What Is “Good Visual Hygiene”?

TRANSCRIPT

0:04

During the COVID pandemic, we all got to appreciate the importance of good physical hygiene.

0:12

If you recall, we all did the infamous elbow handshake for a few years.

0:17

And while it is important to keep your face clean, and particularly to keep the area around your eyes free from grease, bacteria,

0:25

and other contaminants, when optometrists talk about Visual Hygiene, they are talking about something quite different.

0:34

If you want to know how to practice visual hygiene and what it means, keep watching.

0:39

Because once again, I'm talking with Paul Graham. Paul is a leading Gold Coast optometrist with over 30 years of experience,

0:47

and he's the owner of Harmony Vision Care at Varsity Lakes. But first of all, who am I? My name is Paul Sallaway

0:54

i'm the owner of Optics Digital Marketing. We're an agency that helps independent optometrists to grow their practice.

1:00

So hi, Paul. Good to see you again. Likewise, Paul. How are you? Very well, thanks. So it's Good Friday as we're recording this.

1:08

So it's probably just you, me, and the Easter Bunny that are working today, I feel. That's right.

1:13

So do you have any Easter theme happening in your practice there this weekend?

1:19

Yes, the staff are really good at paying attention to getting on to the various themes.

1:25

So there's eggs and chicks and bunnies all scattered throughout the dispensing area.

1:32

When I think of... When most people think of Easter, they think of rabbits, and of course, rabbits love to eat carrots.

1:38

And if what our grandparents told us is true, carrots are good for your eyes, so it's probably like a good It's a good opportunity there.

1:47

I think carrots are rich in vitamin A, but that only helps up to a point, doesn't it?

1:53

Well, that's right. And I think kids are more interested in hearing about the chocolate at Easter than carrots.

1:58

It's a message falling on deaf ears, I suspect. Yeah, I don't blame them. I don't like carrots much.

2:04

There's a particular type of chocolate, apparently, that has a chemical in it that's meant to be good for myopia control.

2:11

Really? Yeah. But you've got to eat kilos and kilos of it for it to be beneficial.

2:18

That's a great excuse. All right. Well, yeah. So visual hygiene.

2:25

So a lot of us spend reading or working at a screen,

2:33

but most of us don't think much about how we're sitting or how far away

2:38

things are from our eyes. So what is good visual hygiene, actually?

2:45

And how does that relate to posture and distance and lighting and those kinds of things?

2:50

And listening to your introduction, I think visual hygiene

2:56

is a bit of an odd word. And I think it's an old phrase that we've had around for decades.

3:01

Maybe visual ergonomics might be a more appropriate phrase because it really is about understanding how you're using your body,

3:09

including your visual system in a potentially inefficient way. I think I say it time and time again, we've got this

3:17

wonderful visual system that's designed for us to move through a three-dimensional space. And instead, what we do is we sit still looking at two-dimensional objects,

3:26

screens, books, those sorts of things. And so we're fighting the the natural physiology for us to move when we're

3:33

doing these more modern things. And it's one of those problems

3:43

that can sneak up on you. It almost becomes that chronic problem where it's the cumulative

3:50

time doing things, and you're busy, you're concentrating, maybe you're getting a monetary or joyful reward out of the work that you're

3:59

doing while you're sitting in a screen or reading a book, and you don't notice the negative impacts on what's happening in your visual

4:07

system and the rest of your body. So this includes things like lighting, doesn't it?

4:14

So this is something that I actually worry about with my own kids sometimes when I

4:19

see them in dark rooms looking at their digital devices. And so should I be concerned about that?

4:26

Is that something that actually could have potential negative

4:32

repercussions on their vision? Yeah, look, the idea is that it could create more strain.

4:38

I mean, I'd be interested to see some research on a screen that's providing some illumination, what it does to the pupil compared to if you're reading a book.

4:46

Interestingly enough, e-readers are more comfortable to read visually than a backlips of LCD screen.

4:53

So there's something in the contrast. I don't know if it's the lighting. But generally, if you look at, say, the presbyopic population,

4:59

So people are celebrating anniversaries of their 39th birthday and starting to have near vision problems.

