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00:00

The amount of energy you're getting from the sun can easily burn a hole in the retina in the back of the eye. I don't wish that on anybody because usually once that tissue is gone, it is gone, it's not going to come back. And so people end up with permanent holes in their vision from it. This is showing a mixture again of yellow light, red light, and near infrared light can not only slow down the development of age-related macular degeneration, but also restore some usable eyesight.

00:26

Dr. Allen, welcome to the show. Hey, thank you so much. Again, this is an honor to be here, to be invited and to talk about eye stuff. Yeah, I'm excited. And, you know, eyes are one of these things

00:38

interesting organs or devices that don't get that much attention. But when you look at it, then they're quite important to our overall health, but also just life satisfaction. Yeah, it's often something, I think it's human nature to always be more reactive, right? We don't think about it until there's a problem. And unfortunately with the eyes, when there starts to be a problem, it's usually a

01:04

too late to do anything about it. So it's kind of the long story of, you know, better to do a prevention and do what you can early on in life rather than be reactive later on once things have started.

01:17

Yeah. And one very fascinating thing about the eyes is that they're actually connected to your brain. In some sense, they could be considered like an extension of your brain, which, you know, most people don't really think about. Is that true? Yeah, absolutely. One of my colleagues, I think, kind of famously said that they're the only like internal organ of your body that is facing the outside of the body. And yeah, the retina is an extension of your brain. That's interesting.

01:46

And with age, eyesight or eye health tends to deteriorate. Why is that so? Is there something intrinsically vulnerable about the eyes or is it just natural aging that every other organ also deteriorates with age? Certainly age plays a big role in what's going on in the eye. And why I think the eye is maybe more susceptible to a lot of aging changes is because it is one of the most highly metabolic disorders.

02:14

And I've seen some publications saying it is the most highly metabolic tissue. And part of that is because of the massive amount of energy it takes to process vision and send the proper signals to the brain, but also because the

02:29

The eye is constantly being bombarded with light energy. And your body has to respond by fixing any sort of reaction, reactive oxygen species or oxidation, but also manage the inflammatory cascade that cells are also going through because of those same processes. And that relates to a lot of different eye diseases. And is like…

02:55

poor eyesight so like with oral health at least there is this association between poor oral health and other systemic diseases like heart disease or alzheimer's is there anything something like that with eyes that poor eyesight walks hand in hand with i don't know diabetes or heart disease or something else or is it could it also be just you know genetic or uh

03:18

I guess random. Yeah, so it's definitely a little bit of both. We do know that some genetic components increase your likelihood of various eye diseases, but there is a lot of associations, right? If you are somebody who is more obese, you have type 2 diabetes or any other form of diabetes or high blood pressure, this dramatically increases the risk of various eye conditions, in fact, have direct disease processes within the eye. But also, you know, if you're somebody who has diabetes,

03:45

problems with your eyesight, even early on in life, or it's deteriorating, then there's also higher risks for other, like dementia and aging, other issues, because your brain's not getting the same amount of information and you're more likely to become sedentary. And that just sort of compounds everything, right? Then you're not moving as much. And then we see higher rates of cardiovascular disease and it just, and depression, and it just sort of cascades. So there's definitely a relationship to many different processes within the body. Mm-hmm.

04:14

Yeah, it's interesting then, you know, too much screen time, too much technology use, you know, watching too much TV or something like that, irrespective of the sedentary component. So would that then increase the risk of those conditions as well, like heart disease, just through the act of worsening your eyesight? And yeah, like…

04:36

let's say we control for being sedentary and being overweight. Yeah, these are good questions. From what I've read, I don't believe just like watching TV or seeing on your computer will have a direct effect on like causing, there are some conditions of the eyes where it can be influenced by what you focus and stare at. But

04:58

it probably isn't going to cause that direct effect on like diabetes. It will be more like, oh, well, you're sitting more because you're watching more TV and because of that, your increased likelihood of obesity and all these other things increases. And so then you can kind of see how that all is linked. But we can talk more about, you know,

05:18

staring at screens and those sort of things and how that affects the eyes. That can affect the eyes in multiple different ways too. Yeah. Yeah, it's just I was wondering because in a modern world we are using more technology and I would imagine because of that reason your eyes are getting more oxidative stress and more exposure to these bright lights and you could be otherwise fit and healthy but because so many people are using technologies I would imagine more people are

05:46

experiencing worse eyesight because of the excessive use of technology as well. So are they increasing the risk of these chronic diseases through the eyes, even though they're otherwise healthy? Or is it just, yeah, like the association that people who have poor eyesight usually watch too much TV and they don't also exercise and they eat too much processed foods? Yeah. So we know that if you are somebody who

06:09

stares at a screen, especially at an early age. People who use more, it's not just screens, but really just doing near work in general, especially for young kids who stay inside a lot of the time. They're also at a higher risk of not only, of actually developing nearsightedness to a greater degree or myopia.

06:26

And that also carries risks of various high diseases, high risk of cataracts, high risk of glaucoma, high risk of retinal degeneration, as well as retinal detachments. So there are issues with that. There is a lot of research looking into how light works.

06:44

can influence the eye and how that light can influence our brain. So we know that high energy light or light exposure in the evening, especially blue light, you'll hear about that affecting your sleep cycle. So we do know that there is an effect in that way. And you know very well that sleep can affect so many different parts of your body and your mental health. And so there's ongoing research to knowing exactly how sleep affects eye health, brain

07:11

We're just starting to get some research on that. I don't think it's very clear exactly to what extent, but it looks like…

07:22

that most of like light energy from devices like computer screens and things like that don't have a direct negative, like damaging effect to the eye. However, there are some in vitro studies or studies done in laboratories on like mice with really high energy, like blue lights right up next to their eye. And they can show that yes, retinal cells can have

07:45

oxidative stress and faster degeneration from that light exposure but most devices like your phone your computer screen television screens don't emit that level of energy to cause that damaging effect so uh at this time we don't have any uh they're all passing safety standards there's nothing really claiming that it's causing this damage so it

08:10

Wouldn't be right to say like the technology screens and light from them is like smoking for the eyes. It's not the same degree. It's not the same degree, no. But we do know that the effects of screens on…

08:26

other parts of the eye. So like we tend not to blink as much when we're staring at a computer screen, our blink rate can either have or go to like one fourth of the amount. And so if you're not blinking as often and our eyelids tend to not blink as completely, so they don't shut all the way. So your tear film is constantly being exposed to air. So you have faster drying out or dry eye disease. But also with that, you have desiccation of the surface of the eye, which

08:52

clicks in an inflammatory cascade on the surface. And so we are seeing increased rates of ocular surface disease, dry eye disease, even in younger individuals, even in like teenagers, we're seeing this. So there, there are some negative consequences from increased levels of screen time and, and issues like that. That's, that's interesting. Are there any like

09:14

exercises or you know we exercise every other part of our body are there any exercises for the eyes that we should consider so like with age there's a decline in muscle mass and muscle strength and if you do resistance training you counteract that are there any like analogous exercises to the eyes that counteract the natural aging of the eye and the natural entropy of the eye so there are several different types of

09:38

eye exercises that have clinical validity. And most of these are used for correcting the posture of how the eyes work as a team.

09:48

This is mainly for either young kids who have an eye that's turning a different direction or they're used for people who've had brain injury of some kind, right? They get in a car accident, they have a stroke. Now the eye is not getting the right signals to move as a team. And so there are some exercises that are prescribed for that.

10:08

In general, as we get older, most of the eye muscle exercises that are out there, they won't strengthen the muscles necessarily, but they improve the teaming. Again, the coordination of what your brain is telling the eyes and where they need to look. The…

10:25

The downside of, you know, people are often like, hey, I can improve my ability to see up close. And as a young age, you can do that because the muscles pull on a lens inside the eye, which is flexible when you are young. But once we all hit our mid-age into our 40s, 50s, that lens becomes thick with age and becomes crystalline. It actually starts to become harder. And so even though the muscle inside the eye, which is a smooth muscle called the ciliary body, even though that's moving,

10:53

the lens is not able to shift and change shape anymore like it was when you were a kid. And so unfortunately, a lot of the eye muscle exercises, they, again, aren't gonna reverse the crystalline hardening of that lens. And so ultimately,

11:13

You're still basically most people, depending on the type of glasses or refractive error, as we say, uh, most people do end up needing reading glasses or some form of bifocal or progressive or varifocal lens to, to help them see better up close. Um, yeah.

11:30

- I still think there's validity to at least taking breaks from staring at devices for long periods of time, giving the eyes a rest because you, kind of like how you can get muscle cramps and it hurts and your arm can be stuck in a position or your leg can cramp up and be stuck in a position. You can also have that with the eye muscles. We call it an accommodative spasm. And we see people who come in and they spend all day on a computer or their phone

11:57

And they come in because they're having these vision issues. And all it is, is they, their muscles are kind of cramped up in that position and they need to learn to relax it. And so I think, I think everyone has, you know, experienced if they're spent majority of the day in front of a screen or looking at a computer, then, uh, you know,

12:13

The vision gets a bit blurry or they can't see in the long distance that much. It kind of reverses after a while, but initially they might have more, or at least I sometimes get more blurry vision if I've been sitting in front of a computer all day. But yeah, I have to look at a far away distance and eventually it kind of clears up.

12:33

I think the best thing is just to be aware of how much your work you're doing to try to purposely take breaks. There are some publications implying that taking a break every 20 to 25 minutes and taking it's not like 20 second break. That used to be a kind of something you'll see posted online is the 20, 20, 20 rule every 20 minutes, take a 20 second break, looking 20 feet away. That was insane.

12:57

kind of just made up and then they actually did a formal test later and they found that in that formal clinical study it really didn't do anything so they in fact recommend now taking a longer break every 20 to 25 minutes closer to maybe three to five minutes and that just looking in the distance giving your eyes a break relaxing the muscle system but also for a mental shift right you're

13:22

taking a break from your work task, getting water, using the restroom, taking a deep breath. And then when you get back to work, you're actually even more productive. So that's generally a recommended thing. Ideally, for me, an ideal scenario would be you have the screen and then

13:40

Behind the screen, you have like a vista, like open window. Yeah. Far away distance. So you can be in a computer and then you can take a look outside as well. But right now I have like a wall here with the lighting. But in an ideal world, you know, you would have in my previous place, I had like a window to the backyard. And that was good, you know, to break it up the distances.

14:03

Right. Give that a little moment of kind of going back and forth. One of the most historical ones you'll ever hear eye doctors talk about for eye exercises are pencil push-ups, which is basically looking at the top of a pencil or a pen and moving it closer to your nose, further back, closer to your nose, further back, and keeping it single. That usually works even better if you have an accommodative target, meaning like a letter or like you're keeping a letter A together.

14:28

because as you bring it closer, it may start to go blurry and then split apart. However, again, while that is really good for just, again, eye teaming,

14:38

People can overdo it. And there are some eye scenarios, depending on how your eyes work, where people can actually make their eyes worse by doing too many types of eye exercises or doing the wrong types of eye exercises. You can actually induce double vision or make things worse. So I always urge caution before people start doing eye exercises without first consulting an eye care professional. The…

15:04

One thing that's more recent is there's some publications on blinking exercises specifically for dry eye disease. And that's basically just taking, again, breaks every like five times a day is the most recent study. They took five breaks, five times a day to basically close their eyes completely and then do a couple sets of closing the eyes and then like tightening the eyes, the

15:29

the eyelids closed without like scrunching the face. Cause when you scrunch the face, you, you end up increasing the risk of like wrinkles along fine lines of wrinkles, you know, crow's feet along the sides of the eyes and the nose, um,

15:40

But that's to strengthen the orbicularis oculi muscles and to improve your blinking processes, which again, when people are on the screen, we tend not to blink. So that's some of the more recent publications. And in fact, it showed some positive benefits. Interesting. What about massaging the eyeballs, like squeezing them and like pushing? Is it a good idea or is it harmful? Yeah.

16:05

It's generally considered more of a risk, a harmful thing. The eyeball does have its own internal pressure, which is generated by a fluid inside the eye called the aqueous humor. And if people push on the eye, you know, momentarily the eye can handle that increase in pressure, but doing it for many times or prolonged time, it ends up causing damage to the

16:30

the ganglion cells or parts of the nerve that connect the eye to the brain. And that can end up in a disease that we call glaucoma. And so it's generally considered not good to push or rub the eyes. Or if you are going to rub the eyelids, you have to be very gentle not to like forcefully push on the eye. And then some people who are at risk of it, there's a condition called keratoconus, where

16:56

It is associated with a high risk of rubbing the eyes. A lot of these people also have atopic issues or severe allergies. So they end up rubbing the eye and then the collagen of the cornea doesn't heal correctly and ends up weakening and protruding outward like a cone. And then they get really severe levels of irregular astigmatism. And they have a hard time seeing. And that's a progressive disease that oftentimes happens

17:25

Needs either severe types or specialty types of contact lenses or they need special surgery, sometimes even corneal transplants. So it's, again, best recommended to not rub the eyes. And if you have itchy or itchy eyes, get a cold wash rag or something like a cool compress that feels better and use artificial tears to lubricate the eyes, those sort of things. So maintaining the lubrication and moisture of the eyes is very important. Very much so.

17:54

Yeah. With the lights, the artificial light has a lot of blue light and green light specifically, which you also alluded that it messes up the sleep rhythms and circadian rhythms. Is there…

18:10

What about the red light and more amber light? Is it more beneficial for the eyes? And what about these red light therapy devices? Are they beneficial for eye health? Thanks for asking that. So red light therapy also goes by a couple different names, low-level light therapy. And then if you dig deeper into the publications, they often use the term photobiomodulation because a lot of the devices don't just use red light anymore. They use a combination of yellow light or near-infrared light as well.

18:38

So the area of red light in the eyes is really fascinating. It's being tested on for dry eye therapies. It's being used as a potential treatment for myopia. It's being investigated more on East Asia for that reason. And then for macular degeneration, it probably has the most research behind it. In fact, here in the United States where I live and practice,

19:01

The Valita light system was just FDA approved this January for macular degeneration. So what we know with red light is that it does help with activation of mitochondria within the cells. It also has some role on reducing inflammation and boosting antioxidant activities.

19:22

And so for dry eye therapy, it is showing that when red light is applied to the eyelids at specific wavelengths, usually somewhere between 630 to 670 nanometers of light. And there's a few studies using near infrared light as well. But that can help boost the tear production. And presumably because the red light can penetrate and get to the lacrimal gland.

19:43

but also because it can help stabilize the lipid layers of the tear film. And you have these oil glands in your eyelids called meibomian glands. And so when you get red light treatment, there can be some heat benefits, but it also is helping the cells within those glands basically heal and produce better. And so those oils sit on your tear film and prevent it from evaporating. And so there is some good publications about use of that type of therapy for dry eye.

20:10

For myopia, for nearsightedness for children, again, this is probably an area that I think the industry is very cautious about because you're putting red light or this intense red light into children's eyes and we're worried about the long-term effects, right? Short-term studies going one to two years right now largely show good safety results, but we just don't know what's going to happen 20, 30 years down the road.

20:36

And there are some devices which have also been tested independently and found to breach safety levels. Because if you're shining a bright light, if anybody who's watching, listening, like…

20:50

A lot of red light devices that are sold just on the internet also come with goggles or they give you a warning like do wear protective eyewear. And part of that can be because if you have too much energy, it's not just the wavelength, but if you have too much energy of the light and it reaches the back of the eye, it could cause photochemical or even thermal damage to the retina. And so there is a lot of safety precautions, I think, in the research right now about like, hey, how do we divide…

21:16

How do we design a research study and how do we make a device that we know is going to be safe but also reach therapeutic levels? And then the area right now, which again, because of the new Valita system being FDA approved, that's really fascinating because this is showing a mixture, again, of yellow light, red light, and near infrared light can not only slow down the development of age-related macular degeneration, but also restore…

21:45

usable eyesight. And we've never had a treatment like that where it wasn't an invasive procedure because other treatments for macrogeneration are like using an injection of a medication inside the eye, which nobody wants. Vitamin supplementation has been shown for macrogeneration to slow down the disease, but not reverse it or improve your eyesight where this is the first time we have a technology again about

22:10

I believe over 50% of people in the phase three clinical trial had at least one line of improvement in their vision, right? That's taking somebody from not being able to drive to being able to drive in some scenarios. Um, about 25% of people in that study also had two lines of improvement or about 10% of people had like a full, I think it was around nine, but 9% of people had a full three lines of improvement, which is just outstanding in the eye care world. So, um,

22:39

It's really exciting right now. I don't think it's on the market yet. So eye clinics probably aren't offering it in the United States, but it has been available in some places in Europe and South America as well for the last several years. So these at-home red light panels, like I have one here, these, you know, very mostly for the whole body. Can you like…

23:04

use them for the eyes as well. Obviously, you probably don't want to look directly into them, but let's say glance away through the side or further away, like a few meters away.

23:15

Are they, would they have any, you know, help if it's 2DI? I think they could. Again, a lot of it has to do with the amount of energy that's coming from it. So it depends on how far away you are from the device. It depends on the fluence or the power density of those devices. And so, yeah,

23:34

We have devices in the eye clinics that are much higher energy doses. And so usually it takes 20 minutes of a treatment, for example, where a lot of the at-home devices, they may not be as effective. You essentially would have to be under it for like six hours to get the same dosage. But I've also seen a few eye devices now on the market that

23:56

Which, they don't have, this is the tough thing I have, is that they don't have necessary clinical studies to show its safety or efficacy of a lot of at-home devices. Right. And some of these devices, it's like, hey, I have two of them that I've been testing out. And they're specifically marketed for the eyes. You keep your eyes closed. But you basically do it for three minutes at a time. And I'm doing it and…

24:23

I still am trying to figure out exactly where in the research, where's the safety limit. I believe these devices are safe, but I don't know if they're clinically effective yet. And so for myself, I'm sort of just sort of trusting some of these, the researchers and other doctors I know who have done the research, but I haven't seen any true clinical data of these devices yet. So I think the…

24:47

I give lectures on this topic, but I, the profession is still very cautious about, we don't want to cause damage to someone's eyes, right? So we're, we're being ultra cautious about it. So that home devices, if someone has one like yourself, if it says wear eye goggles, I would still wear eye goggles. Um, and I wouldn't look directly into the light. Right. Uh,

25:10

Yeah. Yeah. Like until we have more information, more like kind of indirectly, uh, if it reaches the eye in some point you're further away, then it's probably not going to be like harmful, but, uh, don't like sit in front of it. And because sometimes, you know, I use it mostly for the face and the chest. Um, so I'm sitting in front of it.

25:31

but I wouldn't want to open my eyes and look into the light. Yeah, certainly not for very long. It's interesting because even for the clinical trials for the Valida system for macular degeneration, they have three cycles where basically you have your eyes open where some forms of light, like yellow light and some near-infrared light, enters the eye with the eyes open. But then there's another cycle where they have you close your eyes and they use a higher energy dosage of red light

25:57

while your eyes closed. And I would love to get some of the time to talk with some of the PhD researchers who are doing this because I want to know why and how, what other studies do they do to determine the clinical safety and efficacy of the eyes closed versus eyes open versus certain wavelengths. I honestly just don't know that information off the top of my head. I haven't found, I don't know if companies are just purposely keeping it secret or if it's just really that hard to find or maybe they don't know either. I think there's also a lot of

26:27

curiosities and questions around again eye safety and protocols that we just haven't established yet yeah well it's going to be interesting to see what it's going to look like in a few years but with sunlight you know you're getting the full spectrum light from the sun which

26:45

And I don't think you want to look directly into the sun either, although some people might disagree about that. So, yeah, so how about sunlight? Is there any time of the day that is more beneficial for the eyes and eyes?

27:02

Yeah, well, how do you go about, you know, where should you look? Yeah, so this is something I've personally been more interested in. I haven't been able to find, like, solid research to explain, like, because I think there's so many variables, right? Time of day, time.

27:20

the latitude, longitude where you live on the planet. We know that UV light is gonna be most potent later in the day, but also just if it's midday and you stare at the sun, the amount of energy you're getting from the sun can easily burn a hole in the retina in the back of the eye. We call it solar retinopathy. And I don't wish that on anybody 'cause usually once that tissue's gone, it is gone, it's not gonna come back.

