Beyond devices: Vision discomfort may stem from lifestyle factors

Image Credit: AdobeStock/Donson/peopleimages.com

There is no escaping daily contact with an electronic device in the digital age in which we live. These devices play an integral role in the way we communicate and learn. As demand increases, a recent “eye-opening” review highlighted the fact that as we spend more time in front of electronics, the risk of mental health conditions, obesity, cardiovascular disease, and sleep disorders increases.¹ As eye care practitioners, are we tackling patient concerns with a broad point of view concerning a topic that requires so much visual effort?

Day after day, patients enter the examination room with complaints of eye fatigue, redness, blurred vision, and headaches, to name a few. Eye care practitioners are trained to tackle a variety of differential diagnoses—among them dry eye, refractive errors, and accommodative or muscle imbalances. But are we looking at this with a holistic lens while missing significant contributions beyond eyes?

Regardless of symptoms, start with these helpful tips for all device users:

• Review the “20-20-20 rule” regarding visual breaks.
• Demonstrate computer positioning with proper visual posture.
• Prescribe computer lenses when appropriate.
• Recommend blue light filters within device settings.
• Prescribe antiglare lenses for eyeglass wearers.

Delivering preventive options should be equally as important as treating symptoms. So, we must consider all factors contributing to a homeostatic state of eye health. Looking at eye strain holistically can reveal the following links to visual discomfort and their solutions.

Hydration status

With our bodies composed of over 60% water and the eye at almost 98%, visual function will suffer if not enough daily fluids are consumed. The day can slip away while we forget the simple task of drinking water. Dehydration can lead to cognitive disfunction, blurred vision, dry eyes, and, with time, chronic inflammation—not to mention an imbalance of electrolytes such as sodium, calcium, potassium, and magnesium. Maintaining a precise osmotic gradient of electrolytes between the tear film and the ocular surface is of paramount importance in regulating homeostasis while preventing inflammation.²

Stress

As we accumulate work hours on the computer, stress is inevitable. We are busy aiming for deadlines, meeting goal expectations, and trying to get to the next meeting on time. Do not miss the familiar warning signs of aches and pains. Long-term stress leads to increased cortisol release, causing the hypothalamic-pituitary-adrenal (HPA) axis to remain in overdrive. Chronic stress contributes to signs and symptoms of dry eyes, increased inflammation, and poor visual function.³ Uncovering potential causes of HPA triggers from stress will help tackle the root cause of the adverse effects.

Impaired sleep

Sleep is a silent factor we may be overlooking when it comes to eyestrain. It has been estimated that almost one-third of adults are not getting enough daily sleep. Therefore, if we are not getting quality sleep and allowing time for recuperation, then restoration efforts suffer on a cellular and molecular level. It has also been debated that prolonged wakefulness leads to a progressive impairment of functions such as attention, sensorimotor integration, and a range of executive cognitive functions.^4,5 Although the connection is not well understood, studies show that visual function, rather than visual acuity, suffers with sleep disorders.⁶ According to the Centers for Disease Control and Prevention, a recommended 7 or more hours of quality sleep are necessary to recharge for healthy visual performance.

Workplace environment

Figure.The image demonstrates proper form while working on a computer at a desk. Note that the posture should be maintained to ensure minimal head movement is necessary.
(Image courtesy of the American Optometric Association.)

A poor workplace environment can lead to blurred images, headaches, dry eyes, accommodative concerns, and more. These symptoms are caused by screen glare, poor viewing angle, or screen settings—not to mention the stress, anxiety, and depression caused by a workplace that can compound symptoms. Jeffrey Anshel, OD, FAAO, author of Visual Ergonomics in the Workplace, describes symptoms coming on toward the middle or end of the day. Tension headaches, the most common headache we see with device users, can be a result of substandard workplace conditions such as glare or improper lighting and workstation setup.⁷ Dry eyes are another familiar complaint we hear from patients. With mild to moderate symptoms of discomfort, consider contributing factors such as poor humidity, reduced blink rate, and dust. To keep eyestrain to a minimum, adjust monitors to arm’s length (about 16 inches) with the top of the screen at or near eye level, or positioning the center of the screen 10° to 20° below your straight-ahead gaze. This also encourages ideal visual posture and proper blinking, not to mention less visual strain (Figure).

