In this new digital era, there are new risks for user eyes and new challenges for vision care professionals. Ten experts, optometrists, ophthalmologists and researchers have addressed this broad topic and offer us their experience and thoughts in the form of verbatim comments. This overview has been divided into three main thematic areas: risks and prevention, professional practices, and projections and expectations.
1. RISKS AND PREVENTION
What effects do digital displays have on health? The main risks, whether they are known, suspected or potential, primarily concern vision, but may also affect other functions. Experts are reassuring however: good visual hygiene, regular eye exams by professionals, appropriate optical solutions and enhanced public awareness provide effective prevention.
Impact of digital displays on vision
“Our visual system is biologically designed for distance vision. Near vision is only an accommodation reflex that helps us quickly identify objects close at hand. Our eyes are not designed to stare at screens for hours on end.” José de Jesús Espinosa Galaviz
“A reduction in the frequency of blinking during screen use increases the severity of such symptoms as dry eye or irritation and blurred vision. Smartphone users tend to hold their phones very close to the face, thus requiring an intense accommodative effort causing eye strain or headaches.” Sebastian Marx
“In such rapidly developing cities as Singapore, we see concomitant growth in the number of people working in offices and cases of asthenopia, sensitivity to light, transient diplopia and so on.” Koh Liang Hwee
“The increase in ophthalmic disorders is linked to the proliferation of screens and the time spent watching them: in the classroom (from primary school to postgraduate courses, including tablets, computers, electronic tables, etc.), but also at all ages via the social networks, television and e-books, which are becoming increasingly popular.” Helen Summers
“No clinical study to date has demonstrated that overexposure to digital displays is the cause of early macular degeneration. However, blue light emissions are a reality and over time we are bound to see a clinical impact. Concerning the increase in cases of myopia, various studies point to the possible influence of digital displays used at ever closer distances. We still need to understand why certain subjects develop myopia and others don’t, even among twins.” Sebastian Marx
“The main risk for the younger generation is myopia, perhaps not true myopia, but rather an ‘accommodative spasm’ (i.e. near point stress according to Skeffington), since the human eye and brain were not designed for extended near vision.” Aravind Srinivasan
Consequences beyond vision
“In the medium and long term, digital displays affect people in different ways. The impact is not solely ophthalmic. The symptoms are varied, suggesting both physical disorders (neck and back pain, etc.) and psychological disorders (fatigue, irritability, poor concentration, memory problems and so on).” Aravind Srinivasan
“Overexposure to blue light emitted by screens can disrupt the secretion of melatonin and thus affect the quality of sleep. Eye strain can also have an effect on productivity and lead to other disorders, such as stress, anxiety or mood swings.” Koh Liang Hwee
“Ever more pervasive video gaming is associated with player immersion and strong screen flicker. These two situations can eventually stimulate systemic and endocrine functions, resulting in elevated cortisol levels. The main repercussions have been found to affect sleep, behavior, mood, motivation and learning.” Helen Summers
Preventive solutions
“Consumer awareness campaigns are an important means of highlighting the risks and symptoms related to digital displays and offer an opportunity to stress the need for regular eye exams.” Aravind Srinivasan
“Every person consulting a vision care professional should be informed of the impact of digital devices and blue light, as well as the importance of good visual hygiene and the availability of optical solutions. A wide range of high-quality solutions are available; it is regrettable, however, that current prices limit their use primarily to adults rather than children.” Helen Summers
“A new specialty, ergo-optometry, could be created. The ergo-optometrist would counsel patients on how to take better care of their visual health, explain what products to use to treat dry eye and provide personalized information with regard to lenses and frames, even for patients without refractive error. Overweight people can contact Weight Watchers. People with ophthalmic problems should be able to contact Eyes Watchers.” Joachim Köhler
“We are not usually aware of our posture; our organism chooses the most appropriate position for a given situation, without worrying about potential physiological repercussions. It is essential to adopt good posture. For reading, I recommend the Harmon distance at a minimum; this is the distance from the tip of the elbow to the middle of the index finger.” José de Jesús Espinosa Galaviz
“Good visual hygiene also includes: an ergonomic work space; good posture, a straight head and back; good lighting, with lower lighting for screens and adequate room lighting; breaks every 20 minutes; alternating between near and far screen distances, and suitable ophthalmic lenses.” Helen Summers
2. PROFESSIONAL PRACTICES
How are digital devices influencing the everyday lives of vision care professionals? New consultation protocols, near vision refraction and control methods appropriate to digital displays, personalized counseling and more frequent continuing education are the main developments cited by experts. Many professionals are incorporating digital tools into their practices to better assess users’ needs. In the context of overexposure to digital devices, experts are also beginning to take more interest in children and emmetropic people (without refractive error).
