Dr. Cheung’s Blog 1/1/2017

Dr. Cheung’s Blog 1/1/2017

January 1, 2017

Seeing Our Own Mind

In addition to getting plenty of sleep, I make it a habit to meditate the night before or the morning of my surgery days.  I found this routine to be incredibly helpful in allowing me to singularly focus on the intricacies of eye surgery and on the patient before me.  I had my first “formal” meditation training serendipitously some eighteen years ago while traveling through Edinburgh, Scotland during the Military Tattoo Festival (Think marching men in kilts and bagpipes, not sure why it is called a tattoo).  The short meditation course stood out from the many events and street performances during the festival and I decided to give it a try.  The instructor asked us to direct our attention to our breaths, feeling the rise and fall of our diaphragms and the air going in and out of our nostrils.  Invariably, distracting thoughts will come, acknowledge them, let them pass and get back to your breaths.  “Think of your mind as a clear blue sky and the thoughts are like clouds passing through”, he said.  While the military tattoo performance at the Edinburgh castle was a sight to see, what stuck with me were the hour-long meditation instructions.

Since that chance encounter, I have been meditating on and off on a very irregular basis.  Between my work and the kids, finding fifteen minutes to sit quietly on the mat feels like a luxury.  Doing it well is a whole different matter.  Of the 15 minutes of practice, 10 of which might be filled with random thoughts about a patient, my daughter not doing well in school, vacations, what to get my wife for Christmas etc etc.   I read several guidebooks, attended a number of meditation meet-ups, chatted with experienced meditators and trusted that I was doing it “right”.  For many years, I thought that the ultimate goal is to have no intrusive thoughts at all.  Being a perfectionist, I beat myself up for it when I did.  It was only recently that I had a breakthrough.  The goal I have now is to watch myself, almost as a third person looking into my own mind.  When distracting thoughts come in, I can catch myself and not react to it or judge it.  The overall effect is that I am more aware of the present moment and my senses are more acute.  Through my meager meditative practice, I noticed that I can see each step of my surgery more clearly.  It is almost like a slow-motion replay.  I can sense my instruments better in my hands and I am more aware of my posture.  As a result, I stay fresh throughout my surgery day and I am less fatigue at the end of it.  If and when a complication occurs, I can handle it better because my attention is unencumbered by emotional and judgemental overtones.  In other words, I am acutely aware of my own mind.  I am “mindful” of any distracting streams of consciousness and let them pass instead of them taking hold of me.  This same mindfulness also allows me to be more present with my patients on my clinic days.  I take a meditative deep breath before walking into the room to greet each patient.  The breath acts as a reset button for my mind.  The etch a sketch is swiped clean and a new drawing begins anew.

At least for me, the purpose of meditation practice is to cultivate mindfulness.  There is nothing magical about sitting crossed-legged on a mat.  You can do it sitting on a chair and I sometimes do it walking in the parking lot to Costco.  And while meditation has its roots in Buddhism, it can easily be done without any religious or spiritual connotations.  The best known method in the secular meditation category is perhaps MBSR (Mindfulness-Based Stress Reduction) developed by Dr. Jon Kabat-Zinn at the University of Massachusetts Medical Center which is designed to teach awareness of thoughts, feelings and body sensations.  Since this method is standardized and reproducible, it can be used in clinical trials and allow doctors to test the beneficial effects of meditations.  As a result of the pioneering work by Dr. Kabat-Zinn and many others, meditations or mindfulness training has been shown to clinically reduce stress, anxiety and depression, improve subjective well-being and mood, enhance executive function and decrease emotional interference in cognitive tasks.  Meditations have also been found to be efficacious in the treatment of a whole host of medical conditions including psoriasis, chronic pain, fibromyalgia, hypertension and arthritis.  It has also been shown to boost the body response to vaccinations and to reduce the relapse rate for major depression.

For health care professionals, meditations are also associated with significant decreases in depression and anxiety as well as increases in empathy.  They reported less burnout and emotional exhaustion, better connection and less depersonalization with their patients and ultimately less diagnostic errors and possibly improved outcomes for patients.

As an ophthalmologist, I am fascinated by the fact that I subjectively see better after a session of mindfulness meditation.   Subjects who participated in MBSR course or week-long meditation retreat also reported that they see the world with fresh revitalized eyes.  Colors seem more bright and intense and generally more pleasure in seeing.  I concur with that but as a scientist, how do I prove that?

Two recent studies may shed light on this particular issue.  A group of investigators (ophthalmologists and psychiatrists) from Spain published in the August 2016 issue of Mindfulness that experienced Zen meditations, when compared to non-meditators, have significant better visual acuity in normal, high and low contrast levels as well as better contrast sensitivity vision (the ability to perceive different shades of gray).  The improvement in theses visual function, however, does not appear to be correlated with improved retinal thickness suggesting that it is facilitated by enhanced brain function.

A second study from the October 2016 issue of Consciousness and Cognition reported that cultivated mindfulness is associated with improved attention and sensorimotor control.  They looked at 30 experienced meditators and 30 non meditators and studied their ability to track objects with an infrared camera on their eyes.  The Smooth Pursuit eye movement of meditators is significantly less choppy when compared to non-meditators when the target is moving at a velocity of 12 degrees per second.  To test for visual attention, the investigators presented a target in the periphery of the subject’s vision and asked them to look away from it in the opposite direction (Antisaccades).  Meditators as a group show less variability in this attention task compared to the non-meditators.  Interestingly, the frontal part of the brain has been known to control smooth pursuit.  This is the same area of the brain in which meditation has been implicated to have a potential lasting effect especially for those who meditate regularly.

These two studies are by no means conclusive but judging from the many health benefits that mindfulness training can bring, I am not surprised that vision can be improved, directly or indirectly by meditation.  I am not suggesting that meditation can cure blindness.   However, seeing our own mind is indeed a powerful tool for us as doctors and for our patients as well.  Try it and I would love to hear your experience.