm.

Dr. Joseph Allen 49:34 ... but I definitely encourage people, talk to a medical provider, or whether a dermatologist or an eyecare provider who specializes in that area.

Steven Bartlett 49:44 What about red light therapy?

Dr. Joseph Allen 49:46 So red light, there's so much in red light, and this is, I'm glad you brought that up 'cause this is something I've been diving kind of head first into, into the research for many things in the eyes. With the eye bags specifically, I'll say that there is some newer publications showing that red light therapy can help with depigmentation around the eyelids and giving the eyelids more of a youthful appearance. I do waive caution though, 'cause there's a lot of products that are online that re- that offer red light therapy for various reasons, but the s- 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, the devices they've bought online, because the manufac- 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. 'Cause it's not the specific wavelength. The wavelength is important, but the amount of energy in the red light, also 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, and so I think I, I just urge caution to make sure whoever's listening, if you're thinking about red light therapy or you're thinking about getting a red light device specifically for eyecare, definitely talk to a specialist who works in that area. (laughs)

Steven Bartlett 51:25 Okay. Okay.

Dr. Joseph Allen 51:25 The, um... But red light, have you, have you heard much about red light in different areas?

Steven Bartlett 51:31 I've heard a lot about it, but I, I don't know a huge amount about it and I have two red light panels at home-

Dr. Joseph Allen 51:38 Mm-hmm.

Steven Bartlett 51:38 ... which were given to me as a gift. Um, my, my partner has one, I have one. We basically got each other the same Christmas present one year.

Dr. Joseph Allen 51:45 (laughs)

Steven Bartlett 51:45 Uh, but we, we did ask ourselves, we sat in front of it one day and said, "What does this, like what does this do in terms of our health and are we allowed to stare at it?"

Dr. Joseph Allen 51:53 The devices you come, that you got, did they come with goggles?

Steven Bartlett 51:57 No.

Dr. Joseph Allen 51:57 Okay. So that, 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.

Steven Bartlett 52:27 Which is?

Dr. Joseph Allen 52:28 Is, uh, so age-related macular degeneration is one of the leading causes of blindness for older age adults. So if you-

Steven Bartlett 52:36 50 plus?

Dr. Joseph Allen 52:36 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.

Steven Bartlett 52:44 Mm-hmm.

Dr. Joseph Allen 52:45 And so probably some of the best research on red light in the eyes is on macular degeneration. Uh, in fact, there is, it's cert- it's currently approved and being used in Europe, it's not approved in the US 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, it uses some near infrared light and a little bit of, uh, 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 generation, 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 and slow down the progression of macular degeneration, and for some people even restore eyesight. It can actually help people see better.

Steven Bartlett 53:35 Using red light therapy?

Dr. Joseph Allen 53:36 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 generation, there's again concern about the power density and about the potential change in temperature within the eye because it 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, it's something that is really fascinating and I am looking forward to as more information comes out, but it's, I, I personally from 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.

Steven Bartlett 54:44 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, and other dry eye symptoms compared to the placeo-, placebo group.

Dr. Joseph Allen 54:59 Mm-hmm.

Steven Bartlett 55:00 Tear reduction. What does that mean?

Dr. Joseph Allen 55:01 So dry eye, again, is an area where red light therapy is being u- utilized in right now. The, 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-

Steven Bartlett 55:22 Mm-hmm.

Dr. Joseph Allen 55:22 ... because the red light can shut down inflammation, uh, within the tissues and help you produce... Uh, basically it helps the cell re- 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 components ha- in mice, and then now in humans, they're finding that tear production can be improved.

Steven Bartlett 55:53 Which helps with dry eyes?

Dr. Joseph Allen 55:54 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.

Steven Bartlett 56:07 Can you show me on there?

Dr. Joseph Allen 56:08 The, uh... So it's actually on, in the eyelids, but the eyelids would be...

Steven Bartlett 56:14 Oh, in front.

Dr. Joseph Allen 56:15 They're in front, yeah.

Steven Bartlett 56:16 Right.

Dr. Joseph Allen 56:16 So, so my top eyelids have about 30 meibomian glands in them, and my bottom eyelid has, like, 25 to 30.

Steven Bartlett 56:22 Okay.

Dr. Joseph Allen 56:22 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. 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.

Steven Bartlett 57:09 Mm-hmm.

