Subscribe
Share
Share
Embed
Most people think about their health when something goes wrong.
Next Phase Human is for everyone who wants to start thinking about it before that moment arrives.
Hosted by Dr. Sandhu — a cardiologist with a focus on prevention, longevity, and whole-body wellness — this podcast brings together physicians, researchers, and wellness professionals for honest, evidence-based conversations about the topics that actually move the needle on your long-term health.
Each episode covers the intersection of cardiovascular wellness, modern medicine, lifestyle optimization, and human performance — translated into practical, approachable conversations for professionals, business owners, and anyone serious about living better longer.Topics include heart health, metabolic health, sleep, stress, nutrition, longevity diagnostics, wearable technology, recovery, burnout, and the future of preventative care.
This is not clickbait wellness. This is a forward-thinking physician who believes the best healthcare happens before you need it.
New episodes weekly.
If you keep staring at the TV, you're going to mess up your vision.
Yeah.
Is there any truth to it?
Truly, there is actual information to say it will
create changes to your eye.
Welcome to Next Phase Human, where medicine meets performance and
science meets longevity. I'm your host, Dr Asham Sandhu, an
interventional cardiologist with a passion for all things wellness, how we
can live better, more fulfilling lives.
And my guest today is Dr Sandip Walia.
He's the chief medical officer and owner of West Coast Eye Institute,
one of the largest comprehensive ophthalmology practices in Bakersfield,
California.
He is a Harvard-trained cataract and refractive surgeon,
and he specializes in advanced cataract care, refractive surgery,
glaucoma management, and innovative technologies that improve visual
outcomes and quality of life. Dr Walia, it's a pleasure to have you
here.
Thank you for having me, Dr Sandhu.
So I just want our viewers to know a little bit about
you and your practice in your words.
Yeah, okay. Well, that was a very nice intro.
I feel like I should cut that and save that for my wife-
... because next time we have an argument, I sound very accomplished on that.
So thank you for the kind words. Look, I'm very fortunate as an
ophthalmologist. I'm a comprehensive ophthalmologist here in Bakersfield,
California. I moved here about eight years ago and took over a practice,
and have been a part of the medical growth and the patient
care growth that we've seen over the last eight years.
By training, so a little bit about myself, background,
I am from Houston, Texas, so I'm a Texan through and through.
So I'm the rare Texan that moved to California rather than the other way around.
Oh, the reverse way, huh?
Yeah, exactly right. But I picked the most Texan spot of California.
So it worked out well for me on that front.
Family still in Texas, still in Houston, so that's where the roots are.
Did my undergrad at the University of Texas at Austin, so I'm a proud
Longhorn. And if you know anything about Texas, just like California, we're
very state pride, lot of college pride.
Of course.
So I'm burnt orange in my blood. While I was there, I was actually
a business major.
Okay.
So I was a marketing major. I know, a kind of a left turn for the Indian
ophthalmologist here. But, I did that as my undergrad.
I also coached football, so for a short period of time-
Wow
... for the University of Texas. That was a great stint.
Then,
with my parents beaming of joy, I decided to take some time off and get
away from school, so I actually was a stand-up comedian for about two years.
That went well.
Yeah. Well, I'm right here now, so you could tell the peak of the stand-up comedy
is this podcast. So,
it was a really cool experience. I got my MBA, deferred my medical
school admission, and lived life,
which looking back at it, I couldn't have been more thrilled and lucky to
do. My parents probably not so thrilled at the time.
Now everything looks great. And then I went to medical school at Texas Tech,
which is over on East Texas, so a lot more oil, dirt,
agriculture, so similar to Bakersfield in that sense.
Mm-hmm.
Then I went to Emory University, where I did my residency.
During that time period, we had the opportunity to go to Mass Eye and Ear and
learn refractive skills and cataract surgery. That's Harvard.
And the wind blew really hard. My in-laws lived in Fresno,
and so we were trying to figure out where to settle. I voted for Texas.
My wife voted for California.
And we know how that worked out.
And then here we go, man.
Here we are eight years later. So that's a little bit about myself.
Well, we are fortunate to have you here.
So I'm just going to dive straight in. There's a lot to learn from you.
So a lot of questions about eye health, about
what things in our day-to-day life-
Mm-hmm
... put strain on eyes. So eyes are a big part.
80% of our sensory input to the brain comes through eyes.
Mm-hmm.
And people worry a lot about losing eyes, but they still spend a hell of a
lot more on skincare than their eyes.
Yeah.
So
are eyes
aging faster than they used to in today's day and
age?
That's a great question, and a lot of great points.
I think awareness has grown a lot. So when we look at the
idea, are eyes aging, there's a lot of demographics that will show you
that the average age of cataract surgery has moved forward, and that might
be a disillusionment to say yes. But the actual
technology has just gotten so much better and the advancements to the
field that 25 years ago, when you had cataract surgery, it
was just to get some improvement. But now it's actually gotten better that you
actually will get quality of a life and visual outcome, and it's slightly
an actual medical surgery. And then there's the refractive component, trying to get
you to live a little bit independent from your glasses and things like that.
So the age I think shows the downward trend because
of technological advancement, not aging of the eye, not really things on that
nature.
So overall, eyes have been the same for centuries.
They're going to stay about the same health, not necessarily aging faster,
just better option now.
Well, that's encouraging.
Yeah.
So you've done thousands of surgeries.
Yeah.
What surprises you the most still about, whether it be
people's outlook or what you see when you get in
there?
If I get surprised when I walk into that eye or I go into the eye, it's going to be
a long day.
And transparently, actually, I just finished in the OR.
So I went straight from the OR, put on the nicest shirt I have, and I came here.
So we like a good surprise, and I like complex eyes, and that means they're going
to make a difference. But I don't want too many surprises on my day in the OR.
Oh, no.
I like to be a little less surprised than that.
I think probably the two things that really surprise me, as much
information as there is medically, there's this big gap on the
understanding of what cataract surgery and refractive surgery is.
So I think a lot of people still don't really understand the process, which is
always fascinating for me.
And they're always really thrilled at the result.
So that's the nice side of that surprise, where the other side of it is- Having
to explain the concepts of medicine to patients to
really grasp what they can do and what they can't do through the surgical
process. So those are probably the two biggest surprises, and
I'm sure you see the same thing too.
There's a lot of knowledge now out there, but sometimes there's so much knowledge
gap between those fragments that it makes new questions in the
clinic. So surprises, yes, but it's just
redirection of the same question.
And the right kind of knowledge. Sometimes there's a lot of misinformation out
there, too.
Yeah. Dr. Google is- ... prominent in my clinic some days.
Exactly.
So the big question that comes these days is our
iPhones have become a big part-- Smartphones have become a big part of
our lives.
Mm-hmm.
LED screens are everywhere.
Mm-hmm.
In terms of eye health,
there's a lot of talk about blue light.
Does it matter? Does it not matter? How does it affect the eyes?
That's a great question. I get this question and probably a small handful of a
few like pretty much all day long.
The first answer is blue light does have a lot of
circadian rhythm and neurological changes-
Right
... for you about your daily function, and you've actually touched on some of that
in the podcast.
So there is some value to say that, yes, it will have an effect.
From the actual anatomical function and structure of the eye,
no. There is no data to show that blue light is retina toxic at
this point in time, or that screens create some sort of
degenerative disease that's going to accelerate in the eye.
So no, there isn't an actual disease process that's created by
iPhones.
But with that said, I would pull out my iPhone and compare
screen time to this point. I'm not the healthiest on my screen time.
So I'm thoughtful about it because it will create a lot of irritation to the
eye. So it'll create the momentary issues, like the dryness.
So if you ever have those moments when you're sitting in a clinic and you've got to
blink 20 times to clear up the computer, you've worked too hard, Dr.
Sandy. You've got to take a break. Go out there, take a walk or do something else.
But no, it won't create permanent damage, just the momentary issues.
And are blue light glasses helpful at all?
Yeah, for some. If you were to come in or you were to call
me and say, "Hey, I'm having a lot of headaches." Well, again, that points maybe
more to the neurological, the intracranial chemical
pathways of the brain, not the actual chemical and visual stimulation of
the eye. So yeah, blue light glasses have a huge bearing for those patients.
Otherwise, no, there isn't a lot of data to say
that when you walk into your optometrist or your ophthalmologist clinic, that
you should really strongly leave with blue light glasses because there's a
medical necessity to it. No, I don't think that's the case.
So more marketing than medical.