27:48

Uh, and so people end up with permanent holes in their vision from it. Um,

27:52

Early in the day if the sun is just rising or if it's setting at the end of the day Then less energy is going directly to the eye a lot of the sun's light is in fact being bent by the atmosphere And so in some way the energy is being filtered It also tends to look more like a red light. So a red orange hue, right? and so there are some

28:18

thoughts that perhaps that form of light is better for waking the body up, shutting down the melatonin processes, uh, make me feel more awake. Uh, there might be some, you know, cellular benefits to it, but, uh, I don't know of any safety true published, published articles on, on like what's safe and what's not, uh, best though, I would say not to directly eyes open, stare into the sun at any point. Uh,

28:46

And then, yeah, hopefully as, as I'm able to dig more into research, I'm actually looking at this for, to answer this question at a, uh, I'm giving a lecture at the American Optometric Association in a few months. So I've, I'm currently digging into it, but I still haven't found like direct answers. Hmm.

29:01

Yeah, it's very interesting. You know, there's the sun gazers who do blame things about looking directly into the eye, into the sun. But yeah, it's very interesting that it's obviously too much bright light. It certainly will damage the eyes and a lot of cases of that.

29:23

There might be a sliver of truth to it just because of like what we're discovering with things like red light. However, we also know that there's increased risks of other conditions, whether it be solar retinopathy, UV light exposure over the length of your time, we know is increased risk of various not only cataracts, but potentially macular degeneration as well. Mm-hmm.

29:43

So I think there's a lot of curiosities about it, but there's also variability of where you live, what time of the day. Again, there's all those factors. Yeah. So probably early and late sun exposure, so after the sunrise and before the sunset, is more safer for the eyes and you get more of this red light that might have some therapeutic benefits.

30:07

potentially, but the midday sun is very bright and more damaging to the eyes. 100%. Right. Would it be better to wear sunglasses during the daytime or not? Yeah, definitely. So UV light and so sunglasses, assuming you're getting good sunglasses, there are some really poorly made ones out there that maybe don't have full UV light protection, but we know that UV light

30:34

It doesn't just cause damage to the eye, like internally. Again, there's several studies that have shown an association of UV light exposure and risk of developing macular degeneration, which is a blinding eye disease. It accounts for a lot of vision loss for people over the age of 50. The UV light also increases some risk of cataract development.

30:57

But then UV light also damages the surface of the eye and the eyelids. A lot of people, because the eyelids are one of the thinnest skin on the body, we have a lot of patients who end up with various melanomas,

31:10

or sebaceous cell issues on the eyelids and uv light directly impacts that and a lot of people when they put on sunscreen or sunblock they avoid putting it in the eyes i mean you don't want any eyes it even says warning don't get in the eyes so sunglasses have that benefit of protecting the ocular surface and the eyelids and then we also see changes to healing rates of the cornea from uv light also um

31:36

You can have other eye diseases that come from UV light exposure on the surface of the eye, like pterygium and pink wecula are commonly seen. These are like scar formations that are a callus formation that grows on the surface of the eye. If anyone's been around like more mid equator locations around the world, people will develop what's called surfer's eye, which is just a more of a layman's term for pterygium.

32:00

which is, again, a growth of tissue that starts to cover the eye. And that's largely due to environmental exposure of UV light as well as high saltwater content areas. Again, surfer's eye, because a lot of surfers don't wear goggles, and then they're not wearing sunglasses either. And so they end up developing this growth in the eye, which essentially is the eye trying to protect itself from all this harsh damage. Interesting. With the sea…

32:29

the sun reflects a lot of the light from the sea so you actually often you know from the water surface you get a lot of even brighter light without even actually looking directly in the sun so is it

32:42

I would imagine that also is just harmful. The reflective surfaces from, I don't know, car windows or windows, glass buildings in general, as well as the sea. 100%. Yeah. So reflective surfaces, things like UV light will bounce off those reflective surfaces. And we have other epidemiological studies showing that people who are like fishermen throughout their lives, there are risks of not only skin diseases, like skin cancers, but also

33:10

eye diseases, macrogeneration, cataracts, etc., also dramatically increase just from that double dose of light exposure. Yeah. Let's talk about nutrition then. So nutrition can increase the risk of many chronic diseases.

33:27

Are there any foods that are uniquely beneficial to the eyes? For sure. I love that you asked about this, and I've seen some of other videos where you've talked about it. So for the eyes, the biggest thing is basically vegetables and green leafy vegetables, as well as oily fish and various omegas, fish.

33:51

From a purely dietary standpoint, you know, again, the retina on the back of the eye is highly metabolic tissue. And there's some unique components to it.

34:03

When it comes to like oily fish, I'll first mention the omega-3s, the photoreceptors in the back of the eye, over 60% of their lipids are all DHA omega-3. So that's really important to be getting in your diet. The other part with vegetable sources is mainly carotenoids. We know that vitamin A is important for the phototransduction process of actually receiving light and getting that information sent to the brain. Most people are not vitamin A deficient.

34:32

uh you know unless somebody's just um not getting proper um calories to begin with but there is lutein and zeaxanthin uh have you have you read much on on lutein zeaxanthin yeah you have uh become a fan yeah recently and yeah they're very you know these carotenoids in general are very good for the brain and the eyes yes uh so i'm glad that you mentioned the brain as well but uh for the eyes if

35:01

if any viewers, listeners haven't heard of this, so lutein and zeaxanthin, these are carotenoids, they're fat soluble, they're mainly found in green leafy vegetables, you can find them a little bit in some of the egg yolk of eggs, it's really not a high concentration in eggs, but it is there.

35:18

These carotenoids, they go to the eye and they deposit in high concentrations within the retina and the eye, specifically in the macular area, which is like the bullseye of where your sharpest vision is, your color vision, all comes from this area where it gets highly deposited. And they kind of have three functions in the eye. They work as first a filter for high energy light, namely blue light. So…

35:43

So people who have higher amounts of these carotenoids in the eye, we can measure it through some testing called macular pigment optical density. And people who have higher serum levels of lutein have been shown to have about a 30 to 40% decreased incidence of developing macular degeneration, especially severe levels of it.

36:06

But then also it has, outside of just the blue light protection, it also has a strong antioxidant capability and a strong anti-inflammatory capability, which again is really important for the retinal structures. And like you kind of mentioned, there is also clinical evidence that it's good for the brain, good for memory, even for older adults, good for children and their memory formation, visual processing speed, etc.

36:32

It also has reduced glare issues for eyesight and improved contrast ability. So a lot of professional athletes are in fact given supplements of lutein and zeaxanthin. And then one of my friends, Dr. John Nolan, he does a lot of research in these carotenoids. Just last year, they published…

36:50

research finding that supplementation of these carotenoids also helps reduce the oxidation of low-density lipoproteins and other various cytokines that are associated with atherosclerosis. So there's a lot of benefits to these carotenoids. And people can eat that and diet or they can take supplements for it. Yeah. And then, again, back to omega-3s, there's a lot of research…

37:16

showing that people who just consume more fish, at least oily fish twice a week, they have reduced risks of macular degeneration, reduced risks of diabetic retinopathy, and various other conditions, even some benefit for dry eye. But primarily for the retina in the back of the eye, it's DHA. And unfortunately, most of the supplements for omega-3s, whether it be fish oil-based or whatnot,

37:44

generally are more of a triglyceride form and have higher EPA and your body may not absorb the right amount of DHA to get into the retinal tissues.

37:55

Because there's a specific isoform of DHA that they're starting to investigate that your brain has a high specificity for. There's a transporter called MFSD2A that basically allows for a certain type of DHA to get into the blood-brain barrier and into the blood-retinal barrier, or get through it. And so…

38:18

It's largely recommended in the eye care space to eat a Mediterranean diet that has a lot of green leafy vegetables and oily fish. And then if you're going to supplement, there is some benefit to, if you're not eating oily fish, to taking supplements of omega-3s. And then again, lutein, zeaxanthin, if you're somebody who just either can't digest or eat vegetables, or if you just know that you don't eat that much, then that's an option. Yeah.

38:47

Yeah, this lutein and zeaxanthin are quite interesting that they're from a dietary perspective has been seen to be associated with reduced macular degeneration. And there's also the studies of these clinical trials show that they help with degeneration.

39:05

markers of eye health so they you know have actual evidence that they work and you know it's relatively easy to take take a supplement and you know preserve your eye health as as you know naturally it will decline with age yeah and so again it's something i try to talk about with as many patients as i can just about like

39:28

Being more preventative. We know that once somebody develops a condition like macular degeneration, for example, giving supplementations of lutein, zeaxanthin, along with some other supplements of vitamin C, vitamin E, some zinc, that that can slow down that condition by about 25% over five years of taking that supplement. But it won't stop it. It doesn't reverse it. Right.

39:54

But if we can take these supplements or we can eat really well, we can reduce our risk of ever even developing it by up to about 40%. So that's a really important thing. Yeah. With carotenoids, there's another one, astaxanthin, that is shown to be beneficial for eyes and protecting against UV damage in the skin, photoaging in the skin. Does it have any evidence for eye health because it's also like a carotenoid?

40:23

Yeah, there is some evidence that it may be beneficial for the eyes. There's a few clinical studies on even like eye strain and being beneficial there. There's several studies more, I would say in vitro studies on its effect on helping retinal health. There's not too much on human clinical trials at this point, but it is something that's being investigated more now. The only thing I'll kind of tee off to people is know that astaxanthin is a competitor to

40:53

against lutein and zeaxanthin. So you don't want to take them at the same time. If I was going to design a formulation myself, I'd probably have, you know, take lutein or something in the morning and then you'd take astaxanthin in your supplement later in the day. Just because, again, they're competing against each other.

41:11

What if you take like a larger dose, would you overcome the competition? I'm not, I'm not too sure. Uh, that's a good question for like a chemist or somebody who knows that biochemistry better than I do. Okay. But that's a good question. Yeah. Because I, I take, you know, them in the morning usually, but I take pretty large doses. I take like,

41:30

the maximum if efficacious dose that I've found for both of them. So yeah, it would be interesting to see. I used to take them both at the same time. And then I spoke with one of the PhD medical, one of the top advisors for one of the supplement companies in the eye care space. And he knows like every single publication off the top of his head. And then he broke down to me how that works. And I was like, oh my gosh, okay, so I need to change things a little bit. But it is rather interesting. Yeah. Yeah.

42:01

With supplements, there's another one, creatine, that is known for muscle and now it's more commonly known as a brain supplement as well. And you mentioned that the eye uses a lot of energy. It's one of the most energy-consuming organs or tissues in the body. And creatine helps with ATP production and energy production also.

42:25

I don't know if there are studies about this, but would creatine then help with eye health or eye function in some way? I love that you asked this. I've had several people ask me this too. I personally take creatine, but more from a physical standpoint, but also I've seen some of the publications on creatine.

42:42

like mental health. And I, I've noticed a positive benefit over the last several years as I started taking it. It's hard for me to say, is it truly because of the creatine or is it because I'm also getting more exercise, uh, and getting better sleep? Is that causing a better mental health shift? But, um, I've looked into creatine and its effect on the eyes and I can't really find much studies on it. Uh, it might just be something nobody's really researched. And, um,

43:06

I don't know if anybody who's watching or listening and they want to invest in a clinical study, reach out to me because I'll be happy to see if I can put together a study like that. But that would be a really interesting and fascinating thing to look into.

43:20

Yeah, you know, I think it's a pretty new topic, given that the brain component has only recently become more popular. Quick Google search, there is an in vitro study that creates a new projective in retinal neurons, but nothing else yet. Yeah, I'll have to look at that too. The last time I really did a deep dive into it was maybe like last summer. Yeah.

43:45

So maybe something's come out and I just haven't seen it yet. Yeah. But, uh, there is other nutrients and other, um,

43:53

other studies looking at things like, uh, various, what would it be like, um, curcuminoids as being beneficial for retinal health. There is some research into various, uh, like niacin elements that are really good for glaucoma. Um, and they're still in clinical trials right now trying to figure out exactly who is this going to be beneficial for how much, but, uh,

44:19

I still largely just recommend people eat a whole food diet that's along the lines of somewhere around Mediterranean diet. That's where the most research is around eye health. But as far as those other supplements, there's still… Yeah. While there's evidence that they're supportive for retinal health and nerve health, we still just don't have really strong clinical recommendations yet. Yeah. With vitamin E…

44:46

there is the difference between retinol that you get mostly from liver and beta-carotene that you get from sweet potatoes and carrots and those things, and carrots are usually said to be good for the eyes because of containing vitamin A. Is there a difference for eye health between this retinol, which is considered the bioactive vitamin A, and vitamin A from carrots and sweet potatoes?

45:12

Yeah. So a beta carotene your body will take and will turn into like true vitamin A either in your liver or through intestines. But the, the, their eye is going to use the whole vitamin A form. The concern about people who, you know, again, most people are not vitamin A deficient. Your body stores vitamin A pretty well, either in the liver or even in the adipose tissue. So,

45:41

The big concern is some people take vitamins A supplements. Like right now there's kind of some talk about vitamin A supplementation. And the concern is that it's possible to take too much.

45:53

you can have hypervitaminosis of vitamin A and that can have negative effects on the eyes. There are case reports of, I've even seen one of a young girl who is taking vitamin A supplements and she ended up having a swelling of her optic nerve and that was mainly due to increased levels of cerebral spinal fluid as an effect of taking too much vitamin A.

46:18

Uh, and thankfully in her case, she discontinued the vitamin A and then things improved. But, um, there, there are concerns about that. So most people though, if they're eating plenty of, uh, plenty of calories, usually they're not vitamin A deficient. Right. But, um, that it is a concern certainly in some places around the world. Hmm.

46:42

What about sugar and more processed foods? That's a good question. So we know several studies have looked at ultra-processed foods in relationship to eye disease. And they have found that, yes, there is a relationship. People who eat more ultra-processed food usually are getting more sugar. They're also getting higher levels of different types of fats,

47:06

in their diet. Usually, usually our individuals were more sedentary. And so you see this compounding fact, higher risk of obesity, higher rates of inflammatory diseases. And that also ends up with higher risk for various diseases. We do see increased risk of glaucoma, diabetes, macular degeneration. And these are potentially site-threatening diseases. So it is generally

47:30

It is kind of all about the same kind of discussion. You want to eat healthier, want to be more active, take better care of yourself. Yeah. Is it, you know, because there's a difference between eating sugar and

47:43

and having diabetes, which is characterized by chronically high blood sugar levels. If you eat sugar, then your blood sugar will rise. If you're healthy, then it's going to come back down to normal after a while. But if you're diabetic, then it's going to be chronically elevated. So is it the chronic experience?

48:01

chronically elevated blood sugar that you know damages the eyes and leads to vision loss similar that it leads to you know amputation of the arms eventually or neuropathy in the fingers or even like just a mere act of elevation in blood sugar which happens you know normally whenever you eat with just a normal blood sugar elevation would that also damage the eyes and

48:25

at a faster rate. Yeah. So obviously if somebody is not diabetic, then their body will respond correctly and at a faster rate of maintaining adequate blood sugar levels. The problem with people with diabetes and what happens pathophysiologically with the eye is if there is elevated levels of blood glucose inside the lumen of the arterioles inside the retina,

48:51

And what's beautiful is the retina has a dual blood supply. You have blood vessels in the back of the eye, which supply blood nutrients to the eye, but also have blood vessels that go into the retina. And when you have elevated blood sugar levels, there's a cell called a pericyte. Not a parasite like a microorganism, but it's called a pericyte. And these pericytes

49:14

allow for reaction of how the blood vessels constrict and how they allow fluid and nutrients to pass through the lumen. But with elevated high levels of blood sugar,

49:28

The sugar molecules basically pass through and get into the pericet, which causes them to swell because it also brings in fluid because it wants to have that right, the correct osmosis gradient. So the pericytes swell and they eventually die. And if you lose a lot of these pericytes over time, then the blood vessels can't constrict and regulate themselves.

49:49

And then in the eye, clinically, what we end up seeing is we can actually do some functional tests through what's called ERGs, electroretinograms, and we can see decreased function of the retinal cells. So they're just metabolically not healthy.

50:05

And then the first clinical sign that we can, like me looking inside somebody's eye who's diabetic, I can see is usually small outpouching or aneurysms of the blood vessels. Uh, cause the blood vessel wall is now weak. And so they start to kind of have this balloon outpouching and eventually they start to break. And then we see bleeding inside the eye where there's either blood accumulation. We can even see fat deposits or what we call exudates that build up inside the eye. Um,

50:33

The severe consequences is not only ischemia, right? There's blood not getting to where it needs to be. So then now there's lack of oxygen getting to the right tissues. So then you start having death of retinal cells and ganglion cells. And then…

50:51

new blood vessels can start to form inside the eye because there's this ischemia, the cells are dying, they start releasing these markers called VEGF or vasoendothelial growth factors that signal for these new blood vessels to grow inside the eye to like, hey, I need nutrients, bring those blood vessels over here. But the new blood vessels are very weak and they're fragile. And so they either bleed more or leak more fluid inside the eye, or they can start to

51:19

cause scarring. Basically, the new fluid that's leaking into the eye start contracting and you have scar formation inside the eye, which leads to retinal detachments. And then you can also have increased problems with glaucoma. There's a lot of things that happen with diabetes. So it is important for people who are at risk of diabetes, if you're pre-diabetic or already have it, to not only do everything you can in your lifestyle, change

51:44

change of diet, exercise, take medication, lose weight to try and put it into remission if possible. But definitely see an eye care provider at least every year so that we can check and see what's going on with the eye because we do have treatments to stop a lot of these conditions. Yeah. I think I heard that

52:05

When you are diagnosed with diabetes, then you get mandatory like an eye exam or some checkup. It is considered a mandatory recommendation now. Unfortunately, yesterday I had a patient who he even admitted he's been neglecting taking care of himself once he was diagnosed. He never came in for an eye exam. He just came in yesterday because…

52:29

Over the weekend, he had a sudden loss of vision in his right eye and that scared him. So he came in and unfortunately he is in a severe proliferative stage where new blood vessels are leaking inside the eye and one of his blood vessels leaked open and now he's got large hemorrhaging inside the eye and he can't see through it. So in his case, he knew he was paralyzed.

52:52

neglecting it. And, uh, I felt for him, but, um, thankfully he came in so we can get him help and hopefully he's on a better track going forward. Yeah. Um, let's talk about glasses. So, um,

53:05

Usually, I don't know, maybe my impression, but usually people don't want to wear glasses or they're kind of hesitant to start using them. When it comes to deteriorating eye health, is it healthier to start wearing eyeglasses when, let's say, your vision has slightly declined? Yeah.

53:27

Or would it be fine to like continue without the glasses, even though your vision is, um, I don't know, like let's say 10% worse than it was before. Is there, so I guess the question is, is there any, is the progression, is the decline in your vision faster if you don't use glasses once you've had already some decline in your eye health or, uh, is it fine? So, yeah, this is another interesting question. Um,

53:53

I think a lot of it depends on your age. For example, if you're a parent, if a parent's listening to this, kids, their brain is still developing. And there's also, as kids go through their adolescence and they start going through their growth spurts, the eye is also still growing with the body. And so it is, in fact, beneficial.

54:18

for kids who are nearsighted, for example, to get glasses, to get contact lenses, something to correct their vision, not only so that they see their best, so their performance at school is good, but also because there are at least two studies showing that kids who wear correction, in fact, slows down their myopia or their advancement or

54:40

Their need for glasses getting worse. It actually slows it down where kids who don't wear glasses at that same age advance faster at a faster rate. Hmm. The there are a lot of there's I'll put in there's a lot of nuance when it comes to myopia specifically. Yeah.

54:56

The other component to it is just you want at a young age for young kids to have proper brain development to appreciate sharp vision. And so it's also really important to have kids wearing correction and full correction for proper brain development. Otherwise, your brain can choose to not

55:18

develop good cells to appreciate good vision. We call that amblyopia or some kids, you'll hear the term lazy eye. That can happen. As an adult, like you and I, if we choose not to wear glasses, it's unlikely to progress faster or worsen if we choose not to wear them because most of the eye's anatomy is kind of set at this point.

55:45

But, like, after the age of 25, usually things come to a slow crawl. It doesn't really change much in terms of your glasses power, things like that. There is a small 10% of the population who can continue to advance. But,

55:58

Most of it is just quality of life. Like if you're going to see better with glasses or contacts, why would you not want to see better? It's not necessarily going to make things worse. There is this perception, I think for a lot of people that, oh, well, I, I saw, you know, things were a little fuzzy, but I started wearing glasses. The glasses help, but now they take the glasses off. Everything is so much worse. It's not that your eyes actually got worse. It's that the perception, your comparative difference between with and without glasses became worse.

