Attitudes of optometrists in the UK and Ireland to Digital Eye Strain and approaches to assessment and management

Digital eye strain and clinical correlates in older adults

PURPOSE

To evaluate the screen time habits, associated symptoms and clinical characteristics of an older population (60 years and older) drawn from primary care optometry.

METHODS

Consecutive patients aged 60 years and older, who used a digital device for at least 1 hour per day, attending for an eye examination at a primary care optometric practice in Dublin, Ireland, were invited to participate. The study gathered information regarding the participant's use of digital devices, the types of devices used and duration of use. Best corrected distance acuity and near vision adequacy for reading and device use was recorded.

RESULTS

401 responses were included in the analysis. Based on a Computer Vision Syndrome Questionnaire (CVS-Q) score ≥6, the occurrence of DES in this population was high at 51.6 % with females having a higher median score than males. The mean number of hours devices were used for was 4 hours. 71 % of participants reported symptoms of digital eye strain (DES) when using digital devices. Smart phones were the device type used most by participants but tablets were the device type used for the longest duration. Single vision spectacles were the most commonly used method of visual correction when using digital devices. Participants with better levels of acuity used devices for longer periods than those with poorer acuity.

CONCLUSION

This study provides a valuable insight into the screen habits and likelihood of symptoms of DES in an older population and, is to date, the first of its kind. It shows that the prevalence of DES in older age adult device users is high, at 51.6 %, with a clear link between dry eye and symptoms of DES. Its results will enable optometrists to provide specific advice to this age group on how best to reduce symptoms of DES.

Digital eye strain syndrome among higher education health sciences students in Saudi Arabia: severity and preventive ergonomic practices

Background

The increased utilization of digital screens is an unavoidable consequence of the technology era. Digital eye strain (DES) is a prevalent health problem among higher education students in Saudi Arabia, especially health sciences students due to the frequent use of digital sources and virtual classes. Thus, this study aimed to assess the severity of digital eye strain syndrome (DESS) symptoms and preventive ergonomic practices among higher education health science students in Saudi Arabia.

Methods

A cross-sectional study using multistage cluster sampling in three cities (Dammam, Riyadh, Jeddah) in Saudi Arabia. A convenient sample of 328 health science students was selected using an equal allocation technique. The researchers designed and used an online survey of three sections: personal and digital device use-related data, the DESS questionnaire, and the self-reported preventive ergonomic practices scale.

Results

DESS is a widespread problem among 72.0% of health science students, and 58.2% had unsatisfactory ergonomics. The frequently reported symptoms were blurred vision (32.9%) and increased sensitivity to light (33.5%). The severe eye-related symptoms were headache (45.85%), foreign body inside the eye (43.71%), eye burning (40.19%), and dryness (39.76%). Logistic regression analysis revealed that the female sex, years of screen utilization and the number of hours per day, screen use without rest, and frequency of virtual classes per week, eye disease, digital screen utilization for studying, nonuse of protective eye measures, and using numerous digital devices were significant predictors of DESS risk (P < 0.05).

Conclusions

DESS is a common problem among many health science students, with headaches and foreign body sensations in the eye being the most frequent symptoms. Screen utilization time and eye disease are significant predictors of DESS, while most items' application of ergonomic practices was low. Educational programs are needed to increase student's awareness of ergonomic practices.

Digital eye strain and its impact on working adults in the UK and Ireland

CLINICAL RELEVANCE

Digital eye strain (DES) is a condition encompassing visual and ocular symptoms that may arise due to the prolonged use of digital devices. The 2023 Tear Film Ocular Surface Lifestyle report defined DESas"the development or exacerbation of recurrent ocular symptoms and / or signs related specifically to digital device screen viewing". Studies vary as to the prevalence of DES with some reporting values as low as 10 % and some reporting values over 90 %, however no study has examined the prevalence of DES in the UK or Ireland (UK&I).

PURPOSE

To determine the prevalence of DES amongst adults who work with digital devices in UK&I, their symptoms and ameliorative approaches taken by those affected.

METHODS

A web-based survey of digital device users was conducted. Adults who used a device for at least 1 h per day for work purposes were eligible to participate. The questionnaire was designed to determine the prevalence of DES, daily device usage, musculoskeletal and ocular symptoms, how they manage their symptoms and eye care history.

RESULTS

Based on a Computer Vision Syndrome Questionnaire score ≥ 6, the occurrence of DES was high at 62.6 %. The mean number of hours devices were used for was 9.7 h. Musculoskeletal symptoms were reported by 94.3 % of users and ocular symptoms by 89.5 % with symptoms most likely to occur with those working from home. 8.1 % of respondents considered their symptoms significant enough to affect their work.

CONCLUSION

This study provides a valuable insight into DES in digital device users in UK&I and is the first of its kind to be completed. It shows, that while the level of DES is high in device users, at 62.6 %, the actual effect or consequences of it on many does not appear to be significant.

Knowledge, perception and practice towards blue-blocking lenses among optometrists

CLINICAL RELEVANCE

There is a lack of clinical guidelines in India for the prescription of blue-blocking lenses. Therefore, the practice trends will depend on practitioners' knowledge, attitude, and perception.

