Is It Dry Eye Or Digital Eye Strain?

TRANSCRIPT

0:00

Don't underestimate how good a break can be from doing your work.

0:03

We kind of go, yeah, yeah, whatever, but taking breaks is really,

0:07

really an important strategy for both dry eye and eye strain.

0:11

If you have tried things like lubricants and you're taking breaks and you've still

0:14

got persistent symptoms, don't sit on those.

0:17

Go and get your eyes properly tested.

0:19

Have someone actually work out whether you've got the beginnings of a dry eye

0:22

syndrome or some sort of binocular vision problem that's actually

0:25

creating those things.

0:27

And you know, It might not sound like much, but those small little sort

0:33

of aggravating things, you know, if you're spending 8 hours a day

0:37

on the computer, really important for those things for your

0:39

overall quality of life and stress levels to get on top of it.

0:42

So, you know, so taking breaks and then pursuing care if those sort of home

0:48

strategies aren't working are an important piece.

0:53

If your eyes feel tired, blurry, gritty, or uncomfortable after a day at the

1:00

computer, you're certainly not alone.

1:02

The challenge is that many people assume every screen-related

1:06

symptom has the same cause.

1:08

In reality, digital eye strain and dry eye disease are different conditions, but they

1:14

can produce surprisingly similar symptoms.

1:17

Today I'm joined again by Paul Graham, owner and principal optometrist

1:21

at Harmony Vision Care on the Gold Coast.

1:23

We'll be discussing how to tell the difference between digital eye strain

1:27

and dry eye disease, why the distinction matters,

1:30

and what practical steps people can take to achieve more comfortable

1:34

vision throughout the day.

1:35

For those who are new to the channel, my name is Paul Sallaway

1:38

from Optics Digital Marketing.

1:39

We help eye care professionals to share useful educational information with their

1:43

patient communities through videos like this one.

1:46

So Paul, great to have you back.

1:48

Nick, good to be back, thank you.

1:49

So Paul, to start with, what's the difference between digital

1:53

eye strain and dry eye disease?

1:55

And you might even want to tease out the distinction between digital eye

1:58

strain and the garden variety eye strain.

2:01

If we talk about digital eye strain, obviously the name comes from the ocular

2:05

and visual discomfort that comes from using digital devices versus the eye

2:10

strain that we might get from say reading and writing, those more sort of more

2:14

traditional sources of doing lots of near work.

2:17

The difference between that kind of eye strain and digital eye strain is that when

2:21

we're using things particularly like laptops and desktops,

2:25

your eyes are in an elevated position which makes the opening of your eyelids

2:29

wider, and so there's more surface of your eye to be exposed to be drying out.

2:34

And in any activity where we're concentrating, we don't blink as often,

2:38

and then not only that, and we've spoken on this on some other

2:42

videos, is that we get into doing these little habits of half blinks as well,

2:46

which start to compound the problem.

2:48

And the distinction starts to become a little messy because with digital eye

2:52

strain you can get some of the symptoms that you might get

2:55

from dry eye, so sore gritty eyes, maybe your eyes might water,

2:59

maybe they might sting, and they can be some of the symptoms

3:02

that might indicate that you have a dry eye disease.

3:04

And a dry eye disease is a more chronic condition, and probably, you know,

3:08

our lifestyle of doing lots digital work may actually lead and be one

3:13

of the things that lead to eventual, like, an actual dry eye condition.

3:18

So there's a bit of a spectrum of how this kind of runs.

3:22

You know, you could probably say that digital eye strain might be something

3:24

that you only notice after a session on the computer or a session at work,

3:29

but we need to be careful to kind of tease that out and make sure that you're not

3:32

just putting it off to, oh, it's just a bit of eye strain,

3:34

that's just a, you know, just a consequence of doing lots of near work.

3:38

Versus having some sort of underlying problem like a dry eye

3:41

disease that needs treating.

3:44

Or as we'll discuss, you know, there are other eye teaming or binocular

3:47

vision issues that can create sore eyes and stinging and those sorts of things

3:51

as well while you're doing near work.

3:53

And so we need to sort of tease those sort of things out.

3:55

So just to confirm here, somebody could have dry eye disease

3:59

without doing any kind of digital work at all.

