Modern life is harsh on the eyes. We spend much of it indoors, staring at screens, day and night, and when the world starts to blur in our forties we get glasses. Research shows that short-sightedness, or myopia, is increasing at an alarming rate. An estimated 30 per cent of the global population is myopic and by 2050, that is expected to rise to 50 per cent, according to the International Myopia Institute.
“While genetics and environment both play a significant role in the progression of challenges like myopia, I believe environment is the root cause of its drastic increase,” says Dr Bryce Appelbaum, a neuro-optometrist based in Maryland in the US.
“The three biggest risk factors for myopia progression are not enough time outdoors, prolonged ‘near work’ [ie work that involves sustained focus, up close] in the dark and too much screen time,” Appelbaum says. But regularly tweaking the strength of your prescription lenses to keep every distant tree leaf pin sharp may not be the answer because it can make the eye lazier. As for the reflex of buying reading glasses in your forties, he compares it to jumping into a wheelchair because you bruised your knee.
His approach is fascinating. Not only does he believe that we can improve our eyesight with vision exercises and lifestyle changes, he says that working on our vision has the power to transform how we think, feel and function. In fact, our vision is so fundamental to our health and wellbeing, Appelbaum describes it as “the new microbiome”.
Appelbaum stresses the distinction between vision and eyesight. “Eyesight is the ability to focus light clearly, it’s the ability to see,” he says. “But vision is so much more complex. It’s how our brain processes, organises and stores the information coming through the eyes.” He adds: “Vision is a direct reflection of brain function.”
Suffering from eye strain, blurry eyes, decreased productivity throughout the day, visual fatigue, brain fog and stress are all signs that we’re overloading our systems, he says. “That’s really from staring at screens and having this toxic load that’s hard for that eye-brain connection to function through.”
The good news, he says, is that we can improve and enhance our vision and brain function, at any age, along with it our sleep, balance, attention, and our cognitive and mental health. Here’s what we need to know.
How to train your eyes to delay your need for reading glasses
As we age, it gets harder to focus as the lens inside our eyes becomes more rigid and the muscles controlling them become less flexible, Appelbaum says. It’s known as presbyopia. “So you start holding things farther away until your arms aren’t long enough and then you get reading glasses.”
But, he says, by training your eyes as soon as you notice these changes, rather than resorting instantly to corrective lenses, you can slow — even in some cases halt — this decline and delay the need for reading glasses. If you already depend on reading glasses, daily “vision training” can delay your need for a stronger prescription, although “it’s a lot harder, once you’re relying on heavy-power reading glasses, to go backward as you’re basically preventing your brain from utilising that focusing system”.
He recommends the 20-20-20 rule, which is, during any “near work”, to take a vision break for 20 seconds, every 20 minutes, and look at something at least 20ft away. “Look out of a window, out into the distance, ideally, go outside.”
He also suggests daily “eye push-ups”, a near/far focus activity. “Cover one eye, bring your raised finger as close as you can until it’s a little blurry. Stop. Make it clear. Hold it for five seconds,” he says. “Then look into the distance for five seconds, then back at your finger for five seconds, then into distance for five seconds.” Repeat, covering the other eye. “This is gross stimulation and relaxation of that focusing system. It can help build more flexibility and stamina.”
• Read expert advice on healthy living, fitness and wellbeing
Even if you’re short-sighted, you can improve your vision
Many of us need prescription lenses to see. Mine, at -5.5, are not optional and haven’t been since I was 12. Appelbaum, 42, says, “I’m absolutely not anti-glasses or contacts. In fact I wear contacts myself.” (He has had corrective lenses since the age of seven.) But you can still work on developing the flexibility and stamina of your focusing systems. “I’m not saying ‘you’ll never need to wear glasses, if you do this,’” he says. But by improving visual processing and abilities — “what the brain does with the information your eye sends it” — eyesight can improve “as a byproduct”. So it’s often possible to decrease your dependence on glasses and even slow myopia’s progression.
He is aware this is contentious. “Reversing myopia is something that any doctor will say is impossible,” he says.
However, Romesh Angunawela, an award-winning eye surgeon at OCL Vision in central London, concurs that while age-related changes in vision are inevitable, it is possible to slow them down. Specific vision exercises and lifestyle changes can help the focusing muscles of the eyes, he says, if you are rigorous and consistent. If we’re nose to screen all day, the tone of those muscles can become overactive, ultimately leading to increased short-sight. Vision exercises “can relax these over-worked focusing muscles and stop inducing this additional level of short-sight”.
One well-known British physician experienced improvements for himself. As discussed on a recent episode of his Feel Better, Live More podcast, Dr Rangan Chatterjee measured his vision before enrolling on Appelbaum’s five-day vision performance training programme in the US. At the start of the week, Chatterjee could see only the huge letter E at the top line of the eye chart without glasses. By the end, he could read the fourth line down.
“As myopia increases, as far away gets blurrier, there’s often elongation of the eyeball and structural changes,” Appelbaum says. “But in almost every case, there’s also a functional component. In Dr Chatterjee’s case, the inside muscles of the eyes had challenges with stamina and flexibility.”
Appelbaum adds that targeted functional work on Chatterjee’s eye coordination and focusing systems enabled him to learn to see more clearly at every distance. “He got his focusing system to act more like an old-school camera lens that’s on autofocus rather than on manual focus.”
