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0:00 What if the reason your aging parent or spouse is struggling with memory, focus and daily tasks has nothing to do with their brain and everything to do with their eyes? What if nearly 20% of all dementia cases are directly linked to untreated vision problems and does a standard eye exam completely miss all of this? Today's guest has spent his career answering that question, so I'm really excited to bring him here. Dr. Bryce Appelbaum is a brain based eye doctor who has worked with NFL players, Olympic athletes, and thousands of everyday people who were told their vision was fine, but it was not. Eyesight is a symptom. Vision is the brain. What most of us call a vision problem is actually a brain problem. When you fix it at the source,
0:45 the results can be life changing. That's Dr. Appelbaum's philosophy. If you've ever been handed a glasses prescription and told that everything looks fine, this episode was made just for you. I'm, Neal K. Shah, a, Johns Hopkins and NIH funded caregiving researcher and a caregiver myself. I help many people with dementia care and this topic is really near and dear to me. So. Dr. Appelbaum, so glad you're here. Welcome to the show. Such an honor to be here. Thank you for having me today. Awesome. So, let's kick it off. We have some great questions for the audience. So I recently learned that up to 19% of dementia cases can be linked to untreated vision problems. And I mean, that just seems like a really bad and damning number. So why isn't this the first thing that every doctor brings up when a family comes in, worry about, their aging parent
1:30 or spouse's, cognitive decline? It absolutely should be. And hopefully after this conversation, it starts to become top, of mind for more people. You vision, like you said, is, it's, it's brain function and it's a direct reflection of brain function. And when we start to see cognitive, decline or vision decline, a lot of times we just assume that that's, that's normal. It's not normal, it's just really common. And, and when we stop using our dominant sensory system vision the way that's intended to, we start adapting and using our brain differently. And that leads to significant changes in function and specifically in your line of work, having problems navigating your space. It's one of the earliest signs of Alzheimer's and of dementia.
2:17 Yeah, no, I think that's really interesting kind of way to think about it at the root and, and then you have this line that you use a lot that's interesting, that eyesight is a symptom and vision is brain. You I think many of us think if you have 20-20 vision, our eyes are fine, you but I guess yeah. What are we missing about, you kind of that, that philosophy that you have. Yeah. And I'm going to correct you and say if you have 20-20 eyesight, that things are fine. So eyesight is just a symptom. It is our ability to focus light clearly. It's what glasses or contacts are for. And that's usually where most eye exams end. Is, are the eyes healthy? And can you see the tiny letters on the chart? But vision is so much more complex. And vision is how our brain filters, organizes, processes, everything coming in through
3:03 the eyes to be able to make sense of it, derive meaning and then direct the appropriate action. Okay. And functional vision problems are tracking and focusing and converging and depth perception and peripheral awareness and reaction time and really how we engage with our world. That is what we should be testing for from a proactive approach. But very often we're taking this reactive approach and just saying, well, you can't see stuff, here's a device that's going to help you. And although that's important, that's just one small piece of the puzzle. Yeah. Okay, that's interesting. And I think that brings me to kind of your own story, your personal story I thought was really cool you came to this work, overcoming your own vision challenges, through vision therapy as a kid. And what did that experience teach you about what vision really is and how did it
3:51 impact, your own career and deciding, what line of work you want to get into? Yeah, I was an absolute mess as a kid. I had an alternating eye turn, I had essentially no depth perception, my eyes had a really hard time focusing and I was lost in space. And what that meant was on the soccer field, I was just terrified. In the classroom, I had no idea what's going on and, and fortunately was born to the perfect parents. My father was a Developmental Optometrist, my mother a sensory integration based Occupational Therapist. They facilitated the necessary development for me that didn't take place on its own to allow me to soar in life. And I really went from being a reluctant reader to an avid reader. I went from the last one picked on sports teams to a stud with athletics, especially ball sports. And I went from being this insecure,
4:39 scared kid to this confident person by really using my eyes to rewire my brain to change how I was using vision, but to turn a, disability really into a strength. Wow. Wow, that's awesome. Congratulations for sharing your story and I hope that inspires people out there who might be worried about their own limitations, that a lot of these things are fixable and solvable. And in going through kind of more detail around your thoughts on the eye exam and just kind of understanding the difference between what is in a standard eye exam test and what does a functional vision exam test do? And I think many people didn't even, may not even understand that these are two completely different things. And why do so few doctors test for the functional side? Great question. And there's a lot to unpack there, I would say.
