Best Practices for Children's Eye Health & Eye Exams | Dr. Jeff Goldberg & Dr. Andrew Huberman
00:00:00.000 | If a baby comes out, do they check their eyes right away?
00:00:05.160 | And if so, how?
00:00:06.160 | And how often should they check, and what kind of information is there?
00:00:09.280 | Yeah, that's a great question.
00:00:11.560 | It's obviously something that touches us all.
00:00:14.160 | So the answer to that really differs a little bit at the different stages of life.
00:00:19.000 | First of all, every baby gets an eye exam, or should be getting an eye exam.
00:00:24.760 | And one of the main things that you really just are screening for right when that baby
00:00:28.880 | is born, right in the nursery, right in those first few days, is to just look for a red
00:00:33.600 | reflex.
00:00:34.600 | You know when you take a camera picture, a flash picture, and sometimes you get red eye?
00:00:38.520 | That's actually the light from the flash, as you know, reflecting against the retina
00:00:41.840 | and coming back out of your eye, it looks red.
00:00:46.240 | And a red reflex is actually very normal.
00:00:48.960 | That's great.
00:00:49.960 | And if you have one of a number of diseases in the eye that can present even in babies,
00:00:56.760 | even in newborn babies, including most concerning, but thankfully least common, retinoblastoma,
00:01:03.680 | which is the most common pediatric eye cancer, which again, thankfully, is quite rare, those
00:01:10.840 | babies won't have a red reflex in that eye.
00:01:13.520 | It'll be kind of a whitish or gray reflex.
00:01:15.920 | And so even just that first little, you know, doctors taking the little pen light and even
00:01:20.760 | just flashing it in the baby's eyes.
00:01:22.960 | So that's our first eye exam.
00:01:25.440 | And hopefully we've all had that.
00:01:26.800 | And hopefully every baby being born today is getting that first eye exam, is really
00:01:31.680 | just looking for that red reflex.
00:01:34.640 | It's not typical, as long as that's looking good, to worry about getting an eye exam.
00:01:40.960 | From there, kind of through childhood, like maybe early elementary school, unless your
00:01:48.400 | baby is presenting with one of a number of features that parents often pick up on.
00:01:53.820 | For example, as the baby's aging through those first couple of years, you know, through the
00:01:57.600 | first couple of years, babies actually don't have great visual acuity.
00:02:01.960 | And so as they're aging over those first couple of years, it's normal for them to have, you
00:02:06.720 | know, roving eye movements, for example, be searching their environment.
00:02:12.440 | But over those first couple of years, if parents start noticing the baby isn't, you know, isn't
00:02:18.040 | making eye contact or looking where a sound is, certainly if they have what's called nystagmus,
00:02:23.240 | like these rapid flickering alternating eye movements, anything like that, of course,
00:02:27.920 | you're going to trigger an eye exam.
00:02:30.260 | But otherwise, most babies, other than their pediatrician doing that red reflex check when
00:02:35.120 | they're in for their regular well child checks, that's really all that's needed through that.
00:02:40.780 | When most kids get to elementary school age, there will often be, often done at the schools,
00:02:46.640 | an amblyopia screening exam.
00:02:49.480 | If kids' eyes, either if one eye doesn't see that well, like maybe you're very nearsighted
00:02:55.000 | or farsighted in one eye and pretty normal sighted in the other, or the two refractive
00:03:00.360 | errors are quite different from each other, that can lead to a condition you've talked
00:03:05.080 | about on the podcast before called amblyopia, which is probably one of the more common or
00:03:10.100 | most common eye diseases of children.
00:03:14.360 | Or if the eyes aren't aligned, you know, our eye muscles and the brain behind them are
00:03:18.240 | really responsible for keeping the two eyes looking straight ahead.
00:03:21.560 | And if that's not working properly and one eye is off kilter and therefore the image
00:03:27.400 | of what we're looking at is falling on different spots of the retina, it's not syncing up right
00:03:31.560 | in the brain, that can lead to this disease condition called amblyopia where that eye
00:03:36.000 | is no longer talking to the brain properly.
00:03:39.500 | And there's a pretty easy screening exam that can be done for strabismus, the misalignment
00:03:43.480 | of the eyes that kids will do in elementary school.
00:03:46.300 | The other main presenting symptom of kids in elementary school is when they admit to
00:03:50.640 | their parents, I can't see the board or I can't see the teacher up front, and then they
00:03:54.640 | might be quite nearsighted.
00:03:56.160 | And so that will also trigger an exam.
00:03:59.120 | And so those are usually the parts for babies, for toddlers, for children, school aged children
00:04:05.120 | that might reasonably trigger an exam.
