Fundamental Shift in Use of Vision. Fundamental Shift in Use of Vision. Visual Fatigue Syndrome. Widespread Computer Use. Work, Home, School:

(1)

Visual Fatigue Syndrome

The Price of

Today

Today’

’

s

Near and

Intermediate

World

Dr. Kris

Kerestan

Fundamental Shift in Use of

Vision



Past: Primarily used Distance vision



Today: Primarily use

Intermediate/Near

Fundamental Shift in Use of

Vision

Most professionals Most professionals require extended require extended intermediate and near intermediate and near viewing viewing Accountants Accountants Attorneys Attorneys Engineers Engineers Business administrators Business administrators Architects Architects Computer technology Computer technology Designers Designers Medical/allied health Medical/allied health

Widespread Computer Use

Work, Home, School:

•

• Over 55% use computers at workOver 55% use computers at work •

• Out of 100 million in US –Out of 100 million in US – 50% of 50% of workday is spent at a computer workday is spent at a computer

(2)

Widespread Computer Use



 73% of U.S. adults use computers73% of U.S. adults use computers 

 71% access the internet71% access the internet 

 In a recent study of more than 1,000 patients 25 In a recent study of more than 1,000 patients 25

years and older, respondents averaged between years and older, respondents averaged between 6 and 7 hours per day at a computer

6 and 7 hours per day at a computer

In the past decade, computer use among

children in the United States has increased

dramatically

dramatically…

…

Consider these statistics:



 94 percent of American families with children 94 percent of American families with children

have a computer in the home with access to have a computer in the home with access to the Internet

the Internet

Widespread Computer Use



 The amount of time children ages 8 to 18 devote The amount of time children ages 8 to 18 devote

to entertainment media (including computer and to entertainment media (including computer and video games) each day has increased from 6.19 video games) each day has increased from 6.19 hours in 1999 to 7.38 hours in 2009

hours in 1999 to 7.38 hours in 2009

Widespread Computer Use



 In 2009, 29 percent of American children ages 8 In 2009, 29 percent of American children ages 8

to 18 had their own laptop computer, and kids in to 18 had their own laptop computer, and kids in grades 7 through 12 reported spending an

grades 7 through 12 reported spending an

average of more than 90 minutes texting on their average of more than 90 minutes texting on their cell phones

(3)

Visual Fatigue

Today

Today’

’s visual demands place greater

s visual demands place greater

stress on near and intermediate vision

than ever before

than ever before…

…



 More than 70% of 143 million Americans who More than 70% of 143 million Americans who

work on a computer are affected by visual fatigue work on a computer are affected by visual fatigue on a daily basis according to the AOA

on a daily basis according to the AOA



 Studies show that eye strain and bothersome Studies show that eye strain and bothersome

visual symptoms occur in up to 83% of computer visual symptoms occur in up to 83% of computer users users

Visual Fatigue

Approximately 10 million Approximately 10 million

eye exams are performed

annually in the U.S. due to

vision problems related to

computer use, making it a

major public health issue

71% of those patients

examined already wear

corrective lenses for

myopia, hyperopia,

astigmatism or presbyopia

but still have visual fatigue

and eye strain

Visual Fatigue



 Computer use Computer use

is the most is the most common common source of source of visual strain visual strain

and fatigue, but cell phones, and fatigue, but cell phones, handheld electronic devices handheld electronic devices and video games also may and video games also may cause visual strain

cause visual strain

A visual condition consisting of a sum of

TREATABLE symptoms including:



Headache



Loss of focus



Blurred vision



Burning of the Eyes



Tired Eyes

What is Visual

Fatigue Syndrome?

(4)

What is Visual

Fatigue Syndrome?

A visual condition consisting of a sum of

TREATABLE symptoms including:



Red Eyes



Dry Eyes



Neck and Shoulder Pain



Overall general Fatigue

“

The complex of eye and vision

problems related to near work

which are experienced during or

related to computer use.

