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

1. 0:00 – 3:08

   Dr. Jeffrey Goldberg

   1. AHAndrew Huberman0:00

      (music plays) Welcome to the Huberman Lab Podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today my guest is Dr. Jeffrey Goldberg. Dr. Jeffrey Goldberg is the chair of the Department of Ophthalmology at Stanford University School of Medicine. He is a clinician, an MD or medical doctor who sees patients every week, as well as a PhD, meaning a laboratory scientist who directs his own laboratory focused on understanding the mechanisms and cures for diseases of the eye and vision such as glaucoma, retinitis pigmentosa, and macular degeneration. Indeed, Dr. Goldberg is one of the world leaders in developing methods to cure blindness. He is also intensely knowledgeable about all things related to vision. So during today's discussion, we indeed cover most all of visual and eye health. You will learn, for instance, about the benefits as well as drawbacks of wearing corrective lenses such as contact lenses or eyeglasses for reading. You will learn about the benefits and detriments of sunlight, meaning how it can help your vision, in fact, how it can help reverse or prevent myopia, nearsightedness, as well as the things to be cautious about with respect to sunlight in terms of development of cataracts, which are occlusions that prevent vision. We also discuss many tools for maintaining and improving vision across the lifespan, ranging from behavioral tools, so specific vision tasks and exercises for the eye that you can do that are known to improve or maintain your vision, as well as specific surgical procedures such as LASIK surgery. We get into all the details of, for instance, how often to do these various eye exercises, how long the benefits are maintained, as well as age-related considerations for things like LASIK eye surgery. We even get into how to best clean your contact lenses, whether or not to use disposable contact lenses or other forms of contact lenses. We also discuss things like dry eye and the best remedies for dry eye, and we talk about the scientific and clinical data around nutritional approaches and supplementation-based approaches for maintaining and improving vision. So whether or not you suffer from floaters or dry eye, or you're considering changing your eye prescription, or you have concerns about whether or not relying on corrective lenses is impairing your vision and you want to enhance your vision, or if you're somebody who has perfect vision, today's episode is going to include science and protocols that will be highly relevant to you. I should also add that if you are somebody who suffers from or who has family members who suffer from diseases of the eye that can impact vision such as glaucoma, retinitis pigmentosa, and macular degeneration, we also delve deep into the discussion about the most advanced technologies for preventing and offsetting vision loss due to those diseases as well. Thanks to Dr. Goldberg's incredible knowledge, his clarity of communication, and his generosity with that knowledge, by the end of today's episode, you will be armed with all of the modern information you need in order to best maintain and improve your eye and vision

2. 3:08 – 6:29

   Sponsors: Maui Nui, LMNT, Eight Sleep

   1. AHAndrew Huberman3:08

      health. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is Maui Nui Venison. Maui Nui Venison is the most nutrient-dense and delicious red meat available. I've talked before on this podcast about the key importance of striving to get one gram of protein per pound of body weight. Now when one strives to do that, it's also important to maximize the quality protein to calorie ratio. In other words, you don't want to consume a lot of extra calories in order to get your quality protein. Maui Nui Venison, in having an extremely high-quality protein and nutrient to calorie ratio, allows you to do that very easily, and in addition to that, Maui Nui Venison is delicious. I particularly like their bone broth, which has an unmatched 25 grams of protein per 100 calories. I also love their ground venison and their venison steaks. All of them are absolutely delicious. If you'd like to try Maui Nui Venison, go to mauinuivenison.com/huberman and get 20% off your first order. Again, that's mauinuivenison.com/huberman to get 20% off. Today's episode is also brought to us by LMNT. LMNT is an electrolyte drink that has everything you need, that is the electrolytes, sodium, magnesium, and potassium, but nothing you don't, which means no sugar. It's critical that we get electrolytes because every cell of our body, but in particular, our nerve cells, our neurons rely on electrolytes in order to function properly. With LMNT, it's very easy to ingest the correct ratios of electrolytes. They come in these little packets. They're really delicious. You mix them up with anywhere from 8 to 16 to 32 ounces of fluid. I like mine pretty concentrated so I'll drink a 16-ounce glass of water with LMNT in it when I first wake up. I'll also consume another one of those maybe 32 ounces with one packet when I exercise and maybe another one if I happen to sweat a lot during exercise or if I was in the sauna and sweating a lot if it's a very hot day, et cetera. If you'd like to try LMNT, go to DrinkLMNT, that's lmnt.com/huberman to claim a free LMNT sample pack with your purchase. Again, that's Drink LMNT, lmnt.com/huberman. Today's episode is also brought to us by Eight Sleep. Eight Sleep makes smart mattress covers with cooling, heating, and sleep tracking capacity. Now there's absolutely no question that sleep is the foundation of mental health, physical health, and performance. When we're sleeping well and we're sleeping long enough, everything in our daily life goes that much better. Now a key component to getting a great night's sleep is the temperature of your sleeping environment, and that's because in order to fall and stay deeply asleep, your core body temperature actually has to drop by about one to three degrees. Conversely, in order to wake up feeling refreshed, your core body temperature has to increase by about one to three degrees. With Eight Sleep mattress covers, you can cool or heat your mattress at the beginning, middle, and end of your night in order to optimize your night's sleep. I started sleeping on an Eight Sleep mattress cover about two years ago, and it has dramatically improved the sleep that I get each and every night. If you'd like to try Eight Sleep, you can go to eightsleep.com/huberman and save up to $150 off their Pod 3 cover. Eight Sleep currently ships in the USA, Canada, UK, select countries in the EU, and Australia. Again, that's eightsleep.com/huberman. And now for my discussion with Dr. Jeffrey Goldberg.Dr.

3. 6:29 – 11:36

   Childhood & Eye Exams

   1. AHAndrew Huberman6:30

      Jeffrey Goldberg, welcome.

   2. JGJeffrey Goldberg6:32

      Thanks. It's great to be here.

   3. AHAndrew Huberman6:33

      You and I go way back. We will spare people the discussion about all of that, but I'm really excited for today's discussion because I get a tremendous number of questions about vision and eye health, and, of course, as a neuroscientist who has worked on the visual system, I sometimes have answers or partial answers, but more often than not, I don't have the answers, and yet I'm confident that you do, or that if you don't, you can direct us to the proper place to get those answers. So to kick things off, I wanna ask you what was one of the most commonly asked questions when I solicited for questions in anticipation of this episode, which is, how early should one do an eye exam on their child, and how regularly should we all be doing eye exams? Also, is the fact that I think I can see normally confirmation that I can see as well as I think I can? So that's really three questions. But baby comes out, do they check their eyes right away?

   4. JGJeffrey Goldberg7:32

      Yeah.

   5. AHAndrew Huberman7:32

      And if so, how, and how often should they check, and what kind of information is there?

   6. JGJeffrey Goldberg7:37

      Yeah. That's, that's, that's a great question. It's obviously something that touches us all. So the que- the, the answer to that really differs a little bit, uh, at the different stages of life. First of all, every, every baby gets an eye exam or should be getting an eye exam, and, uh, one of the main things that you really just are screening for right when that baby is born, right in the nursery, right in those first few days, is to just look for a red reflex. You know when you take a camera picture, a flash picture, and sometimes you get red eye? That's actually the light from the flash, as you know, reflecting against the retina and coming back out of your eye. It looks red. And, um, and a red reflex is actually very normal. That's, that- that's great. And if you have a n- one of a number of diseases in the eye that can present i- even in babies, even in newborn babies, including most concerning but thankfully least common, retinoblastoma, which is the most common pediatric eye cancer, uh, which, again, thankfully is quite rare, uh, those babies won't have a red reflex in that eye. It'll be kind of a white-ish or gray reflex. And so even just that first little, you know, doctor's taking the little penlight and even just flashing it in the, in the baby's eyes, so that's, that's, that's our first eye exam, and, and hopefully we've all had that, and hopefully every baby being born today is getting that, getting that first eye exam, is really just looking for that red reflex. Uh, it's not typical, as long as that's looking good, um, to worry about getting an eye exam from there kinda through, um, childhood, like, uh, maybe early elementary school, unless the b- your baby is presenting with one of a number of features that parents often pick up on. For example, as the baby's aging through those first couple of years... You know, through the first couple of years, babies actually don't have great visual acuity, and so as they're aging, over those first couple of years, it's normal for them to have, you know, roving eye mo- movements, for example, be searching their environment. Um, but over those first couple of years, if parents start noticing the baby isn't, you know, isn't, uh, uh, making eye contact or looking where a sound is, certainly if they have what's called nystagmus, like these rapid, flickering, alternating eye movements, uh, anything like that, of course you're gonna trigger, trigger an eye exam. But otherwise, most babies, other than their pediatrician doing that red reflex check when they're in for their regular well-child checks, uh, that's really all that's, uh, needed through that. When most kids get to elementary school age, there'll often be, often done at the schools, an amblyopia screening exam. If kids' eyes either... if one eye doesn't see that well, like maybe you're very nearsighted or farsighted in one eye and pretty normal-sighted in the other, or the two refractive errors are quite different from each other, um, that can lead to a condition you've talked about on the podcast before called amblyopia, uh, which is probably one of the more common or most common eye diseases of children. Or, uh, if the eyes aren't aligned, you know, our eye muscles and the brain behind them are really responsible for keeping the two eyes looking straight ahead, and if that's not working properly and one eye is, is off-kilter, and therefore the image of what we're looking at is falling on different spots of the retina, it's not syncing up right in the brain, that can lead to this disease condition called amblyopia, where that eye is no longer talking to the brain properly. And there's a pretty easy screening exam that can be done for strabismus, the misalignment of the eyes, that kids'll do in elementary school. The other main presenting symptom of kids in elementary school is when they admit to their parents, "I, I can't see the board," or, "I can't see the teacher up front," and then they might be quite nearsighted, and so that will also trigger an exam. And, uh, so those are usually the parts for, for babies, for toddlers, for children, school-aged children, that might reasonably trigger an exam.