You said it better than I did, but yeah, we're probably thinking the same thing.
Yeah.
Yeah. But one of those things, just to elaborate, while you say it's to marketing,
look, this is not a concept that's probably completely understood, and we
still learn a lot about retinal anatomy still to this day.
Like when you implant an intraocular lens during cataract surgery, you take out the
natural lens and you get an artificial lens.
Those artificial lenses come in two types now: with the blue light blocker and
then without a blue light blocker.
Okay.
So you become bionic. So congrats.
I'll put in the blue light blocker for you during cataract surgery.
So I don't shy away from those lenses because there's no harm to them,
and there might be value that we don't know.
But as of today, in 2026-
No
... I think it's a little bit more marketing.
No data yet.
Yeah. No data yet.
And would that affect your circadian rhythm, one would think?
Because during the morning, you need that blue light.
Actually, your brain needs that signal.
Yeah.
So having a permanent blue light blocking glasses, would that be
somewhat disruptive to circadian rhythm?
I guess maybe. But if it's disruptive, too disruptive, that actually might make you
productive, right? So-
Fair enough.
Again,
as an honest person, last night my wife and I were watching Netflix till way too
late, right? So realistically, that probably threw off my circadian rhythm
from the emission of light from the TV.
There are bigger offenders than that.
Yeah, exactly right. But a happy wife, happy life.
I wasn't going to deal with that fight, so I had to sit through this rom-com.
So again, if it disrupts already a bad sleep cycle, it might
actually put you on a good sleep cycle. Everybody's a winner on that front.
Fair enough. So staring at screens.
When I was a kid, I don't know if your parents told you that, but we heard that a
lot. If you keep staring at the TV, you're going to mess up your vision.
Yeah.
Is there any truth to it?
For all the moms and dads, because I am a mom and dad. Yes.
I'm never going to say no about a parent there.
But no, truly, there is actual information to say it
will create changes to your eye.
So this big wave of information and literature started to come out
maybe early 2000s, maybe mid
'90s, and it started really in the pediatric population for something called myopia
control. Myopia control studies are essentially
clinical trials and studies to help figure out how do we prevent eyes from
becoming as long as they do for some families.
So let's put it in a sense for all of us to kind of understand.
You yourself, Dr. Sandy, have glasses on right now, and all glasses have a
prescription, a plus or a minus. Typically, a minus means that the eye
is bending light either too strongly or it's really long. Right?
So I take my shirt, and my shirt's meant for my body, but I really
expand my body. It's going to get thinner and thinner-
Mm
... and the material can stretch. So long eyeballs are not a great thing because
you don't get more retina. Your retina stretches.
Stretching can lead to holes that can lead to tears, that can lead to retinal
detachments, degenerative disease.
So we really want to try to prevent that.
So that's what the myopia control study were really targeted for.
How do we make sure our eyeballs don't grow so long?
And in the common vernacular, that's nearsightedness?
Yeah, that's correct. So it'd be like nearsightedness.
That I'm pretty good at a book, but I'm really hard at the TV.
So to tie it to the point of, again, will the TV hurt your eye?
Well, the data shows that for young eyeballs in regular,
just in-room lighting, like clandestine lighting, your muscles are
contracting, and that contraction is actually what's creating that
elongation of the eye. So the studies were trying to
inhibit the ability to contract that muscle, take away your ability to
tighten up the eye muscles, so you can't extend the eye, and if you
can't extend, you won't elongate.
You won't elongate, you don't create the same pathology that you can have.
So yes, there actually is truth to that.
I think it's even more now because, again, the idea of the TV being six feet away,
now the iPhone's 20 inches away. So I think there's more and
more studies like that. There's more and more information that we know about
elongation of the eye and really trying to prevent that.
So yes, Mom and Dad were right. They had this one right.
So yeah, it's something that we're thoughtful now about.
So is there anything we can do to help?
Yeah.
So I guess the first thing would be, if you have a kid that has
two parents that have really long eyeballs, so really minus number,
really nearsighted parents, a minus six, a minus
seven, a minus eight. One, routine screening for the child
really helps. When you start to see that prescription change a bit,
that's when maybe the idea turns from optometry to ophthalmology,
and conjunctively, I guess, working together.
So for just our
listeners, what's the difference, optometry to ophthalmology?
Let's split that out.
Yeah. Oh, this is my favorite question because still to this day,
my dad is very proud of what I do when he remembers I'm an ophthalmologist, not an
optometrist. So he interchanges them pretty quickly.
Both of them are great specialists of the eye, but slightly different.
Optometrists are refractive specialists, doctors of refractive
services, glasses, contact lenses, and they really help the eye
see a high quality of it, which is the function of the eye.
Whereas ophthalmologists work kind of as the eye is a part of the whole
body. So again, for a lot of the conversation that we'll have today, the
eye and the gut have a relationship that we didn't know about 45 years ago.
That's back into the ophthalmology realm.
So ophthalmologist are eye surgeons, they're focused on eye health, not just
the bending of light and the need for glasses.
So that's the big differentiation between the two.
Both of them work really well, and a lot of clinics have both.
So like in our clinic at West Coast Eye Institute, we have an optometrist and
ophthalmology, so this way we can blend the two services together.
But to go to the myopia control and things you can do to prevent,
or watch if you have a kid that you're really concerned about,
one, routine screening. When the prescriptions start to change a little
faster than they should, when you're eight and it's one, and when you're nine, all
of a sudden the numbers are pretty different, you probably should get seen more
often. And then you can try actual clinical drops to try to
shrink the growth rate of the eye, and actual measurements of the eyeball
length would be pretty helpful.
So that's atropine?
Yeah, that's correct, atropine.
Yeah.
So that's where cardiology and ophthalmology intertwine right there .
Right. Exactly.
Yeah, that's atropine drops, yeah.
And does dark mode help at all in these devices, or no?
No. I'll say that there isn't any data that I think would point to turning
on to dark mode to decrease the illumination or kind
of light emission from the devices.
And a lot of people increase the font size. Does it make a difference?
I feel like you looked directly at my soul when you said that, Dr.
Sandhu, because I'm doing one of these now, too.
So I felt that stare. And as an ophthalmologist, I know those stares.
No, increasing your font size does no harm to the eye. If you need it, you need it.
But no benefit either?
If you need it. I mean-
It's comfort?
It's all about comfort, yeah. Essentially, if you have a hard time reading the
font, make it bigger, because bigger is easier to read.
And I get this question time to time.
Is there any difference between the iPad screen versus the Kindle screen?
Oh, that's a good question.
The paperback.
I would assume the amount of light coming from a Kindle...
So transparently, I have an iPad.
The amount of light coming from the iPad might be better, again, for circadian
rhythms and kind of the blue light emission.
But nothing in pertaining-
But nothing in pertaining to actual eye structures or eye diseases.
So whatever kind of screen it is, OLED, LED, it's the distance from the screen
and the amount you stare at it, not what kind of screen.
Yeah, correct.
Is that a fair statement to make?
Yeah, I think that's a great statement to make. Yeah.
And
is there
20/20/20 rule, is that enough? Every 20 minutes, 20 second break, or
look 20 feet away. Does that help?
I love it. We're pulling out all the eye stops today for me, Dr. Sandhu.
I feel great. Yeah, the 20/20/20 rule, for anybody that doesn't know,
exactly what you said. After 20 minutes of working
at near distance, take a 20 second break and look 20 feet away from you.
And that's the same idea. If those muscles are really contracted, it can
create a lot of strain, headaches.
If you're a child, it can create muscle elongation.
You're trying to avoid some of that stuff.
And the other thing it does, when you're staring at a screen, you dry out.
So take the break. Just 20 seconds, look at something 20 feet away.
20/20/20.
So if you're having headaches, maybe you need the 20/20/20 rule.
Yeah, that's exactly it. It's definitely not my kids.
It's definitely the 20/20/20 rule.
All right. And LASIK has become a big part
of eye care now.
Mm-hmm.
And
so there's different kinds. I was reading LASIK, SMILE,
PRK.
Mm-hmm.
Can you tell us, for
some people who don't know, like us, who don't understand the eyes-
Yeah
... what's the difference between PRK, SMILE, and LASIK? Is it the same thing?
No, no.
They're similar. Okay? So if you were to put it in an umbrella, the
umbrella is called refractive surgery.
So refractive surgery is any surgery to try to minimize your need for
glasses. So that would be any surgery that's going to change the way you
bend light in the eye. That's a refractive surgery.
