During my optometry school days, a classmate cartooned an eyeball, styled with a top hat and cane. The caption read: “An eyeball walks into your office…” The drawing was a play on a professor’s comment that “Eyeballs do not walk into your office alone, they are attached to a body that serves them.” The point is, when making a diagnosis and targeting therapy for ocular disease, consider the patient’s entire system, lifestyle, and well-being.

Connecting the Dots

Myopia is predicted to affect almost 5 billion people worldwide by 2050 (Holden et al, 2016). Children are becoming myopic at younger ages (Lin et al, 2004), with the average degree of myopia continuing to increase in magnitude over time (Foster and Jiang, 2014).

Myopia is thought to be caused by a complex interplay between genetic and environmental factors (Morgan et al, 1975; Miraldi Utz, 2017). Environmental risk factors include extended near work, minimal outdoor exposure, and current childhood lifestyles (Tideman et al, 2017).

The 2020/2021 coronavirus pandemic continues to force school closures around the world. Consequently, nearly 36 million students are out of classrooms and into near-distance, electronic-based platforms (Walravens, 2020). Wang et al (2021) suggest that a myopic shift for children aged 6 to 8 years may be due to reduced time spent outdoors and increased home screen time.

Additionally, outdoor activities have been curtailed, sleep patterns altered (Altena et al, 2020), and adolescent mental health impacted (Becker and Gregory, 2020). The COVID-19 pandemic could result in increased adolescent psychiatric disorders—such as post-traumatic stress, depression, and anxiety—as well as grief-related symptoms (Guessoum et al, 2020).

A growing body of evidence suggests that myopia risk and progression can be controlled. Various optical and pharmacological interventions—including atropine eye drops, orthokeratology, defocus-modifying spectacle lenses, and multifocal contact lenses—have been shown to reduce myopia progression (Huang et al, 2016). However, for successful contact lens myopia control, a robust ocular surface is essential.

In a review of advances in the diagnosis and treatment of dry eye/ocular surface disease, Kojima and colleagues (2020) noted that numerous studies support the concept that dry eye is a lifestyle disease. In addition to treating the disease medically, encouraging changes in daily habits, such as diet, exercise, sleep, and so on, may help prevent disease onset. Can we also consider the development of myopia a “lifestyle disease,” at least in part?

Core treatments for dry eye include topical ophthalmic medications, improvements in environmental factors, and adjustments in symptom-triggering daily habits. Recent studies have increased our understanding of lifestyle-related factors that contribute to dry eye. Interestingly, Sano et al (2015) reported that three minutes of abdominal breathing activates the parasympathetic nervous system and increases tear volume. This is a simple, safe, self-care practice that does not require any tools or devices.

Certain practices that are good for the body—smoking cessation, vitamin D supplementation, skin care, gut health, whole body hydration, slow breathing (Askari et al, 2020; Kojima et al, 2020; Sano et al, 2015; Dogru et al, 2009), and practicing the “20-20-20-20-20 Rule” (add 20 complete blinks and 20 deep breaths)—are also good for alleviating and possibly preventing dry eye and support healthy lens wear for contact lens-based myopia control.

Conclusion

Proactivity in education, preventative measures, and thoughtful management for myopia progression and dry eye are likely to incorporate solutions with comprehensive interventional options for the entire body and brain. Think beyond the view of your slit lamp. CLS

For references, please visit www.clspectrum.com/references and click on document #304.