How Postmenopausal Hormone Changes Affect Your Vision, with Dr. Meenal Agarwal

Foreign. Hello and welcome to this episode of the Feel Freaking Amazing podcast. I'm Wendy Trubo. Obviously Ed's not here today. And Today we have Dr. Meenal Agrawal. She is a board certified optometrist and spatial awareness expert who has pioneered a holistic approach to vision as a gateway to brain health, longevity and overall well being. Her work integrates optometry, neuroscience and and lifestyle medicine to address the root causes of visual problems and their impact on cognition, focus and neurodegeneration. Minal, welcome. It's so nice to have you here.

Thank you for having me. My pleasure.

Great. So let's dive in. How'd you get into this?

I think it was frustration and I think a lot of people get into sort of their functional side of their fields. More personal frustration with my own health struggles, but also seeing patients struggle. Whether it was visually eye diseases, it was, you know, sometimes, you know, glasses or eye drops are not always the way to solve the problem and a lot of times it has to do with lifestyle. And these lifestyle changes can affect our entire body. We talk a lot about it affecting our brain, our heart and other parts of our body, but our eyes are so much connected to the brain. And that's where I just started to get into that whole functional sort of side of optometry.

So this is fascinating. So what are the major choices that are lifestyle based that would impact someone's eye health?

Yeah, absolutely. So I mean the biggest one is food that we intake and nutrition and sugar is a, is a big one as well. Other things include being on your device or anything up close so near work for long or extended periods of time, that sort of sedentary lifestyle and not being outdoors as much as a big thing as well most, you know, especially with the new generation and the children and our children, they're on their devices a lot and computers are not getting that outdoor time, which really, you know, affects the eye health and you know, there's so many other things. But I'm going to say, you know, those would be my top three lifestyle choices. That or changes that, you know, I encourage my patients to make to for better eye health overall.

Are there ways in which hormone changes affect the eyes?

Yeah, absolutely. I mean, I'm going to say the biggest one is dry eye disease. 60% of postmenopausal menopausal women experience dry eye disease. And a big part of it has to do with our hormones. So it's not even only the estrogen progesterone dropping, but it's also the androgens dropping, which is kind of a shocker for a lot of people. But that directly impacts two main glands which produce tears or good quality tears. And those are called the meibomian and the lacrimal glands. And when they're not producing that good quality oily tear film, we're getting dry eye disease. So we're getting kind of a double whammy because we're sitting on our computers all day and then we're also having these hormonal shifts which affect our whole body. So I mean, but definitely the eyes. I'm going to say that's the biggest change that, you know, really affects women is that dry eyes. And you know, people sort of pass dry eyes off as, okay, it's just dry. But no, women come in every day suffering with it. You know, whether it's light sensitivity, blurred vision, a lot of times we think it's their prescription. But it's dry eye disease, inflammatory symptoms, itchiness, redness, they want to rip their eyes out, especially in the mornings. These are, you know, scary issues that can be solved with proper treatment. But a lot of people just ignore that dry eye part of it or think it doesn't matter, it's just my eyes.

So do you what, in addition to hormones, what are you recommending for a dry eye treatment? I can't tell you how many people have dry eyes who I know.

Yes, yes, absolutely so I think so. You know, my lifestyle changes would be blinking more. I mean, we do not blink on devices and this would apply for everybody, even the young. We're supposed to blink 15 to 20 minutes, 15 to 20 times, you know, every minute. But we're blinking five, six times every minute. So it's when we're on a device. So, you know, blinking more, staying hydrated is another big thing that definitely helps your tear film quality. So staying hydrated effects helps your whole body and then more of therapeutic. I'm going to say we like to recommend non preserved artificial tears. That's huge because. And it being preservative free is a big one. You know, we have to all jump on that band bandwagon of clearer products, so cleaner products. So preservative free tears at least two to three times a day. And I think another big one for women is makeup. So, you know, staying away from the preservative, toxic sort of makeup products, knowing your clean ingredients, the less preservatives, the better it is. You'd be surprised. I mean, I used to wear mascara and I would have to take it off within an hour, because it would be stinging. I have dry eyes. It would be stinging and burning my eyes even more. But when I started looking at different products that had cleaner, less preservatives, cleaner ingredients, I can now wear it, you know, longer. So I think that's so important for women to start, you know, making that shift as well. Yeah. And you know, eating healthier. So omega rich foods is huge for dry eyes diseases. Right. So, you know, keeping with the omega 3 fatty acid foods or even taking supplements will really help with dry eye disease. But I would say nutrients, lifestyle changes and just taking breaks on your devices.

