The ‘eyes’ have had it

Whether you call it computer vision syndrome or digital eyestrain, a cyber disorder is wreaking havoc on our eyes.

From the pages of In Business magazine.

Nate Harkins, a doctor of optometry, knows there is no escaping the use of computers, especially for many professionals. In his Davis Duehr Dean office, Harkins sees patients who complain of eyestrain or headaches or neck pain but have no idea the source of their misery is the computer screen they’ve been staring into for hours. The multitude of symptoms caused by a condition alternately known as computer vision syndrome or digital eyestrain affects tens of millions of people, and there is really no way to escape it, just alleviate it.

“This digital age, this 21st century has kind of snuck up on us and everything we do [at work] is on electronic media now, and then we go home and we use the same things,” notes Harkins. “There is really not a break from it, ever.”

Anyone who uses computers at work, and increasingly for entertainment, is basically in the at-risk population. Globally an estimated 45 to 70 million people from a variety of professions spend multiple hours each day peering into a computer screen, and some of the health impacts are finally being evaluated. That does not include millions of children who have been born and raised in the digital age who also are staring at the blurred edges of electronic characters, which make it more difficult for the eyes to maintain focus.

“It’s thought that as much as 70% of the population uses a digital device for at least two to three hours a day,” notes Dr. Michael Shapiro, a board certified ophthalmologist affiliated with UnityPoint Health–Meriter. “I can tell you that in my patient population, it’s rare that a patient doesn’t come in telling me they use their computers or smartphones or laptops and their eyes get tired or they have another one of these constellation of symptoms we can talk about, and they can get those from staring at these devices.”

More evidence comes from the Vision Council, which represents the optical industry’s manufacturers and suppliers and says that 65% of Americans report experiencing symptoms of digital eyestrain.

A research paper on the topic was published in a recent edition of Medical Practice and Reviews and the report’s authors, eye care specialists Tope Raymond Akinbinu of Nigeria and Y. J. Mashalla of Botswana, cited four studies that claim the use of a computer for as little as three hours a day will likely result in symptoms related to the condition. Common symptoms include eyestrain, burning eyes, dry and itching eyes, tired eyes, problems with focusing, and blurred or double vision.

Some of these conditions already exist in patients, especially dry eyes, and excessive time in front of a computer screen can make them even worse. “The most common complaint is eyestrain,” notes Amy Walker, a licensed doctor of optometry who is affiliated with UW Health Clinics’ Eye Care Services and the UW School of Medicine and Public Health’s Department of Ophthalmology and Visual Sciences. “By the end of the day, they’ve had it. They are fatigued.”

Prolonged computer use can take us beyond vision-related complaints and into symptoms such as chronic headaches, neck and shoulder pain, and low back pain, some of which stems from an improper viewing distance from the eye to a computer screen.

Any computing device can cause computer vision syndrome, and not just personal computers, laptops, or tablets — the devices with larger screens. Smartphones are culprits, too.

In addition, the condition impacts people across a range of age groups if they spend enough time in front of computer screens (including video games), but the over-40 population is more impacted because they are already experiencing presbyopia, the gradual loss of focusing power in the eyes.

Not surprisingly, research has found that people who wear eyeglasses and contact lenses are particularly susceptible. Here then are seven coping mechanisms to mitigate the impacts of this vision villain.

#1: Follow the 20-20-20 rule

Aging professionals might never again have 20-20 vision, but by following the 20-20-20 rule they can alleviate the symptoms. The rule, which ophthalmologists embrace, is very simple: every 20 minutes take a 20-second break and look at something 20 feet away. The rule can be obeyed by scheduling prompts in your calendaring system.

“I usually tell patients to look out a window every 15 or 20 minutes,” Shapiro says.

#2 Tear up now and then

We don’t mean have a good cry, we mean use artificial tear products. If you have dry eyes, ophthalmologists recommend keeping your eyes moist with artificial tears, which can be purchased over the counter. Unlike commercial eye drops, artificial tear brands like Refresh, Sustain, and Tears Natural do not contain chemicals that when overused can cause irritation.

Walker encourages many of her contact lens and spectacle wearers to have a bottle of artificial tears on their desk. After a couple of hours, they should sit back in their chair and lubricate their eyes with it. “Then close your eyes for a whole minute, let it really absorb into your tissue, and don’t just start up again,” she advises. “I encourage my patients to do this several times a day.”

