[EPISODE]

[0:00:01] LM: Dr. Appelbaum, I’m so excited to have you here. I was telling you before we got on that people have been requesting an iHealth episode for literally years, and it has taken us that long to find what I view as the perfect guest for it. So, welcome to the show.

[0:00:15] BA: Thank you for teeing me up.it’s a pleasure to be here and I am so excited to share with your audience how much more there is to vision than just eyesight. And there’s so much we can all do to live a healthier, happier life, uh, by maximizing our visual potential.

[0:00:31] LM: Well, let’s start there, because that’s something that really surprised me about your work is this difference that you draw between vision and eyesight and how much our vision is impacting so much more than what we see. Can you start us off by just explaining that difference?

[0:00:46] BA: I love that you bring this up, because sadly, health care really has it all wrong about the eyes. Most doctors are solely focused on getting you to see those tiny letters on the letter chart and the pursuit of 20/20 eyesight. And that’s important, but there’s so much more to vision than just eyesight. There should be a distinction between the two. We should be viewing these as different entities. Eyesight being the ability to see, whether that’s letters on a letter chart, in an eye exam, uh, what he teacher writes on the board in the classroom, a street sign when you’re driving. Vision is far more complex. Vision is how our eyes move together and focus and converge and track and process information. And really, how we derive meaning from the world around us and then direct the appropriate action. So, we should think of eyesight as glasses. We should think of vision as brain. And then if we’re looking at vision as brain, that means the majority of vision problems and essentially, all functional vision problems are brain problems.

[0:01:47] BA: And there’s a treatment for these brain problems in something called vision therapy, which essentially rewires the software of the brain to change how somebody takes in the world around them and processes visual information.

[0:01:59] LM: How correlated are they? Like, if somebody has eyesight issues, are they likely to have vision problems, or vice versa?

[0:02:07] BA: I look at eyesight as a symptom of a vision problem. Especially in today’s world where all of us are on screens for way too long and technology is everywhere, so many vision problems are based off of stress from our world and not having the tools in place to meet the demands, specifically the visual stress.

[0:02:30] BA: And then, we either adapt, or we avoid as our two options. Avoidance is an option, but especially with screens and learning and work, it’s hard to do. But these maladaptations really suggest that vision problems are treatable, they’re avoidable, but if we have the right foundation in place, we can actually thrive in that type of environment. But as humans, we’re not meant to be staring at screens all day long. So, that’s not something that’s natural and many of us are not visually ready for it.

[0:02:57] LM: Okay, we’ll get into screens in a second. We’re going to dive deep on screens. But if eyesight is one symptom of vision problems, are there other symptoms of vision problems that have nothing to do with our eyes?

[0:03:09] BA: Absolutely. The biggest would be what’s involved with reading. And if you can think about how difficult it is to read when there’s a challenge, but how so much of us take that for granted. So, three most important visual skills for reading are tracking system, that’s our eye movements across the page. Somebody who has trouble in with that system would notice skipping words, losing their place, skipping lines, uh, our focusing system, the inside muscles of the eyes are responsible for making something clear and keeping it clear. That’s going to cause symptoms like, blurry vision, or words going into an out of focus, sometimes becoming doubled, or just difficulty concentrating, because it’s hard to sustain visual attention. So, it’s going to be that much harder to sustain cognitive attention, compared to if that was not the case.

[0:03:57] BA: And then the third, the binocular coordination, or the eye pointing system and specifically, the ability to converge our eyes, or polarize in to point to the same place to see a single, clear image. When there’s difficulty having the eyes work as a team, that causes words to separate, move, often even become double. And the reason I bring up reading is that takes the whole visual world and, and condenses it right within arm’s length. So, it requires a lot careful synergy between those inside and outside muscle systems to be able to use the eyes efficiently and effortlessly. But that’s the brain’s ability to use the eyes. So, that’s a brain problem that would be causing all those symptoms. Um, and pretty much every visual skill that we will talk about, including those and depth perception and reaction time and peripheral awareness or side vision, those are all skills that when we are born, they’re not in place. And then through our life experiences, we develop the ability to use our eyes together as a team. And it starts with crawling and walking and developing that bilateral integration, ability to use both sides of the body as the world is static and then it becomes dynamic. And that’s why it’s really important to not be, uh, using a tablet as a babysitter for your one or two-year-old, because they’re not visually ready for that. So many vision problems can be avoided if we’re mindful with the right habits that we’re, uh, instilling for ourselves and for our families.

[0:05:26] LM: It’s so interesting. I find when I’m using social media a lot, I have a harder time focusing and reading and I always attributed that to the dopamine that I’m hitting my brain with from scrolling and the effect that that’s having on my attention. But hearing you say that, I’m wondering if I’m also doing something to my focus that comes from my vision by scrolling and by the lights and the dopamine of the social media. So, is there a relationship there? Am I onto something?

[0:05:55] BA: You got it. You’re hitting the nail right on the head here. So, definitely, dopamine is a real thing. But specifically, we’re not meant to be staring at a two-dimensional device. And if you can think about even just the eye movements required to engage with a screen compared to a book, they’re totally different. On a screen, there’s more eye movements. They’re more sporadic and less organized, or less methodical across the page. You’re not holding the book to know in three-dimensional space where to aim your eyes, to know tactily where that is located, um, the brightness, the contrast from the screen, the blue light. I joke about that during the pandemic, blue light has become, uh, the new gluten, where everybody’s talking about blue light and blue light is interfering with so much in life. Blue light is not bad for us. Blue light, we actually need from sunlight and natural light and it helps promote mood and regulate our circadian rhythms. But blue light being blasted to our brains all day long creates this high energy, uh, wavelength that our brain has to process. And that absolutely triggers our brain’s ability to release melatonin from the receptors in our eyes that our sole purpose is to tell whether light is on or off and that can disrupt so much. So even if you were to squeeze your fist really hard, after about five seconds, your fist starts to hurt. If you were to let go and go back and forth a bunch, you could probably do that for hours. Which you’re describing about how you feel after being on a screen, your focusing muscles are literally locked in on that screen until you look away. And our focusing muscles are these sphincter circular muscles. So one suggestion that everyone who’s listening today should take immediately would be the 20/20/20 rule, which means with all near engagement, but specifically on screens, don’t spend more than 20 minutes on the screen, without looking at least 20-feet away and resting your eyes for at least 20 seconds.So, letting the muscles disengage. Ideally get up and walk around. Drink a lot of liquid, so you can hydrate, but then you’re going to bathroom, it’s forcing you to get up. Um, but then that’s going to allow for better flexibility and more productivity staring at that screen for extended periods of time. Because with that dopamine hit you mentioned, you’re getting lost in what’s on the screen. And especially on social media, you go down these rabbit holes and all of a sudden, it’s the end of the day, and you haven’t gotten up, or looked away. So, we can all do better than that.

[0:08:29] LM: Would you say that reading would be in itself like a nice counter exercise to our screen time?

[0:08:37] BA: Absolutely. reading on a printed-out page with ideally print that’s large enough, that we’re not straining, or squinting. But I think very often, people try to read faster and skim. But there’s a lot that can be done to help kind of block off the peripheral words that were hard to organize, so you can use your finger to keep your place, if you’re losing your place. You can use a bookmark. Um, a lot of kids learning to read will block off everything other than exactly what they’re looking at, uh, because it’s a lot easier to organize what’s in front of you centrally and what’s around the page peripherally. If somebody doesn’t enjoy reading, or uses reading as a sleeping pill, or wants to listen to audiobook books, rather than read on their own, those are clear signs that at a minimum, vision is interfering some. And very likely that’s a sign of a functional vision problem.

[0:09:38] LM: Oh, I’m always on everybody that I love to read. I’m just like the biggest evangelist for reading. So, I love having a medical reason that I can try to use to persuade them as well. That’s very helpful for me.

[0:09:50] BA: Absolutely.

[0:09:50] LM: Does that mean Kindles are bad? You say that the text should be big enough. I got my mother-in-law Kindle, so that I could make the text really big, so that she would have an easier time reading. Is that not helpful?

