February 04, 2016
3 min read

The era of digital eye strain: Is it worth it?

Computer vision syndrome is here to stay, and premium surgeons must be ready to alleviate symptoms.

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Recently my 17-year-old son signed a professional eGaming contract to play League of Legends, the largest worldwide computer competition game. He signed with Team Liquid in Los Angeles, the leading 10-person roster for the United States heading into the World Championships in Asia later this year. Last year’s championship was viewed by 27 million people globally, 13 million more than viewed the World Series that same year. The professional perks for this eGamer are no different than that of a professional NBA player once he hits professional status. The good news is, in this era of digital eye strain, chronic gaming was well worth it for my son, as he is on the computer as many hours a day that I am looking through a slit lamp or operating microscope. But is it worth it for premium surgeons and their patients?

Computer vision syndrome

By definition, computer vision syndrome (CVS) is a condition that typically occurs from focusing the eyes on a computer or like device (iPad, tablet, smartphone) for protracted, uninterrupted periods of time. Symptoms of CVS include asthenopia, headaches, fluctuating vision, dry eyes, red eyes and/or diplopia. According to the National Institute for Occupational Safety and Health, CVS affects close to 90% of people who spend 3 or more hours per day at a computer. Evaporative dry eye is probably the most common ocular problem I see in my practice as it relates to CVS. Not only does CVS cause evaporative dry eye, dry eye exacerbates CVS, creating a vicious cycle for the patient.


I prefer to treat these patients with artificial tears that contain an oil-based formulation such as Refresh Optive Advanced (Allergan), Systane Balance (Alcon) or Soothe XP (Bausch + Lomb). I also employ the “20/20/20 rule” for patients with CVS, telling them to focus their eyes on an object 20 feet away for 20 seconds every 20 minutes while doing near vision tasks, especially on the computer.

For those patients who are early presbyopes or pre-presbyopic, over-the-counter low add reading glasses (+1.00 to +1.50) may be helpful in alleviating some of the symptoms of CVS. For those using digital devices, simply adjusting the brightness/contrast setting on the display may reduce eye fatigue. Natural sunlight followed by bright white LED light bulbs seems to give my patients the best near vision ability postoperatively, especially after placement of the Crystalens (Bausch + Lomb), Trulign (Bausch + Lomb), or low add multifocals ZKB00/ZLB00 (Abbott Medical Optics) or ReSTOR +2.5 (Alcon). The impact of preoperative strabismus and/or amblyopia typically sways me to choose a monofocal IOL, toric IOL and/or Crystalens, but patient expectations must be kept realistic preoperatively about what level of uncorrected vision can be obtained postoperatively. I still recommend patients use word-finding books (1 through 6, progressively smaller font in each book), originally created by Eyeonics when Crystalens was launched in 2003 to help with near vision improvement postoperatively. I typically provide these books three at a time so patients can gauge their improvement.

At the 1-week postoperative visit after the second eye cataract surgery for those patients who have a presbyopia-correcting IOL placed, I show both happy and early unhappy patients what their vision would have been uncorrected with a monofocal IOL in both eyes by placing the “purple frame –2.50 sphere glasses” over both eyes. This trick will usually walk those unrealistic patients off the cliff who think they spent money unnecessarily for no gain at near. Nevertheless, the daily near vision tasks by both surgical and non-surgical patients are tested by the long hours most of us spend on computers and like devices mentioned above. Certain apps are available as well to help alleviate CVS and aid in the near vision improvement after presbyopia-correcting IOL implantation, such as GlassesOff. For a small fee, patients can use this app on their smartphone devices on their own time to continually improve their uncorrected near vision.



In the end, this era of digital eye strain or computer vision syndrome is here to stay, whether we like it or not, and we must be prepared to alleviate symptomatology associated with these conditions both preoperatively and postoperatively. We must set patient expectations that near vision daily task demands will challenge our advanced IOL technologies, but using the strategies mentioned above and waiting for full neuroadaptation to finally kick in will make living in the era of digital eye strain all worth it. I am thankful for the opportunity it has brought for my teenage son.

Disclosure: Jackson reports he is a consultant for Allergan and Bausch + Lomb.