Digital devices are inextricably linked to the modern world, and it is widely accepted their daily use, which is already high, will continue to rise over time. The coronavirus pandemic has further contributed to increased use of electronics through large numbers of people studying and working from home; actions that were mandated in the early part of 2020 but continue as the preferred option for numerous communities around the world. Extended periods of digital device use are associated with symptoms of ocular and physical discomfort.1-3 The disruptive nature of contact lens wear on the tear film and resulting discomfort that commonly occurs makes it extremely important to ensure the most appropriate lens technology is recommended to lens wearers who regularly use digital devices.1-2  This article reviews the scale of the problem and the impact of digital devices on the eyes. Part 2 discusses the clinical performance of Biofinity Energys® and shares advice applicable to a wide range of patients.

Widespread and growing use

Before assessing how often they are used, it is helpful to consider what the phrase ‘digital devices’ means. Desktop and laptop computers, smartphones, tablets, and e-readers all fall under the umbrella of digital devices, with wide-ranging use from work and education through to social media, TV and news content, gaming and, increasingly, video communication. When detailed like this it becomes clear how use of digital devices permeates the everyday lives of people around the world, and it is likely most individuals have access to a few of those electronics, using them for both work and leisure activities.

Increased access is illustrated by data showing a near doubling of smartphone ownership, and quadrupling of tablet ownership between 2011-2015 in the US.4 By 2019, nearly three-quarters of adult Americans owned a home computer (74%) and eight out of ten had a smartphone (81%).5 In both European,6 and US7 surveys it has been reported that 90% of adults use digital devices for more than two hours each day, with an average viewing time of 5.6 hours8 and 70% use two or more devices at a time.7 Use is also increasing at either end of the age demographic, with over half of US children owning a smartphone by age 11.9 This increases to 84% ownership in teenagers (13-18 years) who spend an average of 7 hours and 22 minutes on their devices daily, not including time spent on school or homework!9 Seniors or pensioners also report increasing ownership and use of electronics, with Americans over 60 years of age spending just over four hours a day on digital devices.10

The coronavirus pandemic has both increased time spent on digital devices, by around one hour extra a day, and altered what the technology is being used for, with a focus on communication and entertainment.11 Initially driven by widespread global lockdown, it is expected that increased device use will continue, with one reason expressed being a preference to continue with online rather than in-person shopping.12

Digital eye strain

A number of terms have been used to describe the impact sustained digital device use has on the eyes. Early terminology referred to ‘computer vision syndrome’, however, in recognition of the expansion in the number of types of devices over time, ‘digital eye strain’ is now recommended to better reflect the variety of screens being used.1 The condition is characterized by visual disturbance and/or ocular discomfort related to the use of digital devices as a result of stress on the ocular system that includes glare, defocus, accommodation dysfunction, fixation disparity, dryness, fatigue and discomfort.13 It has also been defined more simply as the ocular discomfort felt after two or more hours in front of a digital screen.7

Digital eye strain manifests with both ocular and non-ocular symptoms. Ocular symptoms include tired eyes (asthenopia), tearing, blurred vision, burning sensations, redness and double vision. Non-ocular symptoms include headache, pain in the neck and shoulders, backache and general fatigue.1,2 Some ocular symptoms result from focusing-based issues such as uncorrected refractive error, or accommodative and vergence anomalies.14 Increased accommodative burden due to sustained close-up focus, accommodative demand when using multiple digital devices, and squinting in response to screen glare and font size have all been cited as contributing to the symptoms of ocular discomfort that occur.13,15 Careful binocular assessment of new contact lens fits in exophoric myopes is also relevant due to their loss of base in prism effect when switching from spectacles to contact lenses.13,15

Other ocular symptoms have dry eye-related origins, resulting from a poor quality tear film, and altered blinking patterns such as a reduced blink rate6-18 and increased number of incomplete blinks.16,19 It is recognized that digital eye strain is often multifactorial; refractive and ocular surface anomalies combine with where (the environmental condition), and when (the physical set up) the devices are used. This makes it necessary to take an holistic approach to managing the condition, likely tackling a number of potential causative factors together.1

