#823: Dr. Jeffrey Goldberg — Creating Supranormal Vision, Cutting-Edge Science for Eye Health, Supplements, Red Light Therapy, and The Future of Eyesight Restoration

Transcript from https://podmenti.com/t/f94df0274d0ee228

Hello, boys and girls, ladies and germs. This is Tim Ferris. Welcome to another episode of the Tim Ferris Show. This episode is deeply personal because as someone who is now in his late 40s, my eyes have started to go for the first time. I've always had 2010 vision, and this is unacceptable for me. So
I spoke to everyone I knew and good old Andrew Huberman saw a post that I put up
Texted me, said the person you need to talk to is Dr. Jeffrey Goldberg. So guess who my guest is today? Dr. Jeffrey Goldberg, professor and chair of ophthalmology and director of the Buyer's Eye Institute at Stanford University. He has a wide breadth.
of expertise. He is a leading scientist in the development and degeneration of the visual system from eye to brain, and there are interventions depending on where you want to go at many points along that chain, although it's more of a network, I guess. And a practicing ophthalmologist and surgeon. We dive into all sorts of stuff in this episode, ranging from
Super performance or super normal performance, let's just say for professional athletes, if you want to take your vision from normal or pretty good to
Unbelievably good.
For say competitive purposes, we talk about that. And we also talk about repair and slowing the degeneration of the eye, which naturally comes with age. Dr. Goldberg's research is directed at vision restoration, including neuroprotection and regeneration of the retina and optic nerve, a major unmet need in glaucoma.
and other eye diseases. And we'll define all of these terms in the conversation. So don't worry. His laboratory is developing novel molecular stem cell and nanotherapeutics approaches for eye repair and he is widely recognized for translating advances in the lab into clinical trials.
for patients. So from bench to bedside in some respect. And I really enjoyed this conversation. I took a lot of notes. There's a lot of actionable detail. So we'll dive right into the conversation, but first just a few words from the people who make this podcast possible.
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Okay.
Optimal minimal.
At this altitude, I can run flat out for a half mile before my hands start shaking. And then also the personal question.
No se...
A cybernetic organism, living tissue over metal mental skeleton.
So
Doctor Jeffrey Goldberg. So nice to meet you. Thanks for making the time.
Absolutely. Thanks for having me on. I'm really looking forward to it.
I have so many questions for you, and as usual, I'm scratching my own itch. This is going to be a selfish conversation for
Yours truly in some respects because
The way this whole thing came about is I put up a post on social media asking for cutting edge technologies or treatments related to presbyopia.

Which
For those who don't recognize the term is a very fancy way of saying
Age related visual decline. If you're a word nerd like I am, Presbyterian, similar etymology.
leadership of the elders. And I have noticed in the last year that my
near work, my near vision has started to falter.
Looking at
books, looking at my iPhone, looking at supplement bottles. And this has led to somewhat of a
cris of meaning for me because I have
had my identity based on in some respects very, very good eyesight and visual acuity for my entire life.
And Andre Huberman, mutual friend of ours.
Texted me and said
I know the guy.
And listen to our interview, which I did.
And
For that reason, we're gonna go all over the place, but I thought we would start
Where I had to start, which is supra normal visual performance.
And these are the notes I scribbled down from your conversation with Andrew. I I recommend everyone listen to it. Goggles that reduce frame rate for basketball.
And that was sort of left hanging a little bit. You guys didn't do a deep dive on it, so I wanna start right there.
Because of course there's
Preventing decline.
There's maybe a restoring function, and then there's going further.

And taking things as far as you can. And nowhere are the stakes.
higher and the rewards greater, perhaps, than in professional sports. So could you take that and run with it in any way that makes sense?
Yeah, Presbyope vision of the old. So I'll tell you just uh funny side note. You know, we all get that. I like you have
gone my whole life without needing glasses until I hit around age forty. And when everyone hits around age forty
our uh lens inside the eye
Вонт компрессин решта фокус.
Up close. So your distance vision might still be great, but you just can't bring that focus in as tight.
And
I discovered it accidentally in myself because I was actually like in my house and someone I I found a pair of glass in a closet. Like somebody must have left them there. I see readers. And I was we couldn't figure out who they were. We're calling around, friends and family, fine.
Nobody's claiming'em and then one day I just put'em on like, Well, let's see how I look in glasses.
And I look down at my phone and I'm like Oh my God, wait a second. I can see a lot.
Better with these readers gone. And then once you do it, you're addicted. Good vision is pretty addicting, right?
Yeah, for sure.
Yeah, so now I'm in them too, and uh, you know
I'm pretending to look so young with you not wearing them right now, but here they are, just in case.


