Contact Lens Spectrum
Issue link: https://clssupplements.epubxp.com/i/740958
C O N T A C T L E N S S P E C T R U M S P E C I A L E D I T I O N 2 0 1 6 c l s p e c t r u m . c o m 12 DR Y EYE DX AND TX A M B E R GAU M E G I A N N O N I, O D, FA AO THE REALITIES OF DIGITAL EYESTRAIN D igital eyestrain is a very real diagnosis, yet many of our patients don't associate their symptoms of fluctu- ating vision, eye fatigue, dryness, and irritation with their digital device use. Even fewer will link it to head, neck, and back pain. Nearly 30% of adults spend more than half of their waking hours using a digital device, putting them at significant risk for both short- and long-term effects (The Vision Council, 2015). Take the 31-year-old, healthy, male patient I saw yesterday. He spends more than 10 hours each day on a desktop computer, and reports ocular dryness and redness, headaches, and neck pain. He has no systemic or autoimmune conditions and does not take any prescribed or over-the-counter medications. We evaluated him fully for dry eye disease and discovered that he had a highly unstable tear film with asym- metric, elevated osmolarity, a positive InflammaDry test (Rapid Pathogen Screening), lid wiper epitheliopathy, and moderate meibomian gland dis- ease (MGD). Not uncommonly, he blames his contact lenses for his symptoms and doesn't necessarily associate his com- plaints with long hours in front of a computer. If we didn't ask the right questions and look for the clinical signs noted above, we might have gone ahead and changed his contact lens brand as he requested. Would Therefore, it's not surprising that many practitioners are diagnosing MGD in younger patients (Fenga et al, 2008; Hathan et al, 2015). It's quite possible that there could be a link between the decreased blink rate that tends to occur when people chronically "stare" at digital screens and the development of MGD. More research is necessary. As for my patient, he was quite receptive to my recommended treat- ment protocol, which focused on anti-inflammatory control, copious nonpreserved ocular lubrication, and long-term meibomian gland support. However, when I began to discuss ways to specifically target digital eye strain (Table 1), including computer spectacles, his response was surpris- ingly defensive. He stated: "I'm not old. I don't need those things yet." He was more willing to accept that he had an eye disease than an inability to perform a task due to age. Needless to say, we had a much deeper conversa- tion about the issue. Be Proactive Digital eye strain is a real issue af- fecting patients of all ages. Being pro- active and talking about it early — be- fore symptoms occur — can help us take better care of their ocular health and vision. CLS For references, please visit www. clspectrum.com/references and click on document #SE1016. that have solved his problem? Per- haps temporarily. However, changing his lenses wouldn't address the root cause, which could allow the disease to progress as time passed. Current Usage It's no surprise that digital device use is high across all age groups, with teens and young adults spending an average of 6.1 hours daily and nearly 25% of kids spending more than 3 hours each day on devices (The Vision Council, 2015). We also know that MGD is fairly common in those who spend significant time working on video display terminals. Dr. Gaume Giannoni is a clinical associ- ate professor at the University of Houston College of Optometry and is the director of the Dry Eye Center at the University Eye Institute. She also sees patients in a private practice setting. She is a consultant or advi- sor to Alcon and Allergan. 1. Prescribe targeted intermediate vision correction with blue blocking and anti-reflective lenses. 2. Correct even low amounts of astigmatism. 3. Redirect air vents and reduce overhead/ambient lighting. 4. Recommend anti-glare protective screens for monitors. 5. Increase text size and lower computer height to slightly below eye level. 6. Prescribe frequent visual breaks to rest the eyes. 7. Monitor screen time in children and encourage outdoor play! TIPS TO REDUCE THE EFFECTS OF DIGITAL EYESTRAIN T A B L E 1 U F P. 0 2 5 3 . U S A . 1 6