Photograph by NED MATURA; FRAME: ERNEST HEMINGWAY 4685 from New York Eye

By Catherine Wolinski

Digital Eye Strain (DES) is no rarity these days. According to a 2016 report by The Vision Council, “Eyes Overexposed: the Digital Device Dilemma,” 90 percent of Americans look at digital device screens for two or more hours per day, nearly 60 percent use them five or more hours per day, and 65 percent report experiencing digital eye strain symptoms. That number increases to 75 percent for those who use multiple devices simultaneously, a behavior exhibited by 70 percent of Americans.

The most common complaints patients report that point to digital eye strain are neck, shoulder and back pain (36 percent); eye strain (35 percent); headache (25 percent); blurred vision (25 percent); and dry eyes (24 percent). Some of these symptoms can be alleviated with lifestyle changes, such as sitting an arm’s length from a laptop, holding smartphones 8 to 12 inches from the face and eliminating evening use of devices, which can also affect melatonin levels and sleep cycle.

But what patients can’t necessarily feel—the cumulative effect of high-energy blue light which has been linked to retinal cell damage and which may accelerate long-term vision problems such as age-related macular degeneration (AMD) and cataracts—is what doctors are most concerned about.

20/20 spoke to three optometrists who are helping their patients get screen smart by teaching them about lenses and treatments to alleviate digital eye strain. All three cautioned that as more consumers are becoming aware of computer eyewear and its ability to protect against digital eye strain, staying up to date on the latest technologies and taking initiative to ask patients about their digital lifestyle and potential DES symptoms is increasingly imperative.

EYE TO I-PHONE
Dora Adamopoulos, OD, owner-practitioner of Eye2Eye Optometry Corner in Alexandria, Va., is a proponent of digital eye strain treatment and education. In recent years and months, she has served as a consultant to The Vision Council, helping produce its 2015 digital eye strain report, “Hindsight is 20/20/20: Protect Yourself from Digital Devices,” and she regularly blogs about the topic on her practice website, myeye2eye.com. Adamopoulos tells 20/20 that although digital device use tends to skew the young, doctors should be prepared and proactive about treating symptoms in all age groups.

“We need to remember patients in their 50s and older are also using devices,” says Adamopoulos. And she’s not speculating—according to The Vision Council report, nearly 64 percent of adults in their 50s report digital eye strain symptoms, and 37 percent of adults 60-plus spend five or more hours on digital devices daily. “We’re making sure we are addressing retired folks as well,” she says. “Probing a little bit allows us to give them a lot of options they didn’t know existed.”

These options include single vision, high-fitting bifocal, occupational, progressive and computer progressive lenses, with treatments and filters including anti-reflective coating (to reduce blue light reflection), amber/yellow filters (to minimize harmful blue and violet light emitted from digital devices), and HEV filters and coatings (designed to block out high-energy visible or blue light).

At her practice located in a suburb of Washington, D.C., where many patients are “government workers in dark rooms with bright screens,” Adamopoulos makes computer eyewear as visible to patients as possible. Opticians at the front of the office are equipped with plano computer eyewear displays to demonstrate to patients, and staff members who wear glasses are wearers of blue light reflecting lenses. Her personal eyewear collection includes a blue light filtering pair for use at her desk. “We walk the walk,” she says.

In addition to wearing and displaying blue light reflecting and filtering lenses, Adamopoulos performs in-office demos in the exam lane, where she sits patients down at a desk with a computer to simulate their work environment. While they are seated, she might turn on fluorescent lights or instruct them to take out their tablet or smartphone. “Don’t just tell them, show them,” she says. “It’s almost common sense.”

Adamopoulos also suggests sharing tips outside of appropriate lenswear, such as gradually decreasing screen brightness over the course of the day. One app, Flux—previously available in the App Store for i-Phones and tablets before Apple removed it for contractual reasons—is even designed to do this for the user. According to a blog post by Flux’s developers, their download page was visited 176,000 times in its first 24 hours, and the desktop software was downloaded more than 15 million times, as of November 2015.

“If a major company is doing that, you as the practitioner should be up on it,” Adamopoulos says. “I don’t want patients to see that and say, ‘I didn’t know that,’ or ‘my doctor didn’t tell me that.’”

START ASKING QUESTIONS
In San Jose, Calif., Tommy Lim, OD, owner of Berryessa Optometry, finds that his client base tends to be “up” on technological devices. Located less than three miles from Silicon Valley, Lim says that both prolonged digital device use and awareness of its detriments are common among patients, as is their awareness of computer eyewear.

“Spending all day on the computer is nothing unusual here. Oftentimes, they’ll spend another three hours or so (on their computer) when they get home, whether it’s for work or personal,” Lim says. “They’ve just accepted the fact that your eyes get tired.”

Lim uses patients’ familiarity with digital eye strain symptoms as a starting point to talk prevention and treatment. “Many of them now have seen people with, or at least have heard of, blue blocking lenses,” Lim says. “The message is slowly getting out there. The main (concern) is that doctors have to really grasp this and inform patients about this.”