• The 13 things you need to know about your eye health
Put down that e-reader (and read an actual book)
If you can swap an e-reader for a physical book, your vision — and brain — will thank you. “There’s a very different visual skill set needed to engage with a screen than a printed page,” Appelbaum says. “On screens, there’s more brightness and glare and stimuli that’s hard for our brains to focus on and to process, and there are different eye movements.” Not only are these more frequent, “they’re more sporadic, they’re darting all over the place, whereas if you’re reading on a page, it is very methodical, it is organised. Our brain is taxed faster on a screen,” he says.
“In addition there is a reduced blink rate, which contributes to dry eye, another irritation. Also, you don’t have the tactile feedback [sensory information that comes through touch] that you would have on paper. When you’re holding something with your hand, you get a much better sense of where that’s located in space and it’s a lot easier for the eye-brain connection.”
For better sleep — and daytime alertness — avoid screens first and last thing
It’s no coincidence that our sleep quality has declined as our use of screens — especially first and last thing — has soared, Appelbaum says. “Using screens first thing in the morning, last thing at night is giving us the wrong signals about time of day, the wrong signals from our environment, and it’s altering how we’re releasing melatonin, in terms of how often and the quantity.
“We have these specialised receptors in our retinas, the back of our eye, whose sole purpose is to signal the sleep-wake cycle and secrete melatonin in the brain,” he says. “And when those cells are overly stimulated, that secretion happens in an unnatural fashion.”
So when we reach for our phone the second we wake or scroll before bed, our brain receives misinformation from our eyes on the time of day, he says, disrupting our circadian rhythm. This disrupts sleep and can disrupt overall function throughout the day. Instead, he says, “get fresh, natural light in through your eyes first thing in the morning, and then in the evening, to help reset your circadian rhythm”.
Get outside and move to boost eyes and brain
Take in a ‘panoramic’ view
GETTY IMAGES
Go for a walk outside to help lift the eye strain and brain fog that can descend after hours on the screen. “Movement destresses our visual system,” Appelbaum says. “It was designed to navigate our three-dimensional world.” When we’re moving through space, such as when we walk, what we see changes constantly. “It helps access our side vision, which opens up our central vision. It opens up our visual world.” Gazing into the distant horizon relaxes our focus, which is the opposite of the “tunnel vision” we lock into staring at a screen up close. This panoramic gaze activates the parasympathetic nervous system, calming us, because it signals to the brain that we’re safe.
• How to deal with eye strain: advice from experts
What staring at your laptop all day is doing to your eyes
“Our visual system was developed to scan the horizon in natural light for dinner and for danger,” Appelbaum says. “And that system, developed for the caveman days, is now clashing against our modern day demands that have us indoors and sedentary for too much time, locked into these near screens. It’s changing how we’re thinking, it’s changing how we’re processing, it’s changing our behaviour.”
This is because staring at a screen narrows our field of vision, a physiological reaction that occurs when our brain perceives a real threat. “Our pupils widen, we get tunnel vision and our brain goes into the fight or flight response.” When our sympathetic nervous system is activated, which is what is happening here, it reduces rational thought, as your brain prioritises survival over complex reasoning. “The critical decision-making and the divergent thinking and the outside-the-box processing that is needed for a work day is altered.”
There’s a lot you can do to protect yourself if you’re working long hours on a screen, Appelbaum says. “Ideally, sit in front of a window, so you can look out and disengage. You want the top line of the text to be in line with your eye. And make sure you’re not sitting too close. If you lean back and extend your arms straight ahead, the tip of your middle finger should be between 16 and 30 inches from the screen. That’s the ideal screen distance.” Keep the brightness low. “Dropping the brightness down causes less strain on the system and it’s easier for the inside and outside muscles of the eyes to work together … the sweet spot for most people is between 40 and 65 per cent brightness.”
What to eat for eye health (not just carrots)
Eat omega-3 rich fish
GETTY IMAGES
“Eating for brain health is the same as eating for eye health because our eyes are linked to our brain,” Appelbaum says. Especially good for eye health are lutein and zeaxanthin, two of the carotenoid pigments found in the eye and also in dark green leafy vegetables like spinach, kale and collard greens. Lutein is also contained in egg yolk. “They act as antioxidants and can help protect the retina from harmful UV light,” he says.
Vitamins A, C and E also act as antioxidants, which “help decrease the risk of macular degeneration”. So pack in that citrus fruit. The beta carotene in carrots “everyone talks about, but any orange vegetable provides beta carotene which your body can convert into vitamin A,” he says. Omega 3 is also great for eye health and is found in coldwater fish like salmon, sardines, mackerel and halibut.
Improve your eye coordination to protect your balance in midlife and beyond
The muscles that move your eyes around have to work together so that you see a single image. If our eyes aren’t coordinated well, which can happen as we get older, certain activities such as reading or catching a ball, become difficult. “When the eyes aren’t working well together, vision’s not able to guide movement like it’s supposed to,” Appelbaum says. “There’s a reason why your balance is so much better when your eyes are open. You can allow vision to stabilise your body.”
If your brain isn’t processing what it sees accurately, that can lead to unstable gait, unstable balance, and coordination, he says. It means we can’t trust what we’re seeing: “It’s not being able to take in and process visual input from a change in elevation — a kerb, a stair, a tree root — to plan our motor movements to step over it.”
Working on stabilising our eye coordination can make a significant difference. Appelbaum suggests regular (ideally, daily) “eye stretches’. Look all the way up to the ceiling, all the way down to the floor, to the left, then to the right. Peripheral awareness activities are also effective. “If you’re out on a walk, you can notice a house to one side, a mailbox to the other,” he says, “but if you actively try to take in both simultaneously, that allows you to access more of your periphery.” It activates the different visual centres of the brain — and central and peripheral processing — so they’re working together. “So it helps balance and develop better equilibrium,” he says.