I want to talk to you about bags under my eyes um, a subject that i know a lot of people are interested in, and there's a lot of misconceptions around how we get bags under our eyes.
I think most people think bags into their eyes are because they're tired or something.
Um, and is there a difference between having bags under my eyes and having sort of dark circles under my eyes?
So, when it comes to having dark circles under eye bags,
Dark circles is something that people are definitely concerned about.
It's a huge topic online.
I see all the time.
People ask about it in the eye clinic.
Having dark circles under the eyes is technically different than having under eye bags.
But if you have under eye bags, it'll make the appearance of dark circles worse.
Okay.
So dark circles?
In the clinic we think first what's somebody's skin pigmentation like?
Is the dark circle just because they have more pigmentation?
And if you're somebody who spends a lot of time in the sunlight, you are more likely to develop darker skin complexion around the eyelids.
The eyelids are some of the thinnest, most delicate tissue of skin on your body.
And, in fact, a lot of people who don't know this, but having skin cancer on your lower eyelids is actually pretty high.
So it's good to be wearing either a wide-brim hat or sunglasses to protect the eyes from sunlight damage.
The other kind of components is that if you have vascular changes.
So myself, I have a really pale complexion.
If I have bad allergies, that can cause the blood vessels around my eyelids to dilate.
And so you'll see that color of just the blood vessels coming through the skin a lot easier.
And then there's orbital shadow effects.
Because some people's orbits, they have more prominent brow.
It may kind of cast a shadow onto the lower eyelid.
And that's where having under-eye bags can also make the eyelids seem like they have kind of dark circles because the eyelids are puffy.
And you can have puffiness of the eyelids for multiple reasons.
Allergies are a big one.
Salt content of the tear film.
And even in your body can make some of those changes.
I know for myself if I have a cheat day and I eat a bunch of greasy, delicious pizza, the next morning I can feel that my skin and my face is maybe a little bit more puffy.
Thankfully, that goes away within a few hours.
But that's why a lot of times, even just doing cold compresses, right?
You see people put cucumbers on their eyes.
A lot of that is more have to do with just the cooling process. temperature.
Doing a cold compress for 10 at max 15 minutes can bring some of that puffiness down and that can at least help improve the appearance.
So if I have a really salty diet the night before, there's a greater probability I'll wake up with bags under my eyes.
Possibly.
Okay.
I've tried to research this to find any real publications, to see if it's really there, and I couldn't find anything.
But I know from just my own anecdotal experience that if I eat a really high-salt diet And I've done over the last eight years I've really done a better job.
I know you have too of thinking about my diet, how that affects me, how my body feels after I eat something.
And so I've noticed if I have a cheat day, that sort of thing can happen.
And where does this... What's the sort of physiological rationale for salt playing a role?
So your tear film, for example...
Like I know some people will say hey, if I watch a sad movie and I cry at nighttime the next morning, my eyes are super puffy.
So your tears have salt in them, because if you ever cried and tasted your tears, they taste salty, right.
So the challenge is that when you have salt, it will draw fluid into the tissues.
And so if people cry the night before, the salt remaining in the tears basically get into the tear ducts and sit on the surface of the eye and the eyelids and then that can draw fluid into those tissues.
Does hydration play a role?
That's also something that's been looked at in research.
It's not really conclusive.
I think hydration is still something we need to.
I do encourage people to at least be aware of their hydration.
For dry eye.
There is some research that indicates that people who drink more water tend to have less severe symptoms of dry eye.
When I see someone with bags under their eyes, I used to think well, I still kind of do think that it just means that they haven't slept.
That, again, I recently did a live stream where I did research first and tried to look into this.
And they have looked at quality of sleep, time of sleep and both the subjective and objective appearance of dark circles under the eyes.
And they find that it is.
If you have not been getting good sleep objectively, your under eye dark circles do not change.
Really?
But your subjective appearance of your own image will go down.
Ah, okay.
So they find that for both sleep and stress.
So you believe that you've got bigger sort of dark circles or patches under your eyes.
But objectively, in reality, you haven't.
Yeah.
Because they can measure the type of light being reflected off the surface of your skin.
So they can see how much pigment and what type of light is being reflected.
And so they've been able to find.
Oh, that it's purely just your subjective opinion of your own self-image seems worse when you're tired.
What about stress?
Because I'm thinking about people that I've seen that have like big bags under their eyes and like their eyes kind of look dark.
I always assume it's their stress and they haven't been sleeping.
But you're saying that that's not accurate necessarily.