Yeah.
Very common. It raises a really cool question that you're raising, which is
You know, like as an eye doctor, I spent a lot of time and as a researcher spent a lot of time, we could come back to talking about like how do we
prevent the sick from losing vision on all these big eye diseases. We could come back to that. But like there's a much
bigger world of people who have pretty good vision. Maybe they need glasses, but they've got good vision.
And how do we think about the difference not from
sick to normal, but how do we think about the difference from normal to super normal? And we know there's super normal.
Because when, for example, as you bring up professional athletes get studied.
They have better vision. They have better reflex time. They have sharper vision. You know, we talk about like 2020 vision. That means like
I can see at twenty feet what a quote normal person can see at twenty feet. So I have normal vision.
But you can have
twenty
12 vision, which means like you can see at twenty feet what normal people can see at twelve feet, right? You've got
better than normal. And it turns out like a lot of pro athletes have that.
And then the next question becomes, and you just kinda hinted at it right there.
Can we train
To supernormal vision? Can we like induce
And almost no one studies that, but
There are some really cool tools and toys that actually might have that effect. And so you brought up one of them.
So
We see like our coons inside of our eyes. You know, we've got rods and coons.
The cones, they've got a refresh rate.
You know, around thirty to sixty
frames per second, you know, kind of like our computer screens do, right?
And so if you actually subtract out a couple of frames, so if you put on some glasses.
That's
Dim.
One out of every thirtieth of a second.
Or they dim two out of every thirtieth of s or push it three.
And now you're giving up visual data.
And I throw a basketball at you.
If you've got your regular vision, you'll catch it.
But if I'm only giving you ninety percent of your vision or eighty percent or seventy or sixty percent of that vision.
You might miss the ball.
Right?
But if we practiced
And trained in those goggles.
Where you've got to play basketball, throw and catch, shoot, whatever.
You know, throw baseball back and forth.
At seventy percent vision.
And then we put you in the game back with a hundred percent vision, right? You're gonna be like better, faster, reflex time.
All of that, like anti-coordination.
So it's actually like some of these super normal visual tactics are actually trainable and there's tools that athletes are using, but they're accessible to all of us. Yeah.
You can grab one of those, Tim. Let's dig into this a little bit. I have a number of friends who have engineering shops and have played with sensory substitution experiments and all sorts of wild stuff. In fact, I think there's some folks at Stanford who uh David Eagelman comes to mind who've developed
tools along these lines. We won't go down that route. Let me stick with vision for a second and
Just note that there are, for instance, indigenous groups in various parts of the Amazon. I've seen them in Brazil and in Peru as well.
Which use eye drops.
Of various types.
could be from a plant, could be from a toad for improving not near
work, but distance work. So let's just say using most of them use shotguns these days, but stums still use blow guns and
Bone arrows for hunting save monkeys. Right. So
There seems to be something to it. Now you could say, ah, that's a bunch of voodoo hoodoo nonsense, but then you have eye drops for
as I understand it, temporarily inducing
More
This isn't gonna be the right term, but flexibility in the lens. I think is it pylocarpen?
It's actually the iris. Yeah. Yeah. So iris are using in the plants.
Bye.
We now have
FDA approved eye drops. And what they actually do is they bring your
pupil size down by having your iris constrict to a smaller circle.
And it turns out that if you have
refractive error. So you need glasses. You know the shape of the front of your eye, the shape of your lens isn't perfect.
You have a little bit of glasses or contacts or whatever to correct that, including if it's not focusing up to close.
You could have reading glasses that
Change that.
refractive, you know, that light coming into your eye so that you're focusing up it close.
If you
Come down to a pinhole.
You actually kinda normalize the light so that it's as if it's all coming from infinity and you actually kinda correct refractive error. One of the ways we can tell if someone needs glasses is we have you read the eye chart.
And then we have you read the eye chart through a little pinhole, you know, a little device you stick in front of that eye and read through a pinhole. And if you can read better through the pinhole,
You actually have better vision and could correct it with glasses.
So now we could just give an eye drop that kind of makes your pupil closer to a pinhole.
And then
It allows you to see without glasses, near or far. And in fact
People are
kinda using it now for near vision for that presbyopia you were talking about in the beginning.
So
for people listening and also for me, frankly, could you just give a
vision one oh one and in this case let's focus on the eye just so people understand the basic components
Of the eye. And part of the reason I want to explore this is
There are different levers you might be able to pull on to improve.
vision some of which might be
structurally related, but not all, at least to the eye. But could you just lay out the basic
Anatomy of the eye, the architecture.
Yeah, absolutely. So light comes in the front, goes through the clear window in the front of our eye called the cornea.
You can have
Corneal diseases, obviously that
block that light from coming through clearly, but if it's healthy, that light comes through clearly. The cornea is curved on the front.
And that curvature is actually responsible for curving most of the light into the back of the eye.
Then the light goes through your pupil. So that's the iris, which is
Brown and me, but brown, blue, hazel. So that's our iris. And the iris can open and close like we were talking about a minute ago. Comes through the middle of that, the open middle part of that, goes through the lens.
The lens is like
does fine focusing, you know, a little focusing from far to near, that kind of thing.
That's what we were saying stiffens as we age. So we can't go far to near as well as we get older kind of passing forty years old typically.
And then it goes through the
gelatinous middle part of the eye. We call it the vitreous. After the lens is called the vitreous.
That's where floaters are. People who get floaters
They're floating it's like little concretions of proteins and stuff floating in the vitreous.
It's a gel. As we get older, that gel turns to water, sh kind of shrinks up.
R I doesn't shrink'cause it fills in with, you know, salt water, but
The gel shrinks up.
And then the light hits the retina.
And our retinas are what we call inverted.
So the light actually passes
Through almost all of the retina.
And then it hits the rods and the cones.
And those are the photoreceptors. They absorb the light, like the photons of light, the rods.
are really only good for nighttime vision. They're only good at like very low light.
If you go into normal daytime vision sitting here in the room, whatever.
Those are getting bleached out. You're not really using your rods too much.
And next to them the cones. Cones are great for color vision.
They're great for bright lights.
They're what we use most of the day. That's what you and I are using mainly right now.
The rods and the cunts collect all that light.
They
Process it and transmography it into electrical signals.
And those electrical signals are then propagated back forward through the retina.
There's some internal processing layers in the retina. So it's not just a layer of film. You're actually doing some computation right there in the retina. And then they hit what are called retinal ganglion cells.
And those are the cells that then send a process across the surface of the retina. It's an axon, but it's like a telephone wire. And that then goes back out the back of the eye.
into what we call the optic nerve.
And that optic nerve connects the eye to the brain. So those retinal ganglion cells are collecting all the data.
And sending it all back through the optic nerve to the brain. And then of course the rest of that processing is happening in the brain.
There we go. That was a great summary. Thank you very much. And
I'll tell folks if you thought that is a lot to remember, it is a lot to remember, but the point of it is
As I as my own N of one.
I'm trying to consider
Different path forward.
with prisbiopia. Whether it's glasses, yes, my readers do fix the problem.
Right, they do fix the problem, but I am a little concerned of increased dependency and then increased magnification over time. I know there are arguments for and maybe some arguments against, but when I put up my social post, and I think people can
Identify with this.
There was a lot of noise.
There were some of the most harebranded, insane, certainly potentially dangerous suggestions you can imagine.
And uh
Then there were a few things that came up when I reached out to uh let me get this right, is it uh vitrinal surgeon and researcher.
who I happen to know, and he sent me a number of white papers, or I shouldn't say white papers, more so studies and meta analyses and so on that I read up on and I thought to myself,
Look at that.
Surprise of surprises, a few of the things that came up repeatedly in the hundreds of responses to my post actually show up in the literature and there might be something to them. And we'll definitely come to a number of those.
But it can be very overwhelming for people to try to figure out what to do next. And the reason I wanted you to do that recap, and then I'll stop giving
My second TED talk of our conversation is that
Much like if someone complains of, say, brain fog and fatigue.
A rose is a rose is is a rose is not a rose in the sense that there can be many different
factors and independent variables that contribute to that. So one person might have insulin insensitivity and trouble with glucose disposal. Somebody else might have Lyme disease or some infectious disease that is contributing to metabolic dysfunction. I mean there's so many different
contributing factors that it helps to, I think, get a little
Thinly sliced. So in my case, I have the stiffening of the lens. Please correct my terminology. I also have a really pretty sizable. I had never seen it before I did some
Really
Impressive imaging on the eye, but a huge nevus on the back of my right eye that I need to keep an eye on. So I'll be following up on that in three or four months. But
I wanted to I suppose start with what are other ways
to improve vision. Now there's certain things I'm always looking for.
limited downside potential upside. So for instance, I'm taking the A Reds to supplement.
with lutein and various other ingredients in it.
I would say it's probably not gonna help, but within my patient cohort of the the medical practices I work with, there are a few folks who claimed after six weeks that their vision really improved and they didn't need their readers, even though technically
Mechanistically.
The Air It's too shouldn't have helped them. So whether it's placebo effect or not.
Interesting outcome. I know the plural of anecdote is not data, but I was like, ah, okay, sure, I'll take the supplement. What are some other sort of cutting edge treatments or augmentations?
for improving vision. And I'll shut up in a second, but I've been very excited to talk to you. So I'm like a chopping at the bit here.
Because as you mentioned, I mean, there's this sort of I architecture brain interface.
And among professional athletes, just because I've funded a lot of science in this area.
Low dose psychedelics also seem to improve visual acuity. So everyone from Aaron Rodgers.
to very, very high level athletes that I will not dox here.
report measurable performance improvements.
that they attribute to increased visual acuity. It's probably not changing the anatomy of the eye. So what's going on?
So I would just love you speak to
Any other means of
Supercharging.
Visual perception.
There are some things that we
Have a pretty decent sense on
Arids two and some of these supplements. You know, first of all, like eating a lot of carrots is probably not gonna actually, you know. So great childhood. Get the kids to eat their vegetables. We definitely exercise that ourselves as parents, but Arids Two.
Clinically proven if you have moderate age related macular degeneration.
To slow down your vision loss.
Does that mean it doesn't work at all if you have mild age related macular degeneration or if you have no age related macular degeneration? It might just be like we haven't done a study big enough to detect those effects. And
As you say, like that's probably not gonna hurt. So, you know, feel free if you want. We can't prove it's helping, but feel free. There are other supplements that have, you know, received some study that
maybe suggest there isn't much going on there that again, probably not gonna hurt.
Some patients take CoQ ten, some patients take ginkgo.
There's actually maybe the hottest topic in supplement vitamin space right now internationally is actually vitamin B three.
Nicotinamide, which has you know really been linked to a number of good potential, you know, kind of medical uses and is receiving a lot of study. There's actually
International clinical trials, including one here in the US, actually testing whether it could
Restore vision in certain eye diseases like glaucoma, which is my specialty.
So definitely some hints in that direction. We already talked about some device elements.
And I think between
vision training like we talked about earlier and also visual augmentation. We're moving into augmented reality. And so training vision and visual reflex time.
almost certainly makes a difference in the activities you're training in.
If you're training in basketball, will it also help you doing some weekend surfing? I don't know, but definitely can help move you from normal to super normal or help enhance, improve what you're doing. And then
There's all sorts of stuff that
I'm gonna be honest, Tim.
We don't know.
Because A, it's kind of really new, really hot right now, like microdosing certain psychedelics things like that.
That we know act.
on the nervous system, including the brain.
But
The retina in the back of the eye and the optic nerve that connects the retina to the brain
Those are developmentally
An outgrowth from the brain. They are part of the brain, they are part of the central nervous system.
And
We
barely know about how to influence the wiring
The plasticity
Are there drugs that we can give, you know, a lot of people have talked about gabapentin, drugs in that space, obviously micro dosing and LSD is a really hot area right now for like inducing plasticity. We actually
There's like actually great science showing in animal models and a little bit now in humans that you can actually reopen.
Brain plasticity.
By using some of these, you know, dosing some of these drugs at appropriate doses. Obviously we've got to be careful. We don't know what the right dose is. Yeah.
But it's really worth looking at because
There's clear evidence that these are relevant.
And you know, likely to have some effects. We just got to figure out, you know, a little bit more like how, what's the right dose. By the way, when you're doing it.
Should you be doing some behavioral training like visual training? But these things act on the brain. And about a third of our brain.
Inside our skull.
Is dedicated to processing vision.
Yeah, there's a lot there.
All right. I've been so excited I'm not just overcaeinated because I'm actually not really caffeinated. I might be over ketone. I have quite a bit of ketone monitor in me at the moment, but putting that aside.
I am right now
And this could
Make me seem like I'm in the tin foil.
Hat we're in crowd, but I had a number of companies out to me.
Not surprising after I put up my social posts. Most of them didn't make any sense. A few of them seemed to make sense, and the people involved seemed to have technical chops and also some pretty credible research backgrounds.
And I'm not gonna name the company yet, because I'm not
done with my personal testing, but I have been testing at about eight minutes a day.
I don't know the right descriptor to use. I would say
Maybe visual perception training.
To distinguish it from, and we can talk about this, what I suppose some ophthalmologists or optometrists might call visual education, right? So trying to improve the ciliary
muscle strength and so on around the eyes, much like if people are want a visual sort of the
springs around a trampoline. But in this case, it's very quick flash.
of blurry or not blurry circles and you need to identify what is more blurred.
And there are many permutations. It adapts.
to your successes and failures over time. And
It could absolutely be placebo, but
After about you know a month now of using it, I feel like
My
Your vision has improved.
Even the woman I'm dating has commented on this.
And I'm still waiting. The jury is out. But this is just to say that I'd love to know what you think of visual improvement that is not dependent on surgery.
Or
Drops.
Is there something to the various types of visual education? Is there something there?
Or not.
And then
when we go maybe upstream a bit, if that's the right phrasing to use to the brain.
Are there interesting approaches like limiting the frame rate?
Or removing a number of frames.
that you think are at least plausibly interesting for enhancing performance.
First of all, absolutely. And it and it does get back to that idea of like visual training.
Reducing frame rate.
Training on visual perception
There's actually a fair amount of data. Actually there's enough data to even say like
There's elements that make it better. For example
If you do visual training where you're just showing
yourself, you know, like being shown.
These different objects, maybe they're getting smaller, dimmer, blurrier, et cetera.

