If I were to say to you, “My patient is suffering from DES,” what would be your initial thought? Dry eye syndrome? Possibly. However, now more than ever, we are seeing more and more patients suffering from digital eye strain. Let’s face it: we live in a digital world.
We have TVs and gaming systems at home, tablets and computers at work, and smartphones in our pockets at all times.
Approximately 28 percent of people spend 10 or more hours in front of digital devices daily. The number only goes up from there, as approximately 65 percent spend between three to nine hours per day in front of a digital device.1 In 2011, Internet usage alone was up to 2.2 billion users compared to just three million users in 1990.2 This year alone, it is estimated that nearly 60 million children will use a computer or digital device for multiple hours a day, which doesn’t include TV time or using a game system.3
With the increased resolution, you would think there would be less eye strain. However, due to the increased prevalence, decreased cost, and versatility of electronic devices, it’s no wonder we are suffering more now than ever.
Many people have probably experienced digital eye strain already but just didn’t know how to categorize it. Digital eye strain is a group of eye- and vision-related problems that are due to extended computer or digital device use. Digital eye strain sufferers routinely exhibit eye strain, redness, and dryness due to decreased blinking; blurry vision due to screen glare; headache from prolonged eye strain; and neck/shoulder/back pain that is caused by poor posture and sub-optimal screen position. These symptoms are typically caused by the use of a digital screen for two or more hours per day. Digital eye strain is, in fact, a combination of some or all of the symptoms listed above. As with the range of symptoms, the severity can be widespread as well. Some may have little to no complaints, while others may consider digital eye strain to be disabling.
Although digital eye strain is not a lasting condition, it is very problematic for those it affects, especially in today’s electronic world. Typically, the effects increase throughout the day while electronic usage is highest and then wane once computer use is discontinued. Statistics show that 80 percent of what we learn is through our eyes,3 which can have a dramatic influence on children as well as adults who suffer from digital eye strain. It is estimated that as many as one in four students have visual impairment problems, and 20 percent of middle and high school students have difficulty seeing the board in school.3
Existing eye conditions may play a key role in digital eye strain. Common ocular conditions—such as myopia, hyperopia, astigmatism, and presbyopia—can be major contributing factors to digital eye strain. Any of these conditions, coupled with the nature and effects of consistent use of digital devices, increases the chances that the individual will have discomfort. In order to best eliminate the strain caused by uncorrected refractive error, those who often use digital devices should wear computer-specific lenses with a quality anti-reflective coating. There is a wide range of choices for computer-specific lenses, from progressive lenses all the way down to a simple pair of computer-vision–only readers. Eyecare providers should tailor their refractive prescriptions to best suit the individual patient’s needs.
Check out this great infographic for your patients from AllAboutVision.com:
Battling DES in the workplace
Most complaints of digital eye strain come from work related environments where in which prolonged computer use is the primary culprit. Forty-three percent of adults work in a job that requires prolonged use of a computer or tablet.1 In fact, digital eye strain is now the most common computer-related repetitive strain injury among workers, surpassing carpal tunnel syndrome and tendinitis.1 In an effort to combat digital eye strain, many eyecare providers are prescribing specific lenses designed to minimize computer-related eye strain. Coupling this with well-known advice of taking frequent breaks while at the computer, good posture, proper computer monitor positioning, and using re-wetting drops as needed may help decrease digital eye strain significantly.
Digital eye strain can be compounded by sub-optimal working conditions. For example, at a typical office desk, your chair is normal height, but your computer screen monitor is on one remote corner of the desk, higher than your eye level. This may not be an overwhelming problem for a young emmetrope or even a non-presbyopic patient who has the appropriate visual correction. However, for presbyopes, this is a completely different story. Not only do they have to find the intermediate channel in their progressive lenses, they also have to sit with their heads tilted back the entire time they work on the computer. The solution is simple, get the chair up high, get the screen just below eye level, and get a pair of computer-specific glasses. Also, placing reference materials as close to the monitor as possible will not only minimize the amount of un-necessary head movements but also decrease repeated refocusing.