   7. AHAndrew Huberman11:34

      A couple of questions about early

4. 11:36 – 20:38

   Eye Misalignment & Recovery

   1. AHAndrew Huberman11:36

      eye exams, and we'll, um, get onto, uh, eye exams in older individuals in a second, um, but I wanna interrupt you with this question. So you mentioned that, um, you know, there can be a misalignment of the eyes. I've seen many people's babies where there is one eyeball that seems to be kinda drifting around, and then it might correct, but sometimes they'll have a, uh, we don't wanna get technical here for, uh, for our listeners. We'll keep it general, but either convergent eyes, or one eye converging, crossed eyes, e- or wall-eyed, you know, again, using, uh, n- non-technical language here. Um, and my understanding is that the brain is taking that information in and is very plastic. It's changing at these early stages of development, and that it's fairly critical to get that stuff corrected early on, because if you wait too long, the brain can essentially become blind to the, the, um... or rather, the, the brain cannot learn to handle the proper alignment. So in other words, if a kid has, uh, cross eyes, uh, crossed eyes, excuse me, and they're not corrected, uh, until their 20s, it's possible that they will never recover normal vision, whereas if you recover, if you align the eyes properly early in development, they-... can, indeed, recover vision. How early can and should one consider getting those eye realignments done?

   2. JGJeffrey Goldberg12:52

      Yeah, yeah. Pr-pretty much right on. What they'll do is if they detect any eye misalignment, and sometimes parents are, are good at noticing that, and sometimes you take a picture and one eye got the red eye reflex (laughs) and the other one didn't, and sometimes people notice that their kids' eyes are sort of turning in, uh, it seems like too much. Um, sometimes there's what's called pseudo strabismus, which is where actually, depending on your anatomy, if you have a little extra skin sort of on the inside corners of your eyes, it makes your eyes look turned in when actually they're straight.

   3. AHAndrew Huberman13:23

      Mm-hmm.

   4. JGJeffrey Goldberg13:23

      Um, but if your eyes are actually turned in, or slightly less common in children, more common in adults, misalignment turned out, um, it's really important to correct that early. And the reason is, as you were saying, the brain starts ignoring, it, it fails to fully develop the strong connections from the, for the data coming in from one of those two eyes into the brain. And if you pass certain sort of thresholds during development, during childhood without correcting that connectivity, getting those two eyes to work together properly, um, you can permanently lose that, um... And so we use sort of, we used to use very sort of, uh, you know, gross numbers like fully correctable if you can intervene before age three. It's partly correctable if you can intervene before age six. You got a chance before age nine. But it turns out in follow-on studies that even kids into their young teens-

   5. AHAndrew Huberman14:22

      Mm.

   6. JGJeffrey Goldberg14:22

      ... have a shot at correcting that eye-brain connection, that amblyopia, that, that loss of vision, uh, that, that can occur during early development. So, uh, e-even if you're only, you know, unfortunately detecting that later on in childhood or even sort of the tween years or early teen years, it's still worth a try to really push to, um, retrain the weaker eye and then also realign the muscles so that they can work together to keep the eyes focused. I'll tell you, it's interesting, and there's a lot more to learn about blai- brain plasticity and probably a lot of really cool new therapies yet to discover that could reopen what's called critical period plasticity, this, this, this plasticity that we have during development that kind of goes away as we age. And, and that critical period plasticity, as you know, has been the best studied actually in the visual system, and the idea that we could reopen that is really fantastic. But for different parts of that eye-brain connection, there's different periods for critical period plasticity. For example, even if you get the amblyopic eye to see well again and then you realign the eyes and now they're working together, a lot of kids will never recover full depth perception, stereopsis, the use of two eyes to see depth, for example. So, why that part of the brain doesn't correct as well as the visual acuity or central vision part of the brain, I'm not sure if we understand that yet.

   7. AHAndrew Huberman15:55

      I'm gonna ask for a curbside consult as, uh, it's sometimes called right now, uh, by telling you a story. When I was a kid, I went swimming without goggles and I had one eye closed and the other eye open and closing as it went in and out of the water because I'm a deficient swimmer and I only breathe through one side unless I really consciously force myself to breathe through both sides in a freestyle swim. Got out of the pool and I was seeing double. It was pretty eerie and then it became downright scary because I didn't recover my double vision until they patched one of the eyes, forcing me to use the other eye that had been closed the entire time. And fortunately, this was done early enough and it, I was young enough that within, uh, I think it was about a day or so, I restored what, mo- normal vision. However, my depth perception is terrible. Um, I'm the kid that, you know, fly ball was hit to me in, in the outfield and it's coming, it's coming, and then it hit me. This is why I've generally focused on foot sports-

   8. JGJeffrey Goldberg16:53

      (laughs)

   9. AHAndrew Huberman16:53

      ... throughout my entire life as opposed to, you know, precise ha- um, hand-eye coordination. I'm better at throwing darts and things with one eye closed than I ever would be with both eyes. Maybe that's true for most people. Question I have is, is it true that even just a few hours of misalignment of information to the two eyes early in development can permanently rewire the brain unless there are some corrective measures-

   10. JGJeffrey Goldberg17:18

       Yeah.

   11. AHAndrew Huberman17:18

       ... such as patching up one eye? Um, and the example I gave is just one, but for instance, if, um, uh, you know, someone injures, you know, gets a scratch on their cornea and they close th- they patch the eye and the person happens to be 10 years old, is it important to then patch the other healthy eye after the, the, um, you know, the, the scratched eye is feeling better? In other words, how critical is it to ensure the balance of information coming into the two eyes even on the order of hours or days?

   12. JGJeffrey Goldberg17:46

       Yeah. Your story is, uh, it has some features of, uh, you know, totally usual how we think about misaligned eyes leading to amblyopia where one eye is weaker, patching the strong eye so the weak eye can recover, but not necessarily fully regaining depth perception-

   13. AHAndrew Huberman18:03

       Mm-hmm.

   14. JGJeffrey Goldberg18:03

       ... and so that part of it is, you know, quite stereotypical.

   15. AHAndrew Huberman18:08

       Mm-hmm.

   16. JGJeffrey Goldberg18:08

       The part of your story that's atypical is that for most kids, um, an hour or two, let alone minutes, an hour or two, even an hour or two a day if you were, I don't know, if you were a young kid and you just really were training up on throwing darts and you were-

   17. AHAndrew Huberman18:24

       Mm-hmm.

   18. JGJeffrey Goldberg18:24

       ... just keeping one eye closed to throw the darts, you know, really practicing for an hour a day, it'd be very unusual for that to trigger this kind of either strabismus, misalignment of the eyes, let alone amblyopia, uh, and the strabismus is what's giving you the double vision 'cause they're misaligned, let alone the ambly- amblyopia of one eye turning out weaker. If I had to guess, of course, not having, you know, done your exam before that fateful day in the swimming pool-

   19. AHAndrew Huberman18:50

       Mm-hmm.

   20. JGJeffrey Goldberg18:51

       ... if I had to guess, I would guess that you may have had...... some intermittent strabismus and your brain was already getting, kind of, hit and, and you, neither you nor your parents may have even noticed it. It could be happening, you know, at other times a day or you're not, kind of, really paying attention. It doesn't, kind of, stand out in the way that, that that day that, that you got out of the swimming pool you really noticed it. And it may not have been that strong, it may have been quite intermittent. But if you had had some years of intermittent esotropia, or turning in of the eyes, or exotropia, turning out of the eyes, that just happened here and there but was accumulating, sort of, uh, damage or failure to connect over years leading up to that day in the swimming pool, and that day just tipped you over the edge and you got double vision, you really noticed it, that led to an eye exam and an eyecare provider and they said, "Wait a second, this eye's stronger, this eye's weaker, you've got a little amblyopia. We're gonna start patching your strong eye so you can get your weak eye back." So, for 99.9% of the kids who, like, you know, yeah, they get a little corneal scratch or they're patching one eye closed or, or, uh, you know, any- a- a- anything that's sort of a rare event like that, nothing to worry about. Parents don't have to worry. Kids can be kids, they can play, they can do that kind of thing and, uh, and not have to worry. A- a- and it's unfortunately we can't tell in advance which kid's been having the intermittent amblyopia because we don't do a standard eye exam on every five-year-old who's not complaining of anything, right?

   21. AHAndrew Huberman20:20

       Mm-hmm.