Your ability to train off of that.
is significantly better.
If it demands a behavioral outcome, a motor action.
So for example, you've got to point at the right one or or choose something. And it's not just that you're mentally thinking that was the sharper image.
It's actually the motor output of pushing a button or pointing at something or doing an activity.
That actually reinforces
The visual perception training
So that's one great example. Another great example is after concussion. So concussion, traumatic brain injury, of course, very common in
Athletes because they're more likely to get into the you know head bumps and things like that. But happens all the time in kids. Military. Very big military, very, very big issue. And the line in between mild concussion, severe concussion, traumatic brain injury, that's all on a spectrum, a continuum.
And
There's actually decent data from that.
group of people.
that if you get a concussion, actually visual symptoms are some of the
More significant symptoms, you know, ability to focus, ability to sleep and vision are three of the
big symptoms that people get in that concussion through TBI.
Spectrum.
And those can be debilitating, right? And kids are out of school, they're missing high school, you know, for weeks or longer. It can be really debilitating. Obviously, if you're older adult and you're in your job situation.
Really tough.
And it turns out though that there are
visual perception exercises that you can put patients through in those situations.
That
In the limited clinical studies that have been done, point to
A positive effect of basically rehabbing, like neural rehabbing you back.
Now that of course is back from injured to normal, but the idea that that can also induce the same kind of plastic remodel in our eye and brain, and particularly the eye brain connection.
Yeah.
Patients who are starting from normal and trying to get themselves up to super normal.
Try to improve performance візуал performance.
We've set up here a whole human performance laboratory really just to study.
These questions.
And
The data roll in look, you know, make it look like, hey, there's something here. This is definitely worth chasing.
What can someone search if they want to find it
something to read up on related to the concussion rehabilitation protocol because this type of visual training because there's a lot of

nonsense floating around and charlatans out there. Any particular search terms or principal investigators or anything that people can search?
I would say like, you know, if you want to sort of like at least hit some of the
science or science adjacent web resources, you're gonna want to use a few technical terms in there like concussion.
Neurorehab, neurorehabilitation, plasticity.
And then some of the terms you've already been using, you know, visual perception exercises.
And then
Look, in these situations you've got to look not just to the content, but of the source, right? And so is this like
A dude on his blog, or is this
coming from a foundation or an institute or one of the academic centers or some of the choices like that.

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Alright, Jeff, I would love to hop to another set of interventions and this is in the
Device category.
Red light in the morning for mitochondrial health question mark. Violet light to reduce progression of nearsightedness in children.
Is there
An application.
of red light or violet light. To what extent do we have supporting data?
for using either of these? Do we have an idea of what best practices look like? Is it only for people with a disease state, or can they be potentially used
to preserve vision before
Vision loss.
The disease state data is pretty good and also
The myopia control is pretty good data too.
Just for a definition of for folks, what's myopia?
Myopia is nearsightedness, and you know, it's an epidemic.
More common in Asians or people of Asian heritage.
But common in everyone. And kids can get nearsighted. If you're a little nearsighted, it might be annoying to wear glasses. If you get more severely nearsighted, it actually can lead to all sorts of problems inside the eye, you know, real severe vision loss even early in life.
So that's a big one. And then
What was really shocking was it turns out that a small dose
Of Daily Red Light.
Can
Slow down progression of myopia in young people, you know, we're talking about teens and younger even.
So
What's even more shocking to me is that it also works.
With violet light. So how does it work with light at the two ends of the visible spectrum? And definitely mitochondria are implicated. Mitochondria are the little like kind of powerhouses, energy sources inside the cell. They are
big player in converting the sugar a cell takes in into
Energy that the cell can use for all of the cellular processes our bodies.
clearly need functioning mitochondria. In fact, one of the big
features common across many
Neurodegenerative diseases of the eye and the brain is dysfunction of mitochondria. There's an FDA approved red light therapy for patients with macular degeneration, but
There's good data that it may also be supportive or protective in other eye diseases.
And we're talking in small doses, like this is not overwhelmingly bright lights. And we're talking about minutes a day. You don't have to sit in front of it for two hours a day. So minutes a day. So it's exciting. The
Data suggests that the mechanism of action is kind of giving a little protective booster shot to our mitochondria so that they don't get dysfunctional. Whether that's dysfunctional just from
normal use throughout the day or dysfunctional because you happen to have a disease that's getting in the way of those mitochondria?

Now we don't know what the right dose is, we don't know what the right brightness is.
All we know is that in these initial things that have been tested, the initial brightness of how and how many minutes, three minutes a day, for example.
There's a signal there.
There's something working there. Should we have everybody buying one on the internet right now, hopping on Amazon, spending twenty five bucks, spending three minutes a day? You know, we don't have the data to support that. Is it gonna hurt? Probably not.
You know, Tim, it's a problem because we've got so many things that are like, Oh, that looks promising, and we just
We need a little more science. We need a little more study.
Yeah, well, you know, a friend of mine wanted me to write a blog post about
Look, I'm not a doctor, I don't play one on the internet, but
The difference between sort of getting into science versus getting out of suffering.
In the sense that
You know and I know just having been involved with the funding side, like r randomized control trials are expensive and they take a long time.
But at the same time, if you take the advice of every wackadoodle running around on the internet, you're gonna have six hundred different interventions, some of which could do a lot of damage.
Or you're gonna get the wrong device. I've seen this also because I've talked about accelerated TMS.
And different types of brain stimulation for
Potentially.
addressing treatment resistant depression. And Nolan Williams at Stanford has done a lot of great res research related to that. And you see these people on YouTube with D I Y T M S.
And they've got the polarities reversed and I'm just like, oh my God, what are you doing? Your poor brain.
But I I also
want to preserve my vision as long as humanly possible.
And maybe you can dispel a concern that I have, and this is based on the fact that I have a lot of Alzheimer's and Parkinsons in my family.
And I'm able to three four some two point five times or so more likely to develop Alzheimer's based on what we currently think we know than someone who is, I guess, three three. And
It scares the hell out of me.
And
I've had conversations with audiologists who point out the correlation, I don't know how strong the signal is between hearing loss and onset or progression of dementia. Is there something similar for visual loss?
Absolutely. Actually, one of our faculty here has done some of the really foundational research showing that correlation between vision loss.
And cognitive decline. And
The loss of input again, vision is our
biggest input sense. It's driving, you know, a third of our brain is dedicated, as I said, to uh processing and using that vision and interfaces with every other thing that we do. It also is a
really critical piece around depression and mental health, anxiety is vision, you know, the work that Andy Huberman had done on visual fear and how that plays into the fear and anxieties as well as the depression pathways. And not only
Does visual decline accelerate cognitive decline? Possibly because in part because of
how depression then plays in with cognitive. I mean, these things are all clearly related to each other.
But also
Remarkably.
If you have low vision.
Let's say from something as simple and correctable.
As cataracts, a blurring of the lens that happens with age. If we all live to a hundred, we're all going to need cataract surgery, some people younger, some people older.
But if you
Do cataract surgery and restore vision.
in an older person who appears to be suffering, is suffering with cognitive decline.
And or depression.
You can reverse
A significant amount.
Of that decline in either of those domains. And so it just again it speaks to the interplay.
A vision.
With our mental health, our cognitive health.
This is long term important stuff.
Tell me if um
interpreting this the wrong way, but it seems like this would lead to a strong pro argument for wearing glasses instead of suffering in silence.
I don't know, but that's what I hear when I'm sort of trying to read between the lines.
There's an important myth to dispel, especially when it comes to presbyopi and wearing reading glasses.
Between age forty and around sixty or so.
That lens stiffens and stiffens and stiffens.
And the first year you only need plus one point two five glasses. And then three years later, they're like, ah, I need plus one point five, plus one fifties.
Few years after that, you're moving up to the two point oh's.
Eventually you'll peek out at around two point five or three point oh's'cause that's the difference, basically, that's the refractive the glasses difference between viewing something at infinity.
Which from an optics perspective is actually just kind of like three feet away or further.
And viewing something at fourteen inches, like comfortable reading distance right in front of us. So two point five to three
power of those readers is all you're gonna need. But
You're gonna
progress through those numbers, whether you're wear the readers or not.
So where are the readers?
I got it.
Is it a I a mistaken causality then where people
Yeah, because an optometrist said this to me a couple of weeks ago, and I was like, Well, I assume you know what the hell you're talking about, which is always a stupid assumption.
But that you develop increased dependents, but it's actually just tracking along with the natural stiffening of the lens. In the case of Presbyopia.
And it's psychological dependents. It's just like what I went through. As soon as I started wearing those readers by accident, I didn't think I needed them. I was still reading off my phone. It was fine.
But as soon as I experienced that extra crisp vision, I was like
Well, I like that.
Yeah. I got psychologically dependent because like who doesn't want their best vision?
Yeah, for sure.
And I'm gonna keep saying this, it's gonna get annoying because I'm like a sweaty palm fanboy, like jumping all over you. But I was very excited to chat with you also because I mean the nose, the eyes
These are sort of direct paths into the brain, in a sense. And for instance, I don't know, I don't expect you to track all things in all fields. That would be impossible, but
Cognito therapeutics.
It's a headset.
that is used and they have a lot of good data. I think they're either phase two or phase three.
They've raised a ton of money and it's a headset.
And they have
These visors covering the eyes and then