56:27

much more noticeable and so it's uh again it's just not a physiological change with the eye it's more of a mental appreciation of perception yeah when i was a kid then uh

56:39

my parents and others told me that don't look through the glasses, you know, these other glasses, because you'll actually get worse eyesight because of that. If you use, like say your grandma's glasses, uh, and they're super blurry, right. But, uh, that will actually make your own eyes worse. Um, there might be some truth to that. Uh, certainly if, if you're wearing somebody else's glasses, you're wearing the wrong power. You could end up,

57:02

forcing your eye muscles to work harder than they need to be and then that can it changes the posture of your eyes and how you use those muscles but more so is we do know that the way older glasses lenses have been designed there is a phenomenon where light is focused in the peripheral retina

57:26

And that sends a, what's called a hyperopic defocus. And it somehow communicates to the brain and the eye to make the eyeball grow longer. And so it's not fully understood. And it's only one part of the equation of myopia development, but that's why now you'll see new glasses, lenses made for kids, as well as some contact lenses that are designed to eliminate this, um,

57:55

which is a kind of distortion caused by glasses,

57:59

With the new designs can slow down the rate of myopia development by up to like 50%. So depending on where you live and where those devices are available, like in the United States, the glasses aren't available yet because they're still going through trials. But in some other places like in Canada and in Europe, those lenses have been available for some time and they can help slow down myopia for children. Interesting. Are there any health differences between contact lenses and glasses?

58:28

Oh, yeah. Another good question. So the big issue with contact lenses is just the risk of infection. Especially for people who sleep in contact lenses, the risk of infection is dramatically much higher. Contact lenses also dry out. They absorb the tears and then the tears evaporate much faster. So there is higher rates of dry eye and contact lens awareness and irritation. There is some evidence that contact lenses…

58:57

if worn for long periods of time and depending on the type of lens you wear, can also push on the cornea of the eye and cause some desensitization of the nerves in the cornea, which may alter your body's ability to regulate tear production and may cause problems with neurotrophic or what's called neurotrophic keratitis. So there are cases where that's happened.

59:27

I think in general, most people consider contact lenses pretty safe as long as you have good hygiene habits and you don't sleep in the contact lenses. But there is concern amongst some professionals in the space about contact lens wear at all just because there is an increased risk of dry eye and long-term consequences of dry eye later in life. What about LASIK surgery? I think that's a very popular question. Is it obviously not permanent or is it…

59:57

Yeah, so with the LASIK procedure specifically, like they're removing tissue from your eye and that tissue is gone forever. So it is that part of the procedure where, yeah, LASIK is,

01:00:10

is permanent, but your vision still will change as you get older, especially in your 40s and above that. Again, the lens inside the eye is getting bigger and it starts to crystallize. And as it crystallizes, the light bends differently through that lens inside the eye. And so your prescription and need for glasses can start to shift and change.

01:00:31

And so that's, that's kind of the harsh truth of LASIK. Um, it is considered largely safe. I know you'll, people will see stuff on the internet about some people have unfortunately committed suicide after LASIK. Um, and a lot of that comes from just poor healing circumstances as well as dry eye. Um,

01:00:53

Lasik surgery specifically does sever more nerves on the surface of the eye during that procedure, which then they have to grow back. In most cases, like 99% of cases, people heal great. They do get some dry eye afterward, and the dry eye usually resolves within three to six months. But for some people, if the nerves don't grow back correctly, or if they already had pre-existing dry eye before the surgery, there are symptoms of dryness, pain, constipation,

01:01:22

can be detrimental. Um, and it can cause foggy vision, blurred vision, glare, halos, but then, you know, those unfortunate few, and it's usually less than 1% that's quoted, um,

01:01:35

there's people who have severe issues because of that. And those are the people who have the worst outcomes are always the people who speak the loudest. Um, but the vast majority of people I've, I've ever worked with that have had LASIK usually come back saying they loved it. It changed their life. They would do it again in a heartbeat. So, um,

01:01:53

Thankfully, the clinical trials do show it is still safe. I think just as a profession, we need to be very diligent about who is at risk and who has more dry eye issues before we send them for surgery. Yeah, gotcha.

01:02:07

Last year, there was this video by Mr. Beast where he paid for surgeries for these blind people and they were able to see, I don't know what type of surgery it was specifically, but is it possible to cure blindness with some surgery? Yeah. So that was Mr. Beast did specifically with cataracts and cataracts are the number one, you know, globally, if you look at what's the number one cause of vision loss in the world, it is cataracts. The nice thing is that, so cataracts,

01:02:36

What a cataract is, for people who don't know, like I've been saying, in your 40s and in your 50s and above that, the lens inside the eye starts to crystallize. When you're still that young, usually the lens is still clear. Like it's a clear…

01:02:50

inside the eye, just like your glasses lenses are clear. But as you continue to get older, that lens oxidizes and begins to turn a yellow color and eventually even a white or in some cases even a dark brown color. So I've seen, I've done mission trips in some parts of the world and

01:03:08

You'll see people who are in their 80s and have never had cataract surgery and these lenses inside their eye are very large like a marble and they'll be like coffee brown. They can't see through them.

01:03:21

So cataract surgery, they can go in and they use a tool called phacoemulsification. That's the fun word for the day. But it uses ultrasound to shatter this lens inside the eye. It's like shattering a glass marble into dust particles. They then vacuum out the particles.

01:03:40

And then they put a new plastic lens implant inside of the eye, which they measure and account for any need for glasses and try to put that in the implant. So afterward you see through a clear lens again. And in many cases, people, um, don't need to rely on glasses as much. It's kind of like getting LASIK at the same time almost. Wow. Um, so thankfully we have that surgery. It only takes like 10, 15 minutes to do, uh,

01:04:07

it's considered one of the most successful surgeries that have been invented. The downside is in some parts of the world, people don't have access to healthcare or eye care and vision loss is a consequence of that. That's very interesting. In the future, would we be able to have a type of surgery or like an implant of the eye, like a cyborg eye or something like that, that would, you know,

01:04:36

you know, give you perfect eyesight or, but as well as maybe enhance it to like able to zoom in or something like that. Because, you know, humans, our eyes are pretty good. We are pretty visual. Like our visual system is pretty good, but it's obviously not as good as like eagles or hawks or something like that. Um,

01:04:52

Could be like use some sort of cyber eyes or other ways to enhance our vision. I know there's talks of that. I know there are there's companies who've been kind of working on that in terms of an implant for cataract surgery specifically. I think they do run into some just barriers of technology at this point. Like if they do have that capability to zoom in, it would need some sort of electrical charge.

01:05:15

Or it would need some sort of mechanical movement of the lens inside the eye. And that means it would probably need some sort of battery capacitor. And then how do you charge that through the eye? You know, you probably have to fall asleep wearing some sort of charging goggles that gives, you know, electromagnetic field that charges it. And then how long do those last? What happens if they break? You know, there's a lot of, I think,

01:05:40

just technological things that need to happen. So we're probably, you know, who knows how things will go with AI, but we're probably 40, 50 years away from something like that. I know that there are some contact lens companies building augmented reality contact lenses.

01:05:57

And same thing for augmented reality glasses. And I think that is very much within the grasp of not only some augmented reality glasses that exist right now, but in the next 10 years, we'll see

01:06:11

improved adoption of that technology. And so I think that's going to be very real to the point where even if you don't need glasses to see better, you will have a thin normal pair of looking eyewear that will have a digital screen basically in front of your eyes that you'll be able to see not only text messages and email notifications, but as you look around the room, it'll highlight

01:06:35

you know, food in your fridge and tell you what type of recipes you can do by mixing these various ingredients. You'll be able to drive down the road and it'll tell you, Hey, take a left, take a right. Here's your speed. Just heads up display like a video game almost. Um,

01:06:48

And that may be able to also magnify things in the distance and make it zoomed up in front of your natural eye. I think, I think that will have a lot of applications. And I think that is more realistic again within the next probably five to 10 years. Wow.

01:07:06

Yeah, it like feels that with the eyes, we will be able to reach this point in technology where we are able to pretty much cure all blindness and cure all eye diseases. At least, you know, that's my impression. Because if we can already, you know, do these surgeries, 10-minute surgeries to cure people from this blindness from cataracts, then, yeah, in a few decades, we'll, you know, I think that's what it looks like it is going to be heading. Gosh, I hope so. You know,

01:07:35

So just about two years ago, we had the very first full total eye transplant that was accomplished. The eye didn't work, but the eye has its own specialized immune system. And then connecting the eyeball back to a new person's head, connecting it to their optic nerve, so the eye to not only…

01:08:04

not deteriorate and not be rejected is a huge deal. Um,

01:08:10

But then for this person, they can measure and see that there's electrical input going from the eye, this donor eye to the recipient's brain. But the recipient doesn't have functional vision from it. But just the accomplishment of, hey, we actually got an eye and a technique to get the eye to connect to the body and not be rejected. That is a huge feat in its own. Obviously, we have a long ways to go from there. But that was a pretty big landmark news in the field of eye care that just happened. Yeah.

01:08:40

That's very interesting. Before we wrap up, is there anything specific or special that we didn't cover that people should know about improving their eye health? Is it something they should do or avoid or something like that?

01:08:55

You know, my kind of eye health routine is not only just getting an eye exam every year. I also eat really healthy as we've been talking about. I try to take some supplements for my eye and vision health. I'm experimenting with red light right now. We still don't have full kind of months about it. Sunglasses, you know, we touched on that. I think that's important. Yeah.

01:09:20

And then just taking breaks. Yeah. And especially for young kids being aware that spending a lot of time on near devices, while we want our kids to have good education, we do need them to try to spend more time outside. There's some sort of communication to the eye and the brain that we don't fully understand yet. But we know that kids who spend around an hour and a half to two hours outside, it has a sort of balancing effect where it negates a lot of the drives for nearsightedness development problems.

01:09:49

than than not so i do encourage for families that come in to the clinic i advise them and i'll try to encourage more outdoor time interesting um yeah so it's been great to have this discussion and yeah eyes are super underrated and very important for quality of life before i ask my last question where can people learn more about you and your work

01:10:14

So thank you. Yeah. So of course, my kind of mission with all of my education online is through the Dr. Eye Health YouTube channel. I provide education on various things, whether it be glasses, contacts, surgeries, a lot of disease education, things that you can do with your lifestyle. I also post on other channels, again, under the Dr. Eye Health name. So for anybody who's curious about eyes, learn about more, definitely check us out those channels and reach out to me through there.

01:10:41

Yeah, we'll put the links in the show notes. And my last question is, was this one piece of advice or habit that you wish you'd adopted sooner? Sleep. My number one habit I think I've neglected most of my life is I just never respected my sleep. You know, certainly growing up, I stayed up late nights.

01:10:59

till three in the morning playing video games and my, my academics in high school and even some in college, I think would have been way better. I was a good student, but, uh, I think my performance in so many different ways, physical, mental, um, academic would have been improved tenfold if I just would have had regular consistent sleep. And, uh, when I went to optometry school, I think that was my superpower because I prioritized it.

01:11:25

And unfortunately, when you get into like things like residency for health care, they do not care about your sleep. So I think I lost a lot of my regular sleep habits as I get, I guess I got older, passed optometry school. And now I'm trying to prioritize it a lot again. Yeah. And it definitely affects my physical fitness. It affects my mood. It affects my mental capacity, my productivity. So it is something I'm trying my best to prioritize. Yeah.

01:11:52

Yeah, that's an important tip and very common, common one. Well, yeah, thanks for coming to the podcast. And yeah, it was great to talk with you. Yeah, thank you. I appreciate it. All right, that's it for this episode. Make sure you check out my new book, The Longevity Leap on Amazon. I'd also appreciate if you share this episode with a friend or family member. Other than that, my name is Seem. Stay tuned for the next episode. Stay empowered.

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00:00

太阳光能量很容易在眼底的视网膜上烧出一个洞。我不希望任何人遇到这种情况，因为通常一旦那块组织消失了，就真的消失了，不会再长回来。因此，人们的视力会因此留下永久性的盲点。这再次表明，黄光、红光和近红外光的混合物不仅可以减缓与年龄相关的黄斑变性的发展，还可以恢复一些可用的视力。

00:26 主持人： 艾伦医生，欢迎来到节目。

嘉宾（艾伦医生）： 嘿，非常感谢。再次强调，能受邀来到这里谈论眼睛方面的事情，我深感荣荣。

主持人： 是的，我很兴奋。你知道，眼睛是这样一种……

00:38 有趣的器官或装置，它们并没有得到那么多的关注。但当你仔细观察时，它们对我们的整体健康以及生活满意度都相当重要。

嘉宾： 是的，这通常是，我想这是人性，总是更倾向于被动反应，对吧？我们直到出现问题才去思考它。不幸的是，对于眼睛来说，当开始出现问题时，通常已经……

01:04 太晚了，无能为力。所以这是一个漫长的故事，你知道，最好是预防，尽早采取措施，而不是在事情发生后才被动应对。

01:17 主持人： 是的。关于眼睛，一个非常有趣的事情是它们实际上与你的大脑相连。从某种意义上说，它们可以被认为是你的大脑的延伸，你知道，大多数人并没有真正想到这一点。这是真的吗？

嘉宾： 是的，绝对是的。我的一位同事，我想，曾经说过一句很有名的话，它们是身体唯一一个面向外部的内部器官。是的，视网膜是你大脑的延伸。

主持人： 这很有趣。

01:46 随着年龄的增长，视力或眼部健康往往会恶化。这是为什么呢？眼睛本身有什么内在的脆弱性吗？或者仅仅是自然衰老，其他所有器官也会随着年龄的增长而退化？

嘉宾： 当然，年龄在眼睛发生的变化中扮演着重要角色。我认为眼睛可能更容易受到许多衰老变化影响的原因在于，它是一种代谢率极高的组织。

02:14 我看过一些出版物说它是代谢率最高的组织。部分原因在于处理视觉并将适当的信号发送到大脑需要消耗大量的能量，但也因为：

02:29 眼睛持续不断地受到光能的冲击。你的身体必须通过修复任何类型的反应、活性氧或氧化来应对，同时还要管理细胞因同样过程而经历的炎症级联反应。这与许多不同的眼部疾病有关。而且就像……

02:55 视力差，就像口腔健康一样，至少口腔健康不良与其他全身性疾病（如心脏病或阿尔茨海默病）之间存在关联。眼睛方面是否存在类似的情况，即视力差与糖尿病、心脏病或其他疾病密切相关？或者仅仅是遗传或……

03:18 我想是随机的。

嘉宾： 是的，所以这肯定是两者兼而有之。我们确实知道某些遗传成分会增加患各种眼疾的可能性，但也存在很多关联性，对吧？如果你比较肥胖，患有2型糖尿病或任何其他形式的糖尿病，或者高血压，这会显著增加患各种眼部疾病的风险，事实上，这些疾病在眼内有直接的病理过程。但是，你知道，如果你患有糖尿病。

03:45 即使在生命早期，视力出现问题，或者视力正在恶化，那么患其他疾病（如痴呆和衰老）的风险也会更高，因为你的大脑没有获得相同量的信息，你更有可能变得久坐不动。这只会加剧一切，对吧？然后你活动得少了。然后我们看到心血管疾病的发病率更高，然后，还有抑郁症，就这样不断恶化。所以这肯定与身体内的许多不同过程有关。嗯嗯。

04:14 主持人： 是的，这很有趣，你知道，过多的屏幕时间，过多的技术使用，你知道，看太多的电视之类的，撇开久坐的因素不谈。那么这是否也会增加那些疾病的风险，比如心脏病，仅仅通过视力恶化这个行为？是的，比如……

04:36 假设我们控制了久坐和超重这两个变量。

嘉宾： 是的，这些都是好问题。根据我所读到的，我不认为仅仅看电视或看电脑会对眼睛造成直接影响，比如导致某些眼部疾病，虽然有些眼部疾病确实会受到你聚焦和注视物体的影响。但是：

04:58 它可能不会对像糖尿病这样的疾病产生直接影响。它更像是，哦，好吧，你因为看更多电视而坐得更多，因此，你肥胖和其他所有这些事情的可能性增加了。所以然后你就可以看到这一切是如何联系在一起的。但是我们可以更多地谈论，你知道。

05:18 盯着屏幕以及诸如此类的事情，以及它们如何影响眼睛。这也会以多种不同的方式影响眼睛。

主持人： 是的。是的，我只是在想，因为在现代社会，我们使用越来越多的科技产品，我想象正因为如此，你的眼睛承受着更多的氧化应激，更多地暴露在这些强光下，即使你身体健康，但因为这么多人都在使用科技产品，我想象更多的人因为过度使用科技产品而视力下降。那么，即使他们身体健康，他们是否通过眼睛增加了患这些慢性病的风险？或者仅仅是，是的，就像那些视力差的人通常看太多电视，他们也不运动，而且吃太多加工食品之间的关联？

嘉宾： 是的。所以我们知道，如果你是一个……

06:09 盯着屏幕看，尤其是在年幼的时候。那些更多使用，不仅仅是屏幕，而是通常情况下做近距离工作的人，尤其是那些大部分时间待在室内的年幼孩子。他们不仅有更高的风险，实际上还会发展成更严重的近视或近视。

06:26 这也伴随着各种眼疾的风险，例如白内障的高风险、青光眼的高风险、视网膜变性的高风险，以及视网膜脱离。所以这方面存在问题。有很多研究正在探究光线的作用。

06:44 如何影响眼睛，以及光线如何影响我们的大脑。所以我们知道高能量光线或傍晚的光线照射，特别是蓝光，你会听说它会影响你的睡眠周期。所以我们确实知道它在这方面有影响。而且你非常清楚睡眠会影响你身体的许多不同部位和你的心理健康。所以关于睡眠究竟如何影响眼睛健康、大脑的研究正在进行中。

07:11 我们才刚刚开始对此进行一些研究。我不认为现在已经非常清楚具体到了什么程度，但看起来……

07:22 像电脑屏幕之类的设备发出的光能，大部分对眼睛没有直接的负面影响，比如损伤。然而，有一些体外研究或实验室研究，比如在老鼠身上进行的实验，用非常高能量的蓝光紧贴着它们的眼睛照射。这些研究可以表明，是的，视网膜细胞会因为这种光照而产生：

07:45 氧化应激和更快的退化，但大多数设备，如你的手机、电脑屏幕、电视屏幕，发出的能量水平不足以造成那种损害性影响。所以，目前我们没有任何……它们都通过了安全标准，没有任何证据表明它们会造成这种损害。所以：

08:10 说科技屏幕和它们发出的光线就像眼睛的香烟一样，这是不对的。程度不同。

嘉宾： 程度不同，不。但我们确实知道屏幕对……

08:26 眼睛的其他部位。所以比如我们盯着电脑屏幕时，眨眼的次数会减少，我们的眨眼率可能会减半或减少到四分之一。所以如果你眨眼不够频繁，而且我们的眼睑往往不能完全闭合，所以它们不能完全闭上。所以你的泪膜持续暴露在空气中。所以你的眼睛会更快地变干，或者患上干眼症。但与此同时，你的眼球表面也会干燥，这会：

08:52 引发表面炎症级联反应。因此，我们看到眼表疾病、干眼症的发病率在增加，即使在年轻人中，甚至在青少年中，我们也看到了这种情况。所以，屏幕时间的增加以及类似问题确实带来了一些负面影响。

主持人： 这很有趣。有没有像……

09:14 锻炼或者，你知道我们锻炼身体的其他所有部位，有没有什么针对眼睛的锻炼是我们应该考虑的？比如随着年龄的增长，肌肉量和肌肉力量会下降，如果你进行阻力训练，就可以抵消这种情况。有没有类似针对眼睛的锻炼可以抵消眼睛的自然衰老和自然熵增？

嘉宾： 所以有几种不同类型的：

09:38 具有临床有效性的眼部锻炼。其中大部分用于纠正眼睛作为团队工作的姿势。

09:48 这主要适用于那些眼睛转向不同方向的年幼孩子，或者那些曾遭受某种脑损伤的人，对吧？他们出了车祸，他们中风了。现在眼睛没有得到正确的信号来协同运动。所以有一些针对这种情况的锻炼方法。

10:08 总的来说，随着年龄的增长，市面上大多数的眼部肌肉锻炼并不能真正增强肌肉力量，但它们能改善眼睛的协同工作能力。再次强调，是大脑向眼睛发出的指令以及眼睛需要看向何处的协调性。那个……

10:25 缺点在于，你知道，人们常常想，嘿，我可以提高我看近处物体的能力。年轻的时候，你可以做到，因为眼睛内部的肌肉会拉动晶状体，而晶状体在年轻时是富有弹性的。但是一旦我们都到了中年，四五十岁的时候，晶状体就会随着年龄的增长而变厚，变得像水晶一样。它实际上开始变硬。所以即使眼睛内部的肌肉，也就是一种叫做睫状体的平滑肌，即使它在运动。

10:53 晶状体不再能够像你小时候那样移动和改变形状了。所以不幸的是，很多眼部肌肉锻炼，它们，再次强调，并不能逆转晶状体的晶状硬化。所以最终。

11:13 大多数人，取决于他们戴的眼镜类型或屈光不正的程度，正如我们所说，大多数人最终还是需要老花镜或某种形式的双光眼镜、渐进眼镜或多焦点眼镜来帮助他们更好地看清近处物体。嗯，是的。