4:01

So, it's a condition in its own right, isn't it?

4:04

So perhaps you might want to just give us a quick explanation of what

4:07

causes dry eye disease.

4:09

Yeah, look, the most common dry eye disease is a, what we call,

4:13

an evaporative dry eye.

4:14

So it's the tear film evaporating a lot more quickly than is ideal.

4:19

Most often it's caused by the meibomian glands, the little oil glands

4:22

that sit in our eyelids.

4:24

And what they're meant to do is every time we blink, it squeezes the gland and we get

4:27

this thin oil film over the top of our tear layer which prevents

4:31

the tears evaporating too quickly.

4:33

So a combination of good complete blinks that refresh

4:37

tear film over the front of the eye, plus those glands actually expressing

4:40

the oils, is what a healthy tear film is.

4:43

So if you start to lack those oils being spread, you then rely on— really relying

4:48

on making sure you've got a very good blink rate, which then gets exacerbated

4:52

obviously when we're not blinking as much on computer screens.

4:54

So, so you've actually got something wrong with the glands that either need support

4:58

through artificial tears, lubricants, those sorts of things,

5:01

or treatments to try and get— decrease inflammation in the eyelids, you know,

5:05

using therapies to try and get the meibomian glands working better

5:07

and producing a better bloody oil.

5:09

And so that's when you're getting into a dry eye disease state where we

5:12

actually need to be doing therapeutic things to improve how

5:15

the tears are actually working.

5:16

So it's the, uh, it's like the, it's the quality of the, the tear film,

5:20

um, mostly that's the, the root cause of dry eyes.

5:23

That's the issue, and that's what we've got to look at in terms of people

5:26

complaining about discomfort when they're using the computer.

5:28

I mean, is it just from the activity itself, and,

5:31

and there are things that you're doing where you're kind of overdoing it?

5:34

Um, and so yes, maybe it's a natural consequence of doing

5:37

that work, and if we recognize that, what are the things that we

5:39

can do to try and reduce that?

5:41

Versus the activity highlighting an underlying problem like an early dry

5:47

eye disease or some sort of binocular vision problem.

5:50

Okay, well, if a patient comes to you and says, 'My eyes feel tired and gritty

5:56

by 3 PM in the afternoon when I'm at the computer,' what clues help you work

6:01

out whether dry eye is the main issue or if it's something else?

6:05

You do a thorough history, and sometimes you can get overlapping symptoms.

6:08

So for example, if someone said, you know, 'Things go blurry and I have to blink

6:11

to keep them clear,' the first thought is, well, that sounds a bit like a dry eye.

6:15

It could also be a sign of binocular visual dysfunction,

6:17

but if you get kind of filmy, cloudy kind of symptoms coming through,

6:22

that's what it kind of looks like when the tear film dries up.

6:24

If you get a watery eye, so what actually happens is if the oily

6:28

part of your tears is not working well, you get some tear evaporation,

6:31

then you get an extra additional response from the watery part of your tear, so you

6:35

end up with an excessively watery eye.

6:37

But if someone was saying they tend to get more double vision and things running

6:41

together, then I'm going to start thinking, okay,

6:43

we've got more of binocular visual dysfunction in this particular situation.

6:47

And where it gets kind of a bit blurred and messy, that's when we have to then

6:50

move on to, you know, obviously doing a full assessment to kind

6:53

of understand what's, you know, what's going on.

6:56

Is the tear film looking good?

6:57

How does the binocular system look?

6:58

Probably another thing is, you know, asking people, you know,

7:01

if you've used an artificial tear or a lubricant, how much

7:03

relief do you get from that?

7:05

And so if it's something where, look, it feels great for the rest of the day

7:09

once I use a drop, then you will be dealing with just some

7:13

mild dryness that's occurring from the activity itself.

7:16

So you ask a lot of questions about the types of environments or situations

7:20

they are in where they feel these, these kinds of symptoms.

7:24

So like, I guess, I guess like office air conditioning could be something

7:27

that plays a part in as well. Absolutely.

7:30

So air conditioning, how many hours a day are you spending,

7:34

is your tasks varied, are you getting up and moving around,

7:36

or are you doing sort of several hours straight, and what sort

7:39

of device are you using?