Protocols and refraction
“Just a few years ago, protocols were established on the basis of the symptoms one should look for rather than on patients’ needs depending on their environment. This approach is now changing. Currently, in addition to patients’ histories, we are also interested in their concerns, expectations, environment and so on, and we are adapting protocols accordingly.” Luis Ángel Merino Rojo
“For people who rely heavily on their near vision, I apply a protocol based on behavioral optometry. This approach is important when prescribing the best lenses for a particular type of activity.” José de Jesús Espinosa Galaviz
“My approach? First I exclude ocular pathology and perform a refraction. Then I evaluate the patient’s visual faculties (accommodation, convergence, ocular mobility and sensory aspects such stereoscopic vision, etc.). Once all these criteria have been evaluated, the treatment strategy can be defined.” Elizabeth Casillas
“Far vision refraction is often performed using cyclopegic eye drops with a refractometer. Near vision is examined with trial frames equipped with interchangeable lenses to better evaluate posture, head position and reading distance in relation to a support, computer or digital device. Instruments such as ‘Capture I’ or ‘Visioffice®’ are used to measure frame parameters and such individual parameters as pupillary distance and the eye’s center of rotation.” Helen Summers
“My staff has slightly modified their refraction methods to adapt to digital technologies. We placed a smartphone and tablet in the consulting room and, after the examination, we ask patients to read what is written on the screen. If they are unable to do so, we orient them towards specific lenses. Otherwise, all is well! By using digital devices to test near vision, we fit in more closely with our patients’ digital lifestyles.” Joachim Köhler
Prescriptions and counseling
“There are several complementary approaches. The first involves optical correction, with hightech lenses offering optimal vision quality and protection. The second approach involves training, consisting of various exercises designed to improve visual capabilities. The third approach involves education in visual hygiene (posture, breaks, a good work environment, etc.). The final prescription depends on the age and issues of each patient.” Elizabeth Casillas
“The patient’s age affects the proposed treatment. People with presbyopia will be advised to wear progressive lenses, with a coating (i.e. a filter) suited to the specific issues posed by digital devices. For younger children, with or without a correction, lenses must primarily meet the objective of protecting their vision against the harmful effects of screens.” Aravind Srinivasan
“People working on computers are advised to have regular exams, in order to identify any symptoms of ophthalmic stress. The prevention aspect is particularly stressed for children, especially for children under 10.” Helen Summers
“We must be attentive to each of our prescriptions, always follow the same consultation protocol, compare feedback from each patient and keep a record of all results.” Berenice Velázquez
“Information provided by researchers, universities, specialized societies, suppliers and the like, helps us stay on top of new developments and provide increasingly personalized solutions. We must make an effort to step out of the ‘comfort zone’ of standardized options and adapt them to individual needs.” Sebastian Marx
“We have a real role to play in the treatment of disorders related to digital displays and must devote more time to informing and educating ourselves and to testing new solutions. In this regard, it could be useful to reinforce the sharing of experiences and dissemination of information through forums and professional networks.” Elizabeth Casillas
The place of emmetropes
“My colleagues and I feel that emmetropes (i.e. people without refractive error) have been completely forgotten by our profession. During screen use, they are exposed to the same risks as glasses wearers. So it is important to educate them about the existence of simple solutions and practices to fight against asthenopia and other disorders related to digital devices.” Luis Ángel Merino Rojo
“It would be useful to mount a major information campaign on the risks of overexposure to digital displays. And explain that vision care professionals have solutions to respond to these issues, even for emmetropes.” Berenice Velázquez
Digital devices and professional practice
“For vision care professionals, digital technologies make it possible to share cases and experience, to the benefit of patients.” Jaime Bernal Escalante
“Digital tools and certain applications can be used to take a number of different measurements: asthenopia, the quantity of blue light emitted by screens, etc. They can also be used to disseminate recommendations aimed at optimizing visual comfort and participate in the therapeutic education of users.” Berenice Velázquez
Luis Angel Merino Rojo
“There is a paradox. On the one hand, we have more and more technological tools available to us (auto-refractometers, digital phoropters, photo and video sharing capability to improve diagnosis, etc.), but on the other hand, we have a new generation of professionals who no longer know how to perform an exam without these devices. The right balance must be found between the assimilation of new technologies and basic knowledge.” José de Jesús Espinosa Galaviz
3. PROJECTIONS AND EXPECTATIONS
How do we anticipate future issues and respond to the realities of a multi-screen world? Between increased research efforts and the development of technological innovations that will facilitate customized products and services, the various ideas outlined offer a glimpse of the future of the ophthalmic optics sector, which is in a position to turn the digital challenge into a real growth engine.
