The TFOS Lifestyle Report provides a comprehensive review of how lifestyle and societal factors impact ocular health. A global panel of 158 experts from 38 countries produced eight reports, summarized below, and additional subcommittees focused on evidence quality, industry liaising, and public awareness. The findings and recommendations of the TFOS Lifestyle Report aim to enhance the understanding and management of ocular surface disease (OSD) in clinical practice.
Factors like sleeping in contact lenses, nonadherence to maintenance protocols, and poor hygiene practices increase the risk of contact lens–related adverse events. Additionally, wearing contact lenses when unwell or after eye surgery can lead to ocular complications. Daily disposable lenses are preferred.
Cosmetics migrating into the eye can cause or exacerbate dry eye disease (DED) symptoms. Many cosmetic products contain ingredients toxic to the ocular surface, including parabens, phenoxyethanol, chlorphenesin, formaldehyde, and benzalkonium chloride. Product contamination is also a concern.
Digital screen use. Digital eye strain must be properly diagnosed and distinguished from other conditions. Symptoms of digital eye strain include burning, headache, and eye redness. The treatment options like oral omega-3 supplementation, artificial tears, and the use of specific device settings (eg, dark mode, adjusting screen brightness, increasing display size/resolution) to decrease digital strain are suggested.
Prolonged use of preserved artificial tears and glaucoma drops can lead to medication-induced DED. The preservatives in eye drops, especially BAK, can be toxic to the ocular surface and cause a breakdown of the tear film and damage to the corneal epithelial cells, corneal nerves, and meibomian glands. Preservative-free drops or drops with milder preservatives such as Polyquad, Purite, SofZia, and sodium perborate therefore are recommended. Several medications and procedures were linked to ocular surface complications. Other effective treatments include punctal plugs, low-level light therapy, and manuka honey eye drops. Corneal refractive surgery can contribute to dry eye. SMILE can cause more vision disturbances in the first month compared to LASIK but fewer dry eye symptoms in the long term.
High or low temperatures can exacerbate symptoms, while humidity, especially in bedrooms, can alleviate them. Wind speed and altitude can lead to conditions like corneal frostbite and photokeratitis.
A poor diet is the second-highest risk factor for DED. Omega-3 fatty acids, certain micronutrients (vitamins A, B12, C, and D), dietary supplements (eg, curcumin), and honey have positive effects on the ocular surface. Water intake was not found to be protective against DED.
Mental health challenges, sleep quality, and chronic pain are linked to DED. Additionally, depression, anxiety disorders, stress, and poor sleep quality and sleep disturbances could also lead to DED. Chronic pain conditions like migraine and fibromyalgia increase the risk of DED. Limited data is available on the use of tobacco, cannabis, and alcohol, but caffeine has a beneficial effect on DED.
. Education, access to health care, and health care utilization impact OSD presentation, management, and treatment outcomes. Major influences include systemic disease, age, sex, race, employment, smoking status, COVID-19 effects, regional climate, socioeconomic effects, sanitation, violence/trauma, and cultural effects.
Christopher E. Starr, MD
- Associate Professor of Ophthalmology; Director of Refractive Surgery; Director of Cornea, Cataract, Ocular Surface & Refractive Surgery Fellowship; and Director of Ophthalmic Education, Weill Cornell Medicine, New York-Presbyterian Hospital, New York
- Chair, Public Awareness Subcommittee, TFOS Lifestyle Epidemic: OSD Workshop
- cestarr@med.cornell.edu; www.StarrMD.com
- Financial disclosure: None