So in that umbrella, it's a long list of things, but let's just make the list a
little small for this conversation.
You have things that go into the eye, like cataract surgery is a refractive
surgery.
Then you have implantable contact lenses, ICL,
that go into the eye. Then you have things that work outside the eye on the
surface, called the cornea. And the three that you mentioned, PRK, LASIK,
and SMILE- Those are all acronyms.
We in the eye world, when we like a study, we try to make it as catchy of an
acronym as possible.
Yeah. Right. Fair enough.
So SMILE, LASIK, PRK, they all stand for something, and they're really,
really close to each other. They have differentiation points, but
essentially, they're all going to change or manipulate the cornea, the front
surface, so you bend light more suitable for your eye.
The biggest difference point between LASIK and PRK, the two,
I guess,
forefront surgeries in this realm, is they heal a
little differently. One is kind of letting you heal naturally, kind of
promoting corneal stability, and the other one healing a little quicker.
So PRK is a bit more natural healing.
Takes about a week to heal, maybe some irritation in that week.
Whereas LASIK is the one where people snap their fingers, and by the two hour,
they're done. They can start to see significantly better, and they like the
time value proposition of LASIK. SMILE is in that similar realm,
but it works slightly differently, where instead of working on the surface, just
kind of goes into the cornea and works in the layers of it.
So very similar.
All for the same goal, slightly different on outcomes.
Here in the US, LASIK would probably still be the more
popular of the three options. And they all have their
limitations. So much power can be corrected, so
not every eye is suitable for every surgery.
So the answer can be, it's not
what's the best surgery, it's what's best for you.
Yeah, you got that right. That's all of medicine, right?
We can't put a cookie cutter to say this is going to work for everybody.
But really knowing the eye, knowing what's right for you and what you want,
all great options, but they all have their own specific niche for the right
patient.
And if I'm thinking about having this surgery, I want to get rid of glasses, what
are the complications I should worry about? What this could go wrong.
I feel like this is your patient interview time.
Exactly. Just trying to get what I can out.
My goal is at the end of this, you're going to throw...
There's a guy on YouTube that after he eats a bite of cake, he throws his glasses.
Have you seen this guy on YouTube?
No, I have not.
I'll send you a link here. So when he tries something really delicious, he takes
his glasses off and throws them. So this is going to be at the end of the podcast,
you'll throw yours.
This is the moment.
Yeah, there you go. That's the moment right there.
So the question, if you were thinking about all three, what are the risks?
Look, they're still eye surgeries, so there are risks.
Risk of any surgery, like infection, need for a secondary
surgery, or kind of a haze to your vision instead of the productive clarity that
you want. All really minimal because, again, as technology gets
better, surgeons are better trained, there's better understanding.
We kind of know, again, what's the right fit for that patient, and that's
how you really avoid some of those complications.
And then the other complication that's probably the more commonly talked about one
is dry eye. Dry eye is a surgical
kind of consequence of anything that touches the surface.
You're manipulating it, right? So if I go on a diet and I lose weight and my
skin doesn't hang the same, I wouldn't say it's a
really bad complication, but it's not an aesthetically pleasant one.
But it's a known complication of doing this process.
When you touch the cornea, you're going to manipulate that tear film.
Right.
So it's always really important to be healthy going into it.
You would tell your patients the same thing.
Before you go into a surgery, well, if you had great heart conditions,
status before, well, you'll probably have a really successful outcome.
Right. That defines what you go in with.
Yeah.
Absolutely.
Exactly right.
Is there an age cutoff beyond which you want to do LASIK or any of these?
No, there isn't an age cutoff. There's probably a minimum.
My personal preference would be at 22 or older.
And if you're a young lady and you're in the family planning stage of life,
pregnancy does throw off your vision and your refractive power, so maybe not the
right time for you. From FDA approvals, yeah, it's 18 and
up. So it's not really recommended for pediatric or
sub 18 population. And then as for the cutoff on the other end of it, that's
probably the more common question I get. There isn't really a cutoff.
It's again, what are we trying to accomplish?
Because that might not be the right fit for you.
And after you do LASIK, can the vision still regress and they
might still end up with the glasses at some point?
No, it's a great question. So once you do LASIK, it's always
there because it's a cut. The cut will always be there.
The removal of tissue will have always been persistent.
You can have regression for sure. So it's like if you pierce an ear, the piercing
might always be there, it just closed up because your natural body wants to heal.
And then the second thing, there's multiple things that bend light in the eye.
So no matter how great your LASIK is, let's say you go at 24 years old,
you're going to get older, your lens will change, you will get a cataract, your
vision will alter because of other reasons, not because of the wear
off of LASIK.
So again, depending on the prescription going in, you can get real
longevity out of it
if it's done in with a kind of a healthy conversation with the ophthalmologist.
So chances are if you do it too early, you may end up with
some regression down the line. That's a possibility?
Yeah, I'd say it's a possibility. It's a low possibility.
So for example, in our clinic we talked about atropine.
Atropine's an eye drop to dilate the eye.
The dilation kind of
gives paralysis to the eye muscles. That is what happens when you age.
When I was doing this with my phone, like I said earlier, my muscles just are not
as healthy as they used to be. So if I can see what the
paralysis to the muscles do to your glasses strength, it gives me an
idea of longevity. So essentially, if I give you eye drops to dilate the eye
for your LASIK evaluation, I won't know exactly where, but it'll tell me
from that point and then to maybe around 50, will you change a lot?
And if I can predict that a little bit better with some actual objective and
subjective data, you shouldn't regress a ton to ever be in the same pair
of glasses again.
So it'll help. It just depends how many years you got ahead of you.
Yeah, that's exactly right.
Is there anything coming down the pipeline which is even more fabulous than
LASIK?
Oh,
ophthalmology's a really cool field,
because we got a lot of toys and gadgets and gizmos.
Probably the newest thing that's already out on the pipeline is something called a
light adjustable lens.
So this is in that same realm of refractor surgery, but it's in the
cataract side. So instead of touching the outside, the cornea, this is going into
the eye. You can take out the cataract And put in a new lens.
That's a standard of cataract surgery. We've seen this before.
We have patients that have some family member that's gone
through that standard procedure.
The standard lens is kind of stamped out of an acrylic, and it's set.
Well, the new form of the lens is a light adjustable one, so you can
implant it into the eye and go home.
And then about two weeks after implantation, we can see what the powers of the
eye are and do we need to actually adjust the lens.
So I can shoot a light to the lens while it's still in your eye and change the
shape of it.
How interesting.
And if I can change the shape of it, it changes the power, and so I can really
tailor it into what you're looking for.
So let's say, hypothetically, if I have a friend who's a cardiologist that's doing
surgery all day, hypothetically speaking, of course, and
you're like, "I really want to get perfect vision for where I am surgically," which
is 20 inches away from my face because I'm using loops or a microscope or something
along that nature.
Right.
That's my perfect sweet spot. We can put in a light adjustable lens, and I could
be, based off science, as close as I can.
And then I could really dial you in to make sure that's the sweet spot that we're
looking for. So that's probably the newest wave of refractive technology.
And then there's a lot of stuff in the pipeline that, the accommodative
lens that simulates more like the natural eye,
the holy grail. So maybe in our lifetime.
Getting there.
Yeah, we're getting there.
Excellent. So another topic that I always hear
a lot about.
Mm-hmm.
What we eat defines us.
So there is foods and there are supplements.
Mm-hmm.
And there are some which are kind of more associated with eye health, or we hear
about it, or you see the supplements on Costco shelf for these.
Yeah.
So I just want to go through some of that and see what you think about it.
Okay.
Being an ophthalmologist, what's good, what's not.
All right. Great. I'll also add in if I personally take one.
Perfect.
Yeah, I do. Great.
Omega-3s.
Great.
It's good for dry eye, good just overall
systemically. I do take it. I take a capsule a day.
Lutein?
Lutein is great. It's one of the few ingredients studied in something called the
Age-Related Eye Disease Study, AREDS, and it's
proven to slow down the progression of macular degeneration,
typically in a comprehensive vitamin called an AREDS 2.
Great pill.
Should everyone take lutein?
Once you get diagnosed or you have a high risk for macular degeneration, it's
encouraged.
But not for everyone.
No, not for everybody until you get to the disease state.
Zeaxanthin?
It's also in that AREDS study. Great.
Vitamin A.
Vitamin A is great. Vitamin A is a fat-soluble vitamin, so it
has toxicity. So it's not one of those vitamins you just take an endless supply of.