Posture

Because vision guides learning, posture can fail to achieve optimal visual acuity. As we adapt posture to ease visual strain, this leads to neck and back pain, which can bring about symptoms of headaches and muscle restriction while mimicking or causing eye issues. Prolonged device use causes poor posture such as slouching, forward neck, or rounded shoulders. Sustained forward neck posture leads to injury to the structure of the cervical and lumbar spine. OSHA (Occupational Safety and Health Administration) recommends that hands, wrists, and forearms be straight, in-line and roughly parallel to the floor with head level, forward facing, and balanced in-line with the torso.⁸

Nutrition deficiencies

Nutrition truly encapsulates all the aforementioned. Nutrition should be considered on a bio-individual basis, meaning one diet or food plan does not serve all. Studies show that the Mediterranean diet continues to provide the best balance for a rich plant-focused base (lutein and zeaxanthin) with an abundance of healthy fats (ω-3 fatty acids) and fiber ideal for cognition and eye function.⁹ Because we know that proper nutrition is a direct link to visual longevity, do not dismiss microbiome imbalance, nutritional deficiencies, or food allergies—all leading to chronic inflammation. If symptoms cannot be explained through a comprehensive eye exam, these patients should be referred to specialists. By promoting more antioxidants through food or nutritional supplements, we also aim to prevent and reverse damage from the harmful UV spectrum putting us at risk for macular degeneration, cataracts, and skin cancer.¹⁰ In January 2024, the Office of Disease Prevention and Health Promotion partnered with the Office of Intergovernmental and External Affairs to host the first-ever US Department of Health and Human Services Food is Medicine summit in Washington, DC. The summit, which is part of the larger government-led Food is Medicine initiative to unify and advance collective action, is a step aimed at shifting the US from an illness-care system to a wellness-care system.

Medication adverse effects and chronic disease state

Lastly, we must not overlook chronic disease, or medication toxicities that accompany many of the known deadly, sight-threatening diseases. Uncontrolled conditions such as heart disease, high cholesterol, diabetes, cancer, or hypertension can weaken the body’s response to a homeostatic state of wellness. Additionally, gut dysbiosis, hormone imbalance, or conditions leaching vitamins from our bodies would all be considerations for symptoms leading to eyestrain or headaches. For example, the drug group of statins, which is too often prescribed for hypercholesteremia, is linked to a deficiency in coenzyme Q10 (CoQ10), a key energy source that helps convert food into energy. CoQ10 is found in almost every cell in the body as one of the most significant lipid antioxidants, which inhibits the production of free radicals and modifications of proteins, lipids, and DNA.¹¹ Supplementation in these cases with a known deficiency in the antioxidant CoQ10 was shown to statistically reduce fatigue.¹²

In summary, we must look beyond the common causes of computer-related eyestrain to fully assess generalized symptoms believed to be arising from devices. As we delve into a patient’s history, we can uncover potential lifestyle risks contributing to symptoms beyond vision.

References:

1. Nakshine VS, Thute P, Khatib MN, Sarkar B. Increased screen time as a cause of declining physical, psychological health, and sleep patterns: a literary review. Cureus. 2022;14(10):e30051. doi:10.7759/cureus.30051

2. Woodward AM, Senchyna M, Argüeso P. Differential contribution of hypertonic electrolytes to corneal epithelial dysfunction. Exp Eye Res. 2012;100:98-100. doi:10.1016/j.exer.2012.04.014

3. Roitstein C. Stress can lead to negative effects in the eyes. Optometry Times. January 2, 2024. Accessed March 24, 2024.https://www.optometrytimes.com/view/stress-can-lead-to-negative-effects-in-the-eyes

4. Vyazovskiy VV. Sleep, recovery, and metaregulation: explaining the benefits of sleep. Nat Sci Sleep. 2015;7:171-184. doi:10.2147/NSS.S54036

5. Liu Y, Wheaton AG, Chapman DP, Cunningham TJ, Lu H, Croft JB. Prevalence of healthy sleep duration among adults--United States, 2014. MMWR Morb Mortal Wkly Rep. 2016;65(6):137-141. doi:10.15585/mmwr.mm6506a1

6. Xue R, Wan G. Association between vision-related functional burden and sleep disorders in adults aged 20 and over in the United States. Transl Vis Sci Technol. 2023;12(11):3. doi:10.1167/tvst.12.11.3

7. Anshel JR. Visual ergonomics in the workplace. AAOHN J. 2007;55(10):414-420; quiz 421-422. doi:10.1177/216507990705501004

8. Computer workstations: good working positions. Occupational Safety and Health Administration. Accessed March 28, 2024. https://www.osha.gov/etools/computer-workstations/positions#:~:text=The%20following%20are%20important%20considerations,in%2Dline%20with%20the%20torso

9. Martini D. Health benefits of Mediterranean diet. Nutrients. 2019;11(8):1802. doi:10.3390/nu11081802

10. Böhm EW, Buonfiglio F, Voigt AM, et al. Oxidative stress in the eye and its role in the pathophysiology of ocular diseases. Redox Bio. 2023;68:102967. doi:10.1016/j.redox.2023.102967

11. Saini R. Coenzyme Q10: the essential nutrient. J Pharm Bioallied Sci. 2011;3(3):466-467. doi:10.4103/0975-7406.84471

12. Tsai IC, Hsu CW, Chang CH, Tseng PT, Chang KV. Effectiveness of coenzyme Q10 supplementation for reducing fatigue: a systematic review and meta-analysis of randomized controlled trials. Front Pharmacol. 2022;13:883251. doi:10.3389/fphar.2022.883251