5:26 In general, you know eye exams, like many medical exams and primary care exams, you're in and out quickly. The doctors are dealing with a lot of politics and insurance reimbursement and a packed schedule. And it's really takes away from the quality of care that really people deserve. And for those listening who've been to the eye doctor, it's can you see those tiny letters on that small chart on that far away dark exam room lane where, you that's just one skill and that's looking at how well you can discriminate far away, but it's not looking at. Does your brain have the capacity to use the inside and outside muscles of the eyes together as a team? Do you have depth perception? Can you understand not just where you are in space, but where other things are
6:11 in relation to you in a dynamic fashion? Do you have the ability to attend to what's in front of you and around you simultaneously? Can you process information fluidly and have the visual memory to be able to spell words, to think of pictorial images, to remember somebody's name when they're saying it out loud when you first meet them for the first time? And really to make sure you have the ability for the eyes, brain and body to fluidly work together as a team, which is needed for reading and learning and sports and driving and navigating through space. And I think the last part of that, of why do doctors not test for this? I think there's many reasons, but in school, We're taught how to manage vision decline, right? We're taught how to, when there's problems in place, how to slow down
6:57 the problem, sometimes stop them. But very little is shared with avoiding these problems altogether and taking a proactive approach and recognizing that vision is a skill set and it's something that we don't see with our eyes, we see with our brain. And yet we're just looking at eyes as if they're separate from the brain, separate from the body. And it allows for a lot of misdiagnoses, missed opportunities, and really just kind of going down a path of adapting to lenses, adapting to the stress from our world without actually addressing the root cause for why these changes are even occurring. Yeah yeah. Thanks for the detailed explanation. Actually, while you were talking, I was just thinking about scenarios in my head of, several people that I've helped, who are
7:44 caregiving for parents and stuff, that you mentioned, why people fall, and, why things happen in their lives. Oftentimes it's just a standard eye exam may not catch some of the things you mentioned, like depth perception. And we hear this a lot of time in helping caregivers that after the fact, people realize, something has changed. But, my guess is it probably wasn't caught on the standard eye test, but something did change in, the broader vision, which is why somebody had a harder time, kind of getting around and then had an accident. So that's fascinating. Yeah. Thanks for sharing. Absolutely. And those kind of visual, spatial and visual memory challenges, those are functional vision challenges or functional vision skill sets, because getting lost or getting confused in new spaces or trouble
8:31 identifying objects and people or misperceptions, kind of not processing information and assigning the right label or language to what we're seeing, those are really common with people as they age. And that, Difficulty with kind of spatial reasoning and navigation, being unsure of our surroundings, that's really warning signs and neon, lights around the fact that we're not trusting what we're seeing and we're not using all of the areas of our brain in an integrated fashion. So something needs to be done to figure out what's going on. But then how to change the outcomes that come with that. Yep yep. No agreed. I think. I think this is a great reframe. You know I think another thing that I've written down that might be surprising to a lot of our listeners, you you mentioned, undiagnosed vision problems
9:17 can actually mimic ADHD and even learning disabilities and potentially even early cognitive decline. You know how often do you see people that are potentially misdiagnosed, possibly for several years, when the real issue might have been vision related all along? I love that you're bringing this up literally every day and multiple times a day. So, to really simplify this, if you have a hard time controlling your eyes and their ability to focus, you're gonna have a hard time controlling your mind and its ability to focus. Yeah. Any change in eye movement is a change in attention, whether it's voluntary or involuntary. And again, if you can't control your eyes and ability to focus, you can't control your mind and its ability to focus. And so many of the symptoms of Adhd, Dyslexia, autism spectrum disorders, even
10:05 learning disabilities are so similar to those of hidden functional vision problems, and so they're incomplete diagnoses without addressing vision first. Yeah. And we see so often people who can focus really well in certain tasks, but then when they're doing sustained near concentration tasks, their focus is terrible. Or somebody who can read with their ears but not with their eyes, meaning if it's auditory input, it's easier to process than visual input. Those are clear signs of a hidden functional vision problem that hopefully is no longer hidden now that we're talking about this. But again, it's not like there's this blood test that says, oh, you have ADHD. It's based off of behaviors and symptoms, and 15 of the 18 most commonly associated
10:52 symptoms of ADHD are also symptoms of certain functional vision problems. Wow. I think that's, what's fascinating about that whole thing is just people might be unnecessarily, then at the end point, getting medication when, the root cause could be, fixable or modifiable through correcting vision or addressing that. So that's really interesting, thanks for sharing. There was a recent, study that came out, a meta analysis of tens of thousands of participants that revealed that children labeled as having ADHD have a three times higher likelihood of having convergence insufficiency. So trouble converging the eyes together, pointing them at the same place. Two times the higher likelihood of having strabismus or an eye turn,
11:38 and two times the higher likelihood of having astigmatism or hyperopia. Wow. Which means very often those diagnoses are also confounded by other labels or other challenges. Yeah. Wow. Thanks for sharing. It's a fascinating reframe. Then I think in thinking through, my team and I had the chance to try out Screen Fit, you this past week, and, you it's great. So I think one would love for you to kind of elaborate on it and, you you founded it specifically around, kind of this concept that the damage that digital devices are doing, to our visual system, which is also I think applicable just for generally anyone of any age. And I think you highlighted that humans were not designed to stare at, flat glowing rectangles all day.
