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Naomi: In the last episode, Episode 043, I had a fantastic interview on safer summer skincare with professional makeup artist and esthetician Genevieve Blair.

Continuing on with the "safer summer" theme, on this episode, we are talking about eye health. Now eye health is not a topic that's talked about very much when it comes to our health, but as you'll hear, it can be indicative of so many other health conditions and diseases like diabetes or even thyroid disease.

Joining me today to share her expertise on this topic is Dr. Sandra Miyamoto. Dr. Sandra is an optometrist and has been practicing optometry for the past 12 years. She works with a full spectrum of patients at a private family practice here in the San Francisco Bay area.

In this interview, you'll hear Dr. Sandra talk about the importance of UV protection for your eyes. You'll hear her share her top tips to practice safe summer eye care, especially if you wear contact lenses, and you'll also hear her bust through some common myths around vision and eye care.

I loved having Dr. Miyamoto, or Sandra as I call her, on the show because she is a close personal friend and I always love to share my friends with you. With that, let's get to the show.

Hi, Dr. Sandra. Welcome to the show.

Dr. Sandra: Hi. Thanks for having me.

Naomi: So it's a little bit weird for me to be calling you "Dr. Sandra" because we're friends in real life, but I want to make sure you get the proper professional respect that you deserve.

Dr. Sandra: Okay, thank you.

Naomi: Why don't you start out by just telling us a little bit about yourself and your background as an eye doctor?

Dr. Sandra: Okay, so I was born and pretty much raised in Hawaii, like you. I'm from Mililani, which is on the island of Oahu, and I did my undergraduate work at the University of Hawaii, and then left Hawaii in 2001 and went to Scotland.

I studied abroad for a year, and then I headed over to New York City for optometry school. I was in new York for five years; I worked there a year after graduating, and then my boyfriend at the time, now husband, and I decided we were going to head out west.

I run a lot; that's one of the things I like to do, and so one of the years I was living in New York, a running magazine called San Francisco the number one runner's city in the United States. That kind of piqued my interest, and so we headed west in a car. Didn't have jobs, didn't have a place to live, and landed in San Francisco a little over 10 years ago now already. So we have an almost-four-year-old; my son is almost four.

As far as work goes, ever since moving out here, I've been working at a private family practice in Burlingame. I see patients as young as six-month-old babies all the way up to people who are in their 90s, probably have a 100-year-old every now and then too, and then everyone in between. We do a lot of glasses, contact lenses, your real basic, primary eye care needs. We do wellness exams, eye infections, allergies, dry eye, glaucoma, pretty much everything just primary eye care. I've been doing that for, oh wow, since 2006 I graduated but mainly I've been working at that small practice in Burlingame all that time.

Naomi: That's so interesting. I didn't know you see patients as young as just several months old.

Dr. Sandra: We do eye exams on infants. That's a whole other topic, but yeah, as young as six months. Actually there's a program going on, I think it's nationwide, where if you have a child under the age of 12 months, if you take them to an eye doctor who participates, they actually get a free eye exam. It's called the Infancy Program. Yes, we can do eye exams on little babies. It's important too.

Naomi: I was going ask, is that common because I honestly don't think I had my first eye exam, of course for vision, until I might've been in high school.

Dr. Sandra: Yeah, that's probably pretty common. I would say most of the people who come in are either patients of ours and we educate them about it when they're pregnant, or some pediatricians know about it and refer them over. I won't say it's super common. My pediatrician for my son never recommended it, even knowing that we're eye doctors, but there are some things we look for that pediatricians don't check for. It is important, for sure.

Naomi: Interesting. Well that's something that I did not expect us to talk about today.

Dr. Sandra: I know. I could go on about that, but I won't.

Naomi: Well, what we're going to talk about today, and I'm doing just a few episodes, a miniseries, on safer summer care for ourselves.

Today, I wanted to talk to you about some tips that you have for safer summer eye care. I never really thought of it as a thing, but us being running friends, I remember that you would always counsel me to wear sunglasses when I run because I never wore sunglasses, running or not. I just find the whole thing very, I guess I never had sunglasses that fit well, so they would always fall off my face and I found it just rather cumbersome, and it's just not a habit I got into but I always remember you instilling in me that "you need to protect the health of your eyes."

