Dr. Jameel Rizwana Hussaindeen, M.Phil, PhD, FAAO, FCOVD-I
Head of Academy, Rivoli Vision
Clinical Diplomate – Binocular vision, Perception & Pediatric Optometry Section,
American Academy of Optometry (AAO)
President, Optometric Association of Tamil Nanbargal (OATN) & AAO India chapter
The word Digital eye strain or DES has become a buzzing word among the eyecare fraternity and even among general public in the recent months. This article highlights the increased use and dependency on gadgets in every one of our lives, the increased prevalence of digital eyestrain and related symptoms, and the role of eye care professionals in combating this issue that is expected to surge in the years to come.
Use of digital devices – global trends
Based on the trends for the global ‘State of Digital’ report published in January 2021, (1) 66.6% of the total world’s population use mobile, with around 4.66 billion people (59.5%) using internet. This clearly highlights the fact that digital devices have become a part of our lives, and that there are no boundaries or criteria as to who needs eyecare counseling for digital device use. Earlier the term “computer vision syndrome” was coined to address the eye and vision related complaints experienced by someone who uses a computer or visual display units. The prevalence of asthenopia associated with computer use ranges from 46.3% to 68.5%. (2)
Now that 5.22 billion of the world’s total population uses mobile as their first screen, and an average internet user spends 7 hours every single day on the internet, almost every other person needs to be counseled regarding eye health pertinent to digital device use. And an average of 4.10 hours is being spent on a hand-held device like mobile every day. (1) Thus, the type of screen is multi-modal in the current scenario giving rise to the terminology “Digital eye strain” to represent the eye and vision related symptoms associated with the use of digital devices.
Virtual reality-based devices are also slowly finding its space in gaming, education, and healthcare domains. As the viewing environment is altered in a VR platform, further research is being done to explore the impact of the artificial viewing system on binocular vision and other visual parameters.
The contribution of COVID-19 to digital device usage
More than one billion children experienced disruption to education during COVID-19, resulting in over 90% of the countries adopting online education. (3) And not to mention, workplace dynamics has significantly been altered following the pandemic with increased reliance on digital devices with the remote work from home options. The number of hours of digital device use has also seen a surge among students and professionals resulting in increased prevalence of digital eye strain, and related symptoms. (4-7)
Based on the 2018 Digital Eye Strain report,(8) the self-reported prevalence of digital eye strain was 60% based on survey responses from over 10 000 US adults. Recent reports state that, almost 80.6% of tele-workers have reported an increase in digital eye strain after the pandemic.
These trends are not expected to change anytime sooner, and thus the role of eyecare professionals has become crucial in the current context to raise awareness regarding “Digital devices and eye”. It is also important to consider the increased application of tele-health-based work even among healthcare professionals, increasing the dependency on digital devices. Increased screen time during the COVID-19 pandemic stands top as a significant risk factor in many studies impacting the increase in symptoms of eyestrain and dry eye disease. (9)
On one hand, there is a surge in the debates around the benefit of blue blocking lenses in alleviating the visual symptoms. (10,11) On the other hand, these lenses are being prescribed without understanding the etiology and associated clinical signs, symptoms of DES. This article aims to bring an evidence-based perspective to understanding DES, and the role of eyecare professionals in being able to combat the increased concerns around DES with a protective, and preventative approach.
Understanding digital eyestrain
Digital eyestrain (DES) refers to ocular or visual disturbances due to the use of digital devices, arising from a range of factors or stresses on the ocular system. These factors include the presence of glare, defocus, accommodation and vergence dysfunctions, ocular surface dryness, discomfort, and visual fatigue. (12) The different types of eyestrain, symptoms and causes adopted from Coles-Brennan et al (12) are illustrated below.
Figure: Types of eyestrain, symptoms, and causes (Adopted from Coles-Brennan et al (12))
The impact of digital device usage on children eye health is a key focus area and high priority for all eyecare professionals. Children in their developing years, with additional risk factors such as family history of myopia, are at an increased risk of developing eye and vision related dysfunctions due to excessive use of digital devices. Children who engage in online classes for > 4 hours are likely to develop symptoms of digital eye strain and dysfunctions of binocular vision. The “Digital eye strain among kids (DESK) study” also provides an alarming report of an increase in severe issues such as acute onset esotropia due to excessive digital device used for e-learning in children. (13) All these points out to the need for increased awareness regarding DES among all concerned stakeholders, and the imminent role of eyecare professionals in combating this battle.
More about Assessment and Management of DES is covered in part II
- https://datareportal.com/reports/digital-2021-global-overview-report (accessed 9th August, 2021)
- Heus P, Verbeek JH, Tikka C. Optical correction of refractive error for preventing and treating eye symptoms in computer users. Cochrane Database Syst Rev. 2018 Apr 10;4(4):CD009877. doi: 10.1002/14651858.CD009877.pub2. PMID: 29633784; PMCID: PMC6494484.
