Beyond the screen: caring for our eyes: 2022 kids pandemic eyes for XS Nuvali.pdf
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A lay forum lecture about digital eye strain, dry eye disease in children, myopia and stopping myopia, other refractive errors, common causes of eye consults, some eye myths, the truth about blue light filter in glasses, and a little bit about presbyopia and cataract for parents of Xavier School Nuvali, July 31, 2022
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Beyond the screen: caring for our eyes: 2022 kids pandemic eyes for XS Nuvali.pdf
- 1. Beyond the screen: Caring for our eyes Alvina Pauline D. Santiago, MD @ XS Nuvali, July 31, 2022
- 2. Some of the Materials Brought to you by
- 3. Outline Dry Eye Asthenopia Headache Fluctuating Vision Digital Eye Strain 1 Myths 4 Myopia 2 Nature vs Nurture Myopia Epidemic Controlling Myopia Common Eye Consults 3 Refractive errors Allergic conjunctivitis Blepharitis Sty/Hordeolum Keratoconus Teachers' Eyes 5 Digital Eye Strain Dry Eye Disease Presbyopia Cataract
- 6. Digital Device Exposure • By age 3: • 68% of children regularly use computers • 54% online activity • 2020: Pandemic figures are definitely higher Shepard AL, Wolffson JS, Digital eye strain: prevalence, measurement and amelioration. BMJ Open Ophthalmol 2018 Apr 16;3(1):e000146.
- 7. Digital device exposure Shepard AL, Wolffson JS, Digital eye strain: prevalence, measurement and amelioration. BMJ Open Ophthalmol 2018 Apr 16;3(1):e000146. The Vision Council. 2016 Digital Eye Strain Report. •Multitasking using digital devices •use 2 or more devices simultaneously • 87% of age 20-29 (UK) • 70% of Americans
- 8. Digital Eye Strain Synonyms • Asthenopia • Visual Fatigue • Computer Vision Syndrome • Video Terminal Display Syndrome • Video Display Terminal Syndrome Shepard AL, Wolffson JS, Digital eye strain: prevalence, measurement and amelioration. BMJ Open Ophthalmol 2018 Apr 16;3(1):e000146.
- 9. Digital Eye Strain defined • Physical eye discomfort after >2 h using digital screens The Vision Council. 2016 Digital Eye Strain Report
- 10. Digital Eye Strain •Prevalence: up to 50% of computer users •In children, pooled prevalence of about 20% •Impact on learning and school performance • Shepard AL, Wolffson JS, Digital eye strain: prevalence, measurement and amelioration. BMJ Open Ophthalmol 2018 Apr 16;3(1):e000146. • Vilela MAP etal. Prevalence of asthenopia in children: a systematic review with meta-analysis. J Pediatr 2015; 91-320-325.
- 11. Vergence anomalies (eye misalignment and fusion anomalies) • Motor disorders • Convergence insufficiency • Decompensated eye misalignment • Poor vergence facilities • (Reduced blur points, break points) • Patients with binocular vision problems experience greater discomfort during prolonged use of the eyes. • Shepard AL, Wolffson JS, Digital eye strain: prevalence, measurement and amelioration. BMJ Open Ophthalmol 2018 Apr 16;3(1):e000146. •
- 12. Symptoms of Dry Eye Syndrome Accommodative / Binocular Vision Stress • Headache • Blurred vision • Nausea & Vomiting • Breakdown of eye misalignment External Eye Symptoms • Blinking • Tearing • Dry eyes • Burning sensation • Photophobia • Itchy Eyes Shepard AL, Wolffson JS, Digital eye strain: prevalence, measurement and amelioration. BMJ Open Ophthalmol 2018 Apr 16;3(1):e000146. http://www.techaddiction.ca