As many as 90% of digital device users experience symptoms of digital eye strain.1 A survey of more than 10,000 adults in the US found two-thirds self-reported symptoms, with increased prevalence when two or more devices were used simultaneously (73%).7 Symptoms occur commonly in children, with 80% reporting problems after sustained device use.20 Working in office environments is a risk factor for visual discomfort,21-23 and contact lens wearers may be more likely to suffer symptoms compared to non-wearers.23 Digital eye strain was found to have increased during the ‘lockdown’ phase of the coronavirus pandemic in a survey of nearly 2,000 subjects in Saudi Arabia, with a reported incidence of 78%, with those who used digital devices for more than 6 hours a day at a significantly higher risk of developing more symptoms.24

A new challenge has emerged in 2020: mask-associated dry eye (MADE) occurs when the air exhaled underneath a face mask is channeled up and over the ocular surface.25,26 This directional airflow increases the rate at which the tear film evaporates, leading to symptoms of dry eye. As people gradually return to shared office spaces around the world masks may need to be worn for extended periods of time. Eye care professionals (ECPs) should be vigilant in asking their patients about their ocular comfort with mask-wearing in general, and in particular if they need to be used in combination with digital devices and in air-conditioned spaces. Simple advice has been produced to help alleviate this specific situation and is available as an infographic at COVIDEyeFacts.org.

It is important to recognize the needs of contact lens wearers, with dryness and discomfort remaining the most commonly cited reasons for ceasing lens wear in adapted wearers.27,28 When long hours of digital device use with resulting digital eye strain are factored in, it can be seen just how important it is to ensure both vision and comfort are optimized in these patients. In fact, in soft contact lens wearers who regularly use digital devices, tiredness and dryness were cited as the most common and most bothersome symptoms experienced.29

References

1.         Coles-Brennan C, Sulley A, Young G. Management of digital eye strain. Clinical & experimental optometry. 2019;102(1):18-29.

2.         Sheppard AL, Wolffsohn JS. Digital eye strain: prevalence, measurement and amelioration. BMJ open ophthalmology. 2018;3(1):e000146.

3.         Jones L, Ng A, Thompson B. Continuing Education: Keeping Up with Ocular Fatigue in the Digital Era. Contact Lens Spectrum. 2016;31:3-10.

4.         Pew Research Center. Technology Device Ownership: 2015.  https://www.pewresearch.org/internet/2015/10/29/technology-device-ownership-2015/. Accessed 02 Sep 2020.

5.         Pew Research Center. Mobile Fact Sheet. 2019.  https://www.pewresearch.org/internet/fact-sheet/mobile/. Accessed 02 Sep 2020.

6.         YouGov. European eye fatigue study. April 2016.

7.         The Vision Council. Eyes Overexposed: The digital device dilemma; 2016 Digital Eye Strain Report.  https://visionimpactinstitute.org/wp-content/uploads/2016/03/2016EyeStrain_Report_WEB.pdf. Accessed 02 Sep 2020.

8.         Meeker M. Internet Trends 2017 https://www.kleinerperkins.com/perspectives/internet-trends-report-2017/. Accessed 02 Sep 2020.

9.         The Common Sense Census: Media Use by Tweens and Teens, 2019.  https://www.commonsensemedia.org/research/the-common-sense-census-media-use-by-tweens-and-teens-2019. Accessed 02 Sep 2020.

10.       Livingston G. Americans 60 and older are spending more time in front of their screens than a decade ago. 2019.  https://www.pewresearch.org/fact-tank/2019/06/18/americans-60-and-older-are-spending-more-time-in-front-of-their-screens-than-a-decade-ago/?utm_source=Pew+Research+Center&utm_campaign=041770d7ae-Internet-Science_2019_06_27&utm_medium=email&utm_term=0_3e953b9b70-041770d7ae-400310621. Accessed 02 Sep 2020.