7:40

Is it something that you look at like an iPad down here,

7:43

or is it up like a desktop?

7:44

We might ask questions around, do you experience the same kind

7:47

of symptoms if you go for a long drive?

7:49

And so if we're driving in the car, then we have similar kind of potentially

7:53

similar environments to the office where on a long drive we've got the air

7:57

conditioning on, we're staring straight ahead.

7:59

If it's a drive where we're really needing to pay attention,

8:02

we're probably not blinking as much.

8:04

And if so, someone's getting similar symptoms in that environment,

8:07

then you start to kind of go, okay, we're dealing with some sort

8:09

dry eye caused by the activity itself, or we've got signs of an underlying dry

8:15

eye disease that we might need to manage.

8:17

So blurred vision could be a symptom of either digital eye strain or

8:22

dry eye disease, is that right?

8:23

Yeah, and if you look at the digital eye strain as a very global term,

8:28

that could cover various things like focusing problems, eye tearing problems,

8:32

and the tear film drying out and being unstable.

8:35

Then both vision problems controlling your focusing and control your eye tearing

8:39

and dryness both end up causing blur.

8:42

And so that's what we need to kind of tease out, is where's

8:44

the blur coming from?

8:45

Is it from the front surface, or is it something around how you're able

8:49

to actually sustain focus and sustain the two eyes working together

8:52

while you're doing that near work?

8:53

I think this is maybe something that a lot of people don't realize,

8:56

is that dry— a dry eye condition can actually cause blurred vision, can't it?

9:02

So it like it impacts the clarity of— it's not just an irritation,

9:07

it's not just feeling like something like you've got a bit of sand in your eye,

9:10

that can actually impact on the quality of your vision as well.

9:13

Oh yeah, and you see that amplified when you've got a contact lens wearer and if

9:16

they experience any dryness, then particularly with certain type

9:20

lenses, it can really drop how clearly you see, so that kind

9:23

of amplifies the problem.

9:25

What I like to do is describe to people the cornea, the front surface of the eye,

9:29

it actually looks like frosted glass effectively.

9:32

And if we, if we take the old way of frosting glass where you're not using

9:36

a film, you're actually etching the surface, and you put water across the,

9:40

across that etched surface, it fills in the gaps, and the water film

9:44

and the glass become one optical surface.

9:46

And you, you start to get clarity through that glass again because you, you've

9:51

sort of provided to fill in the gaps.

9:53

And so the tear film on the front of the eye is very, very similar.

9:55

It provides this really smooth optical surface.

9:59

And so if it evaporates and disappears, you're starting to get this dry,

10:03

kind of relatively rough surface, even though we consider corneas to be

10:06

a lot smoother than the skin on elsewhere on their body.

10:09

Okay, well, you mentioned contact lenses, so that's maybe a good segue to the next

10:13

question, which is like,

10:16

how do contact lens wearers perhaps feel

10:22

more aggravated symptoms from dry eye or digital eye strain for that matter?

10:27

Yeah, well, contact lenses are, depending on the quality of your tear film

10:31

and depending on the actual lens material, they all vary in their ability

10:35

to hold water to the front surface.

10:37

And that's where contact lens manufacturers spend an enormous amount

10:40

of money and time on research in trying to maintain wettability, as they call it,

10:46

across the day, because the contact lenses do actually place more strain, for want

10:52

of a better word, on the tear film itself.

10:54

So it's asking your tear film to be in better condition than it would

10:58

be if you weren't wearing them.

10:59

And so you can have someone who might be relatively symptom-free not wearing

11:03

contact lenses because they've got a dry— like, early signs of dry eye

11:07

that they're not quite aware of.

11:09

You put a contact lens on and now they're starting to sort of feel the symptoms.

11:12

And so that's part of the troubleshooting we go when we're looking at people

11:15

being candidates for contact lens wear.

11:17

And then if you start to get into some of the complicated

11:20

Optics Digital Marketing, you know, you've obviously got

11:22

lens that is designed to hug and sit in front of the eye, but it does move,

11:26

and we want a little bit of movement, but too much movement starts

11:29

to move the optics around.