You've got to be kind of monitored for it.
And most people that don't have vitamin A deficiency don't need supplements.
I don't take it.
It's right in the right scenarios. Not for everybody.
Zinc.
Zinc is a great vitamin, part of the AREDS study.
Does a lot of things systemically as well.
It's not necessarily you need to supplement it.
I don't take that, but good pill.
Bilberry.
Oh, you're going out there now. Bilberry-
A little bit. Pushing it.
We're pushing it there, but I can't wait to see this list now.
But bilberry,
not enough data. Its anti-inflammatory properties
probably have some help systemically from the eye standpoint,
and they're kind of touted as
cataract option solutions and to brighten your vision, an eye bright.
More marketing than substance.
Got it. Astaxanthin.
I would say astaxanthin, good.
Kind of a mixed bag, again, still a little early in the studies, but overall, it's
in a lot of vitamins, and it is in the AREDS vitamin.
So it may be useful.
Correct.
Creatine.
Creatine I take.
I take for the neurological effects.
So I take a little bit more than the average five grams per day.
So you take 10?
Yes, I do.
Yeah.
And so then I should ask the cardiologist how that helps my heart area.
I guess at this point, creatine is the miracle supplement.
It helps everything.
Yeah, I would agree. So I take it, I think it's great.
From the eye standpoint, doesn't have a whole lot of studies to show benefit, but
definitely does no harm for the eye.
And collagen.
Collagen is great for a lot of things.
Collagen, typically from supplement, doesn't help regenerate vitreous
or collagen tissue in the eye. So great systemically for the eye,
maybe not that much.
And hydration.
Big one?
Yeah. If I said don't hydrate, I would probably give you my medical
license right now-
... and just walk out of the room. Yeah, great.
I try to hydrate daily. You definitely should.
Has great effects for the eye.
I just wanted to throw it in there because it is just so underrated.
Yeah.
And people don't think about it. We think about all the fancy things.
Yeah. But the simple stuff.
But what's available and what we should, like two, two and a half liters of water a
day. It's just not happening.
Yeah. No, I completely agree. I'll say just as a general human being,
I sometimes hydrate more at work than I do in my personal life because it gets so
busy.
Right.
But I think it's a huge factor. So I strongly recommend it.
Going to the foods, some foods may be better for eyes. Eggs?
Yeah. Eggs have a lot of lutein in it.
So essentially has a lot of factors.
Has some other maybe downside, but just from the eye,
great.
Salmon.
A lot of omega-3, so in the same realm. Yep.
Really good healthy, good tissue.
Could benefit from omega-3 anytime.
Greens.
Oh, greens. So now you're talking my love language here.
So yeah, greens, huge value for the eye.
A lot of anti-inflammatory properties, a lot of
benefit from the retina standpoint.
So from the dietary things that we actually recommend in clinic, I have a
lengthy conversation about greens.
Any particular green or all of them?
I would say this, any green is better than no green.
There is kind of a hierarchy of
properties within the greens.
So I often tell patients the darker the green, the better.
But again, if you're picking between a burger
salad versus a cheeseburger, take the burger salad.
Fair enough. Berries.
Berries have a lot of properties. A lot of them haven't had a
lot of science to the backing for it just yet, but it's all about
anti-inflammation. So yes, but we don't know enough.
So no data at this point?
Yeah, correct.
So now diving into what you do a lot of day-to-day.
Okay.
Cataracts.
Okay.
A lot of us get it. Cardiologists with radiation get that too early
on.
Yeah.
So
is it a matter of
when or all of us are going to get some degree of
cataract, or is it just some get more than others? How does that work?
No, everybody will get a cataract.
So everybody literally looking at their phone right now, I'm
talking to you, you will 100% get a cataract.
So it's not if, it's when.
It's not if, it's when. Because cataracts are aging of natural tissue.
So the only way not to get a cataract is to not have the natural tissue.
If you don't have a lens in the eye, you probably already know this conversation
because that didn't happen naturally, you can't see a ton, there's already a lot of
conversation. So let's go to the majority, if not all of the population.
Lenses inside the eye let you focus.
So when I'm looking at you and then I look over your shoulder and I see the wall
behind you, to zoom in and zoom out, that's my lens.
I should have a lens. It's going to age. Lenses become cataracts.
So unavoidable.
Is there anything you can do to delay it?
Yeah, if you find a way to stop aging.
There's nothing you can do to really stop getting a cataract. They've tried.
There have been clinical trials of injectable medications in animal
models to see if they can maybe dissolve some of the protein buildup in the
natural lens for an animal. Unsuccessful.
So there's probably no way to really stop the aging
process. It's a God-given right. So when I start my speech, I always say
congratulations because there's only two options.
You either got one or you didn't, and I'm glad you did.
Yeah.
You just said it's the aging of the lens.
Mm-hmm.
So what is exactly happening inside lens when you get a cataract?
Boy.
In the simplest terms.
Like you say, hopefully, we got a lot of time on this podcast.
All right, so the lens is really, really unique, okay?
For a couple of reasons, but without boring everybody, it's
cells that are just everywhere in your body.
It's epithelial cells that are inside the eye, and those cells are kind
of laid down. Because of natural just use,
wear, and tear, aging, they build up and they kind of create
waste product, and they kind of fold a bit differently.
So the proteins start to fold differently in the lens.
By folding differently, they lose their transparency.
So think of it like cellophane. If my wife
makes some great lunch for me and she wraps it in cellophane, she does a great job.
She wraps it up, I take it to lunch, I eat it, and then I wrinkle up the cellophane
paper. It's still cellophane, but now I folded it differently, so I lose the
ability to see through that cellophane.
That's what happens to the lens. So it will start to become
opacified, go from clear to cloudy just with time, and
it's inevitable. So that's the process that happens.
But it happens differently for everyone depending on what factors they are exposed
to?
Yeah. Well, look, in the broader encompassing term, cataracts are cataracts, but
there are different types of cataracts. So yes, they do happen in different ways.
They do happen kind of at different paces, and there are things that speed up
cataracts. Everybody's favorite word is cigarettes.
If you talk to your doctor about cigarettes, the next sentence you'll get is,
"Please stop." Because cigarettes do increase the age
speed of the lens. So yeah, there are things you'll do as a human being to
speed it up, but inevitably, there's nothing you can do to avoid it.
UV light?
UV light does age the cataract a bit more.
So for example, here in sunny California, it'll happen
and probably bother people a lot quicker than if we lived in Norway
and we don't have the same UV exposure.
And
by that count, do sunglasses help?
Yeah. Sunglasses help. Sunglasses help for a lot of things.
From, A, the UV exposure to the lens, which is the cataract.
UV light to the retina does create inflammatory processes that can
really create toxicity. So in short, sunglasses are great.
You should use them from a lot of the eye perspective.
Now, do you wear a lot of sunglasses, Dr. Seneviratne?
Not a lot.
No. Are you okay?
Not a lot. So I learned something.
Yeah. I have a pair. No, I'm just joking.
Yeah.
Alcohol, of course.
Yeah. Alcohol is anything that creates inflammation in the body.
And alcohol, probably done in moderation, can have some value
and some social fun. Sure, I can understand it.
But realistically, all alcohol has a ton of sugar in a lot of ways.
Doesn't really do any healthy benefits,
for the eye, it does create inflammation.
So not necessarily a positive thing, but not necessarily have to be
shying away in your day-to-day life.
And the other big ones that I hear is diabetes, steroids.
They do play a part in early cataract?
Oh, yeah. Diabetes and steroid medications, they do kind
of age the eye in a significant way.
Diabetes is a whole separate bag of worms because it creates other problems.
And steroids medication to help with you systemically, the closer the steroid is
to the eye, the more likely you'll have an effect, the higher the amount, the
longer the duration. But it does speed up a very particular type of cataracts.
And people who have to use steroid eye drops-
Yeah
... does it increase the risk?
It does, yeah. There's a lot of people, let's say you have a corneal transplant.
The transplant has value. It's human cadaver tissue.
You don't want it to reject. You don't want any transplant to reject.
And it's a gift, so you'll be on a steroid for a really long time, and some
transplant patients are on it for their life.
And we know it will kickstart other things for them.
But again, the benefit of the steroid in that scenario outweighs the risk of
developing a cataract that you just take care of. So it's risk/benefits.
Yeah, it's okay.
Fair enough. And do genetics predispose you more to get cataract,
or no, if your parents had it early or not, or something like that?