12:25 So yeah, what is excessive screen time actually doing to the brain? Is any damage reversible? And I guess, yeah. Can you give us an overview on screen? Yeah. So screen time is the new pandemic. That's there's no question we know what it does to cognitive development, emotional development, social development. But we're now learning and seeing what it does to vision development. And we're as humans not meant to be staring at these boxes 2 inches from our face, blasting high energy light us for hours on end. We're meant to be scanning the horizon for dinner and danger and exploring through nature. We're now having to make those same eye movements with this near visual stress of up close. And there's very different eye movements required for screens. Our focusing system, the inside muscles of the eyes responsible for clarity, become locked up.
13:12 Our convergence is at a higher demand. There's more eye movements, they're more sporadic, they're all over the place. And then there's all this light that we have to contend with. And so it's causing significant problems, One of the most common of which is myopia or nearsightedness, which is far away, getting blurry often because of a near problem. And we know the three biggest risk factors for myopia progressing. Not enough time outdoors. And it's proven that two hours a day is protective for the development and progression of nearsightedness. Too much near work, especially with poor lighting and too much screen time. And so we created screen fit as a way to have this work be more accessible for the masses. Because I recognize not everybody has the opportunity to fly to us
13:58 in Maryland and go through our treatment. And so this is kind of a, a do it yourself program that's very intentionally sequenced in terms of the learning. And it's designed to teach the specific visual skills and abilities needed for, for life, for reading, for learning, for driving. And it's not more screen time to treat screen time. It's, it's two different courses. Each course has 30 lessons. Each lesson is a video of describing a specific vision exercise. You then put the phone or the tablet down and you do the exercise and really without equipment so that it's kind of body weight work instead of going to the gym. It's sit ups, air squats and push ups but, for the eye brain connection. And of course, if you go to the gym, if you work with somebody one on one
14:43 with all the tech, all the equipment, you're going to get better results faster. But again, not everybody has access to that. So this has been, an absolute monster. We've had as young as 5, as old as 89. Go through it successfully. And listen to this. We've had 100% of people who finish the first course see a reduction in symptoms. And that's out of thousands of people. Wow. But you got to do the work. So people that say vision exercises don't work, that's the same people saying normal exercise doesn't work. You got to do it. You got to know what to do and you got to do the right stuff. Yeah. No, that's awesome. And I like that, I like that range. Age 5 to age 89. That's really awesome. And I think that actually leads me to kind of my next topic was like this idea or this assumption that most people think that eyesight will just get worse as they age.
15:29 That seems to be a generally accepted. And you, have thoughtful pushback on that. So what do you mean when you say vision does not have to decline with age and what kind of habits can make a difference there? Yeah. So let's separate that into kind of two different camps, distance and near. So distance eyesight should not get worse as we age. And if you're getting stronger glasses every year, different glasses or contacts, that means you're adapting to the lens you're in and needing something stronger to maintain that same clarity because of the visual stress of life and not having the foundational tools or skills in place to meet those demands. So as an adult, a distance prescription only changes when there's a functional vision problem. When we then think about near, that's
16:15 a little bit of a different scenario. But also with some of the similar conversation where there's age related changes that happen for most people in their 40s or so, you and I will be there in another few decades, hopefully. Where we have to the lens inside of our eye becomes hardened. The muscles and fibers controlling it become more rigid and less flexible. We have to start holding things farther away from us until our arms aren't long enough. And then the drill. You're grabbing readers. Yeah, but just like we don't jump into a wheelchair when our knee hurts and stop using it, we figure out what happened. We develop, and we work our way back to functionality. The same goes with the eyes in the 40s when you start to notice up close getting a little blurry. Instead of reaching for the over the counter readers the first chance you get, you can train the focusing system and the eye
17:01 coordination systems to hold clarity to close distance for 2 seconds and then 3 seconds, then 5 seconds. And if done right with specific vision performance training exercises, we can actually slow down those changes. We can even stop them and in some cases even reverse them. But it requires knowing what to do and the right type of work. But I would say, I we have patients in their 70s and 80s who are doing work every day but not wearing reading glasses. Wow, that's awesome. I've never heard it explained that way. And I love the analogy of don't get in a wheelchair as soon as your knee hurts. And I think that's. Yeah, most people are absolutely avoiding canes, wheelchairs, whatever, and trying to kind of adapt. And I think that, you're right. Why not do the same thing with your eyes? And I think it's most people just don't think about it that way. So I think that's, that's a great reframe.
