By Brian Chou, OD, FAAO
August 3, 2016
Many of our offices sell lenses that are said to relieve “digital eye fatigue,” but the most significant aspect of digital fatigue may extend well beyond our patients’ eyes, requiring a lifestyle change.
For all the amazing things that smartphones do for us, they have also wrought upon society many ills, ranging from distracted driving, cyber-bullying, avoiding face-to-face conversations, to the general lack of common courtesy. We dislike when our friends talk to us while they simultaneously use their phone, a behavior now with its own name, “phubbing,”1 or when we are tagged in photos on social media sites without permission, and when strangers in our airspace talk too loudly into their phone. Smartphones are a paradox, because for as much as they make us feel connected, they also disrupt real interaction. They make us feel liberated, yet they also enslave our attention. They make us feel together, yet also so alone.
Increasingly, our use of digital devices is moving from habit to addiction. Young kids in art class draw their mom and dad with phones clutched in their hands, as if a bodily appendage, for that’s what they observe. High school students walk to their next class with their heads down at their phones, using the hallway wall and their peripheral vision to guide them so that they don’t have to look up. The fact that organizers at weddings and funerals must tell guests to put away their digital devices speaks to how unconsciously we reach for them.
To clarify, it’s not the digital devices, per se, that addict us. Rather it’s the texts, e-mails, social media updates and games that do.2 The statistics are sobering: Fifty percent of teens and 27 percent of parents say that they feel addicted to their mobile devices.3 True to form, the average American checks their phone 46 times a day, with 18-24-year-olds leading the way checking their phone 74 times a day on average, according to a study performed by Deloitte.4 While most of the texts and Facebook updates we get are inconsequential, similar to how most of our incoming e-mail is junk, every so often we get a nugget of goodness that gives our brain a hit of “feel good” dopamine. This is not too different from playing a slot machine where the majority of spins lose, but periodically you win. Variable reward gets people hooked.5 Just like with drug or gambling addiction, smartphone addicts develop obsessive thoughts and engage in the activity without control, deny the problem, experience withdrawal symptoms, and are more prone to depression.
It’s no wonder that 71 percent of Americans sleep with their cell phone.6 In anticipation of an incoming message, there is such a thing as “phantom vibration syndrome,” or the perceived vibration from a device that is not really vibrating. A study of 290 college students found that 89 percent reported “phantom vibration syndrome.7 The constant digital interaction is what arguably leads to “continuous partial attention,” a term coined to describe the state of paying attention to numerous sources of incoming information simultaneously, but superficially. Alas, we’ve become a nation of digital zombies.
Pent-up Desire to Blame Digital Devices
The news media relishes stories about pedestrians falling off cliffs while texting, car crashes related to Pokémon Go, and moviegoers enacting their own justice over patrons who talk on their phones during the movie. It’s not a stretch to understand why our patients blame digital devices for so much and want to believe they cause eye disorders. I know that I’m not the only clinician who has patients requesting that I tell their child that too much screen time will ruin their eyes.
The reality is that there is no compelling evidence supporting the notion that digital devices cause eye disease. Moreover, there is also a lack of science linking digital device use with changes in refractive error. This is similar to how many patients hold a personal belief that wearing glasses or reading in the dark will ruin eyes, despite lack of evidence-based support for these notions.
Still, the strong desire by consumers to blame digital devices and implicate them in causing eye disorders has led to industry efforts to promote terminology like “digital eye strain” and “digital eye fatigue,” terms more befitting of pseudoscience than belonging in the ICD-10 medical classification. In so doing, our vision-correction industry cultivates consumer demand for a bevy of products targeted to digital users, including ophthalmic and contact lenses with low add powers for non-presbyopes, even without accommodative disorders, and blue light protection.
Do prescribing low-adds and blue light protection truly help smartphone users? The science is still catching up. There are powerful industry forces at work, and the truth has not come out fully. For example, most eyecare practitioners seem to mistakenly believe that digital devices are the predominant source of blue light. In actuality, the sun is a much more intense source of blue light than digital devices, by a factor of at least 100 times. With only about 10 percent of our patients purchasing prescriptive sunglasses from practices, it would be a travesty to promote blue light protection ahead of UV protection. A better approach, I believe, is to promote sun protection, bundling the known benefits of UV protection with the value-added benefit of protecting against blue light, whether or not the latter proves desirable.
I submit that as responsible clinicians, we should not take advantage of our patients’ frustrations with the negative social aspects related to smartphones and leverage these emotions to sell eyewear. It takes sufficient evidence to label digital devices as ruinous to eyes. The underlying dynamics are far more complex and can’t be reduced to simply using prescriptive eyewear to achieve a complete digital detoxification.
Sure, protecting eyes against blue light, and providing a low add power, may offer ocular benefits, but the collateral interference with social interactions is a much larger problem. Given how pervasively smartphones integrate with our lives, a sensible approach is to first accept that their use is here to stay, while conceding that the greater social ramifications of widespread smartphone use is beyond our scope of care.
How do you discuss digital device use with patients? Do you believe there is such a thing as “digital eye fatigue” or “computer vision syndrome?” What is the best approach, if any, for ODs to take in helping patients better manage their digital device use?
- www.stopphubbing.com accessed 7/24/16
- Roberts JA, Yaya LHP, Manolis C. The invisible addiction: cell-phone activities and addiction among male and female college students. J Behav Addict. 2014 Dec; 3(4):254-265.
- Anselme P, Robinson MJF. What motivates gambling behavior? Insight into dopamine’s role. Front Behav Neurosci. 2013; 7:182.
- Drouin M, Kaiser DH, Miller D. Phantom vibration in young adults: prevalence and underlying psychological characteristics. Computers in Human Behavior. 2012: vol 28: 1490-1496.