No, not necessarily. So I don't think that there's a genetic predisposition for the
age pace of the cataract. And also transparently, I think a lot of
our parents, my grandparents, for example, they probably listened to the
radio. Then my parents watched TV-
8 feet, 10 feet away. Now I'm on a cell phone, so my
demands on how I use my eyes have evolved.
So I think the cataract coming about for me would be independent of genetics,
but maybe I'm more cognizant of it because how I use my eyes.
And our kids are probably going to be in VR.
Yeah, you bet.
Yeah, that sounds about right.
Let's dive into a little bit of dry eye.
Uh-huh.
It comes up a lot.
Uh-huh.
And
you touched on this a little bit, the phones are a big part of why everyone-
Oh, yeah
... is developing a dry eye.
Yeah.
Is there any other thing that's contributing to it?
Oh, yeah. Like right now,
hopefully I'm not excessively blinking on the podcast, but I'm standing or sitting
right here, and there's an AC vent right above you.
Mm-hmm.
And that AC vent's blowing right at me.
And so, boy, my eyes are getting beaten up here. It's like I'm at a gym.
The AC does a convection current to the eye, and so
I know it sounds really nerdy, but I really like what I do.
So every Saturday morning, typically, I try to sit down with a small group of
ophthalmologists, some locally, some in the US, some in other countries.
When you talk to an ophthalmologist in India, we do this on our own, we just kind
of chitchat and talk about things. They don't see dry eye at the same rate we do.
They have cell phones. Their air quality's not the greatest.
The humidity may be a little bit better there than Bakersfield, but it's nationally
about the same, just not as much AC. So AC's a big culprit of it.
So that AC, the screen time, the usage of the eye
when you're in an office, the AC's blowing, you're staring at your phone.
Right.
It's just a recipe that gets-
It all adds up
... yep, you bet.
And
hormones?
Yeah.
Hormonally, when you change, your tears change.
Tears are not just water. There's three components.
There's water, oil, and mucus, and essentially those three ingredients need
to be mixed perfectly right to make the perfect tear.
When they're thrown off, the tear's not great, and then it will evaporate too
early, doesn't stick, has other issues.
So when you have a hormonal change, the ingredients change, right?
And so when the ingredients change, your tear's not as good.
It definitely will lead to dry eye.
So tears is not just water.
Yeah, no.
Mostly.
Not just water. It's all the ingredients.
Think of it like the god salad dressing.
It's got a little bit of everything in there.
But for example, when you're going to cook tonight, you're going to, let's say,
make some chicken at home. What's the first thing you put in the pan to
get the heat to coat evenly?
It's oil.
Oil.
Oh, yeah.
It's not water, it's oil. So actually, your tears have a heavy oil component to
it. That's how the tear spreads across the eye.
You don't have a healthy oil film, that tear doesn't spread.
That's the omega-3 that we talked about a little bit ago.
So the omega-3 helps you create better oils that helps the tear stick
longer, that decreases the dry eye.
So yeah, that's the oil component.
Contact lens use?
Contact lens use is a synthetic plastic, right?
And so you're putting something on the eye, it creates hypoxia, so you can
sometimes grow a lot of blood vessels, and that's probably the most
medically worrisome process of contact lenses and hygiene because you don't
want to create infections from the contact lens.
And yeah, essentially when you have hypoxia, you don't get good air exchange.
Air exchange, you'll have a loss of fluid on the eye, and you'll dry out.
So contact lens are a big factor to it.
So that's inevitable with every contact lens?
No, hopefully not inevitable. If you do good contact lens
routine and maintenance and taking things in and taking things out the right way,
daily disposables and contact lenses are now designed to have more
oxygen permeability. So you can put yourself in the right
situation. But again, just like you said with water, sometimes the basic stuff
makes sense. Take out your contact every night, right? Don't sleep in it.
And if my wife is listening to the podcast, I'm talking directly to her.
But yeah, just do the basic stuff and that makes sense.
Fair enough. Sleep. So in terms of sleep,
there's some people who their eyes
don't close all the way.
Yeah.
Is that a big enough problem?
Yeah.
All right, so when you
blink, you naturally have a reflex.
It's called the Bell's reflex. The Bell's reflex is when the eyelid goes down,
the actual eyeball rolls up. So that's the natural tendency of an
eyeball. So you're supposed to roll your eye up when the eyelid
rolls down. The reason for the reflex is the cornea, which is the clear
tissue on the eye, that needs to be covered.
When that starts to dry out, that's not going to lead to good corneal
health, leads to scars, and if the clear window is scarred,
you can't see through it. So essentially, yeah, if you don't close the eye,
you're going to dry out.
If you don't close the eye and you don't roll back, which is the natural reflex, or
don't roll back enough, your cornea gets exposed, and then it's
really problematic. So it is a big problem, for
sure.
If someone has it-
Mm-hmm
... are they able to tell in the morning how they wake up?
What would they look for?
So probably a thing that they'll notice is, one, somebody in their family will say,
"Hey, you
kind of keep your eyes open when you're sleeping. It looks weird." Right?
It looks striking if you've ever seen anybody not completely close their eyes when
they're asleep. When you're a really young kid and you don't have the
muscle strength and you don't have that sort of tone or the
awareness while you're still sleeping to keep them closed.
So you'll see it a lot in kids. There again, perfectly fine because they have a
great Bell's reflex, great tear film.
When you're an adult, you might start to feel this.
You feel irritated, gritty in the morning.
Sometimes the eye will wake up bloodshot because, again, lack of good oxygen.
The other one you'll hear is, "I feel really sticky around the eyes," because you
made the fluid, but it didn't get covered by the eyelid, so it ran
out. So it leaves this kind of residual film on the skin.
Okay.
Yeah.
So if you wake up with a moist skin around eyes, that could be a tip.
Yeah. Or it was a really sad movie you watched last night and-
But yeah, exactly right.
And artificial tears, do they help?
Great. Yeah, they help. Again,
they are probably the simplest, easiest, more
readily available option to help somebody when they're dry.
So they help a lot.
When you go to the drugstore, one of my probably a very nerdy thing of
me, don't judge me here, Dr. Sandhu, is I like to walk down the eye drop
aisle and just see what's going on there, see what's sold out.
There's a ton of stuff in that aisle.
So I get the question of which artificial tear is the best.
If I have the best gym, but I never go, it doesn't matter.
Right.
So if you buy the million-dollar eye drop that you think going to fix your dry eye,
but you never use it, doesn't matter.
You buy something that's clean and a like name that sound like they belong on an
eye, Refresh, Systane, Blink, right?
Those are I words. Visine doesn't sound like an I word.
That sort of stuff, it's a little cleaner, it's more meant for the dryness versus
the redness. Those drops are great. Use them as much as you want.
And should everyone use it here?
Oh, yeah. Again, there is a possibility
of having an allergic response, right?
Anytime you take any medication, you see this in clinic.
Right.
There's no cookie-cutter answer.
But
with that said,
it's very rare, and for most people, not every day is the same,
right? When I go into work, I check my eyes.
On the same street sign every day, I check the left and then the right side and
kind of go from there. And if my vision's blurry, I know I'm dry,
I put in some eye drops. So yes, it's always a great option.
Check it out and put it in whenever you need it. Some days more, some days less.
And warm compresses?
Great, because again, it helps with that oil film, right?
Warm compresses help kind of melt oil, or melted oil coats better.
Lipiflow?
Yeah.
Lipiflow is great. Lipiflow is really good, and what Lipiflow is for anybody that
doesn't know, it's a in-office procedure that you can do to heat up that
oil film, the meibum, that comes from the eyelid, so
your eye can get coated better.
The downside is it's never covered by insurance.
So then you're starting to talk about, hey, again, I spend more on my skincare than
my eye care, and a lot of patients don't view the eye care that same way.
So great thing, can get costly,
but it has a great value for a lot of patients.
And how often do they have to do it?
Typically, when you're on Lipiflow, or when you're starting Lipiflow treatments, or
IPL, which is another growing process in the dry eye realm, which is intense
pulse light, which is light therapy to the eyelid for the same concept,
you'll do it about once every three to four weeks if you're in a
severe case. But for most patients, they really don't need it, but maybe once
every three to four months. They'll get a lot of benefit.
They can still supplement with artificial tears. It doesn't get rid of the tears.
It just improves overall ocular health and maybe decrease how much you need
of the tears.
Got it.
So one of my biggest pet peeves is this lack of sleep
epidemic in the United States.