And it produces, I want to say, gamma waves in the brain.
There's more to it, but using flashing lights.
And this appears to, I'm gonna I'm getting into the sort of deep end of my ignorance pool here because I'm pulling from memory, but it appears to assist in the breakdown of
Beta amyloid plaque, maybe tau as well, I'm not really sure.
So using flashing light to help people with conditions like Alzheimer's, I mean it's kind of mind-boggling, I guess literally and metaphorically.
And that does come from credible researchers. I wish I could cite them offhand, but it's gonna take me too much time to find the scientists.
involved.
But that is one that appears to be
Ed Boyden and Lee Huite Sai.
out of MIT.
Yep, I know them both. Ed was a graduate student here at Stanford when I was at Stanford. Oh, yeah, yeah, yeah. So there you go. Are we gonna see more of these devices and how far away are they? Because I'm seeing decline in my near relatives. I'm currently taking care of two relatives with severe cognitive decline.
scares the hell out of me. And some of them are three three, by the way, and I'm three four, so I'm like
Good God. Okay, if there's anything I can do, and I'm already doing quite a few things, but are there other devices that are sort of on the cusp?
Of being available that you find interesting?
Yeah, I think so. And input through the visual system and output through the visual system are both looking really interesting these days. So you're talking about input, like what can we stick in through the visual system to influence the rest of our brain?
Brainwave activity.
plasticity like we were talking about before.
Help preventing cognitive decline. There is very strong data, for example.
That if you give the right amount
of electrical activity of our neurons in the eye and the brain. So the the neurons in the brain talk to each other through electrical activity like little wires.
And too much activity's bad. I mean really too much activity is
Epilepsy, for example.
Too little's clearly bad too. If you have a stroke, then you've got no electrical activity in that area of your brain and it's just not working anymore.
But providing like kind of that sweet spot in the middle of electrical activity.
In addition to it participating in the processing of whatever that area of the brain does, like in the retina, it's your vision, obviously. It also stimulates pathways like plasticity and responsiveness to the survival and growth factors. And we and others have shown that.
very clearly in animal research over the years.
that you need not just like the right growth factors circulating around in the brain, but you also need
The right levels of electrical activity so that the neurons are maximally responsive. Yeah, it's like weightlifting. You can have all the protein in the world.
Right. You need this. You gotta match that up. So it's really cool. Like we actually know in the eye.
The visual stimulation you were talking about flashes of light, but it turns out like
Different cells in our eye respond
Differentially to different stimuli. We have some cells that fire when the lights go on.
We call those very creatively on cells. We have some cells that fire when the lights go off, called off cells. We have some fi cells that are firing like between blue and yellow, others that are differentiating between red and green. We have some cells that are in charge of motion detection in the eye, and all that data's got to get back to the brain.
But if we stimulate, for example, the motion direction sensitive.
Ratinal ganglion cells in our retinas.
In headsets
Where we devise
C's, you know, basically imagine you're flying through like kind of that
Star Trek field of stars, you know, like you're going into hyperspace, right? And
Engage and you're going into hype and all those stars speed up by you.
Those are great stimuli.
For some of our direction sensitive cells in the eye.
And could those actually stimulate those cells to then like
perform better or not degenerate in disease. And so we've been studying those kinds of questions. Cognitos engaged in that kind of work.
And then how does that affect what's going on in the brain?
Very reasonable that that's going to actually lead to specific patterns of activity, flexibility, plasticity that are going to change our brains. And the idea that
Some of that work can not happen only in the academic world, but that people are excited about it and are funding the startup companies and taking that science into
That kind of either
Health domain, health span domain.
or consumer domain, like how do we get the normals protected against the future?
There's a lot going on there on the on that's on the input side.
Yeah.
I am going to just bookmark that for a second and
I'm gonna highlight a few things that I thought were
of interest and I'd like you to expand on from your conversation with Andy. So glaucoma, could you have a normal reading during the day but higher at night?
And then the potential place of
You know, cannabis edibles.
And my question there was, do we know what compounds are responsible? Well people are listening to me and they're like, What the hell are you talking about? So
If that's enough of a cue, would you mind just discussing that because uh you know big challenge with
People who are trying to do the right thing. They're trying to
get checkups. They're trying to get assessed. They're getting their
blood work done, but maybe it's once a year.
And they had their blood draws, you know, the last one was at eight AM and the next one was at eleven AM, and lo and behold, their testosterone is really different and they freak out and this, that, and the other thing.
So like timing matters among other things. Could you just speak to glaucoma in that respect?
Абсолютно солемій сбак унесет главкома.
After Alzheimer's disease
Glaucoma is the most common neurodegenerative disease. It's the number one cause of irreversible vision loss in the world.
It's a degeneration of that optic nerve connection from the eye to the brain.
So those retinal ganglion cells that are collecting the data in the retina.
And they're
axon fibers, those telephone wires running down the optic nerve carrying that all the vision from the eye to the brain, they degenerate in glaucoma. If you take all Cummers
It's around two percent of people in an aging population that will have developed glaucoma.
If you have a primary family member, a parent, a sibling, a child with glaucoma, your risk probably goes up to about twenty percent. So it it runs in families.
But just'cause your parent has it doesn't mean a hundred percent you'll have it.
There are two main risk factors for glaucoma.
One is increasing age.
And we're all working desperately on correcting that one, but we don't have a slant punk treatment for that yet.
The other main risk factor for glaucoma is actually increasing eye pressure.
If you have real high pressure, you're gonna get Glaucoma.
But a lot of people with
Normal looking eye pressure can also develop glaucoma just like they were more susceptible.
And the eye pressure isn't just the same number. We've got short term variability and long term variability. So long term is like, you know, this month it might be whatever number. Next year it might be a little higher, a little lower. You know, you can vary through your life.
But there's also this short term variability. It actually varies in our diurnal cycle.
So everybody has
a diurnal cycle where you, you know, your circadian rhythm, you know, and some of us like myself are night people and we love to be up at night and getting up in the morning isn't our favorite thing and other people are the opposite. And all this stuff relates to our diurnal cycle, our our circadian rhythm, you know, you can try to take melatonin and affect that.
But your eye pressure also varies by that. And as you say, like if I take your eye pressure in the morning and then the next week I take it in the afternoon and I say, Oh my God, your pressure's gone up. I got to take you to surgery. Well, wait a second, it might just be because I'm measuring it different times.
Now you brought up like the most common question that I get asked. I'll tell you the most common question that I get asked by patients.
With Claw Koma.
Is
Hey, can I take cannabis?
And you know, by the way, it's like
You know, legal for medical use in many states and frankly recreational s use also in many states, and certainly accessible in every state.
Can I take cannabis?
Cannabis.
Whether you smoke it or eat it in the brownie or take the chewy.
It lowers your eye pressure.
If you're using the
version which are available that where you know you feel a little high from it, you know, you get that good feeling.
The problem is that it only really lowers the eye pressure
Kinda during that time that you're getting high.
So I tell patients like it works, but
You'd have to be high twenty four seven.
So maybe you should just use this eye drop instead, right?