17:47 Absolutely. And just to give you a little bit of perspective here, I've been in practice for 17 years. For the first decade of my career, I would have said this conversation we're talking about is impossible. This that's. We didn't learn this was possible in school. What are we talking about? Yeah. But then we started to see all the changes occur around Covid times. Yeah. We then got in the lab and we were blessed to have to learn from hundreds and thousands of patients. And we develop protocols that can actually train that eye brain connection, just like we train the rest of our body, but to actually develop more flexibility and stamina, especially with the focusing system. And my colleagues who say that's not possible, my response is, well, have you ever tried?
18:33 Because if you haven't tried and if you haven't gone through these, these protocols, you can't say it doesn't work. And we have found that those who take an intensive approach, meaning a lot of work in a short period of time, it is better results, faster, and the more opportunity the brain has for learning with the least amount of time between the learning, the faster learning takes place. Yeah. And so we see people every week who fly in from all around the world for intensive boot camp treatments, but with 100% accuracy. We've had adults either slow down, stop, or reverse their age related changes at near but it's also fine tuning our protocols by the day. Yeah, no, that's amazing. I mean, first of all, I mean, that's amazing in terms of both the protocols. And I think it's amazing philosophically
19:20 in terms of hope, you that I think if people realize it's possible for other people, then they'll change their own mind about what could be possible for them. And I think sometimes that itself is a very valuable starting point. So that's awesome. And we'll say for somebody who's got a really high prescription, you've got a lot farther to backtrack, but especially when the changes are early, that's the prime time to jump on it and take a proactive approach. Yeah, I think that's awesome. And I think that shifting a little bit to just the mechanisms of aging, I think as we age, the visual system might change in ways that a lot of people aren't familiar with or hear about. I think, you've talked about, the lens, yellows, contrast sensitivity will drop, depth perception, we talked about a little bit.
20:06 How does this cascade into sometimes things that families would attribute to either normal aging or even potentially dementia or cognitive decline, when the root, cause might actually be the eyes, have you seen situations like that? Yeah. Well, actually, can I. Can I ask you a quick question? So I've. I've been saying that cognitive decline does not have to happen. And you, as the dementia expert and guru in this space, do you agree with that? Yeah, I agree with that, too. Okay. I completely agree with that. I mean, I think in a small subset of people, it may just be heavily genetically predetermined, but even I'm changing my mind on that in recent years, But I think, yes, I've generally seen people do a lot to change cognitive decline trajectory, including people who were on the early
20:53 side of the journey and dramatically changed our lives. So. But again, it's hard to prove. It's hard to prove that, but I think just intuitively, from working with so many people, I think it's not a, it's not a sentence. Right. And it's well documented that when our hearing declines. Right. That. That we're not tapping into the same areas of the brain and that exacerbates cognitive decline. Well, the same should follow for vision as our dominant sensory system. Right. If you're not tapping into all areas of processing and visual processing, you're not going to have the same outcomes than if you did. And I always talk about how there are more areas of our brain dedicated to processing vision than all of the other senses combined.
21:38 And more than half of our brain is dedicated. The real estate of half of our brain is dedicated to vision and processing vision. So I look at the type of work we do as using the eyes almost as like joysticks to tap into the brain, to rewire the software to allow for communication to take place that we're either bypassing or where there's roadblocks in place. And we're literally rewiring the brain to eliminate the roadblocks so that we can allow for more fluid and accurate communication between the proprioceptive centers and the language processing centers and the balance centers and the, different communication centers that allow for us to confidently navigate and process our world. Yeah. And actually, so this.
22:24 So actually, thank you for going in that tangent because I. I didn't have this question on my, on my list, but it made me think. A lot of times in, in the earlier stages or even kind of modern stages of dementia and cognitive decline, we notice a lot of people's daily life patterns turn into watching more and more tv, and I, guess in the theory where you are kind of going through, which I think is an interesting thread to pull, that might actually worsen significantly, the trajectory. So, any thought, I mean, I realize that, Not to put it on spot, but I'm curious about that because I just see it so much and I just know deep down that isn't what, they should be doing. But people default into that mode. But is it making it worse? I mean the whole, if you don't use it, you lose it.
23:10 Saying, I that that applies for cognition, it applies for vision. And I have loved ones in my family who, have a lot less stimulation in their lives. They're on watching TV a lot more, they're reading, they're watching the news, and they're less aroused and less aware and less alert. And it. Our brain is so plastic, which is a good thing, but it's also a bad thing if you stop allowing vision to guide movement, and if you stop getting out and walking and allowing for blood flow and heart rate to regulate the areas of the brain that should be fluidly pumped with oxygen and blood and allow for the right nutrients to get to the right place.