I had someone who's an ophthalmologist say every like 15 minutes, look beyond your screen, look, look 20ft out, just so that you're reminding the eyes to look differently so that you're not hyper focused on this thing right in front of you. So keep looking out. And so do like even when I'm recording, I'm like, okay, when you're talking, I'm going to look over there.

Yeah, we call that, that's great. We call that our 20, 20, 20 rule. So exactly what you said, every 20 minutes for 20 seconds. Look 20ft or just far away. So you know, I like to have like when a lot of us work from home now. So I mean that's a big, big wave. So when you're set up, you know, in your room and your desk should be close to a window so that you can look outside and your window usually has a distant far distance and that's, that's important because you are resting your muscles versus looking up close. You know, if you're going from your computer to your wall, which is only like 2ft away, that doesn't make a difference.

Right, right. I've. When my, I had my eye exam in, I think it was February, and she said something to me and she said it to me last year and I said, what does that mean? I still can't actually remember what she said. And she says that means you have dry eyes. I was like, oh, why don't you just say that? I actually didn't realize that I had dry eyes until she straight up said that. She said something like, there's like, like cuts on my cornea or something. What do you call it when there's.

Yeah, yeah. So we call it punctate keratitis, which are little dots that we see and I like to compare it to like eczema or dry skin. You know when you see like the dots of dry skin flaking off, that's exactly what we see on the cornea. So we call it punct. Little dots of keratitis on our cornea. And that is definitely a sign of dryness or dry eye disease. But the other thing we look for is meibomian glands, which are our glands right on our eyelash margin where our waterline is. And they actually contain the oils or they secrete the oils that help stick the watery tears to our eyes. So if they're not functioning properly, we call that meibomian gland disease or dysfunction. That's a huge part of dry eye disease. That's when people complain of watery eyes. So I'm sure you've. Like, I have a lot of patients that say to me, no, I don't have dry eyes. I have watery eyes. And I'm like, no, no. That is dry eyes because they're watery because they're not sticking to our eyes, so they're useless to us.

Got it. Okay. So that was so funny when she said that. And I went, wait, I have dry eyes. And so I went home, and I started taking 3 grams of fish oil every day. And it was about four months ago. And what was so interesting is, like, I didn't really realize that it wasn't normal to have your eyes feel gritty when you wake up until it went away. And I was like, oh, okay, then that was not. That was not cool. I just. Just thought every morning I just kind of had to let my eyes wake up or something.

You know, an interesting fact about that. It's the action of the two lids coming together. So a blink is actually what helps to stimulate the secretion of the oil from the meibomian gland. So at nighttime, we don't blink. I mean, our eyes are. She's supposed to be closed, so that's why we're driest in the morning. It's like you're peeling your eyes open because there is no stimulation.

Oh, interesting. Okay. Because I would go like, blink, blink, blink, blink, blink. And I was like, I don't know why this feels good, but it does.

Yeah.

So that's really interesting. Okay. Okay. What are things that women can do preventively to protect their eye health?