[0:10:05] BA: They’re definitely our advantages to Kindles and, and to technology where we can increase the print, so we’re not relying on really strong reading glasses that are basically, crutches and relaxing our entire focusing system, so we don’t have to engage at all. Tt’s really nice to be able to bring the brightness and the contrast essentially to zero, and then slowly increase it until it’s at a comfortable level. And it’s nice to have a lot of books in one place. But I would say in general, most people prefer handheld prints, uh, from a comfort level and from a reduction of symptom standpoint in just comparison to a screen.

[0:10:43] LM: Are Kindles damaging our eyes in any way, would you say?

[0:10:48] BA: Uh, I wouldn’t say they’re damaging. I would say, anything though that we’re doing in an excessive amount is not ideal. So, everything in moderation. I still would say, 20/20/20 rule for essentially, all your engagement.

[0:11:03] LM: Okay.

[0:11:03] BA: But it matters that much more for a tablet, or a screen where you’re not going to be able to adjust all, all of those parameters in the same way you would otherwise.

[0:11:13] LM: And if we’re spending all day on a screen, is there a difference between different types of screens? I know that some have like, retina display, or should we always have flux, or something that limits blue light on? Like, what can we do to make the screens better for us?

[0:11:30] BA: So, this is an excuse to get the largest screen you can find and get it as far away from you as you can. So, usually, the bigger the screen, the better. Can I get some tips just on how to set up what we’re doing right now we’ve been looking at computer?

[0:11:41] LM: Yeah, yeah. Yeah.

[0:11:43] BA: Ideally, the top of the screen should be about 15 degrees below your eye level. So, if you were to stick your hand all the way out, you don’t want the screen to be closer than the tip of your middle finger to where you are. For most people, that’s around 16 to 30 inches. And if we’re at that 15-degrees below eye level, that means like the top of the print should be at essentially eye level. Um, we talked about the brightness, but usually, 40% to 65% is kind of the sweet spot for most people. Um, a blue light blocker on the screen, or ideally in lenses on glasses helps tremendously in terms of just improving comfort, um, and then allowing for better regulation of circadian rhythms in your sleep-wake signaling cycle. Um, but I think a lot can also be done in the room. I mean, reducing glare on the screen is really helpful. So, cleaning the screen, as silly as that sounds, it can help a lot and get all the fingerprints off and allow for less of that kind of shimmering, or distortion. Um, anti-reflective, or anti-glare coatings on glasses, or even on the screen filter are wonderful. Um, if we’re going to be really militant with this, even looking at the paint on the walls surrounding the screen and surrounding the room. But ideally, you want kind of dark painted walls in a matte finish.

[0:13:06] LM: Why is that? Just for no glare?

[0:13:09] BA: Less glare and, and less different types of reflection.

[0:13:13] LM: Interesting.

[0:13:14] BA: Using natural lighting in the room is wonderful. Having a window that you can look as far out into the distance as you can when you’re doing your 20/20/20, uh, to really throw the focus as far into the distance as you can. So that when you bring in it back, you’re maintaining a lot more flexibility. Interior lighting that’s almost –avoiding fluorescent lighting in general. The flicker is very annoying, especially for those who are suffering from a traumatic brain injury, or a concussion. Um, but I think usually, sticking with floor lamps or halogen lights, uh, that can provide incandescent, indirect lighting, that’s a lot more comfortable for most people. Really exercising the eyes and getting up and moving around because that allows our body to release a lot of extra tension that comes from staring at a screen all day long.

[0:14:09] LM: It’s interesting that you mentioned looking out the window. I had another guest on the podcast who cited a study. I forget where it was from, but it basically said that looking out the window increased our problem-solving abilities, our creativity, things like that, even if it was just this very brief period. Do you know how our vision is impacting those components of our brain?

[0:14:32] BA: We have two main visual processing systems in our brain. One that responds to central focal input and one that responds to peripheral ambient input. And in a normal, healthy scenario, we’re using central and peripheral processing simultaneously to know what’s around us and what’s in front of us, and we can take in space and be comfortable and confident navigating through space. When we’re under stress in general, the autonomic nervous system taps into the fight or flight response that we all know about. But from a vision standpoint, what that means is our pupils widen and we get locked in with this kind of tunnel vision effect. So, when that happens, you’re almost looking through paper towel holders, looking just right in front of you and, overriding that, over-focusing, over-stimulation. But to be able to actively engage periphery, you can literally see things from other perspectives and you can learn how to, uh, shift your visual processing and how the visual memory and the visualization and how you’re tapping into those can be accessed. There’s lots of different, uh, cool images you can see where you’ll say to somebody, “What does this look like?” And they’ll be looking at all the details and say, “Oh, I’m looking at the foreground. It’s a picture of a bunch of different dots, or somebody in a dress.” But then, when you selectively shift to looking in the periphery and relying on that system in the background and you’re looking at the picture more globally, you actually see aspects of it that weren’t there. I think creativity really comes from the ability to access so much of our brain and allow for, uh, cross-cerebral connections and communication that sometimes get influenced when we’re in that fight or flight response. And when we’re so stuck on the detail, we can’t open up to see the big picture.

[0:16:25] LM: So, if somebody wanted to solve a problem, or stoke their creativity, would you have them look out the window? Would you have them go for a walk? What would be your favorite hack there?

[0:16:33] LM: Absolutely going on a walk. Going on a walk activates peripheral optic flow. And it gets your body and your mind and your eyes to start integrating and working together more efficiently. I work with a lot of athletes in my private practice, and when you hear about athletes saying they’re in the zone, we can actually measure coronally, cortically, what’s happening when they’re in the zone. And it’s this heightened state of peripheral awareness, where you’re so locked in with what’s around you that you can completely lock in and your body’s just on autopilot. Everything happens in muscle memory. We can attach a functional MRI to somebody’s brain as they’re in a vision therapy session, or as they’re in some type of brain training, or even sports training, and you can see which areas are activated. But I think from a creativity standpoint, you really want to be able to balance that autonomic nervous system as best as you can. Motion and peripheral stimulation helps activate that, uh, critical and divergent thinking that’s needed to do things differently.

[0:17:45] LM: And then I had a podcast about fear of flying. And that doctor suggested essentially, pulling out to our peripheral vision and then kind of narrowing in as a way to help with anxiety. Can you talk to me about how our vision can impact our anxiety and our stress?

[0:18:02] BA: I just, uh, was on a podcast a few weeks ago, where they were talking about claustrophobia and driving and how when you go over a bridge, how that can elicit a panic attack for so many people. This goes back to that balance between central and peripheral processing. And we have a system within our body called the vestibular system. And that’s the internal orientation, kind of the GPS of life. Let’s us know where we’re located, which way is up and down and left and right. Our visual and vestibular systems are very intimately related, neuronal in the brain. And so, so many people, let’s say, when they’re in a car, get motion sick if they’re reading, or on a tablet, or in the backseat, because we’re overriding central processing. Yet, our vestibular system is activated that we’re in a motion and our brain is freaking out and saying, “I can’t make sense of all this confusion.” Yet, when you’re in the front seat, it’s usually better, and when you’re driving, it’s always better, because you’re really preparing your body centrally for what’s coming and you’re allowing your brain to plan based off of the motor system, but then also, the visual system. That then, if we transfer that to driving on a bridge, or when there’s all this now peripheral awareness that you know danger is out here but the only way to take that in and know how safe you are is to move your eyes to where that is. But then you take your eyes off the road, we’re kind of going in this downward spiral there. So much of eliminating motion sickness is related to our ability to access periphery and open up periphery. And although not all motion sickness has a visual component, I would say, the vast majority is improvable, and in many cases, completely eliminated with the right type of work, especially with something like, vision therapy.