23:56 And just like, toxicity from our environment can impact our brain screens are toxicity for our visual system and our nervous system. Yeah. And we adapt to the stress that we're in or we avoid it. But these maladaptations, that's really where we start to see vision decline take place. And then not trusting what we're seeing. And then all of a sudden as we get older, changes in elevation, we're less secure on, and we're not seeing the true root that comes out of the sidewalk or going downstairs when we're hesitant. Yeah. And vision can be enhanced and optimized for any brain at any age. But again, you have to treat, it as this fluid dynamic process where learning takes place from our life experiences.
24:43 But if we're not learning from our life experiences, and if our life experiences are becoming more sedentary and static, we're not learning, we're not adapting. We're not applying, these judgments to space. Yep yep. No, I think, I think that's totally agree. And I think that is really interesting. I haven't thought about it, in that way. I think then thinking about other things with older adults that we help falls, obviously, we all know it's one of the leading causes of deaths and even just disability in older adults. Can you talk about the visual component of the fall risk that many, even doctors or family caregivers may not be, fully thinking about? Yeah, And I think it goes back to not trusting what we're seeing. Oftentimes our visual midline becomes unstable as our eye, coordination
25:28 or eye teaming becomes unstable. And then our visual midline and our body midline are sending conflicting signals on how, where we are in space and, falls. Being able to prevent a preventable fall can allow for so much more longevity and happiness. Yes. And especially when, head injuries are in, are in play. We know that if you've had one head injury, you're more likely to have additional ones. That's only if you're not rehabbing the brain to get back to a place where you have a confident sense of central and peripheral processing. And especially with these two pathways, the central and peripheral processing pathways should be like a seesaw that's balanced.
26:13 But when we're under stress, regardless of the stress, how that shows, up visually is that our pupils widen and we get stuck with this tunnel vision. And so when we get stuck with this tunnel vision, this central processing, it means we're not aware of what's around us. We're not able to prevent things from coming into our field and reacting appropriately. Whether that's we're in a car, whether it's. We're on the road and somebody. And somebody or something is coming past us. And a lot of falls are preventable, especially when vision is giving us accurate feedback in real time, in real space on how to prepare ourselves for, what's coming. Yeah, yeah, no, I think. I think that's. I think that's something really important that, people should be thinking about,
27:00 in terms of, fall risk and how to address it through vision, So thanks for sharing that. I think, then. Then if somebody has a, is watching this right now and might have a parent in, assisted living or even, memory care, are there things that, signs they should look for, maybe two or three signs that might suggest they have a hidden vision problem or that a vision problem might be making things worse for their lives? Definitely. And I think some of what we touched on initially, but kind of the, getting lost or not remembering where they parked their car or being confused in a new environment or even in a familiar environment, or trouble identifying an object or a person and assigning the right
27:47 label or language or understanding what they're seeing. I mean, those are clear signs that something has changed. And oftentimes, with early signs of dementia or Alzheimer's, we'll see somebody who, sees a dark rug but perceives that maybe as a hole in the ground or there's. And that can often be a sign of damage to the occipital lobe, to the back of the brain that is responsible for. For eyesight. But it's also these kind of misperceptions of what's around them or where they are in space. And then I think the navigation piece. I mean, certain people rely heavily on maps or waves, or they're in a new environment and they can't orient or locate themselves
28:35 in terms of where everything is around them. I think, to me, I look at that as a functional vision problem along with knocking over a glass of water, bumping into the wall. We have a, gentleman here this week with us for treatment who says that he always, when he turns to the left, trips over his left foot, and we see this all the time, that our ability to have vision guide movement improves. But also it's almost as if we're not fluidly processing space. And then our ability to direct our body becomes compromised. And then it can be as simple as not relating to where you are in space compared to another object is. Or in a New hotel room, you're always bumping in the corner of the bed and your shins are all
29:20 messed up or, oftentimes as we get older and we get progressive lenses where the top of the lens is for distance and the bottom is for near, that can really disrupt going up and down stairs. And without adjusting our whole body, the world is literally perceived differently and almost like it's warped. And that can just be from being in the wrong glasses setup for that person. Yeah. So that visual spatial processing and visual spatial function, I look at that as the clear signs of early stages of cognitive decline, which can lead to other more advanced stages. Yeah, yeah, no, that's super helpful. You and then you talk a lot about vision
30:06 performance training, you just as a way to kind of rewire the eye brain connection, I You is it ever too late to start, you can a 70, 80 year old benefit, you actually from this? Old brains can be taught new tricks. We have a 92 year old in treatment with us developing depth perception for the first time. Wow. And one of the. For anyone medically who's listening, we're all taught in school that there's this critical period of vision development and after age 8, you blow out the candles and all of a sudden what you see is what you get. That is for vision lost, not for vision gained. Meaning if you or I were to wear an eyepatch for six months and take off the eye patch, we'd be a little sensitive to light, but we wouldn't have lost the ability to see.