Dr. Joseph Allen 57:10 And so with red light therapy, uh, 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 and 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 and treating dry eye.

Steven Bartlett 57:37 Is there any research being

Steven Bartlett 57:39 done on red light and myopia? I... Red light and shortsightedness. I, if I look at those red light panels I have at home, is that gonna help with my progressive shortsightedness?

Dr. Joseph Allen 57:50 So there is research going into red light in 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, uh, and used in research are usually a at-home desk-mounted device-

Steven Bartlett 58:10 Yeah.

Dr. Joseph Allen 58:11 ... that kids will stare into for about three minutes twice a day, morning and then night. And they are showing in, 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. There have been at least, there is at least one study that looked at those devices and they, 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, 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.

Steven Bartlett 58:56 And just because I'm an idiot, um, the red light is basically stimulating the mitochondria in the cell, which is kinda like the engine in the cell.

Dr. Joseph Allen 59:04 Yeah.

Steven Bartlett 59:04 And that's making it produce more of the good stuff. (laughs)

Dr. Joseph Allen 59:08 As specifically ATP, uh, adenosine triphosphate, the... Which a- and the, the cell uses for energy.

Steven Bartlett 59:16 What about gazing at the sun?

Dr. Joseph Allen 59:18 Mm-hmm.

Steven Bartlett 59:18 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.

Dr. Joseph Allen 59:26 Yeah. Don't stare at the sun.

Steven Bartlett 59:28 Even for like a second?

Dr. Joseph Allen 59:29 Don't. (laughs)

Steven Bartlett 59:30 Really?

Dr. Joseph Allen 59:31 The... 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, uh, the sun is coming up, the sun is going down," better 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.

Steven Bartlett 1:00:00 Mm-hmm.

Dr. Joseph Allen 1:00:00 And I have a patient right now who she, you know, she's 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 is... We di- diagnose as solar retinopathy. And so, and I'm like, "Have you been staring at the sun?" She's like, "Yeah, I've been sun gazing since I was little. Uh, 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 little blind spots where she cannot see 20/20 anymore.

Steven Bartlett 1:00:35 Where in there? Is that the colored part of the eye?

Dr. Joseph Allen 1:00:38 No. So the, 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 it ends up focusing on the part of the eye called the fovea or the macula.

Steven Bartlett 1:00:52 Which is at the back of the...

Dr. Joseph Allen 1:00:53 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 bullseye of the eye called the macula-That part is your reason you see so sharply.

Steven Bartlett 1:01:06 Mm-hmm.

Dr. Joseph Allen 1:01:06 Is the reason that, 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. 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 focus right in that area and in just a few seconds, you can overwhelm that tissue, causing chemical damage to the retina.

Steven Bartlett 1:01:27 Because people... This phrase sun gazing.

Dr. Joseph Allen 1:01:29 Mm-hmm.

Steven Bartlett 1:01:30 Is this like a spiritual thing? Like I, I, I w- think I was in Bali and people were like, "No, you can. You can sun gaze. You should sun gaze 'cause it's good for you." Sun gazing. W- what is this term?

Dr. Joseph Allen 1:01:41 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 or late afternoon when the sun is largely going down the horizon.

Steven Bartlett 1:01:57 Mm-hmm.

Dr. Joseph Allen 1:01:58 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 the, there is still a high risk. And so, uh, 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, you know, 10:00 to 4:00 PM usually, uh, 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. People can get sunburned on the surface of the eye.

Steven Bartlett 1:02:36 Okay, that's good to know. I'm not gonna look at the sun.

Dr. Joseph Allen 1:02:39 (laughs)

Steven Bartlett 1:02:39 Um, I was being torn

Steven Bartlett 1:02:40 because I've got a friend who, uh, 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, you mentioned blue light a second ago, which is the light that comes off our devices. Um, is that harmful for my eyes?

Dr. Joseph Allen 1:02:53 There's blue light that comes from the sun.

Steven Bartlett 1:02:55 Yeah.

Dr. Joseph Allen 1:02:56 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.

Steven Bartlett 1:03:14 It just impacts my sleep potentially.

Dr. Joseph Allen 1:03:15 Impacts your sleep. There's also some claims that blue light can affect your eye strain.

Steven Bartlett 1:03:21 Mm-hmm.

Dr. Joseph Allen 1:03:21 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 they're 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 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.

Steven Bartlett 1:04:10 What kind of gadgets do you ha- I, I don't know why, but I assume as someone who is an, uh, 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?