- 13. Dry Eye Disease (DED) in Children • Longer daily duration of digital device use increased DED in Children • Cessation of use (4wks!) in 7-12 y improved DED • Improved tear break up time • Improved punctate corneal epithelial erosions Moon JH et al. Association between video display terminal use and dry eye disease in school children. J Pediatric Ophthalmology & Strabismus 2014; 51: 87-92. Moon JH et al. Smartphone use is a risk factor for pediatric dry eye disease according to region and age: a case control study. BMC Ophthalmol 2016; 16: 188
- 15. https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/computer-vision-syndrome?sso=y Figure from PSPOS Infographic Am Optom Assoc Recommendation
- 16. 20.20.20
- 17. Digital Eye Strain •Bigger screens • TV > desktops > laptops > mobiles •Spreadsheets compromise Figure from PSPOS Infographic
- 18. Digital Eye Strain • Neck & shoulder pain • Poor posture https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/computer-vision-syndrome?sso=y
- 19. Recommendations • Top of monitor at eye level • Monitor at arm’s length • Use a document stand https://ssep.com.au/best-posture-for-sitting-at-a-desk-all-day/
- 21. Distancing • Improper viewing distance https://encrypted-tbn0.gstatic.com/
- 22. Digital Eye Strain • Improper lighting • Glare from digital screen Figure from PSPOS Infographic
- 23. Blinking • Squinting to see better increased blink rates if conditions can be improved by squint • Pinhole effect for refractive errors • Reduce glare • If squinting will not cause an improvement, (small font size, low contrast), patient squints more and with reduced blink rates Patel et al. Effect of visual display unit use on blink rate and tear stability. Optom Vis Sci 1991; 68: 888-92. Freudenthaler N et al. Characteristics of spontaneous eyeblink activity during video display terminal use in healthy volunteers. Graefes Arch Clin Exp Ophthalmol 2003; 241: 914-920 Sheedy et al. What are the visual benefits of eyelid squinting? Optom Vis Sci 2003; 80: 740-44. • Reduced blink rates observed with computer use • Patel: 18.4 to 3.6 blinks • Nakamori: 22 to 7 blinks • Increased cognitive demand exacerbates visual stressors, like refractive errors and low contrast https://img.wonderhowto.com/img
- 25. Digital Eye Strain Causes Solutions Uncorrected (mis-corrected) refractive error Proper correction Altered blink Blink Awareness Exercises Intense light exposure Reduced light luminance, reverse polarity Close working distance Comfortable distance 16-30 in Small font size Increase font size Coles-Brennan et al. Management of Digital Eye Strain. Clin Exp Optom 2019; 102: 18-29
- 26. Experimental Evidence Optical Coherence Tomography •Choroid becomes 16 um thinner reading black text on white background •Choroid becomes 10um thicker reading white text on black background THINNER CHOROID = MYOPIA
- 27. Night Mode Ang night mode ay isang feature na makikita sa mga gadget. Ito ay nakakatulong upang mabawasan ang liwanag na nagmumula sa screen ng iyong cellphone, tablet o computer. Ang ilaw mula sa iyong screen ang sanhi ng eye strain, panunuyo ng mata at iba pa. #EyeCare #NightMode
- 28. Outline Dry Eye Asthenopia Headache Fluctuating Vision Digital Eye Strain 1 Myopia 2 Nature vs Nurture Myopia Epidemic Controlling Myopia
- 30. Definition: Myopia spherical equivalent objective refractive error is -0.50 or worse Joint report WHO-BHVI, 2017 https://img.webmd.com
