Dr. Cheung’s Blog 12/21/2017

Dr. Cheung’s Blog 12/21/2017

December 21, 2017

Seeing the Beauty

I just returned from New Orleans, Louisiana, where I attended the Annual Meeting of the American Academy of Ophthalmology.  Each year, thousands of ophthalmologists from around the world gather at this meeting to exchange ideas and learn new techniques in our field.  This year, there was a lot of excitement on the new Extended Depth of Focus (EDOF) intraocular lens, which is a type of multifocal implant that we use to replace the cataract lens after surgery.  As an early adopter of this new technology, I have implanted a few EDOF and I am likewise impressed by the range and sharpness of the vision it affords my patients.  Standard multifocal intraocular lens provide distinct focal points for varied distances.  EDOF, in contrast, provides continuous high-quality vision for far away and intermediate distances and reasonably good vision at near.  Common side effects associated with multifocal lens such as halos, starbursts and glare are also less with EDOF.  Another benefit of the new EDOF platform is that it can correct for astigmatism, imperfection in the curvature of the cornea.  Older style multifocal lens did not correct for astigmatism which therefore excluded many patients as candidates for the lens technology; or the patient will need an additional procedure such as Femtosecond laser to address the astigmatism, in order to realize the full benefit of the multifocal lens.  With the new EDOF, both the astigmatism and the presbyopia (the need for reading glasses) can be simultaneously corrected with the lens, providing unparalleled safety, stability and cost-effectiveness for vision improvement after cataract surgery.  I predict that these new intraocular lens will be widely accepted by patients and Femtosecond laser will be on the decline.  We are still offering laser cataract surgery for the right candidates but I think that the new astigmatism-correcting multifocal intraocular lens is really the way to go.

While I was pretty much in class all day when I was in New Orleans, I did manage to get up early (despite the time change) and went for a few runs in the city.  I ran along the old Mississippi river one morning, stopped by the famed Café du Monde and tasted the  chicory coffee.  (Sorry to say, it did not appeal to my Seattle Starbucks-trained taste buds).  I was impressed by the art work along the river and in general the sculptures and historical monuments that adorned the city streets.  Another morning, I ran through the French Quarter which has a special beauty in the early morning hours than its hedonic image in the night time. The architecture in the French Quarter was grand, elegant and colorful.  The wrought iron railings over the balconies were so geometrically intricate that their beauty literally stopped me on my track as I ran.  I paused my music, took out the earbuds and snapped a few pics of these stunning railings.

How do we see beauty in this world?  What is considered beautiful and what is not?  Is beauty always subjective?  Or is there objective beauty?  Is there a biological basis to beauty?  When the image of the wrought-iron railing fell on my retina, how did my brain process the image such that in that very split second, without any conscious thinking on my part, that I would consider it beautiful and stopped me on my track?  I pondered on those questions during some of the more boring hours of the conference and I stumbled on the answers in the last hour of the last day of the meeting when I attended a lecture by Dr. Vincent P de Luise from Yale University, School of Medicine.

Professor de Luise talked about symmetry and proportion as some of the fundamental principles of beauty.  Symmetry is attractive to the human eye.  Babies, without any social pre-conditioning, spend more time looking at pictures of symmetrical faces than individuals with asymmetrical ones.  Similarly, adult viewers tend to give a perfect 10 to photoshoped image of facies that are super symmetrical.  Facial attractiveness automatically evoked neural activity within a network in our brain involving the bottom part of the visual association cortices and the top part of the posterior parietal and prefrontal cortices (Chatterjee, Thomas, Smith, &Aguirre, 2009).  It appears then that our brains are hard wired for beauty and that objective factors such as symmetry can indeed trigger this network.

Another objective factor that draws the human eye is proportion.  We know that human prefers the golden rectangle with side and length in the ratio of 1.618.  Golden rectangles appear natural looking and pleasing and they are found commonly in architecture across different cultures.  Waist-hip ratio of 0.7 has been linked to female attractiveness in many western cultures.  While the idealized weight for feminine beauty has changed significantly over time, this waist-hip ratio, however, has held relatively constant.  For masculine beauty, we can turn to images of classical sculptures.  A group of Italian researchers (Dio, Macaluso and Rizzolatti 2007) presented paired images of classical sculptures with a modified version of the same image but of different proportions to viewers that are naïve to art.  The viewers were asked to casually observe them as if they were looking at museum pieces.  Observations of the original sculptures were statistically more likely to produce activation of a region of the brain called the right insula, the lateral occipital gyrus and in the prefrontal area.  This is yet another example that we are hard wired for beauty and there are objective factors to beauty that are independent of our emotional responses (subjective beauty which was found to be activated in the amygdala).

Why is beauty so important that our brains would build specific circuits around it?  Beauty is not just skin deep.  It can confer evolutionary advantages that our brains are naturally selective for.  Facial and body asymmetry may be a sign of disease whereas symmetry is suggestive of health.  Similarly, feminine and masculine body proportions may be an indicator of fertility, health and strength, characteristics that increase the odds of reproductive success.  While that might have been the biological basis to beauty, the effect has certainly crossed over to other domains of our lives, such as arts.  While I spoke mainly of visual aesthetics, the same principles can be applied to music, dance and literature.  In fact, there is a whole new discipline called neuroaesthetics that is dedicated to study the properties of the brain as it engages in aesthetics.  I look forward to new discoveries of this field and how it interacts with ophthalmology.  My love of arts is one of the many reasons that I entered ophthalmology and it is always fun for me to hear and understand how my patients use their vision in their artistic pursuits.  Be sure to tell me more when I see you next time.  Happy Holidays!!