Do we know which
Compounds within cannabis.
Are responsible for the lowering of the eye pressure?
Yeah, there's actually data that both the THCs that do get you high and the others also that don't can have that effect. And there's some cool startup companies that have been working on trying to isolate and now test in human patients.
The
you don't get high versions of those compounds or chemically modifying them and by the way, turning them into an eye drop.
So that it's really just treating the eye and make that really accessible. You know, you don't want to be on your glaucoma treatment and not able to drive. So that would be normal. Trade off.
It's gotta be compatible with daily life for most patients, right? So that does work.
That does.
Yeah. The second most common question I got asked is
Well, can't you just like
Fix my eye or give me stem cells or that kind of thing. But number one is cannabis.
Well, what's your answer to the stem cells? The magic stem cells. So if you've lost your retinal ganglion cell connection to the brain through the optic nerve, we're actually getting pretty good
at growing retinal ganglion cells out of human stem cells like in the laboratory cell culture dish.
And we're actually starting to make real progress, you know, in animal models to start.
Showing that you can transplant them in. But I still tell patients like don't go to some clinic that's telling you they'll give you stem cells and pay eighteen thousand dollars of your hard earned money. It is not ready for that yet. Go to Tijuana and get a new pair of eyes. Exactly. Don't waste your money.
Well yeah, that'll be the least to your problem. Will be the money bar. So
Let me circle back to the cannabis for a second. So I don't consume much cannabis, but
I have
experimented with cannabis for
Chronic pain.
And specifically a number of back issues that I have, and some of it's congenital. I have a transitional segment and a bunch of arthropathy and blah blah blah blah blah.
And interestingly, a lot of folks, including people who are sort of credible and familiar with the literature, recommended CBD, but I did not find it to have a pain
relieving effect.
That was sufficient for sleep until adding a little bit of THC, which I thought was actually pretty interesting. And I'm wondering if.
And this actually cycles back to our very short discussion of psychedelic compounds also, because why might psychedelics say improve?
Visual acuity. You can come up with a dozen sort of plausible
Explanations.
But when you look at, say, the depression
outcomes with psychedelics.
People on many different
in many different parties in terms of arguing why or how they exert their effect, one that I think is underemphasized is the anti inflammatory effects, which can be potent.
in some psychedelics. And you can find studies where they look at anti-inflammatory, just standard off the shelf anti-inflammatory effects on depression, which can be substantial.
Do we have any data to suggest that anti inflammatories
Have any effect.
on vision or can in any sub population improve vision.
Decades ago
There is a pretty hot focus on to what degree the immun system.
might be playing a role, particularly in eye diseases, including the common ones, macular degeneration, glaucoma.
Then it was hard to pull that together in part I think because, you know, we didn't know as much about the immune system twenty, thirty years ago as we do today. And now we know a lot about what we call the innate immune system, which is
Not the part that learns about
the flu virus and makes you immune the next time you get the flu virus, but just how our immune system interacts with our body normally and how it also might interact with, you know, our gut bacteria.
And then cross react with
our own body, things like that, right? And so it turns out now that we've got this much deeper appreciation from the
whole immunology crowd about how the immune system and in particular the innate immune system works.
We're now revisiting in neurodegenerative diseases, including glaucoma macular degeneration, and it turns out it is just packed.
with evidence
That the immune system and innate immunity really play a role.
Let me give you one example that is shocking.
If you raise the eye pressure in a mouse.
the retinal ganglion cells and the optic nerve will degenerate just like in human glaucoma.
But in a really beautiful set of experiments that came from a woman, a professor at Harvard, Dong Feng Chen.
She showed that if you raise the eye pressure in a mouse
that was raised itself grew up in a germ free environment and doesn't have kind of all the normal mouse dirty gut bacteria.
And therefore its immune system is at some level fundamentally different.
You can raise the eye pressure in that mouse.
But the optic nerve won't degenerate. They won't get glaucoma damage.
And then if you take the immune cells out of the first mouse.
And just put him back into the bloodstream of the second mass?
then the optic nerve will regenerate.
So like the immune system is playing a huge role.
That was previously totally underappreciated and they're amazing.
drug therapy candidates that are now moving up through the pipeline and in towards human testing to test, hey, if we could like suppress the immune system, not totally suppress it, because by the way, we still want to be like, you know, attacking bacteria and viruses, but just suppress the little leg of that immune system.
That's attacking our body and leading to neurodegenerative disease.
That's gonna be off the charts.
Yeah, you know, I was as you're th talking about
the microbiome and so on. I was doing a bunch of reading for another interview I'll be doing shortly with the scientist, and one of the stories and this is in animal models, of course, but
looked at how and some people have heard through the grapevine one way or another how
You could take the microbiome just for simplicity's sake of, say, obese mice.
and transplant that.
to lean mice.
And they get fat.
Or vice versa. I might be getting some of the details wrong, but roughly you see.
Some very interesting effects.
However.
If you sever the vagus nerve in those recipient
Mice.
They do not exhibit those changes.
Then
Some of the questions that are kinda outstanding as well, if that indicates that you could instead of using like ablation or severing something, stimulation to achieve a similar effect.
Then what can you start to do?
Then you have like hockey puck size things that you put
next to the liver that can you know via some technological wizardry affect these things. But
I suppose the more I look at a lot of these things, also with family with Alzheimer's.
And they might take something like Thericumin, which has
on some level anti inflammatory effects. I'm like, okay. And I don't want to be
a one trick pony with like the one thing I keep beating over the head, but it's like, okay, well, if we know that chronically inflamed like microglia have all of these hosts, or at least they're associated with a host of different neurodegenerative diseases.
And inflammations associated with depression.
To what extent can we mitigate these things? And we're sort of hitting a bunch of birds with one stone, which is why I'm so interested in the
possibility of
Using devices. I'm so interested in
Nutritional ketosis, but also exogenous ketones.
Brain loves this stuff also. Beta hydroxybutyrate, very potent anti-inflammatory. I'm just wondering, do you think that I am just
Too clever by half and I'm like missing the plot here. I feel like
Chronic inflammation, which is kinda like saying
business or the arts, right? I mean, there are like a million different facets to inflammation, and you need inflammation for a lot of reasons.
But when it is
pathological and chronic it turns into a big issue. With
Rapid decline in eyesight, let's just say in glaucoma. How often is that comorbid with like metabolic syndrome?
Yeah.
Something like that, when the decline is faster than say
Average.
The earliest data
looking at, you know, let's say diabetes as a marker of, you know, a lot of patients with type two diabetes, it's associated with what we call metabolic syndrome, which is this cluster of high lipids, high blood pressure, insulin resistance, right? And so there was initial data suggesting that a little bit of diabetes might actually be like a little protect
in glaucoma. And then some of the follow-up like next set of studies suggest that like no no maybe it's a little bit bad for your glaucoma. And so the net net is it's probably not
Metabolic syndrome as a whole is probably not a huge difference, but I'll tell you the place where those two are converging is one of the hottest topics in.
Medical science today.
Which is these GLP one receptor agonists.
Which are gonna have a huge effect on human health.
by reducing metabolic syndrome
Overweight, obesity, et cetera.
But also
Are looking very promising.
for neuroprotective.
And I think it actually gets to that point, you know, you you're trying to tease yourself like are you just like kind of getting ahead of it.
But actually you're touching on, I think, where we're actually coming to as an understanding as you know, where the science is going in the field, which is this access.
Between
The brain
Which you think of like, well, isn't that mostly inside my head, but also the peripheral nerves that are going out to the whole rest of our body.
And the immun.
And those two are talking to each other all the time.
And now we've got the microbiome and that gut axis is like a third leg of that stool, because that's clearly also interacting.
with both the nervous system and the immune system in very specific ways. So we're gonna see a lot more of that really, I think, come together and understand more mechanisms.
You know, is it gonna be one day that we're all just kind of taking that like
Purified poop pill that we just swallow down and it changes our microbiome for the day and it protects us from Alzheimer's or glaucoma in the future.
We're all hoping that's gonna happen. We'd love that protection one day. Uh you know, should you buy the poop pill off the internet just yet? I'm not sure. Yeah, Sri Lankan poop pills from
Rural children. I'm in. Yeah. Be careful with what's out there on the internet, guys. And uh you know, I'm supporting a company, I might have to bleep this out, but called Holobiome and they're actually
creating the most comprehensive library currently of gut microbiota because it's like what you can buy currently off the shelf. First of all, most of it's dead by the like inert by the time you consume it. A lot of it doesn't actually get through your metabolism to where you want it to be. And it only represents maybe in some
A few dozen.
I don't know the right term is strains of bacteria. Whereas there's like thousands upon thousands. So there's so much to explore, which is also very exciting.
Let me give you one more idea of what might be that ideal world on the way to that.
We share microbiome.
Between us, you know. Actually we had our like an
At Stanford Med School years ago when I was there, we we had a microbiology professor.
And he used to kinda tease
The world is covered.
With a
Thin layer.
Of poop.
Because no matter how well you wash your hands after going to the bathroom, like there's a couple bacteria that got on your hands or your belt buckle and you're you know, and then you shake hands or pack someone on the back. I don't wanna
Increase anyone's anxiety. But the world episode is brought to you by a Pure L. There's a thin layer of poop. What we call clean and dirty, he used to say.
is really just how thick that layer is.
Okay, so that joking aside.
If you just shack up with someone who's got great longevity
And probably a great microbiome.
Yeah. Good chance you're gonna absorb their microbiome. Maybe that'll be good for you.
You know, I I gotta put that on the dating websites, you know?
Get your microbiome on that profile. Craigslist Microbiome Casual Encounters.