”

----

American Optometric Association

What is Visual

Fatigue Syndrome?

VFS

-

On the Rise



50

50 -

-

90% of computer users

experience visual symptoms



22% of computer users experience

musculoskeletal disorders

Contributing Factors

–

The

Patient



Condition of the patient

’

s eyes and

visual system



Working environment



Work habits



The eyes leading the body



Too much staring, not enough

blinking

(5)

Contributing Factors

Contributing Factors –

–

The

Computer



Position of the monitor

•

• Distance from the eyes

Distance from the eyes

•

• Location relative to eye level

Location relative to eye level



Nature of the image

•

• Difficult to focus on pixel images

Difficult to focus on pixel images

•

• Eyes tend to relax to a point beyond the

Eyes tend to relax to a point beyond the

screen (resting point of accommodation)

•

• Constant refocus needed, tiring the eyes

Constant refocus needed, tiring the eyes

Contributing Factors

–

The Office

Environment



Inappropriate lighting



Reflections from the computer screen

or outside sources



Poor ergonomics



Dry and poor quality of office air



 During eye health During eye health

exam, must screen exam, must screen

every patient every patient by by asking specific asking specific questions regarding questions regarding their computer use, their computer use, hobbies, reading and hobbies, reading and any

any visual fatiguevisual fatigue symptoms

symptoms that may that may accompany these accompany these activities

activities



 May use a specificMay use a specific

patient questionnaire patient questionnaire or add to case or add to case history form history form

Detection and Diagnosis of VFS based on

patient

SYMPTOMS

…

What Specific Questions should we

_{ask our patients?}

1.

1. How many hours per day are you on a computer How many hours per day are you on a computer or other electronic device at work and/or home? or other electronic device at work and/or home? 2. Do you have any hobbies that require you to use 2. Do you have any hobbies that require you to use

your eyes up close? your eyes up close?

3. Do your eyes ever feel tired or strained while on 3. Do your eyes ever feel tired or strained while on

the computer? the computer?

4. Do you ever have blurred or out of focus vision 4. Do you ever have blurred or out of focus vision

while on the computer? while on the computer?

(6)

What Specific Questions should we

ask our patients?

5.

5. Do your eyes ever feel dry or get red while using Do your eyes ever feel dry or get red while using the computer?

the computer?

6. Do you experience headaches with computer or 6. Do you experience headaches with computer or electronic device use or while engaging in your electronic device use or while engaging in your hobby?

hobby?

7. Do you experience neck or shoulder pain while 7. Do you experience neck or shoulder pain while

using the computer? using the computer?

8. Do you feel overall fatigue during or after 8. Do you feel overall fatigue during or after

computer use? computer use?

Detection and Diagnosis of VFS

based on

CLINICAL FINDINGS

…

What clinical tests will aid the doctors and What clinical tests will aid the doctors and

staff in the diagnosis of VFS? staff in the diagnosis of VFS?

•

•Refractive errorsRefractive errors •

•Binocular visionBinocular vision •

•Accommodative Accommodative problems

problems •

•Presbyopia and nearPresbyopia and near vision correction vision correction •

•Dry eyesDry eyes

Diagnosis of VFS

VFS

Symptoms

+

Clinical findings

=

VFS diagnosis

Who is affected by Visual Fatigue

Syndrome?



 Emmetropes, Myopes, Emmetropes, Myopes,

Hyperopes & Astigmats Hyperopes & Astigmats



 Non-Non-presbyopes & presbyopespresbyopes & presbyopes 

 Spectacle lens wearersSpectacle lens wearers 

 Contact lens wearersContact lens wearers 

 Refractive surgery patientsRefractive surgery patients

Visual Fatigue can affect anyone

at any age…Child, Teen, Young

to Mature Adult

(7)

Treating VFS using

Computer Eyewear

1.

1. Single Vision LensesSingle Vision Lenses

or Readers or Readers

2.