Yeah.
And it affects pretty much all levers of life.
It's a multiplier to all diseases.
Mm-hmm.
Heart disease, dementia, you name it, diabetes.
So does it have the same relationship with eye health?
Yes, it's a
great question.
I'll start with this one first, but I'll ask you, how many hours, if I can ask, Dr.
Sandhu, in front of everybody, how many hours of sleep did you get last night?
Seven hours.
Seven hours.
So I
initially, early part of my career, didn't understand this.
Mm-hmm.
I was proud of less sleep and more work-
Mm-hmm
... as a lot of us are.
Yeah.
But for my personal health journey, once I started having
impaired glucose tolerance and I became serious about
wellness and see what levers I can use to improve-
Mm-hmm
... my health, this became an integral part. So I measure it. I track it.
I'm a nerd about this.
Yeah. I love it. That's part of why the podcast... Now, what do you use to track?
Do you wear like a sleep band before you go to sleep?
So I use Whoop-
Okay
... currently, and the Eight Sleep bed, that does help with my sleep.
That was, I think, a good lever for me in terms of cooling down-
Mm-hmm
... at night. So a lot of us who wake up a little warm at night-
Yeah
... that stopped happening because the mattress cover cools it down.
Yeah.
So that helps, and
I did see actually palpable increase, I have no commercial relationship, but I'd
see palpable increase in
my
deep sleep-
Yep
... and REM sleep-
Mm-hmm
... and some improvement in heart rate variability.
So all three of the big factors.
Yeah.
Now, I'm a nerd about this stuff, so I use a lot of gadgets around it.
That some of which work, some don't.
Yeah.
But that conversation can go on for hours.
This really-
Yeah
... gets me going but-
I think
you're a great byproduct to knowing your body, right?
And so sleep, yeah, if you don't get great sleep, and again, I
won't put it to just the quantity of sleep, it's also, I'd say the quality of
sleep, right? If you get good sleep in whatever quantity it is for maybe your
body, it creates great oxygenation for the whole system, right?
Essentially, blood flow and oxygen is
literally the bloodline for all things healthy in your system.
So yes, I think great sleep helps. I think great sleep's
necessary. I think broadly, whatever the definition is
for you, we have all these gadgets now.
You got rings, watches, and all that stuff like you're saying.
You've tried on probably all of them. And I've tried on my share, too.
Right.
And yeah, so I think sleep, huge factor. It's one of those things that you said.
You said it about water, and I think that's probably a good takeaway.
Sometimes it's simple. It doesn't have to be complicated.
Right.
You don't need technology to sleep well.
If you just make it a point to make that your goal. But huge value.
No, it's the wind-down routine. I think that's probably the single biggest
factor.
Yeah.
Like you mentioned, the blue light.
Mm-hmm.
So blue light at night, so use dim lamps-
Yeah
... in the evening.
Yeah.
And there is an interesting fact that I learned.
So the ceiling height blue lights-
Mm-hmm
... actually target the lower part of your eyes.
Mm-hmm.
And it was designed that way because the sun is overhead.
Okay.
So that's how we evolved.
Yeah.
Morning sunlight, you're awake.
Mm-hmm.
So now I'm getting the same LED light at night.
Okay.
Whether you go to store or you're sitting at home, those are bright LED lights.
Yep, all day long.
1996, they started assault on- Circadian rhythm-
Yeah
... but LED lights, they are phenomenal.
Yeah.
But in the right context.
Yeah, agreed.
So if you're reading at night, high level-
Mm-hmm
... low intensity light, non-LED-
Okay
... is probably helpful. Do red light glasses work?
Yeah. Red light glasses, great topic.
Yes, they do work.
So they'll help your circadian rhythm.
Well, they do a lot more than just that.
So,
I feel like I wanted to hear the sleep routine so much, so I'll make sure I put a
pin on that and come back to it. Red light glasses actually help decrease
inflammation in the retinal tissue.
Okay.
So it's one of those things that probably if you asked me five years ago, I
would've been, "No, there's no data.
No, I don't think so." Now, I would have to be wrong about my own self and
say, "Yeah, there actually is objective data to show a
decrease in inflammation in retinal tissue." And I think if we can
target that as our goal in the way of ophthalmology in the next 20 years, that
might be the precursor of how to treat diseases before they become
diseases. So red light glasses are FDA approved here in the
US for macular degeneration,
specifically in one device. But great value.
I think there's more to learn from it.
I think there's more value than we think about it.
And I wouldn't be surprised if this becomes a growing topic for us in the next five
years.
So mostly evenings, red light.
On label right now, it's a lot of red light therapy, so I think it's a little
impractical to target it right now for the specific disease of macular
degeneration. But for you and for me,
just in general, if you were to put red light therapy for five minutes, again, it
would be hard-pressed to me to say that I think you're going to do something
destructive to the eye. I think we don't have enough data to say what that short
term does now for you, but decreased inflammation is always
a winner.
So that's red light and near-infrared.
Yeah. Correct.
But in terms of the glasses, which kind of turn your light into
red-
Yeah
... so evening-
That won't do a ton.
That won't do it.
If you have a red lens that changes the chromatic color of the
world around you, it's not the same intensity of getting absorption of red
light into the retinal tissue. So it wouldn't have the same things.
But may help somewhat with the circadian biology-
Yeah
... actually, that's-
Yeah. Correct
... because
what kind of wavelength did we use to see go back 200 years-
Yeah
... when there was no artificial light?
Yeah.
And in the evening, the sky colors
is close to that.
Yeah.
So your brain, naturally, there is actually data that your brainwaves change-
Correct
... when you actually have the red light glasses on.
Yeah.
And then, of course, cooling the room,
we evolved as a specie around-
Yeah
... the equator.
Yeah.
So
what happens there is days are bright-
Mm-hmm
... nights are dark, days are warm, nights are cold.
Yeah.
So the temperature sensing area of the brain is right next to the light sensing
area.
Mm-hmm.
So
we need both those cues to sleep well.
Yeah.
And of course, one of the big things, when growing up in India, I used to eat late.
That's the culture.
Mm-hmm.
Now, knowing this and
studying my sleep also, three to four hours
before sleeping-
Mm-hmm
... you're done with eating.
Yeah.
I know if I... And back when I used to drink, if I have
even one drink-
Yeah
... all night sleep is short.
Oh, yeah.
I think also, for me, as I've gotten to try to be more in
tune with what's good for my body, it's also what I eat.
I've got a really big sweet tooth, and so I used to eat a lot of desserts and that
sugar rush right before bedtime. Never great for me systemically.
Never great. I didn't feel great in the morning.
I still like my sweet, I've just moved it a little bit earlier in the day.
So it sounds silly, like, I'll take a dessert near lunchtime if I really have a
sweet tooth that day.
Fair enough.
Versus try to put it at the very last thing right before I go to bed. Yeah.
Yeah, you wake up at 3:00 a.m. with that crash when your body's sugar is down.
Yep.
The insulin has pushed all the sugar in. You're up at 3:00 a.m.
Yep. You bet. Exactly. And then you're looking for the next sweet thing to eat.
Exactly.
What room temperature do you typically sleep with? I'm curious.
I usually go to
66 to 68.
66 to sixty... All right. When it gets hot here, I'm coming to your house.
That's why you got solar.
There you go. All right, I'll be there. Yeah, I agree with you.
I like a good cold house.
And so, the thermostat war goes on in my house
for sure.
Right. All of us. And that's where the mattress cover helped me because you can
actually have one mattress cover and two different temperatures-
Yeah
... on the bed.
Yeah.
So that works.
Yeah. No, I completely agree. I love the sleep routine. I agree with you.
The one thing I try to practically do is put away the screen.
It's really addictive. If you put a hard
stop at, hey, 10:15, which is realistic, or whatever it is realistic for
you, that will really help you be in tune with the idea of, all right, now I'm
just going to sit here in the dark. I don't mind sitting in the dark and just
think, and eventually you'll drift off and-
Right
... I think that helps me a ton.
Or you can read a book if you-
You can read a book
... can't go to sleep.
Yep.
But an actual book.
Yep.
There was a really interesting study from Australia years ago
studying people who had read the same book from iPad-
Mm-hmm
... versus an actual book.
Yeah.
So obviously, the sleep that night for iPad group, you would expect that it was
disrupted. We didn't know that back then, but now we know.
Yeah.
But the more interesting part was the iPad group had worse sleep
for the next seven days.