11:30 我仍然认为，至少从长时间盯着设备上移开视线，让眼睛休息一下是有道理的，因为你，就像你可能会肌肉痉挛，然后会痛，你的胳膊可能会卡在一个姿势，或者你的腿可能会抽筋卡在一个姿势一样。眼睛的肌肉也会出现这种情况。我们称之为调节性痉挛。我们看到一些人进来，他们整天都在用电脑或手机。

11:57 他们进来是因为他们有这些视力问题。而这仅仅是，他们的肌肉在那个位置有点抽筋了，他们需要学会放松它。所以我认为，我想每个人都有过这样的经历，如果他们一天大部分时间都花在屏幕前或看着电脑，那么，呃，你知道。

12:13 视力会变得有点模糊，或者他们看不太清远处的物体。过一段时间后会恢复，但最初他们可能会有更严重的，或者至少我有时如果整天坐在电脑前，视力会更模糊。但是，是的，我必须看远处的物体，最终它会逐渐清晰起来。

12:33 嘉宾： 我认为最好的办法就是意识到你做了多少工作，并有意识地安排休息。有一些出版物暗示每隔20到25分钟休息一次，而且休息时间不是像20秒那么短。以前网上流传过一个说法，叫做20-20-20法则，即每隔20分钟休息20秒，看向20英尺（约6米）远的地方。那太荒谬了。

12:57 这有点像是凭空捏造出来的，后来他们确实做了一个正式的测试，发现在那个正式的临床研究中，它根本没有任何作用。所以事实上，他们现在建议每隔20到25分钟进行一次更长时间的休息，接近三到五分钟，不仅仅是看向远处，让你的眼睛休息，放松肌肉系统，同时也是为了精神上的转换，对吧？你：

13:22 从工作中休息一下，喝点水，上个厕所，深呼吸。然后当你回到工作岗位时，你实际上会更有效率。所以这通常是推荐的做法。理想情况下，对我来说，理想的情景是你有一个屏幕，然后：

13:40 屏幕后面，你有一个开阔的视野，比如一扇敞开的窗户。是的。远处的距离。所以你可以在电脑前工作，然后你也可以看看窗外。但现在我这里有一堵墙，还有灯光。但在理想的世界里，你知道，在我以前住的地方，我有一个通向后院的窗户。那很好，你知道，可以打破距离感。

14:03 嘉宾： 对。给它一点时间，让它来回切换一下。你听过的最古老的眼科医生谈论眼部锻炼的方法之一是铅笔推近法，基本上就是看着铅笔或钢笔的笔尖，然后把它移近你的鼻子，再移远，再移近你的鼻子，再移远，并保持它是一个单一的物体。如果你有一个调节目标，比如一个字母，或者你保持一个字母A是清晰的，那么这种方法通常效果更好。

14:28 因为当你把它移近时，它可能会开始变得模糊，然后分裂开来。然而，再次强调，虽然这对于眼睛的协同工作确实非常好。

14:38 人们可能会做得过火。而且有些眼部情况，取决于你的眼睛是如何工作的，人们实际上可能会因为做太多类型的眼部锻炼或做错类型的眼部锻炼而使他们的眼睛变得更糟。你实际上可能会导致复视或使情况变得更糟。所以我总是敦促人们在开始做眼部锻炼之前要谨慎，首先要咨询眼科专业人士。那个……

15:04 最近的一件事是，有一些关于专门针对干眼症的眨眼练习的出版物。基本上就是，同样，每天休息大约五次，这是最近的一项研究。他们每天休息五次，基本上就是完全闭上眼睛，然后做几组闭眼练习，然后像是收紧眼睛，那个：

15:29 眼睑闭合，但不要挤眉弄眼。因为当你挤眉弄眼时，你最终会增加眼角和鼻子两侧出现鱼尾纹等细纹的风险。嗯。

15:40 但这是为了增强眼轮匝肌的力量，并改善你的眨眼过程，同样，当人们在看屏幕时，我们往往不眨眼。所以这是最近的一些出版物。事实上，它显示出了一些积极的好处。

主持人： 有趣。那么按摩眼球呢，比如挤压它们然后按压？这是个好主意还是有害的？

嘉宾： 是的。

16:05 这通常被认为风险更大，是有害的。眼球确实有其自身的内部压力，这种压力是由眼内一种叫做房水的液体产生的。如果人们按压眼睛，你知道，眼睛暂时可以承受压力的增加，但如果多次或长时间这样做，最终会导致：

16:30 视神经节细胞或连接眼睛和大脑的神经部分的损伤。这最终可能导致一种我们称之为青光眼的疾病。所以通常认为按压或揉搓眼睛是不好的。或者如果你要揉搓眼睑，你必须非常轻柔，不要用力按压眼睛。然后对于一些有风险的人，有一种叫做圆锥角膜的疾病，它：

16:56 与揉眼睛的高风险有关。许多这些人也有过敏性问题或严重的过敏症。所以他们最终会揉眼睛，然后角膜的胶原蛋白不能正确愈合，最终会变弱并向外突出，像一个圆锥体。然后他们会出现非常严重的不规则散光。他们看东西会很困难。这是一种进行性疾病，通常会发生。

17:25 需要非常严重类型或特殊类型的隐形眼镜，或者他们需要特殊的手术，有时甚至需要角膜移植。所以，再次强调，最好不要揉眼睛。如果你眼睛发痒，拿一块冷毛巾或类似冷敷的东西敷一下会感觉好一些，并使用人工泪液来润滑眼睛，诸如此类。所以保持眼睛的润滑和湿润非常重要。

嘉宾： 非常重要。

17:54 主持人： 是的。关于灯光，人造光含有大量的蓝光和绿光，你也提到这会扰乱睡眠节律和昼夜节律。有没有……

18:10 红光和更偏琥珀色的光线呢？它们对眼睛更有益吗？还有那些红光治疗设备呢？它们对眼睛健康有益吗？

嘉宾： 谢谢你问这个问题。所以红光疗法还有几个不同的名字，低强度光疗法。然后如果你深入研究文献，他们通常使用光生物调节这个术语，因为很多设备不再仅仅使用红光。它们使用黄光或近红外光的组合。

18:38 所以红光在眼睛领域的应用非常引人入胜。它正在被测试用于干眼症的治疗。它被用作近视的潜在治疗方法。由于这个原因，东亚地区正在对此进行更多的研究。然后对于黄斑变性，它可能拥有最多的研究支持。事实上，在我居住和执业的美国这里。

19:01 Valita光系统今年一月刚刚获得FDA批准用于治疗黄斑变性。所以我们对红光的了解是，它确实有助于激活细胞内的线粒体。它在减少炎症和增强抗氧化活性方面也发挥着一定的作用。

19:22 因此，对于干眼症治疗，研究表明，当红光以特定波长（通常在630到670纳米之间）照射到眼睑时。也有一些研究使用近红外光。这可以帮助促进泪液分泌。据推测，这是因为红光可以穿透并到达泪腺。

19:43 但也因为它能帮助稳定泪膜的脂质层。你的眼睑里有这些叫做睑板腺的油腺。所以当你接受红光治疗时，会有一些热效应的好处，但它也帮助这些腺体内的细胞基本上愈合和更好地产生油脂。所以这些油脂会附着在你的泪膜上，防止它蒸发。所以有一些很好的出版物是关于使用这种疗法治疗干眼症的。

20:10 对于近视，对于儿童的近视，再次强调，这可能是一个我认为行业非常谨慎的领域，因为你把红光或这种强烈的红光照射到儿童的眼睛里，我们担心长期的影响，对吧？目前进行的一到两年的短期研究，大部分显示出良好的安全性结果，但我们就是不知道20、30年后会发生什么。

20:36 有些设备也经过了独立测试，发现超过了安全水平。因为如果你照射强光，任何正在观看或收听的人，比如……

20:50 很多在网上销售的红光设备也配有护目镜，或者会警告你务必佩戴防护眼镜。部分原因在于，如果你能量过大，不仅仅是波长的问题，而是如果光的能量过大并且到达眼底，可能会对视网膜造成光化学甚至热损伤。所以目前研究中有很多安全预防措施，我想，比如，嘿，我们如何设计……

21:16 我们如何设计一项研究，以及我们如何制造一种我们知道是安全的但又能达到治疗水平的设备？然后目前这个领域，再次强调，由于新的Valita系统获得了FDA的批准，这真的非常令人着迷，因为这表明黄光、红光和近红外光的混合物不仅可以减缓与年龄相关的黄斑变性的发展，还可以恢复……

21:45 可用的视力。我们以前从未有过这样的治疗方法，它不是一种侵入性手术，因为其他治疗黄斑变性的方法，比如在眼睛内部注射药物，这是没有人想要的。维生素补充剂已被证明可以减缓黄斑变性的疾病进程，但不能逆转它或改善你的视力，而这是我们第一次拥有这样的技术，再次强调，大约：

22:10 我相信在第三期临床试验中，超过50%的人视力至少提高了一行，对吧？在某些情况下，这意味着一个原本不能开车的人能够开车了。嗯，大约25%的参与者视力也提高了两行，或者大约10%的人视力完全提高了，我想是九行左右，但9%的人视力完全提高了三行，这在眼科界简直是出类拔萃的。所以，嗯。

22:39 现在真的很令人兴奋。我想它还没有上市。所以美国的眼科诊所可能还没有提供这种服务，但在欧洲和南美洲的一些地方，过去几年已经可以获得了。

主持人： 所以这些家用的红光板，比如我这里有一个，这些，你知道，主要用于全身。你能不能像……

23:04 也用在眼睛上。显然，你可能不想直视它们，但是比如说从侧面或者更远的地方，比如几米远的地方斜视一下。

23:15 它们，它们会有任何，你知道，如果距离是2DI，会有帮助吗？

嘉宾： 我想它们可以。再次强调，很多程度上取决于它发出的能量大小。所以这取决于你离设备的距离。这取决于这些设备的通量或功率密度。所以，是的。

23:34 我们在眼科诊所使用的设备能量剂量要高得多。所以通常例如，一次治疗需要20分钟，而许多家用设备，它们可能没有那么有效。你基本上需要在它下面待上大约六个小时才能获得相同的剂量。但我现在也看到市场上有一些眼部设备。

23:56 它们没有，这是我遇到的难题，就是它们没有必要的临床研究来证明许多家用设备的安全性或有效性。对。而其中一些设备，就像，嘿，我有两个我正在测试的。它们是专门针对眼睛销售的。你闭着眼睛使用。但你基本上一次做三分钟。我正在做，而且……

24:23 我仍在试图弄清楚研究中的确切位置，安全极限在哪里。我相信这些设备是安全的，但我还不知道它们是否具有临床效果。所以对我自己来说，我有点只是相信一些，那些做过研究的研究人员和我认识的其他医生，但我还没有看到这些设备的任何真实临床数据。所以我认为……

24:47 我讲授这个主题的课程，但我，这个行业仍然非常谨慎，我们不想对任何人的眼睛造成损害，对吧？所以我们，我们对此非常非常谨慎。所以那些家用设备，如果有人像你一样拥有一个，如果上面写着佩戴护目镜，我还是会佩戴护目镜。嗯，我不会直视灯光。对。呃。

25:10 主持人： 是的。是的。比如在我们获得更多信息之前，更像是间接地，呃，如果它在某个点到达眼睛，你离得更远，那么它可能不会造成伤害，但是，呃，不要像坐在它前面。因为有时，你知道，我主要用它来照射脸部和胸部。嗯，所以我坐在它前面。

25:31 但我不想睁开眼睛直视灯光。

嘉宾： 是的，当然不要太久。有趣的是，即使是Valida系统治疗黄斑变性的临床试验，它们也有三个周期，基本上你在某些形式的光线下，比如黄光和一些近红外光，眼睛是睁开的，光线会进入眼睛。但还有另一个周期，他们会让你闭上眼睛，然后使用更高能量剂量的红光。

25:57 在你闭着眼睛的时候。我很想花些时间与一些正在做这件事的博士研究员交谈，因为我想知道为什么以及如何，他们还做了哪些其他研究来确定闭眼与睁眼以及特定波长的临床安全性和有效性。老实说，我一时想不起来这些信息。我还没有找到，我不知道公司是不是故意保密，还是真的那么难找，或者也许他们也不知道。我想还有很多：

26:27 关于眼睛安全和我们尚未建立的方案的好奇和问题。

主持人： 是的，嗯，几年后会是什么样子，这很有趣，但是关于阳光，你知道，你从太阳那里获得全光谱的光线，而这些光线……

26:45 我想你也不想直视太阳，尽管有些人可能不同意这一点。所以，是的，那么阳光呢？一天中什么时候对眼睛和眼睛更有益呢？

27:02 主持人： 是的，嗯，你打算怎么做，你知道，你应该看哪里？

嘉宾： 是的，这是我个人比较感兴趣的一点。我还没能找到，比如，可靠的研究来解释，因为我认为变量太多了，对吧？一天中的时间，时间。

27:20 你居住在地球上的纬度和经度。我们知道紫外线在一天中晚些时候会最强，但如果在中午你直视太阳，你从太阳获得的能量很容易在眼底的视网膜上烧出一个洞。我们称之为日光性视网膜病变。我不希望任何人遇到这种情况，因为通常一旦那块组织消失了，就真的消失了，不会再长回来。

27:48 呃，所以人们最终会因此在视力上留下永久性的盲点。嗯。

27:52 清晨太阳刚刚升起，或者傍晚太阳即将落下的时候，直接照射到眼睛的能量会减少，很多阳光实际上被大气层折射了。所以从某种程度上说，能量被过滤了。它也往往看起来更像红光。所以是一种红橙色的色调，对吧？所以有一些：

28:18 有人认为那种光线可能更有利于唤醒身体，抑制褪黑激素的产生，让我感觉更清醒。呃，它可能有一些，你知道，细胞层面的好处，但是，呃，我不知道有任何关于安全性的真正发表的，发表的文章，关于，关于什么是安全的，什么是不安全的，呃，不过最好，我会说在任何时候都不要睁着眼睛直视太阳。呃。

28:46 然后，是的，希望随着我能更深入地研究，我实际上正在研究这个问题，为了回答这个问题，呃，几个月后我将在美国验光协会做一个讲座。所以我，我现在正在深入研究，但我仍然没有找到像直接的答案。嗯。

29:01 主持人： 是的，这很有趣。你知道，有些太阳凝视者确实指责一些关于直视眼睛，直视太阳的事情。但是，是的，这很有趣，显然太强的光线。它肯定会损害眼睛，而且有很多这样的案例。

29:23 嘉宾： 这其中可能有一丝道理，仅仅因为我们通过红光之类的东西发现了一些东西。然而，我们也知道其他疾病的风险会增加，无论是日光性视网膜病变，还是长时间暴露在紫外线下，我们知道这会增加各种疾病的风险，不仅是白内障，还可能包括黄斑变性。嗯嗯。

29:43 所以我认为人们对此有很多好奇，但这也取决于你住在哪里，一天中的什么时间。再次强调，所有这些因素都有影响。

主持人： 是的。所以可能早期和晚期的阳光照射，也就是日出后和日落前，对眼睛更安全，而且你会获得更多这种可能具有一些治疗效果的红光。

30:07 嘉宾： 可能吧，但正午的太阳非常刺眼，对眼睛的伤害更大。

主持人： 百分之百。对。白天戴太阳镜会更好还是不戴？

嘉宾： 是的，当然。所以紫外线，所以太阳镜，假设你买的是好的太阳镜，市面上有一些质量很差的，可能没有完全的紫外线防护功能，但我们知道紫外线：

30:34 它不仅仅对眼睛造成损害，比如内部损害。再次强调，有几项研究表明紫外线照射与患黄斑变性的风险之间存在关联，黄斑变性是一种致盲性眼疾。它是导致50岁以上人群视力丧失的主要原因之一。紫外线还会增加患白内障的风险。

30:57 但是紫外线也会损害眼球表面和眼睑。很多人，因为眼睑是身体上最薄的皮肤之一，我们有很多病人最终会在眼睑上出现各种黑色素瘤。

31:10 或眼睑皮脂腺问题，而紫外线直接影响这一点，很多人涂防晒霜或防晒乳时会避开眼睛，我的意思是，你不想让任何东西进入眼睛，它甚至会警告不要进入眼睛。所以太阳镜具有保护眼表和眼睑的好处，然后我们也看到紫外线对角膜愈合率的影响，还有……

31:36 你可能会因为紫外线照射眼球表面而患上其他眼疾，比如翼状胬肉和睑裂斑就很常见。这些就像疤痕形成，是在眼球表面形成的胼胝。如果有人去过世界各地更靠近赤道的地区，人们会患上所谓的“冲浪者眼”，这只是翼状胬肉的一个更通俗的说法。

32:00 这同样是由于紫外线的环境暴露以及高盐分含量的区域，组织开始覆盖眼睛。再次强调，冲浪者眼，因为很多冲浪者不戴护目镜，他们也不戴太阳镜。所以他们最终会在眼睛里长出这种东西，这基本上是眼睛试图保护自己免受所有这些严重损害。

主持人： 有趣。关于海洋……

32:29 太阳从海面反射了大量的光线，所以你实际上经常，你知道，从水面获得甚至更亮的光线，而无需直视太阳。所以这是……

32:42 我想象那也同样有害。来自，我不知道，汽车窗户或窗户，一般的玻璃建筑，以及海洋的反射表面。

嘉宾： 百分之百。是的。所以反射表面，像紫外线这样的东西会从那些反射表面反弹回来。我们还有其他流行病学研究表明，那些一生都在当渔民的人，不仅有患皮肤病（如皮肤癌）的风险，而且还有：

33:10 眼部疾病，如黄斑变性、白内障等，也因双重光照而显著增加。

主持人： 是的。那么我们来谈谈营养吧。所以营养会增加许多慢性病的风险。

33:27 有没有什么食物对眼睛特别有益？

嘉宾： 当然。我很高兴你问到这个，我看过你其他一些谈论这个的视频。所以对于眼睛来说，最重要的基本上是蔬菜和绿叶蔬菜，以及富含油脂的鱼类和各种Omega脂肪酸，鱼类。

33:51 从纯粹的饮食角度来看，你知道，再次强调，眼底的视网膜是代谢率很高的组织。它有一些独特的成分。

34:03 说到富含油脂的鱼类，我首先会提到Omega-3脂肪酸，眼底的光感受器，它们超过60%的脂质都是DHA Omega-3。所以从饮食中获取这些非常重要。蔬菜来源的另一部分主要是类胡萝卜素。我们知道维生素A对于光转导过程非常重要，也就是实际接收光线并将信息发送到大脑的过程。大多数人并不缺乏维生素A。

34:32 呃，你知道，除非有人一开始就没有获得足够的卡路里，但是有叶黄素和玉米黄质，呃，你对叶黄素和玉米黄质了解多少？是的，你最近成了粉丝，是的，它们非常，你知道，这些类胡萝卜素总的来说对大脑和眼睛都非常好。

嘉宾： 是的，呃，所以我很高兴你也提到了大脑，但是呃，对于眼睛来说，如果：

35:01 如果任何观众或听众没有听说过这个，那么叶黄素和玉米黄质，这些是类胡萝卜素，它们是脂溶性的，主要存在于绿叶蔬菜中，你可以在一些蛋黄中找到一点，鸡蛋中的含量其实不高，但确实有。

35:18 这些类胡萝卜素会进入眼睛，并在视网膜和眼睛内，特别是在黄斑区域高浓度沉积，黄斑区域就像是你最清晰视力、颜色视觉的靶心，所有这些都来自于这个高度沉积的区域。它们在眼睛里大概有三种功能。它们首先作为高能量光线，即蓝光的过滤器。所以……

35:43 所以那些眼睛里含有较高量这些类胡萝卜素的人，我们可以通过一种叫做黄斑色素光学密度的测试来测量它。而血清叶黄素水平较高的人，已被证明患黄斑变性的几率降低约30%到40%，尤其是严重程度的黄斑变性。

36:06 但除此之外，它不仅具有蓝光防护作用，还具有很强的抗氧化能力和很强的抗炎能力，这对于视网膜结构来说同样非常重要。正如你提到的，也有临床证据表明它对大脑有益，对记忆力有益，即使对于老年人也是如此，对儿童的记忆形成、视觉处理速度等也有好处。

36:32 它还能减少眼睛的眩光问题，并提高对比度。所以很多专业运动员实际上都在服用叶黄素和玉米黄质的补充剂。然后我的一个朋友，约翰·诺兰博士，他在这些类胡萝卜素方面做了很多研究。就在去年，他们发表了……