2. ““AntiAnti--FatigueFatigue”” LensesLenses

for Non

for Non--PresbyopesPresbyopes

2.

2. Near Variable Focus Near Variable Focus

“

“ComputerComputer”” LensesLenses for Presbyopes for Presbyopes

4.

4. Progressive lensesProgressive lenses

Single Vision Computer Lenses



 In the past most lenses prescribed in computer In the past most lenses prescribed in computer

glasses were Single Vision because not many glasses were Single Vision because not many other lens options were available

other lens options were available



 Although SV lenses sometimes are an adequate Although SV lenses sometimes are an adequate

solution for near tasks, the range of focus is solution for near tasks, the range of focus is extremely limited to one set distance. Patients extremely limited to one set distance. Patients are unable to walk around or see other distances are unable to walk around or see other distances in the office, so must constantly be taking on and in the office, so must constantly be taking on and off

off

Single

-

Vision Lenses



Most presbyopes wearing single vision

lenses for reading and up

lenses for reading and up-

-close work have

close work have

blurred mid

blurred mid-

-range vision

range vision



One solution is to move mid-

One solution is to move mid

-range objects

range objects

closer, but that is not always possible



Another solution is an extra pair of single

vision lenses for mid

vision lenses for mid-

-range use; usually

range use; usually

purchased from a pharmacy

Single Vision Lenses



 For those ages 13 to 29, add +0.50 to their For those ages 13 to 29, add +0.50 to their

spherical distance correction spherical distance correction



 For those age 30 and over wearing Single Vision, For those age 30 and over wearing Single Vision,

add +0.75 to their spherical distance correction add +0.75 to their spherical distance correction



 These glasses are intended for use at These glasses are intended for use at

computer/intermediate distance only and will computer/intermediate distance only and will cause blur at all other distances

cause blur at all other distances **Always Rx with AR coating** **Always Rx with AR coating**

(8)

Distance Zone Near Zone Unwanted Blur

Progressive Lenses



 Progressive lenses usually require more Progressive lenses usually require more

power change from top to bottom and power change from top to bottom and therefore are not the best option therefore are not the best option



 Consequently, they produce more blurConsequently, they produce more blur 

 As adds increase, there is less stable and As adds increase, there is less stable and

narrow power in intermediate area narrow power in intermediate area

General Purpose PAL

Optometrists

’

Quotes

“

“Up until now I

Up until now I basically gave up on

basically gave up on

these patients

that have visual fatigue

symptoms. I didn

symptoms. I didn’

’

t feel like I had

anything to offer them in my clinical

arsenal.

arsenal.”

”

“

“There really are not

There really are not

enough products

for us to pick from

for dealing with

some of these accommodative

disorders that we

disorders that we’

’re identifying.

re identifying.”

”

“

The progressives don

The

progressives don’

’t cut it

t cut it

for those

patients who spend great deals of time

on the computer.

on the computer.”

”

Increasing Demand for New

Computer Lens Technologies



Despite significant regular computer use

by over 75% of the population, only 3% to

4% of Americans today wear eyeglasses

to relieve vision problems at a computer.

Why??

• Not receiving appropriate diagnosis

and treatment

• Not aware of lens options available

Newer Lens Solutions for

Visual Fatigue Syndrome



Addresses the following:

•

• Different diagnoses by the ODDifferent diagnoses by the OD such as accommodative VFS such as accommodative VFS in pre

in pre--presbyopic patients or presbyopic patients or true presbyopic VFS

true presbyopic VFS •

• Must have lens options to treat a Must have lens options to treat a broad range of patient

broad range of patient types and ages

(9)

Newer Lens Solutions for Visual

Fatigue Syndrome



New category of lenses under

“

“Visual Fatigue

Visual Fatigue”

”



Anti

-Fatigue

-

Fatigue

——A primary wear pair for A primary wear pair for

non

non--presbyopes or emerging presbyopes presbyopes or emerging presbyopes who suffer from VFS

who suffer from VFS



Variable Focus “

Variable Focus

“Computer

Computer”

”

---A A

task specific lens for presbyopes who task specific lens for presbyopes who suffer from VFS

suffer from VFS

“

Anti

_Anti

-

_-

Fatigue

_Fatigue

”

_”

Computer Lens

Solution

Treating VFS with

“

Anti

-

Fatigue

”

Lenses

Who is it for?