- https://data.unicef.org/topic/education/covid-19/ (accessed 9th August, 2021)
- Salinas-Toro D, Cartes C, Segovia C, Alonso MJ, Soberon B, Sepulveda M, Zapata C, Yañez P, Traipe L, Goya C, Flores P, Lopez D, Lopez R. High frequency of digital eye strain and dry eye disease in teleworkers during the coronavirus disease (2019) pandemic. Int J Occup Saf Ergon. 2021 Jul 7:1-6. doi: 10.1080/10803548.2021.1936912. Epub ahead of print. PMID: 34082647.
- Cartes C, Segovia C, Salinas-Toro D, Goya C, Alonso MJ, Lopez-Solis R, Zapata C, Cabezas M, Yañez P, Flores-Rodriguez P, Lopez D, Matus G, Traipe L. Dry Eye and Visual Display Terminal-Related Symptoms among University Students during the Coronavirus Disease Pandemic. Ophthalmic Epidemiol. 2021 Jul 12:1-7. doi: 10.1080/09286586.2021.1943457. Epub ahead of print. PMID: 34251964.
- Mohan A, Sen P, Shah C, Datt K, Jain E. Binocular Accommodation and Vergence Dysfunction in Children Attending Online Classes During the COVID-19 Pandemic: Digital Eye Strain in Kids (DESK) Study-2. J Pediatr Ophthalmol Strabismus. 2021 Jul-Aug;58(4):224-231. doi: 10.3928/01913913-20210217-02. Epub 2021 Jul 1. PMID: 34288760.
- Alabdulkader B. Effect of digital device use during COVID-19 on digital eye strain. Clin Exp Optom. 2021 Aug;104(6):698-704. doi: 10.1080/08164622.2021.1878843. Epub 2021 Feb 22. PMID: 33689614.
- The Vision Council. The vision council shines light on protecting sight – and health – in a multi-screen era. https://www.thevisioncouncil.org/blog/vision-council-shines-light-protecting-sight-and-health-multi-screen-era (accessed 9th August, 2021)
- Barabino S. A Narrative Review of Current Understanding and Classification of Dry Eye Disease with New Insights on the Impact of Dry Eye during the COVID-19 Pandemic. Ophthalmol Ther. 2021 Sep;10(3):495-507. doi: 10.1007/s40123-021-00373-y. Epub 2021 Jul 17. PMID: 34275088; PMCID: PMC8286160.
- Sheppard AL, Wolffsohn JS. Digital eye strain: prevalence, measurement and amelioration. BMJ Open Ophthalmol. 2018 Apr 16;3(1):e000146. doi: 10.1136/bmjophth-2018-000146. PMID: 29963645; PMCID: PMC6020759.
- Rosenfield M, Li RT, Kirsch NT. A double-blind test of blue-blocking filters on symptoms of digital eye strain. Work. 2020;65(2):343-348. doi: 10.3233/WOR-203086. PMID: 32007978.
- Coles-Brennan C, Sulley A, Young G. Management of digital eye strain. Clin Exp Optom. 2019 Jan;102(1):18-29. doi: 10.1111/cxo.12798. Epub 2018 May 23. PMID: 29797453.
- Mohan A, Sen P, Mujumdar D, Shah C, Jain E. Series of cases of acute acquired comitant esotropia in children associated with excessive online classes on smartphone during COVID-19 pandemic; digital eye strain among kids (DESK) study-3. Strabismus. 2021 Jul 5:1-5. doi: 10.1080/09273972.2021.1948072. Epub ahead of print. PMID: 34223812.
Dr. Jameel Rizwana Hussaindeen, M.Phil, PhD, FAAO, FCOVD-I
Dr. Jameel Rizwana Hussaindeen is currently serving as the president for the Optometric association of Tamil Nanbargal (OATN), the legal association for Optometry in Tamil Nadu. She is also an adjunct faculty at the Sankara Nethralaya Academy, and an honorary visiting consultant at Sankara Nethralaya, Chennai where she was formerly heading the Binocular vision and Vision therapy clinic. She is serving as a consultant for the International Agency for the Prevention of Blindness (IAPB).
Dr. Hussaindeen is the first clinical Diplomate from India, in the section of Binocular vision, perception and pediatric Optometry of the American academy of Optometry (AAO) and is the inaugural president for the AAO-India chapter. Dr. Hussaindeen’s expertise spans across clinical specialties of binocular vision, pediatric optometry, learning related vision problems, cerebral visual impairment, amblyopia, and neuro-optometry. She serves as a committee member and trainer for the Rashtriya Bal Swasthya Karyakram’s (RBSK) -Government of India’s initiative in the preparation of a manual for the vision assessment and rehabilitation of cerebral visual impairment (CVI). Dr. Hussaindeen has been involved in the school eye health initiatives for over a decade now. She also served as a mentor to the World council of Optometry’s Advocacy for eye health program.
Her doctoral research pertains to understanding binocular vision anomalies among school children. She has authored the book titled “Keep it single and simple – Binocular vision testing and treatment made easy” along with her mentor Prof. Mitchell Scheiman. Dr. Hussaindeen has many peer reviewed publications in international journals and also has authored chapters in books. She serves as a reviewer for national and international peer reviewed journals including Optometry and Vision Science, PloS One, BMJ-BJO, Journal of Optometry, Indian journal of Ophthalmology, and Nature-scientific reports. She also serves as a PhD co-supervisor at the Deakin University, Australia, and at the Chitkara University, Chandigarh.