- 31. Definition: High Myopia • Uncorrected acuity 6/172 • Worse than blindness threshold of <3/60 (6/120) in better eye Joint report WHO-BHVI, 2017 spherical equivalent objective refractive error is -5.00 or worse ◦ Axial length > 26 mm Cannot see even the biggest letter on chart
- 32. Definition: Pathologic Myopia (degenerative myopia, malignant myopia) vPresence of vision threatening changes in retina vPosterior staphyloma vHigh myopia + myopia- related fundus abnormalities such as myopic macular degeneration or glaucoma Joint report WHO-BHVI, 2017 https://webeye.ophth.uiowa.edu
- 33. Consequences of High Myopia MYOPIC MACULAR DEGENERATION MYOPIC CHOROIDAL NEOVASCULARIZATION RETINAL DETACHMENT GLAUCOMA CATARACTS https://www.researchgate.net https://imagebank.asrs.org https://www.thelancet.com https://journals.plos.org https://endmyopia.org/
- 36. Causes of Myopia Optical: Peripheral Defocus Intense near work Not enough time spent outdoors Genetics https://www.ahaparenting.com http://www.pointsdevue.com https://s3-ap-southeast- 1.amazonaws.com https://ugc.futurelearn.com
- 37. MYOPIA OCULAR MORBIDITY AMBLYOPIA STRABISMUS HEAVY EYE SYNDROME https://m4.healio.com
- 38. MYOPIA and VISUAL ACUITY without correction Degree of myopia Visual acuity -0.50 6/9 to 6/12 -1.00 6/15 -2.00 6/36 -3.00 6/60 -4.00 4/60 -5.00 3/60 -6.00 2/60
- 39. Conventional Treatment for Myopia Single vision spectacle correction (Concave lenses) Contact Lenses Refractive Surgery Intraocular Collamer Lens https://ae01.alicdn.com https://www.aao.org
- 40. Causes & Treatment of Myopia Optical 20.20.20 Go out! Genetics Modification? https://www.ahaparenting.com http://www.pointsdevue.com https://s3-ap-southeast- 1.amazonaws.com https://ugc.futurelearn.com
- 41. http://cdn.coverstand.com/55224/571097/article_assets/2c24c81b54d706a59fbd2d4d3752cc5ab1dc27bc.jpg
- 42. The promise is not to stop PROGRESSION per se but retard the rate of progression.
- 46. • Myopic parents • Retinopathy of Prematurity • Indoor • Near work • Higher Education
- 47. https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/computer-vision-syndrome?sso=y Figure from PSPOS Infographic
- 48. 20.20.20
- 51. Taiwan study: Recess outside classroom trial • Population: • G1, 693 children • 267 intervention group • Intervention: • outdoor up to 11 hrs weekly • Outcome: • change in spherical equivalent • Change in axial length after 1 year https://e5rxtr4t5ah.exactdn.com/wp- content/uploads/2019/01/taiwan-with-kids-header.jpg Wu PC, Chen CT, Lin KK, Sun CC, Kuo CN, Huang HM, Poon YC, Yang ML, Chen CY, Huang JC, Wu PC, Yang IH, Yu HJ, Fang PC, Tsai CL, Chiou ST, Yang YH. Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial. Ophthalmology. 2018 Aug;125(8):1239-1250. doi: 10.1016/j.ophtha.2017.12.011. Epub 2018 Jan 19. PMID: 29371008.
- 52. Taiwan study: Recess outside classroom trial • Results: Intervention group: • Less myopic shift: 0.35 vs 0.47D • Less axial elongation: 0.28 vs 0.33 mm • 54% lower risk of rapid myopia progression Authors recommended: Outdoor exposure with strong sunlight not necessary, lighter light intensity should be considered https://e5rxtr4t5ah.exactdn.com/wp- content/uploads/2019/01/taiwan-with-kids-header.jpg Wu PC, Chen CT, Lin KK, Sun CC, Kuo CN, Huang HM, Poon YC, Yang ML, Chen CY, Huang JC, Wu PC, Yang IH, Yu HJ, Fang PC, Tsai CL, Chiou ST, Yang YH. Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial. Ophthalmology. 2018 Aug;125(8):1239-1250. doi: 10.1016/j.ophtha.2017.12.011. Epub 2018 Jan 19. PMID: 29371008.