Age is a definite contributing factor to digital eye strain. Not only do the eyes become drier with time, they also lose the ability to focus up close. Therefore, the older your patients, the more potential they have for having more pronounced symptoms of digital eye strain. So, the next time an emerging presbyopic patient comes into your office, don’t just give him a glasses prescription and some artificial tears. Ask him about the amount of time he spends using digital devices. You may be surprised to find how many people have symptoms of digital eye strain.
Dangers of HEV light
Most people are aware that ultraviolet (UV) light is harmful to the eye and may contribute to the development of cataracts and other eye diseases, such as age-related macular degeneration (AMD). UV light is the portion of the spectrum below 400 nm.4 While the most abundant source of UV light is the sun, other sources include welder's flash, video display terminals, such as computer monitors, tablets, and smartphones, and fluorescent lighting. UV light is further divided into three separate segments, which are designated as A, B, and C.4
UVC (below 286 nm) is effectively filtered by the earth's ozone layer. UVB (286-320 nm) is that solar energy which is the cause of sunburn and snow blindness and is absorbed by the cornea.
UVA (320 to 400 nm) is of particular concern to eyecare professionals.4 UVA is considered to be the most damaging of the three because it directly affects the crystalline lens of the human eye. Although UVA is very damaging, recent studies suggest that the blue end of the light spectrum may also contribute to retinal damage and thereby contribute to AMD. This is thought to be caused by high-energy visible (HEV) or blue/violet light that penetrates the macular pigment, causing more rapid retinal changes.4 These changes not only damage the retina structurally but can also decrease visual acuity. The type of damage depends on the wavelength, power level, and exposure time.4
Although HEV light can be harmful, certain bands of blue light are indeed beneficial. Blue-turquoise light is essential for color perception and aids circadian rhythms, cognitive performance, and pupillary constriction reflex.1
Protecting against blue light
There are many easy ways for individuals to decrease their daily digital eye strain. Primarily, patients should have annual eye exams to check for potential refractive error. If glasses are prescribed, patients should wear them. Glasses can help decrease digital eye strain only if used appropriately. Decreasing the brightness of a device is beneficial, as well as installing an anti-glare screen protector on the devices. Decrease the amount of external lighting, thereby reducing the amount of glare on the devices. The monitor should be just inside arm’s length. It should sit approximately even with the wrist with the arms extended straight out. The monitor should also be slightly lower, approximately 20 degrees below eye level.5 Use the digital device’s accessibility features, including increasing the font size, using zoom features, and choosing different fonts or background colors.
Because using digital devices decreases blink rate, patients should remind themselves to blink often while working on a computer or other device. Also, artificial tears are essential for prolonged computer use. The 20-20-20 rule for computer use is beneficial in educating your patients on decreasing eye strain. Every 20 minutes, take a 20 second break and look at something at least 20 feet away.1 This will help relieve eye strain and also decrease generalized fatigue. Although these are very easy ways to combat digital eye strain, 41 percent of adults have never tried—or don’t know how—to reduce digital eye strain.1
Although we can only speculate on the digital wonders that may lie ahead, it does seem apparent that no matter what is invented it will be taxing our eyes. From tablets, smartphones, TVs, computers, and even head-up displays, our eyes are subject to a constant barrage of digital input. We must take action now if not only to protect our patients’ eyesight for the here and now, but also to engrain good habits for the future.ODT
1. The Vision Council. TVC DigitEYEzed Report 2013. http://www.thevisioncouncil.org/consumers//media/ResearchReports/des2014/TVCDigitEYEzedReport2013.pdf. Accessed 01/01/2014.
2. Essilor USA. Dependence on Digital Devices. Available at: http://news.essilorusa.com/stories/detail/dependence-on-digital-devices-affects-vision. Accessed 01/01/2014.
3. Vision Service Plan. Eye Strain. Available at: https://www.vsp.com/eye-strain.html. Accessed 01/01/2014.
4. American Macular Degeneration Foundation. Ultra-Violet and Blue light. Accessed in January 2014. http://macular.org/ultra-violet-and-blue-light
5. American Optometric Association. Computer Vision Syndrome. Accessed in January 2014. http://www.aoa.org/patients-and-public/caring-for-your-vision/protecting-your-vision/computer-vision-syndrome