Digital Eyes

Digital devices have become a huge part of our lives, yet we are only beginning to understand the effects they’re having on our eyes. Here are some strategies for educating your patients about what can be done to make them more comfortable in front of the small screen

By Susan Tarrant

Gunnar Technology Eyewear from Carl Zeiss Vision offers a line of Rx-able specialty eyewear designed for gamers or anyone who spends a lot of time in front of a video, computer, or digital screen

It’s been a little more than a decade since the first smartphone was introduced, six years since we saw the first iPhone, and three years since the tablet was introduced. Yet considering the relative youthful status of these and similar digital devices, it’s hard to imagine life without them.

A NEW DAY

According to a report by The Vision Council, 34 percent of adults are in professions that require prolonged use of digital devices. Couple that with the fact that even outside of work we are tethered to our phones (on which, let’s face it, we do everything but talk) and tablets, or glued to a video game monitor, and we are putting different visual demands on our eyes than even a decade ago.

The bright and unhealthy light emitted from digital media (as well as those energy-saving light bulbs) is also taking its toll on our eyes. The high-energy visible (HEV) light, or blue light, can cause retinal toxicity and is being studied as a possible cause of macular degeneration. (HEV light from the sun also poses an eye health danger, but that’s a story for another day.)

New digital technology has expanded our way of communicating, working, gaming, and even reading. But with it comes a new visual situation that we are just now beginning to understand, and whose long-term effects we don’t yet know.

Essilor of America’s Crizal Prevencia offers a no-glare treatment as well as protection from UV rays and harmful HEV light, but allows the beneficial range of blue light through

“We’re living in an experiment right now,” says Thomas Gosling, OD, of Optical Matters in Littleton, CO. “We don’t really know what the effects are going to be.”

DIGITAL EYE STRAIN

Digital eye strain, loosely defined as discomfort following two or more hours of digital device use, occurs whenever patients are overusing one zone of their vision. It’s the result of many factors: staring at a backlit, LED screen; the number of hours we spend on computers/digital devices; and how they are positioned according to our eye level. A 2012 study by The Vision Council found that nearly 70 percent of adults experience some form of digital eye strain.

InTouch lenses from Shamir Insight are PALs that offer a quicker transition to the add power in the intermediate zone and a broader reading zone to provide comfortable everyday vision for digital device users

“People think they can use these things all day and not have any effects,” Gosling says.

Key symptoms of digital eye strain are fluctuation vision, tired eyes at the day’s end, headaches, overall body fatigue, dry eyes, and the desire to keep rubbing the eye.

Because this new media has strained patients’ near vision, even “locking up” the muscles at a certain distance, optometrists are reporting that patients are losing their ability for near accommodation at an even earlier age.

“I’m seeing patients becoming presbyopes at age 38,” says Dora Adamopolous, OD, of Eye 2 Eye Optometry Center in Alexandria, VA.

She adds that the focus the industry, as well as lens manufacturers, is starting to put on the topic of digital eye strain is not an overreaction, or an attempt to push the latest products.

“All the things I’m reading about in these reports, I can see that it’s real. This is what I’m seeing in my exam room,” she says.

BLUE LIGHT

High-energy visible (HEV) or blue light is the most potent light in the visible spectrum; the light that scatters the most.

While UV light rays can cause damage to the skin around the eye as well as the cornea, blue light enters the eye and reaches the retina. It’s known to cause retinal toxicity and is being studied as a possible link to macular degeneration.

Part of the blue light range plays a beneficial role on our health (helping regulate our internal biorhythms and positive moods, for example), but part of the range can be harmful to the retina. Though it exists in natural sunlight, it is also emitted from LED lights and LED screens, as well as our favorite digital devices.

Of particular concern for HEV light exposure are children. Young people are already well-versed in digital devices.

Parents hand kids an iPad or smart phone to keep them occupied, and schools are starting to switch from textbooks to iPad- or computer-based learning. That adds up to a lot of screen time.

In addition, children tend to play with digital devices very close to their faces, exposing their eyes to even more blue light.

“Because the retinal cells are such metabolically active cells, they are being bombarded” by the HEV light, explains Jeffrey Anshel, OD, FAAO, of Poinsettia Vision Center in Carlsbad, CA.

Given our propensity for staring at blue light-emitting screens, the harmful effects of blue light is worthy of a conversation with your digital-loving patients.

“I try to be careful when talking [to patients] about this, because I don’t want to scare,” Gosling says, “but I do want to educate. Are those five year olds going to start exhibiting macular degeneration at an early age?” asks Gosling. “We just don’t know yet.”