BACKGROUND

Exposure to blue light with increased use of light-emitting diode (LED) lights and digital devices along with the commercial availability of blue blocking lenses has warranted the need to understand the factors that influence the prescription of blue blocking lenses among eye care practitioners. Hence, we aim to assess knowledge, perception, and practice pattern of blue blocking lenses among Indian optometrists.

METHODS

This cross-sectional online survey was conducted among Indian Optometrists. The survey was distributed through various social groups of optometrists and state associations. The questionnaire had four main domains with 29 items in total. The four major domains were knowledge, practice, perception and demographic details on education. Descriptive analysis and logistic regression were performed to study the impact of these domains on the prescription of blue block lenses.

RESULTS

Out of 341 responses, 247 were included for analysis as per study criteria. About 50% (n = 123) of the participants had appropriate knowledge about blue light. Blue-blocking lenses were prescribed always or most of the time by 52% (n = 130) of the participants. The odds of prescribing blue blocking lenses were higher among practitioners who considered blue light as an important factor in causing computer vision syndrome (OR 3.77, 95% CI: 1.33-10.69, P = 0.01) or if they considered there is adequate published evidence (OR 3.95, 95% CI: 1.58-9.87, P = 0.003).

CONCLUSIONS

The source of evidence for prescribing blue-blocking lenses for our participants was mainly from advertisements rather than from scientific studies. Factors such as awareness, knowledge, education, and nature of practice did not play a significant role in prescribing blue-blocking lenses. This raises the need for evidence-based practice and the development of practice guidelines for prescribing blue-blocking lenses.

2022 Glenn A. Fry Award lecture: Enhancing clinical assessment for improved ophthalmic management

ABSTRACT

Detailed clinical assessment is critical to allow sensitive evaluation of the eye and its management. As technology advances, these assessment techniques can be adapted and refined to improve the detection of pathological changes of ocular tissue and their impact on visual function. Enhancements in optical medical devices including spectacle, contact, and intraocular lenses have allowed for a better understanding of the mechanism and amelioration of presbyopia and myopia control. Advancements in imaging technology have enabled improved quantification of the tear film and ocular surface, informing diagnosis and treatment strategies. Miniaturized electronics, large processing power, and in-built sensors in smartphones and tablets capacitate more portable assessment tools for clinicians, facilitate self-monitoring and treatment compliance, and aid communication with patients. This article gives an overview of how technology has been used in many areas of eye care to improve assessments and treatment and provides a snapshot of some of my studies validating and using technology to inform better evidence-based patient management.

Spotlight on Digital Eye Strain

Digital Eye Strain (DES) is a clinical syndrome manifested with visual disturbances and/or ophthalmic dysfunction related to the usage of screen-enabled digital equipment. This term is gradually replacing the older term computer vision syndrome (CVS) that focused on the same symptoms found on personal computer users. DES is encountered more frequently during the past years due to the explosive increase in the usage of digital devices and subsequent increase in time in front of any screens. It presents with a series of atypical symptoms and signs stemming from asthenopia, dry eye syndrome, preexisting untreated vision issues and poor screen ergonomics. This review summarizes research data to date to determine whether the concept of DES has been conclusively defined and demarcated as a separate entity and if sufficient guidance is offered on professionals and the lay public. The maturity of the field, grouping of symptoms, examination techniques, treatment and prevention modalities are summarily presented.

Digital Eye Strain- A Comprehensive Review

Digital eye strain (DES) is an entity encompassing visual and ocular symptoms arising due to the prolonged use of digital electronic devices. It is characterized by dry eyes, itching, foreign body sensation, watering, blurring of vision, and headache. Non-ocular symptoms associated with eye strain include stiff neck, general fatigue, headache, and backache. A variable prevalence ranging from 5 to 65% has been reported in the pre-COVID-19 era. With lockdown restrictions during the pandemic, outdoor activities were restricted for all age groups, and digital learning became the norm for almost 2 years. While the DES prevalence amongst children alone rose to 50-60%, the symptoms expanded to include recent onset esotropia and vergence abnormalities as part of the DES spectrum. New-onset myopia and increased progression of existing myopia became one of the most significant ocular health complications. Management options for DES include following correct ergonomics like reducing average daily screen time, frequent blinking, improving lighting, minimizing glare, taking regular breaks from the screen, changing focus to distance object intermittently, and following the 20-20-20 rule to reduce eye strain. Innovations in this field include high-resolution screens, inbuilt antireflective coating, matte-finished glass, edge-to-edge displays, and image smoothening graphic effects. Further explorations should focus on recommendations for digital screen optimization, novel spectacle lens technologies, and inbuilt filters to optimize visual comfort. A paradigm shift is required in our understanding of looking at DES from an etiological perspective, so that customized solutions can be explored accordingly. The aim of this review article is to understand the pathophysiology of varied manifestations, predisposing risk factors, varied management options, along with changing patterns of DES prevalence post COVID-19.