Preventative measures for dry eye include the entire body and brain
When I was in optometry school, one of my artistic classmates created a cartoon eyeball, sartorially styled with a top hat and cane. The caption read, “An eyeball walks in…” and the drawing showed the eyeball walking. The cartoon 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 it.”
The point here, of course, is that in making a diagnosis and targeting therapy for ocular surface disease, the patient’s entire system, lifestyle, and well-being must be considered.
Earlier this year, Kojima et al1 in a comprehensive review of advances in the diagnosis and treatment of dry eye, noted that in addition to the medical treatment of dry eyes, it is becoming possible to prevent the onset of ocular surface disease by intervening with changes in daily habits, e.g., diet, exercise, and sleep. Thus, we arrive at the concept that dry eye is a “lifestyle disease.”
Core treatments for dry eye can include topical ophthalmic solutions, improvements in environmental factors, and adjustments in symptom-triggering daily habits. In recent years, ODs have increased their understanding of the lifestyle-related factors that are related to dry eye.
This has, in turn, led to a gradual shift from focusing on treatment alone to initiating more aggressive attempts to prevent dry eye onset. Another shift has occurred in not relying solely on ophthalmic solution-based treatment strategies, but rather, more actively pursuing intervention strategies based on preventative medicine.
It has been pointed out that oxidative stress is involved in the pathology of dry eye,2 and intervention is targeted at reducing inflammation by improving diet and taking nutritional supplements (calorie quality and restriction and control of reactive oxygen species that are considered a contributor to the functional decline that is characteristic of aging).
Consider that a lifestyle-intervention approach consisting of exercise and diet therapy is the basic treatment and preventative method for type II diabetes and metabolic syndromes. Of interest, the results of a cross-sectional study indicated that subjects in a non-dry eye group exercised more than those in the dry eye group, and that those who exercised more had a higher tear volume.3
It is important to remember the fact that desk work engaged in by office workers is a risk factor for dry eye, and a “sedentary lifestyle” may also influence risk. The World Health Organization (WHO) has listed a sedentary lifestyle as a health risk, alongside smoking and obesity.4,5
Depression and therapy
In addition, recent evidence has indicated that depression has a strong relationship with dry eye, particularly dry eye symptoms.6
Evidence for the effectiveness of exercise therapy on depression has already been established, and based on this, exercise as a treatment for dry eye could be an important lifestyle intervention.7
Dry eye intervention based on positive psychology may be effective in ameliorating subjective symptoms8 though the mechanisms of action underlying this are still being studied.
Evidence is accumulating that practices that are good for the body; for example smoking cessation, vitamin D supplements, skin care, gut health, whole body hydration, practicing the “20-20-20- 20 Rule” (I added the extra 20 for 20 nice complete squeezy-blinks) are also good for dry eye. In the future, treatment and preventative measures for dry eye are likely to incorporate solutions with comprehensive interventional options for the entire body and brain.
1. Kojima T, Dogru M, Kawashima M, Nakamura S, Tsubota K. Advances in the diagnosis and treatment of dry eye. Prog Retin Eye Res. 2020;100842.
2. Dogru M, Wakamatsu T, Kojima T, Matsumoto Y, Kawakita T, Schnider C, Tsubota K. The Role of Oxidative Stress and Inflammation in Dry Eye Disease. Cornea. 28. S70-S74. 10.1097
3. Kawashima M, Uchino M, Yokoi N, Uchino Y, Dogru M, Komuro A, Sonomura Y, Kato H, Nishiwaki Y, Kinoshita S, Tsubota K. The association between dry eye disease and physical activity as well as sedentary behavior: results from the Osaka study. Journal of Ophthalmology, J Ophthalmol. 2014;2014:943786.
4. World Health Organization. Physical activity. Available at: https://www.who.int/news-room/fact-sheets/detail/physical-activity. Accessed 7/18/2020.
5. Sano K, Kawashima M, Ikeura K, Arita R, Tsubota K. Abdominal breathing increases tear secretion in healthy women. Ocul Surf. 2015;13(1):82-87.
6. Labbé A, Wang YX, Jie Y, Baudouin C, Jonas JB, Xu L. Dry eye disease, dry eye symptoms and depression: the Beijing Eye Study. Br J Ophthalmol. 2013;97(11):1399-1403.
7. Sano K, Kawashima M, Takechi S, Mimura M, Tsubota K. Exercise program improved subjective dry eye symptoms for office workers. Clin Ophthalmol. 2018;12:307-311.
8. Kawashima M, Sano K, Takechi S, Tsubota K. Impact of lifestyle intervention on dry eye disease in office workers: a randomized controlled trial. J Occup Health. 2018;60(4):281-281.