I thought being summer, a lot of us are outdoors a lot more often. If you could share with us maybe some of your top tips for safer summer eyes?

Dr. Sandra: Sure, yeah. The first one is the one that you just touched on, so UV protection. That's super important because UV light, it does a lot of things to your eyes. It can accelerate cataract formation. Macular degeneration has been linked to UV exposure-

Naomi: What does that mean?

Dr. Sandra: Oh, so "macular degeneration" is a disease which affects usually the elderly, but it damages the macula in your eye. The macula is the part of the eye that gets your best vision. When you look directly at something, you're using your macula. In macular degeneration, there'll be a degradation of that area and you'll lose, really catastrophic vision loss. That's linked to UV exposure.

Naomi: Is that one like, I maybe look directly at the sun and I start to see dots and I actually can't see for a few minutes?

Dr. Sandra: No, that's solar retinopathy. I probably should've put that on my list. Yeah, you should not look directly at the sun. You can actually burn a hole in your macula, sometimes permanently, and you'll get that sort of after image forever. That's different. Macular degeneration, it's more of a disease process which doesn't affect everyone, but it's normally seen in, 50s are sort of young, 60-year-olds, 70-year-olds, but really a catastrophic loss. If you ever know anyone who has macular degeneration, it's not fun. You look directly at something and you won't be able to see it. If you ever see someone who's older and their eyes are sort of scanning back and forth, they're searching for an image. They probably have a macular issue.

Naomi: So they don't see it at all, or is it just displaced?

Dr. Sandra: It depends. It depends what part of the macula and how much damage there is. Some people tell me, "I'm looking directly at you. I can't see your face, I can see everything around it." They'll kind of have to look from the side, but even if you look slightly to the side of something and try to use your side vision to see it, it won't be as good. That's one of the things that's linked to UV exposure. You can get melanomas inside your eye. There are changes that can happen to the white of your eye with a lot of UV exposure.

I grew up in Hawaii; I didn't wear sunglasses when I was younger. I have those types of permanent changes. You can also get skin cancer just on the lid of your eye. You want to protect that area from the son. I mean, you touched on the main one: sunglasses. Hats with brims will also do the trick if you really just are sort of reluctant to wear sunglasses.

One of the things I talk to people a lot about that they're not aware of is that the tint of a lens and the UV protection are totally separate things. You can have a clear lens that has either a UV coating put on it or an inherent lens that's UV protected, and it will protect your eyes just as much as a darkly-tinted sunglass. The tint is really more of a comfort issue, so if you go outside you don't have to squint your eyes and the glare. People who just wear regular glasses, if you make sure you have the UV protection, you will get coverage from that too.

Naomi: Oh, interesting. I didn't know that.

Dr. Sandra: Yeah. A lot of people don't. I tell people tint is like standing in the shade, and then the UV protection in the sunglasses are like sunblock. As long as you've got that clear component, it's helping you. You don't necessarily have to have the darkly-tinted lens.

Naomi: So I was going to ask you, are there some sunglasses that work better than others for UV protection, but it really comes down to the protection on the lens itself.

Dr. Sandra: Not from a cost standpoint. More expensive sunglasses aren't necessarily more protective. The optics might be a little bit better, but the UV protection will be there if go to, let's say Target, and get a pair of cheaper sunglasses that will protect your eyes. I think though, if you're looking at frames, a larger frame will cover more area. Then the sportier frames that kind of wrap around, that will also give you a lot more protection. Those are the kind of things that you can look for.

Naomi: Interesting. I never thought about that in terms of selecting frames. You always go for what looks best-

Dr. Sandra: Yes, yeah.

Naomi: But those are interesting. My next follow-up question related to UV protection is, are there contacts that-

Dr. Sandra: Yes.

Naomi: There are? Okay.

Dr. Sandra: There are, yes. Yeah. Some brands of contact lenses have UV protection. If you're wearing a contact lens, ask your eye doctor and say, "Hey, am I in a lens that offers UV protection?" It won't protect the white of your eye or the skin around your eyes, but it's better than nothing if you're outdoors and you don't put your sunglasses over that or hats. Yes, you can get contacts with UV protection in them.