36:50 研究发现，补充这些类胡萝卜素还有助于减少与动脉粥样硬化相关的低密度脂蛋白和其他各种细胞因子的氧化。所以这些类胡萝卜素有很多好处。人们可以通过饮食摄入，或者服用补充剂。是的。然后，再次回到Omega-3脂肪酸，有很多研究……

37:16 研究表明，那些每周至少吃两次富含油脂的鱼类的人，患黄斑变性、糖尿病视网膜病变以及各种其他疾病的风险降低，甚至对干眼症也有一些好处。但主要对于眼底的视网膜来说，是DHA。不幸的是，大多数Omega-3补充剂，无论是鱼油还是其他来源的。

37:44 通常更多的是甘油三酯形式，并且EPA含量较高，你的身体可能无法吸收适量的DHA进入视网膜组织。

37:55 因为有一种特殊的DHA异构体，他们正在开始研究，你的大脑对它具有高度的特异性。有一种叫做MFSD2A的转运蛋白，它基本上允许某种类型的DHA进入血脑屏障和血视网膜屏障，或者穿过它们。所以……

38:18 在眼科领域，人们普遍推荐食用地中海饮食，这种饮食富含绿叶蔬菜和富含油脂的鱼类。然后如果你要补充，如果你不吃富含油脂的鱼类，那么服用Omega-3补充剂会有一些好处。然后再次强调，叶黄素、玉米黄质，如果你是一个要么不能消化或吃蔬菜的人，或者你只是知道自己吃得不多，那么这也是一个选择。是的。

38:47 主持人： 是的，这些叶黄素和玉米黄质非常有趣，从饮食角度来看，它们被认为与黄斑变性减少有关。而且还有一些临床试验研究表明它们有助于改善与退化相关的……

39:05 眼部健康指标，所以它们，你知道，有实际证据表明它们有效，而且，你知道，服用补充剂相对容易，而且，你知道，可以保护你的眼部健康，因为，你知道，随着年龄的增长，它自然会下降。

嘉宾： 是的，所以，再次强调，这是我尽量与尽可能多的病人谈论的事情，就是关于：

39:28 更具预防性。我们知道，一旦有人患上像黄斑变性这样的疾病，例如，给予叶黄素、玉米黄质以及其他一些维生素C、维生素E、一些锌的补充剂，可以在五年内将病情发展减缓约25%。但它不会阻止病情发展。它不会逆转病情。对。

39:54 但是如果我们能服用这些补充剂，或者我们能吃得很好，我们就能将患病风险降低高达约40%。所以这是一件非常重要的事情。

主持人： 是的。关于类胡萝卜素，还有一种叫做虾青素，它被证明对眼睛有益，并能保护皮肤免受紫外线损伤和光老化。它对眼睛健康有任何证据吗，因为它也像一种类胡萝卜素？

40:23 嘉宾： 是的，有一些证据表明它可能对眼睛有益。有一些关于甚至像眼睛疲劳的临床研究，结果显示它在这方面有益。还有几项研究，我会说更多的是体外研究，关于它对帮助视网膜健康的影响。目前关于人体临床试验的研究还不多，但现在正在对此进行更多的研究。我唯一想提醒大家的是，要知道虾青素是叶黄素和玉米黄质的竞争对手。

40:53 与叶黄素和玉米黄质竞争。所以你不想同时服用它们。如果我自己设计配方，我可能会，你知道，早上服用叶黄素之类的东西，然后在一天晚些时候服用虾青素补充剂。仅仅因为，再次强调，它们是相互竞争的。

41:11 主持人： 如果你服用更大的剂量，是否能克服这种竞争？

嘉宾： 我不，我不太确定。呃，这对于化学家或者比我更了解生物化学的人来说是个好问题。

主持人： 好的。但这是个好问题。

嘉宾： 是的。因为我，我通常早上服用它们，但我服用的剂量相当大。我服用的是，比如：

41:30 我发现的两者最大有效剂量。所以，是的，这会很有趣。我以前同时服用它们。然后我和眼科领域一家补充剂公司的顶级顾问之一，一位医学博士交谈。他几乎能脱口而出每一篇相关的出版物。然后他向我详细解释了它是如何运作的。我当时想，哦，我的天哪，好吧，所以我需要做一些改变。但这确实很有趣。是的。是的。

42:01 主持人： 关于补充剂，还有一种叫做肌酸，它以对肌肉有益而闻名，现在也越来越被认为是на脑部补充剂。你提到眼睛消耗大量能量，它是身体中最耗能的器官或组织之一。肌酸也有助于ATP的产生和能量的产生。

42:25 我不知道是否有关于这方面的研究，但是肌酸是否会在某种程度上帮助眼睛健康或眼睛功能？

嘉宾： 我很高兴你问这个问题。也有几个人问过我这个问题。我个人服用肌酸，但更多的是从身体角度考虑，但我也看过一些关于肌酸的出版物。

42:42 比如心理健康。而且我，我在过去几年开始服用它后，注意到了一些积极的好处。我很难说，这真的是因为肌酸，还是因为我也在做更多的运动，呃，并且睡眠更好？是这些导致了心理健康的改善吗？但是，嗯，我研究过肌酸及其对眼睛的影响，但我找不到太多相关的研究。呃，这可能只是没有人真正研究过的东西。而且，嗯。

43:06 我不知道是否有任何正在观看或收听的人想投资一项临床研究，请联系我，因为我很乐意看看我是否能组织这样一项研究。但这将是一件非常有趣和引人入胜的事情。

43:20 主持人： 是的，你知道，我想这是一个相当新的话题，因为大脑方面的研究直到最近才变得更受欢迎。快速谷歌搜索一下，有一项体外研究表明，肌酸对视网膜神经元有新的投射作用，但目前还没有其他发现。

嘉宾： 是的，我也得看看那个。我上一次真正深入研究它可能是在去年夏天。是的。

43:45 所以也许有什么新的进展，我只是还没看到。

嘉宾： 是的。但是，呃，还有其他营养素和其他，嗯。

43:53 其他研究正在关注诸如，呃，各种，它会是什么样的呢，嗯，姜黄素对视网膜健康有益。有一些研究是关于各种，呃，比如烟酸元素对青光眼非常有益。嗯，它们目前仍在临床试验中，试图弄清楚这到底对谁有益，有多少益处，但是，呃。

44:19 我仍然主要建议人们食用全食物饮食，大致遵循地中海饮食的原则。这是关于眼睛健康研究最多的领域。但至于那些其他补充剂，仍然……是的。虽然有证据表明它们对视网膜健康和神经健康有支持作用，但我们仍然没有非常强有力的临床建议。

主持人： 是的。关于维生素E……

44:46 视黄醇（主要从肝脏获取）和β-胡萝卜素（从红薯和胡萝卜等食物中获取）之间存在差异，而胡萝卜通常被认为对眼睛有益，因为含有维生素A。视黄醇（被认为是具有生物活性的维生素A）和来自胡萝卜和红薯的维生素A，对眼睛健康有区别吗？

45:12 嘉宾： 是的。所以β-胡萝卜素，你的身体会吸收它，并在你的肝脏或通过肠道将其转化为真正的维生素A。但是，那个，那个，眼睛会使用完整的维生素A形式。令人担忧的是，那些，你知道，再次强调，大多数人并不缺乏维生素A。你的身体储存维生素A的能力很好，要么在肝脏，要么甚至在脂肪组织中。所以。

45:41 最大的担忧是有些人服用维生素A补充剂。比如现在有一些关于维生素A补充剂的讨论。而令人担忧的是，过量服用是可能的。

45:53 你可能会患上维生素A过多症，这会对眼睛产生负面影响。有一些病例报告，我甚至见过一个年轻女孩服用维生素A补充剂，结果她的视神经肿胀，这主要是由于服用过量维生素A导致脑脊液水平升高。

46:18 呃，幸运的是，在她的案例中，她停止服用维生素A后，情况有所改善。但是，嗯，确实存在这方面的担忧。不过大多数人，如果他们摄入足够的，呃，足够的卡路里，通常他们不会缺乏维生素A。对。但是，嗯，在世界某些地方，这确实是一个令人担忧的问题。嗯。

46:42 主持人： 那么糖和更多加工食品呢？

嘉宾： 这是个好问题。所以我们知道有几项研究关注了超加工食品与眼疾之间的关系。他们发现，是的，确实存在关系。吃更多超加工食品的人通常会摄入更多的糖。他们的饮食中也含有更高水平的不同类型的脂肪。

47:06 在他们的饮食中。通常，通常是那些更久坐的人。所以你会看到这种复合效应，肥胖风险更高，炎症性疾病发病率更高。这最终也会导致各种疾病的风险更高。我们确实看到青光眼、糖尿病、黄斑变性的风险增加。这些都是可能导致失明的疾病。所以通常是：

47:30 这基本上都是关于同样的话题。你想吃得更健康，想更积极地运动，更好地照顾自己。

主持人： 是的。是吗，你知道，因为吃糖和：

47:43 糖尿病，其特征是长期高血糖水平。如果你吃糖，那么你的血糖会升高。如果你身体健康，那么一段时间后它会恢复正常。但如果你是糖尿病患者，那么它会长期升高。所以是长期的经历吗？

48:01 长期高血糖会导致眼睛受损并导致视力丧失，就像它最终会导致手臂截肢或手指神经病变一样，还是仅仅是血糖升高这个行为，你知道，当你吃饭时正常发生的血糖升高，也会损害眼睛并：

48:25 以更快的速度。

嘉宾： 是的。所以很明显，如果某人不是糖尿病患者，那么他们的身体会正确地做出反应，并以更快的速度维持适当的血糖水平。糖尿病患者的问题以及眼睛的病理生理变化在于，如果视网膜内小动脉管腔内血糖水平升高。

48:51 而美妙之处在于，视网膜具有双重血液供应。眼底有血管，为眼睛提供血液营养，但也有血管进入视网膜。当你血糖水平升高时，有一种叫做周细胞的细胞。不是像微生物那样的寄生虫，而是叫做周细胞。这些周细胞：

49:14 允许对血管如何收缩以及它们如何允许液体和营养物质通过管腔做出反应。但是随着血糖水平的升高。

49:28 糖分子基本上会穿过并进入周细胞，导致它们肿胀，因为它也会带入液体，因为它希望有那个正确的渗透梯度。所以周细胞会肿胀并最终死亡。如果你随着时间的推移失去了很多这些周细胞，那么血管就无法收缩和自我调节了。

49:49 然后在眼睛里，临床上，我们最终会看到的是，我们可以通过所谓的ERG，即视网膜电图，进行一些功能测试，我们可以看到视网膜细胞的功能下降。所以它们只是代谢不健康。

50:05 然后我们能看到的第一个临床体征，比如我观察糖尿病患者的眼睛内部，通常是血管出现小的囊状突出或动脉瘤。呃，因为血管壁现在变弱了。所以它们开始出现这种气球状的突出，并最终开始破裂。然后我们看到眼睛内部出血，要么是血液积聚。我们甚至可以看到脂肪沉积或我们称之为渗出物的东西在眼睛内部积聚。嗯。

50:33 严重的后果不仅仅是缺血，对吧？血液没有到达它需要到达的地方。所以现在正确的组织缺氧了。所以你开始出现视网膜细胞和神经节细胞的死亡。然后……

50:51 眼睛内部可能会开始形成新的血管，因为存在这种缺血，细胞正在死亡，它们开始释放这些叫做VEGF或血管内皮生长因子的标记物，这些标记物会发出信号，让这些新的血管在眼睛内部生长，就像在说，嘿，我需要营养，把那些血管带到这里来。但是新的血管非常脆弱。所以它们要么更容易出血，要么更容易在眼睛内部渗漏液体，或者它们可能会开始：

51:19 导致疤痕形成。基本上，渗入眼睛的新液体开始收缩，眼睛内部就会形成疤痕，从而导致视网膜脱离。然后你还可能出现更严重的青光眼问题。糖尿病会引发很多问题。所以对于有患糖尿病风险的人来说，如果你是糖尿病前期或者已经患有糖尿病，不仅要尽一切可能改变生活方式，而且要做到这一点，这很重要。

51:44 改变饮食、运动、服药、减肥，尽可能地使其缓解。但一定要至少每年去看一次眼科医生，这样我们就可以检查并了解眼睛的情况，因为我们确实有治疗方法可以阻止许多这些疾病的发生。

主持人： 是的。我想我听说过那个：

52:05 当你被诊断出患有糖尿病时，你会接受强制性的眼部检查或其他检查。

嘉宾： 现在这被认为是强制性的建议。不幸的是，昨天我有一个病人，他甚至承认一旦被诊断出来，他就一直忽视照顾自己。他从未做过眼部检查。他昨天才来，因为……

52:29 周末，他的右眼突然失明，这吓坏了他。所以他来了，不幸的是，他正处于严重的增殖期，新的血管正在眼睛内部渗漏，他的一根血管破裂了，现在他的眼睛内部有大量出血，他看不清东西了。所以在他的案例中，他知道自己麻痹大意了。

52:52 忽视了它。而且，呃，我为他感到难过，但是，嗯，谢天谢地他来了，我们可以帮助他，希望他以后能走上更好的轨道。

主持人： 是的。嗯，我们来谈谈眼镜吧。所以，嗯。

53:05 通常，我不知道，也许是我的印象，但通常人们不想戴眼镜，或者他们有点犹豫是否开始使用眼镜。当眼部健康恶化时，当比如说你的视力略有下降时，开始戴眼镜是否更健康？

嘉宾： 是的。

53:27 或者即使你的视力，嗯，我不知道，比如说比以前差了10%，不戴眼镜也可以吗？所以，我想问题是，一旦你的眼部健康已经出现一些下降，如果你不戴眼镜，你的视力下降速度是否会更快，还是说，呃，没关系？

嘉宾： 所以，是的，这是另一个有趣的问题。嗯。

53:53 我想很大程度上取决于你的年龄。例如，如果你是父母，如果父母正在听这个，孩子们，他们的大脑仍在发育。而且，随着孩子们进入青春期并开始经历生长突增，眼睛也仍在随着身体一起生长。所以事实上，这是有益的。

54:18 例如，对于近视的孩子来说，戴眼镜、戴隐形眼镜，或者用其他方法矫正他们的视力，不仅是为了让他们看得最清楚，从而在学校表现良好，也因为至少有两项研究表明，戴矫正眼镜的孩子，实际上会减缓他们的近视发展或：

54:40 他们对眼镜度数加深的需求。实际上，这会减缓近视的发展，而同龄不戴眼镜的孩子近视发展速度更快。嗯。关于近视，具体来说，有很多细微之处。是的。

54:56 另一个方面是，你希望年幼的孩子在早期就能有正常的大脑发育，从而能够欣赏清晰的视觉。因此，让孩子佩戴矫正眼镜并且是完全矫正的，对于正常的大脑发育也非常重要。否则，你的大脑可能会选择不：

55:18 发展出良好的细胞来欣赏良好的视觉。我们称之为弱视，或者有些孩子，你会听到“懒惰眼”这个词。这可能会发生。作为一个成年人，比如你和我，如果我们选择不戴眼镜，它不太可能发展得更快或恶化，如果我们选择不戴它们，因为此时眼睛的大部分解剖结构已经基本定型了。

55:45 但是，比如，25岁以后，通常情况会进展缓慢。在眼镜度数等方面不会有太大变化。有一小部分，大约10%的人，可能会继续发展。但是。

55:58 大部分只是生活质量的问题。比如如果你戴眼镜或隐形眼镜能看得更清楚，你为什么不想看得更清楚呢？这不一定会让情况变得更糟。我想很多人都有这种看法，哦，好吧，我，我看到，你知道，东西有点模糊，但我开始戴眼镜了。眼镜有帮助，但现在他们摘下眼镜。一切都变得更糟了。这并不是说你的眼睛真的变糟了。而是你的感知，你戴眼镜和不戴眼镜之间的比较差异变得更糟了。

56:27 更加明显，所以这，再次强调，这并不是眼睛的生理变化，更多的是一种心理上的感知。

主持人： 是的，我小时候，那么，呃：

56:39 我的父母和其他人告诉我，不要透过眼镜看东西，你知道，这些其他的眼镜，因为那样你的视力实际上会变得更差。如果你戴，比如说你奶奶的眼镜，呃，它们会非常模糊，对吧。但是，呃，那实际上会使你自己的眼睛变得更差。嗯，这其中可能有一些道理。呃，当然，如果，如果你戴着别人的眼镜，你戴的度数不对。你最终可能会。

57:02 迫使你的眼部肌肉比平时更努力地工作，然后这会改变你眼睛的姿势以及你使用这些肌肉的方式，但更重要的是，我们确实知道，旧款眼镜镜片的设计方式，存在一种现象，即光线会聚焦在周边视网膜上。

57:26 这会发出一种叫做远视性离焦的信号。它以某种方式与大脑和眼睛沟通，使眼球变长。所以这还没有完全被理解。这只是近视发展过程中的一个方面，但这就是为什么现在你会看到为儿童设计的新款眼镜镜片，以及一些隐形眼镜，它们旨在消除这种，嗯。

57:55 这是一种由眼镜引起的变形。

57:59 通过新的设计，可以将近视发展速度减缓高达约50%。所以，取决于你住在哪里以及这些设备是否可用，比如在美国，这些眼镜还没有上市，因为它们仍在进行试验。但在其他一些地方，比如加拿大和欧洲，这些镜片已经上市一段时间了，它们可以帮助减缓儿童的近视发展。

主持人： 有趣。隐形眼镜和框架眼镜在健康方面有什么区别吗？

58:28 嘉宾： 哦，是的。另一个好问题。所以隐形眼镜最大的问题就是感染的风险。特别是对于那些戴着隐形眼镜睡觉的人来说，感染的风险要高得多。隐形眼镜也会变干。它们会吸收泪液，然后泪液蒸发得更快。所以干眼症以及隐形眼镜意识和刺激的发生率更高。有一些证据表明隐形眼镜……

58:57 如果长时间佩戴，并且取决于你佩戴的镜片类型，也可能压迫眼角膜，并导致角膜神经的一些脱敏，这可能会改变你身体调节泪液分泌的能力，并可能导致神经营养性或所谓的神经性角膜炎问题。所以确实发生过这样的病例。

59:27 我想总的来说，只要你有良好的卫生习惯并且不戴着隐形眼镜睡觉，大多数人认为隐形眼镜是相当安全的。但是业内一些专业人士担心佩戴隐形眼镜本身，仅仅因为干眼症的风险增加以及晚年干眼症的长期后果。

主持人： 那么LASIK手术呢？我想这是一个非常受欢迎的问题。它显然不是永久性的，还是……

59:57 嘉宾： 是的，所以具体到LASIK手术，比如他们会从你的眼睛里移除组织，而那些组织就永远消失了。所以这是手术的一部分，是的，LASIK是。

01:00:10 是永久性的，但你的视力仍然会随着年龄的增长而改变，尤其是在你40多岁及以后。再次强调，眼睛内部的晶状体正在变大并开始晶状化。当它晶状化时，光线通过眼睛内部的晶状体的方式会发生改变。所以你的处方和对眼镜的需求可能会开始发生变化。

01:00:31 所以，这就是LASIK残酷的真相。嗯，它被认为是基本安全的。我知道你，人们会在网上看到一些关于一些人不幸在LASIK手术后自杀的事情。嗯，其中很多是由于愈合情况不佳以及干眼症造成的。嗯。

01:00:53 LASIK手术特别会在手术过程中切断眼球表面更多的神经，这些神经随后必须重新生长。在大多数情况下，比如99%的情况下，人们愈合得很好。术后确实会出现一些干眼症，通常在三到六个月内会消退。但对于一些人来说，如果神经没有正确地重新生长，或者如果他们在手术前就已经存在干眼症，那么干燥、疼痛、便秘等症状。

01:01:22 可能是有害的。嗯，它可能导致视力模糊、眩光、光晕，但是，你知道，那些不幸的少数人，通常引用的比例不到1%。

01:01:35 有些人因此出现了严重的问题。而那些预后最差的人总是声音最大的人。嗯，但我接触过的绝大多数做过LASIK手术的人，通常都说他们很喜欢，它改变了他们的生活，他们会毫不犹豫地再做一次。所以，嗯。

01:01:53 谢天谢地，临床试验确实表明它仍然是安全的。我想只是作为一个行业，我们需要非常谨慎地判断哪些人有风险，哪些人在我们送他们去做手术之前有更严重的干眼症问题。

主持人： 是的，明白了。

01:02:07 去年，Mr. Beast有一个视频，他为这些盲人支付了手术费用，然后他们就能看见了，我不知道具体是什么类型的手术，但是通过一些手术治愈失明是可能的吗？