5:05

All of them go, I'm fine if I'm reading in good light. And it just goes to show how much difference

5:11

good lighting can make around the effort of seeing so that your brain is able to...

5:17

It's got much more light energy going in, your pupil is smaller, your depth of focus is greater.

5:22

So there's so many benefits to having good light simply because it just makes everything more efficient.

5:27

And so, again,not having enough light, not having the room light on, not having bright task lighting means that your focusing system

5:35

has to work a lot harder, which means that you're opening your self more fatigue.

5:40

And fatigue is one of those things that can creep up over time, and then you can't understand why you're falling asleep while you're doing your

5:47

work or getting headaches, eye strain, those sorts of things. And you mentioned presbyopia.

5:53

So that it affects our ability to focus

6:00

focus on near material, doesn't it? Yeah. So basically throughout your life, and again, I'll bring out the old playful

6:10

model here, the lens inside your eye here, it actually... I'll just get to try and get my fingers out of the way there.

6:16

This lens actually is a flexible lens. And so the muscle that we see around that contracts and the lens flexes

6:25

and changes shape in order to be able to bring our focus in. That lens continues to grow throughout our life, so it gets bigger

6:32

and it gets harder in the center. And so it's not an issue around the muscles getting weak. It's about that lens not responding to what our muscle wants to,

6:40

responding to what the muscle is trying to get it to do as we age. So it gets less flexible.

6:45

And so you become more reliant on trying to get more light in because at the same time as the lens getting harder, it gets less clear.

6:52

It's more denser, which is what eventually turns into a cataract. And so it's a process where our ability to focus at near it peaks sometime in our

7:01

teenage years and then gradually declines. And when we hit late 30s through late 40s, it starts to impact right where we do

7:08

everything in that 40 to 60 centimeter mark. So it means that we become more conscious of making a difference in that situation

7:18

to get through that density and also to make the pupil small. And so maybe there's something here that you could clear up for me,

7:26

and that is, so people who are naturally myopic, presbyopia can still affect them. Is that what you're saying?

7:34

Correct. Yeah. So if we look at myopia as a growing longer of the eyeball,

7:39

and the way to look at it is that it is actually an adaptation to allow near work

7:46

to occur more easily, assuming that you haven't put a spectacle correction on or contact lenses to restore distance vision.

7:54

So if we imagine wearing a contact lens to correct your distance vision,

7:59

You're still having to then make the lens change shape in order to focus up close. And so if you're presbyopic and short-sighted, that's when you start

8:08

to find that you're having to lift up your reading glasses to help use the myopia to act like an inbuilt reading lens.

8:15

I say to people who are myopic, it's almost like you built your own pair of reading glasses. It's built in.

8:20

And when you correct your vision with glasses or contact lenses, you're effectively seeing nearly like everyone else.

8:27

And therefore, you can end up with the same problems noticing that the lens no longer changes shape very easily, and you have to start

8:35

getting into multifocal lenses, or like I said, taking glasses on and off.

8:40

Okay. Well, so you mentioned about reading devices.

8:45

I actually bought one of the very first Kindles on the market back

8:50

years and years ago. But these days I use an iPad, and I do actually feel like the Kindle,

8:58

it was a more comfortable reading experience experience for me. So can you talk us through your opinion about the different kinds

9:06

of devices, Kindles, iPads, smartphones,

9:13

even curved monitors on the desktop? How do you think those things can influence our visual comfort?

9:20

Yeah. So if we start with the e-reader, so the electronic ink is the actual screen

9:26

comes to the actual surface rather than being behind a plane of glass. It has a contrast, a much higher contrast, almost like actual print on a page.

9:37

So despite electronic screens being high definition, they just don't match

9:42

the contrast that we find comfortable from a book or an e-reader. So that's why a e-reader is typically more comfortable.

9:51

You only need to watch people using devices. So if you look at device size, you watch people on a phone

9:57

and it's always this distance away. And even if you've got presbyopia and you find your focussing more difficult,

10:02

you tend to still pull your phone closer than you would a tablet or a screen. So having a bigger screen means that you're going to hold it further away.

10:10

That's less demand on your focussing system and your convergence.

