Eye strain, also known as asthenopia, is a common condition caused by prolonged eye focus. Frequent examples where patients may complain of eye strain would be associated with long periods of reading, digital screen use, and prolonged driving.1
As frequently as eye strain is experienced in the patient population, many of the symptoms are generally ignored due to a lack of patient education on the matter.
A 2016 study reported that over 90% of 10,000 patients who self-revealed experiencing eye strain did not consider talking to their eyecare provider (ECP) about the symptoms in their last eye exam.2 This indicates the importance of asking the patients important key questions during the exam to elicit indications of eye strain.
Hence, understanding the future prevalence of eye strain is important for eyecare professionals to provide patient education on the signs and symptoms to tackle the impending epidemic.
Addressing the rise in asthenopia
In recent years as technology has advanced, it has become incorporated in our everyday social lives, which has impacted our usage of devices and screens. Further, the coronavirus disease 2019 (COVID-19) pandemic impacted our everyday work and social lives by increasing screen time.
This trend was recognized by the World Health Organization (WHO) which estimated that almost two out of three Americans experienced eye strain after the pandemic.3 The way we experience common things has shifted from this experience, like working from home or online schooling, which has now become the new normal.
Women at increased risk of eye strain
As the world changes, eyecare professionals must stay up to date on the prevalence of eye strain and educate their patients on the new demands that are required from their vision. In addition, recognizing at-risk patients is key in prevention.
For example, the sex of the patient can help optometrists target key patients who may have a higher chance of experiencing eye strain. Women, in particular, are more likely to report symptoms of eye strain (69%) compared to men (60%). Another interesting fact is that women are more likely to use multiple screens (two or more) at a time compared with men (74% versus 67%).2
Alarming statistics on children and screen time
Optometrists should consider different trends in our patient populations corresponding to their age group. It only takes 2 hours of screen time a day to elicit digital eye strain, according to the American Optometric Association (AOA),4 and on average, children aged 8 to 18 years are currently spending a surprising 7.5 hours per day on screen time on entertainment (not including academic work).5
As these children are using devices for entertainment and educational purposes, parents must be aware of the long-term consequences on eye health, such as an increase in myopia (nearsightedness). One study found that children who spend more time outdoors were 23% less likely to develop myopia compared to those who did not.2
Eye strain most prevalent in Gen Z
Adults under 30 reported the highest rates of digital eye strain compared to any age group, with it impacting 73% of them.2 Optometrists should be aware that this population uses screen time for multiple purposes throughout their day as they multitask between work and socially.
In addition, they are generally more likely to use their smartphones over a desktop. Above 30 is characterized by visual changes in their up-close vision and having challenges switching distances between their devices. This generation also relies heavily on computers and laptops as their main digital screen.
The trend of digital eye strain seems to decrease as the population gets older. In fact, 66% of patients in their 40s experienced one or more symptoms of digital eye strain compared to 53.4% of patients 60 and older.2
Want to learn more about the connection between digital eye strain and dry eye? Check out the article Chicken or Egg: Digital Eye Strain and Dry Eye, with a detailed case report and tips for educating patients on good digital hygiene habits!
Common causes of eye strain
Eye strain symptoms generally fall into three main categories:
- Binocular vision dysfunction
- Accommodative stress
- Dry eye symptoms
Binocular vision dysfunction (BVD)
Binocular vision dysfunction is an eye disorder where the eyes are slightly misaligned, causing the eyes to not be able to create a clear, single image to the brain. Some symptoms of BVD include dizziness, motion sickness, headache, and light sensitivity.6 These symptoms can cause both adults and children to have difficulty functioning in daily life.
In children, these are generally picked up when the child has difficulty with school-related tasks like reading. They generally complain that the words may “float” or may have attention difficulties.
Many times, binocular vision disorders may be misdiagnosed as learning disabilities like dyslexia, attention deficit disorder (ADD), or attention-deficit/hyperactivity disorder (ADHD). Some treatments that can help successfully treat BVD are prism lenses and vision therapy.6
Accommodative stress
Accommodative stress occurs when the eye has difficulty focusing at distance and near, and is usually seen in adults or children who have prolonged near work. Treatment generally occurs with undetected refractive errors, vision therapy, and prisms.7
Dry eye symptoms
Dry eye occurs as the inability to adequately produce enough lubrication in the tears for the eyes resulting in dry eyes. Dry eye is extremely common and affects millions of Americans every year.
