Our Jan./Feb. issue featured an article on strategies for identifying and helping patients with digital eye strain. The optometrists interviewed for the piece, Heidi Q.T. Pham-Murphy, O.D., of Visions Optometry and Eye Designs Optometry in California and Kelci Rolfstad, O.D., of Heights Eyecare in Montana had plenty of advice to share.
In this Web Exclusive, Drs. Pham-Murphy and Rolfstad continue the discussion on the effects of digital device use and how they treat it in their practices.

EB: How does your office identify patients who should get the “digital screen” talk?
 
Dr. Pham-Murphy: We have a questionnaire for patients to assess their lifestyle. I also ask every patient: “So do you spend a lot of time in front of electronics?" This is more of a rhetorical question, since

the answer in most cases is “yes.”  
This leads to conversations not only about what my patient does for a living and leisure but also on how they move in their work space and life spaces. There are many different types of movements that require specific lens design solutions.

Key things to understand:

1. What type of electronics our patients are looking at (usually it's multiple platforms)
2. How intense is the information (spreadsheets, emails, gaming, social media, etc.)
3. How our patients move their eyes while they are looking at the device (within a room, within an office space, out in open spaces)
4. The timing of day in which our patients are looking at their devices. 
 
Dr. Rolfstad: I’d say I have those conversations across the board with every patient. It’s a rare patient—maybe one every couple days—who spends only an hour or less, or no time, looking at screens an hour or less a day.
Even the older generation has adapted to technology quite a bit. So, like we talk to everyone about the importance of UV protection, now we talk to everyone about blue light protection and the type of eye strain that comes along with digital device use.
 
EB: Do specific usage habits result in specific symptoms or visual problems?
 
Dr. Rolfstad: The more you’re on the device the longer your eyes have to work up-close and the more exposure you have to digital light and the reduced blink rates that goes along with it. The longevity of being on the device definitely makes a difference. But also the type of device makes a difference, because of the how close the device is.

The symptoms are similar, but the severity correlates to the extent of the device use. There are multiple factors with dry eye that could make one patient start to suffer from symptoms after just one hour, while another patient can become symptomatic only because of the long time they are exposed to their device.

For instance, someone who suffers from dry eye already will notice symptoms much earlier. Kids can get so ingrained in what they’re doing on the device that they can be much less apt to notice any kind of eye strain. Also, because they’re young they just assume whatever visual experience they’re having is normal.
 
EB: Do you recommend a blue light coating or lens material to all your screen-using patients?
 
Dr. Pham-Murphy: YES! The screen/computer glasses are made complete by the lens materials and treatments we prescribe. Anti-glare treatments filter only short wavelength blue light (about 400-420nm). They help with eye fatigue (reflecting the blue light that scatters and causes fatigue) and they are much more cosmetically appealing.

Blue-light-blocking solutions (like BluTech: absorbs and attenuates wavelengths 400-480nm) have an impact in eye fatigue, but also macular cell stress, and sleep patterns. I have been prescribing BluTech for the last 5 years with much positive feedback on digital eye strain, headaches, and sleep.

All lenses for digital devices should have some type of blue light filter.  I discuss the pros and cons of AR treatments and lenses that absorb blue light across the blue light spectrum. These lenses absorb or reflect different blue light wavelengths.
 
EB: When do you prescribe single-vision lenses with an accommodative bump in the near zone?

Dr. Pham-Murphy: Every single-vision lens wearer can benefit from lenses with the accommodative bump in the near zone. Where I definitely prescribe it is in patients who struggle with near-point accommodation testing, patients who describe a sluggish or struggling ability to maintain focus.

These SV lenses with small amount of add are also wonderful for presbyopes who want single-vision lenses at the computer but also need to look at documents and paperwork. Children also do really well with these lens designs. We’ll prescribe them with AR that filters some blue light or in the BluTech material that takes out much more of that spectrum of light.