If we can notice that we’re going into that fight or flight response, and we can notice that our emotions are taking over and, and we’re tunneling in in so many aspects, once you develop conscious awareness of periphery and the ability to actually open up periphery and not just see what’s on the left and what’s on the right, but see what’s on the left and the right simultaneously can literally open up our world. And one great strategy to help do that is when we walk, getting outside and being creative, notice the mailbox to the side and notice the house to the left, but really actively notice that you’re not going to be able to see both sides, unless you really are intentional with it. And once you can open that up, there can be so much to be more confident in terms of your surroundings. I do teach something called peripheral pointing, which essentially means, uh, we can do with one eye, or with both eyes. But picking something straight ahead, uh, closing your eyes, figuring out where the room was and then say, “All right. Okay, I’m going to pick the trash can that’s off to the left and I’m going to point to where it is. But when I open my eyes, I want to see how far off I am from where I was pointing.” And then you’ll notice, you’re off. Come back to the center, bring it back down, but you’re kind of painting the room, essentially, with the image you’ve created, but then actively engaging what’s in the periphery. if that is something that you’re doing daily, along with, let’s say, eye stretches, where you can cover up one eye, look all the way up to the ceiling as far as you can, hold it for five seconds. As far down to the floor as you can, hold it for five seconds and then left, right, a diagonal is due at the same amount of time, right eye and left eye. I would say, that would be the second activity I would say, do daily. And then the third would be something called a near-far focus, which cover up one eye, you can take a pen, or pencil, or even your finger, bring it as close to you as you can, until it gets a little blurry, stop, try and make it clear. Think about how you’re stimulating your focusing system, how the pupil’s getting smaller, how you’re kind of locking into what’s in front of you, hold it for five seconds and then look as far across the room into the distance as you can, and throw your focus out into the distance and relax that stimulation. Open up periphery, hold that for five seconds. Then if you come back to the, the finger for five, as you’re going back and forth, it’s kind of like doing push-ups, but for your focusing system.

Even just doing those three exercises daily, you’ll notice a small difference. And for people who have significant challenges, you’ll notice even more than a small difference. For the majority of the people I work with, which is a lot of those with eye turns, or lazy eyes to develop depth perception for the first time and avoid surgery, or children with visual developmental delays impacting reading, learning and academics, or we see a ton of concussion brain injury rehab, a lot more is needed than just those three exercises and a tailored approach that’s specific to what’s needed, uh, on their recovery with technology and VR and eye tracking computers and lots of movement in three-dimensional space.

That’s the gold standard. But there’s a lot we can do, um, just to have vision be more top of mind and just like, you could do body weight work at home to get into better shape. It’s better than nothing, but ideally you go into the gym and you’re working with the trainer and you’re working with all the equipment.

[0:23:29] LM: So, what would be the expected results for somebody who isn’t struggling with these other issues, like these more advanced vision problems? Are we preventing, um, our eyes degrading as we get older? Are we eliminating migraines and other vision related problems in the short term? What are the results we can expect?

[0:23:53] BA: First of all, many people don’t realize that what they experience on a day-to-day basis is not normal. So, what that would be would be tired eyes, fatigue, headaches, or eye strain, reduced productivity as the day goes on, planning important meetings in the morning, or not having back-to-back Zooms without wanting to slam your screen down. And I think all of those are related to this crazy amount of visual stress that is our new normal, as screen time is the new pandemic. With that said, however, so much of just naturally how our bodies change as we get older can at least be slowed down and prolonged. So, most of us when we hit our 40s, If we hold things farther away, we notice all of a sudden, we can’t make things clear up close. And so, the joke is that in our 40s, a lot of times we have to have longer arms to make things clearer. And then the eye doctors will say, “Okay, you need reading glasses.” That’s just part of blowing up the candles every year. There’s truth to the fact that the internal muscles in our eyes responsible for clarity become more rigid and less flexible as we age. But for some reason, people think that all of our other muscles, we can exercise and we can develop better stamina and flexibility and strength, but we can’t do that with our visual system. It’s completely not true.

We have patients who are in their 50s, 60s, even 70s prolonging the need for reading glasses, or when they are getting reading glasses, having the number be dramatically lower than it would be otherwise. And the whole if you don’t use it, you lose it scenario, that holds true with many aspects of vision. And so often, when we do get a lens or a pair of glasses that does the work for you, that becomes your new normal, you then adapt to that, you then need something stronger to maintain that same clarity, and then we go down this vicious cycle. But I would say, especially for reading glasses, you got to do work. You got to exercise and you got to do the activities daily, or else things are going to counter. Uh, but for so many of us, we can prolong that need and when we do get those, we can get the lowest readers over the counter, rather than the highest ones, and it still allows for some level of engagement and kind of keeping things sharper for longer.

[0:26:25] LM: Okay, so would you say that the lowest hanging fruit is doing the 20/20/20 and something maybe like, reading incorporating that into our life, if we’re just trying to have that mild protective effect? But then if we are really trying to protect our vision as we get older, or perhaps, we’re dealing with vision problems in the moment that would relate to focus and attention, or migraines, or things like that, then we could add in those exercises, and that would be sort of the next step of the ladder? And then maybe the next step of the ladder would actually be seeing a vision specialist?

[0:26:55] BA: Well, I would say seeing somebody board certified in vision therapy, who knows about functional vision, who does the tests that most doctors don’t do. That should just be a given, because many of us are struggling without even knowing that we are. But low hanging fruit, I mean those exercises, there’s no reason not to do those. You can do them at a stoplight, in the shower in between meetings even if you’re on Zoom and you’re turning the video off. along a similar parallel, nutrition and supplements, there’s so much we can be doing to keeping our eyes healthy for longer and for maintaining optimal vision. Most eye doctors are saying, here’s the strongest lens possible to allow you to see the tiny letters., I’m kind of the opposite. I believe in the weakest lens possible, that’s the most balanced between each eye, that we’re only going to make a change if it’s improving performance. And being 20 happy is way more important than being 20/20. We all don’t have to see the same.

We don’t all have to see HD clear at every distance. And for many of us there’s actually a lot more comfort when there is a little bit of defocus in place. And when we don’t have to see every single hair on somebody’s face across the room, uh, because sometimes you don’t even want to see that stuff. Especially when you’re getting glasses, or you’re going to a new eye doctor and they’re recommending glasses, if they don’t seem right when you first put them on, they’re not. And then the first response you’re going to get is, “Oh, just wear them, you’ll get used to them.” You will get used to them. Your brain will adapt and you’ll be going down a vicious cycle, where things change. Your prescription should not change every year, unless functionally something is going on that’s allowing for that change.

[0:28:40] LM: Okay. That makes sense. You mentioned food and supplements. Best food and supplements for protecting our eye health and our vision.

[0:28:48] BA: Uh, my one seed would be omega 3s. The omega 3s that are in cold water fish, like salmon, or sardines, or anchovies. Um, but in, in a supplement form, because you’re providing your brain high doses of what it’s made of, but what it needs to function at its potential. From a fruit and vegetable standpoint, dark, green leafy vegetables like kale, spinach, collard greens, they have these carotenoids in them called zeaxanthin and lutein, which help protect, uh, so many aspects of the retina, the inner layer of the eye that, that, uh, allows us to see and can kind of protect from a lot of harmful UV light.

Uh, colorful fruits are wonderful. Vitamins, AC&E and antioxidants are great. Eggs have lutein in them and in the yolk, great for the health of the sweet spot of the back of our eye called the macula. Uh, choline, great for cognition and, in general, just what we hear from so many of our doctors, or what we should be hearing from so many of our doctors, sugar and processed foods and inflammatory foods are terrible for our systemic health, but they’re also terrible for our visual health. And so many medical problems within the eyes, like macular degeneration, or diabetic retinopathy, or changing of the structure can be dramatically reduced, and in many cases, even avoided if we have a healthy diet that is limiting of inflammatory type foods.