嘉宾： 是的。所以Mr. Beast做的具体是关于白内障的手术，而白内障是头号，你知道，全球范围内，如果你看世界上视力丧失的头号原因，那就是白内GH。好消息是，所以白内GH。

01:02:36 白内障是什么，对于那些不知道的人来说，就像我一直说的，在你40多岁、50多岁及以后，眼睛内部的晶状体开始晶状化。当你还那么年轻的时候，晶状体通常还是透明的。就像它是一个透明的……

01:02:50 眼睛内部，就像你的眼镜镜片是透明的一样。但是随着年龄的继续增长，晶状体会氧化并开始变成黄色，最终甚至变成白色，在某些情况下甚至变成深棕色。所以我见过，我在世界一些地方做过医疗援助。而且：

01:03:08 你会看到一些80多岁的人，他们从未做过白内障手术，他们眼睛里的晶状体非常大，像弹珠一样，而且会是咖啡棕色的。他们看不清东西。

01:03:21 所以白内障手术，他们可以进去，然后使用一种叫做超声乳化术的工具。这是今天的一个有趣的词。但它使用超声波来粉碎眼睛内部的这个晶状体。就像把一个玻璃弹珠粉碎成灰尘颗粒一样。然后他们用真空吸出这些颗粒。

01:03:40 然后他们会在眼睛内部植入一个新的塑料人工晶体，他们会测量并考虑到任何对眼镜的需求，并尝试将其植入人工晶体中。所以之后你又能透过透明的晶体看东西了。而且在很多情况下，人们，嗯，不再那么依赖眼镜了。这几乎就像同时做了LASIK手术一样。哇。嗯，所以谢天谢地我们有这种手术。它只需要大约10到15分钟就能完成，呃。

01:04:07 它被认为是已发明的最成功的手术之一。缺点是在世界某些地区，人们无法获得医疗保健或眼科护理，视力丧失是其后果之一。

主持人： 这非常有趣。未来，我们是否能够进行某种类型的手术或眼部植入，比如像半机械人那样的眼睛，你知道，那会……

01:04:36 你知道，给你完美的视力，或者，也许还能增强它，比如能够放大之类的。因为，你知道，人类，我们的眼睛相当好。我们相当依赖视觉。比如我们的视觉系统相当好，但显然不如鹰或隼之类的动物那么好。嗯。

01:04:52 能不能像使用某种电子眼或其他方法来增强我们的视力？我知道有人在谈论这个。

嘉宾： 我知道有一些公司一直在研究这个问题，特别是在白内障手术的植入物方面。我想他们目前确实遇到了一些技术障碍。比如如果他们确实有放大的能力，那就需要某种电荷。

01:05:15 或者它需要眼睛内部晶状体的某种机械运动。这意味着它可能需要某种电池电容器。然后你怎么给眼睛充电呢？你知道，你可能得戴着某种充电护目镜睡觉，它会产生，你知道，电磁场来给它充电。然后这些能持续多久？如果它们坏了怎么办？你知道，我想有很多。

01:05:40 只是技术上的事情需要发生。所以我们可能，你知道，谁知道人工智能会发展成什么样，但我们可能离那一步还有四五十年。我知道有一些隐形眼镜公司正在研发增强现实隐形眼镜。

01:05:57 增强现实眼镜也是如此。我认为这不仅在目前已存在的一些增强现实眼镜的掌握之中，而且在未来10年内，我们会看到：

01:06:11 这项技术的应用得到改善。所以我认为这将非常真实，甚至即使你不需要眼镜来看得更清楚，你也会拥有一副看起来正常的薄眼镜，它基本上会在你的眼前有一个数字屏幕，你不仅能看到短信和电子邮件通知，而且当你环顾房间时，它会突出显示：

01:06:35 你知道，你冰箱里的食物，并告诉你通过混合这些不同的配料可以做什么类型的食谱。你开车在路上，它会告诉你，嘿，左转，右转。这是你的速度。就像视频游戏一样的平视显示器。嗯。

01:06:48 而且它也许还能放大远处的物体，并在你的自然眼前放大显示。我想，我想这会有很多应用。而且我认为这更现实，再次强调，可能在未来五到十年内。

主持人： 哇。

01:07:06 是的，感觉就像关于眼睛，我们将能够达到这样一个技术水平，我们几乎能够治愈所有失明和所有眼疾。至少，你知道，这是我的印象。因为如果我们已经能够，你知道，做这些10分钟的手术来治愈白内障导致的失明，那么，是的，几十年后，我们会的，你知道，我想它看起来会是这样发展的。

嘉宾： 天哪，我希望如此。你知道。

01:07:35 所以大约两年前，我们完成了第一例完整的全眼移植手术。眼睛没有功能，但眼睛有其自身的特殊免疫系统。然后将眼球重新连接到新人的头部，将其连接到他们的视神经，所以眼睛不仅……

01:08:04 不恶化并且不被排斥是一个巨大的成就。嗯。

01:08:10 但是对于这个人来说，他们可以测量并看到有电信号从这个捐赠的眼睛输入到接受者的大脑。但是接受者并没有因此获得功能性视力。但仅仅是完成，嘿，我们实际上获得了一只眼睛和一种技术，让眼睛连接到身体并且不被排斥。这本身就是一个巨大的壮举。显然，我们还有很长的路要走。但这是眼科领域刚刚发生的一个相当大的里程碑式新闻。是的。

01:08:40 主持人： 这非常有趣。在我们结束之前，还有什么我们没有涉及到的，人们应该知道的关于改善他们眼睛健康的具体或特殊的事情吗？是他们应该做的事情还是应该避免的事情，或者类似的事情？

01:08:55 嘉宾： 你知道，我自己的眼部健康日常护理不仅仅是每年做一次眼部检查。正如我们一直在谈论的，我也吃得很健康。我尝试服用一些补充剂来保护我的眼睛和视力健康。我现在正在尝试红光疗法。我们仍然没有完全确定它的效果。太阳镜，你知道，我们提到了，我认为这很重要。是的。

01:09:20 然后就是休息。是的。尤其是对于年幼的孩子，要意识到长时间使用近距离设备，虽然我们希望孩子接受良好的教育，但我们确实需要让他们尽量多花时间在户外。眼睛和大脑之间存在某种我们尚未完全理解的交流方式。但我们知道，每天在户外待大约一个半到两个小时的孩子，会产生一种平衡效应，可以抵消许多导致近视发展问题的因素。

01:09:49 所以，对于来诊所的家庭，我都会建议他们，并努力鼓励他们多进行户外活动。

主持人： 有趣。嗯，是的，很高兴进行这次讨论，是的，眼睛被严重低估了，而且对于生活质量非常重要。在我问最后一个问题之前，人们可以在哪里了解更多关于你和你的工作的信息？

01:10:14 嘉宾： 所以谢谢你。是的。所以当然，我所有在线教育的使命都是通过艾伦医生眼健康YouTube频道。我提供各种方面的教育，无论是眼镜、隐形眼镜、手术，还是很多疾病教育，以及你可以通过生活方式做的事情。我也会在其他频道发布内容，同样是以艾伦医生眼健康的名义。所以任何对眼睛好奇，想了解更多的人，一定要去看看那些频道，并通过那里联系我。

01:10:41 主持人： 是的，我们会把链接放在节目介绍里。我的最后一个问题是，有没有一件你希望自己早点养成的建议或习惯？

嘉宾： 睡眠。我认为我一生中忽视最多的习惯就是我从未尊重过我的睡眠。你知道，当然，在我成长过程中，我经常熬夜。

01:10:59 直到凌晨三点玩电子游戏，我的，我的高中甚至大学的一些学业，我想会好得多。我是个好学生，但是，呃，我想我在很多不同方面的表现，身体上，精神上，嗯，学业上，如果我能有规律的睡眠，都会提高十倍。而且，呃，当我上验光学校的时候，我想那是我的超能力，因为我把它放在了优先位置。

01:11:25 不幸的是，当你进入像医疗保健领域的住院医师培训这样的阶段时，他们根本不在乎你的睡眠。所以我想随着年龄的增长，过了验光学校之后，我失去了很多规律的睡眠习惯。现在我正努力再次把它放在优先位置。是的。而且它确实影响我的身体健康。它影响我的情绪。它影响我的心智能力，我的工作效率。所以这是我正尽力优先考虑的事情。是的。

01:11:52 主持人： 是的，这是一个重要的提示，而且非常普遍，很常见。嗯，是的，谢谢你来到播客。是的，很高兴和你交谈。

嘉宾： 是的，谢谢你。我很感激。

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Edit:2025.05.13<markdown>

阳光的能量很容易在眼底的视网膜上烧出一个洞。我不希望任何人遇到这种情况，因为通常一旦那块组织消失了，就真的消失了，不会再长回来。因此，人们的视力会因此留下永久性的盲点。这再次表明，黄光、红光和近红外光的混合物不仅可以减缓与年龄相关的黄斑变性的发展，还可以恢复一些可用的视力。

主持人： 艾伦医生，欢迎来到节目。

嘉宾（艾伦医生）： 非常感谢。再次强调，能受邀来到这里谈论眼睛方面的事情，我深感荣幸。

主持人： 我很兴奋。眼睛是这样一种有趣的器官或装置，它们并没有得到那么多的关注。但当你仔细观察时，它们对我们的整体健康以及生活满意度都相当重要。

嘉宾： 是的，这通常是人性使然，我们总是更倾向于被动反应。直到出现问题才去思考它。不幸的是，对于眼睛来说，当开始出现问题时，通常已经太晚了，无能为力。所以这是一个漫长的故事，最好是预防，尽早采取措施，而不是在事情发生后才被动应对。

主持人： 关于眼睛，一个非常有趣的事情是它们实际上与大脑相连。从某种意义上说，它们可以被认为是大脑的延伸，大多数人并没有真正想到这一点。这是真的吗？

嘉宾： 是的，绝对是的。我的一位同事曾经说过一句很有名的话，眼睛是身体唯一一个面向外部的内部器官。是的，视网膜是你大脑的延伸。

主持人： 随着年龄的增长，视力或眼部健康往往会恶化。这是为什么呢？眼睛本身有什么内在的脆弱性吗？或者仅仅是自然衰老，其他所有器官也会随着年龄的增长而退化？

嘉宾： 当然，年龄在眼睛发生的变化中扮演着重要角色。我认为眼睛可能更容易受到许多衰老变化影响的原因在于，它是一种代谢率极高的组织。我看过一些文献说它是代谢率最高的组织。部分原因在于处理视觉并将适当的信号发送到大脑需要消耗大量的能量，但也因为眼睛持续不断地受到光能的冲击。身体必须通过修复任何类型的反应、活性氧或氧化来应对，同时还要管理细胞因同样过程而经历的炎症级联反应。这与许多不同的眼部疾病有关。

主持人： 视力差，就像口腔健康一样，至少口腔健康不良与其他全身性疾病（如心脏病或阿尔茨海默病）之间存在关联。眼睛方面是否存在类似的情况，即视力差与糖尿病、心脏病或其他疾病密切相关？或者仅仅是遗传或随机的？

嘉宾： 是的，所以这肯定是两者兼而有之。我们确实知道某些遗传成分会增加患各种眼疾的可能性，但也存在很多关联性。如果比较肥胖，患有2型糖尿病或任何其他形式的糖尿病，或者高血压，这会显著增加患各种眼部疾病的风险，事实上，这些疾病在眼内有直接的病理过程。但是，如果患有糖尿病，即使在生命早期，视力出现问题，或者视力正在恶化，那么患其他疾病（如痴呆和衰老）的风险也会更高，因为大脑没有获得相同量的信息，更有可能变得久坐不动。这只会加剧一切，然后活动得少了。然后看到心血管疾病的发病率更高，然后，还有抑郁症，就这样不断恶化。所以这肯定与身体内的许多不同过程有关。

主持人： 是的，这很有趣，过多的屏幕时间，过多的技术使用，看太多的电视之类的，撇开久坐的因素不谈。那么这是否也会增加那些疾病的风险，比如心脏病，仅仅通过视力恶化这个行为？比如控制了久坐和超重这两个变量。

嘉宾： 是的，这些都是好问题。根据我所读到的，我不认为仅仅看电视或看电脑会对眼睛造成直接影响，比如导致某些眼部疾病，虽然有些眼部疾病确实会受到聚焦和注视物体的影响。但是它可能不会对像糖尿病这样的疾病产生直接影响。更像是，因为看更多电视而坐得更多，因此，肥胖和其他所有这些事情的可能性增加了。所以然后就可以看到这一切是如何联系在一起的。但是我们可以更多地谈论盯着屏幕以及诸如此类的事情，以及它们如何影响眼睛。这也会以多种不同的方式影响眼睛。

主持人： 我只是在想，因为在现代社会，我们使用越来越多的科技产品，我想象正因为如此，眼睛承受着更多的氧化应激，更多地暴露在这些强光下，即使身体健康，但因为这么多人都在使用科技产品，我想象更多的人因为过度使用科技产品而视力下降。那么，即使他们身体健康，他们是否通过眼睛增加了患这些慢性病的风险？或者仅仅是那些视力差的人通常看太多电视，他们也不运动，而且吃太多加工食品之间的关联？

嘉宾： 所以我们知道，如果是一个盯着屏幕看的人，尤其是在年幼的时候。那些更多使用，不仅仅是屏幕，而是通常情况下做近距离工作的人，尤其是那些大部分时间待在室内的年幼孩子。他们不仅有更高的风险，实际上还会发展成更严重的近视。这也伴随着各种眼疾的风险，例如白内障的高风险、青光眼的高风险、视网膜变性的高风险，以及视网膜脱离。所以这方面存在问题。有很多研究正在探究光线如何影响眼睛，以及光线如何影响我们的大脑。

所以我们知道高能量光线或傍晚的光线照射，特别是蓝光，你会听说它会影响你的睡眠周期。所以我们确实知道它在这方面有影响。而且你非常清楚睡眠会影响你身体的许多不同部位和你的心理健康。所以关于睡眠究竟如何影响眼睛健康、大脑的研究正在进行中。我们才刚刚开始对此进行一些研究。我不认为现在已经非常清楚具体到了什么程度，但看起来像电脑屏幕之类的设备发出的光能，大部分对眼睛没有直接的负面影响，比如损伤。

然而，有一些体外研究或实验室研究，比如在老鼠身上进行的实验，用非常高能量的蓝光紧贴着它们的眼睛照射。这些研究可以表明，是的，视网膜细胞会因为这种光照而产生氧化应激和更快的退化，但大多数设备，如手机、电脑屏幕、电视屏幕，发出的能量水平不足以造成那种损害性影响。所以，目前我们没有任何证据表明它们都通过了安全标准，也没有任何证据表明它们会造成这种损害。所以说科技屏幕和它们发出的光线就像眼睛的香烟一样，这是不对的。程度不同。

但我们确实知道屏幕对眼睛的其他部位有影响。所以比如我们盯着电脑屏幕时，眨眼的次数会减少，我们的眨眼率可能会减半或减少到四分之一。所以如果眨眼不够频繁，而且眼睑往往不能完全闭合。所以泪膜持续暴露在空气中。所以眼睛会更快地变干，或者患上干眼症。但与此同时，眼球表面也会干燥，这会引发表面炎症级联反应。因此，我们看到眼表疾病、干眼症的发病率在增加，即使在年轻人中，甚至在青少年中，我们也看到了这种情况。所以，屏幕时间的增加以及类似问题确实带来了一些负面影响。

主持人： 这很有趣。有没有像锻炼或者，我们锻炼身体的其他所有部位，有没有什么针对眼睛的锻炼是我们应该考虑的？比如随着年龄的增长，肌肉量和肌肉力量会下降，如果进行阻力训练，就可以抵消这种情况。有没有类似针对眼睛的锻炼可以抵消眼睛的自然衰老和自然熵增？

嘉宾： 所以有几种不同类型的具有临床有效性的眼部锻炼。其中大部分用于纠正眼睛作为团队工作的姿势。这主要适用于那些眼睛转向不同方向的年幼孩子，或者那些曾遭受某种脑损伤的人。他们出了车祸，他们中风了。现在眼睛没有得到正确的信号来协同运动。所以有一些针对这种情况的锻炼方法。

总的来说，随着年龄的增长，市面上大多数的眼部肌肉锻炼并不能真正增强肌肉力量，但能改善眼睛的协同工作能力。再次强调，是大脑向眼睛发出的指令以及眼睛需要看向何处的协调性。缺点在于，人们常常想提高看近处物体的能力。年轻的时候，可以做到，因为眼睛内部的肌肉会拉动晶状体，而晶状体在年轻时是富有弹性的。

但是一旦我们都到了中年，四五十岁的时候，晶状体就会随着年龄的增长而变厚，变得像水晶一样。它实际上开始变硬。所以即使眼睛内部的肌肉，也就是一种叫做睫状体的平滑肌，即使它在运动，晶状体不再能够像小时候那样移动和改变形状了。所以不幸的是，很多眼部肌肉锻炼并不能逆转晶状体的晶状硬化。所以最终，大多数人，取决于他们戴的眼镜类型或屈光不正的程度，正如我们所说，大多数人最终还是需要老花镜或某种形式的双光眼镜、渐进眼镜或多焦点眼镜来帮助他们更好地看清近处物体。

我仍然认为，至少从长时间盯着设备上移开视线，让眼睛休息一下是有道理的，因为就像你可能会肌肉痉挛，然后会痛，你的胳膊可能会卡在一个姿势，或者你的腿可能会抽筋卡在一个姿势一样。眼睛的肌肉也会出现这种情况。我们称之为调节性痉挛。

我们看到一些人来，他们整天都在用电脑或手机。他们来是因为他们有这些视力问题。而这仅仅是他们的肌肉在那个位置有点抽筋了，他们需要学会放松它。所以我认为，我想每个人都有过这样的经历，如果他们一天大部分时间都花在屏幕前或看着电脑，那么视力会变得有点模糊，或者他们看不太清远处的物体。过一段时间后会恢复，但最初他们可能会有更严重的，或者至少我有时如果整天坐在电脑前，视力会更模糊。但是，我必须看远处的物体，最终它会逐渐清晰起来。

嘉宾： 我认为最好的办法就是意识到你做了多少工作，并有意识地安排休息。有一些文献暗示每隔20到25分钟休息一次，而且休息时间不是像20秒那么短。以前网上流传过一个说法，叫做20-20-20法则，即每隔20分钟休息20秒，看向20英尺（约6米）远的地方。那太荒谬了。这有点像是凭空捏造出来的，后来他们确实做了一个正式的测试，发现在那个正式的临床研究中，根本没有任何作用。所以事实上，他们现在建议每隔20到25分钟进行一次更长时间的休息，接近三到五分钟，不仅仅是看向远处，让眼睛休息，放松肌肉系统，同时也是为了精神上的转换。从工作中休息一下，喝点水，上个厕所，深呼吸。然后当回到工作岗位时，实际上会更有效率。所以这通常是推荐的做法。理想情况下，对我来说，理想的情景是有一个屏幕，然后屏幕后面，有一个开阔的视野，比如一扇敞开的窗户。远处的距离。所以可以在电脑前工作，然后也可以看看窗外。但现在我这里有一堵墙，还有灯光。但在理想的世界里，在我以前住的地方，我有一个通向后院的窗户。那很好，可以打破距离感。

嘉宾： 对。给一点时间，来回切换一下。你听过的最古老的眼科医生谈论眼部锻炼的方法之一是铅笔推近法，基本上就是看着铅笔或钢笔的笔尖，然后移近鼻子，再移远，再移近鼻子，再移远，保持它是一个单一的物体。如果有一个调节目标，比如一个字母，或者保持一个字母A是清晰的，那么这种方法通常效果更好。因为当把它移近时，它可能会开始变得模糊，然后分裂开来。然而，再次强调，虽然这对于眼睛的协同工作确实非常好。人们可能会做得过火。而且有些眼部情况，取决于眼睛是如何工作的，人们实际上可能会因为做太多类型的眼部锻炼或做错类型的眼部锻炼而使他们的眼睛变得更糟。实际上可能会导致复视或使情况变得更糟。

所以我总是敦促人们在开始做眼部锻炼之前要谨慎，首先要咨询眼科专业人士。最近的一件事是，有一些关于专门针对干眼症的眨眼练习的出版物。基本上就是，同样，每天休息大约五次，这是最近的一项研究。他们每天休息五次，基本上就是完全闭上眼睛，然后做几组闭眼练习，然后像是收紧眼睛，眼睑闭合，但不要挤眉弄眼。因为当挤眉弄眼时，最终会增加眼角和鼻子两侧出现鱼尾纹等细纹的风险。但这是为了增强眼轮匝肌的力量，并改善眨眼过程，同样，当人们在看屏幕时，往往不眨眼。所以这是最近的一些文献。事实上显示出了一些积极的好处。