   22. JGJeffrey Goldberg20:21

       But yeah, so that's an u- that's an unusual case than yours, and if I had to guess I, I would bet that you were having some sort of subclinical, untracked, uncharted, unnoticed maybe strabismus leading up to that point.

   23. AHAndrew Huberman20:34

       Okay, great. Thank you.

   24. JGJeffrey Goldberg20:35

       Yeah. (laughs)

   25. AHAndrew Huberman20:35

       You can send me a bill at the end. Um,

5. 20:38 – 30:04

   Myopia (Near-Sightedness), Children & Sunlight

   1. AHAndrew Huberman20:38

      along those lines, I'm 47 years old, so I was, um, part of the generation that grew up with some computers in the classroom, but not a lot. Uh, nowadays, kids from a very young age are looking at iPads and phones and screens and things very close up. And there is a wealth of experimental animal data showing that if you limit vision to, uh, just close range that the l- eyeball lengthens and therefore the visual image falls in front of and not directly onto the neural retina, the, essentially the light-sensing portion of the, of the eye, and those animals become myopic or nearsighted. What can we say about the environmental conditions in which kids are seeing from the time they're born through, let's say, adolescence and their teen years, in terms of how their visual system wires up? And are there any recommendations that are coming from the scientific literature, clinical studies, clinical trials, excuse me, or otherwise, that indicate what a healthy visual environment consists of?

   2. JGJeffrey Goldberg21:51

      Yeah. Yeah. That's a great question, and actually it's really relevant these days because, uh, you know, myopia is so common, uh, it's more common, um, in Asian populations, you know, it's called an epidemic in China. Uh, in California we have a lot of Asian heritage or Asian Americans, and so we see a lot, like at Stanford we see a lot of, um, you know, myopia in kids and adults, and really starting to get thoughtful on the science of myopia control. How do we, how do we provide the right environments? Now, what's interesting is that for decades the assumption, some of the data, really led us to the path of thinking like, gosh, the more you spend at near activities, and these are mouse model experiments like you described, but also well-designed human cohort studies, you know, figuring out, like, asking, you know, kids and families, like, "How long is your kid reading or in front of the computer? How myopic are they? How nearsighted are they?" Versus, "How much time is your kid in front of the computer or doing near work? How myopic or nearsighted are they?" And these well-designed cohort studies did point towards this concept that if you do too much near work as a kid, that you're more likely to develop nearsightedness as you get through those, those, sort of, you know, uh, pre-teen and even into the teen years, which is when most of that myopia progression, or eyeball elongation, is actually happening to cause nearsightedness. It's only been in the last few years that some really exciting studies have actually pointed in a slightly different direction, and that's that maybe it's not all... Not to say it's not about near activity, but maybe it's not all about near activity. Maybe it's actually a little more about the kind of light we're getting into our eyes. And I think you've talked about this before and it's really important. When they've now studied and asked the kids instead of just, "How much near and how much far are you doing? How much time are you spending indoors in indoor lighting, which doesn't have full spectrum light in a typical indoor environment, versus how much time are you spending outdoors, playing in the yard? You could be reading outside, but what are you j- what, what kind of time are you spending outside?" And n- a- and of course when you're outside in sunlight, even if it's in direct sunlight, you're getting a different spectrum, kind of full spectrum lighting from the sun. And it looks like it's pretty clear now, actually, that it has maybe more to do with outdoor lighting time than just near work, and so I think that, you know, we- we've, we've actually already seen the first couple randomized controlled trials where they're having kids intentionally spending time outdoors versus, sort of, standard life, which, you know, is gonna be often much more indoor time, and, uh, and seeing some effects. You follow those kids over a couple of years...... and the kids who spend time outdoors are, are progressing in their nearsightedness less. Like their, their nearsighted prescription is not getting as strong as the kids who are spending more time indoors. And there's some pretty good biology that's getting worked out, going back to animal models, more about, about how that might be working in the retina, in this inside the eye, uh, but it's pretty compelling, uh, concept and, and so, you know, as a parent, uh, you, you may want to be, you may want to be telling your kid like, "Okay, yeah, I want you to read that book." Or, you know, I, if your kid's playing on the phone or something like that, or the iPad or something like that, they're allowed that time, "Okay, you can have that time, but I want you to spend some of the time that you're doing that outdoors." Um-

   3. AHAndrew Huberman25:39

      Are there any thresholds for the amount of time that, uh, one would suggest their child be outdoors, um, to get that full spectrum light?

   4. JGJeffrey Goldberg25:46

      It's a great question. You know, we talk about cohort studies where we just ask people what are they doing and there seems to be, you know, a little bit of what we would call a dose dependent response, maybe the more time outdoors might be better. We don't know if there's an upper limit, like, gosh, if you go over two or three hours, there's no additional benefit. Talk about that in cohort studies. The real gold standard for answering these kinds of questions are randomized controlled trials, and specifically placebo controlled or, or a control group that's not getting the intervention. That's our highest level of evidence for clinical evidence for, for any of this kind of science, uh, when we're talking about humans or pre-clinical models in the laboratory. And w- the study that hasn't been done yet to really answer that question is to randomize kids to telling this group of kids, "You just do your normal life." Tell this group of kids, "We want you outside an hour." This group of kids, "We want you outside two hours a day." This group of kids, "Three hours a day." And see between the groups, is there a big difference? Like we have pretty good evidence now from the studies that have been done that the difference between zero and one or two hours is clearly there. Is five minutes enough? Is five hours better? I don't think we know the answers to those questions yet, like what's the right dose? Um, but there's probably at least some dose dependence to that.

   5. AHAndrew Huberman27:11

      And it, I can imagine it's a little bit hard to tease apart the near far viewing from the indoor outdoor because yes, of course, a child could be outside on an iPad up close, but it's hard to imagine that at some point they aren't seeing off into the distance, far viewing-

   6. JGJeffrey Goldberg27:25

      Yeah.

   7. AHAndrew Huberman27:26

      ... as it's called. And the reverse is also true if you're indoors, unless you live in a very, very large home or you're staring off a balcony, far viewing is much harder to achieve.

   8. JGJeffrey Goldberg27:36

      Yeah. Yeah.

   9. AHAndrew Huberman27:37

      So it's, uh, and perhaps it isn't important to isolate these variables, although I can see the challenge in developing a really good clinical trial, randomized clinical trial for this. Meanwhile, I, I, you know, I'm cons- I'll go into the grave shouting, you know, or saying rather and suggesting that people get some morning sunlight in their eyes to set their circadian rhythm, um, but far viewing a few, at least a few minutes and ideally hours per day, or a mixture of near and far viewing by being outdoors just seems like a good thing to do regardless of age. So are there any data in older people, not necessarily elderly, but older people, so, um, people when they're, uh, from say 25 years of age into their 60s or 70s, that getting outdoors and getting this full spectrum light is healthy for the eye in ways that are separate from the known healthy effects of doing that on circadian rhythm setting?

   10. JGJeffrey Goldberg28:27

       Yeah. Yeah. The circadian part's pretty clear. The, in most patient, in most, in most people, the near, the development of nearsightedness happens a lot until age 10, little more through age 20, little more than that into the, in, you know, in through the 20s up to 30, tiny bit in the 30s up to 40, but usually by those later ages, your prescription might be changing a quarter of a diopter, that's the measurement that we use when we, you know, give you your glasses prescription, a quarter of a diopter, half a diopter. It could get a half diopter more nearsighted or less nearsighted, you know, once you're aging into your 40s, 50s and beyond. So most of the action on nearsightedness development is actually really happening in the younger ages. So again, the, the premise of intervening in an older person, and I'll just include you and me in older people for the sake of this definition, as much as I'm reticent to do that in general, um, I think the, the premise of in- of a of, of sort of light modulation for nearsightedness in older people is probably, probably not so strong. I think there are a lot of other benefits. You've talked a lot about circadian rhythm. There are so many health benefits to exercise and, you know, if you're getting outdoors, there's a good chance you're going to be walking or bicycling (laughs) , you know? So, so exercise value for the health of our eyes and the rest of our body is clearly there. Um, but I don't know that there's really a, a strong premise that you're going to change your glasses prescription, you know, in our 40s or 50s or, or beyond.

6. 30:04 – 31:18

   Sponsor: AG1 (Athletic Greens)

   1. JGJeffrey Goldberg30:04

   2. AHAndrew Huberman30:04

      I'd like to take a quick break and acknowledge one of our sponsors, Athletic Greens. Athletic Greens, now called AG1, is a vitamin mineral probiotic drink that covers all of your foundational nutritional needs. I've been taking Athletic Greens since 2012, so I'm delighted that they're sponsoring the podcast. The reason I started taking Athletic Greens and the reason I still take Athletic Greens once or usually twice a day, is that it gets me the probiotics that I need for gut health. Our gut is very important. It's populated by gut microbiota that communicate with the brain, the immune system, and basically all the biological systems of our body to strongly impact our immediate and long-term health. And those probiotics in Athletic Greens are optimal and vital for microbiotic health. In addition, Athletic Greens contains a number of adaptogens, vitamins and minerals that make sure that all of my foundational nutritional needs are met, and-It tastes great. If you'd like to try Athletic Greens, you can go to athleticgreens.com/huberman, and they'll give you five free travel packs that make it really easy to mix up Athletic Greens while you're on the road, in the car, on the plane, et cetera, and they'll give you a year's supply of vitamin D3 K2. Again, that's athleticgreens.com/huberman to get the five free travel packs and the year's supply of vitamin D3

7. 31:18 – 40:07

   Eye Safety & Protection; Eye Hygiene

   1. AHAndrew Huberman31:18

      K2. It's probably worth touching on some of the dos and some of the don'ts for eye health generally, uh, and then I promise I'm going to get us back to adult eye exams, um, 'cause I have a lot of questions about that. I can imagine that it's probably not a great idea to be exposed to extremely bright light, and this is why people who weld wear eye shields, um, but of course most people are not welding.