Recharge, from Hoya Vision Care, is an AR treatment reducing blue light transmission and the visual “noise” from digital screens and CFL lighting, reducing digital eye strain. It can be paired with Hoya’s TACT or Sync digital media lenses

WHAT CAN BE DONE

“People are staring at a light source for literally hours on end. So how do we deal with this and help patients with their vision?” asks Randall Fuerst, OD, FAAO, of Eye-Center Optometrics, which has three locations in the Sacramento area. “We can offer them better lenses than what they came in wearing that will give them better quality vision at the distances they need them.”

And those “better” lenses are coming in various forms. Many manufacturers have released lens designs, both single vision and progressive addition, to address digital eye strain.

Special PAL designs (computer or office use only) open up the intermediate distance to provide better vision at the computer’s distance, at the expense of the distance zone.

Others offer enhanced visual comfort in the zone used for reading handheld digital media. Single vision lens designs tout comfortable adjustments to all distances, reducing fatigue and strain.

“If we can re-allocate that lens, with less real estate given to distance, or with a more gradual transition in the middle, or a better reading area, it’s going to give them better vision where they need it,” and provide patients with more comfortable vision says Fuerst.

But it doesn’t stop with lens designs. Coatings and other treatments are available to block the worrisome blue light. These treatments exist as separate coatings or part of an AR treatment. Together with AR, they can reduce glare as well as blue light exposure.

And sometimes, it’s not just a lens design or treatment that can help patients’ eyes with stress. Sometimes it’s a matter of re-evaluating the current prescription.

Gosling reports that many young adult patients come to him thinking they need glasses for distance vision, when all they need to do is let their eyes relax a bit. Their eyes have “locked up” so much at the near vision that distance vision becomes difficult when they finally look up from their devices. At the phoropter, he’ll add extra power to blur vision completely, forcing the eye to relax.

Typically, he finds that the patient will see clearly at a lower lens power than they were originally wearing. “I kick power out of their glasses 70 percent of the time,” he says.

TALKING IT UP

Because our reliance on digital media doesn’t seem to be lessening, it makes sense to begin educating patients on what’s happening with their eyes, and what strategies and products can be set in place to help.

A case history regarding computer use should be the opening salvo of the conversation. Identifying first that they use the computer or a digital device for more than a couple of hours a day should open the door to further questions about how they use those devices.

The easiest way? Include questions about how long patients are on a computer daily, either for work or pleasure, and if they own an iPad, tablet, or smartphone.

“A large number of patients coming in now have digital eye strain,” says Fuerst. “It’s just a matter of flushing them out.” A computer use questionnaire is a great way to segue into more exact questions.

Anshel has written two books about computer vision and the visual ergonomics of computer use. If a patient indicates they spend more than three hours in front of a computer or digital device, he digs further to be able to correctly troubleshoot the visual problem.

iBlu coat lens coating from PFO Global is an AR treatment that is designed to block blue light as well as UV rays. It’s available on the company’s Resolution polycarbonate lens

BluTech lenses from VSP Optics Group filter harmful blue light and can be combined with the company’s UNITY CVx computer vision lenses

That digging includes finding out what the monitor is like, how they sit in relation to the computer, and how they hold their mobile devices.

Most important, don’t be afraid to recommend a product or prescribe a lens that’s going to help with digital eye strain.

“It’s not just another add-on,” Anshel says. “It’s something for their eye health.”

“People like to hear new things when they go to the doctor,” says Adamopolous. “I would hate to leave my doctor’s office and find out later that something exists to help me see better but he never mentioned it.”

She adds that, as an OD, she considers herself and her colleagues to be the ones with the responsibility to talk to every patient about what may be happening to their eyes as a result of computer use, and how best to deal with it.

“I don’t know who goes to the dermatologist and doesn’t get the lecture about sunscreen,” Adamopolous says.

PRACTICE GROWTH

Taking a proactive approach to patients’ digital device use is not only responsible optometry, but it can be a boost to your practice, too.

Adamopolous states that by talking to every patient about digital media use, and what you can prescribe to help, “you are creating the perception that you are keeping up with the times, and that you are offering the latest innovations for your patients’ vision.”

And, it can only help your practice if patients go to an exam with symptoms of eye strain, then go back to work and talk to officemates about what they’ve learned—from you—during their exam.

An outgrowth of educating the patient about the causes of eyestrain or the dangers of HEV exposure is that there will be a second- or third-pair sale. And even if that second-pair sale doesn’t happen at the initial visit, you’ve planted the seed.

“One pair of lenses doesn’t cover everything anymore,” Anshel says. “They used to, but times have changed.”

Fuerst agrees: “You cannot get hung up on ‘How do I make one size fit all?’ You have to help them with their vision.” And, in this technological age, that often means more than one pair of eyewear. EB