Oh
So this is gonna be a bit of a hard left, but
Preservative free strips of tears for dry eye.
Why?
That was one of my notes from the conversation that you had with Andrew, because I'm also looking for just
low hanging fruit for people who are contending as we all do with aging eyes.
Maybe you could speak to that and then I do have to ask about the blood serum for eye drops.
Maybe you can hit that too.
Sure.
Sure, so look.
Actually the most common
Eye disease
as we get older is actually dry eye.
As we get older, we we make fewer tiers. We also make lower quality tiers or tiers at high quality have a liquid phase, like a water, salt water phase.
There's also like an oily component to good high quality tears, and that oily component also kind of
dissipates a little bit as we get older, gets less as we get older. So we make fewer tiers and lower quality tiers. And a real simple over the counter solution.
For so many people is just
Put in some artificial teardrop.
The thing is is that those little bottles
come with preservative so that you know when you use it all month, by the end of the month it's not growing bacteria.
And if you're just using a drop or two a day.
Fine.
That's getting you by fine.
Just buy those bottles, they're the cheapest.
But if you're getting to the point where it's three, four, five, six times a day, you like you know, maybe you work on the computer a lot, so you blink less and your eyes get drier.
You want to use more of those.
Then we usually recommend at that stage switch over.
To preservative free artificial tears, because it turns out that preservative.
In those bottles of drops.
Add a drop or two a day, fine.
But if you're getting up to a lot of drops a day.
The preservate is actually irritating and kind of inflammatory to the ocular surface. It actually kind of breaks down some of the cells on the surface of our eyes. So at that point, we like to switch people to recommending the preservative free. They're the ones that come like usually they come in like a little strip of
tiny little plastic. You break one off. It's got its own little cap on it. It's got this tiny little bubble of fluid that you can squeeze. It really tests, you know, if you've got bad fingers or bad, you know, by the way, if you've got bad vision, you're poking yourself in the eye with it. So anyway, that's what we recommend. Twitter to free.
And then
People who need more than that.
We actually have
drugs that for example reduce inflammation on the ocular surface to help
that your quality and quantity bounce back a little bit.
And then we also have drugs that
Contain growth factors.
things like nerve growth factor that are almost certainly also good for the surface. And when our eyes get dry, the surface, the reason it feels irritating is not just because it feels dry. It's actually because the surface starts to break down a little bit.
And when you go to sleep every night and your eyelids are closed and nothing can evaporate.
You know, it bounces back a little bit by morning. So it kind of regenerates or rejuvenates. The ocular surface can regenerate pretty well every day.
But at some point
your eyes are getting dry enough that you're, you know, you're having much more chronic problems. And that's where sometimes we can use what are called serum tears. So our blood serum, if you take out a blood
Like a tube of blood, you're getting your blood drawn. That tube of blood
has
Your red blood cells carrying all your oxygen.
Your white blood cells, which is like your immune system.
And then all just the liquid with the proteins in it, that's what we call the serum. That's the ser so you could take that tube, you spin the cells out. Let me ask a dumb question. Is that different from plasma? Are we talking
Serum and plasma, yeah. Depending how you treat some of those proteins, that's serum and plasma. Let's just say you're spinning out the cells.
Yep.
And then you can take that serum, maybe you dilute it a little bit in some of that preservative free
you know, artificial tears. Maybe you just use it straight. Usually we dilute it a little bit.
And we can give patients their own serum.
as artificial teardrop and that serum is
Filled with really good juicy growth factors that help the surface.
Rejuvenate.
And that's the
principle of in some patients using serum tears.
Maybe this is uh just a
difference in terminology, but
It makes me think of
platelet rich plasma or platelet poor plasma. Other experiments with different
Not sure, concentrations or cocktails.
Different cocktails, that's a great way to put it, yeah.
And
Platelet rich plasma, again, one of the reasons that that looks so rejuvenating for our bodies is again, it's just like chalk a block full of growth factors.
And so I don't know. I'm sure somebody's testing this as another way to treat really severe dry eye.
Or if your dry eye is so bad you're actually getting like kind of ulcers on the surface of your eyes.
Some of the most severe cases might really benefit from like serum tears, maybe platelet rich plasma would work too. So that's a hot area right now. And again.
Filled with growth factors.
We talked about the importance of timing with, say, glaucoma exams, things of that type. What are some other
recommendations for perhaps
Avoiding common mistakes or filling gaps that are commonly unfilled. Any recommendations to folks?
There's a bunch of things. First of all
Get an exam. And if you have a family member or blood relative with eye disease, you know, maybe get that exam even sooner.
You know, take glaucoma as an example. If you got an exam and you're 40 and you don't have a family history and your exam was normal, you don't have to come do that full exam every year. You could come back in five or ten years, try it again. But especially as we get older. Now half the people in the world need glasses, half the people in the US need glasses. So
You might be going into your local eye care provider, optometrist, getting your glasses checked each year or two, anyway, just to see if you're still in the right prescription. And they can do
The full exam, check for everything else, make sure nothing else looks suspicious.
leave you in great shape. So getting that periodic eye exam, especially
As we get older and more of those age related diseases like macular degeneration.
Laucoma, et cetera.
Obviously, if you have diabetes, you're supposed to get an eye exam every year just to make sure because if you've got diabetes and it's starting to affect the retina inside your eye.
We could get ahead of that. We've got good treatments that can prevent you from losing vision. So we wanna stay ahead on these diseases. That's the main thing. Other things, you know.
Everyone's gonna get cataracts eventually, but what can we do to
Slow down.
The development of cataracts.
Well, one real easy one.
Is reducing UV light exposure. So you're out in the sun a lot, wear sunglasses, all sunglasses made today.
have UV protection.
By the way, all regular glasses that don't have darkened tinted shades.
They also block the UV light.
from going through. So even if you're wearing your regular glasses outside because you need glasses, that works too. So wear sunglasses or some sort of eyewear protection.
And then eyewear protection is another big one, like depending on what industry you're in. You're gardening, you're in steelworks, you've got anything where you've got like kind of eye injury.
Risk?
Wear protective eyewear. It costs like a buck fifty at Home Depot to get those really attractive plastic glasses that are wrap around, you know. But wear them when you're in those work situations, that's a big one too.
You know, you see a lot of athletes now wear eyewear and sometimes it's for sun protection, but you'll see a lot of them when it's not that sunny day or they're even playing inside. And they might be wearing it for prescription, but also just for eye protection. Eye protection. Is there anyone out there
And I don't have a dog in the fight. It's just that this conversation around sunlight and exposure is like a religious war online. Is there anyone you would consider scientifically credible?
Who has
Any counterargument with respect to UV Light.
why it is important to also get natural exposure or
Could be.
important to get exposure to
U V light or is does that just not exist? Is there a strongman argument for that or does it just not exist? I don't ever want to say something doesn't exist because there's someone on the internet Well, which is why I say scientifically credible.
But no.
Full spectrum light.
White light that goes from violet through red, full spectrum light.
There's a lot of decent evidence that that's good and important.
By the way, let's come back to the development of near sightedness.
You know, we used to say like, oh, maybe people are getting nearsighted as kids because they're spending too much in time's indoor reading. And so it's just like too much near work is leading to nearsightedness. There's now pretty good data, actually, that it's not the near work, it's the being inside part.
of reading inside. And if you just send your kid outside and let them read outside in full spectrum lighting,
They could still be doing their near work or doing their homework, whatever it is.
But it's the full spectrum lighting that will actually slow down their development of near sightedness. So you can get full spectrum white light.
But skip the UV.
by either having full spectrum lighting indoors or through the window and you've got a nice sunny window.
the sun that comes through the window, the glass actually filters UV light. So that's fine. Your car window filters UV light. So even if you're not wearing sunglasses inside the car, you're getting that full spectrum sunlight.
Go outside in the morning, fine, you know, get that first sunlight if you want. But there's no data.
That suggests that part of that full spectrum light has to include UV light.
Okay.
Got it.
What do you think?
Yeah.
This might be asking a lot, but
What do you think we might be getting?
wrong currently in any paradigm of how we think about.
Vision or
Eye health. I mean, I have a lot of doctor friends, a lot of researcher friends, and I guess it's especially common among MDs, but they'll say, Yeah, 50% of what we know is wrong. We just don't know which 50%. Which doesn't mean science isn't important, guys. By the way, it is incredibly critical for not fooling ourselves. And I don't think I need to preach that to you. But
What would you not be surprised to see overturned?
In the next one.
Five years if you're like you know what, we've always thought X
And it turns out
Nope.
Stick.
I'm gonna pull one out of my personal favorites list. Yeah, great.
For this.
And it comes back to these big ticket eye diseases like glaucoma, macro degeneration, even diabetic retinopathy, and other less common versions of these degenerations, let's say, of the retina, the optic nerve.
And we have
Always said. I mean, I even said earlier
In the podcast with you, Tim, that glaucoma is the number one cause of irreversible blindness in the world.
And that I think is gonna be the piece.
That we overturned.
We have always said, like, hey, we gotta prevent you from losing vision. We gotta slow down the disease because once you've lost
Whatever vision you've lost.
I can't get that back for you.
And I think that
is about to topple.
We are about to get into
Vision restoration
At a level that is been totally unexpected.
А толі унпрецеденте, а саєнс.
Soporti
These directions in these diseases is getting really
Really juicy.
We have discovered.
So many molecular pathways, approaches to cell therapy. Some of the things we even talked about earlier, like inducing plasticity in the brain.
You know, if I stick a stem cell into the adult retina and I say, hey, I need you to turn into a retinal cell.
Hook up with your partners and start doing vision.
Well
During development, the retina, those cells are all developing, they they learn to
You know.
Wire up together, do it right.
How do we get
A cell that we're gonna put into an adult person.
To say like hey
I know all you other retina cells are already neighbors with each other, but I'm moving into the neighborhood.
And I want you to accept me.
But we're figuring out how to like induce that plasticity, like open up the neighborhood, let that cell get into the network.
Start to participate in the network and restore vision.
So
It is moving.
really quickly right now, and it is starting to translate this laboratory science is starting to really move quickly into
Appropriate
Safe
Human clinical trials.
And so I think that is gonna be the biggest topple.
is gonna be that we can restore vision. And I will not be surprised if our colleagues in the brain
follow suit quickly. You know, we like to tease who's gonna f come first, the eye or the brain. I will not be surprised if our colleagues in the brain follow quickly. And maybe we could restore
Cognition.
In people with severe cognitive disease, Alzheimer's and these others. So
I think this kind of
Restoring the central nervous system, including the retinoptic nerve, spinal cord injury. I think this is all.
We're gonna topple that.
In these next few years.
That's very exciting. And I I also when I talk to folks, I'm like look
I know it seems like one day they're like bananas will kill you, and the next day like bananas will help you live forever. And it's like first of all, a lot of that is funhouse mirror warping by media coverage.
And secondly, there are so many breakthroughs or
Breakthroughs that are on the cusp.
of making their way into clinical practice, I can't help but be uh super optimistic about so many, at least the fields that I have decent amount of exposure to.
And uh
I'm gonna ask you a few follow up questions, but first I'll just say for people interested, if you are interested in looking at
How for instance. And there are multiple ways to induce
Greater plasticity.
in various ways, but if you're interested in the reopening of critical periods, which we alluded to earlier, Gool Dolan, who was at Hopkins and is now at UC Berkeley, has done some
wild work and
has really rocked the boat in I think a very productive way, looking at how
MDMA but also potentially other compounds can potentially do that. And she's got wild
experiments with octopuses and all this stuff that people should check out. But I believe that at some point if she's not already doing it, she's gonna look at, for instance, using these compounds to
Help.
Stroke patients recover motor function.
And
There are also devices like DARPA and the Defense Language Institute in Monterey have used for improving language acquisition. I mean, there's there I really feel like there's a lot of stuff that is not only happening, but converging.
In interesting ways. What leads you
to believe that we're so close. I mean the next five years is close.
Right. So is it just the publications you're seeing, the types of science?
that is being done? Is it new and novel ways to induce plasticity? Is it because the eye people are playing nice with the other brain people? What is actually happening?
You know, I was teasing before, but the truth is like we I people love to work closely with our colleagues in brain and because there's so much shared science. I do think that there's an increasing
Attention to hey, let's answer these questions properly.
Let's do proper trials. Let's really study these things properly. And let's also move things out of the laboratory and into human testing, right? And have it not just be like kind of the fantasy in the mice, but never move it to the person. Right. And so I think that transition, that willingness to grow in that direction.
We've had actually to be honest like
A remarkable
Two to three decades now.
of increasing support for science, you know, at the federal level, but also startups, biotech has had an amazing age. And that biotech, you know, when you've got an amazing age cooking on the pharma side, like big pharma,
You know, that then trickles down. So that means startups can say, like, hey, let's roll the dice and
Test this anti aging formula because
If it hits
There's a market for it at the end of the day. Like this is important. These are big impact areas. So I think the investment that we make in science.
And we're sort of like coming to a head, a culmination. And I think that happens to be matching.
In time.
The advances we've been making in neuroscience. You know, I think we made like
huge advances in immunology and cancer biology.
couple decades ago, like even just understanding what all the cells are.
And I think that the analogy is the advances we've made even just in the last decade of being able to like map the brain.
Not just even down to the cell level, but the cell cell connections called synapses.
We're now mapping entire brains at that level.
And understanding how they talk to each other and recording and creating. We've got a colleague here who just had an amazing suite of papers.
Andreas Tolius and his colleagues.
Creating a digital
Win.
Of the entire brain.
And then you can do experiments on the digital twin.
of the brain. You don't have to actually do them on an animal or a person to start. You could start there. So the advances in neuroscience
An understanding of plasticity in all of these elements.
I think are converging with the advances that we've just been
willing to make over the last couple decades in
Health care.
Health related research, discovery research, translational research.
Clinical trial research.
And I think we're just kind of seeing those two converge right now.
In an amazing way.
If you don't mind, let's talk about mitochondria again for a second. So mitochondria
Often referred to as the powerhouses of the cell. I won't bore people with more ketone talk, but also read a piece recently from a very credible scientist, beautifully written also, about how they're not just the powerhouses, but maybe the motherboards of the cell. And there's actually a lot of what you could view as social interaction.
Between
Mitochondria and uh among mitochondria, really just the deeper you go, the more interesting it becomes. And I'm wondering outside of the red light.
If there are other
interventions or technologies.
Bio logic's anything.
that you think are interesting for improving mitochondrial health.
Within the visual system, however you want to take that.
Mitochondria, not only are they social with each other and they actually talk to each other, they actually fuse and then separate.
They get trafficked up, you know.
Neurons, you know.
We talked about the ones that stretch from the eye to the brain. There are neurons, of course, that stretch from the top of our brain all the way down to the bottom of our spinal cord. There are neurons that stretch from our spinal cord all the way down to our toe tip. These are some long cells, right? And they're trafficking.
mitochondria all up and down. So they are social creatures for sure.
But it turns out they're yet a third thing. So they're powerhouses, they're social creatures.
But there are also scaffolds.
And they're actually like kind of the foundation.
Upon which a lot of other cellular signaling
That's regulating what a cell is supposed to do.
Із хапанен on the surface.
Of the mitochondria.
So you got metabolism, energy
Scaffolding of signalling.
Half of our neurodegenerative diseases are associated with one or another defect that we can trace back to mitochondria.
So that kind of adds up at the end of the day when you look at it that way. And some of the things we've already talked about, I mean, you brought up red light therapy, that would be one for sure.
But
Vitamin B three nicotinamide.
It's directly affecting some of that metabolic signaling that is interfacing with the mitochondria metabolism biology. And so actually a lot of these
supplements that are about metabolism end up having some link back.
mitochondria just yeah I was gonna say it's kind of hard to dodge the mitochondria. Yeah, yeah, yeah. And look, it's cool. Look, I mean I just read the they're they're now doing successful mitochondrial transplants.
Like for example into an embryo. So you can have inherited diseases.
where the diseases inherited because your mitochondria are bad. Mitochondria get most of their proteins and lipids and all of that that make up a mitochondria. They get most of that built.
From the nucleus, the regular DNA of the cell.
But they have a little bit of DNA themselves that make some of the proteins inside the mitochondria.
And so you can inherit
That mitochondrial DNA that has mutations and have, you know, real serious diseases.
It's now been shown you can transplant mitochondria so that
baby will not have
An inherited mitochondrial disease.
Is it that far off to think that we could like transplant mitochondria into
The retina of your eye and stave off another decade of glaucoma.
I you know, these things are on the table. So definitely on the table. Okay. So I saw some news about I think
You can't trust the headlines, but basically babies with three parents, so to speak, out of the UK. Now, so you mentioned embryo. So this is a case where you'd be taking third party
Mitochondria. You're hitting it. That's exactly what I was talking about. So you got
DNA from the mom.
You know, in the egg, so you got DNA from the dad in the sperm.
But you could take a third party's
mitochondria outside of their cell
inject it into that egg just like the sper went into the egg.
And now that egg with mom and dad's DNA and a third person's mitochondria, including their mitochondrial DNA.
Well propagate and form the whole embryo and it's an amazing headline, like does that mean there's three parents involved?