10:17

So that could be helpful. There's a different theory going on with myopia that maybe computers

10:24

are a little worse than small screens. So I'm interested to see watching that space. And I'm not I'm not sure why the theories around that, but that's still early days.

10:34

I think that comes into some of the other things we'll talk about in terms of just taking breaks from what you're doing.

10:40

And you can theorize that if you're reading a book, you're taking these natural breaks as you're flipping the page.

10:46

If you're on a device that has other apps, then there's always the distraction of heading into other apps where your attention is captured and you're looking

10:57

at the screen for a lot more often compared to tapping

11:02

pages if you're reading a book on a kindle lap or on the screen. And it doesn't matter what device you're using, you have to pay attention to what

11:11

you're actually doing with the rest of your posture. And you got that rounded shoulder and pushing neck forward

11:19

that we see a lot of... You look at a lot of young people walking around, and it's almost become part of their structure to have that change in their body shape.

11:26

And so the same things that we might recommend to look after your visual

11:32

ergonomics is the same for your posture. The old classic rule was you make a fist, stick it on your chin,

11:40

stick your elbow out, and that's your natural working distance. And what you basically wanting to do is create a right angle and not

11:47

have it closer but further away. And so that becomes that natural distance, having the page parallel to your face.

11:54

So if you've got a tablet or a book on the table, you have it tilted up towards you so that you're not having to lean over the desk

12:02

and create that strain on your posture. One of the things I see when I go into the electronics shops

12:10

is the curved screens, which I gather are popular with gamers.

12:16

I've never got one of them myself, but is there any evidence that those

12:21

curved screens are beneficial? Yeah. I've got my camera mounted on a curved screen

12:29

at the moment, and I get a lot of questions from patients, how do you find the curved screen? And the story was I needed a new bigger screen towards the end of, I think, COVID,

12:39

coming out of COVID, and I wanted a screen of a particular size. And the only thing I could get is a curved screen.

12:46

And I'm like, okay, well, I remember Curve TV's being a bit of a fad, and they disappeared.

12:52

And I thought, well, it's interesting that a decade later, why are Curve monitors still around?

12:59

And doing what I do, I went, well, let's look at the research. And the research actually indicates that within a certain range of radii

13:07

of curvature, they do reduce eye strain. And I have to say, I do find it more comfortable to use the Curve screen.

13:14

Once you You got to get used to the Curve, you got to make sure you're front onto it. So there's a few things there. But yes, there are little things you can do,

13:22

like adding a Curve screen to help with improving your visual comfort. Absolutely.

13:28

And I guess one One of the advantages of digital material is that you can

13:34

usually adjust the font size. So for older people, if you are struggling,

13:41

you can increase and bump up the fonts, whatever it is that you're looking at. So I guess that is one potential advantage.

13:48

And it can be a little bit of a trap, but yes, effectively, you're taking the demand off the focusing system.

13:54

I'm run by the model that most of our visual fatigue starts with the focusing system. Anything you can to help the focussing system be more relaxed

14:02

and is going to help. I think your brain still registers how far away that object is, though.

14:08

So there is still some fatigue that can occur. So it's a bit of a short term strategy. So again, the presbyopias come in and say, look, I get by, by making

14:16

the font bigger on my phone. But if you ask them, they're still getting some fatigue.

14:21

And everyone's journey into presbyopia is a little different. For me, I didn't notice things being blurry up close.

14:29

So I just caught myself holding my breath and not reading as much. And it showed that there was a bit more effort going on.

14:36

So some people, it will be more of a strain and an effort, whereas others, it's a definite, I have to push things further away or

14:42

it's blurry and I just can't focus. And so it's that extra effort that some people don't realize is something we

14:50

sometimes need to provide some relief for, not just whether it's clear or not.

14:55

And part of our slogans are good visions more than clear And it's in the background

15:02

of that is how much effort are you using in order to see?

15:08

Okay. Well, I guess the definition of fatigue is when you're forcing your body to do

15:14

something repetitive that it's not meant to do. And so I've heard you talk about the importance of taking breaks.

15:24

So can you just refresh us on what is this 20/20/20 rule?

15:29

Okay. How important is it really for taking breaks? Is digital eye strain something that people should take seriously?