30:53 But if you take a six year old and give them an eye patch for six months and take it off, there literally will be eyesight lost. Because that's a rapidly developing brain that's still allowing new firing and wiring. But in terms of what can be taught, with the right work, right motivation and right compliance, we can tap into stereopsis, which is the medical term for depth perception. As long as there's eyes connected to the brain and no one is born with the ability to see in 3D, it's all developed through our life experiences. We develop cells in our visual cortex that only respond to two eyed. learning and learning from our life experience to be able to understand where things are in relation to us. And then we develop these cortical pathways. So eyesight develops through biology,
31:40 the eyes develop through biology, but vision develops really from experience and learning from our experience. And so putting yourself in a learning experience in novel environments where we're regulating and adapting in real time. I mean that's how we can really tap into a lot of our brain function that often we bypass or stop using because our brain often takes that path of least resistance and does what's easiest. Yeah, that's fascinating. I think that's fascinating. So thanks for sharing the insights. And then now turning into rapid fire, I think some rapid fire round of questions. I love that. Let's do it. Okay, so 20-20 eyesight overrated or, is it a most dangerous number in medicine?
32:26 Oh, most dangerous number in medicine, definitely. I love that. So I always preach 20-happy, meaning not everybody has to see the HD small letters. Right. And for some people, myself Included, I'm around 20-30, because for me that allows me to have this kind of comfort where I'm not over focusing at any distance, but I'm also, there's a little bit of kind of wiggle room everywhere, but no two people see the same. So we don't need to make everybody see the same. And I'm always a big believer of if we're in glasses or contacts, it should be the weakest lenses possible that give the most improvement, that, are the most balanced between each eye but that improve performance. So if you're going to the eye doctor and
33:11 they're saying you need new glasses and here's what the prescription is, there better be an improvement in performance or reason why you're doing that, rather than just because the tests say that you need something stronger. What does that mean in terms of quality life and activities of daily living? And if there's a benefit, by all means, then let's go down that path. But if there's not, we don't just need to respond to test results, we need to interpret them and understand what that means. Yeah, yeah, no, that's helpful and very practical advice. Then what is the single worst thing we do, daily for the visual brain screens? Screen time is terrible. It is. We're not meant to be doing this. And it is directly causing challenges with
33:56 eyesight, eye health, visual function, and even mental health and happiness. And it's crazy. I have three young kids and seeing what was happening when Covid first hit when they're on screens too much. I mean, it was clear as day. And so, all three of my kids have been through vision performance training. All three of my kids didn't have a choice. But also, I don't worry about screen time as much with them because I know they've trained their brain to have the visual foundation to thrive. Yeah. But then also I have them in protective, what we call digital performance lenses, which are glasses specifically for screens that have a high quality blue light filter. But they're way more than just a blue light filter. They have a specific prescription
34:43 that decreases the visual stress associated with near and gives their brain a better opportunity for the inside and outside muscles of the eyes to work together in unison. And so that's something that, really, when you know better, you can do better. That those are so protective, especially for kids. But there's also a level of digital performance lens that every adult can be in as well. It just requires the right, mindset and approach to be able to know how can we develop, a support system there to handle screen time? Yep yep. Great thanks. Awesome insights. Is there a vision exercise that someone can do, right now, after they finish watching the episode
35:28 that actually works and can benefit them? There's so many. So I would say the most bang for your buck would be something that I call eye push ups. And so let's all do this together, and then I'll explain what this does. So eye push ups. Cover up an eye with a hand, and then stick a thumb up with your other hand and look at the nail portion of your thumb. Then you're gonna slowly bring your thumb towards you, keeping it clear the whole time. And then stop as soon as it gets a little blurry. And then when it gets a little blurry, you want to stop. Try and make it clear. Look really hard at your fingernail. Think about stimulating your focusing system. Visualize your pupil getting small. Think about locking in, looking hard at this. You're gonna hold it for five seconds. Then you look into the distance for five seconds and relax your focus. Okay, and then look.