So, at least in the few studies that I've been able to read that were published in the last five years, don't seem to find that conclusive necessarily.
There are other physiological changes that happen when people don't sleep or are under stress, right.
Cortisol releases, inflammation in the body will change, hormones can change.
So they may all play a role there.
But right now it seems to have a less effect on the true pigmentation of the eyelids.
Okay.
And the cucumber and the cold compress and all that kind of stuff.
Does that stuff work in changing the appearance of dark circles and bags and demise?
Because when i filmed dragon's den, a tv show in the uk, if i sometimes it's weird because, like sometimes when i'm underslept i come into the studio and the makeup artist she won't say anything to me, but she'll just put the cucumber on and i know what she's saying.
She's saying you look like shit but but she doesn't say it, so and it's always when i haven't slept.
So i put two and two together and thought okay well, she knows that My eyes don't look great today.
But is it actually doing anything, the cucumber?
The coolness effect, I believe, is going to be causing constriction of blood vessels.
It's going to be helping the tissue come down and swelling.
Just like if you bend your knee or elbow really hard on something, it swells.
There's a little bit of inflammation.
And so putting cold on there can help momentarily, but I wouldn't do it longer than 15 minutes.
The reason why is because if you do it longer than 15 minutes, your blood vessels can go the opposite way and cause constriction.
More inflammation.
There's other things like eye creams.
There's a plethora of different eye creams on the market.
Some of those do work to help constriction.
Some of those are to help truly remove pigmentation.
And a lot of those products can have effect, but it takes months to truly remove the pigment.
Mm-hmm.
So you're talking – you're using that two, three times a day for like 14, 15 weeks.
But outside of that, if somebody has tried all those other avenues, talked with their dermatologist or an eye care provider of any kind and things still aren't getting better, there are some surgical procedures that can be done to help people with the appearance of under eye bags and some dark circles.
What do those surgeries do?
They either use – various forms of light or light therapies to help remove pigmentation.
You have to be careful around the eyes when it comes to those sort of therapies, but they do exist.
And then there's fillers, like they'll do hyaluronic acid fillers to change the shadowing effects around the eye.
And then there's forms of what are called a blepharoplasty, which are true eyelid surgeries.
And for that you would want to see an ophthalmologist who specializes in in those type of therapies or those type of surgeries.
So if I never want to get dark circles, bags and demise again, what is the natural easy solution?
I do still encourage good sleep, eating healthy, staying hydrated.
I think all of those things are good habits to have because we know they affect the body in so many other ways.
If somebody is truly struggling with it, then you can look at those various creams.
But I definitely encourage people talk to a medical provider or whether a dermatologist or an eye care provider who specializes in that area.
What about red light therapy?
So red light, there's so much in red light.
And this is I'm glad you brought that up because this is something I've been diving kind of headfirst into into the research for many things in the eyes.
With the eye bag.
Specifically, I'll say that there is some newer publications showing that red light therapy can help with depigmentation around the eyelids and giving the eyelids more of a youthful appearance.
I do wage caution though, because there's a lot of products that are online that offer red light therapy, for various reasons.
But They're not really standardized very well.
And so there are also publications showing people who've had damage to the eyes because they've used these various forms of red light therapies devices they bought online.
Because what the manufacturer states isn't actually what's being measured when they do it in the research and find out hey, what type of wavelength is this?
How much energy is being produced here? by the device, because it's not the specific wavelength.
The wavelength is important, but the amount of energy in the red light also is super important.
And if you have too much energy, you can go through the eyelid and go into the eye and cause damage.
And so I think it's really important.
This is still a very early area of research when it comes to the eye.
And so I think I just urge caution to make sure whoever's listening.
If you're thinking about red light therapy, you're thinking about getting a red light device specifically for eye care?
Definitely talk to a specialist who works in that area.
Okay.
But red light, have you heard much about red light in different areas?
I've heard a lot about it.
I don't know a huge amount about it.
And I have two red light panels at home, which were given to me as a gift recently.
My partner has one.
I have one.
We basically got each other the same Christmas present one year.
But we did ask ourselves.
We sat in front of it one day and said, what does this do in terms of our health?
And are we allowed to stare at it?
The devices that you got, do they come with goggles?
No.
Okay.
So that is sort of the concern I have is again, what energy is – really not just what wavelengths of light is it emitting, but what's the energy and also how far away from the device are you sitting?
What's the recommendations?
And specifically with the eye.
There is evidence that red light therapy can help with dry eyes, that red light therapy can help with macular degeneration.