[0:30:26] LM: Okay. Basically, inflammation in our body is going to cause inflammation in our brain and in our eyeballs. if we’re talking about brain health and we’re talking about vision problems as brain problems, everything that’s good for brain health is good for vision health. We see a lot of head injury individuals who fly in from out of state, or out of country and local ones, too. If we’re not addressing systemic health, you’re leaving so much of the healing journey still on the table, because hitting the visual component, I mean, vision therapy should be life changing to getting back to engaging with screens, getting back to work and eliminating all of these terrible symptoms that happen after pretty much every head injury. And the reason for that being vision, not eyesight is represented in every lobe of our brain. And there’s more areas of our brain dedicated to processing vision than all of other senses combined. So, it’s almost impossible to not have a head injury without vision being impacted. It’s just a matter of what level. So, many of us have head injuries from when we were kids, or random car accidents that all of a sudden, there’s these symptoms and things have shifted, but it’s not this glaring head injury that it’s forcing us to pause life. And then if we’re then embedding more and more screen engagement and near engagement that can embed those bad habits, then all of a sudden, there’s all this neuro inflammation and our body’s not functioning the way that we should. So, from a brain health standpoint, supplements are wonderful, um, like Omega 3, like magnesium, CoQ10, any of the anti-inflammatory supplements like curcumin, turmeric, I mean, there’s so much out there.

[0:32:44] LM: I have so many things on my list and my head that I’m like, “Oh, I want to finish up that subject,” but you keep saying other interesting things that I want to get to. So, let’s just dive into the concussion thing. I would love to know if you have a protocol that you would recommend right after somebody gets a concussion, what should they do? And then maybe a protocol, if somebody had a concussion in the past and they didn’t deal with it well, and they wanted to bring their brain back and their vision back and all of that to optimal health now.

[0:33:13] BA: I love that you bring this up So, two-thirds of the neurons that enter our brain originate from our eyes. And what so often happens, we talked about vision being represented in every lobe of our brain, when there’s a brain injury, when there’s a concussion, suddenly, these previously normal activities of daily life, like chasing after your kids, going to the mall, going to the grocery store, all of a sudden, become completely visually overwhelming, because the brain can’t process all of that sensory input all at once. And so often, reading and engaging with screens can elicit the dizziness, the nausea, the blurred vision that are far too common. So, protocol, truthfully, is seeing a doctor who’s board certified in vision therapy, or at least a doctor who has experience with head injury. Because with the right work and the right motivation and the right compliance, I’m a big believer that almost every concussion can return to previous level of function and return to so much of what they were avoiding. And especially with vision therapy, we can literally rewire the brain to change how somebody’s using their visual system and establish order from all of this disorder. And it’s estimated that over about 50% of head injuries have vision problems that are related and most of the time, we don’t even know about it. There’s a huge discrepancy in the medical community over old school, versus new school.

Some doctors say, “Go sit in a dark room and don’t do anything, until you feel fine,” which is the worst thing to do. And others say, “Just get back to life. You got your bell wrong. You’re okay.” There’s definitely a happy medium. There is a wonderful neurologist I work with in one of the hospitals right by us, uh, here in DC, who says, his rule of thumb is, and you can do pretty much anything after, you know taking it easy for a couple of days, as long as you recognize that when a symptom is elicited, you have to stop and that means you’ve done too much. So often, an autonomic nervous system is in this disconnect. Even just working out elicit symptoms when a heart rate increases, or our sleep is disrupted. So, I think definitely, you want to have things ruled out by a professional first and foremost. But usually, that’s if you go to the ER, that’s them running a bunch of expensive testing that says, everything is fine, because there’s not pooling of blood and disconnected wires up in your brain. Of course, you have to make sure that that’s not the case. I would argue, there’s way better ways to be able to assess that. Um, but then from there a collaborative team of occupational therapy, physical therapy, vestibular therapy, um, vision therapy there’s multiple members needed on to support and work together to help somebody return to life. But I think the biggest thing that we can do initially is limit screen time, because screen time a 100% raises your awareness so much of what you’ve been trying to avoid and can make it really hard to engage and can elicit a lot of these symptoms.

Providing the brain high doses of what it needs and eliminating a lot of what it doesn’t need. So, what it doesn’t need from an inflammatory standpoint. And that’s not saying, avoid everything, don’t have fun in life. But we see some really complicated, really symptomatic individuals. And getting the right team approach is huge. Uh, and along with that team, functional medicine is crucial. And looking at the microbiome and looking at gut health and looking at our overall immunity. I mean, these are now becoming kind of sexy members of the team, where in the past, it was why are we even doing any of this? And we now have learned how much more we have to learn about head injuries, but we’ve learned a lot more in the last three to five years than we did previously.

We also know that no two head injuries are the same. So, no two head injuries should be treated the same. But in general, you’re going to be surprised, vision is always impacted. And sometimes it’s just clarity, sometimes it’s blur, sometimes it’s short term. But if we don’t do the test, if we don’t know what to look for, sometimes it’s hard to be able to find those challenges and those are areas of opportunity for improvement.

[0:37:55] LM: You said that sitting in a dark room is like, the worst thing you can do, even for that first few days, we shouldn’t be doing that?

[0:38:03] BA: If there’s tremendous light sensitivity and sound sensitivity, by all means, get in a scenario where you’re not in the sensory overload. But so often, you go and enter the world, and the first thing you do is go to the grocery store, or Target, or the mall, and that sets you back, because of that huge influx of sensory input that your brain can’t filter, or process. So, at the beginning, you know, rest. But obviously,, there’s a lot that goes into rest and a lot into providing the brain, the nutrients it needs to heal. The first thing is making sure you have the quarterback, or the team leader who is a sports medicine doctor, or a physiatrist, or somebody who has experience with head injury. And that’s not always just a neurologist.

[0:38:55] LM: Okay. To wrap up the peripheral vision conversation, if we are in a situation where we can’t go anywhere and do anything, we can’t go for the walk and get the optic flow, or anything like that, let’s say, we’re anxious in a work meeting, or on a date, can we just widen into our peripheral vision and experience the benefits, the anti-anxiety, anti-stress benefits of that?

[0:39:23] BA: There’s so much with breath work and with meditation and with calming our systems that is so intimately related with periphery and accessing periphery. So, there’s many different profiles visually of how somebody’s functioning. Very often, somebody who’s a type A personality, very detail-oriented, uh, has this tendency where they actually align their eyes as if they perceive things closer in space and where they’re located. So, they’re really overly focal. That somebody who is looking at each individual tree, not the whole forest, and we were kind of talking previously about big picture versus details. Um, it’s going to be a lot harder for that person to actively open up periphery and to sit and look soft at the world. That can be taught for anybody. But there’s probably some listeners right now who are saying, “What is this guy talking about using my periphery? I can tell the door is here,” but you really don’t know how collapsed periphery is, until you’re in a scenario where the conditions are arranged to raise your awareness, what you’re doing, so you can learn how to self-correct and self-monitor.

Now, another profile is an exoposture, where you’re perceiving things farther back in space and where it’s located, and you’re almost stuck in peripheral processing more than you are in central processing. That’s somebody often who’s got trouble sustaining visual attention for desk work, for reading, or writing tasks, or a child in the classroom who looks like they’re not paying attention. And it’s not that, they’re just relying on their ears, rather than their eyes, because they can’t lock in for an extended period of time at near. Um, or somebody who is in deep thought, or deep conversation and they have to close their eyes to eliminate that sensory input to really process and listen to what’s being presented. I’m of course biased, but visions are dominant sensory system, and it should be what’s guiding and leading and it should be what’s tying everything together. But in many cases, it’s not. I think an ideal scenario is to be able to use both simultaneously, but to be able to selectively shift back and forth. A lot of athletes we work with, especially let’s say a point guard in basketball, we want you to be able to bring the ball down the court and take in the whole court. But then, when you’re having to pull up for a shot, or know exactly where somebody is to be able to anticipate where they will be, you can lock in centrally at will and really have a best of both worlds.

Our brain and our visual system can be taught to be optimized to use vision to our advantage, whether it’s for sport, whether it’s for reading, for driving, for skiing. I mean, there’s so much where this rapid flow of information is being processed and filtered that should be unconscious and automatic. But for many of us it’s not, because we’re asking our visual systems to do more than we’re able to handle.

[0:42:10] LM: I’m just wondering, like, the therapist who is on my fear of flying podcast, if we’re stuck in an airplane seat, is there like a way that we’re hacking our vision by switching into peripheral that’s actually hacking the anxiety mechanisms in our brain?

