TLDR;
This episode of the Tim Ferriss podcast features Dr. Jeffrey Goldberg, a leading expert in ophthalmology, discussing cutting-edge technologies and treatments for vision improvement and restoration. The conversation covers topics ranging from supra-normal vision training for athletes to potential breakthroughs in reversing irreversible blindness caused by glaucoma. They also discuss practical advice for maintaining eye health, the role of supplements, and the exciting possibilities of future vision restoration therapies.
- Supra-normal vision is trainable with tools like frame rate reduction goggles.
- FDA-approved eye drops can improve near vision by constricting the iris.
- Visual decline is correlated with cognitive decline, making proactive eye care essential.
- Emerging research suggests vision restoration may be possible in the near future.
Introduction and Personal Context [0:00]
Tim Ferriss starts by explaining his personal interest in the topic due to age-related visual decline (presbyopia). He mentions seeking cutting-edge treatments and technologies to address this issue. Andrew Huberman recommended Dr. Goldberg, leading to this conversation. Ferriss expresses his lifelong reliance on excellent eyesight and his desire to explore ways to maintain and improve vision, referencing a previous discussion on supra-normal visual performance and technologies like frame rate reduction goggles used in sports training.
Defining Normal vs. Supra-Normal Vision [2:40]
Dr. Goldberg humorously relates to Ferriss's experience with needing reading glasses after age 40, a common condition due to the lens's decreased ability to focus up close. He then transitions to the concept of supra-normal vision, noting that professional athletes often have vision better than 20/20. The discussion explores whether it's possible to train and induce supra-normal vision using tools like goggles that reduce the frame rate, forcing the brain to adapt and potentially improving visual reflexes and hand-eye coordination.
Enhancing Vision with Eye Drops and Vision 101 [6:47]
Ferriss brings up indigenous practices in the Amazon involving eye drops for improving distance vision. Dr. Goldberg explains how FDA-approved eye drops containing pilocarpine constrict the iris, creating a pinhole effect that can improve near and far vision by normalizing light and correcting refractive errors. He then provides a "Vision 101" overview, describing the basic anatomy of the eye: light enters through the cornea, passes through the pupil (controlled by the iris), is focused by the lens, travels through the vitreous humor, and hits the retina. Rods and cones in the retina convert light into electrical signals, which are processed and sent to the brain via retinal ganglion cells and the optic nerve.
Exploring Vision Improvement Methods [12:44]
Ferriss expresses his concerns about increasing dependency on reading glasses and the overwhelming amount of often dangerous advice he received online regarding vision improvement. He seeks Dr. Goldberg's insights on safe and effective methods. Dr. Goldberg addresses the use of supplements like Areds 2, noting that while clinically proven to slow vision loss in moderate age-related macular degeneration, their effectiveness in other cases is uncertain. He mentions other supplements like CoQ10 and Ginko, and highlights Vitamin B3 (nicotinamide) as a promising area of research for restoring vision in diseases like glaucoma.
Vision Training, Psychedelics, and Brain Plasticity [16:39]
The conversation shifts to vision training and visual augmentation, including augmented reality. Dr. Goldberg confirms that vision training and visual reflex exercises can improve performance in specific activities. He also touches on the emerging and somewhat controversial topic of micro-dosing psychedelics, noting that they act on the nervous system, including the retina and optic nerve, which are extensions of the brain. He explains that psychedelics may induce brain plasticity, potentially reopening critical periods for visual improvement, but emphasizes the need for careful research to determine appropriate doses and behavioral training protocols.
Visual Training and Concussion Rehabilitation [23:00]
Dr. Goldberg emphasizes the importance of behavioral outcomes and motor actions in visual training for better results. He uses the example of concussion rehabilitation, where visual symptoms are significant. Visual perception exercises can aid in neuro-rehabilitation, helping patients recover from injury to normal function. He suggests search terms like "concussion," "neuro rehab," "plasticity," and "visual perception exercises" for those seeking information on concussion rehabilitation protocols, while also advising caution and scrutiny of sources.
Light Therapy and Myopia Control [26:59]
The discussion moves to light therapy, specifically red and violet light, and their applications in vision. Dr. Goldberg notes that small doses of daily red light can slow the progression of myopia (nearsightedness) in young people. Both red and violet light appear to work by supporting mitochondrial function, the energy sources within cells. He mentions an FDA-approved red light therapy for macular degeneration and suggests it may be protective in other eye diseases as well. However, he cautions against widespread adoption without further research on optimal dosage and brightness.
Vision Loss and Cognitive Decline [31:30]
Ferriss expresses concern about the correlation between vision loss and cognitive decline, given his family history of Alzheimer's and Parkinson's. Dr. Goldberg confirms this correlation, explaining that vision is a major sensory input that drives a significant portion of the brain and interfaces with mental health. He notes that restoring vision through cataract surgery can reverse cognitive decline and depression in older individuals. He dispels the myth that wearing reading glasses increases dependency, clarifying that the need for stronger magnification is a natural progression of presbyopia, regardless of glasses use.