   2. JGJeffrey Goldberg31:42

      (laughs)

   3. AHAndrew Huberman31:43

      Um, what other sorts of environmental conditions are detrimental to our vision health across the lifespan, um, including brightness of light, uh, we talked a little bit about near, far. Um, obviously we want to keep toxins and acids and solvents and things out of the eye, but what do you see f- I'm not, 'cause it hopefully not commonly, but what are some of the things that you feel might not be discussed enough in terms of eye health?

   4. JGJeffrey Goldberg32:06

      Yeah. You know, I think at all ages, eye safety is something that we don't talk about enough. Um, you know, our eyes are delicate. The front surface of the eye, the cornea, the clear window that lets the light go into your eye, that's a delicate, very sensitive structure. It's thin, maybe a millimeter at the thickest, a half-millimeter in the center of our eye. Uh, the retina is, it, it's neural tissue. This is like really an outgrowth of the brain. This is very sensitive. It's subject to degenerative disease and injury. Our eyes, even if they just get hit, can get very inflamed. Our eyes can be more inflammatory than a bruise on our skin on our shoulder might be. So eye safety's a big one, and people who are, um, working in certain industries, um, you know, anyone who's doing any metal grinding, people who are even just gardening, you know, and if you're, if you're doing some significant gardening and cutting and you could, you know, fleck a little bit of dirt, and you know, there's a lot of, there's a lot of, for example, fungus that lives in the ground, natural stuff. It's all very normal in the, in the earth. But you know, our eyes aren't really made to absorb that fungus and, and have, have a piece of dirt kind of-

   5. AHAndrew Huberman33:23

      Mm-hmm.

   6. JGJeffrey Goldberg33:23

      ... stick in our eye like that. And so, people are at risk, I think, for, you know, for not... And we see too much kind of really unnecessary eye injury, eye trauma, that if people wore either their glasses 'cause they happen to wear prescription glasses, or goggles, or for more advanced work, you know, safety goggles of course, um, if you're sanding, doing wood shop projects, anything like that, sawing, including, you know, again, in the garden, cutting things. Um, you know, I think, I think eye safety, you know, eye trauma is a big one, and you know, we probably see one or two, um, what we call open globes a week come into the oper- uh, i- into the emergency room, and, um, you know, those are tough because, you know, again, the eye's delicate, and it can do a lot of healing, but, but not infinite, right?

   7. AHAndrew Huberman34:17

      Yeah.

   8. JGJeffrey Goldberg34:17

      And so we really, you know, that's, that's one that I think is really an untapped opportunity is just a little more education around-

   9. AHAndrew Huberman34:26

      Mm-hmm.

   10. JGJeffrey Goldberg34:26

       ... um, around eye protection, protecting against eye trauma.

   11. AHAndrew Huberman34:31

       What about eye cleanliness? There's some pretty dramatic videos also, um, I've put some of these on my Instagram handle of, uh, these are MRIs of people rubbing their eyeballs and people really getting a sense of, first of all, a restatement of what you said, getting a real sense of just how much the eyes are an outgrowth of the brain 'cause of the op- when you see 'em with the optic nerves and all their beauty and the eyeballs moving around as someone rubs their eyes. I have to imagine that rubbing your eyeballs a little bit isn't bad, but I actually called you. I don't know if you remember. When I was a, a junior professor, I woke up from a nap one day and I couldn't see out of one eye. I was freaking out, so of course, I called you, and I had pressure blinded myself by falling asleep on my hand or something like that, and you assured me that my vision would come back, and indeed it did, so you played dual role of ophthalmologist and psychiatrist.

   12. JGJeffrey Goldberg35:17

       (laughs)

   13. AHAndrew Huberman35:17

       Thank you. And indeed I can see out of both eyes, um, now. Um, but rubbing our eyes, getting gunk in our eyes, you know, I think unless somebody has lost their vision temporarily, it's hard to imagine this is like a big deal, but when it happens, it is truly frightening.

   14. JGJeffrey Goldberg35:37

       Mm-hmm.

   15. AHAndrew Huberman35:37

       We're so dependent on vision. So, um, you know, what are your recommendations about rubbing or not rubbing eyeballs, about, (laughs) um, handwashing and cleanliness, and also, how do you wash an eye properly?

   16. JGJeffrey Goldberg35:49

       Yeah.

   17. AHAndrew Huberman35:49

       Do you use soap and flush it with water?

   18. JGJeffrey Goldberg35:50

       Yeah.

   19. AHAndrew Huberman35:50

       Or do you just flush it with water, or should you not even do that? Should you use saline? And I realize these might sound like low-level questions, but these are the things that people deal with on a, on an all too frequent basis.

   20. JGJeffrey Goldberg35:59

       Yeah. You know, for most people most of the time, actually the eyes are a very good, clean environment, and actually our tears are-... are, contain enzymes that help break down bacteria and bacterial toxins.

   21. AHAndrew Huberman36:13

       Mm-hmm.

   22. JGJeffrey Goldberg36:13

       And so, for most people, regular eye washing doesn't have to be any part of their standard routine. In terms of the surface of the eye, the part of your eye, the conjunctiva, uh, over the whites of the eyes, underneath the eyelids, anything underneath the eyelids, it's pretty self-cleaning. And actually-

   23. AHAndrew Huberman36:30

       Right.

   24. JGJeffrey Goldberg36:30

       ... our tear production and blinking is very good at keeping our eyes clean. Uh, the eyelids, eyelashes can be another story, and especially as we age, uh, we can, you know, like our skin is breaking down a little differently than when we were younger. You can develop what we sort of nickname scurf, which is like kind of little dead skin bits that accumulate around the eyelashes. A lot of people develop what we call blepharitis-

   25. AHAndrew Huberman36:56

       Mm-hmm.

   26. JGJeffrey Goldberg36:56

       ... which is just, just means inflammation of the eyelashes.

   27. AHAndrew Huberman36:59

       I've had that.

   28. JGJeffrey Goldberg36:59

       Yeah.

   29. AHAndrew Huberman37:00

       Yeah.

   30. JGJeffrey Goldberg37:00

       And for that, doing some eye scrubs is a good idea. They actually sell, uh, little pads that you can buy-
8. 40:07 – 46:35

   Adults & Eye Exams; Optometrist vs Ophthalmologist

   1. AHAndrew Huberman40:07

      Uh, let's talk about eye exams in adults. So, uh, people are aware, presumably, that there are optometrists and ophthalmologists. I think it's important that we define their different and also overlapping roles. And for those that, you know, are past high school age, probably not getting eye exams unless they're sensing a problem, um, perhaps not even with blurry vision or, or difficulty seeing at a distance, but sometimes just what feels like fatigue of the eyes or a hard time maintaining alignment of the eyes. Um, so how often do you recommend people get eye exams? What is a true regular eye exam? (laughs) And is it important that people go to an ophthalmologist or will an optometrist suffice? Typically, optometrists are a little bit easier for most people to access because there's usually one someplace near an eyeglass store. Um, so what are their roles? How often should we get our eyes checked?

   2. JGJeffrey Goldberg41:01

      Yeah. Um, optometrists and ophthalmologists do have very overlapping roles in being eye care providers. Uh, there are something over 40,000 or 50,000 optometrists in the United States. There's somewhere around 20,000 ophthalmologists in the United States. Optometrists get an optometry degree. They often have OD after their name. Opthamologists usually went, you know, went to medical school, so they either have an MD after their name or they're kind of a DO version of a medical degree. And, uh, and then optometrists will have done additional clinical training in that area, in their area, uh, of eye care provision. Opthamologists, MD, doctor ophthalmologist, uh, eye care providers, in addition to that training will have done surgical training in ophthalmology. Um, now, uh, there's a lot of overlap and, um, in both scenarios, uh, you can be getting your sort of general exam taken care of, maybe a screening exam. I think that there's been a traditional differentiation between optometrists and ophthalmologists with optometrists providing a little more of the-... primary care, eye screening, maybe managing early disease, common diseases as well, uh, with a more advanced disease often sort of upgrading to perhaps specialist ophthalmologists in those areas. But, uh, that distinction has been, uh, declining over time. It's still true that in, I think, most if not all states, only the MD ophthalmologists, uh, surgeons can do eye surgeries, but, um, both, both groups of eye care, care providers can diagnose, both can prescribe, uh, uh, appropriate eye drop treatments, including prescription eye drop treatments for, for many of our diseases-

   3. AHAndrew Huberman42:55

      Mm-hmm.