15:37

Absolutely. And there's an interesting one about if digital eye strain is just normal,

15:42

it doesn't need management. And it's a bit like saying, if 80-90% of people get digital eye strain,

15:48

then there's nothing to do. It's just a consequence of using computers and whatever else. And I go, well, if 90 % of the population becomes obese, do we consider that normal

15:56

and something we just don't have to deal with anymore? So there's two parts to it.

16:01

Yes, digital eye strain is a consequence of our lifestyle, but that doesn't mean we can't do something about it to make it more comfortable and have less impact.

16:08

And there's a lot of the 20/20/20 rule has been around for a very long time.

16:14

And I think it It's a cute cliche. It rolls off the tongue very easily. I don't think it's all that effective or practical to do.

16:23

So effectively, it's look away to 20 feet, which is six meters.

16:28

And then 20/20 is where is the American version of a site measurement? We use 6/6 here in Australia.

16:35

And so look away 20 feet for 20 seconds every 20 minutes. And the practicality of actually getting that done is one thing.

16:43

So are you going to remember it every 20 minutes? Is looking away for 20 seconds enough?

16:49

And I also argue that is just looking away enough or is there more that we need to be

16:56

doing in terms of getting up and moving around, having that That optic flow

17:01

that we know is a natural part of how our visual system gets the information, that movement of the world across the back of our eyes, or the images of the world

17:10

across the back of our eyes. And I've seen an article recently that starts to question the 20/20/20 rule.

17:16

So it's nice that it's out there because now people are starting to question it and push back on it. And so my guidelines are more like every 40 to 60 minutes, you can get a reasonable

17:28

amount of work done in a 40 to 60 minute time span.

17:33

Set yourself a Timer, and take a break for 5 to 10 minutes that involves walking around.

17:38

Get moving. Not only is that good for your visual system, it's good for the rest of your posture.

17:44

And if you look at ergonomic research, they look at both digital eye strain and postural strain together when they're looking at their research.

17:53

And 30 to 60 minutes is about the right window. For vision, taking a break every 15 minutes actually does something,

18:02

but it's just not practical. I can't see people doing it enough to make a difference.

18:08

Whereas at 30 to 60 minutes, you're getting into that 5 to 10 minute break of moving around, making yourself Do

18:16

you think looking out the window or physically going outside might help as well, getting some natural sunlight?

18:23

Absolutely. I think the ideal would be, get outside. Don't take your phone with you.

18:28

Don't start looking at your phone. You're not really escaping anything then. So you've got the ideal.

18:34

And anything that move towards that is good. So even just moving around the office if you can't get outside is great.

18:41

Even being able to look out the window is great. You want to be able to change that focus and recalibrate your visual system

18:48

to further distances. I think there are some apps available where you can set yourself a reminder,

18:56

like every 20 minutes, some alarm goes is off where you get a message to remind you to take a break, but especially in a busy office

19:04

environment, I think that would be problematic. Yeah, yeah. And I think there's one named after a tomato.

19:12

Pomado? Pomado? There's an app, which is an extension of Chrome that does that thing. And you just need to do whatever works for you.

19:20

I think the critical part is committing to the actual taking the breaks.

19:25

And I think of the mindful blinking for dry eye as part of that is that you've got to commit to...

19:32

When we look at a screen, we don't blink as much. We tend not to blink well.

19:38

So rather than the eyelids coming together, we do these half blinks, and that creates dryness across the bottom of the eye.

19:44

And So I had remarkable improvements in people's dry eye when they're not necessarily aware of how dry their eye is by getting to do mindful blinking or blink

19:54

awareness, where you take a break, you make sure that you blink a dozen times, making sure that the islands actually meet, and you do

20:01

that a dozen times a day. And that's tricky part is committing to a multiple times a day to do it for several weeks.

20:08

And I think for taking the ergonomic breaks is the same thing we've got to commit to.

20:14

Well, let's talk about dry eye, so a bit more about that. So why is it important that your eyelids actually meets?

20:21

So it's got something to do with the expression of oils from the eyelids.

