Digital Eye Strain Guide – Content by Dr. Jason Morris
When we use a computer, tablet or smart phone for an extended period, many of us experience digital eye strain. There are several reasons why this occurs including: current glasses’ lens design, posture & ergonomics, long periods of sustained focus, back-lit screens, improper prescription glasses or contact lenses, eye muscle / alignment issues. The fact that we blink significantly less when our attention is focused on a screen also significantly contributes to eye irritation, blurry vision and fatigue.
Explore reasons for digital eye strain in the following table:
Our eyes work like cameras. Before autofocus cameras we manually focused a camera by moving lenses closer and further apart by twisting the camera’s lens system. Moving the lenses would change the focal length and create clarity.
Our eyes work very much the same way with a flexible lens in the eye changing shape to create clarity. Our eyes are not designed to hold static close focus. They are designed to focus dynamically and continually move. Keeping the same high point of focus (e.g. smart phone) fatigues the system and it becomes sore.
If you do not wear glasses at all there are options to relax your eyes. Essilor EyeZen, Zeiss Digital and Nikon Relaxsee are examples of antifatigue lenses. These lenses help reduce eye strain by assisting your eye’s focusing system.
Current Glasses Lens Design:
This is the domain of an Optometrist. Please speak your Optometrist for all your options however…
If you do not wear multifocal (bifocal or progressive) lenses there are options to relax your eyes. The lenses mentioned above come in prescription versions (Essilor EyeZen, Zeiss Digital and Nikon Relaxsee are examples of antifatigue lenses. These lenses help reduce eye strain by assisting your eye’s focusing system.)
If you wear reading glasses only, these may not work well at a desktop screen because traditional readers only provide a narrow depth of focus. There are products that extend this range (e.g. Essilor Digitime or Zeiss Officelens) and are very helpful to reduce strain and address multiple working distance issues.
If you wear multifocal lenses, a lined bifocal may work for a tablet, laptop or phone but may not work well for a desktop screen. Conversely, a no-line bifocal (progressive lens) may help for a desktop and not be great for details. It is a matter of finding the right combination for your visual demands.
Hippus is the normal involuntary small rhythmic pulses (dilation/constriction) of the pupil. The frequency and size of hippus movements are influenced by light. There is a school of thought that backlit screens cause more fatigue and strain because they induce more intense hippus movements. This would be why many people enjoy reading more on paper or e-readers vs. tablets/laptops/phones. There is not much research on this topic to make recommendations.
Posture and Ergonomics:
Extended smart phone use creates problems because working distances are so close. Sustained focus (see above) and extended convergence (in-turning of eyes) cause fatigue and strain. Proper eye wear and taking breaks are the best solutions.
Progressive lens users also have postural issues. At a desk, the ideal spot to view a desktop screen is partway down the lens… this causes users to lift their chin for extended periods resulting in aches and pains. There are products that allow for more comfortable postures (e.g. Essilor Digitime or Zeiss Officelens). These lanes very helpful to reduce strain and address multiple working distance issues. If a separate set of glasses is not practical, setting the computer monitor as low as possible is important (i.e. with straight ahead gaze, the top of your computer screen should be at eye level)
Having an outdated, inaccurate prescription seems like a logical thing to correct when having digital eye strain issues but you would be surprised how many folks do not consider this factor when experiencing eye ache and strain symptoms. Step #1 - See your Optometrist!
Contact lens wearers with low amounts of astigmatism are susceptible to strain because low astigmatism is not generally corrected in soft contact lenses. If this sounds familiar, the solution may be to have glasses for extended screen use times. Or even antifatigue glasses (see above) for over your contacts!
Ocular alignment/ Eye Muscle Imbalance
Having your eyes work well together is critical for reading and screen comfort. There are six muscles behind each eye that must work in concert for comfort. Your Optometrist can assess your eye muscle coordination and make recommendations. Vision Therapy is like physiotherapy for the eye muscles and can help strengthen and align misalignments (not all Optometrists offer Vision Therapy). Alternatively, a lens with “prism” can sometimes be used to relax misalignments and help eyestrain.