Dr. Joseph Allen 1:04:24 I mean, I, I've, yeah, we're, I have multiple computer screens open. I have my phone screen open all day. Uh, I, the other day I was texting a, a friend, I'm like, "I've got two laptops open at a coffee shop." (laughs) You know, I'm like, "I'm doubling down on the blue light here." Uh, so there's a lot-

Steven Bartlett 1:04:42 Or-

Dr. Joseph Allen 1:04:42 ... going on there, but yeah. Uh-

Steven Bartlett 1:04:43 Or practices. Is th- are there any practices that you've been disciplined with because you're aware of the impacts it will have on your eye?

Dr. Joseph Allen 1:04:51 Specifically on blue light?

Steven Bartlett 1:04:52 No, all of it, just-

Dr. Joseph Allen 1:04:53 All o-

Steven Bartlett 1:04:53 ... your overall eye health.

Dr. Joseph Allen 1:04:55 So the biggest things for myself is diet.

Steven Bartlett 1:05:00 Okay, let's talk about diet then.

Dr. Joseph Allen 1:05:01 Sure.

Steven Bartlett 1:05:03 W- what do I need to know in terms of what I'm eating and drinking to make sure that my eye health stays, um, optimal?

Dr. Joseph Allen 1:05:08 So they've been looking at lifestyle factors on aging eye diseases for, for gen- for, for a long time, many decades. The biggest one, thing when it comes to diet, and they even have more recent publications. Um, a mentor of mine, uh, Julie Poteet, she's a past president of the Ocular Wellness and Nutrition Society who I'm, who, 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 large cohort of people, like 4,000 people they watched over nine years, tracking their diet, tracking, uh, their eye health and how things were changing. 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 prov- 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 gr- 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.

Steven Bartlett 1:06:29 And macular degeneration leads to blindness.

Dr. Joseph Allen 1:06:31 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, um, 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, reduced risk of developing conditions like macular degeneration, reduced risk of things like diabetic retinopathy. And so I try to focus on eating a good, healthy diet.

Steven Bartlett 1:07:27 I mean, the thing that I heard growing up was that you need to eat lots of carrots.

Dr. Joseph Allen 1:07:31 Mm-hmm.

Steven Bartlett 1:07:31 And then carrots will help your vision.

Dr. Joseph Allen 1:07:34 So carrots... Do you know where that came from?

Steven Bartlett 1:07:36 No.

Dr. Joseph Allen 1:07:37 That's actually a... It was propaganda started in the UK by, uh, Great Britain, um, from what I understand, and 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 war planes dropping bombs on them, especially at nighttime. And they had already established radar to detect war planes coming, but they didn't want Germany to know that. So they put out their own propaganda saying, "Hey, our scouts can detect German war planes 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.

Steven Bartlett 1:08:30 Ah, okay.

Dr. Joseph Allen 1:08:32 But-

Steven Bartlett 1:08:32 'Cause I al- also used to hear that you eat, if you ate carrots you could see in the dark.

Dr. Joseph Allen 1:08:36 Yeah. So it's a...

Steven Bartlett 1:08:37 Hm.

Dr. Joseph Allen 1:08:37 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, in the eye clinic. Unless you, uh, happen to live in a place that's pretty malnourished.

Steven Bartlett 1:08:59 You mentioned oily

Steven Bartlett 1:09:00 fish. I was on your YouTube channel and I saw that you did an experiment where you took omega-3 for 90 days, uh, I guess because there's some kind of implications for vision with omega-3?

Dr. Joseph Allen 1:09:12 Omega-3 does play a role in the eyes for two reasons. Uh, that specific video, uh, I was really looking at omega-3s and its relationship to my own dry eye symptoms.

Steven Bartlett 1:09:21 Mm-hmm.

Dr. Joseph Allen 1:09:22 Because there's a lot of studies looking at omega-3 and, and its dry eye. And the research is still a bit all over the place. Most, most eyecare 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, 'cause a lot of dry eye disease has to do with inflammation. And so there is a, a large belief that it does work. There are some publications, of course, 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, this... Again, this kinda orange-pink tissue in the back.

Steven Bartlett 1:10:04 Mm-hmm.

Dr. Joseph Allen 1:10:05 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 retina is essential. So the photoreceptors, about 50 to 60% of the fatty acid content of the photoreceptor ha- is DHA omega-3.