 Non-Non-Presbyopic patients sufferingPresbyopic patients suffering

from VFS symptoms from VFS symptoms



 Emerging PresbyopesEmerging Presbyopes 

 Individuals who use near vision for Individuals who use near vision for

extended periods doing activities such as extended periods doing activities such as reading, texting, electronic device use, reading, texting, electronic device use, paperwork, etc.

paperwork, etc.

Treating VFS with

“

Anti

-

Fatigue

”

Lenses

How do they work?



 Use as the primary pair to replace a patients Use as the primary pair to replace a patients

single vision lenses single vision lenses



 Provides a slight +0.60D Provides a slight +0.60D ““power boostpower boost”” in the in the

lower part of the lens lower part of the lens



 Provides greater patient comfort and reduced Provides greater patient comfort and reduced

visual fatigue than standard single vision visual fatigue than standard single vision

correction by allowing the eye muscles to relax correction by allowing the eye muscles to relax thereby decreasing the accommodative effort thereby decreasing the accommodative effort

(10)

“

Anti

-

Fatigue

”

Lenses

How do they work?



 Sustains the accommodative effortSustains the accommodative effort 

 Aspheric, so little or no distortionAspheric, so little or no distortion 

 Compatible with all frame types => 23 mm BCompatible with all frame types => 23 mm B

***Only available with Non

***Only available with Non--glare***glare***

Concept:



 SV lens with distance vision (exactly as in a SV lens with distance vision (exactly as in a

regular SV) w/a slight power variation regular SV) w/a slight power variation (+0.6 D) in bottom part of lens to give (+0.6 D) in bottom part of lens to give some comfort in near vision, preventing and some comfort in near vision, preventing and relieving visual fatigue

relieving visual fatigue



 +0.6 D power variation reached at 12mm +0.6 D power variation reached at 12mm

from center = down gaze of 26 from center = down gaze of 26°°

“

“Anti

Anti-

-

Fatigue”

Fatigue

”

Lens

“

Anti

-

Fatigue

”

Fitting & Mounting



 Center pupil fitting heightCenter pupil fitting height   13 mm minimum13 mm minimum   23 mm minimum B 23 mm minimum B measurement measurement 

 Monocular Distance PDsMonocular Distance PDs

“

Anti

-

Fatigue

”

Lenses

Key Patient Types



35 to 45 year olds just starting to

need slight plus for reading



Myopes or Hyperopes aged 13 to 34

years when they indicate VFS

symptoms of tired eyes, eye strain

or others

(11)

“

Anti

-

Fatigue

”

Lens

Essilor Anti

Essilor Anti--fatiguefatigue is only lens is only lens available in this available in this category category

Variable Focus

“Computer” Lens

Solution

Treating VFS with Variable Focus

“

Computer

”

Lenses

Who is it for?



 Task specific wear by Presbyopes whoTask specific wear by Presbyopes who

spend extended time at intermediate and spend extended time at intermediate and near viewing

near viewing



 Meant to be used as a second pair toMeant to be used as a second pair to

complement a patient

complement a patient’’s primary pair ofs primary pair of progressives

progressives

Treating VFS with

“

Computer

”

Lenses

How does it work?



