March 14, 2024
Presbyopic patients often gripe about uncomfortable symptoms after spending the day on their digital devices or enjoying a hobby that requires near vision. Retirees often use their eyes at near as much, if not more, than they did when they were working. Several optometrists have become worldwide experts in digital eye strain including Dr. Jim Sheedy, OD, PhD, who worked for several years on research at Pacific University investigating all aspects of the condition. (Dr. Sheedy is also known as Doctor Ergo because of his expertise in ergonomic body positions.) The most common complaints reported to optometrists are blurred vision, diplopia, dry eyes, red and irritated eyes, headaches and often neck and/or back pain.
Computer Vision Syndrome
There are many potential causes of computer vision syndrome (CVS), also referred to as digital eye strain. Screen glare, poor lighting, poor posture while using a computer, viewing the computer at the wrong distance and angle, uncorrected vision problems or a combination of these many factors.1 At a recent Alpha Omega2 consultants meeting, Dr. Selina McGee, OD, FAAO, Dipl. ABO, of BeSpoke Vision in Edmond, Oklahoma, told me that she often sees older patients who complain of eye strain, and the problem often turns out to be dry eye that has gone undiagnosed. Dr. McGee specializes in treating patients with dry eye and has lectured frequently on the syndrome. She admits to also diagnosing computer vision syndrome in her clinic as well.
Several colleagues, including Dr. Paul Karpecki, OD, FAAO, have emphasized that with the proper diagnosis these presbyopic patients don’t necessarily need to give up their screen time as there are several solutions to help ease the digital dilemma. Dr. Karpecki feels that the simple act of focusing on the screen for too long can be the culprit. He pointed out that computers, tablets, and particularly smartphones, seem to be in use everywhere. This is something my wife and I also noticed this past Valentine’s Day when we went to dinner and sat across from a middle-aged couple who were holding their smartphones in one hand and their utensils in the other. We counted no more than three conversation exchanges between the two of them during the two-hour event. Isn’t love grand.
Ways to Ease Digital Eye Strain
When I discussed this subject with Dr. Robert Lopanik, OD, who practices in Charleston, S.C., he mentioned that he reads a lot on his e-reader, and often has to put the device down to rest his eyes. Dr. Lopanik follows the 20-20-20 rule, which recommends that when you engage in near work that every 20 minutes you should focus 20 feet away for 20 seconds.
This practice will encourage more blinking, which is greatly reduced when staring at a computer screen. According to a study at the University of Iowa, individuals blink 66% less frequently when they are working on a digital screen.3 Blinking spreads the tear film over the entire ocular surface and prevents evaporation of the film from occurring.
There are several tools we can prescribe to our patients to help ease their eye fatigue. First and foremost, be sure they have the correct vision prescription in their eyeglasses, including a near addition that isn’t too strong. Using an incorrect or outdated prescription can increase eye strain and often causes headaches. Many optometrists prescribe special single vision near glasses adjusted for the proper working distance that the patient enjoys.
Visual Ergonomics
Screen glare occurs in many workstation configurations. This phenomenon is caused when light is reflected off the digital screen. Desks that are near a window can cause this as can overhead lighting fixtures, particularly fluorescent bulbs. Many businesses now offer screen glare filters to their employees to place on their computer screens. Dimming overhead lights, using lower wattage bulbs, and proper shading on windows can also help reduce screen glare.
Computer placement is critical for good eye health. Oftentimes individuals sit too close to their computer. I suggest having the patient sit in front of a computer screen in your office and observing how close the patient’s preferred working distance is. Most experts suggest a distance of 22 to 28 inches away from your eyes. The screen should not be above the patient’s eye level.
Dr. Sheedy has stated that poor posture can also contribute to eye strain. It is important to not let your neck sag forward. He has worked with several office chair manufacturers, and his research found that people need to keep their feet flat on the floor and knees level.4
The American Optometric Association recommends that during a comprehensive eye examination it is important to test how the eyes focus, move, and work together. In order to obtain a clear, single image of what is being viewed, the eyes must effectively change focus, move, and work in unison. The testing will look for problems that keep the eyes from focusing effectively or make it difficult to use both eyes together.5 In my experience this type of exam is best performed in an optometrist’s office.
Finally, eye strain complaints from your presbyopic patients should be thoroughly investigated in a comprehensive eye exam, followed up with a discussion with the patient about work, hobbies, and viewing habits. The optometrist is the first line of defense, so we need to make sure patients know remedies exist that can offer them true comfort and increased quality of life.
References
1 Cedars Sinai Health Online Library, Computer Vision Syndrome, pp1.
2 Alpha Omega is a private group optometrists who frequently are invited to meet with ophthalmic companies and evaluate new products and services. Dr. Jack Schaffer is chairman of the group.
3 7 Ways to Ease Computer Vision Syndrome. Healthline.com
4 Discussion held over lunch in Forest Grove, Oregon in 2014.
5 Computer Vision Syndrome. American Optometric Association.org