   4. JGJeffrey Goldberg42:56

      ... uh, eye diseases. And, um, and in some states, optometrists have successfully lobbied for, uh, sort of expanded rights of providing air care... eye care. And again, um, access to care for, you know, the regular person, wherever they may live is, is the most important element. And so, being able to access eye care, whether it's with an optometrist in your community or an ophthalmologist that may be in your community or maybe at a distance, I think that's the, the really important thing, is to access care. Now, kind of like we were talking about with kids, uh, if you're in your teens, 20s, maybe even 30s, and not having any problem, you've got no complaints, you can see at distance, you can see at near, um, you know, so you can read without glasses, you can drive without glasses, um, you're not having any eye pains, you know, pains around the eyes, you know, redness of the eyes, you may never present to an eye care provider, uh, through the first four decades of life. And almost all the time, it's gonna be okay, right? If you're not symptomatic, the chance you've got some terrible lurking disease in there is low.

   5. AHAndrew Huberman44:13

      Mm-hmm.

   6. JGJeffrey Goldberg44:15

      But we do wish that we had a little more screening going on, because there are some diseases, glaucoma for example, my specialty, the two main risk factors for glaucoma are increasing age, and that usually presents, you know, in most cases actually after age 40, but also increasing eye pressure. And if your eye pressure is too high, you can't feel that. That won't feel funny to you if it sort of slowly has crept up over the years. And so from a screening perspective, it is good to get some kind of screening exam. Could be at a public health fair, could be that you go into the local optometrist, just say, "Hey, I've never been checked. I'd like to be checked once, make sure everything's good." They would-

   7. AHAndrew Huberman44:57

      Could you ask for... Sorry to interrupt.

   8. JGJeffrey Goldberg44:58

      Yeah.

   9. AHAndrew Huberman44:58

      But could somebody say, "I'd like my pressures checked"? As I recall, at the optometrist they're gonna do a puff test.

   10. JGJeffrey Goldberg45:02

       Yeah.

   11. AHAndrew Huberman45:03

       So, they're gonna blast some air-

   12. JGJeffrey Goldberg45:04

       Right.

   13. AHAndrew Huberman45:04

       ... um, get a sense of how, how rigid or, or, um, soft, again, using non-clinical, non-technical language here, th- the eyeball happens to be. Um, n- right now, by the way, I'm sure there are, um, several hundreds of thousands of people who are g- Mm-hmm.

   14. JGJeffrey Goldberg45:18

       ... with eyes closed touching the sides of their eyeballs. And I'm only half-joking. Please don't do this, folks, um, given the conversation we just had about eye cleanliness and eye rubbing. But my understanding is that the old fa- truly old-fashioned eye pressure exam was you would close your eyes and the ophthalmologist- Yeah.

   15. AHAndrew Huberman45:33

       ... would gently press-

   16. JGJeffrey Goldberg45:35

       Yeah.

   17. AHAndrew Huberman45:35

       ... to see whether or not your eyes were more rigid than last time.

   18. JGJeffrey Goldberg45:38

       Yeah.

   19. AHAndrew Huberman45:38

       Is that right?

   20. JGJeffrey Goldberg45:38

       Yeah. That's called ballottement, and you can kinda... you can, you can kinda just take one second if you're listening and press on your eyes just very lightly. And you... there's a little give. Of course, the eyelid's part of that give, but, but it's not, it's not like rock hard.

   21. AHAndrew Huberman45:52

       Mm-hmm.

   22. JGJeffrey Goldberg45:52

       And if we press and it feels under the eyelid like, gosh, something under there is rock hard, then we know something is wrong. That is way too high pressure if it's rock hard.

   23. AHAndrew Huberman46:02

       Rah. Rah.

   24. JGJeffrey Goldberg46:02

       But I'll tell you, our ability to differentiate the fine points of eye pressure other than rock hard-

   25. AHAndrew Huberman46:08

       Mm-hmm.

   26. JGJeffrey Goldberg46:08

       ... or not rock hard is (laughs) pretty limited. So yeah, the optometrist office or the ophthalmologist's office as part of a comprehensive screening exam, they'll check the eye pressure, they'll look at the surface of your eyes, make sure everything's looking healthy there, including the eyelids and lashes, and they'll look inside the eye and be able to screen for these diseases that way too, in addition to checking if you're complaining of any, you know, blurriness at distance or at near. Now,

9. 46:35 – 54:54

   Presbyopia (Age-Related Vision Decline), Reading Glasses

   1. JGJeffrey Goldberg46:35

      after age 40 or so, a lot of people will present to an eye care provider because we all get what's called presbyopia. And presbyopia just translates to disease d- uh, uh, uh, uh, vision of the aged. So, you know, myopia is our word for nearsighted. Hyperopia is farsighted. Actually, emmetropia means normal sight. It's how I can see at distance without any glasses. I'm emmetropic. But then we all get presbyopia. And as we age, the lens inside our eye that's helping focus light onto our retina gets stiffer, such that our eye muscles are no longer able to relax and reshape that lens, and we're not as good as we age at moving our focus from distance vision... Distance vision, by the way, is basically anything three feet or further away.

   2. AHAndrew Huberman47:30

      Mm-hmm.

   3. JGJeffrey Goldberg47:30

      You're basically viewing light rays coming from infinity a- once you're past three feet. So, three feet or further, being able to focus that in to 14 inches or 12 inches, which might be a normal comfortable reading space for you, we lose that ability to flex our lens, relax our lens, uh, refocus our lens from distance to near. And most people around age 40, could be a couple of years, uh, before, could be five or 10 years later that you notice it, but sort of around that time, you start needing reading glasses. You need a little extra b- even if you can see fine at distance and don't need prescription glasses for distance, you need a booster, you need reading glasses for near. I don't know if you're-

   4. AHAndrew Huberman48:13

      (laughs)

   5. JGJeffrey Goldberg48:13

      ... experiencing this yet.

   6. AHAndrew Huberman48:14

      Uh, yeah, I'm, I'm really intrigued by this. Uh-...but maybe you could clarify. When you say reading glasses, do you mean just a magnifier? Because I use a, a, you know, a 0.5 or a 0.75 magnifier for reading-

   7. JGJeffrey Goldberg48:27

      Yep.

   8. AHAndrew Huberman48:27

      ...but I try and rely on them as little as possible, and I want to get to this, about y- using glasses as a crutch, and the problems with that. Um, I have a story about that too.

   9. JGJeffrey Goldberg48:37

      Oh, okay.

   10. AHAndrew Huberman48:37

       I soon, uh, you know, it's, it's no coincidence I decided to work on vision.

   11. JGJeffrey Goldberg48:40

       (laughs)

   12. AHAndrew Huberman48:40

       I mean, after all, um, had a bunch of vision issues, uh, that fortunately are, are corrected. But, you know, I, I do experience, for instance, when I wake up in the morning, if I look at my phone, which, by the way, folks, I try and get outside and see sunlight first before ever looking at the phone. But I'll notice when I first look at my phone in the morning, that I can see it very clearly through my right eye, but that if I cover my right eye, my left eye is extremely blurry to the point where I'm like, "Oh, I'm calling Jeff." You know?

   13. JGJeffrey Goldberg49:09

       (laughs)

   14. AHAndrew Huberman49:09

       I'm, I'm, I'm afraid, but then over the course of maybe 10, 15 minutes, it resolves, and I don't think it's because something's in my eye. I don't think it's pressure of having slept on that side. I don't think it's a lubrication of the eye issue. Um, but the two eyes seem to come into focus, so to speak, um, at different rates early in the day, and if I pop my readers on, I can see right away.

   15. JGJeffrey Goldberg49:30

       Mm-hmm.

   16. AHAndrew Huberman49:31

       So, I will use readers late in the day often-

   17. JGJeffrey Goldberg49:33

       Mm-hmm.

   18. AHAndrew Huberman49:34

       ...um, if I wanna read at night or something. That's right. It just, it feels so much more relaxing. I feel like, oh, like I can finally relax, whereas, otherwise, I realize that I'm straining in order to see. Does, is there any, um, clinical, clinical data in what I just described?

   19. JGJeffrey Goldberg49:47

       Yeah.

   20. AHAndrew Huberman49:47

       Yeah.

   21. JGJeffrey Goldberg49:47

       I'll, I'll, you know, Andy, I'll tell you my story that's like that, and, um, we were living down in San Diego when you and I were both professors at UC San Diego, and, uh, we had moved into a house, and I found a pair of glasses, a pair of reading glasses, uh, in a closet. And, you know, we asked around, you know, "Did any of the grandparents, uh, leave some glasses behind?" N- nobody seemed to know who they were, so we, we finally just decided, like, "Well, I guess the people who moved out of the house just left a pair of glasses, you know, in this, in the back of this closet." And then I tried the glasses on, and I looked at my phone up close, and was just like, "Oh my God. Wait a second. I didn't realize how blurry my near vision was." And this is back, I was about 40, 42, something like that. So, so I didn't even realize until I put on the readers, and these were, you know, 1.25 magnifiers, you know?

   22. AHAndrew Huberman50:46

       Not huge.

   23. JGJeffrey Goldberg50:46

       So also mild ones.

   24. AHAndrew Huberman50:47

       Yeah, fairly mild.

   25. JGJeffrey Goldberg50:48

       Mild ones.