Harkins’ take is a bit different. “The artificial tears thing is sort of a tough one because they can be really helpful if you know that your problem is that your eyes are drying out because you’re staring at the computer,” he states. “To replenish that moisture is of course an excellent thing, no different than drinking water after you go for a run.”

The tough part, he adds, is when someone is dumping commercial drops in their eyes 15 or 20 times a day. If used too often, the preservatives that keep these drops in good condition also are known to be irritating to the eye’s surface. He tells patients not to use the regular eye drops more than four times a day. “For my patients who need to use them more often than that, we have them use preservative-free artificial tears that come in individual vials,” he notes. “Those can be really helpful.”

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#3: Keep your distance

Substandard ergonomics also contribute to the problem, and the distance of the video display terminal to the eyes is considered to be an important risk factor. For the purpose of focusing the eyes, the optimal distance from your face to the computer screen is 20 to 25 inches (though some recommend 25 to 30 inches).

The position of the eyes should be about four or five inches, or about 20 degrees above the computer screen, which is a more normal viewing position for your eyes and one that helps ensure your neck muscles won’t get as tight. Shapiro likened computer-related eyestrain to carpel tunnel in that it’s related to your posture and the position of the computer screen. “What happens is people will say, ‘Oh, I’ll just put on my reading glasses to use the computer,’ but those glasses for reading are set at a reading distance, which is usually 14 to 16 inches,” he explains. “A computer is usually 20 to 24 inches away so it’s a whole different lens distance that you need to have your vision corrected at.”

A multifocal spectacle, especially for people over 40, can help ensure people are not tilting their head backward to see print. “In other words, you have to have this healthy posture like you’re almost sitting and reading a book,” Walker notes. “You have to have your head in a downward position, and that is the most comfortable position for the eyes and the neck. A lot of times people with bifocal products on will tilt their head back and that [pertains to] this whole musculoskeletal involvement. They become fatigued not just from vision problems but because of stress on their neck and shoulders.”

Harkins agrees that the screen should be just a little bit lower than eye level. “People do better when they see just a few degrees down from straight ahead,” he states. “When you experiment with that in the office, you’ll notice that when your eyes are just tilted down a little bit you feel much more comfortable.”

Part of the solution has to do with how the light enters the eye at a right angle because you don’t want direct light shining straight at your eyes. “You’re kind of looking down toward it,” Harkins notes. “It helps with some of the glare, too, because the glare exists off the computer screen even if you can’t see it. If you turn your computer screen off and you have the black screen up and you see glare on the screen, even when you turn the monitor back on that glare is still reflecting back at you.”

Katie Reiels, program manager for the Wellness Council of Wisconsin, says employers should assess each employee’s ergonomic situation, whether by survey or by audit, on an annual basis. Employers should investigate worker’s distance away from their workstations, whether they have a problem with the computer, and their posture. “You want that 90-degree angle where your feet are on the floor, where your wrist is on the computer desk, and where you are not straining your neck forward,” she notes. “If an assessment finds a problem within an organization, most wellness programs that assess their employee population will implement some sort of strategy to positively influence that.”

Tailored assessments, she adds, can prevent an organization from going along with trends, proven or unproven, and zero in on each worker’s legitimate needs.

#4: Blink more often

Working in front of a computer is thought to reduce the frequency of blinking, which can contribute to dry, irritable eyes. To replenish some of the moisture lost through staring, make a conscious effort to blink more often, even if it means putting a Post-it note somewhere on your computer to serve as a reminder.

“The tears that coat the surface of your eyes are only designed to last 12 to 15 seconds until they start to evaporate,” Harkins explains. “When we stare at a computer screen, we aren’t even blinking 30 times a minute normally. You’re getting this evaporation, this cumulative affect of this loss of moisture in the eye, and it not only causes blurring but it also causes the discomfort and burning that people experience at the computer.”

#5: Get an annual eye exam

To have their eyeglass or contact lens prescription up to date, younger and healthier consumers are advised to have their eyes examined every one to two years, but people over 40 who suffer from computer vision issues are advised to have an annual eye exam. Vision can deteriorate with age, and digital eyestrain can accelerate the decline.

“The thing I tell patients is first of all you need an eye exam to correct any other underlying eye conditions if you are nearsighted, farsighted, or have an astigmatism — the normal stuff because that has to be corrected first,” notes Shapiro.