主持人： 有趣。那么按摩眼球呢，比如挤压它们然后按压？这是个好主意还是有害的？

嘉宾： 这通常被认为风险更大，是有害的。眼球确实有其自身的内部压力，这种压力是由眼内一种叫做房水的液体产生的。如果人们按压眼睛，眼睛暂时可以承受压力的增加，但如果多次或长时间这样做，最终会导致视神经节细胞或连接眼睛和大脑的神经部分的损伤。这最终可能导致一种称之为青光眼的疾病。所以通常认为按压或揉搓眼睛是不好的。或者如果要揉搓眼睑，必须非常轻柔，不要用力按压眼睛。然后对于一些有风险的人，有一种叫做圆锥角膜的疾病，与揉眼睛的高风险有关。许多这些人也有过敏性问题或严重的过敏症。所以他们最终会揉眼睛，然后角膜的胶原蛋白不能正确愈合，最终会变弱并向外突出，像一个圆锥体。然后他们会出现非常严重的不规则散光。他们看东西会很困难。这是一种进行性疾病，通常需要非常严重类型或特殊类型的隐形眼镜，或者他们需要特殊的手术，有时甚至需要角膜移植。所以，再次强调，最好不要揉眼睛。如果眼睛发痒，拿一块冷毛巾或类似冷敷的东西敷一下会感觉好一些，使用人工泪液来润滑眼睛，诸如此类。所以保持眼睛的润滑和湿润非常重要。

主持人： 关于灯光，人造光含有大量的蓝光和绿光，你也提到这会扰乱睡眠节律和昼夜节律。红光和更偏琥珀色的光线呢？它们对眼睛更有益吗？还有那些红光治疗设备呢？它们对眼睛健康有益吗？

嘉宾： 谢谢你问这个问题。所以红光疗法还有几个不同的名字，低强度光疗法。然后如果深入研究文献，通常使用光生物调节这个术语，因为很多设备不再仅仅使用红光。使用黄光或近红外光的组合。所以红光在眼睛领域的应用非常引人入胜。正在被测试用于干眼症的治疗。被用作近视的潜在治疗方法。由于这个原因，东亚地区正在对此进行更多的研究。然后对于黄斑变性，可能拥有最多的研究支持。事实上，在我居住和执业的美国这里。Valita光系统今年一月刚刚获得FDA批准用于治疗黄斑变性。

所以我们对红光的了解是，确实有助于激活细胞内的线粒体。在减少炎症和增强抗氧化活性方面也发挥着一定的作用。因此，对于干眼症治疗，研究表明，当红光以特定波长（通常在630到670纳米之间）照射到眼睑时。也有一些研究使用近红外光。这可以帮助促进泪液分泌。据推测，这是因为红光可以穿透并到达泪腺。但也因为能帮助稳定泪膜的脂质层。眼睑里有这些叫做睑板腺的油腺。所以当接受红光治疗时，会有一些热效应的好处，但也帮助这些腺体内的细胞基本上愈合和更好地产生油脂。所以这些油脂会附着在泪膜上，防止蒸发。所以有一些很好的文献是关于使用这种疗法治疗干眼症的。

对于近视，对于儿童的近视，再次强调，这可能是一个我认为行业非常谨慎的领域，因为你把红光或这种强烈的红光照射到儿童的眼睛里，我们担心长期的影响。目前进行的一到两年的短期研究，大部分显示出良好的安全性结果，但我们就是不知道20、30年后会发生什么。有些设备也经过了独立测试，发现超过了安全水平。

因为如果照射强光，很多在网上销售的红光设备也配有护目镜，或者会警告务必佩戴防护眼镜。部分原因在于，如果能量过大，不仅仅是波长的问题，而是如果光的能量过大并且到达眼底，可能会对视网膜造成光化学甚至热损伤。所以目前研究中有很多安全预防措施，我想，比如，我们如何设计一项研究，以及我们如何制造一种我们知道是安全的但又能达到治疗水平的设备？

目前这个领域，再次强调，由于新的Valita系统获得了FDA的批准，这真的非常令人着迷，因为这表明黄光、红光和近红外光的混合物不仅可以减缓与年龄相关的黄斑变性的发展，还可以恢复可用的视力。我们以前从未有过这样的治疗方法，它不是一种侵入性手术，因为其他治疗黄斑变性的方法，比如在眼睛内部注射药物，这是没有人想要的。维生素补充剂已被证明可以减缓黄斑变性的疾病进程，但不能逆转它或改善你视力，而这是我们第一次拥有这样的技术，再次强调，我相信在第三期临床试验中，超过50%的人视力至少提高了一行。在某些情况下，这意味着一个原本不能开车的人能够开车了。大约25%的参与者视力也提高了两行，或者大约10%的人视力完全提高了，我想是九行左右，但9%的人视力完全提高了三行，这在眼科界简直是出类拔萃的。所以现在真的很令人兴奋。我想它还没有上市。所以美国的眼科诊所可能还没有提供这种服务，但在欧洲和南美洲的一些地方，过去几年已经可以获得了。

主持人： 所以这些家用的红光板，比如我这里有一个，这些主要用于全身。能不能也用在眼睛上？显然，可能不想直视它们，但是比如说从侧面或者更远的地方，比如几米远的地方斜视一下。会有任何帮助吗？

嘉宾： 我想可以。再次强调，很多程度上取决于它发出的能量大小。所以这取决于你离设备的距离。这取决于这些设备的通量或功率密度。所以，我们在眼科诊所使用的设备能量剂量要高得多。所以通常例如，一次治疗需要20分钟，而许多家用设备，它们可能没有那么有效。基本上需要在它下面待上大约六个小时才能获得相同的剂量。但我现在也看到市场上有一些眼部设备。

这是我遇到的难题，就是它们没有必要的临床研究来证明许多家用设备的安全性或有效性。而其中一些设备，就像，我有两个正在测试的。它们是专门针对眼睛销售的。闭着眼睛使用。但基本上一次做三分钟。我正在做，而且我仍在试图弄清楚研究中的确切位置，安全极限在哪里。我相信这些设备是安全的，但我还不知道它们是否具有临床效果。所以对我自己来说，我有点只是相信一些做过研究的研究人员和我认识的其他医生，但我还没有看到这些设备的任何真实临床数据。所以我认为这个行业仍然非常谨慎，我们不想对任何人的眼睛造成损害。所以我们对此非常非常谨慎。所以那些家用设备，如果有人像你一样有一个，如果上面写着佩戴护目镜，我还是会佩戴护目镜。我不会直视灯光。

主持人： 是的。比如在我们获得更多信息之前，更像是间接地，如果它在某个点到达眼睛，离得更远，那么它可能不会造成伤害，但是不要像坐在它前面。因为有时，我主要用它来照射脸部和胸部。所以我坐在它前面。但我不想睁开眼睛直视灯光。

嘉宾： 是的，当然不要太久。有趣的是，即使是Valida系统治疗黄斑变性的临床试验，也有三个周期，基本上在某些形式的光线下，比如黄光和一些近红外光，眼睛是睁开的，光线会进入眼睛。但还有另一个周期，他们会让你闭上眼睛，然后使用更高能量剂量的红光在你闭着眼睛的时候。

我很想花些时间与一些正在做这件事的博士研究员交谈，因为我想知道为什么以及如何，他们还做了哪些其他研究来确定闭眼与睁眼以及特定波长的临床安全性和有效性。老实说，我一时想不起来这些信息。我还没有找到，我不知道该公司是不是故意保密，还是真的那么难找，或者也许他们也不知道。我想还有很多关于眼睛安全和我们尚未建立的方案的好奇和问题。

主持人： 是的，几年后会是什么样子，这很有趣，但是关于阳光，你从太阳那里获得全光谱的光线，而这些光线。我想你也不想直视太阳，尽管有些人可能不同意这一点。所以，那么阳光呢？一天中什么时候对眼睛更有益呢？你应该看哪里？

嘉宾： 是的，这是我个人比较感兴趣的一点。我还没能找到可靠的研究来解释，因为我认为变量太多了。一天中的时间。居住在地球上的纬度和经度。我们知道紫外线在一天中晚些时候会最强，但如果在中午直视太阳，从太阳获得的能量很容易在眼底的视网膜上烧出一个洞。我们称之为日光性视网膜病变。我不希望任何人遇到这种情况，因为通常一旦那块组织消失了，就真的消失了，不会再长回来。所以人们最终会因此在视力上留下永久性的盲点。

清晨太阳刚刚升起，或者傍晚太阳即将落下的时候，直接照射到眼睛的能量会减少，很多阳光实际上被大气层折射了。所以从某种程度上说，能量被过滤了。它也往往看起来更像红光。所以是一种红橙色的色调。所以有一些想法认为那种光线可能更有利于唤醒身体，抑制褪黑激素的产生，让人感觉更清醒。它可能有一些细胞层面的好处，但是，我不知道有任何关于安全性的真正发表的文章，关于什么是安全的，什么是不安全的。不过最好，我会说在任何时候都不要睁着眼睛直视太阳。然后，希望随着我能更深入地研究，我实际上正在研究这个问题，为了回答这个问题，几个月后我将在美国验光协会做一个讲座。所以我现在正在深入研究，但我仍然没有找到直接的答案。

主持人： 是的，这很有趣。你知道，有些太阳凝视者确实指责一些关于直视太阳的事情。但是，这很有趣，显然太强的光线。肯定会损害眼睛，而且有很多这样的案例。

嘉宾： 这其中可能有一丝道理，仅仅因为我们通过红光之类的东西发现了一些东西。然而，我们也知道其他疾病的风险会增加，无论是日光性视网膜病变，还是长时间暴露在紫外线下，我们知道这会增加各种疾病的风险，不仅是白内障，还可能包括黄斑变性。所以我认为人们对此有很多好奇，但这也取决于住在哪里，一天中的什么时间。再次强调，所有这些因素都有影响。

主持人： 是的。所以可能早期和晚期的阳光照射，也就是日出后和日落前，对眼睛更安全，而且会获得更多这种可能具有一些治疗效果的红光。

嘉宾： 可能吧，但正午的太阳非常刺眼，对眼睛的伤害更大。

主持人： 百分之百。对。白天戴太阳镜会更好还是不戴？

嘉宾： 是的，当然。所以紫外线，所以戴太阳镜，假设你买的是好的太阳镜，市面上有一些质量很差的，可能没有完全的紫外线防护功能，但我们知道紫外线它不仅仅对眼睛造成损害，比如内部损害。再次强调，有几项研究表明紫外线照射与患黄斑变性的风险之间存在关联，黄斑变性是一种致盲性眼疾。它是导致50岁以上人群视力丧失的主要原因之一。紫外线还会增加患白内障的风险。但是紫外线也会损害眼球表面和眼睑。

因为眼睑是身体上最薄的皮肤之一，我们有很多病人最终会在眼睑上出现各种黑色素瘤。或眼睑皮脂腺问题，而紫外线直接影响这一点，很多人涂防晒霜或防晒乳时会避开眼睛，我的意思是，不要让任何东西进入眼睛，它甚至会警告不要进入眼睛。所以太阳镜具有保护眼表和眼睑的好处，然后我们也看到紫外线对角膜愈合率的影响。你可能会因为紫外线照射眼球表面而患上其他眼疾，比如翼状胬肉和睑裂斑就很常见。这些就像疤痕形成，是在眼球表面形成的胼胝。

如果有人去过世界各地更靠近赤道的地区，人们会患上所谓的“冲浪者眼”，这只是翼状胬肉的一个更通俗的说法。这同样是由于紫外线的环境暴露以及高盐分含量的区域，组织开始覆盖眼睛。再次强调，冲浪者眼，因为很多冲浪者不戴护目镜，他们也不戴太阳镜。所以他们最终会在眼睛里长出这种东西，这基本上是眼睛试图保护自己免受所有这些严重损害。

主持人： 有趣。关于海洋。太阳从海面反射了大量的光线，所以实际上经常从水面获得甚至更亮的光线，而无需直视太阳。所以我认为那也同样有害。来自汽车窗户或窗户，一般的玻璃建筑，以及海洋的反射表面。

嘉宾： 百分之百是的。所以反射表面，像紫外线这样的东西会从那些反射表面反弹回来。我们还有其他流行病学研究表明，那些一生都在当渔民的人，不仅有患皮肤病（如皮肤癌）的风险，而且还有眼部疾病，如黄斑变性、白内障等，也因双重光照而显著增加。

主持人： 那么我们来谈谈营养吧。所以营养不足会增加许多慢性病的风险。有没有什么食物对眼睛特别有益？

嘉宾： 当然。我很高兴你问到这个，我看过你谈论这个的视频。所以对于眼睛来说，最重要的基本上是蔬菜和绿叶蔬菜，以及富含油脂的鱼类和各种Omega脂肪酸鱼类。从纯粹的饮食角度来看，再次强调，眼底的视网膜是代谢率很高的组织。它有一些独特的成分。

说到富含油脂的鱼类，我首先会提到Omega-3脂肪酸，眼底的光感受器，超过60%的脂质都是DHA Omega-3。所以从饮食中获取这些非常重要。蔬菜来源的另一部分主要是类胡萝卜素。我们知道维生素A对于光转导过程非常重要，也就是实际接收光线并将信息发送到大脑的过程。大多数人并不缺乏维生素A。除非有人一开始就没有获得足够的，但是有叶黄素和玉米黄质，你对叶黄素和玉米黄质了解多少？是的，你最近成了粉丝，是的，这些类胡萝卜素总的来说对大脑和眼睛都非常好。

嘉宾： 是的，所以我很高兴你也提到了大脑，但是对于眼睛来说，如果任何观众或听众没有听说过这个，那么叶黄素和玉米黄质，这些是类胡萝卜素，它们是脂溶性的，主要存在于绿叶蔬菜中，可以在一些蛋黄中找到一点，鸡蛋中的含量其实不高，但确实有。这些类胡萝卜素会进入眼睛，并在视网膜和眼睛内，特别是在黄斑区域高浓度沉积，黄斑区域就像是最清晰视力、颜色视觉的靶心，所有这些都来自于这个高度沉积的区域。它们在眼睛里大概有三种功能。它们首先作为高能量光线，即蓝光的过滤器。所以那些眼睛里含有较高量这些类胡萝卜素的人，我们可以通过一种叫做黄斑色素光学密度的测试来测量它。而血清叶黄素水平较高的人，已被证明患黄斑变性的几率降低约30%到40%，尤其是严重程度的黄斑变性。但除此之外，它不仅具有蓝光防护作用，还具有很强的抗氧化能力和很强的抗炎能力，这对于视网膜结构来说同样非常重要。

正如你提到的，也有临床证据表明它对大脑有益，对记忆力有益，即使对于老年人也是如此，对儿童的记忆形成、视觉处理速度等也有好处。它还能减少眼睛的眩光问题，并提高对比度。所以很多专业运动员实际上都在服用叶黄素和玉米黄质的补充剂。

然后我的一个朋友，约翰·诺兰博士，他在这些类胡萝卜素方面做了很多研究。就在去年，他们发表了研究发现，补充这些类胡萝卜素还有助于减少与动脉粥样硬化相关的低密度脂蛋白和其他各种细胞因子的氧化。所以这些类胡萝卜素有很多好处。人们可以通过饮食摄入，或者服用补充剂。

然后，再次回到Omega-3脂肪酸，有很多研究表明，那些每周至少吃两次富含油脂的鱼类的人，患黄斑变性、糖尿病视网膜病变以及各种其他疾病的风险降低，甚至对干眼症也有一些好处。但主要对于眼底的视网膜来说，是DHA。不幸的是，大多数Omega-3补充剂，无论是鱼油还是其他来源的。通常更多的是甘油三酯形式，并且EPA含量较高，身体可能无法吸收适量的DHA进入视网膜组织。因为有一种特殊的DHA异构体，他们正在开始研究，大脑对它具有高度的特异性。有一种叫做MFSD2A的转运蛋白，基本上允许某种类型的DHA进入血脑屏障和血视网膜屏障，或者穿过它们。

所以在眼科领域，人们普遍推荐食用地中海饮食，这种饮食富含绿叶蔬菜和富含油脂的鱼类。然后如果要补充，如果不吃富含油脂的鱼类，那么服用Omega-3补充剂会有一些好处。然后再次强调，叶黄素、玉米黄质，如果是一个不能消化或吃蔬菜的人，或者只是知道自己吃得不多，那么这也是一个选择。

主持人： 是的，这些叶黄素和玉米黄质非常有趣，从饮食角度来看，它们被认为与黄斑变性减少有关。而且还有一些临床试验研究表明它们有助于改善与退化相关的眼部健康指标，所以它们有实际证据表明它们有效，而且服用补充剂相对容易，可以保护眼部健康，因为随着年龄的增长，它自然会下降。

嘉宾： 是的，所以，再次强调，这是我尽量与尽可能多的病人谈论的事情，就是关于更具预防性。我们知道，一旦有人患上像黄斑变性这样的疾病，例如，给予叶黄素、玉米黄质以及其他一些维生素C、维生素E、一些锌的补充剂，可以在五年内将病情发展减缓约25%。但它不会阻止病情发展。它不会逆转病情。但是如果我们能服用这些补充剂，或者我们能吃得很好，我们就能将患病风险降低高达约40%。所以这是一件非常重要的事情。

主持人： 关于类胡萝卜素，还有一种叫做虾青素，它被证明对眼睛有益，并能保护皮肤免受紫外线损伤和光老化。它对眼睛健康有任何证据吗，因为它也像一种类胡萝卜素？

嘉宾： 是的，有一些证据表明它可能对眼睛有益。有一些关于甚至像眼睛疲劳的临床研究，结果显示它在这方面有益。还有几项研究，我会说更多的是体外研究，关于它对帮助视网膜健康的影响。目前关于人体临床试验的研究还不多，但现在正在对此进行更多的研究。我唯一想提醒大家的是，要知道虾青素是叶黄素和玉米黄质的竞争对手。与叶黄素和玉米黄质竞争。所以不要同时服用。如果我自己设计配方，我可能会早上服用叶黄素之类的东西，然后在一天晚些时候服用虾青素补充剂。仅仅因为，再次强调，它们是相互竞争的。

主持人： 如果服用更大的剂量，是否能克服这种竞争？

嘉宾： 我不太确定。这对于化学家或者比我更了解生物化学的人来说是个好问题。

主持人： 因为我通常早上服用，但我服用的剂量相当大。我服用的是我发现的两者最大有效剂量。所以，是的，这会很有趣。

嘉宾： 我以前同时服用。然后我和眼科领域一家补充剂公司的顶级顾问之一，一位医学博士交谈。他几乎能脱口而出每一篇相关的文献。然后他向我详细解释了它是如何运作的。我当时想，哦，我的天哪，好吧，所以我需要做一些改变。但这确实很有趣。

主持人： 关于补充剂，还有一种叫做肌酸，对肌肉有益而闻名，现在也越来越被认为是脑部补充剂。你提到眼睛消耗大量能量，它是身体中最耗能的器官或组织之一。肌酸也有助于ATP的产生和能量的产生。我不知道是否有关于这方面的研究，但是肌酸是否会在某种程度上帮助眼睛健康或眼睛功能？

嘉宾： 我很高兴你问这个问题。也有几个人问过我这个问题。我个人服用肌酸，但更多的是从身体角度考虑，但我也看过一些关于肌酸对心理健康有益的出版物。而且我，我在过去几年开始服用它后，注意到了一些积极的好处。我很难说，这真的是因为肌酸，还是因为我也在做更多的运动，并且睡眠更好？是这些导致了心理健康的改善吗？但是，我研究过肌酸及其对眼睛的影响，但我找不到太多相关的研究。这可能只是没有人真正研究过的东西。而且，我不知道是否有任何正在观看或收听的人想投资一项临床研究，请联系我，因为我很乐意看看我是否能组织这样一项研究。但这将是一件非常有趣和引人入胜的事情。

主持人： 是的，你知道，我想这是一个相当新的话题，因为大脑方面的研究直到最近才变得更受欢迎。快速谷歌搜索一下，有一项体外研究表明，肌酸对视网膜神经元有新的投射作用，但目前还没有其他发现。

嘉宾： 是的，我也得看看那个。我上一次真正深入研究它可能是在去年夏天。所以也许有什么新的进展，我只是还没看到。但是，还有其他营养素和其他研究正在关注诸如各种姜黄素对视网膜健康有益。有一些研究是关于各种烟酸元素对青光眼非常有益。它们目前仍在临床试验中，试图弄清楚这到底对谁有益，有多少益处。但我仍然主要建议人们食用全食物饮食，大致遵循地中海饮食的原则。这是关于眼睛健康研究最多的领域。但至于那些其他补充剂，虽然有证据表明它们对视网膜健康和神经健康有支持作用，但我们仍然没有非常强有力的临床建议。

