The Science Behind Digital Eye Strain and What ODs Should Know

Jan 27, 2021
8 min read
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You’re halfway through your clinic shift. Yet another patient sits in your exam chair with familiar symptoms. Blurry vision, loss of focus, eye strain, and more. Your patient would like to know what they are experiencing, why they are experiencing it, and how to remedy the condition.

Digital eye strain, also known as Computer Vision Syndrome, is common. It’s prevalent and cases of this condition have increased in the past year. As an eye doctor, you’re tasked with caring for the health of your patient and improving their visual clarity and comfort and thus their wellbeing.

Let’s dive into what exactly Digital Eye Strain is and then a step by step way to improve the quality of life of your patients by treating their condition.

What is Digital Eye Strain?

Digital Eye Strain includes a group of vision problems that result from increased use of digital devices and screens including computers, tablets, and cell phones. Digital devices are a huge part of our daily lives from the workplace and the classroom to at home and on the go. 90% of Americans have at least one digital device and about 50% of all individuals experience a number of visual problems from prolonged digital device use.

When using a digital device, the eyes have to work harder to focus and see clearly than when viewing a printed sheet or page from a book. The text on different devices is not as well-defined, contrast between the letters and the background is reduced, glare may be present, and viewing angles may vary. The eyes have to work harder to focus clearly and to move together precisely. This leads to the development of symptoms related to the use of a digital device. With the addition of uncorrected vision problems and untreated ocular concerns, symptoms are increased and made even more apparent.

Diagnosing Digital Eye Strain in Clinic

When a patient presents with symptoms of Digital Eye Strain, complete a thorough comprehensive eye exam to diagnose the condition and to identify the cause to provide the best treatment.

During patient case history, talk to your patient about their full experience while working at their computer or using their digital devices. Ask about their current situation to uncover symptoms your patient is experiencing and any other concerns that may be an additional factor. Assessing visual acuity at distance and at near will indicate how your patient’s current vision is affected. During refraction, determine the accurate prescription to correct myopia, hyperopia, astigmatism, and presbyopia. Assess how effectively the eyes focus, move and work together to identify accommodation and vergence weaknesses. In the slit lamp exam, check for signs of dry eye syndrome.

Causes of Digital Eye Strain

During examination, you’ll identify the main causes of the digital eye strain that your patient is experiencing. Oftentimes, multiple causes will be identified that contribute to increased and worsened symptoms.

  • With uncorrected vision problems, overcorrected myopia, and undercorrected hyperopia, astigmatism and presbyopia will contribute to increased eye strain and visual blur.
  • Accommodation insufficiency, infacility, and spasm as well as convergence insufficiency and vergence infacility will contribute to asthenopia.
  • Aqueous deficient and evaporative dry eye will also contribute to visual discomfort with digital eye strain.
  • Glare and blue light also cause an increase in visual discomfort and eye strain.
  • Workplace set-up and environment will also contribute to discomfort while using digital devices. Poor desk setup and distancing, poor sitting posture, and poor lighting and glare are all added factors.

Common Symptoms

These are some of the common symptoms that you will hear your patients mention:

  • Blurry vision
  • Eye strain
  • Double vision
  • Headaches
  • Neck and shoulder pain
  • Dry eyes
  • Burning
  • Redness
  • Eye fatigue

Once digital eye strain is diagnosed along with the identification of the causes and symptoms, you’ll be able to provide the best treatment options.

Treating Digital Eye Strain in Clinic

Prescription Glasses and Contacts

Up-to-date prescriptions that correct for myopia, hyperopia, astigmatism, and presbyopia are important, even when they are minimal. A small amount of blur from undercorrected astigmatism or inadequate presbyopia correction leads to eyestrain. General glasses and contacts may not be adequate for computer use.

Computer-specific glasses with an adjusted prescription may be appropriate for the workplace distance. This will be the case for presbyopia and for accommodation weaknesses like insufficiency. Consider single vision glasses for computer use or workplace progressives and/or bifocals for patients who require a computer and reading prescription. Discuss the workplace distance with your patient to determine the prescription of the computer-specific glasses to ensure they will be suitable.⁣

Focusing Breaks and Exercises

While glasses that address accommodation weaknesses will be helpful, discuss the importance of focusing breaks and exercises with your patients. During the workday, your patient should relax their eyes and take a break for a few minutes every hour. They should also use focusing exercises to help maintain or improve the flexibility of focusing.

Instruct your patient to use the 20-20-20 rule: “Every 20 minutes, look into the far distance (about 20 feet away) for 20 seconds.” ⁣⁣Looking at objects far away in the distance after doing work up close, allows the ocular muscles responsible for focusing to relax thereby reducing fatigue.

Prisms and Vision Therapy

When there is a vergence weakness, consider prescription modifications, prism, or vision therapy. Added low plus prescriptions allow the eyes to relax relieving exophoria and the convergence insufficiency it may cause. Prism can help further align images when there is pronounced vergence insufficiency, excess, and infacility. Some patients will have difficulty using their eyes together as a team with vision correction. Vision therapy in the office or at home may be needed to improve vergences and also accommodation. Vision therapy trains the eyes to work together more effectively to move as a team and to focus.

Anti Glare and Blue Light

Excess glare and increased blue light can be modified with the aid of glasses treatments. Anti-reflective coating decreases the amount of glare and should be prescribed to help reduce glare on devices for more comfortable and clear vision. Blue light blocking glasses help to reduce the amount of blue light reaching the eyes and help alleviate eye strain in many patients. Prescribe blue light blocking glasses for patients that will benefit from it.

Dry Eye Therapy

Eye discomfort and fluctuating vision from dry eye syndrome can only make digital eye strain worsen. Patients may have dry eye syndrome that is independent of, increased with, or due to digital device use.

Aqueous dry eye symptoms contribute to discomfort and increased symptoms. Patients should be compliant with their specific therapies for dry eyes.

Evaporative dry eye may arise from computer use due to incomplete and infrequent blinking. When staring at a screen, blinking rates are reduced by 66% and blinking is often incomplete. With less blinking, tears are not distributed evenly over the ocular surface. Instruct patients to be cognizant of blinking by taking complete and regular blinks. Every 20 minutes after looking at the distance, patients should complete this blinking exercise: Close your eyes completely for 2 seconds and open, then squeeze your eyes closed for 2 seconds and open.

Patients should maintain good eyelid hygiene with regular daily cleansing. During the day, patients should also stay hydrated by drinking water and may use preservative-free artificial tears for lubrication.

Workplace Set-up and Environment

Talk with your patient about the best way to improve their workplace setup for optimal comfort.

Patients should choose a comfortable cushioned chair with armrests positioned at a desk with legroom. When seated, the top of your patient’s computer screen should be at or just below eye level and the monitor should be arm’s length away. Additional work material can be placed on a document holder so that the head does not have to be repositioned so much.

Go over monitor display, brightness, and lighting options for optimal comfort. Screen brightness should match the brightness in the room. Neither should be much more bright or dim than the other. The amount of blue light can also be reduced and modified via monitor screen settings for optimal comfort.

Conclusion

Using screens and digital devices has become much more common. With prolonged device usage, related symptoms arise affecting how well an individual can work or function on a daily basis. Addressing your patients’ concerns and symptoms and identifying the causes of their particular digital eye strain will allow you to provide patient-specific care and treatment that is effective.

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About Fatima Ibrahim, OD

Fatima Ibrahim is a Doctor of Optometry and content creator. She is passionate about eye care and helping her patients see clearly and maintain their ocular health. Fatima grew up in Chicago and received her Doctorate from the Illinois College …

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