A very basic test for alignment issues… stare at the asterisk below and alternate covering one eye and then the other. If the asterisk shifts at all up/down or significantly right/left you should see your optometrist.
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Dryness and Ocular Surface Issues
One of the most impactful things that you can do to stabilize vision and reduce digital eye dryness issues is use a non-preserved rewetting eye drop (such as Thealoz®) at least twice a day.
This is especially true for contact lens wearers as the ocular surface dries more quickly!
Warm compresses, prescription medications and Omega 3 supplements are also used to combat dryness – digital or not! See more information here.
Digital Device Dilemma
Except from "Eyes Over Exposed: The Digital Device Dilemma" (The Vision Council 2016)
We awake to the glow of a phone acting as an alarm clock. We work for hours on our computer screens, perhaps stopping to look at something on another screen—a television, a tablet, a smartphone. The pattern is repeated again and again as our days are filled with electronic images of news reports, online shopping, video games, movies, emails and texts….
This constant exposure to technology is a shock to our eyes. For centuries, we have evolved our sight by viewing a wide variety of objects outside from varying distances. A combination of factors including the proximity at which we view digital screens, the frequency and length of time of this use, physical responses to screen habits, and exposure to high-energy visible (HEV) or blue light, have conspired to cause visual discomfort in 65 percent of Americans. 1 This stress and strain, combined with other physical discomforts, is called digital eye strain. READ MORE
- Category: Guides
Dry Eye Guide - Content by Dr. Jason Morris
The condition name 'DRY EYE' is inherently confusing as many people with 'Dry Eyes' excessively tear. They may have symptoms that do not necessarily feel dry. 'Dry Eye' refers more to an imbalance in your tear chemistry. The thin film of fluid on the surface of your eyes is quite a complex recipe and if that is not produced by your body properly, unstable vision and discomfort and sometimes permanent damage to the ocular tissue can ensue.
For the purposes of mapping a treatment plan and communicating status, I break down DRY EYE into two main forms  suspected lipid deficiency  suspected aqueous deficiency
Note that these can occur concurrently and are listed as ‘suspected’ as they are sometimes hard to distinguish clinically but are treated differently.
Management options for progressing severity for both forms of dry eye will be highlighted below. If not treated, eyes that are chronically dry progress to having DRY EYE DISEASE. This is an inflammatory condition that generally requires prescription drops or oral medications to manage. Advancing Dry Eye Disease is not only uncomfortable but can cause unstable vision and irreparable damage to ocular tissue.
Concurrent with any treatment, I recommend four easy changes that you can make to help both forms of Dry Eye
Hydration – drink lots of water!
Humidity – consider a humidifier in house or work environment for winter or dry environments
Screen use use – try to limit and take breaks of 5 minutes minimum each hour
Make-Up – consider hypoallergenic make-up and be sure not to line eye lid margins (tissue between lashes and eyeball)
How do I know what form of Dry Eye that I have?
The BEST way to determine what form of dry eye that you have is an eye exam by an Optometrist! Special dyes and tests are used to identify your type of dry eye (AQUEOUS vs. LIPID Deficiency) and the best treatment course. If this this is not possible, start with recommendations on LIPID deficiency based dry eye as it is much more common.
| Recommendations based on a Lipid Deficiency Dry Eye (MOST common)
The goal of treating lipid deficiency dry eye is to reduce the evaporation of tears from the ocular surface as low moisture causes irritation and damage to the ocular tissue.
LEVEL ONE: Use non-preserved rewetting drops designed for Lipid Deficiency. Recommended 2-6 times per day.
