Eye Worthy: Is It Eye-Worthy? Is it Meibomian Gland Worthy?

I have wanted to write about this for a long time.

With the epidemic of dry eyes and meibomian gland dysfunction, most eye surgeons are seeing, a new concept has come to my mind:

“Is what I am looking at, ‘eye worthy’? Is it ‘meibomian gland worthy’?”

“Is what I am looking at putting my eyes and meibomian glands at risk?”

“Do I want to risk having chronic eye pain, irritation, redness, for the rest of my life by choosing to use my eyes for this activity?”

These may seem silly questions to most, but as I continue to see younger and younger children with severe meibomian gland atrophy, it is important for everyone to ask themselves these questions and especially for parents to ask themselves this for their kids. And I think teachers need to ask this for their students.

There may come a time where assigning homework on the computer or coordinating meetings on the computer with young children for school is frowned upon by everyone. We may be getting there soon.

Everyone will have decide for themselves but below are my thoughts on what is “Eye Worthy” and “Meibomian Gland Worthy” for kids and adults.

If you have been following my blog and research, you know that I am very concerned about the loss of meibomian gland structure and function in all my patients, particularly those who are in chronic pain, those about to have cataract, pterygium or any other surgery (as their visual outcomes can be greatly affected by dry eye disease and meibomian gland dysfunction), AND all the young kids we are seeing with corneal signs of dry eye and new corneal scar tissue affecting their vision.

I have introduced these new dry eye terms “Eye Worth” and “Meibomian Gland Worthy” to these kids and many patients casually, but I want to formally emphasize that everyone should think about this whenever something is brought to the attention of their eyes. They have to make a split second decision at times to either look away so as not to get drawn in (likely a majority of stimuli on regular tv is not “eye worthy”) OR  pay closer attention (like your child is about to spill a gallon of milk on the floor).

When meibomian glands are almost gone, I tell patients, you have to stay away from “non-eye worthy things,” like video games, facebook, instagram, random internet stuff. And of course you have to blink fully (no partial eye blinks) around every 4-5 seconds and look away ever 5-10-20minutes for 5-10-20 seconds depending on the severity of the meibomian gland atrophy. In general, everyone, especially children, should be encouraged (…maybe even forced at school) to look away from the screen every few minutes (there is no research to say what is optimal but I would err on saying at least every 5-10minutes for young kids doing homework on the computer); look away for 5-10 seconds with many full, purposeful blinks, looking 5-10-20feet away (preferably outside).

But often there is an addiction involved and patients cannot turn off their phones for hours on end. Often, it is very hard, even painful, to not check messages, texts, emails, etc every few minutes.

The book Irresistible, an “Eye Worth” book (thank you to Lisa S. for recommending this book), shockingly explains how many addictions can cause incredible brain re-wiring to the extent that all other bodily needs, such as eating, sleeping, and I would have to add involuntary and voluntary blinking, are put aside.

The sad story of the Korean couple that allowed their baby to starve to DEATH because of their addiction to video games (see link), highlights the physiological risk of addictions. http://www.newsweek.com/2014/08/15/korean-couple-let-baby-die-while-they-played-video-game-261483.html

The issue is that most US school systems and parents have happily put into the hands of millions of children, addiction-inducing gadgets without any type of medical investigations or controlled trials performed ahead of time.

The book by Cal Newport, Deep Work, is also an “Eye Worth” book that emphasizes the need for everyone on the planet to relearn how to deeply concentrate and not allow ourselves to be distracted so easily. I will have to look at the literature but I suspect one’s blinking rate decreases when one is on an addictive device, such as virtual reality headsets, in addition to the known addictive devices of smartphones, tv, laptops, ipads, etc.

So here is my personal list of Eye Worthy and Meibomian Gland Worthy Activities: Everyone will have to determine what is their’s.
Either way, always try to look away from your activity if you can safely every 10 minutes for 10 seconds, looking at least 10ft away. I prefer this to taking a break every 20 minutes for 20 seconds looking 20 ft away: there has been no randomized, controlled trial to prove one is better than the other. They key message is to look away from your electronic device frequently and for as long as you can.

1. Prayer, Reading the bible, Reading good books.
2. Exercise: walking, running, swimming with goggles to protect against chlorine.
3. Sitting down together as a family and eating together without any gadgets at the table every night is very “eye worthy” and “ear worthy!”
4. Working: really working, not checking Facebook, not posting on instagram. Not checking emails every couple of minutes for social issues. I tell young patients who have severe meibomian gland atrophy that they should consider a career that does not require extensive computer screens (at least until we can find a cure for meibomian gland atrophy and do a better job of forcing people to blink when using electronic screens.) Saving the world is “eye worthy,” but it may not be for patients who will surely have chronic eye pain if they try saving the world by using their eyes constantly on screens. 
5. Talking to family, friends, colleagues at work

Non- “Eye Worthy” & Non- “Meibomian Gland Worthy” Activities: personal but suggestions: This is a personal list. Many would argue that moderation is ok.  I would say that if a person can not get addicted and actually close a device in the middle of a tv show or movie and really blink fully every few seconds, then there is less risk of meibomian gland atrophy. But my experience is that most people find it hard to close the device or put down the electronic screen. I would recommend avoiding looking at stupid/waste of time stuff in general. 

1. Looking at any device which is showing material which is a waste of time: video games, porn, stupid movies like Armagedon
2. Looking at comic books, silly books, “waste of time” books.
3. Looking at newspapers or reading something on a device when a paper copy is available: always choose a real newspaper or book over an electronic device when possible.

None of the above even discusses the real concern some retina MDs have about the back blue light hitting all our maculas for so many hours a day. Will macular degeneration rates increase in a few years because of this? I do not know but will be looking into this as well. 

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