11:31

It starts to cause buckles and wrinkles in the front surface of the lens,

11:34

and so you get some general sort of aberrations from those sorts of events.

11:39

Some lenses need to sit the right way in terms of being tilted on the eye

11:43

the right way, and so if your eye starts to dry out,

11:45

then your eyelid starts to grab the lens and spin it and turn it, and so you

11:48

can get this kind of variable vision.

11:50

And then finally, you get into the really complex optics of multifocal lenses,

11:54

which is what I wear.

11:56

And, you know, if I've got a particular brand, you know, I have preferred brands,

12:01

brands I do okay, and I've got some brands that I don't wear because for me

12:05

the vision drops off as soon as they get even a little bit dry, whereas other

12:10

brands where not as noticeable.

12:11

And it's because they've got these highly complex optical surfaces in order to give

12:16

you that depth of focus that you might want to enjoy if you're trying

12:20

to avoid wearing glasses like I do.

12:21

I know it's probably a lot less common these days, but

12:24

For anyone who does wear the rigid contact lenses, so-called hard contact lenses,

12:31

is dry eye a much bigger— or does it make wearing those type of lenses

12:35

much more problematic?

12:36

It can be a bit mixed.

12:37

Certainly you can sometimes use soft lenses as an example,

12:41

is almost like a bandage lens where some people might actually get less symptoms

12:45

when they're wearing the lens because there's less of the actual eye itself

12:48

being exposed and there's moisture being held underneath the lens.

12:52

Certainly what will tend to happen with the hard lenses,

12:54

not necessarily that they dry out quicker.

12:57

It's more that they move around a lot more on the eye, and so they're a bit more

13:01

susceptible to issues occurring once you start getting dryness.

13:04

The biggest challenge with the hard lenses is getting people to get comfortable

13:07

initially to wear it, and so any additional factors like dry

13:11

eye, it's more about how well they adapt to the lens in the early stages rather

13:15

than is there a big difference in long-term dryness between one

13:18

and the other, because we can actually use one or the other on a particular

13:22

patient to solve a comfort issue.

13:24

So it's not a sort of black and white you know, hard lenses are better

13:27

or soft lenses are better.

13:29

It really depends on the situation, but a lot of it comes down to what's

13:32

the journey like when you're first, you know, getting used

13:35

to wearing contact lenses.

13:37

And there are things like hybrid contact lenses, aren't there, which maybe, you

13:41

know, give you the best of both worlds?

13:43

Yeah, and so there are again another complex lens where they've got a hard

13:47

center and a soft surround, and they're designed to reduce the feeling

13:51

of that movement that you from a hard lens by having a soft skirt on the outside.

13:56

And they tend to, being a complex lens, they tend to get reserved for complex

14:00

corneal cases rather than a problem solver for everything.

14:04

Okay, well, if you're finding this information useful,

14:08

then please take a moment to like the video and subscribe to the channel.

14:12

It really helps us to continue producing educational content like this one.

14:17

All right, Paul, so For someone working at a screen all day,

14:22

what kind of breaks actually help realistically?

14:25

You know, I hear people talking about the 20-20-20 rule.

14:28

So what's your take on this?

14:30

As my sort of little bit of a bent to kind of go, well, what does the research say?

14:34

And I did look up that 20-20-20 rule because it's a cute thing to say because

14:38

of the American way of saying 20/20, which we call 6/6 sort of vision.

14:42

And certainly, you know, a 15-20, 15 10 to 20-minute bit of work time with a

14:47

micro-break is shown to improve comfort.

14:51

And a micro-break is looking away and blinking.

14:53

Now, the practicalities of whether you remember to do that or

14:56

not is the next question.

14:58

If you're in deep work, then half an hour, 40 minutes can blow by pretty quickly

15:02

before— and you realize that you've missed that break.

15:05

So I think it's much more practical to go into sort of half an hour, 45,

15:10

or even an hour-long break.

15:11

And take a decent 5 or 10 minute break away from the near work.

15:14

That's been shown to be again positive for visual symptoms, and it's also

15:19

a positive thing for your whole body.

15:21

Physically getting up and moving around is a good thing, and it gives you a moment

15:25

to do some proper considerations around what's happening with your tear film.