00:04:07.200 | A couple of questions about early eye exams and we'll get onto eye exams in older individuals
00:04:14.240 | in a second.
00:04:15.240 | But I want to interrupt you with this question.
00:04:16.720 | So you mentioned that there can be a misalignment of the eyes.
00:04:20.080 | I've seen many people's babies where there is one eyeball that seems to be kind of drifting
00:04:24.600 | around and then it might correct, but sometimes they'll have a, we don't want to get technical
00:04:28.680 | here for our listeners, we'll keep it general, but either convergent eyes or one eye converging
00:04:34.880 | cross eyes or wall-eyed, again, using that non-technical language here.
00:04:41.640 | And my understanding is that the brain is taking that information in and is very plastic.
00:04:46.940 | It's changing at these early stages of development and that it's fairly critical to get that
00:04:51.360 | stuff corrected early on, because if you wait too long, the brain can essentially become
00:04:55.760 | blind to the, or rather the brain cannot learn to handle the proper alignment.
00:05:02.980 | So in other words, if a kid has cross eyes, crossed eyes, excuse me, and they're not corrected
00:05:09.840 | until they're 20s, it's possible that they will never recover normal vision.
00:05:14.200 | Whereas if you recover, if you align the eyes properly early in development, they can indeed
00:05:19.720 | recover vision.
00:05:20.720 | How early can and should one consider getting those eye realignments done?
00:05:25.640 | Yeah.
00:05:26.640 | Yeah.
00:05:27.640 | Pretty much right on.
00:05:28.640 | What they'll do is if they detect any eye misalignment, and sometimes parents are good
00:05:32.020 | at noticing that, and sometimes you take a picture and one eye got the red eye reflex
00:05:36.880 | and the other one didn't, and sometimes people notice that their kid's eyes are sort of turning
00:05:41.640 | in, it seems like too much.
00:05:44.900 | Sometimes there's what's called pseudostrabismus, which is where actually, depending on your
00:05:48.640 | anatomy, if you have a little extra skin sort of on the inside corners of your eyes, it
00:05:53.120 | makes your eyes look turned in when actually they're straight.
00:05:56.720 | But if your eyes are actually turned in, or slightly less common in children, more common
00:06:01.080 | in adults, misalignment turned out, it's really important to correct that early.
00:06:07.360 | And the reason is, as you were saying, the brain starts ignoring it.
00:06:11.840 | It fails to fully develop the strong connections for the data coming in from one of those two
00:06:18.320 | eyes into the brain.
00:06:20.600 | And if you pass certain sort of thresholds during development, during childhood, without
00:06:25.480 | correcting that connectivity, getting those two eyes to work together properly, you can
00:06:32.440 | permanently lose that.
00:06:35.000 | And so we used to use very sort of gross numbers, like it's fully correctable if you can intervene
00:06:42.160 | before age three.
00:06:43.880 | It's partly correctable if you can intervene before age six.
00:06:47.600 | You got a chance before age nine.
00:06:50.280 | But it turns out in follow-on studies that even kids into their young teens have a shot
00:06:55.880 | at correcting that eye-brain connection, that amblyopia, that loss of vision that can occur
00:07:02.880 | during early development.
00:07:04.620 | So even if you're only unfortunately detecting that later on in childhood, or even sort of
00:07:11.160 | the tween years, or early teen years, it's still worth a try to really push to retrain
00:07:19.000 | the weaker eye and then also realign the muscles so that they can work together to keep the
00:07:24.520 | eyes focused.
00:07:25.520 | I'll tell you, it's interesting, and there's a lot more to learn about brain plasticity
00:07:30.800 | and probably a lot of really cool new therapies yet to discover that could reopen what's called
00:07:37.480 | critical period plasticity, this plasticity that we have during development that kind
00:07:42.280 | of goes away as we age.
00:07:44.640 | And that critical period plasticity, as you know, has been the best studied actually in
00:07:48.420 | the visual system.
00:07:50.280 | And the idea that we could reopen that is really fantastic.
00:07:53.280 | But for different parts of that eye-brain connection, there's different periods for
00:07:59.620 | critical period plasticity.
00:08:01.000 | For example, even if you get the amblyopic eye to see well again and then you realign
00:08:06.360 | the eyes and now they're working together, a lot of kids will never recover full depth
00:08:12.080 | perception, stereopsis, the use of two eyes to see depth, for example.
00:08:17.280 | So why that part of the brain doesn't correct as well as the visual acuity or central vision
00:08:23.800 | part of the brain, I'm not sure if we understand that yet.
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