- 53. Singapore National Myopia Prevention Program OBJECTIVE: Delay onset and progression of myopia • Public education • Captain Eye • Mass Media • Vision Screening for early detection and management • Intervention: • Increase exposure to green spaces • Increase exposure to natural daylight • Increase outdoor time • Increase physical activity • Sports • Reduce near work and computer work • Parental control app “plano” Karuppiah V, Wong L, Tay V, Ge X, Kang LL. School-based programme to address childhood myopia in Singapore. Singapore Med J. 2021 Feb;62(2):63-68. doi: 10.11622/smedj.2019144. Epub 2019 Nov 4. PMID: 31680176; PMCID: PMC8027142. https://www.nationsonline.org/gallery/Singapore/Merlion-at-the-Singapore-River.jpg
- 55. Vision Screening: Philippine Eye Research Institute
- 57. Historical Manage- ment Under correcting myopia: believed to slow down myopia due to reduced accommodation Studies show under correcting ACCELERATED myopia progression Optical blur SHOULD NOT be used to slow progression RGPs no evidence of effect on myopic eye growth 1.Walline JJ, Lindsley K, Vedula SS, Cotter SA, Mutti DO, Twelker JD. Interventions to slow progression of myopia in children. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD004916. doi: 10.1002/14651858.CD004916.pub3. Update in: Cochrane Database Syst Rev. 2020 Jan 13;1:CD004916. PMID: 22161388; PMCID: PMC4270373.
- 58. • effects of atropine for both myopia progression and axial elongation • dose-dependent for the concentration 0.025% to 1%. • Results for 0.01% atropine are still equivocal. Sau, S. A., Santiago, A. P., Peralta, M. D., Lo, J. J., & Vera Cruz, A. (2021). Efficacy of atropine eyedrops in reducing myopia progression and axial elongation in myopic children: a meta-analysis. Asian Journal of Ophthalmology, 18(1), 75-91. https://doi.org/10.35119/asjoo.v18i1.593
- 60. Atropine for Myopia Progression •Concentration? 0.01%, 0.02%, 0.05% •Commitment: Daily for 2 years •Side effects with higher doses •Rebound on cessation •Use till 18?
- 64. Outline Dry Eye Asthenopia Headache Fluctuating Vision Digital Eye Strain 1 Myopia 2 Nature vs Nurture Myopia Epidemic Controlling Myopia Common Eye Consults 3 Refractive error Allergic conjunctivitis Blepharitis Sty/Hordeolum Keratoconus
- 67. High astigmatism vs irregular astigmatism •Amblyopia •Eye misalignment or strabismus •Progressive: Keratoconus? www.clevelandeyeclinic.org
- 69. Prevent astigmatism (& keratoconus) •Wear correct prescription •Address eye problems like allergies and dry eyes •Do not rub eyes •Protect eyes from UV •Glasses •Rigid gas permeable (RGP) or hard contact lenses •Corneal collagen cross- linking •Corneal transplant
- 70. Refractive Error: Hyperopia • More prone to lazy eye / amblyopia • Risk factor for crossing of eyes (amblyopia) • Decreases as one grows (eyeball grows bigger) https://www.news- medical.net/image.axd?picture=2017%2F8%2Fshut terstock_476189572.jpg
- 71. Refractive Accommodative Esotropia • May be controlled with glasses • Dependent on glasses to keep eyes straight • Some decompensate and may need eye muscles surgery
- 72. PD: 55 or 28/27
- 73. Rx OD: +3.00 -3.00 x 180 OS: -2.50 Adds: +2.00 PD: 55/53 Or Distance PD: 27.5/27.5 Near PD: 26.5/26.5 Or Mark pupil parameters on lens blank
- 75. Allergic conjunctivitis • Avoid allergen • Cold compress • Do not rub eyes! • Systemic antihistamine • Topical antihistamine • Topical mast cell stabilizers • Lubricants