15:29

And so I think we've discussed before, I had a patient invent a term called

15:33

mindful blinking as we were describing some of the things that we like to do.

15:37

And I've seen some people with some fairly pretty dry, dry looking eyes where our

15:41

only thing thing that we did to help manage it

15:45

and to like reverse what I was seeing on the front surface was get her doing

15:49

decent blinks regularly through the day.

15:53

And so that becomes that be mindful about how well you're blinking

15:56

and how often you're blinking.

15:57

So in those 5 or 10 minute breaks, you, you do, you know, 10 to 12 good blinks.

16:02

And a good blink is making sure that the eyelids come together.

16:04

We're not talking about squeezing the eyes, but making sure that the eyelids

16:07

actually come together, because that's the moment those oil glands are squeezed.

16:11

And that would— and we— and as the eyelid comes up, it spreads those

16:14

nice oils across the tears.

16:16

It also means that the eyelids are coming together and making sure the tear film is

16:19

coating the entire front of the eye, because it tends to be that lower

16:22

half of the eye that dries out.

16:24

Because it's not only that we don't blink fully, is that we do

16:27

these little half blinks.

16:28

So during those breaks, we're making sure we get good 10,

16:32

10 to 12 good blinks as part of that break, you know, get up and moving around.

16:36

So, you know, I think 45 minutes is a good sort of trade-off between needing to get

16:40

the work done and and actually doing a proper job at having a break.

16:44

And that break doesn't mean, uh, turning away from your computer and,

16:47

uh, and looking at your iPhone.

16:49

Yes, your iPhone either, does it?

16:51

Yeah, yeah, that's right, moving from one device to another.

16:53

Yeah, absolutely.

16:55

So, so you'd recommend like actually getting up, moving around the office,

16:58

getting outside if you can, or at least looking out the window if you, if you can?

17:01

Yeah, absolutely.

17:02

Look, the visual system, our whole being, our whole development as we're developing

17:05

as kids, that vision is very much attached to moving through the world..

17:09

And so that's a really important piece, is that we get up and move.

17:12

It's, it's, you know, we know it's part of the whole myopia

17:16

story of people becoming more and more short-sighted is they're

17:18

not outside moving enough.

17:19

And so, you know, on a more minor level, you know, but probably, you know,

17:24

just as chronic, is, is the eye strain that we're getting

17:26

from doing so much computer work and just the basic things of ocular discomfort.

17:30

Well, I'm proud of the fact that I quit smoking decades ago,

17:34

but maybe that was one of the, one of side benefits of being a smoker is

17:38

actually forced to go outside every now and again.

17:41

Trading off lung health for eye health.

17:42

Yeah, yeah, that's right.

17:44

It's, it's a very minor side benefit, maybe.

17:46

Yeah.

17:47

All right, let's talk about blue light glasses.

17:49

So a lot of people may assume that blue light glasses are the answer

17:54

to screen-related eye problems, and how, how much of that is fact and how

17:58

much of it is myth, you think?

18:00

Yeah, look, if we look back at the, my understanding of the original blue

18:03

light kind of, pardon the pun, the energy that got put behind it was

18:09

around cumulative blue light over the years being harmful to retinal

18:13

tissues and things like that.

18:14

And I'm not really convinced that the evidence is going to stand up

18:18

over the longer term that that's actually the case.

18:20

Now, there's certainly people who, when you block blue light,

18:23

do find things more comfortable.

18:25

If you have the kind of blue light lenses that are available through

18:30

a prescription from the optometrist.

18:32

And if I've got a pair of glasses here, which they're not blue light,

18:35

but you wouldn't know because they don't look— these don't look any different.

18:38

If they were blue blocking glasses or regular glasses, you wouldn't notice any

18:42

difference because of the anti-reflection coating.

18:44

And the blue blocking is at the very, very short wavelengths that adds

18:48

a bit of yellowness to the tint.

18:50

But some people generally find that a bit more comfortable,

18:53

and if you do, go for it.

18:54

The challenge is when you're buying stuff online, we don't know if they're TGA

18:58

approved, we don't know if they've been created from a particular body of research

19:02

to sort of demonstrate that they actually have any sort of meaningful impact

19:05

on actually filtering out the harmful, whatever harmful blue

19:08

light's meant to be there.