Which is?
So age-related macular degeneration is one of the leading causes of blindness for older age adults.
50 plus.
50 plus.
In fact, if you're over the age of 40 and somebody's legally blind, 50 of them, it's due to macular degeneration.
And so probably some of the best research on red light in the eyes is on macular degeneration.
In fact it's currently approved and being used in Europe and It's not approved in the US just yet, but it is going through FDA trials.
But that is a form of red light therapy.
It doesn't just use red light.
It uses some near-infrared light and a little bit of kind of a yellow light.
But they shine that in the eye in intervals, and they do it for a few weeks.
And then a few months, you do it again.
And for macular degeneration.
They've been able to show that not only can the protein that builds up in the back of the eye in that condition diminish—.
But they can slow down the progression of macular degeneration.
And for some people, even restore eyesight.
They can actually help people see better.
Using red light therapy.
Using that form of red light therapy.
What about gazing at the sun?
Because I've been told so many things.
When I was younger, it was like, never look at the sun.
And then I got older and people are like, no, stare at the sun.
And now I don't know what's true.
Yeah, don't stare at the sun.
Even for like a second?
Don't.
So the challenge is sunlight is good for the eyes, especially early on in the day and, of course, toward the end of the day, just so that you're getting the signals to your brain to hey, the sun is coming up, the sun is going down to kind of influence your melatonin production.
The staring directly into the sun.
Though the sun is so powerful, it can very quickly burn holes inside your retina.
And I have a patient right now who she, you know, she comes in, her vision is not getting to 20-20.
We look inside the eye and she has burn holes, a burned hole in her retina that is we diagnose as solar retinopathy.
And I'm like, have you been staring at the sun?
She's like, yeah, I've been sun gazing since I was little.
I was in Florida recently and I stared at the sun.
And I was doing this for how many minutes?
And now she has permanent blind spots where she cannot see 20-20 anymore.
Where in there?
Is that the colored part of the eye?
No.
So the colored part is the iris.
But the light going through the eye is magnified so strongly by the cornea and the lens inside the eye that ends up focusing on the part of the eye called the fovea or the macula.
Which is at the back of the... It's in the back part of the eye.
Imagine if we were going to play darts.
We're going to go to the pub.
I'm going to throw darts.
The center bullseye of the eye called the macula, that part is your reason you see so sharply.
It's the part of the eye that you're using when you're reading words, when you're studying, when you're looking at your friends and family in the face.
You're using that bullseye in the back of the eye.
So when someone looks at the sun, they're putting all of that light energy focused right in that area.
And in just a few seconds, you can overwhelm that tissue, causing chemical damage to the retina.
Because people – this phrase sun gazing –
Is this like a spiritual thing?
I think I was in Bali and people were like, no, you can, you can sun gaze.
You should sun gaze because it's good for you.
Sun gazing, what is this term?
That is usually in some sort of either religious or spiritual practice.
People will gaze toward the sun.
Usually, from my understanding, it's people doing it in the early morning or late afternoon, when the sun is largely going down the horizon.
And because the light is indirectly being bent, perhaps it's not giving as much energy to cause thermochemical damage to the back of the eye.
But there is still a high risk.
And so it's always best to not stare directly into the sun or try to look off center from it.
And especially during the high UV times of the day, 10 to 4 PM.
Usually it's good to be wearing UV light protection.
Not just because UV can penetrate into the eye, but because UV light damages the skin of the eyelid, it can cause changes to the front surface of the eye.
You can get sunburn on the surface of the eye.
OK, that's good to know.
I'm not going to look at the sun.
I was being torn because I've got a friend who told me that sun gazing is good for you and you should do it and stuff.
But I'll take your word for it.
You mentioned blue light a second ago, which is the light that comes off our devices.
Is that harmful for my eyes?
There's blue light that comes from the sun.
Yeah.
Really high energy.
That could potentially cause aging changes inside the eye.
The blue light that comes from your digital screens does not have enough power and has consistently shown in research to not increase the risk of aging eye diseases.
It just impacts my sleep potentially.
Impacts your sleep.
There's also some claims that blue light can affect your eye strain.
But again, research on blue light glasses on using devices shows that blue light does not impact eye strain.
A lot of people will claim that they will.
I have a lot of patients who come in and anecdotally are like oh, my eyes feel so much better from getting the blue light glasses.
And that could just be placebo effect.
It could potentially be the fact that a lot of blue light glasses will have anti-glare or glare-free protection put onto it.
And the anti-glare is probably improving their focus and they're not having as much glare issues when staring at the device.