[0:42:26] BA: Yeah. first of all, closing the eyes, as silly as that sounds, if we’re eliminating vision altogether and we’re not having to have the visual and vestibular systems have a relationship that is intimate together, then for many people, that’s enough. For others in aisle seat, where you can actually sit with your head in the aisle and look straight ahead, you’re kind of like that driving scenario, where you’re focusing on what’s coming, that can help balance the system. Um, but one piece to motion sickness is the inner ear and the vestibular system, and not always is there a visual component to those scenarios. But when we are under that, that fight or flight response, and when we’re into that panic attack, literally, our world collapses from a visual processing standpoint.

With the help of breathing and meditation and actively opening periphery, you can come out of it. I’ve actually got an email, uh, last week from somebody who was listening to that previous podcast about in an elevator when you’re stuck and they feel claustrophobic, uh, they took some of the tips we talked about and for the first time ever, went in an elevator and he said, he only made it up one floor, because that’s where he had to go, but had been taking the stairs forever to avoid that. So, I think a lot of times, it’s going to need some hand holding and some, some teaching and, you know, the utilization of the right tools and equipment to really teach you what it feels like, what it looks like and the depth that ensues when the eyes are working together in a certain way and the brain’s turning on to that information, versus when you’re not. But I mean, we’re utilizing neuroplasticity, which occurs, which is apparent at every age, especially for the visual system. Any brain can be taught new tricks at, at any age.

[0:45:08] LM: I love that. It’s also helpful as somebody with anxiety to just know that anxiety is accompanied by this narrowing of focus, and that if I can broaden that, I can help with the anxiety in the moment. Let’s talk about kids. You said no screens for kids. Screens are impacting our kids’ vision, their eyesight, all of these different things and all of these ways we’re not thinking about. I’ve heard you talk about how vision can be misdiagnosed, these things like ADHD. Um, I would love to what would be your age protocol for screens in kids, and then also, all of the ways that, that impact of vision might be showing up that we might not be aware of in our kids.

[0:46:00] BA: Let’s talk about the latter first and then I promise, I will not forget, I’ll give some recommendations for different age groups for kids for screen time. Um, but I would say, this still goes back to vision being our dominant sensory system. And it’s estimated that over 80% of what a child learns in the classroom comes from the visual processing of information. And yet, sadly, one in 10 kids has a vision problem that is significant enough to impact learning. And when children haven’t developed the necessary visual skills and abilities to support the demands from the classroom, they’ll experience symptoms, like losing their place with reading. So, whether that’s skipping words, skipping lines, words going into and out of focus and becoming blurry, sometimes even double – and difficulty copying from the chalkboard, where they have to make the corresponding eye movements from near to far with both the inside and outside muscles of the eyes. And what’s really frustrating is that so often in the medical world, labels like ADD, ADHD, dyslexia are so quick to just be slapped on behaviors when in fact, these are hidden functional vision problems. And then on top of that, to make matters even worse, this is exacerbated by the fact that our children are being exposed to technology and screens earlier than ever before, and often being asked to read in kindergarten, or even earlier, but before they’re visually ready. So, as silly as this sounds, if you know a child who hates to read, who struggles in school, who is squirmy with desk work, I would say, the chances are they have a vision problem.

And one that’s probably treatable through vision therapy. The world that our kids are living in today is very different than the world that you and I were living in decades ago.And there’s an image I have in on this, on a presentation I give about screen time being the new pandemic, where it literally has the 90s, where parents are dragging their kids in from outside, where the best thing in the world was playing with your friends in the street, playing ball, climbing the woods and until it was either dark out, or your mom’s saying it’s dinner time, you’re outside.

And now, 2023, it’s that same mom, but dragging their kid outside away from the screens, away from the technology and the social media, and it’s a huge problem. We’re now seeing that the negative impact this is having on social development, emotional development, cognitive development, and then of course, vision development.

From a vision development standpoint, myopia, or nearsightedness is at an alarmingly increasing rate right now. And especially countries that value technology and education, I mean, the statistics are through the roof. When we landed on the moon, uh, I think it was estimated about 25% of Americans were nearsighted. And then now, it’s about 42% to 44% of Americans. It’s estimated by 2050, that 50% of the world, which is not just America, countries that don’t even have access to technology like we have, 50% of the world will be nearsighted.

[0:49:20] LM: Wow.

[0:49:20] BA: And we know that with nearsightedness, there’s three main risk factors, um, prolonged near work, whether that screens, or reading, or up close. Uh, doing reading and near work in the dark and not enough time spent outdoors.

[0:49:38] LM: Wait, so when my mom told me as a kid, I shouldn’t be reading in the dark, that was actually accurate?

[0:49:44] BA: She actually knew what she was talking about.

[0:49:46] LM: Okay.

[0:49:46] BA: Whether she knew that or not, and to be honest, the research has come out fairly recently to support that. But reading in the dark is not good for our visual system. So, let’s just say your mom was ahead of the times and she knew better. But now the two main realistic risk factors for nearsightedness are genetics and environment. From the genetics component, if two individuals were to have a child today and both parents were nearsighted, their child would have a one and two chance of being nearsighted. If one parent was, the child would have a one in three chance. And if neither parent was, the child would have a one in four chance.

[0:50:25] LM: Wait. With those numbers, is that even if the parent developed nearsightedness as a result of environmental factors, versus they carried that you have a predisposition?

[0:50:38] BA: I love that you bring that up. So, that has not really been looked at, because now individuals having children are part of this, environmentally induced nearsightedness. But I think the study for sure just said, check in a box, nearsighted or not, do you need glasses for a far away?

[0:50:57] LM: Interesting.

[0:50:58] BA: And that’s because of the environmental components that we’ve been talking about, vision being intended to help us guide movement and to explore and navigate our three-dimensional space, not to be stuck on one screen, or a near device. So it’s scary. And screens are not going anywhere. What most people don’t recognize is with the right foundation in place, whether that’s with vision therapy and establishing the appropriate visual skills and abilities to support those demands, or certain online vision training programs like ScreenFit, we can literally get to a place where although we should do everything in moderation, we can handle those demands, we can have the right mindful habits in place, and we can ensure that bad habits don’t become embedded.

[0:52:07] LM: But screens for kids are harder on their eyesight, harder on their vision, because their vision is still developing at that age, correct?

[0:52:18] BA: Correct. Because the visual system is not developed to the level that is for you or I. I usually give recommendations for different ages based off of what’s ideal. A child that’s less than 18-months-old, let’s say, we shouldn’t be on a screen for more than a half hour a day. And it really should only be very high level content. So, if it’s FaceTiming with a loved one who you don’t get to see much, totally fine. But again, don’t FaceTiming with a loved one all day every day.

And there’s a time and a place to have a screen help a stressful situation for a parent. But also, let’s not have that screen parent the child. Um, if we’re under two-years-old, it should still be very limited. From two to five, not more than an hour. But again, really high-level content. And then, six and above, the American Academy of Pediatrics says, not more than two hours, but I will add to that and say, with at least that same amount of time, if not more, outside.

So, if your child is going to be on gaming for two hours, let’s take a lot of breaks. Let’s make sure that’s spread out throughout the day, but then let’s have them outside for at least two hours kind of balancing that system. Um, and I said, 18 months is kind of the earliest age. If we’re thinking about under six months, we really shouldn’t be using screens at all. And anyone who has a child at age, you’ll notice, I mean, when there’s a screen on the floor, or on the wall, immediately, their eyes are glued to that. And what is this really cool, bright, flickery object here? And the dopamine hit that we spoke about at the beginning of this discussion, I mean, that starts the second we start looking at screens and dopamine is able to be released in our brains.

[0:54:12] LM: So interesting. Okay. And then to the point that you said earlier, a TV is probably better than an iPad, because it’s farther away.

[0:54:21] BA: Yeah. So, larger the TV, larger the screen, the farther away. So, if you have an opportunity to watch something on a huge flat screen far away, or on YouTube on our phone, bigger, the better, the farther away, the better.

[0:54:48] LM: I’ve read studies that time outside literally decreases your risk of nearsightedness. Is that just for kids? Is that for people of all ages? What’s happening there?