19:10

From a, you know, minor side benefit, if you are getting dry eye related

19:15

symptoms from digital eye strain, then what a pair of,

19:18

any pair of glasses does is creates a humid environment in front of your eyes,

19:21

so you actually block the tears from escaping more quickly.

19:25

And so, you know, one of we've seen experiments in the past

19:28

when they're looking at dry eye status, actually getting people to wear goggles as

19:31

a way of measuring how much moisture builds up behind the goggles.

19:34

And so glasses can certainly do that to another degree.

19:38

So wearing anything like that does provide a more humid environment for the eyes.

19:42

But in terms of the actual yellow filter, hard to say, particularly when you're

19:46

buying sort of cheap ones online that may not be sort of necessarily approved.

19:50

And then I'd be concerned about them— people wearing them out in the sunlight

19:54

and exposing themselves to more UV.

19:56

That's probably a bigger issue once go outside wearing something like that.

20:00

Whereas, you know, if it's been made and prescribed to you,

20:03

then it's going to have UV filters and, and those sorts of things in them.

20:07

Probably the other aspect of blue light is, you know, what it does

20:10

to your sleep patterns.

20:11

And if you're concerned about that, then there's a couple

20:13

of strategies around that.

20:15

One is that you— most of our devices, we can go into settings and create night

20:19

mode kind of settings, which reduce the amount of blue light.

20:21

And the other thing is get off your device an hour to 1.5 hours before bed.

20:26

There's a great way of making sure that blue light is not impacting on your sleep.

20:30

You mentioned about glasses, there are actually, I think they're called

20:33

moisture chamber frames that you can get that actually kind of like create a sealed

20:39

environment around your eye if you've got extreme dry eye symptoms.

20:44

Yeah, look, it wouldn't surprise me that, it's not something we sort of use in our

20:47

practice, but it wouldn't surprise me those sorts of things are available

20:50

particularly for people who might have more extreme dry eye disease.

20:54

If you've got someone who is dealing with Sjögren's syndrome which you know,

20:57

which is a much more severe dry eye than— and I'm pretty sure from memory I've seen

21:01

things where people can add stuff to frames to help, yeah,

21:04

not quite create a goggle, but that kind of idea where you're just

21:07

trying to reduce the amount of airflow behind so you build up humidity.

21:11

Just to wrap up, Paul, if there's one key message that you'd like

21:15

viewers to take away from today's discussion about dry eye and digital

21:19

eye strain, what would it be?

21:21

Well, I'm going to be greedy, I'm going to say two.

21:24

so don't underestimate how good a break can be from doing your work.

21:29

We kind of go, yeah, yeah, whatever, but taking breaks is really, really a,

21:33

you know, an important strategy for both dry eye and eye strain.

21:36

And the second part is, if you have tried things like lubricants

21:39

and you're taking breaks and you've still got persistent symptoms,

21:42

don't sit on those.

21:43

Go and get your eyes properly tested.

21:45

Have someone actually work out whether you've got the beginnings of a dry eye

21:48

syndrome or some sort of binocular vision problem that's actually

21:52

creating those things.

21:53

And, you know, they might, might not say, might not sound like much,

21:57

but those small little sort of aggravating things, you know,

22:01

if you're spending 8 hours a day on the computer,

22:04

really important for those things, for your overall quality of life

22:06

and stress levels to get on top of it.

22:08

So, you know, so taking breaks and then pursuing care if, um, if the, those

22:14

sort of home strategies aren't working.

22:16

Are an important piece.

22:18

All right, and so for viewers who'd like to learn more or book an appointment,

22:23

how can they get in touch with Harmony Vision Care at Varsity Lakes?

22:28

www.harmonyvisioncare.com.au.

22:29

We're also on Facebook and the other socials.

22:33

If you're in the Gold Coast area, then you can call us on 0755205900,

22:40

and obviously you can look at other links on this channel information.

22:44

And, uh, once again, if you've found this conversation helpful,

22:47

then please subscribe and maybe share it with somebody who spends a little bit too

22:53

much time staring at a computer screen.

22:55

All right, well, thanks for watching.

22:57

Um, thanks, Paul, and we'll see you all next time.

23:00

Bye-bye.