Yeah, I think. I mean, again, the big one we discussed was nutrients. So lutein, zeaxanthin, which are carotenoids. Carotenoids, rich foods. So anything colored. So that's kind of where a myth about carrots came from. But really, we're looking at all the colored vegetables. Colored, you know, fruits. The berry class is huge. Kale, red pepper. Anything colored that pigmentation has lutein and zeaxanthin in it, which is super important for eye health. It goes right to help reduce oxidative stress on your retina, which helps with diseases like macular degeneration. So the macular degeneration stat is huge in women. Two thirds of all macular degeneration patients are women or female. So, I mean, that's, that's huge. And that's why eating healthy is so important. And then, of course, the Omega 3 is adding that on for dry eyes. Then there's other nutrients like zinc, vitamins, vitamin E is great, but the most important would be those three compounds. Sleep is huge. Sleep is great for our whole body, but to regulate our circadian rhythm and prevent eye strain, that is really important. And then that goes hand in hand with being off our device for a couple of hours before bedtime because that blue light coming in disrupts our circadian rhythm and causes more eye strain, tiredness, everything overall. Another thing is when you don't sleep well, your blood sugar usually is not as great or fluctuates, and your metabolism is not usually great. And when you. We know that we see a lot more women have complications related to diabetes, blood pressure, cholesterol in the eyes than, you know, male counterparts. So I think it's important, again, sleep for blood sugar management, especially for women. UV protection, that's a huge one. So wearing your sunglasses, but not just any sunglasses, they should or have to say UVA, 100% UVA and UVB protective. Or the other way it can be written is UV 400, which means it's cutting off all the wavelengths of light under UV, under 400. And that's, that's really important. I think those would be my, my top, my top choices for recommendations to my patients.

Do you recommend people wear blue light blacking glasses?

Yeah. So that's a big debate in our field. And, you know, I want to say that studies have not proven that blue light causes disease. We are still undergoing studies. We probably won't find that out for years. But we know that there is a harmful component in it. So I do recommend it to my patients. A, because we don't know, so why not add it onto your glasses? And B, it does help regulate your circadian rhythm. We know that for sure. So it will help us sleep better, especially for those of us and children that are all on their devices at nighttime. So I don't think there's a harm to add it on. Anecdotally, my patients do say that it helps with digital eye Strain. That's anecdotal. I've tried. It doesn't help me. I don't notice the difference. I do have some patients that say with blue light filter glasses, the contrast of things is slightly different, which makes sense because it's filtering that. That wavelength. So really, I would just say try it. If it works for you, please, you know, keep it on. But I don't think it's mandatory.

I mean, I don't think you're going to harm yourself with it, which is what I like is that there's no risk and there might be a potential high upside, so might as well.

Exactly.

I'm really struck with everything you're saying that there's this commonality to. Right. We're talking about eye health. But when you're looking at heart health, brain health, gut health, menstrual health, female health, man's health, reproductive health, all of these things really do funnel into a very consistent commonality in terms of the foundations of our health. Right. Eat well, sleep, move your body, get outside, have good relationships. Don't be on a screen too much. The things you're saying for the eye health are all the things I would say, right, to live long and live well. You're going to want to do these anyway.

Absolutely. And a lot of those conditions that make. If you don't make all those good lifestyle choices, all those conditions, those metabolic syndromes and everything, affect your eyes equally. And I think that's. That's huge. And your eyes, people don't realize this, but your eyes are the only place in your entire body where you can actually see your blood vessels. Nowhere else in our body can a doctor just see you and look at your blood vessels. But your eyes, that's what we're looking at when you go for an eye exam. So obviously, you know, I can't stress enough having those regular eye exams, they are truly the window to our body because what's happening in those blood vessels are mimicking what's happening in the rest of our body. And that's why people with diabetes, you know, high blood pressure, cholesterol, they should be having their routine exams. Is there.

I know that there's a relationship between hearing loss and brain health. Is there also a relationship between eyesight loss and brain health or some other type of eye dysfunction in brain health?

Absolutely. And, you know, 50% of our brain, or 50% of our brain's real estate, I should say, is spent processing vision. And it's crazy, but that's a stat. And 10 to 15% is hearing and their other senses are a little bit less. That's huge. So when you have visual impairments, your brain is working so hard to process visually that. Absolutely. And I cannot tell you that how many Alzheimer's dementia patients that I see with cognitive decline that have visual impairments related to that and, you know, their kids or they themselves are wondering, like, I don't understand where I got this from. And if they had corrected their vision sooner, we. We think, and, you know, studies have shown that they can definitely have prevented that decline.

This is, like, really freaking me out. What are the. What are some of the things that we want women to look out for in men? Like, what are there warning signs and symptoms that if you experience these list of things, you should walk yourself into your nearest optometrist, ophthalmologist group. What are those things?