[0:55:01] BA: That’s for all ages. So, it has to do with not only the light and light being so crucial to just us as humans and the growth factors that come into play with the elongation of the eyeball that occurs when there are changes. But specifically, we’re applying the same eye movements that we’re using on screens, the tracking the converging, the focusing, but to distant space. And we’re applying what we use on a daily basis to fast moving space. And we’re getting the feedback of where I’m moving my eyes is where I think something is. So, I look at a change in eye movement as a change in attention whether it’s voluntary or involuntary. And as silly as it sounds, if we have trouble controlling our eye movements, we’re going to have trouble controlling our attention.

So, a lot of times, individuals who are diagnosed as being on a spectrum of lots of different type of spectrums that exist now. So often, vision is the window to so much, because we have difficulty integrating central peripheral processing. So, we go into a room where there’s a lot of overwhelm. We retreat and we look down, because we can’t take it all in. Or for those of us who have difficulty maintaining eye contact with somebody, or when you’re talking to somebody, you’re thinking to yourself, “Should I look at their left eye, or their right eye, or their nose, or I don’t know where to look.” That right there is, an imbalance between that central peripheral processing, where we should be able to take in the whole image at once, without having to lock in on different details. And that’s something that can be taught and trained to be able to take in a larger quantity of space, um, at many different times.

[0:56:43] LM: Let’s talk about light hitting your eyes, which brings me back to the blue light thing, which I had filed away on my brain to come back to. Um, do we want to be wearing blue light glasses during the day? Because during the day is when we actually want blue light to be in our eyes, I would assume for our circadian rhythm. how do we balance that with getting so much blue light from our screens that we want to decrease it no matter what? How does that fit in?

[0:57:10] BA: So, again, blue light is not bad. Blue light promotes alertness, regulates circadian rhythm, helps with our mood. But it also can contribute to eye strain, eye fatigue, light sensitivity, disrupted sleep. So, in general, we want to be outside and we want to be getting in blue light, especially in the morning, first thing to kind of set our circadian rhythm for the day. if we’re really sensitive, then definitely, sunglasses are helpful. But in sunglasses, do decrease direct UV damage, or light damage that could occur as we age. But in general, we want to be getting light in. Blue light has gotten so much attention, not because there’s evidence that it damages the eyes, but more how it influences so many other factors.

[0:58:00] BA: I think blue light glasses for screens, especially if there’s a lot of screen use can be very helpful in improving comfort and increasing productivity. Blue light can be anywhere from 400 to 450 nanometers. But a lot of places that make glasses, for instance, will have different tiers of blue light filters. So, a pair of glasses that technically blocks 433 nanometers, and that’s it, could be called a blue light filter. But the better-quality ones block a way wider, longer range, so that we’re able to have a better balance in terms of what our brain is filtering and processing. And in general, the shorter the wavelength of light, the higher the energy and the harder it is for the brain to kind of contend with that type of light. So, I think that blue light filters for glasses are helpful. But ideally, what I like to prescribe, or what I call digital performance lenses, or glasses that have the right prescription for near, along with blue light. When I say right prescription, not a crutch, not something compensatory that does the work for you and take something blurry and makes it clear but the right type of prescription that allows for a healthy balance between the inside and outside muscles of the eyes we spoke about, the focusing and eye coordination systems. And very often, by reducing visual stress from near, our then resultant response to that stress is different. And we can maintain visual attention and overall attention on a near task for longer with that right amount.

[1:00:43] LM: Is there a time of day that would be too early to put on your blue light blocking glasses, because it would have a negative impact on your circadian rhythm?

[1:00:52] BA: Great question. It does depend on the person. If we’re exposing ourselves to natural light early and we’re even being mindful with meditation and grounding and lots of other things that can help kind of connect us much more easily the impact of screens are less detrimental. I would say, late afternoon would probably be ideal for most. And in general, wearing them all dayI don’t think would cause problems. If in fact, you’re still getting outdoors, you’re experiencing natural light and, if anything, that would be comfortable and probably preferred by most people.

[1:04:13] LM: Okay., what should we be doing for dry eyes, other than consciously telling ourselves to blink?

[1:04:37] BA: So, we spoke about supplements previously. Omega 3 is phenomenal for dry eye. It helps your own tear film be produced in a more viscous fashion. So, your own tears won’t evaporate as quickly and it’s protective. I see so many patients who are on anti-inflammatory drops, systemic medications, so many things for dryness and using a very high dose of Omega 3 fatty acids with the right balance of DHA and EPA can do wonders for cognition and heart health, but especially for dryness in the eyes.

Artificial tears can be really helpful as well. Artificial tears, you want to use drops that are preservative free ideally, and that anything that says gets the red out, don’t even touch. Because what happens is the visine and everything that constricts the blood vessels, your blood vessels are red for a reason. They’re red to bring in more oxygen and from a healing standpoint. When you’re putting those drugs in, that constricts the blood vessels. Sure, your eyes look whiter. And if you’re giving a big presentation, or you need to have white eyes, so it doesn’t look like you went out the night before, then, okay, once in a while. But I would still say, when the drug wears off, the rebound effect is twice as bad, and you become desensitized to it. So, best things, Omega 3s in a very high dose. Artificial tears and view your tear film as the grass outside. You want to water it, but then you also want to support the fertilizer and everything beneath. And so much of diet and microbiome and gut health contribute to dryness and integrity of the tear film.

[1:06:27] LM: And then I just want to talk about UV for a second. I know we want to get sunlight in our eyes in the morning to set our circadian rhythm, but then basically, as soon as that time is over, are we wanting to put our sunglasses on? I know that my father-in-law has cataracts, and he’s always like, “It’s because I went in the sun without sunglasses, and like, I have light eyes.” Is that true? What’s the best way we should view getting a healthy amount of UV and avoiding UV related problems when it comes to our eyes?

[1:07:00] BA: It’s a delicate conversation, because UV damage absolutely can exacerbate cataract formation and damage to the back of our eyes, our maculas. And so, direct exposure to UV light, we want to avoid. We don’t want to look at the sun. And especially on the water when there’s a lot of glare and light coming in, I think that’s something that in general, is a good thing to block and to avoid. But, there’s also a healthy balance where you’re not wearing blackout shades and saying, no natural light near me. Because although your cataracts and your maculas are going to be healthier in the long run, so many other aspects of just overall equilibrium will not be. So, as we age, it’s definitely helpful. Um, and in the morning, try and do what you can to get outside, expose yourself to light without sunglasses on. But again, don’t stare at the light and pretend like it’s a tunnel you need to look down. Uh, but then throughout the day, it’s going to be a little bit different for everybody and it’s going to be the type of thing that you have to kind of experiment, where, you may notice you try a week of putting on your blue light filters at 4.00 and you see how easy it is to fall asleep. And then you try noon and then you try 8.00. But in general, you should shut down screens at least two hours before bedtime. And ideally, even longer than two hours before bedtime. And then especially if you’re spending a significant amount of time outdoors, uh, to really protect, uh, the pupils and everything that’s behind the pupils.

[1:08:55] LM: Okay. I want to get to a few listener questions and then we’re going to do a quick fire. How bad is it to sleep in contacts and wear daily contacts for more than a day?

[1:09:08] BA: How bad is it to sleep in dirty underwear and not change your underwear throughout the next day? I mean, that’s literally what you’re doing. So, clean eyes, clean case, clean lenses, you’re not going to have problems. But if you can think about how much bacteria and germs are naturally in our eyes and that we’re exposed to throughout the day. And then bacteria loves dark, warm, cozy environments to be able to bring all his friends around. I hate to say this, but it’s pure laziness. And if that’s where we are, get daily disposable lenses, so that you’re lying in bed, you can just take them and flick them across the room near the trash can. That’s still gross, but it’s less gross than sleeping in them.

[1:09:48] LM: Are there any long-term negative effects of wearing contacts and what are your thoughts on the plastic of the contacts touching your eyeballs all day?

