IS AGING PROGRAM DRIVEN OR DAMAGE DRIVEN?
This debate has been central to gerontology for many years. Is aging destiny and God’s will or is it something we can control and modify?
Program-driven theory suggests that aging follows a biological timetable, possibly regulated by genes, much like growth and development. It says that all living creatures have preprogramed DNA with pre-determined timeline. Even epic stories with reincarnations of God state that it is time for them to leave, having accomplished their mission.
In contrast, the damage-driven theory posits that aging results from the gradual accumulation of cellular and molecular damage over time, caused by environmental factors, metabolic processes, and imperfect repair mechanisms. Much of this is our own doing and by modifying our lifestyle we can live longer and healthier.
Program-driven theory opine that lifespan is already etched in the genes as we are born. A house fly lives only 35 days, dogs live for 15-20 years, horses live for 30-40 years, a sequoia tree lives for 2000 years. No human has lived beyond 122 years. Everyone is destined to die. There appears to be biological constraints beyond these age limits, even with maximum care and support.
One consideration is their reproductive ages. Innate biology of all living beings is that they reproduce. Once the reproductive function is over, the purpose of existence is completed and slowly the DNA starts to deteriorate. One can observe this in plants, insects and animals also. In other words, if humans are to live longer than 120 years, their reproductive capacity should be extended to 60 or 70 years of age, as is noted among whales that live for 200 years.
Damage-driven theory has much more evidence to show, as science has progressed. People are living longer. Life expectancy of all humans has doubled in last 100 years. This has to do with control of infections, tests for early diagnosis of medical problems, wonderful medications and advanced surgical or interventional procedures. Many disorders that were considered as fatal in the past are now being cured. We have better public health measures, vaccinations, and environmental control. Humans with their intellect are better protecting themselves from variety of damages compared to all other animals.
But damages are happening constantly inside the cells at molecular level and repairs are also being carried out. As the damages are overwhelming the system, toxins accumulate slowly, DNA damages occur and apoptosis and cell death occurs. Studies of cellular function have given us better information about ways to increase longevity and reduce chronic illnesses.
Mitochondria are the power houses that control energy mechanism. It converts glucose to ATP providing energy for the body. Too much supply of glucose overburdens and strains the mitochondria. This leads to conversion of excess glucose to fats, and excess secretion of ineffective insulin or insulin resistance, resulting in type 2 diabetes mellitus, obesity, atherosclerosis, liver and heart problems. Certain diet components can support or strain the mitochondria. Hence, a healthy diet is necessary for longevity and good health.
Mitochondria in certain organs such as heart and brain are healthier since they are made to work constantly. Same should apply to the skeletal muscles also. In other words, regular exercise wards off various disorders and increases longevity. Other lifestyle measures such as adequate sleep, stress reduction and avoidance of risky substances are useful measures.
Besides mitochondria, there are several other organelles in the cells that affect cellular longevity. One such factor inside the cell is the telomere. It is the very end of the double stranded DNA molecule, which replicates itself to keep the strand alive and active. When the last molecule fails to replicate, the entire DNA strand tends to break up and leads to cell death. Telomerase is an enzyme that keeps the telomere active. Other agents affecting the longevity are stem cell renewal, lysosomes and autophagy, proteo-stasis machinery and immune regulation.
Lifestyle habits of exercise, meditation, happiness, stress reduction and diet can promote cellular health in various ways. All the intracellular functions are interconnected, which explains why one physical or mental health issue can affect the whole body.
Most scientists now believe that aging is influenced by a combination of both programmed genetic factors and the cumulative effects of damage, making it a complex interplay rather than a process governed solely by one mechanism. The old aphorisms are valid still – God helps those who help themselves or half of it is your efforts and the other half is God’s will.
EYE CARE
Spring, Screens and Sight: What Your Eyes Are Telling You This March
March is a month of quiet change. The light shifts. The days stretch a little longer. We begin driving more at dawn and dusk, spending more time outdoors and re-engaging with routines that demand visual endurance — work, screens, reading and travel. For many people, it is also the time when their eyes begin to feel different.
Some notice mild blur that comes and goes. Others experience glare while driving, irritation they blame on allergies, or eyes that simply feel tired sooner than they used to. Most dismiss these changes as seasonal or age-related and move on.
After decades of caring for eyes at every stage — from perfectly healthy to profoundly complex — I can say with confidence that eyes rarely complain without reason. They tend to whisper long before they shout. And spring is often when those whispers begin.
The truth is that vision is far more than reading letters on a chart. Seeing clearly is only one part of how the visual system functions. Our eyes must work together, focus effortlessly on different distances, tolerate light and glare, maintain a healthy surface, and do all of this for hours at a time without fatigue. When even one part of that system begins to strain, the brain works harder to compensate. That effort shows up as headaches, eye strain, fluctuating clarity, light sensitivity, or a sense that “something just isn’t quite right.”
This is why many people tell me they can still see well yet feel visually uncomfortable. That distinction matters.
Spring tends to expose these subtle imbalances. Increased sunlight reveals glare issues that went unnoticed during darker months. Longer daylight extends screen use. Seasonal allergies disrupt the delicate tear film that keeps vision clear and comfortable. Dry indoor air lingers, blinking decreases, and eyes that have been quietly compensating finally reach their limit.
Dry eye, in particular, is one of the most overlooked contributors to visual problems, even in spring. Watery eyes do not necessarily mean healthy eyes. In fact, allergy-related tearing often washes away the very components that keep the eye’s surface stable. Add prolonged screen use and certain medications, and vision can fluctuate despite otherwise “good eyesight.” People are often surprised to learn that dry eyes affect not just comfort, but the quality of vision itself — especially in bright light and at night.
Another common misconception I encounter is that cataracts only become relevant when vision is clearly impaired. In reality, cataract changes begin quietly. Early cataracts often affect contrast, color perception, and glare long before they cause an obvious blur. Many people adapt without realizing how much visual quality they’ve lost, adjusting their habits instead of addressing the cause. Modern eye care allows us to identify these changes early and guide patients thoughtfully, rather than waiting for vision to decline unnecessarily.
The same is true for vision correction in general. Whether someone is considering updating glasses, exploring laser vision correction, or simply understanding their long-term eye health, the most important step is not choosing a procedure — it is choosing a careful, experienced evaluation. Eyes are not identical, and meaningful vision care has never been one-size-fits-all. The best outcomes come from understanding how a person’s eyes function as a system and planning accordingly.
What concerns me most is how often people normalize visual discomfort. Eye strain is brushed off. Headaches are tolerated. Night driving is avoided. Screens are endured. These are not badges of aging; they are signals. Addressing them early is almost always easier — and more effective — than waiting.
Around the world, I see the same pattern repeated: people wish they had come sooner. Not because something went wrong, but because it could have been simpler. Vision is deeply personal. It shapes how we work, connect, move and enjoy life. Protecting it requires attention, timing, and experience.
As spring arrives, I encourage people to pause and listen to their eyes. Be aware of subtle changes. Don’t dismiss discomfort. Understand the role of dry eye. Learn where you stand with cataracts, even if they are early so you can take advantage of technological advances in multifocal and trifocal lens implants to seek vision freedom without glasses.
Seek thoughtful guidance when considering vision correction whether you are nearsighted, farsighted or have astigmatism or reading vison issue. And above all, choose care based on judgment and experience, not convenience.
Arun C. Gulani, M.D., M.S., is director and chief surgeon of Gulani Vision Institute in Jacksonville. He can be reached at [email protected] or visit www.gulanivision.com