- 78. Outline Dry Eye Asthenopia Headache Fluctuating Vision Digital Eye Strain 1 Myths 4 Myopia 2 Nature vs Nurture Myopia Epidemic Controlling Myopia Common Eye Consults 3 Refractive error Allergic conjunctivitis Sty/Hordeolum Keratoconus
- 79. MYTHS VS TRUTHS
- 83. Blue light (400-500 nm) and Digital Eye Strain Harmful to retina • suprathreshold acute doses • Peak damage at 440 nm • Longer duration, even if less intense also cause damage Ham et al, Retinal sensitivity to damage from short wavelength light. Nature 1976; 260: 153-155. Jaedane et al. Retinal damage induced by commercial light emitting diodes (LEDs) Free Radical Bio Med 2015; 84: 373- 384
- 84. How much blue? • ICNIRP Luminance Cut off Value 10.4 cd m2 • Incandescent lamp (14%) • Domestic Lamps including LEDs exceed limit by 10-20% (assuming intentional viewing) • Screens even at maximum brightness (Computers, smartphones, tablets) lower than “natural” exposures • Highest luminance from white screen O’Hagan et al. Low energy light bulbs, computers, tablets and the blue light hazard. Eye 2016; 30: 230-233. International Commission on Non Ionizing Radiation Protection. Guidelines on limit of exposure to incoherent visible and infrared radiation. Health Phys 2013; 105: 75-96 https://www.learnreligions.com/angel-colors-blue-light-ray-123860
- 85. Blue light and digital screens • Low levels of blue light from digital screens NOT a biohazard • More blue light from low energy light bulbs (LED lights) O’Hagan et al. Low energy light bulbs, computers, tablets and the blue light hazard. Eye 2016; 30: 230-233. International Commission on Non Ionizing Radiation Protection. Guidelines on limit of exposure to incoherent visible and infrared radiation. Health Phys 2013; 105: 75-96 https://images.theconversation.com
- 86. O’Hagan et al. Low energy light bulbs, computers, tablets and the blue light hazard. Eye 2016; 30: 230-233. International Commission on Non Ionizing Radiation Protection. Guidelines on limit of exposure to incoherent visible and infrared radiation. Health Phys 2013; 105: 75-96
- 87. O’Hagan et al. Low energy light bulbs, computers, tablets and the blue light hazard. Eye 2016; 30: 230-233. International Commission on Non Ionizing Radiation Protection. Guidelines on limit of exposure to incoherent visible and infrared radiation. Health Phys 2013; 105: 75-96 None of the computer monitors, laptops, tablets, and smartphone screens exceeded 0.39% of ICNIRP blue light exposure limit Blue light from these screens DO NOT present a biohazard even with prolonged viewing
- 88. Performance of Blue Blocking Lenses • Commercially available blue light filtering spectacles reduced calculated phototoxicity only by 10.6-23.6% • Blue Control (Hoya), BlueProtect (Zeiss), Crizal Prevencia (Essilor), StressFree and Noflex (Swisslens) • Reduced scotopic sensitivity 2.4-9.6% • Melatonin suppression by 5.8-15.0% Leung TW et al. Blue light filtering spectacle lens: optical and clinical performances. PLoS One 2017; 12: e0169114
- 89. Performance of Blue Blocking Lenses Leung TW et al. Blue light filtering spectacle lens: optical and clinical performances. PLoS One 2017; 12: e0169114
- 90. Blue Light and Digital Eye Strain • Need for high quality research (RCTs) for blue blocking spectacles and its effects on eye health
- 94. Glasses or Contact Lenses can cure myopia. No. Glasses and Contact Lenses can provide clear vision but will not change the need for glasses.