[1:09:57] BA: There are so many different types of contact lenses and so many different materials out there, and there definitely have not been longitudinal studies on the effects of what that material will do to us. But similar to breast implants and we know it’s a foreign substance and a lot of times our bodies can react negatively to foreign substances. Uh, there are really cool, interesting new types of contacts that are becoming really prevalent now. One particular called orthokeratology, or contact lenses you sleep in at night that are kind of like a retainer for your eyes, instead of your teeth that change the shape of your cornea. Uh, FDA approved, to actually slow down the progression of nearsightedness and in most cases, dramatically slows it down. They’re intended to sleep with them on, because there are different material, they’re are rigid gas permeable material that allows more oxygen to come to the cornea than normal contacts. You wake up in the morning, you take them off, you see crystal clear all day long. But then you put the lens back in at night and as long as you’re continually to wear the lenses, then your eyesight stays as clear as you want it to be throughout the day.

[1:12:02] LM: Is that only for a particular type of vision, or of eyesight problem? Like you couldn’t use that for all types of reasons people wear contacts?

[1:12:11] BA: It’s typically for myopia and astigmatism. Myopia is medical term for nearsightedness, which means far away is blurrier than it is up close. Astigmatism, uh, can be looked at one of two ways, either that the front surface is shaped like a football, rather than a basketball. So, it’s more curved in one direction, a little bit flatter in the other. Or that there’s almost like a twisting that has occurred in terms of the extraocular muscles and overall vision development.

Either way, things are not uniformly clear all around. So Ortho K, or there’s other types of contacts that slow down the progression based off of the way that they’re, they fit and, uh, how the image is focused on the back of the eye. Typically, a lot more effective for those conditions, rather than hyperopia, which is, um, something that in our forties and beyond becomes a lot more of an issue. Or, presbyopia where our arms aren’t long enough and we need help from up close.

[1:13:09] LM: In general, if somebody was choosing between glasses and contacts and they like the aesthetics of contacts better, you wouldn’t say there was a health, or long-term vision reason to choose glasses over contacts on a regular basis?

[1:13:21] BA: I would say the complete opposite. I would say choose contacts. From a functional standpoint, as a functional eye doctor, contacts allow you to access periphery so much more easily than glasses would.

[1:13:34] LM: Oh.

[1:13:35] BA: And having the lens be that much closer to the eye and having the optical center be that much more expansive allows us to functionally take in more of our world, especially as your prescription increases. There’s many patients where we’re working with them. We get to a point where we say, “All right, improvement is going to be drastically accelerated if we can get you in contacts, versus glasses.” This is one aspect where I think the benefits outweigh the negatives personally of wearing contacts.

[1:14:30] LM: So like, in a nutshell, both contacts and glasses will help your eyesight, but contacts will help your vision.

[1:14:39] BA: Yeah. So, think of eyesight as a symptom. if that’s the only symptom you have, that stuff’s blurry at a certain distance, technically a glasses lens, or a contact lens should be able to allow that blurry image to be clear. But from a functional standpoint and how the brain uses the eyes as a team and uses the different muscle systems and visual processing systems in general for pretty much every visual condition, contact lenses allow for a big advantage. If there’s a big discrepancy between each eye’s prescription, you want to be in contacts, because that discrepancy is smaller. If you’re in a high prescription, it’s actually less distortion and easier to access what’s around us if the lens is that much closer enough for wearing contacts.

[1:15:30] LM: That’s so interesting.

[1:15:31] BA: And I would say in general, daily disposables are the healthiest contacts, but a little bit more wasteful. Um, but I have seen studies that talk about the plastic used and the foils and it’s not a huge discrepancy between monthlies, or dailies in terms of being wasteful. I would say in general, there’s a higher risk for infections and red eyes if we are manipulating our eyelids and using lenses, versus not. Because if not, we’re hopefully not going to be rubbing our eyes all the time. But again, clean water, clean hands, clean cases. It’s, you can avoid a vast majority of infections. And plenty of people get eye infections, even if they don’t wear contacts.

[1:16:12] LM: Okay, next listener question. How bad is rubbing our eyes and what can we do instead if they itch?

[1:16:22] BA: I don’t want to get in trouble here. So if they’re itching, usually that’s the sign of some sort of allergy. And very often, by rubbing our eyes, if we have these certain bumps under our lids that are only there with an allergic response, rubbing them is going to almost elicit a lot more of the material to kind of come around and be more irritating. Um, I would say, figuring out what the allergy is to would be my recommendation, whether that’s environmental, food, a loved one that you’re spending too much time around. No, I’m just kidding. But in general, there’s dirt, there’s bacteria in your hands. If you’re rubbing your eyes without really being intentional behind it and washing your hands first, that’s going to increase risk of challenges.

Um, typically, you’re not going to rub too hard because you’re putting extra pressure and you’re going to damage things, and that’s going to hurt. But in most cases, if it’s a chronic type of response, we got to figure out what’s causing that, so that we can eliminate the trigger.

[1:17:28] LM: In the moment when it’s really, really itchy, should we rub? Is there a best way to rub? Should we just sometimes I just like close my eyes really tight and try to will away the itch? Is that a good approach?

[1:17:45] BA: Is that successful? Because if so, that’s great. If it was in the moment, this is going to sound a little strange. I would bend my finger and I would not use the pad, because the pad’s going to be touching more things. I would start in the middle and I would just kind of once look around the lid margin and then pull it away. But again, chronic rubbing, especially if you’re in contacts, that’s usually not a good thing.

[1:18:17] LM: What causes one-off eye symptoms that go away quickly, things like eye twitching and eye floaters and are they assigned that there’s something bad going on underneath?

[1:18:28] BA: So, definitely, maybe. It depends on what it is. Uh, eye twitching. So, there’s something called myokymia, which is most commonly the upper lid and most commonly only on one side. So, of course, with all this, bring this up to your eye doctor. But typically, myokymia comes from stress, fatigue, dehydration, caffeine, doing too much. And a really neat, uh, way to make that go away quickly is something called quinine or quinine. I’m not sure how to pronounce it, but that’s what’s in tonic water. And there are supplements of this as well. I would say, that’s a pretty clear sign that we got to put the brakes on and try and de-stress as much as we can. Um, floaters are a really hot topic. I get questions on social media about floaters several times a day. There’s three main types of floaters. There’s one that is, uh, just structural floaters, where the inside of our eyes, this kind of, gelatinous goo material called our vitreous. As we get older, it becomes more liquefied and less solid. And what happens for many people is that, uh, it’s attached around the whole retina in the back of the eye.

One of the attachment points will separate and we’ll see where it was attached as this ring that’s floating around in our eyes. So, anytime you see a sudden onset of floaters, definitely call your eye doctor. If you’re seeing flashes of light with the floaters, call your eye doctor even faster. Um, but very often, you’ll notice them and once it has already detached, there’s a follow-up schedule that we keep going to make sure that it is detached, so it’s not pulling or causing tension on the retina, but then it’s something you notice on a really sunny day, or against a white wall. You’re kind of seeing the shadow of that floater on the back of the eye. So that’s one type.

Uh, second type is, uh, something called visual snow, which is lots of little floaters around and these are getting a lot more attention lately. The cause is a little bit less clear in terms of what’s known, but very often, it’s associated with a head injury, or a hypersensitivity cortically to something that had occurred in life, whether it was being under anesthesia, or certain medications and there’s lots of these little floaters almost like snow, like you’re in a snow globe. And it’s very debilitating and it’s really annoying and it impacts many people’s mental health. There’s a certain tint that typically is way more favorable than others, a certain colored lens that we can prescribe in glasses that will decrease a lot of that and improve symptoms. And vision therapy can also be very effective in helping desensitize the brain and improving some of the, uh, perception of those floaters. And then, there’s another cluster of floaters that occurs in children, where there’s these kind of blobs that they see and it’s kind of their new normal and whenever we talk about it, or ask them in the exam chair, that’s the first time the parents have heard about it and the child says, “Yeah, I thought everybody saw this way.” And very often, by activating different areas of our brain with vision therapy, we can dramatically decrease and often eliminate that type as well. Uh, I lied and said there were three types. I would say, the fourth type of floaters, um, very often can come from, uh, the standard American diet. And from a lot of almost inflammatory mediators that with the right type of antioxidants and the right type of supplements, uh, they can attack the free radicals and make it so that those are less pronounced.

[1:22:10] LM: Okay, I’m going to do a quick speed round. LASIK, are you pro, or against LASIK surgery?

