Computer vision syndrome, progressive myopia deserve extra attention
Click Here to Manage Email Alerts
Computer vision syndrome, sometimes called digital eye strain, is real, as is the epidemic increase in myopia worldwide.
Both appear to be related to the increased near vision demands, including significant digital device use, required in the modern era. First, a few thoughts on computer vision syndrome.
Many children and adults spend 8 or more hours looking at a computer, iPad or cellular phone every day. When concentrating at a near object for hour after hour, significant stress is placed on the visual system, neck and back. It has been shown conclusively that when concentrating on a near task, the blink rate declines from the normal 20 times a minute to about 10, exacerbating dry eye disease. In addition, many people have convergence insufficiency, challenging the oculomotor system during sustained accommodation. Progressive prism glasses can reduce symptoms associated with convergence insufficiency (Neurolens). Finally, poor posture often leads to neck, upper back and even lower back strain.
The symptoms of computer vision syndrome include visual asthenopia, blurry vision, diplopia, fatigue, DED with its usual signs and symptoms, headache, neckache, backache and sleep disturbances. Computer vision syndrome is basically a repetitive stress injury and results in reduced quality of life and significant loss of employee productivity, costing companies worldwide many millions of dollars every day.
Management includes rest breaks, blinking exercises, DED management and ergonomics, including good posture in front of the computer. High-energy violet and blue light exposure may play a role, and many are recommending high-energy violet and blue light blocking at the digital device level or in eyeglasses (Healthe/Eyesafe, Essilor). Excess computer time carries a double risk for the younger patient as it may also trigger or accelerate progressive myopia.
It is important that the young myope be recognized early, around age 6 years. Their myopia can be expected to progress for 20 years if near demand remains excessive. Capturing these progressive myopes at an early stage in an eye care provider’s office is critical today as treatments that can retard progressive myopia are evolving.
Behavior modification is at the base of the progressive myope’s treatment pyramid. The 20-20-20 rule recommends that after every 20 minutes of near work, everyone, especially a child with progressive myopia, should look at a distance target 20 feet or more away for a minimum of 20 seconds. To facilitate this distance gazing every 20 minutes, a child’s study desk should be placed in front of a window, rather than adjacent to a wall, to facilitate distance viewing. In addition, at a minimum, the young progressive myope should spend 2 hours outside every day in natural lighting, with physical activity and distance viewing encouraged.
Full correction of the myopic refractive error is important, as is the management of convergence insufficiency with fixed or progressive base-in prisms. The use of bifocals, whether fixed power or progressive, has not been confirmed in some well-controlled prospective trials to be helpful. Specialty contact lens wear, such as the CooperVision MiSight or the new Johnson & Johnson Vision myopia contact lenses, can be helpful. Orthokeratology has supporting evidence. Low-dose atropine therapy is promising in several clinical trials but is not yet FDA approved. For select patients, an eye care provider can order prescription low-dose atropine from several compounding pharmacies.
Computer vision syndrome and progressive myopia should be on the radar of every eye care provider, whether ophthalmologist or optometrist. Both negatively affect quality of life, work or school productivity and are common. They deserve our attention, as we now have effective treatments with evidence-based support.
Collapse
Read more about
Click Here to Manage Email Alerts