   26. AHAndrew Huberman50:49

       Yeah, yeah.

   27. JGJeffrey Goldberg50:49

       And I'll tell ya, I got addicted because who doesn't like good vision?

   28. AHAndrew Huberman50:56

       Right.

   29. JGJeffrey Goldberg50:56

       Right? I mean, oh my God, now I can make the type smaller on my phone. I can, you know, it was wonderful.

   30. AHAndrew Huberman51:02

       And you can relax a bit. I, I think the musculature that's responsible for, for moving the lens and focusing the eye, and then all this extraocular m- musculature, I mean, we forget. I mean, I'm definitely going crow's feet, um, around my eyes, uh, probably 'cause I, you know, squint or something, but, you know, just the ability to relax one's face. It just feels-
10. 54:54 – 58:34

    Reading Glasses: Use & Recommendations

    1. JGJeffrey Goldberg54:54

    2. AHAndrew Huberman54:54

       Assuming that somebody doesn't have, um, you know, some form of amblyopia or the need for some really robust corrective lenses, and they are already using readers, let's say a plus one or so, you know, plus one, plus or minus 0.5 reader, would you recommend, based on my experience and based on your experience, that people strive to avoid using them for as long as they can? 'Cause in some sense, if that's-

    3. JGJeffrey Goldberg55:24

       Yeah.

    4. AHAndrew Huberman55:24

       ... the recommendation, then the recommendation is that people, kind of, deal with the fact that they're seeing a little less well or a lot less well than they possibly could. So I'm assuming that people can still drive well, people can still read, but it involves-

    5. JGJeffrey Goldberg55:35

       Yeah.

    6. AHAndrew Huberman55:35

       ... a little bit more effort. In other words, are we weakening our eyes by using these, these readers? I-

    7. JGJeffrey Goldberg55:40

       No.

    8. AHAndrew Huberman55:40

       ... I realize you said that the data are a little bit mixed, but, uh, as long as one can perform their required daily activities, would we be better off delaying-

    9. JGJeffrey Goldberg55:49

       Yeah.

    10. AHAndrew Huberman55:49

        ... the use of readers?

    11. JGJeffrey Goldberg55:51

        There's two important answers to that question. One is regarding the lens and the eye muscles that control the lens. And it's entirely plausible, that's what I was saying, kind of, the data's mixed on, but it's plausible that if we were to just exercise, like work a little harder, kind of, not use as strong a reader as we want or not use that reader as often as we might really enjoy, uh, are we exercising those muscles and, kind of, exercising the ability to, to, to stretch versus relax the lens and, kind of, slow the progression from the 1.0 reader to the 1.25 reader to the 1.5 reader, et cetera, right? And so that, that's why I was saying, the data's mixed, but there's a good premise that maybe if you're exercising. But let me give you the on, on the other hand. It's probably ideal to give your retina and your brain the sharpest visual signals you can, so why hamstring your retina and your brain and your vision and your enjoyment and ability to read or do near work by constantly undercutting the, the, the reading glasses or leaving them out or... You're not helping the whole back part of your... Maybe your, maybe you're helping the lens, but you're definitely not helping your retina and brain by feeding it blurry information all of that time.

    12. AHAndrew Huberman57:25

        Got it.

    13. JGJeffrey Goldberg57:25

        So I actually think, just give in.

    14. AHAndrew Huberman57:28

        Mm-hmm.

    15. JGJeffrey Goldberg57:28

        Use the readers. Have your be- enjoy your best vision all the time, and if that means wearing glasses... And by the way, if that means that you're gonna have minus two glasses for vision and you'll eventually need minus 250s for distance vision, or if you're gonna need readers, 1.5 readers now and in a few years 2.0 readers, okay, so you'll get the next reader. It's, uh, it's, it's actually not a big deal.

    16. AHAndrew Huberman57:55

        Yeah.

    17. JGJeffrey Goldberg57:55

        You can, you can... You know, you're not, you're not hurting. You're probably helping, and in the meantime, it's an enormous enjoyment to actually have good vision all the time, right? So, so I actually counsel people, "Just wear the glasses that work best for you."

    18. AHAndrew Huberman58:11

        Mm-hmm. Mm-hmm.

    19. JGJeffrey Goldberg58:12

        You know, you're only minimally changing how your prescription's gonna change over time, very minimally, so just enjoy your best vision-

    20. AHAndrew Huberman58:21

        Mm-hmm.

    21. JGJeffrey Goldberg58:21

        ... even if it's using readers for close or, or prescription glasses for far.

    22. AHAndrew Huberman58:26

        I appreciate that recommendation. I do enjoy uti- using the readers at night. It really helps for all the reasons I mentioned before.

11. 58:34 – 1:02:55

    Night Vision & Glasses

    1. AHAndrew Huberman58:35

       I've noticed that driving at night presents an enormous strain on my visual system, and I've noticed this for a number of years. Are there any, um... I know there's something called stationary night blindness. I don't think I'm stationary night blind. Um, I think the mutation for stationary m- night blindness was identified in the Kalusia horse or something like that. These were horses that you could walk up to very easily and they wouldn't even see you until you were right there. Someone's gonna correct me on this. It's the internet. But it l- I think the, the mutation was identified, um, et cetera, but I don't think I'm stationary night blind. But I do find that driving at night, I get very fatigued-

    2. JGJeffrey Goldberg59:08

       Mm-hmm.

    3. AHAndrew Huberman59:09

       ... like, and then I'll sometimes even wear my plus one readers when I drive at night, which removes the fatigue, even though I'm looking more or less at a distance. Are there some conditions that make it hard for people to see at night for which they would want corrective lenses?

    4. JGJeffrey Goldberg59:24

       Yeah.

    5. AHAndrew Huberman59:25

       Um, and what, what sorts of biology underlies that, assuming that somebody is not stationary night blind or a Kalusia, I think is the name of the breed horse?

    6. JGJeffrey Goldberg59:35

       Yeah, that's a great question. You know, we... For the, for the optical defects in our eyes, m- most or many of which can be corrected with just having the right prescription lenses, we can get away with it without using those corrections in brighter light. And so during the daytime, um, you know, uh, you could be slightly blurry. You know, if I have a real bright light, uh, and a good high-contrast book, you know, with black letters on the white page, I can get away with reading that without my readers. Unlike if, if, uh, if I'm in dim light, then I feel... And that might be, kind of, what you're describing-

    7. AHAndrew Huberman1:00:14

       Mm-hmm.

    8. JGJeffrey Goldberg1:00:14

       ... if you're reading at night, you actually prefer to use the readers a little more even at night, because we can make up for a lot of that blur if we just have bright enough signal and contrast coming into our eyes.

    9. AHAndrew Huberman1:00:27

       Makes sense.

    10. JGJeffrey Goldberg1:00:27

        Yeah. So when you're driving at night and noticing this, this might be revealing a little bit of a need for glasses. Now, I'm not suggesting this is the answer, but far more common than having congenital stationary night blindness (laughs) would be being what's called a latent-... hyperope. Okay. Now, we talked about, already, how the lens inside our eye goes from focusing at distance to then we squeeze the muscles, the lens actually rounds up, and it allows us to focus it near. Some people's optical system of their eye is actually wired, uh, uh, or designed or sort of set up in length, not for regular distance, which would be anywhere from about three feet to infinity, but it's actually designed, it's actually tuned for being beyond infinity, which doesn't make any actual sense when you talk about it, but just the optics of the eye, at their best focus, are actually focusing the light behind the retina. And, and if you're doing that when you're younger, you're actually using some of your focusing power to, to s- to use those muscles, strain those muscles, relax that lens, round up that lens, and have your vision focus from beyond infinity to normal distance, like distance vision. And so if you're a latent hyperope, you are constantly using those muscles. And again, if you're tired, it's the end of the day, your muscles are feeling a little fatigued, uh, your latent hyperopia... Or by the way, if you've had a drink or two, uh, alcohol can do this too. Your latent hyperopia can kind of kick in, especially as we age and we're not as good at refocusing that lens anyway, and now all of a sudden, your vision is kind of reverting to its natural state-

    11. AHAndrew Huberman1:02:20

        Mm-hmm.

    12. JGJeffrey Goldberg1:02:20

        ... which is slightly out of focus at distance, because it's actually focused beyond infinity, if you will. And so all of a sudden you put on that plus one just for a little extra booster kick, and you're like, "Oh, yeah, yeah. Distance vision is clean and easy now." So I'll have to bring you into the clinic to really be sure, but you could be exhibiting a little bit of that kind of latent hyperopia.

    13. AHAndrew Huberman1:02:43

        I definitely want the eye exam, and I want it from you. And I've been called a lot of things in life, um-

    14. JGJeffrey Goldberg1:02:47

        (laughs) .

    15. AHAndrew Huberman1:02:48

        ... and we can now lat- add, perhaps, latent hyperopiaque, uh, to that.