Walker notes that computers and hand-held devices emit blue wavelengths, and it is suspected the blue wavelengths cause glare and eyestrain. In addition, the pixels in print can, depending on the quality of a device, appear blurry. “So you are straining to see blurry, poor-quality print and putting you in glasses may improve the quality of the image,” Walker says. “The industry is suggesting that lenses with blue wavelength filters comfort the eyes. It’s not just the anti-reflective coatings that you can put on your spectacle lenses, but you can put a coating on that also cuts the blue wavelengths.”

Harkins believes annual exams are important for anybody who has any of the risk factors for vision loss, including family history. “It does not mean you have a specific problem, but if you have a family history of glaucoma, an annual exam just gives us more baseline data points where we can notice a change,” he says. “If you are seen annually we might notice a change happen over three years, whereas biannually you would see it over six. The sooner you find those problems, the better off patients tend to be.”

#6: Try computer glasses

After having their eyes tested and having any refractive errors taken care of, patients can consider the required distance for having a separate pair of computer glasses, which are very different than reading glasses in that they are set at different distances. One lens will not satisfy both needs. If you are over 40 and you are presbyopic, or losing focus in the eyes, there is a power to set that computer distance in focus. “Say I’m sitting at my desk and my desktop is actually closer to 30 inches away,” Shapiro says. “I’d want to have that distance measured and then set the computer glasses for that particular distance.”

On those glasses you might want to add an anti-reflective coating to reduce the glare from the computer screen. On the screen itself, especially on older computers, you might consider adding a glare filter.

#7: Lighten the light

Sometimes the last thing you want to do is have big, overhead fluorescent lights shining down on your computer screen. If you can control room lighting and computer-screen glare, you can mitigate eyestrain. The trouble is, in this age of energy consciousness, the more efficient fluorescent lights are not going anywhere.

To fight the glare, find a spot in your office that minimizes the way overhead fluorescent lights reflect off your computer screen. Change the angle of where you sit in relation to overhead lights, and alter the brightness factory setting on your computer monitor so that it doesn’t seem like you’re staring into the sun. “It’s about finding a good balance because if the brightness is set too low you’ll be straining to see the types and images,” Harkins notes. “If you can get it a little bit lower than its factory setting, if that seems to help how your eyes feel, there is an experimentation that does really help.”

The balance to see clearly

One of the most important things you can do for your eyes and your overall health is to get balance in your life starting at a young age. “You need heart healthy activity, as well as sitting at a computer station all day,” Walker states. “One of the questions parents ask me all the time is how long should their children be on the computer? Or how much should they be on their hand-held device or their gaming device? That needs to be monitored. I think for every hour they have been on their video game, they need to get outside and play and do a heart healthy activity like run and skip and ride bikes.”

Working parents, in turn, have to provide an example. “They have to show balance in their lives, too,” Walker notes, “but of course we see parents tied to their phones also.”

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COWed into computer glasses

Sometimes the symptoms of digital eyestrain are produced with just a few hours in front of a computer screen, and sometimes the solution is simple. It’s certainly that way for Anne Abraham, a local physical therapist.

Abraham, who spends two or three hours a day working in front of a COW, or computer on wheels, suffered from bad headaches before her optometrist, Dr. Michael Shapiro, recommended she try computer glasses.

Tension headaches can often be caused by the strain of trying to focus on a computer screen, but the computer glasses have made a world of difference. Abraham’s headaches are gone and while she jokes that she still needs to wear more conventional eyeglasses “for nearsightedness and old age,” the computer glasses help her cope with digital images from a set distance.

“Put it this way, I use them for the computer but I do also use them for anything up close, such as when I’m sitting at a table reading or writing,” Abraham says.

She does little else to ward off cyber headaches — no eye drops or artificial tears, for example — although she does pay attention to ergonomic advice. Combatting digital eyestrain is pretty straightforward.

“I just notice that when I wear these glasses, it’s made a significant difference in having headaches or not.”

Shapiro, who is affiliated with UnityPoint Health–Meriter, notes that Abraham uses computer glasses with a lineless bifocal built into the lenses. The top part of a lens is geared right to the distance of the computer, but as users look through the lower part of the lens, documents — which are closer than the computer screen — will come into focus.

“It’s in the form of a bifocal,” Shapiro explains, “but when people talk about bifocals they usually think of distance vision and reading vision. This is a bifocal where we talk about the computer vision and the reading vision.”

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