Clinical studies and R&D
“Technological progress is making rapid headway, but the ophthalmic optics industry should be further ahead than it is if it is to adequately meet the health challenges associated with digital displays. It is important to invest more in health research in general and vision health in particular.” José de Jesús Espinosa Galaviz
“New studies on the relationship between blue light and macular degeneration and the connection between the development of myopia and digital displays could provide clinical responses to current hypotheses based solely on interpretation.” Sebastian Marx
“We must continue research efforts on myopia and its development, solutions to amblyopia, eye reactions during screen use, night vision, light radiation, etc.” Luis Ángel Merino Rojo
“All studies focusing on the exact relationship between connected life and ophthalmic disorders should prove useful. And in my opinion, the development of shared databases would be a real ‘plus’ for all vision health players.” Jaime Bernal Escalante
Expected innovations
“More precise measuring equipment. The fact of having 20/20 (10/10) vision reveals nothing about the way patients’ use their eyes while watching a screen.” Elizabeth Casillas
“Tools to measure the impact of luminous digital displays on the eye.” Aravind Srinivasan
“New products, particularly ophthalmic lenses capable of protecting the eyes against technological ‘radiation’.” Jaime Bernal Escalante
“The ideal lens: a product capable of integrating all treatments and filters on demand, based on the individual needs of each patient.” Koh Liang Hwee
“A completely innovative approach, with ‘flexible’ smart lenses capable of adapting their optical properties to specific situations. A high level of modularity that could involve the use of electronic components.” Sebastian Marx
Vision health in the future
“The multi-screen environment is part of daily life. This environment can potentially pose certain risks, particularly for the eyes, and it is up to us as vision care professionals to concern ourselves with these risks and provide some answers, either directly or via the Internet. Indeed, technological and societal developments are opening up new fields of practice that offer our industry an opportunity to evolve! Personally, however, I prefer direct contact with patients, to show them that I am indispensable as a specialist.” Joachim Köhler
“New visual needs concern a large number of everyday activities; therefore growth opportunities for the vision health sector can only increase. The solutions developed must provide added value: filters to prevent eye strain or blue light-related risks, lenses capable of stimulating peripheral areas of the retina to fight against myopia or stimulate amblyopic eyes and improve their performance. There are still many little exploited or untapped areas that will undoubtedly drive development in the future. The response to digital issues is part of this.” Luis Ángel Merino Rojo
Conclusion
The new digital era is witnessing new societal, sensorial and behavioral transformations. This brief survey of the situation worldwide highlights the increased overall level of awareness of the ophthalmic optics sector confronted with the rapid, wide-scale changes driven by the emergence of digital technology and, more particularly, its impact on users’ vision and posture. From stronger prevention efforts to personalized treatment options, without forgetting projections for the future, the vision health sector is joining forces to adapt to developments, anticipate upcoming challenges and provide better performing solutions for ametropic and emmetropic patients of all ages.
Insights collected by Oliver Vachey, science journalist.
Article from the magazine "Point de vue"