12. 1:02:55 – 1:03:54

    Sponsor: InsideTracker

    1. AHAndrew Huberman1:02:55

       I'd like to take a quick break and thank our sponsor, InsideTracker. InsideTracker is a personalized nutrition platform that analyzes data from your blood and DNA to help you better understand your body and help you reach your health goals. I've long been a believer in getting regular blood work done for the simple reason that many of the factors that impact your immediate and long-term health can only be assessed with a quality blood test. The problem with a lot of blood and DNA tests out there, however, is that they'll give you information about certain lipid markers or hormone markers, but no information about what to do with all of that data. InsideTracker makes it very easy to look at your levels of hormones, metabolic factors, lipids, et cetera, and then to assess what sorts of behavioral, nutritional, supplementation, or perhaps other interventions you might want to use to bring those numbers into the ranges that are appropriate and indeed optimal for you. If you'd like to try InsideTracker, you can visit insidetracker.com/huberman and get 20% off any of InsideTracker's plans. That's insidetracker.com/huberman to get 20%

13. 1:03:54 – 1:09:52

    Corrective Eye Glasses, Exercises

    1. AHAndrew Huberman1:03:54

       off. Another piece here, and a- again, this discussion is not designed to be an eye exam for me, but, um, I have yet another experience that I think illustrates the key importance of both critical period plasticity and the questions about whether or not to rely on corrective lenses, and that is, uh, from the time I was pretty young, I could make my sister laugh by deviating one eye inward. So not crossing my eyes, but moving one eye inward. And then what happened was when I was in college and studying a lot, a lot, and getting very fatigued, I noticed that this eye started just to kind of drift in a little bit. So I went to the campus health center, and they gave me a prescription for a prism lens, which re- of course redirects the image, but then I noticed that this eyeball moving inward, and I guess for those of you watching on (laughs) on YouTube and not just listening, um, I can do this, um, by just moving one eye in. All right? Is this... I can move this eye in.

    2. JGJeffrey Goldberg1:04:49

       Oh, I see. Andrew Huberman: Yeah. It's fairly pronounced. It started to really drift in at, at a relaxation state, and I started seeing double again. So I thought, "Whoa, these prism l- this one prism len- lens is a crutch of the sort that I really don't want." Crushed the glasses, broke them, and never went back to them. Um, I have voluntary control over it. But that's one example where the corrective lens can actually create a pretty significant shift in eye position if one relies on it. So this gets back to this issue of, um, when should people force themselves to work with their natural vision, maybe do some more far viewing, um, as opposed... And certainly get outside and get sunlight, into the sunlight, full spectrum light, as opposed to relying on corrective lenses. Yeah. And, and you've raised a very important distinction here, and that's the distinction between the muscles that are inside our eye that we use to relax and refocus the lens and the muscles that are on the outside of the eyeball, of course, inside our orbit, but on the outside of the eyeball, that turn the eyes, and if everything's working right, keeps our eyes really yoked straight. And we talked about, earlier, uh, this possibility that you may have been having a little bit of intermittent esotropia, or intermittent turning in of the eyes, that then culminated on that day of, uh, day at the pool when you really noticed it. Um, and your ongoing ability to actually turn one eye in could be related to that. I, I remember as a kid standing in front of the mirror and I, I couldn't get my eyes to cross even though friends could do it and, you know. So, you know, I, I, I was in the losing group on that, on that end of the spectrum.

    3. AHAndrew Huberman1:06:25

       And you became an ophthalmologist. Perfect.

    4. JGJeffrey Goldberg1:06:26

       And then I became an ophthalmologist.

    5. AHAndrew Huberman1:06:28

       Which... And I must say, it is very reassuring that you have excellent vision. You know, I always worry when I go to a new dentist and then I look up at them in one moment, and if they're not wearing a mask, that their teeth are not...... you know, pristine. I think, "Well, what am I doing here?" So, you know, an, an ophthalmologist with excellent vision gi- brings me, uh, great comfort. Um-

    6. JGJeffrey Goldberg1:06:44

       The cobbler's children should have shoes. Yeah.

    7. AHAndrew Huberman1:06:46

       Right. Exactly. Um, but yeah. So, so when to correct, when not to correct with lenses, and I realize here we haven't talked at all about contacts. We've been talking about eyeglasses.

    8. JGJeffrey Goldberg1:06:57

       Yeah. Let's come to contacts in a sec if you want, but yeah. Let, let, let me return to your question. The difference between providing corrective lenses that allow you to focus for near or distance, uh, in your glasses so that you can go easy on the inside the eye, eye muscle having to work so hard. And a lot of people get eye strain and sort of, uh, headaches even from that, from not having an adequate correction that they're wearing. That's different actually, especially when we're children or again into the, maybe even into the teens and even young adult years. Uh, from the eye muscles on the outside of the eyes, which are supposed to be yoking our eyes straight and so that you have them both looking at the same point in space. And, and there, it's actually quite a common treatment to try to under-correct and ask people to exercise and not just give a prism that says, "Hey, if your eye's in sometime, we'll use a prism so the light sort of looks right to you." But rather under-correct that and sort of really force you to exercise trying to yoke your two eyes straight together.

    9. AHAndrew Huberman1:08:04

       Mm-hmm. Mm-hmm.

    10. JGJeffrey Goldberg1:08:04

        And so that's, that's in contrast, and there actually, uh, I think many optometrists who often specialize in, in what are the right glasses to give in a situation like that. Uh, wherever possible, especially during, uh, development as our bodies are developing, as we're sort of growing in our younger years, uh, take the approach of intentionally trying to under-correct, not use a prism or not use a full prism correction, uh, and, um, to, to really help. Uh, sometimes it's also like an accommodative reflex that your eyes are just, you're spending so much time reading at near. When you read at near, your eyes actually naturally turn in a little bit to focus, uh, at that near so that they can be looking at the same word on the page. Uh, and that can also, if you've got kind of too much muscle drive, you can overshoot that.

    11. AHAndrew Huberman1:08:56

        Hm.

    12. JGJeffrey Goldberg1:08:56

        And so sometimes just using not a prism, but like a little bit of a plus lens in kids just so they don't have to work quite so hard to turn their eyes in and sort of exer- over-exercise those muscles. These are all great examples where going to an eyecare provider, often for these kinds of issues an optometrist is the right first place to start. You'd like to say that every optometrist and every ophthalmologist is always going to give the exact right thing for, for each kid or young adult or older adult to do, and, and we wish all medical care providers were, were always right on target. And a lot of times it's a perfect science, but a lot of times it's an imperfect science. And so, it could be that at least with, you know, we're now 20, 25, 30 years later, but like it could be that today that 20-year-old version of yourself would have been given a different, uh, approach to having one eye intermittently occasionally turning in like that.

    13. AHAndrew Huberman1:09:51

        Mm-hmm.

14. 1:09:52 – 1:13:25

    Near-Far Exercise & Presbyopia; Smooth Pursuit Exercise & Concussion

    1. AHAndrew Huberman1:09:52

       Is there any real value to, um, near-far exercises, you know, so-called pencil push-ups or, uh, smooth pursuit tracking? I've talked a little bit about it before on the podcast, but that was, you know, some time ago. So what are your thoughts on, on that? Uh, is there any value whatsoever? I mean, they, they require a little bit of work just like going to the gym, but, you know, you know, 25 reps a day of near far, um, especially as one is transitioning from age 30 to age 50. Um, is it worthwhile?

    2. JGJeffrey Goldberg1:10:20

       Yeah.

    3. AHAndrew Huberman1:10:21

       Is it harmful in any way?

    4. JGJeffrey Goldberg1:10:22

       Definitely not harmful. And again, uh, you know, would it slow down or sort of, um, uh, slow down your progression to presbyopia or needing those reading glasses? Uh, could be. Some people also develop, um, sort of, uh, you know, a real failure to properly turn their eyes in, and so they actually would benefit if you've been diagnosed with that inability or having double vision at near but not at distance. Um, so that kind of convergence insufficiency, for example. Uh, then, then pencil push-ups often get prescribed as a way to try to exercise those skills in you, uh, in, in your eye muscles, um-

    5. AHAndrew Huberman1:11:03

       I should interrupt here and just tell people, for those of you that are listening, not watching, the pencil push-up, uh, we can put a, a link to it, uh, in the show note captions, but it's essentially taking a pen or a pencil, looking at it at, um, at arm's distance and then, uh, slowly moving it toward your nose and, um, deliberately working hard, and it is a bit of effort to continue to focus on it at a close distance. At some point it will become blurry because I can't cross my eyes any further, uh, um, unless I become a cyclops. And then moving it back out again and doing that for, you know, 10 to 25 repetitions maybe once or twice a day, a few times a week, um, th- that's what, those are pencil push-ups.

    6. JGJeffrey Goldberg1:11:40

       Yeah.

    7. AHAndrew Huberman1:11:41

       Yeah.

    8. JGJeffrey Goldberg1:11:41

       Yeah. So, um, you're certainly not going to hurt anything. There are other situations where those really do get prescribed and there's definitely some good clinical trial data suggesting that they can actually help, for example, recovery from concussion.

    9. AHAndrew Huberman1:11:54

       Hm.

    10. JGJeffrey Goldberg1:11:55

        A lot of people... Actually one of the really telling ways to diagnose concussion, and this can be concussion from sports or a fall or, you know, any, any source of concussion, uh, your smooth pursuit, which is the ability... Let's say I've got a dot moving around in a circle on a screen and I'm following that dot with my eyes. My eyes should be able to very smoothly follow that circle around, uh, rotating the eyes.