Naomi: Cool. Okay, moving on. Speaking of contacts, what's your, I know your second tip but go ahead and share it with us.

Dr. Sandra: Okay, so swimming and contact lenses. If you are wearing a contact lens that you re-wear, so a two-week lens or a monthly lens, anything that you take out, clean, store, and put on your eye a second, third, fourth time, you never ever want to swim in contact lenses.

If you're doing a lot of water activities, I'll put my patients in some daily contacts. Daily lenses, you pop them on in the morning, you wear them for the day, you take them out and you throw them away.

If you're going to be doing really any type of water activity; swimming is the one we mentioned, but even sitting in hot tubs or kayaking, fishing, anything where there's a potential for water to get on your hands or splash on your face. There are lots of organisms in water which get into the lens matrix and cause nasty eye infections. You don't want to mix the two.

I encourage my patients if they're in daily lenses and doing water activities, as soon as you're done with it, take out the lens and toss it. You don't want to be wearing it again or throughout the day even.

Naomi: So it's not even a situation where your head needs to be submerged-

Dr. Sandra: Correct.

Naomi: You just need to be in close proximity. What about people who work indoors? Like say if you're doing a lot of cooking or, I don't know what you do indoors with water. Cleaning maybe.

Dr. Sandra: I've never come across that, but I've had a patient who was in a hot tub, dunked his head, slept in the lenses overnight, and then had a really terrible infection the next day. Freshwater is a huge culprit, so if you're doing any kind of lakes or rivers activities. Even the pool, even though it has chlorine to kill things, that will also cause infections. Any kind of water activity. Even showering; you want to not wear lenses when you shower. Same thing. Tap water has got those little bugs in it that get into the lens.

Naomi: Yes, and we shower in tap water.

Dr. Sandra: Yes.

Naomi: Yes. I was just looking for a shower filter online this morning, actually.

Dr. Sandra: Oh, okay.

Naomi: All right, your next tip for safer summer eyes.

Dr. Sandra: Okay. I was thinking about this one. During the summer, people go on trips a lot, get on airplanes. This is, again, sort of a contact lens-related thing but plane travel. A lot of times, you get on an airplane, take a cat nap, or you're taking a red eye and you'll sleep, if you're lucky, through the duration of the flight. You don't want to be sleeping in your contacts.

You might have heard that there are lenses that are FDA-approved to sleep in; I get asked about them all the time. The reason there are lenses that are FDA-approved to sleep in is years ago before contacts were really more oxygen permeable, people would get all sorts of problems from not getting enough oxygen to the front of their eyes when they slept. All these hypoxyia issues were coming up and we tell them, "Don't sleep in contacts." Then the companies over the years started making these really nice lenses that brought a lot of oxygen in, and all those issues sort of disappeared more or less. They got this approval to let people sleep in them.

I never ever encourage people to sleep in contacts. I will never give someone contacts saying, "Hey, this one's FDA-approved so you can go ahead and sleep in it." People who sleep in contacts develop corneal ulcers much more frequently than people who don't. A corneal ulcer, when you think about an eye infection, you think about pink eye. Pink eye is an infection of the white of the eye, which is fairly self-limiting and rather benign. You won't lose vision over that, generally. Corneal ulcers are infections of the cornea, which is the clear dome that covers the colored part of your eye, so where contact lenses sit. The cornea, it's a clear tissue so you can see out of it. When it gets infected, it tends to scar afterwards and the scar is cloudy. If you're unlucky enough to get a corneal infection on your line of sight, you will have permanently reduced vision. You do not want to get corneal eye infections.

The number one thing you can do to not get a corneal eye infection is to not sleep in contacts. I always tell people, "If you're going to get on an airplane, if you're prone to sleeping and it's not just a short flight during the day, then wear glasses instead. Put your contacts on when you get there." That's the tip for planes and contacts, and also planes tend to be drier. That makes contacts really uncomfortable.

Even for people who don't wear contacts, if you do have dryness issues on the airplanes, artificial tears work really well. You can buy them at the drugstore if you go to the contact lens aisle. Just pick one that says "for dry eye." You don't want to get one that says "get the red out"; those actually have a medication in it you don't need. Anything for dryness, that's something you can pop in when you're on the airplane.