- 95. https://nycancer.com/media/images Eye exercises or vision therapy will improve vision. MYTH
- 96. https://nycancer.com/media/images 1. Orthoptics work for convergence insufficiency 2. Behavioral vision therapy scientifically unproven 3. No evidence that VT improves or retards myopia . FACTS https://aapos.org/glossary/vision-therapy
- 97. https://nycancer.com/media/images Computer refraction is accurate. MYTH
- 98. https://nycancer.com/media/images Computer refraction is less reliable in children with strong accommodation than it is in adults. FACT
- 99. Outline Dry Eye Asthenopia Headache Fluctuating Vision Digital Eye Strain 1 Myths 4 Myopia 2 Nature vs Nurture Myopia Epidemic Controlling Myopia Common Eye Consults 3 Refractive error Allergic conjunctivitis Sty/Hordeolum Keratoconus Teachers' Eyes 5 Digital Eye Strain Dry Eye Disease Presbyopia Cataract
- 100. Presbyopia • Loss of focusing ability for near • Near sighted patients remove glasses to read • Extend hand to see better • +1.00 for 40 yo • +2.00 for 50 yo • +3.00 for 60 yo https://images.ctfassets.net/u4vv676b8z52/vmmHJ2tVIU4dQLhdllVO3/b190ad48d6bdc0d3cb0442002e39842a/presbyopia-678x450.jpg?fm=jpg&q=80
- 101. Presbyopia correction Pilocarpine: miosis, acts on ciliary muscle https://ophthalmologybreakingnews.com/files/images/blog_presbyo pia-correcting-drops.jpg https://www.bettervisionguide.com/wp- content/uploads/2016/11/shutterstock_362615045.jpg
- 102. Cataract • Any opacity in the lens • Cloudy vision • Cataract extraction with intraocular lens implantation https://image.shutterstock.com/image-illustration/intraocular-lens-implanting-inside-capsule- 260nw-1047036862.jpg https://www.verywellhealth.com/types-of-cataracts-3421562
- 103. References 1. Coles-Brennan et al. Management of Digital Eye Strain. Clin Exp Optom 2019; 102: 18-29 2. Computer vision syndrome. https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/computer-vision-syndrome?sso=y 3. Freudenthaler N et al. Characteristics of spontaneous eyeblink activity during video display terminal use in healthy volunteers. Graefes Arch Clin Exp Ophthalmol 2003; 241: 914-920 4. Leung et al. Filtering spectacle lenses: Optical and Clinical Performances. PLoS One 2017; 12: e0169114. 5. Moon JH et al. Association between video display terminal use and dry eye disease in school children. J Pediatric Ophthalmology & Strabismus 2014; 51: 87-92. 6. Moon JH et al. Smartphone use is a risk factor for pediatric dry eye disease according to region and age: a case control study. BMC Ophthalmol 2016; 16: 188 7. O’Hagan et al. Low energy light bulbs, computers, tablets and the blue light hazard. Eye 2016; 30: 230-233. 8. Patel et al. Effect of visual display unit use on blink rate and tear stability. Optom Vis Sci 1991; 68: 888-92. 9. Sheedy et al. What are the visual benefits of eyelid squinting? Optom Vis Sci 2003; 80: 740-44. 10. Shepard AL, Wolffson JS, Digital eye strain: prevalence, measurement and amelioration. BMJ Open Ophthalmol 2018 Apr 16;3(1):e000146. 11. Vilela MAP etal. Prevalence of asthenopia in children: a systematic review with meta-analysis. J Pediatr 2015; 91-320-325. 12. The Vision Council. 2016 Digital Eye Strain Report. https://visionimpactinstitute.org/wp-content/uploads/2016/03/2016EyeStrain_Report_WEB.pdf 13. Walline JJ, Lindsley K, Vedula SS, Cotter SA, Mutti DO, Twelker JD. Interventions to slow progression of myopia in children. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD004916. doi: 10.1002/14651858.CD004916.pub3. Update in: Cochrane Database Syst Rev. 2020 Jan 13;1:CD004916. PMID: 22161388; PMCID: PMC4270373. 14. American Association of Pediatric Ophthalmology and Strabismus. Vision Therapy. https://aapos.org/glossary/vision-therapy 15. Philippine Society of Pediatric Ophthalmology and Strabismus. Myths. https://www.facebook.com/pspos1 16. Joint report WHO-BHVI, 2017 17. Wu PC, Chen CT, Lin KK, Sun CC, Kuo CN, Huang HM, Poon YC, Yang ML, Chen CY, Huang JC, Wu PC, Yang IH, Yu HJ, Fang PC, Tsai CL, Chiou ST, Yang YH. Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial. Ophthalmology. 2018 Aug;125(8):1239-1250. doi: 10.1016/j.ophtha.2017.12.011. Epub 2018 Jan 19. PMID: 29371008. 18. Karuppiah V, Wong L, Tay V, Ge X, Kang LL. School-based programme to address childhood myopia in Singapore. Singapore Med J. 2021 Feb;62(2):63-68. doi: 10.11622/smedj.2019144. Epub 2019 Nov 4. PMID: 31680176; PMCID: PMC8027142.