Some of the symptoms of dry eye are foreign body sensation, burning, red eyes, photophobia, and blurred vision.8 Treatments for dry eye include eye drops, in-office treatments, prescription medications, lifestyle changes, and surgery.
Other common symptoms of eye strain that might be seen in patient care can be sore neck, blurred vision, itching, double vision, and photophobia.1
6 steps to manage eye strain
As eye strain becomes ever prevalent in our society, here are some tips we can use to relieve our patients’ eyes:
1. Use the 20/20/20 rule.
After 20 minutes of screen time, look 20 feet away for 20 seconds.
2. Blink.
It is estimated that when we stare at a screen, we blink 66% less than usual.9 As prolonged screen time has become the norm, the rate at which our eyes are drying has been exacerbated. Blinking plays an important role in maintaining the stability of the tear film.
Every time we blink, the tears are released from our glands and spread across the anterior surface of the eye as lubrication. Explaining the importance of blinking more frequently can help patients maneuver possible dry eyes caused by infrequent blinking.
3. Lubricate the eye.
Artificial tears can help the eyes feel more lubricated throughout the day. According to research, it is recommended that artificial tears be used four times a day for one month to begin to notice improvement in the surface quality of the cornea.10
In addition, preservative-free artificial tears generally have less additives and are great for patients who are on multiple eye drops.10 Artificial tears are typically considered the first line of management for dry eyes, but there are other considerations, such as ointments, gels, and punctal plugs,
4. Consider computer glasses/anti-fatigue glasses.
Computer glasses are used by individuals with specific requirements for their visual needs. The computer glasses prescription allows for an intermediate distance (usually that of the distance between the patient and their screen) and the bottom portion is used for reading.
Anti-fatigue glasses are prescribed for individuals experiencing eye strain secondary to accommodative excess or a binocular visual disorder. The top portion of the glasses is their distance prescription, and the bottom is a very small add power such as a +0.50 to help release their accommodation.
5. Utilize filters.
Filters can be a great way to help with managing eye strain. Anti-reflective (or anti-glare) coating helps increase the ability for the eye to focus by reducing unwanted glare and increasing light to pass through the lens.
Blue light filters help decrease artificial blue light from screen time at night that can disrupt the circadian rhythm of the patient (sleep cycle).11 In effect, patients report feeling less fatigue and eye strain.
6. Take advantage of artificial intelligence
As new advancements in technology are on the rise, the same advancements are occurring to combat eye strain. Companies such as Apple are releasing artificial intelligence (AI) technology that helps remind patients to hold their phones at a specific distance.
Apps, such as Sightkick, use AI to detect when the blink rate decreases and nudge the user to look 20 feet away from the screen for 20 seconds. Of note, in a recent survey completed by 400 optometrists, 72% agree that AI will improve optometry in the future.12
Patient education on asthenopia
Speaking to patients about eye strain is extremely important in this generation. Here is a sample script that optometrists can use to educate patients and also elicit a cue to discuss their possible signs and symptoms of eye strain.
“Eye strain is when your eyes become tired after prolonged use, especially while using screens for greater than 2 hours a day. It can feel like tired, sore, watery, itchy, or dry eyes. This is not a serious condition, although it can be annoying.
Here are some simple steps to ease this problem: 20/20/20 rule, artificial tears, frequent blinking, computer/anti-fatigue glasses, filters, and technology to help monitor screen time. Getting your annual eye exam can help you and your optometrist combat this problem.”
Conclusion
In conclusion, this article highlights the effects of eye strain and how we, as eyecare professionals, need to stay up-to-date to provide our patients with the best treatments.
The rising incidence of eye strain post-pandemic and increased demands of digital work make this condition a common occurrence in our patients.
Prior to treating this condition, we need to determine its underlying cause, which could be binocular vision dysfunction, accommodative stress, or dry eye symptoms. The treatment can vary based on the cause of the eye strain.
It is essential to speak to your patients, recognize at-risk patients, understand their day-to-day activities, and assess their ocular health, all of which go hand in hand with providing the highest quality of care to them.