Naomi: So even if they're FDA-approved, just don't sleep in them.

Dr. Sandra: Don't sleep in them. Yeah, no. Never ever. They've been pushing it, a lot of companies too. They advertise it. I think it's a disservice really.

Naomi: Well, I think a lot of advertisements of pharmaceuticals that we see a lot on TV these days are a little bit of a disservice because there's so many other things we can do before we resort to those things, but that's a conversation for another day. Now, I have a list here of some common eyecare myths. Well, I don't know if they're "myths"; you tell me if they're myths or not.

Dr. Sandra: Okay.

Naomi: I have a couple of them I'm going to read to you, and you tell me if they're true or false. These are actually things that I've wondered. Okay, so the first one, and this goes really along the lines of my eyecare habits because I don't wear contact lenses; I've never had to. You told me in my eye exams that I barely need glasses, right?

Dr. Sandra: Mm-hmm (affirmative).

Naomi: I have pretty good vision, which shocks everybody because I come from a family of people who have really poor vision. I'm like, "Well not everything's genetic. I have good vision." I'm very thankful for that, but if you have good vision, does this mean that you don't need an annual eye exam?

Dr. Sandra: No, so that is definitely not true. I tell people all the time, "Healthy eyes and good vision do not go hand in hand." You can have really healthy eyes and really terrible vision, and need really thick glasses. The opposite's true too: you can have very good vision and very unhealthy eyes.

Naomi: So what makes a healthy eye, then, and an unhealthy eye if your vision isn't-

Dr. Sandra: Affected?

Naomi: Yes.

Dr. Sandra: Okay, so there lots of things that can go on in your eye that don't affect your vision, at least in the early stages. For example, like I tell people, "The inside of the eye doesn't have any pain receptors." If you had a rip or tear in the retina, or something growing inside your eye, you would never ever feel anything. You wouldn't even notice it, really, until and unless it affects your vision, which it may or may not. A lot of times, by the time it affects your vision, it's gone on for a very long time. You want someone to dilate your eyes, which is when they put the drops in, opens up your pupil. We can see inside a little bit easier, and just give a thorough check to the back of your eye. Glaucoma's a really good example; glaucoma is a disease where you'll lose your peripheral vision slowly over time. Your peripheral vision's not that great to begin with, like we were just discussing previously. If you lose it, you don't notice it. Your brain is so good at filling in all the missing pieces, and unless you have very, very advanced glaucoma, you won't even realize you're missing any pieces of your vision.

I have patients who can't see everything above midline, let's say. If you ask them, "Are you missing any vision?", they'll say, "Oh no, everything's fine." You can lose a lot of vision and not be aware of it. Unless someone's looking in your eyes, something like glaucoma, there's no pain. There's really no symptoms until the very end. You'll never know that you have that. Everyone should really be getting their eyes checked at least every two years, is the recommendation.

If you're healthy, you don't have diabetes, high blood pressure, or any condition where someone said you should get your eyes checked more frequently, then you should probably get an annual check, more frequent for some people. If not, every two years is good. For a lot of people, it's not the eyeglass check so much as the ocular health check that's important. Does that make sense?

Naomi: That totally makes sense.

Dr. Sandra: Okay.

Naomi: I'm thinking it's been way more than two years since my last eye exam.

Dr. Sandra: Yeah, I tell people the eye is the only place that you can see a nerve and your blood vessels without cutting into your body. It's indicative of the health of that throughout your entire body. There are a lot of systemic diseases you can pick up in a routine eye exam that'll show up that people may not be aware of.

Naomi: That's actually very true. It's been about, I don't know, 25 years or so, maybe 24 years. My mother actually was a kidney donor to her sister, who had double kidney failure but it was picked up through an eye exam.

Dr. Sandra: Yeah, diabetes, high blood pressure, thyroid issues. A lot of things show up on eyes. Yes, very important.

Naomi: That really goes back to the whole body being connected.

Dr. Sandra: Yes.

Naomi: All right, so if you haven't had an eye exam in two years, go get your eyes checked-

Dr. Sandra: Correct.