Yeah, I mean, I think they're pretty basic. Obviously, if there's any pain, burning, stinging, odd feelings in your eyes, go to see your optometrist. But some of the bigger ticket items would be vision loss, even if it's transient. What I mean by that is even a couple of minutes, that can be signs of a stroke. So we want to, you know, vision changes. And I always encourage patients to get to, you know, cover one eye and then the other, because, remember, they compensate for each other. So if you're not sure, cover one eye and cover the other really quickly to see if it's. If it's a true loss.

Now I have to do it while we're talking.

And they don't have to be equal, but at least know if the vision. If you are having visual loss, because if you're having it in one eye, the other eye might compensate for it. So, you know, doing this regularly, just checking, but any permanent changes in vision as well, like all of a sudden your vision changed or became foggy. That's. That's also pretty. Pretty big flashes and floaters. So we. We call it that casually. But there are little dark spl. Dark spots, you know, blackish gray. A lot of people have them that float around in our vision. If we're seeing a new onset or change in the number of them, you need to see your optometrist right away and then flashing lights, so you will not see flashing lights. So colored flashing lights are usually indicative of an ocular migraine or a migraine, because the brain is the place that perceives the color part of it. But if it's truly your eye health, so your retinal health, the. The flashes will be white. So when patients come in to me and say, I have fashion lights. I need to see you right away. And they're like, they're purple. I feel so much better.

Right.

So I would say those are my big ticket items where we consider emergencies. Obviously, they're the smaller things like redness, you know, and other symptoms, but, you know, is there.

Do you find that it's hard for people to advocate for themselves within the healthcare system, for eye health?

Yes. Yes, absolutely. For some reason, I think. I don't even think it's just eyes. I think across the board, and then we just fall into that category where, you know, they felt gaslighted, and I think all these years they felt gaslighted, and so they come into us and again, expect that they will be gaslighted. So they don't want to advocate. I love when my patients come in to me and say, hey, I looked this up and I feel I could have this. I know a lot of Doctors are against Dr. Google, but I am so pro it, unless you're a hypochondriac. I'm very pro it because our medical system has so much gaslighting in it. And also there's a lack of care and a lack of doctors such that where are they supposed to turn? I Google things for my kids or for myself, and then I go into my doctor and say, hey, I might need this. If my doctor says, no, you might not. That's different. But at least having that idea, I love when my patients can advocate and come in and say, hey, I'm having these flashes, him having these floaters. Could I be having a retinal detachment? I'm like, okay, let's just check your retina.

Calm down.

Don't worry. You know, it's a small percentage of people who do. But I'm glad that that brought you in, because if you didn't Google that, then. So I don't know why we don't allow our patients to advocate for themselves. And I really hope more doctors, they change and recommend advocating for themselves.

Yeah, I think you can't open a closed mind, but certainly new generations of providers who experienced gaslighting may be less likely to gaslight. Hopefully at least hear people. Okay, Meenal, this is cool. Where can people find out more about you? And we'll put everything in the show notes so that it's easy for them to find.

Yeah, you can find me on Instagram @ Dr. Meenal Agarwal. And I also have a podcast called uncover your eyes the truth about health and.

Wellness. Yeah, I love it. Okay, we'll put that in the show notes. And is there anything I didn't ask you that I should have asked you or that you want to make sure the listeners really hear and.

Understand? Yeah, I just. I think you did ask me this, but, you know, I want to reiterate that the importance of your eye health for your overall health, you know, whether it's your cognitive, your spatial awareness. So when, you know, for the. For the younger generation listening. So when parents are harping you on you about your screens, they're not just doing it for fun. There are other issues that we can have, such as, you know, cognitive decline, vision decline. So your vision or your eyes are really the window to your body. So listen to your eyes. Have your regular visits, make it like your physical, where you're. Where you're going.

Annually. Okay, thank.

You. This is really well done. Thank you for having.

Me. Thank you. Thank you for joining this episode of the Feel Freakin Amazing podcast. And really, the eyes are the window to the soul. So we want to see inside you and keep you healthy. So thanks for joining us.

Today. Thank.