By Suzanne LaKamp, OD, FAAO
June 27, 2018
Patients undoubtedly sit in your reception area with their noses in their phones. Many of them also spend hours in front of a computer at the office, or at school. Just as undoubtedly, digital eye fatigue affects many of them.
More than half of my patients complain about digital eye fatigue. Some reports indicate as many as 70 percent of our patients experience discomfort from electronics. Patients utilize electronics for school, work, business and leisure time. Screen time is now prevalent with young children, teenagers, baby boomers and the elderly, who all spend part of their day using electronics.
Here’s how to find out which of your patients could benefit from the products you sell to relieve digital eye fatigue.
The Right Questions to Ask–and How to Ask Them
I ask patients questions about how they are seeing, how their eyes feel, and if they are having any difficulties with their vision. Patients experiencing digital eye fatigue will often mention their discomfort after these questions, if not at the beginning of the exam. They may mention a feeling of visual straining, headaches, blurring, eye pain, doubling letters and trouble focusing.
I will then follow-up with questions such as, “How much time do you spend per day on the computer or electronics?” Patients spending all day on the computer have more difficulties than patients who report occasional use, and may require more intervention with glasses or filters for their devices.
Listen & Respond Well to Their Questions
When I tell patients they have digital eye fatigue, they will ask questions such as “Should I get glasses” and “What can I do?”
Depending on lifestyle, amount of usage and refractive error, there are numerous options, I explain. Patients with a prescription can benefit from special light filters on their corrective lenses. For patients without significant refractive error, and mild symptoms, there are still options for computer and digital device glasses, such as those from Gunnar Optiks.
Explain Blue Light
Most patients have never heard of blue light, and those who have, probably don’t understand the difference between helpful and harmful blue light. So, I explain it to them: “The harmful spectrum of blue light, or high-energy visible (HEV), is emitted from screens and electronics, but we are exposed everyday from LEDs, fluorescent bulbs and sunlight, as well. The harmful part of the blue-violet spectrum runs from about 380-450 nm. Light in this spectrum causes oxidative damage, and has potential to damage the retina. Blue-turquoise light, which has health benefits in regulating circadian rhythm, and pupillary function is about 450-500.”
I discuss the effects of electronics on a patient’s health and eye health. I mention “harmful blue light,” which patients are increasingly familiar with.
Have Patients Show You How They Use Their Electronics
I ask patients to show me where they sit at the computer, or where they hold their electronics. Each of the exam rooms has a tape measure, and I measure the working distance. Sometimes patients hold electronics too close or too far away, and the solution can be as simple as changing the working distance. Posture and ergonomics are also an often overlooked, but important, part of digital eye fatigue. Font size can be changed, but making the font too large decreases readability.
Have a Go-To Mix of Digital Eye Fatigue-Relieving Products
There are prescription lenses and plano lenses, which can reduce digital eye fatigue and HEV. Gunnar Optiks are a popular choice among my patients who work or spend long hours on the computer, such as computer programmers or gamers. Patients who have severe strain, and like the convenience of online glasses, usually buy online before their consultations in office. I discuss prescription options with them to if warranted.
To reclaim optical sales from online retailers, practitioners can carry BluTech glasses. Transitions Signature, Vantage and XTRActive lenses also filter harmful blue light. In addition, there is the VSP TechShield Blue AR treatment, which reduces blue light. Essilor has Eyezen+ Lenses and the Smart Blue Filter, and Crizal Prevencia No-Glare lenses.
My current practice, a shared OD-MD partnership focused on refractive surgery, does not have an optical. I refer patients to practices where they can get nice-looking frames and good quality lenses. I also send patients to practices with great customer service and plenty of experience with optical. I want patients to protect their eyes, and feel that they will get healthier lenses for their eyes at a local optical than they will online.
You Might Connect Digital Eye Fatigue to Case of Dry Eye
We do not utilize any special instrumentation to measure digital eye fatigue. However, we can capture blink rate and lid closure using the LipiView II in office. We use the imaging for all patients, and will take additional imaging for our patients in the dry eye clinic, as well, following treatments.
There is a link between digital eye fatigue from prolonged screen time and dry eye. I remind all patients about complete blinks, as well as discuss daily lid hygiene due to the ocular stress from digital fatigue. Screen time reduces the overall blink rate so significantly that we are seeing damage to the meibomian glands.
We discuss the 20-20-20 rule in office, or I will simply remind patients to take breaks from prolonged screen time. Warm compresses using a Bruder masks, lid scrubs and omega 3 supplementation are commonplace recommendations for our practice. I would estimate that at least half of my patients with digital eye fatigue also have dry eye.
Presbyopia & Digital Eye Fatigue Sometimes Go Hand-in-Hand
Digital eye fatigue can be a sign of beginning presbyopia. Difficulty focusing at near, especially for lengthy periods of time, becomes increasing difficult for patients, usually starting in their forties. For true presbyopia, this will also be in settings or times outside of screen use. Menus, books and labels are also usually harder to read. Screen fatigue is one of the more common symptoms for presbyopia in my patients.
However, I also see younger patients, who are experiencing digital eye fatigue, which makes near work challenging. Young patients, particularly students, have increased difficulty due to a greater near work demand and screen time. Some of my colleagues in their thirties started wearing low-powered adds in their glasses or contacts during optometry school.