January 17, 2014
New Year’s Resolution
Happy New Year! I wish you all a healthy and prosperous 2014. New Year is a mark in time that prompts us to reflect on our past achievements and set goals for the future. Like many of you, I set a number of resolutions each New Year, many of which I failed to keep. For 2014, again, I stand to lose a few pounds by reining in my uncontrollable urge for dark chocolate, be a more patient father and a more understanding husband, and to commit to reading every eye journal that arrives on my desk each month. Reasonable and achievable goals? Yes, indeed they are. A 250 IQ or Herculean strength is not a prerequisite for reaching these goals but they do require me to develop good habits to have a reasonable chance of success. And that is the rub: good habits can be just as powerful, if not more so, than any superhuman trait. In health, creating good habits can lead us away from diseases, even those that we might be genetically predisposed to.
For example, one of the most common eye conditions that I see in my practice is blepharitis – inflammation along the eyelid margin. Patients with blepharitis complain of burning irritation in both eyes, often with crusty mattering that sticks to the eyelids in the morning. Redness in the eye and on the eyelids and a gritty sensation are often present. The causes of blepharitis are multiple but the main culprit is excess oil production by the glands along the eyelid margin that can lead to bacteria overgrowth which in turn can produce toxins to further irritate the eyes. While medications such as erythromycin ointment, azithromycin eye drops, and in severe cases, topical steroids and oral tetracyclines can be very helpful, the most important aspect in the management of blepharitis is daily lid hygiene – cleaning the eyelids with a hot wash cloth with or without a dab of baby shampoo. A process that takes 20 seconds or less but very few patients do it consistently once the acute phase of the disease is over. I must admit, I have blepharitis and I don’t do the cleaning regularly and you won’t believe how many times a day I have to give this spiel to patients (and therefore to myself)!! If only I can develop this HABIT, my eyes will feel and look so much better.
Perhaps the most common eye “disorder” that we see in our office is myopia, or nearsightedness. Myopia is a mismatch between the refractive elements of the eye (the lens and the cornea) and the length of the eye such that images are brought into focus in front of the retina. Usually, this is because the length of the eye is too long (axial myopia). Myopia can easily be corrected by glasses, contact lens or refractive surgery but severe myopia can predispose patients to the development of retinal detachment, glaucoma and cataract. Genetics plays a strong role in myopia and parents who are highly myopic themselves are particularly concerned about how fast myopia is progressing in their children. They often ask me what they can do to prevent or slow down their nearsightedness. Are there effective medicine or exercise? Can special glasses or contact lens work? Recently, three clinical trials showed that there is no quick fix for myopia. The Correction of Myopia Evaluation Trial (COMET), the Contact Lens and Myopia Progression study (CLAMP) and the Atropine for the Treatment of Myopia (ATOM) respectively showed that progressive spectacle lens, hard contact lens and atropine drops provide no or marginal benefits in slowing down myopia. Interestingly, two separate studies, one conducted in Taiwan and one in Denmark showed that children in those countries who are encouraged to play outdoors showed significant benefit in halting myopia progression. The mechanism of this benefit is unclear at this time. One theory is that indoor artificial lighting and light stimuli such as those from computer monitors, tablets, smart phones and video games are particularly rich in red light. The unbalanced stimulation to the red cones may in turn mediate signals that stimulate axial growth of the eye. Supporting this theory is the recent finding by a group of UW vision scientists that one form of inherited myopia is caused by defects in the red and green cones due to mutations in these visual pigment genes. This same group of investigators is now looking into the effect of wearing red/green glasses on myopia.
Over the holidays, I have been reading The Power of Habit by Charles Duhigg. The science behind habit formation is fascinating and the stories on how people transformed their lives by developing good habits are very moving. It appears that to curtail myopia, parents need to stow away the electronic gadgets that they just bought for their children over Christmas and develop the habits of taking them outdoors and play. I understand this simple message as a physician but also realize that as a father, this is not so easy to do in our fast paced world. “All our life, so far as it has definite form, is but a mass of habits” so wrote William James in 1892. In health, as in life, developing good habits is the key to success – whether it is for blepharitis, myopia or obesity. May that be my ultimate resolution for the New Year.