    11. AHAndrew Huberman1:12:20

        It's the lit up hockey puck on one watching a hockey game. Is that-

    12. JGJeffrey Goldberg1:12:23

        Like that.

    13. AHAndrew Huberman1:12:23

        You're a hockey fan, right?

    14. JGJeffrey Goldberg1:12:24

        Like that.

    15. AHAndrew Huberman1:12:25

        Yeah, exactly.

    16. JGJeffrey Goldberg1:12:25

        You know, just following a ball. Right, right.

    17. AHAndrew Huberman1:12:27

        Yeah.

    18. JGJeffrey Goldberg1:12:27

        You know, following any movement with smooth pursuits of your eyes. And after concussion, that actually, those systems in our brain, the sort of reflexive ability to properly follow that use that visual input to tell your eye muscles exactly where to move.... gets disrupted, and so all of a sudden your smooth pursuit starts to look choppy. It's not so smooth anymore. And it's actually a way to diagnose and follow recovery from concussion.

    19. AHAndrew Huberman1:12:54

        Mm-hmm.

    20. JGJeffrey Goldberg1:12:54

        And part of the visual rehab, sort of neuro-rehab, one of the approaches being used and, and further studied still in recovery from concussion, is actually doing those kinds of exercises, like pencil push-ups, or b- basically what you've described, is focusing from far away to focusing near, and doing that back and forth and using that to sort of, like help regain, uh, the, a tighter control of our eye movements and that eye-brain connection.

15. 1:13:25 – 1:19:11

    Supranormal Vision & Performance Training

    1. JGJeffrey Goldberg1:13:25

    2. AHAndrew Huberman1:13:25

       So if traumatic brain injury causes deficits in smooth pursuit eye movements, and some of the recovery protocols for traumatic brain injury are to have people do smooth pursuit protocols and pencil push-ups, are these also the sorts of things that anyone can just do? I mean, whenever possible, we like to share tools for various aspects of health on this podcast, but, of course, we don't want people cowboying this stuff in a way that could be detrimental to their, to their vision. So is it okay to get on YouTube and find a smooth pursuit, um, uh, tool? Uh, we can put a link to these, there, there are several of them, um, and people will spend a few minutes doing this?

    3. JGJeffrey Goldberg1:14:03

       Yeah.

    4. AHAndrew Huberman1:14:03

       Yeah.

    5. JGJeffrey Goldberg1:14:05

       Y- y- you're definitely not gonna hurt anything, so totally fine to do it. And some people may notice, you know, like they feel a little more visually active if they do these kinds of exercises. Um, I think most people would do them and not notice something in their daily life. We actually have, um, made so much progress, you know, in research, in thinking about, how do we take the diseased or dysfunctioning or aging eye and get it back to healthy and normal? But there's a whole other area of science that's, we're really just barely touching. We've actually, we've actually just opened a vision performance center to really get at, not just how do we rehab the sick eye back to health, but what's the difference between functioning normally and functioning above normally? For example, athletes, when they get studied for visual- vision characteristics, they have faster visual reflexes, higher visual acuity. Uh, how much of that was, you know, genetic? How much of that is trained? We don't really understand. Could we train all of us with, you know, normal vision to get up to supranormal vision? These are, like great and important questions that are really relevant to, you know, every regular person. Of course, you know, people doing esports and the gaming communities and athletes, is part of what we're studying in the vision performance center, but these are really, really big opportunities to try to understand, how do we move people from normal vision to supranormal vision? And there's evidence that you can do it. So here, here's a great example. Some athletes train using these special goggles that actually use electrical signals in the glasses part of the goggles to actually black out your vision one-thirtieth of every second, two-thirtieths of every second, three-thirtieths of every second. Now imagine you and I are passing a basketball back and forth, except you're wearing goggles, and all of a sudden you're only getting 90% of the data of, "Where's that basketball (laughs) on its way to my hands?" Now you're only getting 80%. Now you're only getting 70% of that visual information, and you are practicing, right? You are getting good at catching a basketball when you only have a fraction of the visual information, and now I put you back on the basketball court without the goggles. Why, you might be really good at passing that basketball around and catching that basketball, right? And so the idea that we could train and understand the biology of training to get the eyes from normal to supranormal performance, I think is an amazing area and one that we've really just started to dig into.

    6. AHAndrew Huberman1:17:00

       Well, that's fantastic. So this is a, a new program at Stanford through the Department of Ophthalmology. Is it linked up at all with the Wu Tsai Performance Institute?

    7. JGJeffrey Goldberg1:17:09

       Yeah. A- actually, there's been a lot of focus over the years, I think, in human performance, and there's actually a new human performance, uh, uh, alliance and center. We've, we've, we've long had, really run through the Department of Ar- Orthopedics a human performance laboratory that's really, you know, much more about joints and muscles and strength and conditioning and stretching. Uh, to layer onto that now a real understanding of how vision is operating, you know, it's interesting. Let's go back to the example of concussion. You know, we've got, I don't know, about 800 varsity student athletes in all the different sports at Stanford, and you might have a student athlete come in and say, "You know, something doesn't feel right. I got a little hit on the head. Uh, I feel like my vision is a little bit messed up. Maybe I've got a mild concussion." You could imagine doing some of these tests on some of these performance athletes, for example, and saying, "Well, gosh, you, you look normal," but actually they used to be operating at a supranormal rate, and this is a noticeable decrement for them. And so just starting to study and understand what's the difference between normal and supranormal, how do we go back and forth between those two, how do we measure that difference, and maybe ultimately, how do we train into that difference, I think it's gonna be exciting, and not just for athletes. You know, for, for regular people, you know? You talk about driving at night. Is there a solution where we could train our eyes to be better at driving at night, and I don't know-

    8. AHAndrew Huberman1:18:41

       Mm-hmm.

    9. JGJeffrey Goldberg1:18:41

       ... maybe reduce the number of accidents that happen out in the world? So...

    10. AHAndrew Huberman1:18:44

        Well, certainly there's, um, physical training protocols which are redefining what a 60-year-old or a 70-year-old-... could look like and feel like and be able to perform like. Uh, why not do the same for vision? Um, so I don't think there's anything, um, supernatural or greedy about doing it. I think, uh, that's the excitement of b- biology and neuroplasticity that you can extend it forward as opposed to just trying to wire up correctly during development.

16. 1:19:11 – 1:24:51

    20/20 Vision; Visual Acuity

    1. AHAndrew Huberman1:19:11

       This is a perfect time for me to ask you a question that I'd love a clear answer on if it's possible, it's not always possible, which is, could you define 20/20 vision-

    2. JGJeffrey Goldberg1:19:22

       (laughs)

    3. AHAndrew Huberman1:19:22

       ... and a few of the variants so that any person could understand it? So we think of 20/20 as perfect vision. What does that mean? What would degraded vision look like, whatever those numbers are? And then what would above normal, supra-normal vision look like?

    4. JGJeffrey Goldberg1:19:42

       Yeah.

    5. AHAndrew Huberman1:19:42

       And is it true that fighter pilots have supra-normal vision?

    6. JGJeffrey Goldberg1:19:46

       Yeah, that's another population, like, like, like many athletes of, of people who may have sort of better than normal vision. 20/20, you know, we define almost everything we do based on, you know, kind of a average, not sick human being, adult, whatever it is, right? And so 20/20 vision means that you can read the smallest letters at 20 feet away that the average healthy person can read at 20 feet away. So you can read at 20 what they can read at 20. Okay? Now if you have worse than 20/20 vision, maybe you have 20/25 vision, 20/40 vision, maybe you have 22/100 vision, which on the eye chart at the office is like the big E at the very top is 22/100 vision. That means you can read at 20 feet what a normal person could read at 200 feet, right? So you've got pretty limited lower vision. We can measure down to, like, 24/100, 28/100. At that point, we're getting into, like, "Gosh, can you count how many fingers I'm holding up?" You know, that kind of thing, and then ultimately hand motion, "Can you even tell if my hand is moving in this side of your vision or this side of your vision?" And then ultimately after that light perception, "Can you tell if the room lights are on or off?" Right? And that's kind of the edge of, of being actually fully blind. We call legal blindness in the United States typically 22/100 or worse.

    7. AHAndrew Huberman1:21:23

       And is it true that there are people who are legally blind that are out there driving as we're having this conversation?

    8. JGJeffrey Goldberg1:21:29

       I, I have to imagine that that is unfortunately (laughs) the case.

    9. AHAndrew Huberman1:21:33

       Mm-hmm.

    10. JGJeffrey Goldberg1:21:33

        But it shouldn't be, because those people obviously are really severely impaired, and, and, and that's obviously quite dangerous, so. So, so that's 20/20. Now, it gets worse, 20/40, 20/80, 20/100. Can it get better? Yeah, it turns out that people can be sort of on the other end of that curve, and so we could have athletes and fighter pilots or people who have had LASIK surgery who are 20/15, 20/10. If you're 20/10, that means you can see at 20 feet what the average person needs to be only 10 feet away to see, right? And so you've got better than normal vision, and people do get to that through a variety of ways, and so it is possible to have better than 20/20 vision.

Episode duration: 3:08:44