I mean it's equally fascinating when you just understand what you're describing and
Part of the reason I've been reading and really trying to do a deep dive, always dangerous when uh you are
Only half scientifically literate, but
On my mom's side of the family, a lot of Alzheimer's and my mom's had some deterioration as well, but she's APO33. And also just
Word of the wise, again, not a doctor, talk to your medical professional, but if you're trying to evaluate your
Metabolic health don't just
Get fasting glucose.
Taken because you can get lucky with fasting glucose.
And you might even do hemoglobin A one C.
Which is
Like a running three month average of your fasting glucose is maybe a simple way to think about it. Something like that.
But also get your insulin.
measure because that was missed by my mom's
Local doc for many, many years.
And her fasting glucose, even her hemoglobin was kind of within tolerable levels, and then her
Insulin was
It was so out of range as to just jump off the page.
And so then I was looking at it, and there of course could be a million different contributing factors, but I was like, I wonder if there's some
Type of
issue in her mitochondria, in which case my understanding is you do inherit the mitochondria from your mom's side, is my understanding. And I was like, okay, well if that's the case, I'd like to
I don't know if there's anything to be done about it at this point, frankly, but
If there is even a
small possibility that you could do something about it. I'm like, well
I'd like to kinda know what I'm dealing with.
So that's the genesis of me asking about also the mitochondrial health side of things.
Yeah. We don't have like a great blood test for your mitochondria yet. Uh obviously you could get it sequenced.
We don't know how much
You know, like
Your fidelity to mom's mitochondria.
might play a role in your future cognitive health.
I would add to your list though two other
standard screening
Tests.
That
certainly are likely to impact your cognitive health as you age. And with that again, the eyes part of the brain.
Your visual health too. And that's gonna be your lipids.
Your fasting lipids.
And your blood pressure.
And you know, like every bit of science points to, yes, you can inherit it your Apo E genes that can change your risk.
But a very big contributor is going to be
Your lipids and your blood pressure because those are gonna contribute to what we call microvascular disease.
And ultimately brain atrophy.
as we get older and ultimately cognitive function. And if you could be really ahead of the curve.
And be really clean with your lipids.
Whether that's with diet and exercise or upgrading to some of the medicines that help with that.
and really clean with your blood pressure again.
Diet and exercise.
Or there are medicines we can give to help with that.
Staying ahead of the curve on those is almost certainly
A huge contributor.

