How to talk about digital eye strain to patients

Mouqy Eyewear optometrist, Zi Xuan, on digital eye strain and how he discusses the topic with patients


As we move into an increasingly digital world, the importance of discussing digital eye strain during patient consultations grows. Here, optometrist at Mouqy Eyewear, Zi Xuan, shares his experiences on how best to approach this topic

As our modern visual habits change, the conversations we have with patients also need to evolve. With 50% of UK adults looking at screens for 11 hours or more a day, there’s little wonder that the effects of digital eye strain (DES) are more commonly showing up during eye consultations.

As eye care professionals, I feel it falls into our role to help patients understand DES and how they can manage it. After all, there is still a great deal of public confusion and misinformation on the topic.

Some patients have a vague idea of the negative effects of being ‘glued to a screen,’ whilst others may be entirely unfamiliar with DES or what they can do about it.

What is DES?

DES refers to a group of ocular and vision related symptoms that develop as a result of using digital devices for a prolonged period of time. DES occurs as the visual demands of the task exceed the visual abilities of the individual to perform them comfortably.

In the modern world, the common culprits tend to be smartphones, tablets and laptops. Folks who spend two or more continuous hours a day on a digital device tend to have higher chances of developing DES. And, as reliance on such devices increases (particularly after COVID-19 lockdowns), so grows the prevalence of DES.

DES is also sometimes known as computer vision syndrome, and may manifest in problems such as blurry vision, eye strain and dry eye.

How to discuss DES with patients

Talking outrightly about DES to patients can help them recognise the symptoms and better manage the root causes. The steps I use are outlined as below:

1. Taking a LOFTSEA history before conducting the eye test

To facilitate your discussion of DES, it’s important to first take a complete eye history to understand the patient’s visual requirements for near work.
Conduct a thorough LOFTSEA (location, offset, frequency, type, self-treatment, effects, associated symptoms) history of the patient to rule out any other possible ocular diseases. This will also help you understand factors that can affect digital eye strain, including the time of occurrence, and any environmental factors.

2. Understanding the patient’s lifestyle and daily habits

Following the eye history, it’s important to ask the patient about their lifestyle, hobbies, and daily habits. This conversation typically takes place during or directly following the eye exam.

Pay particular attention to understanding the patient’s digital devices usage time per day, and identifying the regular activities that can further worsen their DES.
This will also help you to determine whether the patient requires any special lenses for their regular prescription.

3. Consult with the patient on DES

Naturally, some patients may be worried that their DES symptoms may arise from an underlying disease. They may be fearful that they suffer from presbyopia and that they’ll require reading glasses at a younger age than expected.

As optometrists, aside from conducting eye exams, I feel it’s our responsibility to not feed into anxiety or panic over digital eye strain. Taking the time to have a thoughtful in-depth consultation with the patient is so important.”

Remember - most patients may not easily be able to escape heavy digital device use, since many rely on it for their work or education.

When consulting with patients, my recommendations are:

  • Explain DES clearly to the patient, and assure them that it’s an extremely common syndrome caused by multiple factors (eg a patient’s lifestyle) and isn’t limited to any age range
  • List all the possible causes that may contribute to the worsening of the patient’s DES. This may include time usage of digital devices, illumination, and the set-up in home or offices (for example, the distance between the patient and their monitor, or the tilt of the monitor screen)
  • Let the patient know DES is becoming increasingly common these days due to factors such as increasing computer usage post-COVID. More adults, teenagers and students than ever before have been pushed towards working from home or taking virtual meetings.

4. Discuss the patient’s options for handling DES

Your recommendations for the patient for managing DES should be decided on a case-by-case basis.

Recommendations may include tips on better illumination, posture, and adopting healthier habits such as the 20-20-20 rule to help their eyes rest.

You might also recommend digital tools to reduce screen time, such as the Digital Wellbeing feature (Android) and App Limits in Screen Time (iOS).

The bottom line should be that patients can still use digital gadgets, but should avoid doing so continuously, since doing near work without taking periods of rest will ultimately strain their eyes.

It’s also important to manage patients’ expectations. After all, DES cannot be cured in a short period of time.

Explaining DES prevention to patients

Explaining how to prevent DES is similar to explaining how to manage its symptoms. In both cases, maintaining visual hygiene is crucial to help prevent DES and to maintain good eye health.

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