Option 1 - Hyabak® available through mEYE Spa (filtered bottle)
Option 2 – non-preserved Optive Fusion or Optive Advanced - available through any pharmacy – individual use
LEVEL TWO: All level ONE recommendations but to an enhanced vigilance also add
 5-10min of Bruder Mask at bedtime
 Omega 3’s (ideally of Trigyceride form) 1000mg/day to 2000mg/day (note that Omega 3 is not to be used with Coumadin or other Rx blood thinners)
LEVEL TWO+: (overnight irritation) All level ONE recommendations but to an enhanced vigilance also add a non-preserved eye gel at bedtime -
Recommended: Ocunox available at mEYE Spa or select pharmacies
LEVEL THREE: Burst of prescription topical steroid and/or oral medications would be discussed by Optometrist for inflammatory dry eye disease
| Recommendations based on an Aqueous Deficiency Dry Eye
The goal of treating aqueous deficiency dry eye is to dilute the tears so that they are less salty and irritating to the ocular tissue.
LEVEL ONE: Use non-preserved rewetting drops designed for Aqueous Deficiency. Recommended 2-6 times per day.
Option 1 - Thealoz® available through mEYE Spa – filtered bottle
Option 2 – non-preserved Theratears or non-preserved HypoTears – available through any pharmacy - individual use
LEVEL TWO: All level ONE recommendations but to an enhanced vigilance also add a non-preserved eye gel at bedtime -
Recommended: Ocunox available at mEYE Spa or select pharmacies
LEVEL THREE: Burst of prescription topical steroid and/or Restasis® would be discussed by an Optometrist for inflammatory dry eye disease
Allergic Eyes Guide - content by Dr. Jason Morris
A huge percentage of the population suffer from allergies. If you are reading this then your environmental and/or animal allergies likely effect your eyes. Allergic eyes are red, itchy (especially in the insider corners) and may have a stringy white discharge. This guide is not meant to be diagnostic and you should see an Optometrist to diagnose ocular allergies.
Oral antihistamines give broad allergy relief and may be adequate for some ocular allergy sufferers. However eye drops can be very useful for those individuals who:
- Do not really have systemic allergy signs/symptoms like sneezing and congestion
- Find that even with oral medications, ocular allergies persist
- Find that the needed oral antihistamines dry out their eyes and create irritation or contact lens intolerance
What non-prescription and prescription eye drop options do ocular allergy sufferers have?
Rewetting drops - Do not under-rate regular use of non-preserved rewetting drops. When using oral antihistamines, your eyes will be more dry and using a drop like Thealoz® can help flush your eyes and make them feel better. Regular use of rewetting drops can also make you more tolerant to contact lenses during your seasonal allergies.
Ice - If your allergies are more acute in nature (e.g. animal dander), ice can be a useful treatment if you simply do not have drops or need immediate relief. An ice cube in a cloth applied to the lids can slow rapid onset reactions.
Cell Stabilizer Eye Drops - These drops act to shield the [mast] cells that release histamine. The older drops based on sodium cromoglycate (e.g. Cromolyn) seem to have limited success in clinic. There is a new cell stabilizer drop that our Optometry advisors are using with great success Hylo® Dual. This drop is innovative because is combines a create lubricating drop with a novel mast cell stabilizer. When used regularly, Hylo® Dual has shown to be very effective for environmental allergy use and can be used for very long periods of time without fear of adverse effects.
Antihistamine Eye Drops - There is a broad spectrum of these drops and depending upon where you live, some are prescription and some are over-the-counter. These drops combat free antigens in the eye (versus stabilizers that only prevent histamine release). Older antihistamines like Naphcon-A, Opcon-A are reasonably effective for short-term or acute relief. Slightly newer drops like Zaditor have more punch for sure. The most successful drop that our Optometry advisors prescribe (because it is once a day and effective as both antihistamine and stabilizer) is Pataday. Pataday is sold under prescription in some areas and non-prescription in others - talk to your Optometrist.
Steroid Based Eye Drops - Steroid drops are always prescription. They are very effective in reducing ocular allergy symptoms fast! The most common steroid drops for allergy are FML, Lotemax and Alrex. The last two are the same drug at different concentrations. Speak to you Optometrist about these medications.