Cognitive health.
I've got this
suspects under control and very well dialed. I'm just like the mitochondria the boogeyman in the closet that I'm not contending with. But yeah, I'm trying to do all the stuff you would expect to also
help support mitochondrial health and
I don't think this is immediately obvious. People think of exercise
As
Body exercise.
But if you want to increase, you know, the brain drive neurotrophic factor release and cloth release, which hopefully someday soon we'll have.
as an injectable therapy for humans.
Exercise.
Just she gotta do it.
Do some weight training, do some zone two.
Do VO2 Mac every once in a while.
Incredibly valuable. And I think the important thing for listeners is that and when I say listeners, I include myself because
I intellectually know I need to do more exercise and you know, I still gotta figure out how to get around to actually doing that more exercise. So so I'm in the listener crowd here of what I need to say, but the important thing to remember is that the biggest gain.
comes from going from none
To some.
If you go from some to twice as much.
Yeah, there's an improvement there too.
But not as big as the value proposition of going from none.
To some.
Yeah.
Yeah. Just scale it down, guys, if you have to, but don't do nothing. Don't do nothing because you feel like I'm not I can't do
I can't do a million hours, so ah I'm throwing in the towel and I can't I won't do any. You know, half an hour.
Four or five days a week.
Brisk walk at that heart rate up.
Have it count.
You know
Easy. You know, like make it easy on yourself.
If you want to then go nuts and do like hardcore weight training, hit your Peloton, have your trainer, you know, train for a marathon, okay, fine.
But the biggest difference in your life was going from none.
To some.
Yeah.
Can I give you the greatest non-sequidor in the history of my podcast? It's just because you mentioned that your number one most common question was, can I have cannabis?
So I'm lucky to know a bunch of very
amazing docs and blah blah blah. You know, I interview people, so I get to meet a lot of fascinating folks.
And one of these super high end, really sophisticated docs.
He was telling me
The most can you guess? I'll I'll give you a shot.
I'll give you a shot on uh the three pointer. What do you think is I'll be astonished if you guess this. Cause even if you believed it, you probably wouldn't say it. But what do what do you think is most
One of his most common questions is that he gets that that he still refuses to answer publicly. I've wanted him to do it.
Oh my God, this is a guess what you're thinking. You'd better you know, as a when we're in training for medicine, we get asked questions like this all the time and it's some of them are like Okay, I want you to guess what I'm thinking. Go ahead. Three trial. No, no. All right, let me say it on lay it on. What did he say? This is the question he gets all the time, which is
From male patients. How can I shave my balls safely? This is
This is the question he gets more than any other. He's like, Really?
I've done all this training. I've done all this And that's the question that I get more often than not. Anyway, I don't know why I feel compelled to share that. Sorry. I'm gonna trust that he's not an eye doctor,'cause I never get that though.
Ha ha ha.
Yeah.
It's like what are you talking about? Tim, you interview a lot of people. What did Matt McConahe say to that question?
Maybe this should be one of my rapid fire questions that I finish with.
I'll take a pass on that one. I don't have enough experience to talk that. Yeah, yeah. No, we can we can both pass on that one, but is there anything else we haven't covered that you would like to mention? Any treatment or research or researchers that you think people should take a look at? I mean, we talked a bit about mitochondria.
Certainly talked about the lens. We talked about glaucoma and hopefully within the next five years, as you said, being able to
potentially restore function or stave it off.
To a much greater extent.
We didn't really get into treating nerves. I have a note about treating nerves, but I'm not sure we need to cover that. Is there anything else that
You'd like to mention that we didn't have a chance?
To discuss?
I want people to understand that first of all, these are all amazing questions. You've hit a wide range.
And we can't answer them.
without doing the science behind it. So first of all
You know, as they might be drying said
Science is real.

So first of all, science is real. And second of all, like, you know.
I would just encourage people, you know, like ask your in this case eye care provider, like, you know, what's going on with me?
Are there clinical trials like volunteering to be in clinical trials? I'll tell you, I know like
Patients are so grateful.
When they get into our clinics here.
And they get into a clinical trial because they are accessing a treatment before it is publicly available to see if it's gonna work. We don't know if it's gonna work, but they're taking a swing at that. And they are so grateful to get into these trials.
But I always say like
We are so grateful, like we can't do the trials.
And therefore
decide whether you should take the supplement or use this virtual reality device.
Or go in front of red lights every day.
Or microdose LSD or change your microbiome. We can't figure that out.
If we don't have the patients come be in the clinical trials and volunteer their time and energy, the extra trips to the office to get their eyes measured or special pictures taken or all that kind of stuff. So I say, like, I know you're grateful to be in this trial, but I'm grateful to you too. We are grateful to the patients. So
I think like we've all got participate in science as a community.
So we can do these trials and figure out like how we're gonna fix ourselves and go from disease to normal. And by the way.
Go from s normal to super normal, right? We gotta prove that, right? Yeah. Where would you suggest people
Search for
Or find clinical trials around them. And I'll just reiterate what you said. I have seen so many
Studies that I've been involved with hit a wall with subject or patient recruitment.
They just hit them.
They really
really benefit from people who are proactive. But if someone's listening, they're like, that sounds amazing. I'd love to actually see what this looks like in practice and
maybe figure or help people figure out something in the process for also for myself. Where do they even look? Where would they begin?
One really good place in the US to look is a website called
Clinical trials
Dot gov. So it's got it right there in the name.
And you go on the front page for clinical trials dot glove and you type in your disease.
So you could type in glaucoma, diabetes, whatever it is.
And it'll give you a list of here's trials that are recruiting right now actively. And then you can
Click on any of those and say, like, Oh, that one's in my city or
Not my city, but I'm gonna
call or send the email to them anyway and say, like, hey, could I be eligible for that? So that's probably one great resource. And then the other would be again for diseases would be
In the case of like, you know, research for specific diseases.
Almost every disease has one or more
foundations or
patient support sites that bring people together.
You know, I think of one in our backyard here in San Francisco called
the glaucoma research foundation
There's another one in New York City called the Glaucoma Foundation, dozens more, of course, but like
They also maintain websites
That have a lot of patient
directed information, patient facing
What to learn about your disease. You know, you were asking before, like, where's a reliable source to learn about stuff? That's one. But they'll also sometimes talk through like what's happening in clinical trial space, or where is that happening, or where are some
Hot spots for clinical trials.
So I think that's another those are a couple of good resources.
Of course nowadays Google, you know, just any w any web search
engine.
You know, it'll get you started in the right direction.
Yeah, perfect. And
If people are wondering, Well, Tim, have you done any of this yourself? Yeah, I've actually I've been a subject
In all sorts of
Different studies.
From undergrad all the way up to a few years ago for various things, including at Stanford way back in the day, when uh this is a few years after college. So it's fascinating also just to see what it looks like.
In real life, what does a scientific study look like when it's implemented?
Well thank you so much, Jeff. This has been fantastic, wide ranging romp. It's still
And will continue to be intensely personal, so I will keep people listening posted. I wanna promise not to sell you any uh Kratum IMAS.
Through some.
You know, M L M scheme and I will be continuing to investigate all this. This has been super helpful. I took a ton of notes. Is there anywhere you would point people to
Find you online or learn more about you.
Yeah, absolutely, Tim. You know, you joked in the beginning that this
Podcast is yours and certainly allowed to be self-serving, but I'll throw one plug in here at the end, the Stanford Ophthalmology website. We actually maintain a list of clinical trials.
And again, if we want to tap this whole team here on the back, our faculty, our clinical research staff, everyone involved in it, STEM to Stern is fantastic. And I'd like to set point out like, you know, a lot of the
Clinical trials of trying to pull things out of the lab and test them in patients for the first time. A lot of work on vision restoration, vision protection and restoration clinical trials going on right here.
my work and some of the work of our amazing faculty and staff here. So you can actually go to the Stanford Google Stanford Ophthalmology Clinical Trials. We have a web page on our Stanford ophthalmological.
That goes disease by disease and has contact info and how you plug right into the trials here. And we have people in our community participating, but we have people who fly in from everywhere to participate in these clinical trials. So we're happy to see if we can fit you into.
Beautiful. And
For people listening, I will link to that in the show notes at Tim.blog slash podcast. So that'll be easy to find if you just search Jeffrey Goldberg. Goldberg, I think you might be the only Goldberg. There might be one other. Search Jeffrey Goldberg.
And it'll pop right up. You'll be able to find the links.
Jeffrey, thanks so much. I really appreciate the time.
And

As mentioned, show notes Tim.blog slash podcast. You'll be able to find links to everything we discussed and more.
Until next time, be just a bit kinder than is necessary.
Two
others, but also to yourself. And thanks for tuning in.
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Explore gamma today at gamma.app. That's g-a-m-m-a dot ap. Gamma.app. Listeners get 30% off any plan by using promo code TIM at checkout. So use promo code TimTIM at gamma.app.
As many of you know, for the last few years I've been sleeping on a midnight luxe mattress from today's sponsor, Helix Sleep. I also have one in the guest bedroom downstairs and feedback from friends has always been fantastic. Kind of over the top, to be honest. I mean they frequently say it's the best night of sleep they've had in ages. What kind of mattresses and what do you do? What's the magic juju?
It's something they comment on without any prompting from me whatsoever. I also recently had a chance to test the Helix Sunset Elite in a new guest bedroom, which I sometimes sleep in, and I picked it for its very soft but supportive feel to help with some more back pain that I've had. The Sunset Elite delivers exceptional comfort while putting the right support in the right spot.
It is made with five tailored foam layers, including a base layer with full perimeter zoned lumbar support right where I need it.
and middle lay with premium foam and microcoils to create a soft contouring feel. Which also means if I feel like I want to sleep on my side, I can do that without worrying about other aches and pains I might create. And with a luxurious pillowtop for pressure relief.
I look forward to nestling into that bed every night that I use it. The best part of course is that it helps me wake up feeling fully rested with a back that feels supple instead of stiff. That is the name of the game for me these days. Helix offers a 100 night sleep trial.
fast free shipping and a 15 year warranty. So check it all out.
And now you can get 27% off anything on their website. So site wide. So just go to helixleep.com slash Tim. One more time, helixleep.com slash Tim.
With Helix, better sleep starts now.