[1:24:09] BA: Personally, I am very anti. And I would say, if you go into LASIK surgery saying, “I don’t want to wear glasses, or contacts, and I don’t care really what happens from that, as long as I can see pretty well and I’m all right with dryness, or irritation.” Okay, then I’d say, by all means, go ahead with LASIK. But, um, there’s a reason why the scientists who FDA approved LASIK have come out recently and changed their tune a little bit. There’s a reason why a lot of eye doctors don’t get LASIK surgery themselves. There’s a reason why dryness, halos, glare, irritation can become terrible for some. In general, when you look at the statistics, the vast majority of those who’ve had LASIK are happy. But for the ones who are unhappy, oh, man, are they unhappy. And those are the ones who literally just cannot function in life, because of all of the irritation and symptoms and, uh, in many cases, emotional and mental health are influenced by the negative implications, or the challenges that have occurred post-LASIK.

[1:25:18] LM: Could they come and get vision therapy and help with some of those negative side effects?

[1:25:24] BA: Uh, they often do. Orthokeratology, which we talked about, reversible LASIK. We have a lot of patients who go through with that procedure to say, “I want to see what LASIK is like, knowing it’s completely reversible. I stop wearing them, I go back to where I was.” And the vast majority who go into those, then don’t even seek out LASIK. Not to talk negatively about any of my colleagues, but, when you hear all these advertisements for X amount off and this eye for free, that should raise some eyebrows in terms of why those deals are being put out there. And I think when it first came out, it was really cool. I still think it’s very cool optically that that can be done. But at the same time, it’s an elective procedure. Insurance doesn’t cover it, because it’s elective. And for those who feel like they’ve made a mistake, it’s really clouded my judgment.

[1:26:17] LM: Yeah, that’s fair. We talked about blue light glasses. I would love just like, to wrap up that conversation with how do we know if we have effective blue light glasses? What are you looking for in terms of judging quality?

[1:26:29] BA: Typically, you pay for the quality that you get. So, if something is $5 on Amazon, you’re probably going to get quality that’s about $5 on Amazon. Um, some doctor’s offices do have machines that can measure the light permeability of a lens. Um, but if you get them made through an eye doctor, you’re pretty certain they’re going to be good quality. And I would say those are, in my opinion, definitely worth the investment uh, rather than having a hundred different pairs around the house, but that don’t do a whole lot. there are certain companies that sell really, really high quality, very expensive ones that are really helpful, but also, not needed in terms of how robust they are for, for many people.

[1:27:13] LM: A hack, I tell people, and you can be totally free to tell me if I’m wrong, is just to buy the yellow, or red-like construction glasses, because even though they’re not fancy, they are blocking the blue spectrum of light. Would that be true or not true?

[1:27:27] BA: Uh, for some, yes. then there’s some that block a little bit, a lot less light that are kind of yellowish. But again, it depends on the quality of the filter. Certain filters can do wonders for symptoms. There’s a certain, um, kind of purplish color tint that’s called omega that can be really effective for visual snow. We talked about FL41, this yellowish one. Um, but we have about six different tints that we prescribe more often than others. It’s pretty neat what we can do to alter how our brain processes light and how we take in the world, even from a syntonics, or light therapy standpoint, where we can prime the brain for different processing as well.

[1:28:49] LM: It’s helpful to even know that that exists and is something you should discuss with an eye doctor. Like, I have migraines. Is there a tint that would be helpful for me? I think a lot of people wouldn’t even know to have that conversation. So, it’s nice to even have the awareness that exists. Okay, last one, is there anything we should be aware of with eye makeup, or skincare products touching our eyes?

[1:29:12] BA: Yes. Uh, one of my good friends is a – eyebrow and makeup artist, and she sees so much that she has to send to my office. So, in general, there are certain colors that can be a lot more irritating for some. A lot of women notice there’s a certain pigment in the purplish, bluish eyeshadows and eyeliners that can cause a reaction. Um, in general, you want to make sure the brushes are cleaned. You want to make sure contacts are usually on before you’re doing the makeup, um, if you’re wearing contacts. But I think especially for eyelash extensions, or for certain products that allow your own eyelashes to grow, a lot of them utilize a certain chemicals, or drugs whose side effects are increased lash pigmentation, or darkness around there, which can be favorable, but when it’s permanent, that’s not something that people, uh, typically enjoy until it’s too late. So, there are some out there that are, um, better than others.

[1:30:27] LM: In general, by succumbing to the societal standards of beauty for women and choosing to wear eye makeup, I’m not like making it so that I’m going to have really intense eye issues down the line.

[1:30:40] BA: Shouldn’t be as long as you’re not irritating your eyes, your lids or prying your lids really far in one direction and stretching out the skins that you’re going to have droop your eyelids sooner than you would. You want to be really cognizant of what’s in the makeup you’re using especially if you’re doing it all day every day for decades.

[1:31:05] LM: And then can you just leave us with one homework assignment, something that we could all do as soon as we turn off this podcast to increase our eye health?

[1:31:20] BA: if you have a headache, you might see a neurologist. If your child is squirmy in the classroom, you may go to a psychiatrist, or a learning specialist. If you’re motion sick, you may see an ENT, or an otolaryngologist. But with almost every symptom, you need to consider that vision could at least be a part of the problem. And that’s why I always advocate for really putting your vision first and that goes way beyond just seeing your eye doctor and seeing if you need glasses. When everyone goes to their eye doctor, and hopefully, everyone does go from a preventative standpoint, when the doctor’s talking about your eyesight and your eye health, please then follow up with, well, what about my vision?

And please ask about the functional skills needed and to support healthy reading and learning and driving, because, uh, so many doctors don’t test for these, because when they do find these challenges, they don’t know what to do with that information. And there’s so few of us who are specialists in this area. But, uh, if you go to covd.org, which is the College of Optometrist and Vision Development, that’s the international organization that board certifies doctors. there’s a tab that says, ‘Locate a Doctor’, you can put in your zip code and put in a search radius. Anybody who has the letters FCOVD after their name, that’s somebody who you’re in good hands to be able to at least have an evaluation and know what’s going on.

Treatment is not as consistent as it needs to be yet, but it will get there where there’s going to be a lot more standard protocols, especially for concussion and brain injury rehab and developing depth perception, things like that. Tip would be, um, the, 20/20/20 eyesight we talked about. Um, but I think the tip would be that the vast majority of vision problems are treatable and they’re avoidable. And anything you can do to decrease the amount of screen time you have and balance that out with active, uh, work outside, the happier you’re going to be.

[1:33:44] LM: It’s nice to even think about the antidote to screen time being outside time in a way. Like, that those kind of should go together. If you’re going to do more screen time, do more outside time.

[1:33:53] BA: Absolutely.

[1:33:55] LM: Can you tell us a little bit about where people can find you on the Internet and any fun programs that you want to call attention to?

[1:34:01] BA: You can find us on myvisionfirst.com. And on Instagram, I’m @DrBryceAppelbaum. Uh, but my ancestors tried to make it difficult for everybody. Appelbaum is spelled E-L, not L-E. So, it’s D-R-B-R-Y-C-E-A-P-P-E-L-B-A-U-M. We have a really powerful online vision training program called ScreenFit, which, uh, you can find at screenfit.com. And if you haven’t heard about ScreenFit, you’re going to be hearing about it soon. It is a revolutionary program to minimize symptoms, reduce the damages that screens have on our visual system, and really help promote healthy habits for extended screen use.

It’s designed, so that even though we’re talking about avoiding screen time, even though you’re using screen time to, to accomplish this, uh, they’re very quick, short videos that are user-friendly, that are, uh, allowing you to put these habits into daily life and certain things that you can just add onto your daily routine. And all of us can be ScreenFit, where we are not, uh, limited based off of our potential and vision getting in the way.

[1:35:30] LM: I love that. Well, thank you so much for taking the time to join us today. You have so much incredible information. My mind has been blown several times over, so I really appreciate it.

[1:35:41] BA: Such a pleasure being here and love the work that you’re doing and love that, uh, we can all now be healthier together with our visual system as well.

[END]