Steven Bartlett 1:10:24 Hm.

Dr. Joseph Allen 1:10:25 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, 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-3s supplements have not seen the same results w- in terms of this form of retinal health. And there is some insight. They're thinking they've kinda figured this out, and this is still very early research, but... So there is a transporter called the MFSD2A. This transporter helps transport specific forms of DHA omega-3 into bl- through the blood-brain barrier into neural tissue, and they're finding that that same transporter works for the 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 lip- lysophospholipid DHA that binds to that transporter and helps that get into neural tissue. And the current research is showing that with mice at least, uh, 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-

Steven Bartlett 1:11:59 So-

Dr. Joseph Allen 1:11:59 ... it's still very early research, but...

Steven Bartlett 1:12:01 So the omega-3 that I've got in my cupboard at home is probably not gonna help, but the, the new versions of omega-3 that they're working on probably will?

Dr. Joseph Allen 1:12:09 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 triacylglycerol, which your body can convert in the liver to get to neural tissue, but it's not very efficient.

Steven Bartlett 1:12:26 Okay.

Dr. Joseph Allen 1:12:26 There are some forms of... So if you are eating fish, fish, krill, and then, like, fish eggs... Do you like sushi?

Steven Bartlett 1:12:35 Yeah.

Dr. Joseph Allen 1:12:36 So fish eggs are often on sushi, um, fish roe. Those types of... Like, salmon, I've read, 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.

Steven Bartlett 1:13:00 Hm.

Dr. Joseph Allen 1:13:00 And your body 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, at a better bioavailability.

Steven Bartlett 1:13:16 What did you discover when you started taking omega-3 for 90 days as part of that experiment?

Dr. Joseph Allen 1:13:21 So that was, again, looking more at dry eye.

Steven Bartlett 1:13:24 Yeah.

Dr. Joseph Allen 1:13:25 And specifically, I took ... First, I just looked at, "Hey what's my blood level of omega-3's right now?"

Steven Bartlett 1:13:31 Mm-hmm.

Dr. Joseph Allen 1:13:32 Just by diet, and it was pretty low at that time. It was like 4.7 or something like that, but you want between eight and 12%. Then I started taking ... I also did measurements of my dry eye symptoms. Uh, my dry eye symptoms, I took dry eye measurements that we do in the clinic to 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, my blood again at the end. And I found that after taking those omega-3's, that specific formula, that it ended up getting to about 9.5% omega-3.

Steven Bartlett 1:14:07 It's like a 100, more than 100% increase.

Dr. Joseph Allen 1:14:09 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 one (laughs) -

Steven Bartlett 1:14:17 Yes, of course, yeah.

Dr. Joseph Allen 1:14:17 ... you know, I'm just one person. Uh, there's a lot of... Dry eye is really complicated too.

Steven Bartlett 1:14:22 What is dry eye? I don't think I've ever had dry eye.

Dr. Joseph Allen 1:14:24 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 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 r- it could be a reduced amount of production of tears, it could be that your tears evaporate too quickly. That's a h- lot of people. And then what happens is that there's little bit of damage on the surface of the eye 'cause the y- tear film has to stay stable to protect the tissue underneath. If the tears are gone, the tissue underneath gets exposed to air 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 in the surface of the eye here in the cornea. It then has little micro-damage, which the 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 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

Dr. Joseph Allen 1:16:04 well.

Steven Bartlett 1:16:04 Is there one food in particular that is, in your view, the top food for good eye health?

Dr. Joseph Allen 1:16:12 So green leafy vegetables.

Steven Bartlett 1:16:14 What about sweet potatoes?

Dr. Joseph Allen 1:16:17 Sweet potatoes can certainly have help, help you with things like vitamin A. They've got other nutrients in them, I think they're really good. Uh, sweet potatoes technically have beta carotene, right? 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, uh, mainly in green leafy vegetables you can not only get things like beta carotene, but you can get lutein and zeaxanthin, which, uh, are amazing for eye health in many ways. Not just eye health, but also brain health.

Steven Bartlett 1:16:49 What about sugar? What impact does e- 'cause you mentioned diabetes earlier-

Dr. Joseph Allen 1:16:53 Mm-hmm.

Steven Bartlett 1:16:53 ... I think. If I'm having a lot of sugar in my diet, will that have an impact on my eye health?