36:14 Think about looking soft, kind of diverging your eyes. Panoramic viewing. Then back at your thumb for five. Back in the distance for five. So this is a stimulation relaxation. Stimulation relaxation. So everyone listening, you wanna do this same amount of time right eye as you do left eye. And most people will notice that you can probably hold your thumb a little closer with one eye than the other. Which means under two eye conditions, you're actually focusing your eyes at slightly different planes, likely because it's too hard to focus them at the same plane. And your brain is adapted to use one a little more for near and the other a little bit more for far so that it doesn't have to avoid the task. Yeah, this eye push ups. This is crazy to think about Neal but if you do this every day, you literally will not need stronger reading glasses. You may be, may be able to even get
37:00 by with weaker lenses and for some people even avoid lenses. And this is a gross activity. It's turn on, turn off. And it is not the most exciting activity. And obviously there's way more dialed in treatment that we can use with lenses and prism and tech and filters and things like that. But this is the type of thing that if you could do this, let's say you did this every day for a week and your thumb is 2 millimeters closer. Yeah. Millimeters add up to centimeters, centimeters add up to inches, and then that extends. That is probably the single biggest bang for your buck exercise in terms of the lift that it does. But then there's certain exercises to help engage periphery that we could talk about, or certain ones that help your visual and vestibular systems communicate more effectively so that maybe motion sickness is less often, or
37:48 certain ones that can help with convergence or with tracking. And so it's really a matter of knowing what system we're trying to target and what the outcome should be. But even something as simple as eye stretches, which is almost like yoga for the eyes, it's going to help calm the nervous system and allow for better flexibility with the outside muscles controlling the eyes. Yeah. So we could knock a lot of these out if we wanted. I really appreciate you sharing it. I'm glad you did the exercise real time because when we did that, I now realize your earlier point that when I brought it over here, it was kind of like blurry and fuzzy and then by just trying, eventually it focused and I was okay, that's super interesting, you and Yeah, I think
38:33 so. Yeah. Thanks everyone watching. Try that. You and something like the eye push ups we're doing there. Yeah. Think of that as it can also be done with, let's say you're doing bicep curls. You start with a 5 pound dumbbell, then you go to a 10 and then a 15. In our clinic we have lens powers that would ask you use one side of the lens and it turns on your focus a little bit and we use the other side and it relaxes a little bit. And then those powers can extend. And we're all honestly putting in work to build the flexibility and stamina of that system. And that's just one system, but that is the system that gets impacted from age and the age related changes. And then for many people, when you stop having the rapport with your focusing system that used to have then the outside muscles try and take over what the inside
39:19 muscles couldn't do as well as they did previously. And then we often see fragile eye teaming. And that can cause the words to move when you're reading. Or sometimes in a more advanced stage, go to double vision. And really that just is a spatial mismatch of, aligning your eyes in a different position than where you perceive something to be. Yeah. And if we can eliminate that mismatch and you can align point and focus where target is, then you have more single, clear, comfortable vision and the eyes working better together as a unit. Yeah. That's awesome. Thanks for sharing. That was great. What's one piece of advice that conventional eye doctors should stop giving out? I would say, I mean, there's so many, but probably the one that I
40:06 often hear is that glasses or contacts don't make your eyesight worse. And I would say that is accurate that the glasses or contacts do not make your eyes worse, but your adaptation to that lens and still having the same visual stress, but not the tools in place to be able to meet the demands or support that stress. That's what causes the changes because you're still trying to make sense of this unstable world. And so it's really. If you were to take a ton of breaks from screen time, then you're going to develop better stamina over time and you're not going to adapt as likely. Or if you're going to get outside more and not be stuck behind a screen and indoors all
40:51 day, I mean, that's going to allow for more distance engagement and panoramic viewing. So again, it's not the lens, it's your, your adaptation to that lens by having the same visual stress of life. Yeah. Yep. Okay great. That makes sense. Yeah. Yeah, it does. And that's a good one. And then last one, what did you change in your own daily life after everything that you've learned? So I've done more vision performance training than I would confidently say anybody has, because I just, I live, breathe, and sleep this stuff. But, I would say taking frequent and often vision breaks. Okay. So even on this, recording now, I mean, there's times where I'm relaxing my eyes, looking through the screen and actually
41:37 diverging my eyes and softening my gaze. And then I come back. And so it's almost like if you were to stay with your bicep flexed for an hour, your arm's gonna get tired. But if you were to flex and let go and flex and let Go. You can do it for much longer. Yeah, so I think the 20, 20, 20 rule, I hope most people have heard this by now, but really what that means is at least every 20 minutes, taking a break for at least 20 seconds and looking at something at least 20ft away. But that's kind of the maximum we should be taking breaks, vision breaks even every five minutes and coming back because it's going to allow you to perform at a higher level for longer and that, that's going to make it so that screen time is providing less toxicity to the nervous system and you're going to be
42:22 able to have better critical decision making, energy, focus and productivity throughout the workday when you are on screens, if you are allowing for more flexibility and not just staring at one plane for eight to ten hours straight. Yeah, no, that's helpful. Do you mind clarifying, actually explaining maybe to the audience, even for myself, what do you mean by looking through the screen? Because I suspect I have sometimes days where I have back to back zoom calls or I'm on a screen. A lot of people in the audience might, depending on their type of work, might be in a situation like this where they're looking at a screen. What do you mean? Looking through the screen? Are you looking at something behind and then focusing the eye on that? Or how can people practically, during a one hour zoom call setting like that, look through or you do something? Yeah, so it's really engaging
43:08 your periphery, your side vision. And periphery is what grounds vision, grounds us in space. And so for a lot of people, it takes active work to get to this place where you can learn how to soften your gaze and look beyond. One great exercise for that would be something like peripheral pointing, which would mean look at something straight ahead, don't move your eyes away from that, but then notice something off to the side. So I'm going to notice this light switch here, I'm pointing to where I think it is without looking there. And then I make the eye movement over and see. All right, was I right on or was I off? And then bring it back down. And so you want to kind of like actively paint or open up the periphery. You can do this on a walk where you're seeing the house to the left, the mailbox to the right. But if you're intentional, you can see them both at the same time. And so it opens up your world.