Yeah.
It was almost like a drug that hung around in the body.
Wow.
Yeah.
So it kind of goes way beyond. So we digressed a little bit, so
let's kind of bring it back. So does poor sleep
make you more likely to get glaucoma or
any of that, like macular degeneration, glaucoma, or any of that?
I would say poor oxygenation
in your sleep. So if you're not getting good quality of sleep more than
quantity, I think that's where data will definitely support the idea.
That will lead to disease processes.
It'll lead to
lack of perfusion of the optic nerve, which can create elongation, which is the
glaucoma process. So in short, yes, quality may be over
quantity, but I think they go hand in hand.
You don't really get great sleep in just two hours. You need your night of sleep.
Right. You need your full seven to eight hours of sleep.
Exactly.
So-
Most of diseases, when we think eye, we think, okay, that'll be pretty obvious.
Mm-hmm.
If your eye is not healthy-
Mm-hmm
... you'll stop seeing or see poorly.
Yeah.
But
before that happens, usually in a lot of diseases, we see that before
you actually see the disease, it's been whispering to you for years.
Mm-hmm.
So in eyes, what are some of the diseases that'll
come that you won't even know?
Well, that's a great question. I don't think I've ever been asked that.
So diseases that you probably won't know.
Probably the most common quiet disease of the eye is one that we just talked
about, glaucoma. And it's not that you won't know it's coming if you're
getting routine eye checks, but because it's a slow
process, decade-long disease, not day long disease, so
it's not going to instantly hit you.
It typically starts in your phases of life where you're too busy to
go to an eye doctor, and it's not something you get screened at when you're 30 or
40 because you're pretty good. You just quickly go get your glasses and you're
done. So you might miss the screening windows for it.
You might not find all the cues. And so I think that's probably the most common
silent disease, because it affects your side vision first.
So looking at you, you'd still be in great clarity, but looking
behind you at the plant or something like the doorknob, that might become
tougher to see. And I'll just adapt. I'll just rotate my head.
So that's probably the most common quiet disease of the eye.
And macular degeneration?
Yeah. That's also a quiet disease because there's stages.
So for anybody that doesn't know macular degeneration, it's a degenerative or
kind of age-related wasting away or buildup
of bad
metabolic tissue and fluids in the back of the eye.
And there's two real types of macular degeneration, dry and wet.
When you have wet, it means you're leaking blood.
That's the real serious stage. That means that there's some fluid back there.
You'll know right away. That's not a silent one.
You'll come in and say, "Something is funny." The dry kind is the
quiet one because it's not as glaringly obvious.
It's not going to hit you in the face and say, "I can't see something." It's just
not as sharp as it used to be. One of the predisposing kind of
signs for it, light and dark. So what happens is as your cells
get light, they should turn over. Well, if they're not turning over fast, that's
how you build up this metabolic waste in the back of your eye, and that could be
the precursor of macular degeneration.
So when you turn off the lights to go to bed, if it goes completely dark and it
takes you two minutes where it used to take you 15 seconds, aging
and maybe something you should go talk to your eye doctor about.
Got it. And a lot of times you hear people tell, "I see floaters."
Mm-hmm.
What should they think? Is it always worrisome? Is it never worrisome?
What do you typically see?
So floaters are really common. And I think floaters by
themselves need more information to kind of figure out which one it is.
So typically for a ten-second, what is a floater?
A floater is a breakdown of collagen that we talked about dietarily.
You have collagen inside your eye, just like you do your skin, right?
Unfortunately, you can't supplement the collagen in the eye.
So as it breaks down like it does on your skin, if you get collagen breakdown
in your skin, you'll get wrinkles.
Well, the gel will fold on itself, and it will create a floater.
So you're seeing your own tissue that's no longer transparent.
So a lot of them are benign. They come, they're natural, they're annoying.
I have a floater, so when I read that book late at night, right before bedtime,
mine's four words behind me on the page, and it just hops along the page.
But if you have floaters that are new, not just one, a lot of them,
you want to maybe go get that checked out, as well as if you're starting to get the
other symptoms. My vision is changing.
I'm having flashing lights. It's been a two-day process. It's not going away.
There's no harm to go make sure that we're not talking about retinal
disease versus something that's a benign process inside the eye.
Got it. So if it's new, if you're having too many of them-
Yep
... if it's increasing rapidly, that's when floaters really become a concern.
You should get it checked out.
Correct. And I'd add if there's another symptom like flashing lights, curtain
sensation, loss of vision, definitely go get it checked out.
Got it.
And then what about retinal tears?
How do they present?
Same thing. So with the actual physiology behind it, so
retina, the tissue inside the eye that sees light and gets excited,
turns the light into this chemical process and tells the brain what you see.
So if the retina, and I like examples, you've got a great wall here with this
nice textured wall decor wallpaper.
Let's say the wallpaper is the retina and the wall is the back of the eye.
And if the retina starts to come off of it, those cells will start to get
excited, and those are your sparks of light.
So if you're starting to get a lot of sparks of light, that's your warning sign
that something's excited somewhere in the visual pathway.
Is it your brain because you have a migraine?
Are you dehydrated and there's some stimulation going on?
Or is the retina actually peeling off the back of your eye?
That's why we see flashing lights.
So if you're getting a lot of flashing lights, even in the light, and you're still
getting the flashing lights, and you had a traumatic injury, or you're diabetic,
or you have another factor, pick up the phone.
You want to catch those early because if you put the wallpaper back in time, you
can salvage a lot. If it's kind of off for a long time, even if you put it
back, that wallpaper's already tattered.
So it won't work.
It won't work. Yep.
Got it. And
so
for a 40-year-old-
Mm-hmm
... for their eye health,
what's one test you would tell them to do, and how often should they get it
checked?
You're asking for a hypothetical friend, of course.
Exactly. Always.
Yeah. For your hypothetical friend, of course.
All right, I think if you're 40 and you just want to talk about, "What
should I do to be thoughtful about my eyes?" I think
get artificial tears and keep them available.
You don't have to become dependent on the artificial tears, but don't be afraid of
them. Put them by your computer, put them in your workplace.
If you feel dry, go ahead and use an artificial tear. I think that's helpful.
I think doing some of the holistic systemic stuff like we talked about.
Get good hydration, sleep, and do all the other things.
And then realistically, at about 40 to 45, most people will start
to call their ophthalmologist or the optometrist because, hey, I'm doing one of
these with the phone.
It's okay. Don't be scared of the idea that you might need reading glasses.
Don't just grab them off the shelf at Walmart.
Go make sure that that's your window, that let's check with the other silent
things.
So normal advice for any 40-year-old,
pay attention to your eyes. When they hurt and they irritate, that's their way of
telling you something's not as comfortable as it should be.
Make the appointment, make it make sense, and just make sure that you're healthy
in total.
And do people need a screening for glaucoma or
check eye pressures because it's silent?
Does anyone need it, or does everyone need it?
No, there isn't an overarching guideline for
glaucoma screening. I think if you have a family member that has glaucoma,
you should always put it on your radar.
If you have any really long or short eyes, meaning you've had
glasses, you probably should have had that checked.
So those are two really big factors.
I don't think that there's a generic sweeping, like you should get your eyes
checked for pressure just broadly.
So there isn't that guideline. And probably one of the things I'll add to that is I
have a lot of patients that tell me, "I don't know if my mom and dad had glaucoma."
You mentioned it, I grew up in an Indian household.
My parents didn't talk about health diseases when I was a kid.
The kids stay at the kids' table at Thanksgiving, and the adults stay at the
adults' table.
Right.
We don't talk about diseases. We're two different tables.
And so from that standpoint, a lot of people don't know if their mom and dad had
glaucoma, and a lot of second generation or
first generation, they didn't have grandparents that went to the eye doctor and
knew. So, if you see your parents using a lot of eye drops and you're like,
"You know what, now that you say that, my mom does use a lot of eye drops." Might
be an artificial tear, or it might actually be systemic or actually a
medication for glaucoma. She may not tell you, but that's her warning sign.
Yeah, now that you say that, my mom did use eye drops.
That might be a glaucoma medication. That might mean you did have some risk factor.
Go get checked out.
Got it.
So
we move into this era, AI is everywhere.
Mm-hmm.
And I'm sure you're seeing it because ophthalmology is very gadget-heavy.
Yeah.
So could a retinal scan become the future of health check?
It could tell the whole story about a person.
Yeah. I think this is where our two circles on the Venn diagram
overlap.