11.       Coronavirus productivity data: How the pandemic is changing the way we use digital devices, apps, and tools. 2020.  https://blog.rescuetime.com/coronavirus-device-usage-statistics/. Accessed 02 Sep 2020.

12.       29% of US Consumers will Increase Long-term Use of Digital Channels Because of COVID-19 Pandemic. 2020.  https://www.prnewswire.com/news-releases/29-of-us-consumers-will-increase-long-term-use-of-digital-channels-because-of-covid-19-pandemic-301058495.html. Accessed 02 Sep 2020.

13.       Hall L, Brennan-Coles C. More screen time = more digital eye strain. Contact Lens Spectrum. June 2015;30:38-40.

14.       Sheedy JE, Hayes JN, Engle J. Is all asthenopia the same? Optometry and vision science. 2003;80(11):732-739.

15.       Jaiswal S, Asper L, Long J, Lee A, Harrison K, Golebiowski B. Ocular and visual discomfort associated with smartphones, tablets and computers: what we do and do not know. Clinical & experimental optometry. 2019;102(5):463-477.

16.       Portello JK, Rosenfield M, Chu CA. Blink rate, incomplete blinks and computer vision syndrome. Optometry and vision science. 2013;90(5):482-487.

17.       Patel S, Henderson R, Bradley L, Galloway B, Hunter L. Effect of visual display unit use on blink rate and tear stability. Optometry and vision science. 1991;68(11):888-892.

18.       Schlote T, Kadner G, Freudenthaler N. Marked reduction and distinct patterns of eye blinking in patients with moderately dry eyes during video display terminal use. Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie. 2004;242(4):306-312.

19.       Chu CA, Rosenfield M, Portello JK. Blink patterns: reading from a computer screen versus hard copy. Optometry and vision science. 2014;91(3):297-302.

20.       Survey Reveals Parents Drastically Underestimate the Time Kids Spend on Electronic Devices. 2014.  https://www.prnewswire.com/news-releases/survey-reveals-parents-drastically-underestimate-the-time-kids-spend-on-electronic-devices-268088521.html. Accessed 02 Sep 2020.

21.       Gonzalez-Meijome JM, Parafita MA, Yebra-Pimentel E, Almeida JB. Symptoms in a population of contact lens and noncontact lens wearers under different environmental conditions. Optometry and vision science. 2007;84(4):296-302.

22.       Uchino M, Schaumberg DA, Dogru M, et al. Prevalence of dry eye disease among Japanese visual display terminal users. Ophthalmology. 2008;115(11):1982-1988.

23.       Tauste A, Ronda E, Molina MJ, Segui M. Effect of contact lens use on Computer Vision Syndrome. Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians. 2016;36(2):112-119.

24.       Alabdulkader B. Effect of digital device use during COVID-19 on digital eye strain. Clinical & experimental optometry. 2020. In press

25.       Moshirfar M, West WB, Marx DP. Face Mask-Associated Ocular Irritation and Dryness. Ophthalmology and Therapy. 2020;9(3):397-400.

26.       Jones L. Why face masks can make eyes feel dry, and what you can do about it. Aug 2020.  https://theconversation.com/why-face-masks-can-make-eyes-feel-dry-and-what-you-can-do-about-it-143261. Accessed 02 Sep 2020.

27.       Dumbleton K, Woods CA, Jones LW, Fonn D. The impact of contemporary contact lenses on contact lens discontinuation. Eye & contact lens. 2013;39(1):93-99.

28.       Dumbleton K, Caffery B, Dogru M, et al. The TFOS International Workshop on Contact Lens Discomfort: Report of the Subcommittee on Epidemiology. Investigative ophthalmology & visual science. 2013;54(11):TFOS20-36.

29.       Meyer D, Huenink S, Rickert P, Kollbaum P, Chamberlain P. Symptoms associated with eye fatigue in soft contact lens wearers. American Academy of Optometry Meeting; 2015; New Orleans.

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