To determine if patients are experiencing symptoms of digital eye strain, Lim and his staff administer a “pretest” when patients arrive. “Our staff will ask patients how much time they spend on electronic devices and if they notice any eye strain or fatigue,” says Lim. “When they come see me, I probe a little bit deeper.” Questions may include whether patients practice the 20/20/20 rule (every 20 minutes look away from the device screen at something 20 feet away, for 20 seconds), or how their eyes feel at different parts of the day during and after digital device use, during the week versus on weekends. “As we discuss their lifestyle more, it kind of points to the fact that using these electronic devices is probably the cause of the eye strain and fatigue they’re experiencing.”

Lim also extends patient education efforts to Berryessa Optometry’s website and social media pages. “We talk about this in our office, and we talk about this on our Facebook page,” he says. “I’ll post articles I’ve written or use an article from a national source that people can read.”

When it comes to lens selection, Lim prefers the amber/yellow filter treatment “which filters out about 60 to 70 percent of blue light,” he says. However, for those who shy away from the amber tint, he prescribes a lens with an AR coating “which has very minimal color to it and reflects the blue light about 30 percent,” he says. (For a comprehensive guide to blue blocking lenses, see “Solutions for Digit-Eyezed Living.”)

In either case, and with AR treated lenses in particular, emphasizing long-term benefits is essential, Lim says. “It’s like vitamins. You’re not going to notice a sudden change in your life, but by reflecting that light over time, you will benefit. I’m a big believer in that.”

Prescribing Blue Light Lenses: Use Metaphors

A common practice among the ODs we interviewed is explaining lens treatments in a context that patients can understand based on everyday life. Here are some of their metaphorical tips.

"It's like having a pair of running shoes and thinking you can use them for a business meeting or evening out. You can't do that. If a person's mindset is 'everything in one pair,' that's fine as long as we explain to them the features and benefits they won't be getting if they do that." —Tommy Lim, OD

"I consider (computer eyewear) to be like safety glasses. In a factory, you wear safety glasses to protect your eyes, but you wouldn't wear them out with your friends."" —Gary Morgan, OD

"A construction worker needs various tools to do work, like hammers, screwdrivers and saws. For someone who works on an electronic device for long periods of time, this is something they need to get their work accomplished in an efficient way." —Tommy Lim, OD

ON THE SAME WAVELENGTH
At a recent conference for Independent Doctors of Optometric Care (IDOC), Gary Morgan, OD, IDOC network member and practitioner at Eye Tech Eyes in Peoria, Ariz., found digital eye strain to be a common topic of conversation. “It’s never far from anybody’s mind these days,” he says. And he certainly sets an example: Since selling his practice a year and a half ago, he has consulted for various lens companies, as well as a nutriceutical supplement brand, each pertaining to DES prevention and alleviation.

For Morgan, introducing patients to lenses and treatments designed to protect the eyes from high-energy and blue light is more important than selling a brand. This is especially true when comparing lens technology today to what was available as recently as five years ago, he says, when blue light blockers were mainly geared toward sunwear and often presented problems with color perception.

Like Lim, Morgan has seen public awareness of digital eye strain increase in recent years, and he believes mainstream media coverage is bridging a gap between optometrist and patient. “Patients really are becoming more and more educated about this,” Morgan says. “This is here, it’s now, and we really need to learn everything we can about how blue light affects the eyes. You don’t want your patients coming in knowing more than you do.”

When treating patients for digital eye strain, Morgan takes a more scientific approach, using a large printed picture of the eye. Pointing to the poster, he walks patients through the cones of the eye, how each accepts (or does not accept) different wavelengths of light and eventually reaches the conclusion that “the light we can’t process is what is causing digital eye strain,” a concept he finds patients readily accept and understand. Finally, he’ll demonstrate a pair of lenses with the patients, who, he says, “immediately see contrast increase.”

“We know blue light causes chromatic aberration in the eye. We know the main color coming off of (digital) screens is blue. If you diminish that light, it will enhance your contrast and increase your comfort,” Morgan says.

Morgan also sees digital eye strain as an avenue to fuel optometric business growth. He describes digital eye strain as a “practice-building opportunity,” referring in particular to a Vision Council statistic regarding the impact of digital devices on their children, which is becoming a significant concern for many parents. The report states that “70 percent of parents who let their children use devices for three or more hours a day, or who do not set limits, report being very or somewhat concerned about the impact of digital devices on their children’s developing eyes.”

“Isn’t this a perfect opportunity for us to empower parents, discussing blue light protective lenses as a way to protect their children?” Morgan asks.

His question is echoed by Adamopoulos, who has seen the aging of her patient population as an opportunity to inquire about their children, grandchildren and young relatives. “Why not? It’s not only about the patient, it’s about the family,” she says.

“A lot of times, patients have symptoms and don’t realize it’s digital eye strain. Overlooki
ng the fact that some symptoms could be alleviated with computer eyewear would be a disservice to them,” she says.
Indeed, both share Lim’s attitude that optometrists have a responsibility to educate their patients and regard the public’s increasing awareness of digital eye strain as an invitation to inquire about and better treat their symptoms, rather than as a sign that patients will seek treatment themselves.

“Optometry is doing a good job of getting the message out, but I think we need to do an even better job,” says Lim. “As doctors, we need to be up on the latest innovations and developments, and help steer our patients on the right path so that they’re healthy. We all want to be healthy.” ■


Cat Wolinski is a New York-based freelance writer.