43:53 And periphery is the key to central localization. And so even right now I have our window. And don't take this the wrong way. But I have it really small so that I'm just kind of engaging with the whole screen, the whole room, rather than directly at you. And so I can soften and kind of look through the monitor. Yeah. But most people would not even know that's possible or even know how to do that. Thanks for sharing. Because I'm doing the opposite. I'm staring right at where your face is. The entire, thing. And you're right. That's. I do that often on calls. And then I later wonder, hey, I was spending the one hour staring at almost like a, one inch, point on my screen, the entire time. And I think that's really interesting that,
44:39 practical advice that anyone can take. Yeah absolutely. And then neat practice to kind of translate this to the real world. Yeah. Oftentimes when you're talking to somebody, you're thinking, do I look at their left eye, their right eye, their nose, their mouth? But if you kind of look at the whole face. Yeah. And you kind of look at the whole. The forest, not just each individual tree. The more you can take in. Yeah. The more regulated your nervous system is, but then the less you're kind of locked in with that central focal processing. And that really can be, wonderful for allowing performance to stay heightened for longer. Yeah. This is awesome. Thank you. I think there's so many practical tips. I hope everyone watching, it makes you rethink a lot of things, in your life. And also just, helps everyone, practically, I think, Yeah.
45:24 Bryce, this has been, you a wonderful conversation. It's been a treat. You I think, I'm actually gonna start, thinking about how I do things in my daily life after this conversation. I love that. So, you thanks for that. And I think just the whole concept of, eyes, you being a direct window to the brain, I think is really interesting. And I guess. Yeah. If you could share with everyone, you where can they find, you Screen Fit and, you know, my vision first and just follow along, you where can they follow you? Follow your work. Amazing. Thank you so much. So myvisionfirst.com is our practice, and that's where we kind of house everything that we're involved with. Screen, Fit is our online vision training program. That's screenfit.com it's actually in the process of being turned into an app right now. So it's going to be gamified and allow for better compliance. And then we're all over social media. Instagram's probably our best one
46:11 with just the most content and exercises that we're always pumping out. And that's just Dr. Bryce Appelbaum. But, my ancestors wanted to make life really challenging for us. So Appelbaum is spelled A, P, P, E, L, B, A U, M Not like apple the fruit. But you'll find us when you type it in. And I'm always just trying to get people to recognize how much vision is related to so many areas of life and so much struggle that we all just assume as normal that doesn't have to be that way. And we're now learning that training the eye brain connection can be the most critical driver of performance, longevity, focus, critical decision making, energy. So much so that when our brain's not
46:56 on overdrive, just trying to align, point and focus our eyes so we can actually utilize and tap into so much more of our capacity. Yeah, that's, I think, awesome philosophy. And I would highly urge everyone to, check out Dr. Applebaum's work. I think there you have it. And if this hit home for you, do one thing which is book a functional eye exam or functional vision exam, I guess 100%, not just a standard eye exam. And check out screen fit. I think that, this would be awesome things for people to try out. I think there's a broad range of people that could benefit as we learned about on the episode. And we'll be sharing short clips and tips from this conversation across all of our platforms. And of course, tag you guys on Instagram, Facebook, YouTube, TikTok, et cetera. Keep an eye out.
47:41 And if watching this makes you think about someone you love that might be struggling with, vision issues or a friend or a family member, send it their way. And if you're not subscribed, hit the subscribe button. Dr. Appelbaum, thank you again. I think this was an awesome show. I learned a lot. I hope the viewers learned a lot. And thanks so much for spending time with us. And, yeah, we'll see you in the next one. Honor to be on here. Appreciate you having me.