主持人： 关于维生素E。视黄醇（主要从肝脏获取）和β-胡萝卜素（从红薯和胡萝卜等食物中获取）之间存在差异，而胡萝卜通常被认为对眼睛有益，因为含有维生素A。视黄醇（被认为是具有生物活性的维生素A）和来自胡萝卜和红薯的维生素A，对眼睛健康有区别吗？

嘉宾： 是的。所以β-胡萝卜素，身体会吸收它，并在肝脏或通过肠道将其转化为真正的维生素A。但是，眼睛会使用完整的维生素A形式。令人担忧的是，那些，再次强调，大多数人并不缺乏维生素A。身体储存维生素A的能力很好，要么在肝脏，要么甚至在脂肪组织中。所以最大的担忧是有些人服用维生素A补充剂。比如现在有一些关于维生素A补充剂的讨论。而令人担忧的是，过量服用是可能的。可能会患上维生素A过多症，这会对眼睛产生负面影响。有一些病例报告，我甚至见过一个年轻女孩服用维生素A补充剂，结果她的视神经肿胀，这主要是由于服用过量维生素A导致脑脊液水平升高。幸运的是，在她的案例中，她停止服用维生素A后，情况有所改善。但是，确实存在这方面的担忧。不过大多数人，如果他们摄入足够的热量，通常他们不会缺乏维生素A。但是，在世界某些地方，这确实是一个令人担忧的问题。

主持人： 那么糖和更多加工食品呢？

嘉宾： 这是个好问题。所以我们知道有几项研究关注了超加工食品与眼疾之间的关系。他们发现，是的，确实存在关系。吃更多超加工食品的人通常会摄入更多的糖。他们的饮食中也含有更高水平的不同类型的脂肪。在他们的饮食中。通常，通常是那些更久坐的人。所以会看到这种复合效应，肥胖风险更高，炎症性疾病发病率更高。这最终也会导致各种疾病的风险更高。我们确实看到青光眼、糖尿病、黄斑变性的风险增加。这些都是可能导致失明的疾病。所以通常这基本上都是关于同样的话题。要吃得更健康，要更积极地运动，更好地照顾自己。

主持人： 是吗，因为吃糖和糖尿病之间存在差异，糖尿病的特征是长期高血糖水平。如果吃糖，那么血糖会升高。如果身体健康，那么一段时间后会恢复正常。但如果是糖尿病患者，那么会长期升高。所以是长期高血糖的经历损害眼睛并导致视力丧失，就像它最终会导致手臂截肢或手指神经病变一样，还是仅仅是血糖升高这个行为，当吃饭时正常发生的血糖升高，也会损害眼睛并以更快的速度？

嘉宾： 所以很明显，如果某人不是糖尿病患者，那么他们的身体会正确地做出反应，以更快的速度维持适当的血糖水平。糖尿病患者的问题以及眼睛的病理生理变化在于，如果视网膜内小动脉管腔内血糖水平升高。而美妙之处在于，视网膜具有双重血液供应。眼底有血管，为眼睛提供血液营养，但也有血管进入视网膜。当血糖水平升高时，有一种叫做周细胞的细胞。不是像微生物那样的寄生虫，而是叫做周细胞。这些周细胞允许对血管如何收缩，以及它们如何允许液体和营养物质通过管腔做出反应。但是随着血糖水平的升高。糖分子基本上会穿过并进入周细胞，导致它们肿胀，因为它也会带入液体，因为它希望有那个正确的渗透梯度。所以周细胞会肿胀并最终死亡。如果随着时间的推移失去了很多这些周细胞，那么血管就无法收缩和自我调节了。然后在眼睛里，临床上，我们最终会看到的是，我们可以通过所谓的ERG，即视网膜电图，进行一些功能测试，我们可以看到视网膜细胞的功能下降。所以它们只是代谢不健康。

然后我们能看到的第一个临床体征，比如我观察糖尿病患者的眼睛内部，通常是血管出现小的囊状突出或动脉瘤。因为血管壁现在变弱了。所以它们开始出现这种气球状的突出，最终开始破裂。然后我们看到眼睛内部出血，要么是血液积聚。我们甚至可以看到脂肪沉积或我们称之为渗出物的东西在眼睛内部积聚。严重的后果不仅仅是缺血。血液没有到达它需要到达的地方。所以现在正确的组织缺氧了。所以开始出现视网膜细胞和神经节细胞的死亡。然后眼睛内部可能会开始形成新的血管，因为存在这种缺血，细胞正在死亡，开始释放这些叫做VEGF或血管内皮生长因子的标记物，这些标记物会发出信号，让这些新的血管在眼睛内部生长，就像在说，我需要营养，把那些血管带到这里来。但是新的血管非常脆弱。所以它们要么更容易出血，要么更容易在眼睛内部渗漏液体，或者它们可能会开始导致疤痕形成。基本上，渗入眼睛的新液体开始收缩，眼睛内部就会形成疤痕，从而导致视网膜脱离。然后还可能出现更严重的青光眼问题。

糖尿病会引发很多问题。所以对于有患糖尿病风险的人来说，如果是糖尿病前期或者已经患有糖尿病，不仅要尽一切可能改变生活方式，而且要做到这一点，这很重要。改变饮食、运动、服药、减肥，尽可能地使其缓解。但一定要至少每年去看一次眼科医生，这样我们就可以检查并了解眼睛的情况，因为我们确实有治疗方法可以阻止许多这些疾病的发生。

主持人： 我想我听说过当被诊断出患有糖尿病时，会接受强制性的眼部检查或其他检查。

嘉宾： 现在这被认为是强制性的建议。不幸的是，昨天我有一个病人，他甚至承认一旦被诊断出来，他就一直忽视照顾自己。他从未做过眼部检查。他昨天才来，因为周末，他的右眼突然失明，这吓坏了他。所以他来了，不幸的是，他正处于严重的增殖期，新的血管正在眼睛内部渗漏，他的一根血管破裂了，现在他的眼睛内部有大量出血，他看不清东西了。所以在他的案例中，他知道自己麻痹大意了。忽视了。我为他感到难过，但是，谢天谢地他来了，我们可以帮助他，希望他以后能走上更好的轨道。

主持人： 我们来谈谈眼镜吧。通常，我不知道，也许是我的印象，但通常人们不想戴眼镜，或者他们有点犹豫是否开始使用眼镜。当眼部健康恶化时，当比如说你的视力略有下降时，开始戴眼镜是否更健康？或者即使你的视力比以前差了10%，不戴眼镜也可以吗？所以，我想问题是，一旦你的眼部健康已经出现一些下降，如果你不戴眼镜，你的视力下降速度是否会更快，还是说没关系？

嘉宾： 所以，是的，这是另一个有趣的问题。我想很大程度上取决于你的年龄。例如，如果你是父母，如果父母正在听这个，孩子们，他们的大脑仍在发育。而且，随着孩子们进入青春期并开始经历生长突增，眼睛也仍在随着身体一起生长。所以事实上，对于近视的孩子来说，戴眼镜、戴隐形眼镜，或者用其他方法矫正他们的视力，不仅是为了让他们看得最清楚，从而在学校表现良好，也因为至少有两项研究表明，戴矫正眼镜的孩子，实际上会减缓他们的近视发展或他们对眼镜度数加深的需求。实际上，这会减缓近视的发展，而同龄不戴眼镜的孩子近视发展速度更快。关于近视，具体来说，有很多细微之处。另一个方面是，你希望年幼的孩子在早期就能有正常的大脑发育，从而能够欣赏清晰的视觉。因此，让孩子佩戴矫正眼镜并且是完全矫正的，对于正常的大NB发育也非常重要。否则，你的大NB可能会选择不发展出良好的细胞来欣赏良好的视觉。我们称之为弱视，或者有些孩子，你会听到“懒惰眼”这个词。这可能会发生。作为一个成年人，比如你和我，如果我们选择不戴眼镜，它不太可能发展得更快或恶化，如果我们选择不戴它们，因为此时眼睛的大部分解剖结构已经基本定型了。但是，比如，25岁以后，通常情况会进展缓慢。在眼镜度数等方面不会有太大变化。有一小部分，大约10%的人，可能会继续发展。但是，大部分只是生活质量的问题。比如如果你戴眼镜或隐形眼镜能看得更清楚，你为什么不想看得更清楚呢？这不一定会让情况变得更糟。我想很多人都有这种看法，哦，好吧，我看到东西有点模糊，但我开始戴眼镜了。眼镜有帮助，但现在他们摘下眼镜。一切都变得更糟了。这并不是说你的眼睛真的变糟了。而是你的感知，你戴眼镜和不戴眼镜之间的比较差异变得更加明显，所以这，再次强调，这并不是眼睛的生理变化，更多的是一种心理上的感知。

主持人： 我小时候，我的父母和其他人告诉我，不要透过眼镜看东西，那些其他的眼镜，因为那样你的视力实际上会变得更差。如果你戴你奶奶的眼镜，它们会非常模糊。但是，那实际上会使你自己的眼睛变得更差。这其中可能有一些道理。当然，如果你戴着别人的眼镜，你戴的度数不对。你最终可能会迫使你的眼部肌肉比平时更努力地工作，然后这会改变你眼睛的姿势以及你使用这些肌肉的方式，但更重要的是，我们确实知道，旧款眼镜镜片的设计方式，存在一种现象，即光线会聚焦在周边视网膜上。这会发出一种叫做远视性离焦的信号。它以某种方式与大脑和眼睛沟通，使眼球变长。所以这还没有完全被理解。这只是近视发展过程中的一个方面，但这就是为什么现在你会看到为儿童设计的新款眼镜镜片，以及一些隐形眼镜，它们旨在消除这种由眼镜引起的变形。通过新的设计，可以将近视发展速度减缓高达约50%。所以，取决于你住在哪里以及这些设备是否可用，比如在美国，这些眼镜还没有上市，因为它们仍在进行试验。但在其他一些地方，比如加拿大和欧洲，这些镜片已经上市一段时间了，它们可以帮助减缓儿童的近视发展。

主持人： 有趣。隐形眼镜和框架眼镜在健康方面有什么区别吗？

嘉宾： 哦，是的。另一个好问题。所以隐形眼镜最大的问题就是感染的风险。特别是对于那些戴着隐形眼镜睡觉的人来说，感染的风险要高得多。隐形眼镜也会变干。它们会吸收泪液，然后泪液蒸发得更快。所以干眼症以及隐形眼镜意识和刺激的发生率更高。有一些证据表明隐形眼镜如果长时间佩戴，并且取决于你佩戴的镜片类型，也可能压迫眼角膜，并导致角膜神经的一些脱敏，这可能会改变你身体调节泪液分泌的能力，并可能导致神经营养性或所谓的神经性角膜炎问题。所以确实发生过这样的病例。我想总的来说，只要你有良好的卫生习惯并且不戴着隐形眼镜睡觉，大多数人认为隐形眼镜是相当安全的。但是业内一些专业人士担心佩戴隐形眼镜本身，仅仅因为干眼症的风险增加以及晚年干眼症的长期后果。

主持人： 那么LASIK手术呢？我想这是一个非常受欢迎的问题。它显然不是永久性的，还是？

嘉宾： 是的，所以具体到LASIK手术，比如他们会从你的眼睛里移除组织，而那些组织就永远消失了。所以这是手术的一部分，是的，LASIK是永久性的，但你的视力仍然会随着年龄的增长而改变，尤其是在你40多岁及以后。再次强调，眼睛内部的晶状体正在变大并开始晶状化。当它晶状化时，光线通过眼睛内部的晶状体的方式会发生改变。所以你的处方和对眼镜的需求可能会开始发生变化。所以，这就是LASIK残酷的真相。它被认为是基本安全的。我知道人们会在网上看到一些关于一些人不幸在LASIK手术后自杀的事情。其中很多是由于愈合情况不佳以及干眼症造成的。LASIK手术特别会在手术过程中切断眼球表面更多的神经，这些神经随后必须重新生长。在大多数情况下，比如99%的情况下，人们愈合得很好。术后确实会出现一些干眼症，通常在三到六个月内会消退。但对于一些人来说，如果神经没有正确地重新生长，或者如果他们在手术前就已经存在干眼症，那么干燥、疼痛、便秘等症状可能是有害的。它可能导致视力模糊、眩光、光晕，但是，那些不幸的少数人，通常引用的比例不到1%。有些人因此出现了严重的问题。而那些预后最差的人总是声音最大的人。但我接触过的绝大多数做过LASIK手术的人，通常都说他们很喜欢，它改变了他们的生活，他们会毫不犹豫地再做一次。所以，谢天谢地，临床试验确实表明它仍然是安全的。我想只是作为一个行业，我们需要非常谨慎地判断哪些人有风险，哪些人在我们送他们去做手术之前有更严重的干眼症问题。

主持人： 去年，Mr. Beast有一个视频，他为这些盲人支付了手术费用，然后他们就能看见了，我不知道具体是什么类型的手术，但是通过一些手术治愈失明是可能的吗？

嘉宾： 是的。所以Mr. Beast做的具体是关于白内障的手术，而白内障是头号，全球范围内，如果你看世界上视力丧失的头号原因，那就是白内障。好消息是，白内障是什么，对于那些不知道的人来说，就像我一直说的，在你40多岁、50多岁及以后，眼睛内部的晶状体开始晶状化。当你还那么年轻的时候，晶状体通常还是透明的。就像它是一个透明的眼睛内部，就像你的眼镜镜片是透明的一样。但是随着年龄的继续增长，晶状体会氧化并开始变成黄色，最终甚至变成白色，在某些情况下甚至变成深棕色。所以我见过，我在世界一些地方做过医疗援助。而且你会看到一些80多岁的人，他们从未做过白内障手术，他们眼睛里的晶状体非常大，像弹珠一样，而且会是咖啡棕色的。他们看不清东西。所以白内障手术，他们可以进去，然后使用一种叫做超声乳化术的工具。这是今天的一个有趣的词。但它使用超声波来粉碎眼睛内部的这个晶状体。就像把一个玻璃弹珠粉碎成灰尘颗粒一样。然后他们用真空吸出这些颗粒。然后他们会在眼睛内部植入一个新的塑料人工晶体，他们会测量并考虑到任何对眼镜的需求，并尝试将其植入人工晶体中。所以之后你又能透过透明的晶体看东西了。而且在很多情况下，人们不再那么依赖眼镜了。这几乎就像同时做了LASIK手术一样。所以谢天谢地我们有这种手术。它只需要大约10到15分钟就能完成。它被认为是已发明的最成功的手术之一。缺点是在世界某些地区，人们无法获得医疗保健或眼科护理，视力丧失是其后果之一。

主持人： 这非常有趣。未来，我们是否能够进行某种类型的手术或眼部植入，比如像半机械人那样的眼睛，那会给你完美的视力，或者也许还能增强它，比如能够放大之类的。因为人类，我们的眼睛相当好。我们相当依赖视觉。比如我们的视觉系统相当好，但显然不如鹰或隼之类的动物那么好。能不能像使用某种电子眼或其他方法来增强我们的视力？我知道有人在谈论这个。

嘉宾： 我知道有一些公司一直在研究这个问题，特别是在白内障手术的植入物方面。我想他们目前确实遇到了一些技术障碍。比如如果他们确实有放大的能力，那就需要某种电荷。或者它需要眼睛内部晶状体的某种机械运动。这意味着它可能需要某种电池电容器。然后你怎么给眼睛充电呢？你可能得戴着某种充电护目镜睡觉，它会产生电磁场来给它充电。然后这些能持续多久？如果它们坏了怎么办？我想有很多只是技术上的事情需要发生。所以我们可能，谁知道人工智能会发展成什么样，但我们可能离那一步还有四五十年。我知道有一些隐形眼镜公司正在研发增强现实隐形眼镜。增强现实眼镜也是如此。我认为这不仅在目前已存在的一些增强现实眼镜的掌握之中，而且在未来10年内，我们会看到这项技术的应用得到改善。所以我认为这将非常真实，甚至即使你不需要眼镜来看得更清楚，你也会拥有一副看起来正常的薄眼镜，它基本上会在你的眼前有一个数字屏幕，你不仅能看到短信和电子邮件通知，而且当你环顾房间时，它会突出显示你冰箱里的食物，并告诉你通过混合这些不同的配料可以做什么类型的食谱。你开车在路上，它会告诉你，左转，右转。这是你的速度。就像视频游戏一样的平视显示器。而且它也许还能放大远处的物体，并在你的自然眼前放大显示。我想，我想这会有很多应用。而且我认为这更现实，再次强调，可能在未来五到十年内。

主持人： 是的，感觉就像关于眼睛，我们将能够达到这样一个技术水平，我们几乎能够治愈所有失明和所有眼疾。至少，这是我的印象。因为如果我们已经能够做这些10分钟的手术来治愈白内障导致的失明，那么，几十年后，我想它看起来会是这样发展的。

嘉宾： 天哪，我希望如此。所以大约两年前，我们完成了第一例完整的全眼移植手术。眼睛没有功能，但眼睛有其自身的特殊免疫系统。然后将眼球重新连接到新人的头部，将其连接到他们的视神经，所以眼睛不仅不恶化并且不被排斥是一个巨大的成就。但是对于这个人来说，他们可以测量并看到有电信号从这个捐赠的眼睛输入到接受者的大脑。但是接受者并没有因此获得功能性视力。但仅仅是完成，我们实际上获得了一只眼睛和一种技术，让眼睛连接到身体并且不被排斥。这本身就是一个巨大的壮举。显然，我们还有很长的路要走。但这是眼科领域刚刚发生的一个相当大的里程碑式新闻。

主持人： 这非常有趣。在我们结束之前，还有什么我们没有涉及到的，人们应该知道的关于改善他们眼睛健康的具体或特殊的事情吗？是他们应该做的事情还是应该避免的事情，或者类似的事情？

嘉宾： 我的眼部健康日常护理不仅仅是每年做一次眼部检查。正如我们一直在谈论的，我也吃得很健康。我尝试服用一些补充剂来保护我的眼睛和视力健康。我现在正在尝试红光疗法。我们仍然没有完全确定它的效果。太阳镜，我们提到了，我认为这很重要。然后就是休息。尤其是对于年幼的孩子，要意识到长时间使用近距离设备，虽然我们希望孩子接受良好的教育，但我们确实需要让他们尽量多花时间在户外。眼睛和大脑之间存在某种我们尚未完全理解的交流方式。但我们知道，每天在户外待大约一个半到两个小时的孩子，会产生一种平衡效应，可以抵消许多导致近视发展问题的因素。所以，对于来诊所的家庭，我都会建议他们，并努力鼓励他们多进行户外活动。

主持人： 有趣。很高兴进行这次讨论，眼睛被严重低估了，而且对于生活质量非常重要。在我问最后一个问题之前，人们可以在哪里了解更多关于你和你的工作的信息？

嘉宾： 谢谢你。当然，我所有在线教育的使命都是通过艾伦医生眼健康YouTube频道。我提供各种方面的教育，无论是眼镜、隐形眼镜、手术，还是很多疾病教育，以及你可以通过生活方式做的事情。我也会在其他频道发布内容，同样是以艾伦医生眼健康的名义。所以任何对眼睛好奇，想了解更多的人，一定要去看看那些频道，并通过那里联系我。

主持人： 我们会把链接放在节目介绍里。我的最后一个问题是，有没有一件你希望自己早点养成的建议或习惯？

嘉宾： 睡眠。我认为我一生中忽视最多的习惯就是我从未尊重过我的睡眠。当然，在我成长过程中，我经常熬夜到凌晨三点玩电子游戏，我的高中甚至大学的一些学业，我想会好得多。我是个好学生，但是，我想我在很多不同方面的表现，身体上，精神上，学业上，如果我能有规律的睡眠，都会提高十倍。而且，当我上验光学校的时候，我想那是我的超能力，因为我把它放在了优先位置。不幸的是，当你进入像医疗保健领域的住院医师培训这样的阶段时，他们根本不在乎你的睡眠。所以我想随着年龄的增长，过了验光学校之后，我失去了很多规律的睡眠习惯。现在我正努力再次把它放在优先位置。而且它确实影响我的身体健康。它影响我的情绪。它影响我的心智能力，我的工作效率。所以这是我正尽力优先考虑的事情。

主持人： 是的，这是一个重要的提示，而且非常普遍，很常见。谢谢你来到播客。很高兴和你交谈。

嘉宾： 谢谢你。我很感激。

主持人： 好的，本期节目就到这里。请务必在亚马逊上查看我的新书《长寿的飞跃》。如果您能将本期节目分享给朋友或家人，我也会非常感激。除此之外，我叫Seem。敬请期待下一期节目。保持强大。

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Edit:2025.05.13

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