Naomi: And I'm putting that on my to-do list. Okay, secondly, when I was in elementary school, I was always told that if I wanted good vision that I had to eat my carrots.

Dr. Sandra: Okay, so that's a yes/no kind of answer. Carrots do have a lot of vitamins, which are essential for good vision, but in the developed world, so the United States, if you don't eat a carrot in your life you will not be deficient in vitamin A, let's say. Yes, they're good for your eye health, but they're not necessary. The carrot itself is not necessary for good eye health. I think that's where the myth kind of started, with "carrots are great for your eyes." I think where people misinterpret it, and I get asked this is a lot, is "if I eat a lot of carrots," it will not prevent you from needing glasses. It will not affect what your prescription is. That's definitely a myth, yes.

Naomi: Kind of sounds so funny, and I don't know if the adults who told me this when I was a kid if they were really serious or they were just trying to get me to eat my vegetables.

Dr. Sandra: Yeah, I think they were serious because I still get asked a lot about that. "Oh, tell him to eat his carrots so he won't need glasses." I'm like, "Well, actually..."

Naomi: They're good for you. Dr. Sandra: They are good for you, yes. They are very good for you.

Naomi: Okay, so my last myth: again, going back to being a kid, I used to love reading. I won my second-grade read-a-thon. I was so addicted to books I used to lie in bed under the covers with a flashlight reading when I should've been asleep-

Dr. Sandra: Yes, I did that too.

Naomi: My parents used to get so angry at me and they would tell me that I would ruin my eyes if I continued to read in the dark like that, which technically I would say was not dark because I had a flashlight. But, is that true or false?

Dr. Sandra: That is definitely false. If you read in the dark, you can strain your eyes and make your eyes tired, but you take a break, you stop, everything goes back to the way it was. You will not cause any permanent damage by reading in the dark. Same thing; I have parents tell me, "Can you please tell him to stop reading in the dark?" I say, "Well, actually..." that one is definitely false.

Naomi: All of these things that we were told to as kids.

Dr. Sandra: I know, right? No, I used to read when we used to drive at night. I'd be reading in the backseat of the car trying to follow the streetlights. I would do that all the time, too, and my parents were like, "Don't read in the dark. It's bad for your eyes."

Naomi: Anything else to add? This was really, really informative. I think the eyes are something that's often overlooked-

Dr. Sandra: Yes, definitely.

Naomi: When we think of our healthcare, but as you said, it can be so indicative into other things that are going on in our body. Any other tips to add?

Dr. Sandra: The one thing I might mention is kids and UV protection. One thing too is kids tend to spend more time outdoors than adults, and children tend to have larger pupils than adults, so more UV light gets back there. I always encourage parents to try to get their kids to wear hats with brims or sunglasses if they can. You want to start young. A lot of the issues we talked about earlier have to do with your lifetime accumulation of UV. If you can get started when they're younger, it can only help them when they're older. That'd be the one other thing I might add for people.

Naomi: Absolutely. Goes along with your whole toxic load. I know a lot of the clients that I work with, they think that the things that they're struggling with just happen to them. I say, "Things don't just happen; things have been accumulating over a long time. They're just at the point where maybe your body can't handle the load anymore and now the symptoms are manifesting," so kind of the same thing with your vision-

Dr. Sandra: Same thing, yes. If you're aware of it, start them when they're young for a healthier life for them.

Naomi: Interesting. I just had a conversation with someone else on UV protection when it comes to your skin, but it really is so vital in your eye care as well.

Dr. Sandra: Correct. Sun blockers, you can put on your face but you don't really want to put it on your eyes. People tend to go around that, and so that's why it tends to get overlooked, even if you're being really careful with other parts of UV protection. You kind of have to think of it separately because you don't want to get sunblock all in your eyes and on your lids and things like that.

Naomi: Well it's not meant to protect those things.

Dr. Sandra: Well yes, correct, but even the skin under your eyes. Even me when I put sunblock on, I'll kind of go around my eyes because I don't want it to get in my eyes and sting my eyes. It's one of those things if you're careful, you have to think about it separately.

Naomi: Cool. Well thank you so much for being here. I appreciate it. I feel like there were so many great nuggets in here.

Dr. Sandra: Thanks for having me, Naomi.