Devices for Brain Stimulation and Cognitive Enhancement [35:45]
Ferriss brings up Cognoa Therapeutics, a company developing a headset using flashing lights to produce gamma waves in the brain, potentially assisting in the breakdown of amyloid plaque in Alzheimer's patients. Dr. Goldberg confirms his familiarity with the researchers involved and discusses the potential of visual input to influence brain activity and plasticity. He explains that providing the right amount of electrical activity to neurons in the eye and brain can stimulate pathways related to plasticity and growth factors. He describes experiments using visual stimuli, such as motion-sensitive patterns, to stimulate specific cells in the retina and potentially improve their function.
Glaucoma, Cannabis, and Stem Cells [41:22]
The conversation shifts to glaucoma, a neurodegenerative disease and the leading cause of irreversible blindness. Dr. Goldberg explains that glaucoma involves the degeneration of the optic nerve, which connects the eye to the brain. Risk factors include age and eye pressure, which can vary throughout the day. He addresses the common question of whether cannabis can help, noting that while it can lower eye pressure, the effect is temporary and requires constant use. He mentions companies working on cannabis-derived eye drops that don't produce psychoactive effects. Regarding stem cells, Dr. Goldberg says that while progress is being made in growing retinal ganglion cells from stem cells, the technology is not yet ready for clinical use.
Inflammation, Microbiome, and Vision [47:11]
Ferriss explores the potential of anti-inflammatory interventions to improve vision, drawing parallels to the anti-inflammatory effects of some psychedelic compounds on depression. Dr. Goldberg confirms that the immune system and innate immunity play a significant role in eye diseases like glaucoma and macular degeneration. He cites experiments showing that mice raised in germ-free environments do not develop glaucoma damage, even with increased eye pressure, highlighting the role of gut bacteria and the immune system. The discussion touches on the microbiome, the vagus nerve, and the potential for therapies targeting chronic inflammation to mitigate neurodegenerative diseases.
Dry Eye, Tears, and Eye Exams [58:21]
The conversation turns to dry eye, a common condition in aging eyes. Dr. Goldberg recommends preservative-free artificial tears for those using drops frequently, as preservatives can be irritating. He also discusses drugs that reduce inflammation and contain growth factors to improve tear quality. In severe cases, serum tears, made from a patient's own blood serum, can be used to rejuvenate the ocular surface. He recommends regular eye exams, especially for those with a family history of eye disease or diabetes, and emphasizes the importance of UV protection to slow cataract development.
UV Light Exposure and Nearsightedness [1:06:19]
Dr. Goldberg addresses the debate around sunlight exposure, clarifying that while full-spectrum light is beneficial, there's no evidence that UV light is necessary. He notes that spending time outdoors in full-spectrum lighting can slow the development of nearsightedness in children, and that glass filters UV light, making indoor sunlight exposure through windows a viable option.
Future of Vision Restoration [1:08:26]
Ferriss asks what current paradigms in vision and eye health might be overturned in the next five years. Dr. Goldberg expresses optimism that irreversible blindness caused by diseases like glaucoma may become reversible. He believes that advancements in molecular pathways, cell therapy, and inducing plasticity in the brain are leading to breakthroughs in vision restoration. He highlights the potential for stem cells to integrate into the retina and restore vision, and suggests that similar advancements may soon follow in treating cognitive diseases.
Factors Driving Progress in Vision Restoration [1:14:00]
Dr. Goldberg attributes the progress in vision restoration to increased attention to proper research and trials, a willingness to move from laboratory findings to human testing, and significant investment in science and biotech. He notes that advances in neuroscience, particularly in mapping the brain and understanding plasticity, are converging with healthcare research, leading to breakthroughs.
Mitochondrial Health and Interventions [1:17:07]
The discussion returns to mitochondria, described not only as powerhouses but also as "motherboards" of the cell, involved in social interactions and scaffolding cellular signaling. Dr. Goldberg notes that mitochondrial defects are associated with many neurodegenerative diseases. He mentions red light therapy and Vitamin B3 (nicotinamide) as interventions that affect mitochondrial metabolism. He also shares news about successful mitochondrial transplants, including into embryos to prevent inherited diseases, suggesting the potential for similar transplants to stave off glaucoma.
Genetics, Lifestyle, and Cognitive Health [1:20:47]
Ferriss discusses his family history of Alzheimer's and his interest in mitochondrial health, noting that mitochondria are inherited from the mother's side. Dr. Goldberg recommends additional screening tests, including lipid panels and blood pressure checks, to assess cognitive health risks. He emphasizes the importance of maintaining healthy lipids and blood pressure through diet, exercise, and medication to prevent microvascular disease and brain atrophy. He also stresses that the biggest gains in health come from going from no exercise to some exercise.
Clinical Trials and Community Participation [1:29:09]
Dr. Goldberg encourages listeners to ask their eye care providers about clinical trials and to volunteer for research studies. He emphasizes the gratitude researchers have for patients who participate in trials, as their involvement is essential for advancing scientific knowledge and developing new treatments. He suggests clinicaltrials.gov as a resource for finding clinical trials and recommends looking at websites for disease-specific foundations.
Resources and Closing Remarks [1:33:43]
Dr. Goldberg mentions the Stanford Ophthalmology website as a resource for clinical trials and vision restoration research. Ferriss thanks Dr. Goldberg and promises to keep listeners updated on his personal journey. He encourages listeners to be kind to others and themselves and provides links to resources in the show notes.