But right now there's still just no concrete evidence showing that blue light is contributing to eye strain.
But then the sleep cycle, we do know that blue light can influence your sleep.
What kind of gadgets do you have?
I don't know why, but I assume, as someone who is an eye doctor, you must have loads of gadgets around your house that you use because you know all of the information about eyes and vision and stuff.
Am I wrong?
I mean, yeah.
I have multiple computer screens open.
I have my phone screen open all day.
The other day I was… texting a friend, I'm like, I've got two laptops open at a coffee shop.
You know, I'm like, I'm doubling down on the blue light here.
So there's a lot going on there, but yeah.
Or practices.
Are there any practices that you've been disciplined with because you're aware of the impacts it will have on your eye?
Specifically on blue light?
No, all of it.
Just your overall eye health.
So the biggest things for myself is...
Diet.
Okay.
Let's talk about diet then.
Sure.
What do I need to know in terms of what I'm eating and drinking to make sure that my eye health stays optimal?
So they've been looking at lifestyle factors on aging eye diseases for a long time, many decades.
The biggest one thing when it comes to diet And they even have more recent publications.
A mentor of mine, Julie Poteet.
She's a past president of the Ocular Wellness and Nutrition Society, which I'm a member of.
She even brought my attention to a publication just this year from the American Journal of Nutrition.
They looked at the original publication of AREDS, the Age-Related Eye Disease Study.
It has a large cohort of people, like 4,000 people.
They watched over nine years of tracking their diet, tracking their eye health and how things were changing.
And they find that just eating a Mediterranean diet green leafy vegetables, oily fish reduces your risk of developing conditions like macular degeneration, specifically slowing down the progression of that condition.
In that specific study, this publication that just came out, they showed that just having 27 servings of green leafy vegetables a in a week not a day, but just even a week right.
We're supposed to have more than that in a day, but just 27 servings or more can slow down your risk of progression of that condition macular degeneration by 25 from going from early to more of an advanced stage.
And macular degeneration leads to blindness?
It can, yeah.
Especially as we get older.
Because that condition and we can go into it, but that condition has a lot to do with your inflammation.
It has to do with metabolism and oxidative stress that occur within the eye.
But green leafy vegetables at least 27 servings a week.
That's that specific study.
They find that oily fish eating two servings of oily fish a week slowed it down by 21.
And then they found a synergistic effect for people who ate both.
It was a 41% reduced risk of progressing in that disease.
So, and that's not just the only study.
They find that people who eat diets that have more fruits and vegetables, that have oily fish, reduce risk of developing conditions like macrogeneration, reduce risk of things like diabetic retinopathy.
And so I try to focus on eating a good, healthy diet.
I mean, the thing that I heard growing up was that you need to eat lots of carrots and then carrots will help your vision.
So carrots...
Do you know where that came from?
No.
That's actually a – it was propaganda started in the UK by Great Britain.
From what I understand, I'm sure there's like a historian out there who's just like grumbling at me.
But from what I have read and studied is that I believe it was World War II that Britain had – was being attacked by the Germans, and they were worried about German warplanes dropping bombs on them, especially at nighttime.
Yeah.
They had already established radar to detect warplanes coming, but they didn't want Germany to know that.
So they put out their own propaganda saying hey, our scouts can detect German warplanes better because they eat their carrots.
Because carrots have beta carotene, which your body can convert to vitamin A, which is essential for nighttime vision and retinal health.
Oh, okay.
Because I also used to hear that if you ate carrots, you could see in the dark.
Yeah.
I mean, it is based on some like vitamin A is essential for photoreceptors in the back of the eye, but most people are not vitamin A deficient by far.
And so it's pretty rare that we see vitamin A deficiency in the eye clinic, unless you happen to live in a place that's pretty malnourished.
Is there one food in particular that is, in your view, the top food for good eye health?
So green leafy vegetables.
What about sweet potatoes?
Sweet potatoes can certainly help you with things like vitamin A.
They've got other nutrients in them.
I think are really good.
Sweet potatoes technically have beta carotene, same thing as carrots.
If you're deficient in Vitamin A, your body will convert that beta carotene to vitamin A, which is good.
But mainly in green leafy vegetables.
You can not only get things like beta carotene, but you can get lutein and zeaxanthin, which are amazing for eye health in many ways.
Not just eye health, but also brain health.
What you just listened to was a most replayed moment from a previous episode.
If you want to listen to that full episode, I've linked it down below.
Check the description.
Thank you.
