By Alan G. Kabat, OD, FAAO
According to The Vision Council, approximately 80 percent of American adults report using digital devices for more than two hours per day, with nearly 67 percent using two or more devices simultaneously.1 It’s no wonder that more than half of adults today experience symptoms of digital eye strain, and young people are equally susceptible.1,2 The American Optometric Association lists the most common symptoms of this syndrome as follows: eye strain (32.4 percent); dry eyes (27.2 percent); headaches (27.7 percent); blurred vision (27.9 percent); and associated neck and shoulder pain (35 percent).3 While these symptoms are often transient, digital eye strain can cause significant, frequent discomfort for sufferers and may even have economic consequences for vocational computer users in the form of calculation errors or the need for frequent work breaks.4
Although the public may view them as innocuous and vital tools for life in 2019, digital devices may have multiple negative effects on the eye and visual system. Accommodation and vergence are the first potential casualties. Smart phones, tablets and computer screens can place excessive demands on these systems, leading to blur, visual discomfort, and even double vision.5,6 The blink mechanism is also impacted by the use of digital devices, typically reducing both the frequency and completeness of eyelid closure.2,5 A five-fold reduction in blink rate has been documented in association with computer use, and this can contribute directly to signs and symptoms of evaporative dry eye.7 Another common response to digital devices is squinting, which may be an unconscious attempt to improve visual acuity, diminish glare, or increase concentration.5 Unfortunately, this response increases tone in the orbicularis oculi, frontalis and procerus muscles, and when excessive can result in eye pain or headache. Other issues associated with digital eye strain include reduced contact lens wear or tolerance, hyperemia, and even potentially harmful exposure of the retina to blue light.2
Optometrists are uniquely positioned to detect and address digital eye strain by probing patients’ device habits and history, and proactively searching for uncorrected refractive error, binocular and accommodative issues, dry eye disease and other related sequelae. Raising patients’ awareness to the potential impact of digital devices can be accomplished through newsletters, websites, and social media. A simple, comprehensive eye examination can help to shed light on the problems patients experience both in and out of the office, and may alleviate the litany of symptoms described previously.
Additionally, eye doctors can provide practical advice for combating digital eye strain. Several of these tips are listed below:
• Address glare. Glare is defined as excess, unfocused light entering the eye from external sources. In association with digital devices, the source of glare can be an uncovered window, bright overhead fluorescent tubes, or other nearby sources of light such as TVs or lamps. Patients should be advised to reduce glare whenever possible and to adjust their settings to minimize excessive brightness, maximize text size and contrast, and modify color temperature to avoid high levels of blue light.
• Make a conscious effort to blink. While it sounds strange, patients need to be reminded of the need to blink regularly and completely while engaged in digital activities. Blinking exercises have been advocated since the 1970s to help contact lens wearers and can be equally beneficial for patients with digital eye strain and evaporative dry eye. This video displays the proper technique.
• 20-20-20. Accommodative and convergence fatigue can be remedied by taking regular breaks from the digital device and allowing the eyes to relax. The American Optometric Association reminds practitioners to advocate the 20-20-20 rule: take a 20 second break from the screen every 20 minutes and focus on something at least 20 feet away.8 The patient can also be advised to stand up and stretch their arms, legs, back, and neck during these breaks to reduce tension and muscle fatigue.
• Lubricate. Evaporative dry eye is a common issue for digital device users because of diminished blinking and the high incidence of meibomian gland dysfunction. The use of good quality ophthalmic lubricants, particularly those with lipid-restorative capabilities, can be helpful in alleviating symptoms of burning and irritation while engaging with the computer or tablet.9
• Consider computer eyewear. For individuals who use computers and/or tablets more than four hours daily on a regular basis, a designated pair of computer spectacles may be very beneficial, particularly for the presbyopic patient. A larger intermediate viewing area in a progressive or flat-top bifocal can provide greater clarity and functionality. Anti-reflective coatings and mild, neutral tints can help to reduce glare and reflections, preventing visual discomfort and even some of the harmful blue light emitted by these devices.10
While digital eye strain is an exceedingly common problem in America today, there is much that can be done to identify and manage this pervasive condition. And it all begins with a comprehensive examination at the hands of a primary eye care provider.
Dr. Alan Kabat is a credentialed provider for and Optometric Consultant to National Vision Administrators, L.L.C (NVA). He practices at The Eye Institute in Philadelphia and is affiliated with Pennsylvania College of Optometry at Salus University.
1. The Vision Council. Digital Eye Strain. Thevisioncouncil.org 2019. Available at: https://www.thevisioncouncil.org/content/digital-eye-strain [Accessed February 24, 2019].
2. Sheppard AL, Wolffsohn JS. Digital eye strain: prevalence, measurement and amelioration. BMJ Open Ophthalmol. 2018 Apr 16;3(1):e000146.
3. American Optometric Association. Computer vision syndrome. 2017. Available at: https://www.aoa.org/patients-and-public/caring-for-your-vision/protecting-your-vision/computer-vision-syndrome [Accessed February 24, 2019].
4. Daum KM, Clore KA, Simms SS, et al. Productivity associated with visual status of computer users. Optometry. 2004 Jan;75(1):33-47.
5. Coles-Brennan C, Sulley A, Young G. Management of digital eye strain. Clin Exp Optom. 2019 Jan;102(1):18-29.
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7. Patel S, Henderson R, Bradley L, et al. Effect of visual display unit use on blink rate and tear stability. Optom Vis Sci. 1991 Nov;68(11):888-92.
8. American Optometric Association. Infographics. Aoa.org 2019. Available at: https://www.aoa.org/documents/infographics/SYVM2016Infographics.pdf [Accessed February 24, 2019].
9. Jones L, Downie LE, Korb D, et al. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017 Jul;15(3):575-628.
10. Heiting G. 10 Tips for Computer Eye Strain Relief. All About Vision 2019. Available at: https://www.allaboutvision.com/cvs/irritated.htm [Accessed February 24, 2019].