Dr. Joseph Allen 1:16:58 It can. For patients who don't, or for people who are diabetic or have elevated blood sugars, when you're- have too much sugar in your blood, it can enter into the eye. It can cause the l- 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 notice 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. We have to send you in for, like, a diabetic workup."

Steven Bartlett 1:17:36 Do

Steven Bartlett 1:17:37 people with diabetes suffer more with their vision?

Dr. Joseph Allen 1:17:40 They can. Uh, diabetes is c- is devastating for the, the health of the eye because with diabetes, when your blood sugar's elevated, it causes damage to the endothelium of the blood vessels and the arteries in the back of the eye.

Steven Bartlett 1:17:54 The things at the back of ... Those things there.

Dr. Joseph Allen 1:17:56 Yeah, because the, the back of the eye is one of the most highly vascularized area of your body. As soon as we can ... 'Cause you have blood vessels, again, on the inside of the retina, you have blood vessels on the backside of the retina, and so when people have damage to those blood vessels, the blood, 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 tissues, the retinal tissues not getting the nutrients, the oxygen and the nutrients it needs to stay alive.

Steven Bartlett 1:18:27 Mm-hmm.

Dr. Joseph Allen 1:18:27 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.

Steven Bartlett 1:18:37 Mm-hmm.

Dr. Joseph Allen 1:18:38 And ultimately, if people unfortunately are diabetic, they don't know it or they're poorly controlled, they can bleed so much from 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.

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Dr. Joseph Allen 1:20:52 Mm-hmm.

Steven Bartlett 1:20:53 What is that?

Dr. Joseph Allen 1:20:54 Eyelid myokymia.

Steven Bartlett 1:20:56 Is that what it's called?

Dr. Joseph Allen 1:20:57 It is. That's the, that's the medical definition for it.

Steven Bartlett 1:20:59 Twitching eye, I call it.

Dr. Joseph Allen 1:21:00 Yeah, twitching eye.

Steven Bartlett 1:21:00 Twitching eyelid, like the eyelid starts going bzz. What is that?

Dr. Joseph Allen 1:21:05 So that is your threshold of your eyelids, t- to blink is your level of stress. You're like h- holding really tight muscles. And so, they find... And this is historically, even in, in textbooks, they call it basically the med s- medical student twitching eye, 'cause 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 c- uh, 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 a- have an energy drink with them. And I'm like, "Okay." (laughs)

Steven Bartlett 1:21:41 Ah, okay.

Dr. Joseph Allen 1:21:42 So that- that is largely what it is. Some people can have a true

Dr. Joseph Allen 1:21:49 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 in their eyelids, it's usually not a concern. It's just get more sleep, stop drinking so much caffeine, try to l- look at your stress levels. And that's a tough thing, because even myself, 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 d- 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, 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 ha- you know, 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."

Steven Bartlett 1:22:39 Mm-hmm.

Dr. Joseph Allen 1:22:40 I've just, I've come so accustomed to it, I haven't, I didn't realize it, haven't been that self-aware.

Steven Bartlett 1:22:45 Glaucoma. Now glaucoma is something that people over 60 typically get, um, from what I've understood.

Dr. Joseph Allen 1:22:51 Mm-hmm.

Steven Bartlett 1:22:51 Is that preventable at all or is that just a consequence of aging, and what is glaucoma?

Dr. Joseph Allen 1:22:56 So glaucoma is where the nerve, the nerve in the back here that connects the eyeball to the brain...

Steven Bartlett 1:23:02 So this thing here?

Dr. Joseph Allen 1:23:03 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. And so glaucoma... There's different types of glaucoma, but the nerves die for some reason.

Steven Bartlett 1:23:23 So the nerves m- at the back here?

Dr. Joseph Allen 1:23:26 Mm-hmm.

Steven Bartlett 1:23:27 Okay.

Dr. Joseph Allen 1:23:28 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, 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.

Steven Bartlett 1:24:04 Mm-hmm.

Dr. Joseph Allen 1:24:05 And that basically

Dr. Joseph Allen 1:24:06 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 at each of the ganglion cells to a point where it starts to die off.

Steven Bartlett 1:24:21 That's not reversible, is it?

Dr. Joseph Allen 1:24:22 Unfortunately, no.

Steven Bartlett 1:24:23 Doesn't sound reversible.

Dr. Joseph Allen 1:24:23 When you lose, 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