By: MICHELE PENDRAK BUSH, O.D.
Looking back on 2020…If you weren’t working long hours on the computer before the pandemic, the likelihood is that you now are. Long hours on the computer often equates to all sorts of eye issues. Who knew that one of the unintended hazards of social distancing would be digital eye strain and dry eye?
Step one of any evaluation should always be a thorough history. This standard is maintained as we open the Dry Eye Center of Excellence at Siepser Eyecare. A big part of that history is knowing what you do all day with your eyes. If you are spending a decent amount of your time staring at screens, then chances are you have some level of dry eye disease.
Even if you don’t work on the computer, in 2021 the average US adult spent 3 hours and 43 minutes on their mobile devices. That is roughly 50 days per year!
The average blink rate has been reported to be anywhere from 8 to 22 times/minute. However, when we are focused on something like a work project on the computer, that blink rate plummets by 60% per individual and averages out at approximately 4 times/minute.
Guess what we are not doing when we fail to blink enough? We are not refreshing our eyes with tears. When we blink, the three layers of our tear film are smoothed out over our eyes. In particular, the 20ish oil or meibomian glands that line our upper and lower eyelids release oil over the top surface of our tears. This oil is meant to prevent our tears from evaporating. We hope that our tears last at least 10 seconds without evaporating, but so many people have a tear evaporation rate that is much less than 10 seconds. And when your tears evaporate, it is not just that top oil layer that evaporates. It is all of the layers below it as well.
So when you combine the fact that our tears can evaporate rapidly between blinks with the a very low blink rate – guess what happens to our eyes by the end of the day? After an entire day of allowing your tear film to evaporate, your eyes feel tired, strained, and chances are your vision is blurry. I can’t tell you how many people come into the Dry Eye Center complaining of blurry, filmy, hazy, fluctuating blurry vision that is worse by the end of the day.
There is also something referred to as computer ergonomics. This is having your computer in the proper position to eliminate eye strain. When reading a book, there is a reason why there is a natural tendency to place it in down in your lap and tilt the bottom of the book in towards you. It is because when you read, your eye muscles turn your eyes down and inward – this allows the lens inside of your eye to focus or accommodate more easily. So, when you place a book down and tilt in inwards, you are matching your eyes natural reading position.
Now think about your average desktop computer. How is it placed? Often up and flat. So right out of the gate, you are forcing your eye muscles to go up and out – the opposite of where they need to land to comfortably read for sustained periods of time. No wonder why so many people’s eyes are strained by the end of the day!
To illustrate this, if you are under 40 (meaning you don’t need a bifocal) try this: Take small print. Line it up with your eyes and bring it in until it blurs. Then take that same print and keep it at the same distance from your eyes, but drop it down and tilt the bottom of whatever you are reading in towards you. You will instantly see it clear up. It’s the same distance from your eyes, just a different, more ergonomically pleasing position.
All of the above are reasons why you may have heard of the 20/20/20 rule. It is advised that for every 20 minutes of screen time, we take a 20 second break, stare 20 feet into the distance, and blink. This gives the focusing system of our eyes a much needed rest and allows our tears to replenish the front surface of our eyes.
This is obviously just a start. It would be so much better if we could start out our long days on screens with a nice thickened tear film and healthy oil glands. It is approximated that 33 million US adults have dry eye. That dwarfs the 3 million who have glaucoma and the 11 million who have macular degeneration. Only about 1 million US adults are taking prescription eye drops for dry eye. This means that this disease is very common, but also very undertreated.
The vast majority of dry eye (86%) is evaporative in nature. Evaporative dry eye is exacerbated under evaporative conditions such as dry, cold, and windy weather conditions. However, long days on the computer with low blink rates absolutely counts as an evaporative condition as well. The most common symptom of evaporative dry eye is that filmy, hazy, fluctuating blurry vision that is worse at the end of the day which I mentioned earlier. So many people with evaporative dry eye don’t even realize they have the condition because their eyes may feel fine, with their vision being vaguely blurry.
No surprise, we are seeing dry eye in children as well. Because kids and screens…Need I say more?
There have been many advances in the treatment of dry eye. Many of these treatments can be done in the office with therapeutic benefits lasting for months and sometimes years. Some of the newest dry eye therapies even have additional, aesthetic, anti-aging and anti-acne benefits that patients appreciate.
Are you curious if you have dry eye? I am excited to share all of my dry eye treatment tips and tricks with you. I would love for you to schedule a dry eye evaluation at our recently opened Siepser Eyecare’s Dry Eye Center of Excellence. It’s the area’s only center dedicated exclusively to the treatment of dry eye disease. We’re here to roll up our sleeves and start getting your eyes more comfortable for those long days on your digital devices.