 Intermediate VisionIntermediate Vision : Wide and comfortable : Wide and comfortable

“

“Computer Computer ““lenses provide full vision at intermediate lenses provide full vision at intermediate

distance by accommodating a patient

distance by accommodating a patient’’s natural posture s natural posture and workplace ergonomics

and workplace ergonomics



 Near VisionNear Vision : Smooth transition: Smooth transition

Wide near area that provides a smooth transition

for looking at the keyboard or documents



 Distance VisionDistance Vision : Functional and efficient: Functional and efficient

Offers clear vision at full distance within an office setting

to most patients, allowing for effective sight at all distan

(12)

“

Computer

”

Lens



 Contains an intermediate field of vision designed Contains an intermediate field of vision designed

to offer full coverage of the screen area. to offer full coverage of the screen area.



 Lens power specifically tailored for clear screen Lens power specifically tailored for clear screen

vision and frequent movements from keyboard to vision and frequent movements from keyboard to screen to surroundings.

screen to surroundings.



 The design was based on user observations; The design was based on user observations;

lenses let you keep a natural posture: a 30

lenses let you keep a natural posture: a 30°° angle angle between the positions for viewing keyboard and between the positions for viewing keyboard and screen.

screen.

These lenses should NOT be worn for driving or other distance viewing activities.

“

Computer

”

Lens

-

Benefits

• Comfortable viewing at distance, intermediate, and near • Wide clear intermediate area

• Small area of viewing at distance to see across office

• No more head tipping – correct intermediate power is placed at center of lens

These lenses should NOT be worn for driving or other distance viewing activities.

Near Variable Focus (NVF) Lens

“

“Computer

Computer”

”

Design

“

Computer

”

Lens

Key Patient Types



 Any presbyope indicatingAny presbyope indicating

VFS symptoms VFS symptoms



 Also perfect lens for Also perfect lens for

activities at intermediate activities at intermediate and near

and near –– hobbies,hobbies, remodeling, sewing, auto remodeling, sewing, auto work, Optometrists, work, Optometrists,

Optometric Assistants, etc. Optometric Assistants, etc.

(13)

“

Computer

”

Lenses Available



 Essilor “Essilor “ComputerComputer”” LensLens 

 Zeiss “Zeiss “BusinessBusiness”” and and ““AccessAccess””

Computer Lens Computer Lens



 Shamir “Shamir “OfficeOffice”” Computer LensComputer Lens

Specific Fitting techniques and

Lens parameters available through

Sales Reps.

Next Steps

Put a plan together to:

•Identify patients and educate them on lens options • Prescribe the best lens for their needs

• Become comfortable using Anti-Fatigue and Computer Lenses to treat their VFS

Additional Steps to Relieve VFS



Use Proper Lighting

Decrease both bright sunlight coming in and Decrease both bright sunlight coming in and

replace bright overhead fluorescent lighting with replace bright overhead fluorescent lighting with full spectrum bulbs or floor lamps

full spectrum bulbs or floor lamps



Minimize Glare

AR coating, Anti glare screen, paint white walls AR coating, Anti glare screen, paint white walls a darker color in matte finish

a darker color in matte finish

Additional Steps to Relieve VFS



Adjust screen

Brightness, contrast, text size and color Brightness, contrast, text size and color



Blink more

Blink more -

-

5X less when using computer5X less when using computer

Rewets eyes to decrease dryness and irritation Rewets eyes to decrease dryness and irritation Artificial tears

Artificial tears



Relax Focusing

20

20--2020--20 rule 20 rule -- look away from computer Q 20 look away from computer Q 20 mins, 20 ft away for 20 sec.

(14)

Additional Steps to Relieve VFS



Frequent breaks

Two 15 min breaks plus 4 mini 5 min breaks Two 15 min breaks plus 4 mini 5 min breaks

through day through day

Stand up, walk around, stretch arms, legs, back Stand up, walk around, stretch arms, legs, back and neck

and neck



Modify Work Station

Copy stand next to monitor, screen 20

Copy stand next to monitor, screen 20--24 inches 24 inches from eyes and 10

from eyes and 10--15 degrees below eyes, good 15 degrees below eyes, good posture