20:27

Is that right? Yeah, there's a number of things. So you've got the They call it the lid wiper action. So the goal of blinking is to spread the tear film across the cornea because

20:36

the cornea gets its clarity from the tear film. Because our corneas, as much as they're considered clear,

20:42

are really almost like frost glass if they didn't have the tear film in front of it. They also get our corneas also, the cells on the front of our eye and

20:50

the cornea gets the oxygen from the air. So it's part of providing fresh oxygen and also sweeping away byproducts

20:58

from metabolism, also sweeping away anything that's in the way. And so you have this lid mechanism to do that.

21:06

But yes, there are muscles and oil glands in the eyelids that only get squeezed and activated when the eyelids actually come together.

21:13

And those oils are good to stop what is probably the most common form of dry eye

21:18

is called evaporative dry eye, where the tear film is evaporating because there's not an oil slick on the top of it.

21:24

They're trying to stop the aqueous part heading off into the air.

21:30

Yes. I think the analogy that makes sense in my mind is when you put a

21:38

cover on a pool, like a pool cover. So I think one of the benefits is that it reduce evaporation of the water.

21:45

So the oil, that oil surface is important for that reason, isn't it?

21:53

Absolutely. Yeah. And so part of taking breaks is not just giving your posture and your visual system

21:59

a recovery, it's getting that tear film and the cornea keeping it healthy.

22:05

When I started to learn about dry eye, I can understand that people who do

22:12

suffer from dry eye get that irritation. But I didn't really fully understand why some people also get blurry

22:19

vision from dry eyes. But I think your analogy of the frost glass is a good one.

22:25

So do you mind just going over that again? Yeah. So if the traditional , if you have a frosted glass that's done

22:32

by etching the surface where you've sanded the surface or you use some chemical to make it rough, and then you put water on that over

22:40

that etched glass surface, the water fills in the gaps and creates this new clear surface, and the glass becomes clearer again

22:49

while the water is sitting over the top. And so effectively, that's what the cornea is like. The other thing that can happen, too, is that if you've got a buildup

22:57

of excessive mucus in your tear film, that can make things look a bit filmy. So people will say their vision's filmy or ghosty,

23:05

and it can either be ghosty because the tear film is evaporated and we're looking through a frost glass effectively, or you've got this excess mucus hanging

23:13

around because it's not been cleared by good blinking. There was an interesting stat that people were talking about that 30 %

23:19

of prescription remakes are because of dry eye problems. Really? Yeah, it was something huge.

23:24

Yeah. It's something that we're a lot more mindful of in this practice because we've

23:29

been caught with someone, with a few people where we go around

23:34

circles during a test wondering what's going on, why we can't get an accurate prescription.

23:40

And then you look at their tear film and it's messy. So their vision is constantly changing.

23:45

And it makes it hard for them to make judgments of what's better one or two.

23:50

Well, okay. Maybe that's a good segue into my last question here, which is about lenses.

23:56

And do the types of lenses that you wear have a noticeable difference for how comfortable your eyes feel.

24:05

So whether that be like single vision lenses, progressive lenses, even blue light blocking lenses.

24:12

Yeah, absolutely. And let's start with a blue light, I guess. I mean, a big deal was made about the dangers of blue light,

24:20

and I think it's been toned down and maybe even debunked to a certain degree.

24:27

And I said to people, look, if you're worried about blue light, Right, let's take blue light from disrupting your sleep patterns.

24:33

I mean, part of the advice is stop using your device an hour before bed. And then you've interrupted the problem with excessive blue light.

24:41

Honestly, if you find the yellowing that the blue light lenses does to your vision, when you're using something, you find it more comfortable, use it.

24:49

It's not something that we promote unless someone is particularly light sensitive or

24:54

has found some benefit. We always demonstrate the difference. A lot of people don't like the yellowness. But like I said, I think there are other ways of managing

25:00

blue light rather than just through lenses. The aggressive lenses. So if you need a multifocal, so you have a distance portion in the top,

25:08

and then you have this gradual increase in reading prescription down to the bottom. Sometimes they can be challenged to use with a on the top screen

25:15

like I've got in front of me. And you see people doing this in order to use the reading segment,

25:21

and that has obvious issues with what happens with your neck. And it changes the way that you're aligning your eyes as well.

