Eyeworld

EW CORNEA 43 by Michelle Dalton EyeWorld Contributing Writer Identifying digital eye strain May 2014 With the number of electronic devices people use increasing, the risk for digital eye strain also increases D igital eye strain—the physical discomfort experienced after two or more hours in front of a digital screen—is becom- ing more prevalent as people have a need to be digitally connected to the world almost 24/7. "Certainly, presbyopia is an issue as well as the strain from main- taining a fixed focus for prolonged periods of time," said Uday Devgan, MD, in private practice in Los Ange- les, and chief of ophthalmology, Olive View – UCLA Medical Center. "Also, dry eye can be an issue since there is less blinking when staring at a computer screen versus casually watching TV." The Vision Council (Alexandria, Va.) found in a recent survey of 7,000 Americans that more than a third of adults in the U.S. say they spend between 4 and 6 hours a day using digital computer devices (14% say they spend 10 to 12 hours a day looking at digital screens), and nearly 70% of U.S. adults experience eye strain while on digital devices, including computers, tablets, and smartphones. "I've certainly seen an increase in the number of people who com- plain about eye strain," said Sonia H. Yoo, MD, professor of ophthal- mology, Bascom Palmer Eye Insti- tute, Miami. "Most people today receive their information in some kind of digital form. Regardless of age, if people can read, they're using electronic devices," Dr. Yoo said. It's not necessarily younger pa- tients who are complaining, Dr. Yoo said, but people who were already slightly at risk for eye strain—older patients who were marginally at risk before the advent of digital technol- ogy now have and use smartphones and tablets. "They're more sympto- matic much earlier than the same patient would have been even 5 years ago," she said. According to the Vision Coun- cil, digital eye strain is now "the most common computer-related repetitive strain injury among work- ers, surpassing carpal tunnel syn- drome and tendinitis." The group also adds that many digital devices emit high-energy visible (HEV) or blue light, which may have long- term effects on vision health. Re- search suggests that overexposure to HEV light can damage the retina and increase the likelihood and severity of eye disorders such as age-related macular degeneration and cataracts, the group said. "The HEV/blue light may be an issue if the patient is using a tablet every night in bed while trying to fall asleep. But in most cases, it's not a huge issue," Dr. Devgan said. What may exacerbate the bor- derline dry eye patient's symptoms is a lack of blinking that normally occurs when someone is concentrat- ing on a computer screen, Dr. Yoo said. Reminding yourself to take a break from staring at the screen is helpful, she added. Dr. Devgan said a patient's age and general ocular health also play a role—a 22-year-old who works on a computer 12 hours a day does not have presbyopia and "likely no dry eye issues," so the need for anti-glare spectacles may be overkill, he said. The Vision Council said people with all existing refractive errors, except myopia, have a greater likelihood of developing digital eye strain. The Vision Council's DigitEYEzed: The Daily Impact of Digital Screens on the Eye Health of Americans makes several suggestions on how to potentially eliminate or reduce eye strain. Among them: 1. Viewing distance. Set computer screens about an arm's length away; likewise smartphones and tablets should be kept at a com- fortable distance from a person's eyes and "at an angle just slightly below eye level." 2. Use the 20-20-20 rule. "Every 20 minutes, take a 20-second break and look at something 20 feet away, or even more often," Dr. Yoo said. 3. Limit the amount of overhead and surrounding light that com- petes with the device's screen. (Dr. Yoo notes this may not be possible in office cubicle situations with fluorescent lighting.) 4. Install anti-glare screens on computer monitors, and if necessary, anti-reflective coating on spectacles. 5. Get regular, comprehensive eye exams; eyecare professionals should be asking how much time patients spend in front of their digital devices, and patients should volunteer the information. EW Editors' note: The physicians have no financial interests related to their comments. Contact information Devgan: devgan@gmail.com Yoo: syoo@med.miami.edu The findings of low recurrence rates among medically treated pa- tients may bolster a growing trend toward the use of interferon as a primary agent for squamous cell carcinoma, as identified in recent research. The growing use of a med- ication-only approach is a "signifi- cant change in the pendulum of treatments over the last few years among specialists," Dr. Karp said. Dr. Fraunfelder agreed that oph- thalmologists are moving away from surgical removal of every OSSN lesion. "Topical ocular treatment is acceptable and successful, but this is not true for every patient," Dr. Fraunfelder said. "So much of our clinical decision making is depend- ent upon our training, patient pref- erences, and the size and extent of the lesion or lesions. Also, it may be acceptable to follow treatment suc- cess with serial OCTs, which can show shrinking of the lesion to eventual resolution of the condition after topical ocular treatment." In addition to the shift in recent years to treatment with topical chemotherapy even without biopsy—especially for recurrent disease—is the use of topical chemotherapy to help reduce the size of large lesions, which in turn helps to reduce the size of excisions, said Dr. Mian. The follow-up used by Dr. Mian for patients on medical treatment includes exams every 2 to 4 weeks. After treatment, follow-up exams can increase to every 3 months in the first year, followed by annual visits. EW Reference 1. Nanji AA, Moon CS, Galor A, Sein J, Oellers P, Karp CL. Surgical versus Medical Treatment Changes continued from page 42 of Ocular Surface Squamous Neoplasia: A Comparison of Recurrences and Complica- tions. Ophthalmology. 2014 Jan 8. Editors' note: Drs. Fraunfelder, de Luise, Karp, and Mian have no financial interests related to their comments. Contact information Fraunfelder: ffraunfelder@health.missouri.edu de Luise: eyemusic73@gmail.com Karp: ckarp@med.miami.edu Mian: smian@med.umich.edu

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