There are great companies, and I'll stand to say, I don't know the ins and outs of
all the
IP that's around some of this software.
But there is a growing push for retinal scans
getting interpreted to help see systemic diseases.
Can a retina scan be used, and the caliber of the
blood vessels help us pre-risk
stratify patients for cardiovascular disease? Yes.
Do we know enough? Do we have a practical
application? No. But again, when you have
great minds that have the motivation to find solutions to
diseases, it's going to happen. So for sure,
that this is going to be the way of the future.
And
even now, we can tell about diabetes.
Mm-hmm.
We can tell about high blood pressure, we can tell about stroke risk a little bit-
Yeah
... having those things in eye. And can you tell about dementia,
looking at the retina?
There's a great study, and the answer is that there is some answer yes to
that, where they actually extracted vitreous fluid, and they try to
see the genomic sequencing, if there will be a precursor for
Alzheimer's or dementia, and there are some correlation between
the two. It's just not easy to extract some of that tissue.
A lot of the stuff inside the eye, a good rule of it, doesn't regenerate.
Right.
So when you pull out vitreous, you don't get it back.
When you take off a retina for a biopsy, you don't regenerate that.
So because the yield is not worth the reward,
maybe we don't have that answer through the eye just yet, but at some
point, we know that there is a correlation. How do we access that?
Right.
Give it time.
And the other part, the other side of health comes, like we
talked about AI, but then there is a term called biohacking.
Mm-hmm.
So biohack the vision.
Okay.
So we talked a little bit about red light therapy. Real data?
Yeah. Real data.
So that may help. What would it help with?
I think the wave of ophthalmology, and I'm sure
cardiology too, is inflammation,
inflammation, inflammation, right?
Right.
You have a lot of body inflammation, not great for your joints, it's not
great for your arteries, it's not great for your retina, and I think that's
something we know more now of.
And it's probably in the eye world, we'll say
that there's ophthalmology and then there's body medicine.
My friend's a body medicine guy. He does all the other stuff, and I'm just
going to stick to the eyeball, and that's kind of how it's always been viewed in
medical school. Probably even in your own training.
Right.
You had maybe two days of an eye lecture.
Right.
Right? And that was it, just some guy that came in, talked about an eye, and then
left. And you don't get a lot of exposure.
But I think now as we understand it, there is a lot of
correlation. The data is growing a ton to understand
dietary effects on the eye. We've known about it from the AREDS
study, like we just talked about it, but moving ahead, I think there's going to be
more. I think anti-inflammatory processes and medications,
GLP-1s, have an anti-inflammatory process.
If we can harness that, I think we can be proactive to disease, and that's really
the goal of medicine, right? Not to be reactive to you getting a disease-
Right
... and I monitor it. If I can be proactive, we're all winners.
Absolutely.
Does intermittent fasting help?
Calorie restriction and intermittent fasting, there isn't any data that I know
of to say that it would.
Hyperbarics?
Having great oxygen is the goal. So essentially, again, if you can
decrease the
stress on the eye without creating toxicity from that oxygen and creating free
radicals, yeah, that's a great thing.
So,
hyperbaric chambers, probably not recommended for somebody that is,
from the standpoint, having low profusion to the eye, because you don't want
to oversaturate that eye, or it can also speed up cataracts.
But aside from that,
it's a good thing overall.
Got it. So I'm just going to dive into rapid-fire, short one or
two-word answers.
Okay. Let's do it.
And your views on a lot of stuff that gets talked about.
Okay.
So good, bad, in between.
Good, bad, in between. All right, let's do it.
Coffee.
In between.
Matcha.
In between.
So both may or may not help?
I think in moderation, not bad. In overdose,
not good.
And no benefit.
And no benefit.
Sunglasses indoors.
Great.
Yes. Good. Indoors.
Oh, indoors. I'm sorry. I was so excited for the one word.
Indoors, no benefit.
Outdoors, definite.
Definite.
Reading glasses if you need them.
Definite.
Absolutely. Daily contacts.
Helps you see better, definite, with good hygiene.
Contacts versus glasses.
Glasses.
Why?
No real complicated risk of glasses wearing, but you can
have bad results from contacts if you don't have good education.
Eye vitamins.
Great.
Can we supplement a
little bit, AREDS study, what all things were in it?
So if someone just listens to this, what's in AREDS study?
So the AREDS study is a study that studied a lot of eye
diseases in relation to age-related changes.
The vitamins that are strongly recommended is called AREDS 2.
AREDS 2 has beta carotene, lutein, zeaxanthin, and
zinc as the prominent ingredients, and those are shown to
decrease inflammatory process and slow down macular
degeneration. Not necessarily reverse or cure, but slow down the
idea of dry patients, that's dry macular degeneration,
becoming wet patients, meaning if you have the disease, you don't start to
leak blood.
And artificial tears useful?
Great.
Great.
Blue light glasses.
Okay.
Apple Vision Pro.
If this is sponsored by Apple, no, I'm just joking.
No value.
No value.
Annual eye exams.
Great.
Everyone or a certain age?
Definitely from a pediatric population, very early, if you have any eye
strain or blurry vision, for sure, to catch diseases.
So between zero to 12, strongly recommended.
If you fail a screening at school, go in.
And then probably again at
30 to 40s, yes, and 60s, yeah, 100%.
And
eye massage devices, any of that fancy stuff, any benefit,
value?
If you want a gadget, yes, but not a ton.
No. Not really. We talked about it. Omega-3s or fish oil.
Great.
Yes.
And
in your practice,
people with eye diseases.
Mm-hmm.
Do you see a common theme in regret? You know what, I got to this.
Like in cardio, I see a lot, "Could have done this differently."
Mm-hmm.
What do you see in your world?
Oh, that's an interesting one. So our population is very skewed.
We have very young, because they fail a screening, and then we have very old.
And probably the most common thing I'll say is,
most people know that they don't have good vision before they sit in the
chair. So you're not breaking bad news to them.
So I think that's one thing that makes our world differently.
People don't realize that their heart isn't that great.
Right.
Even though they haven't been walking upstairs for a decade.
Right.
But they all know that they don't see the TV very well.
Probably the most common thing that I see is really advanced
cataracts. And the really advanced cataracts, I call them caregiver
cataracts. When you're caring for other people in your family, you put yourself on
the back burner, and then the cataract gets so dense and hard that
it's a lot more recovery time, a lot more complex surgery,
not as straightforward. And so from that factor,
probably the most common regret I hear is, "I knew I had a problem.
I should've come in earlier."
Fair.
Yeah.
So just closing up, and I want to get the takeaway.
Okay.
So if you're talking to your kids and grandkids and you wish for them
to have good eyesight for the rest of their lives,
give me four or five things that you would tell them, highest value advice.
All right. Highest value.
So I have three kids. Only one of my kids will actually pay attention and listen.
Well, that's most of us.
Yeah. So what advice would I give to my kids for the four
or five takeaways, or for the listeners?
I think one would be logical. If it doesn't
seem right, it's not right. So I would definitely say go get
checked out. Number two
is
balance of how you use the eyes. You
should use the eyes for up close. You should use them for far away.
There's an over-straining the eye.
But you don't necessarily want to not follow the 20/20/20 rule.
Take a break, be sensible, play your Xbox, but then at
some point, put it down and go outside and go run
around. It's good to be a kid. Get all that stuff going.
Right.
So I think that one for sure.
I think something I would say for my kids as they get
older,
start your
healthcare process early. So I think a lot of people I see
don't show up until there is a problem with the eye, and that's when you break the
conversation of, "Oh, yeah, by the way, you have to talk about diabetes, and
it's out of control for your eye," or, "You've got to talk about glaucoma." So pay
attention to your health, be proactive. So those would be the three.
And then I think the last one that I probably would make sense, if you
have a pair of glasses, and talk to your ophthalmologist, because there's nuance to
this one,
that I hear commonly, "I don't wear my glasses all the time." And
I'll tell my patients directly, I'll say, "Well, if you were my friend and you're
going to drive us to McDonald's, I wouldn't get in the car if you don't have your
glasses." So if you need a pair of glasses,
they will not make the eyes weaker over time. You need it.
Why struggle and not see well and put yourself in harm's way or not develop
the way you need to? Wear them. So if you get advice, sometimes take
it.
Perfect. That's helpful.
Yeah.
So this was a lot of fun, a lot of good information.
So I thank you for taking the time.
No, thanks for having me. This was a lot of fun.
Thank you.
Thank you.