25:28

And so if If you are someone who uses a computer for many, many hours a day and you're doing it in blocks of several hours,

25:36

then it's worthwhile having a lens that's dedicated, that's set up for your office environment.

25:42

And we call them extended focus lenses or office lenses. And there's plenty of them around where they provide a much wider reading area

25:51

for the computer screen, wider reading area for what's on your desk. You don't have to move your head around as much to find the right area.

25:59

The minus is, is it not as clear for distance vision? Often you can get ones that will provide a little bit of a window of

26:05

clear vision for being able to see someone walk in the door of your office. And then you have your regular progressive for when you're not at the desk.

26:14

And so We use the analogy of it's like having different shoes for different purposes.

26:19

You don't necessarily wear your hiking boots everywhere.

26:25

Do we call them jandals or thongs? Flip flops? They're not sure how international our audience is, but you don't

26:34

wear those everywhere. You can't wear them into the pub. And so different glasses for different purposes.

26:40

And that's part of our job as an optometrist is finding out, okay, what screens are you using?

26:46

What devices are you doing? We've got some people who are happy to have a separate pair of glasses just

26:52

for their computer and then a different one just for their reading glasses because they don't want to have to mess around with looking through

26:59

different parts of the lens. They just go single vision. So we listen and discuss these things with each patient so they get

27:06

a solution that suits their particular situation and lifestyle. And then we have a look at what if you can see the It's screened clearly,

27:17

but you get uncomfortable. And discomfort can be something obvious where I'm getting the frontal headaches,

27:23

I'm getting eye strain, maybe it's going a bit blurry, or it could be more things So you blame on other things.

27:31

So I'm losing concentration. I'm nodding off a little bit. I'm really struggling to keep my thoughts together while I'm doing that.

27:38

So eye strain can pop up in both ways, the more obvious eye-related symptoms,

27:44

and then more about performance. And we can certainly use lenses as what I call an ergonomic tool.

27:51

It's eye ergonomics. And if we accept that ergonomics for our posture, so having an ergonomic keyboard,

27:59

ergonomics I mean, mouse, curved screens. I'm sitting on an ergonomic stool because it's better for your posture.

28:06

If we accept all of those things are good for your whole body, why would the visual system be any different?

28:11

And so we can actually use lenses as an It's an economic tool to help people be more comfortable.

28:17

So you don't have to put up with eye strain. And for some people, that's all they need. Others might need more help.

28:24

They might need some rehabilitation. We might find that a lens is not enough to reduce their symptoms,

28:29

and we might be getting into some retraining, some vision therapy, those sorts of things. There's a lot you can do with a lens. Okay.

28:38

Well, on that note of thinking about ways

28:45

that we can improve our visual ergonomics. So we might wrap up there, I guess.

28:52

So any last thoughts, Paul, before we finish today?

28:58

I'll probably back to what we're So again, good vision is more than clear sight. So having good vision means looking after your visual system, taking those breaks,

29:05

work on your working distance, consider using bigger screens. If you're getting symptoms, you don't have to put up with it.

29:12

Go and see an optometrist and get a check. There are things that we can do to make that lifestyle choice more comfortable.

29:18

And sometimes it requires more than just a pair of glasses as well. So there's lots of things we can do to help you be more efficient at work.

29:28

And I can just remind people how to get in touch with you there at Harmony Vision Care.

29:33

so harmonyvisioncare.com.au is our website. You can find more information there. You can ask questions.

29:39

You can book appointments through the website. If you want to talk to one of the staff, it's 07-5520-5900.

29:48

And yeah, so website or phone call. All right. We do have, I always forget, we have a Facebook page.

29:57

Of course, yes. And a YouTube So if you're watching this on YouTube right now,

30:04

don't forget to hit the like button. Give us the thumbs up. Subscribe if you want to be notified when there are more videos like this released

30:11

because it all helps us with the YouTube algorithm. So all right.

30:17

Well, let's wrap up there, I guess. So thanks a lot once again for your time, Paul. Thanks, Paul.

30:23

All right. So until next time, everyone. Have a happy Easter. Bye for now..