Working from home has taken a toll on many, with a growing number of people now adding eye problems to their long list of troubles. A typical day may now consist of checking and corresponding via email, doing zoom calls, watching television and face-timing with friends and family.
As a result, many are neglecting the health of their eyes. Furthermore, with schools shifting to online lessons at home, children are spending more time in front of computer screens, and many parents are relaxing screen-time rules for TV and video games to keep kids occupied while social distancing. In the midst of the crisis, many children are spending less time playing outdoors.
This combination – more screen time and less outdoor time – may actually harm children’s vision and put them at higher risk of developing myopia, or nearsightedness. That can lead to serious eye problems in the future, including some potentially blinding diseases.
Eye health can easily be overlooked because eye conditions often don’t present symptoms early on. Pharmacists and their teams can be encouraging customers to have regular eye tests, at least every two years, resulting in any general health problems and signs of eye conditions being picked up.
Take the opportunity to talk about specific eye health issues. For example, ensure customers who have a positive diabetes screening test result are made aware of the importance of annual screening to prevent diabetic retinopathy.
Symptoms of computer eye strain can be divided into four categories:
• Eye strain (asthenopia);
• Dry or painful eyes relating to the ocular surface;
• Difficulty focusing (visual blur);
• Or non-ocular symptoms.
Asthenopia can be defined through non-specific symptoms such as fatigue, pain in or around the eyes, headache, or even double vision. In patients with dry eye, the ocular surface dries out, causing scratchy, tired, irritated eyes, which may become worse with contact lens use. Refractive errors may result in complaints of blurred vision, slow focusing, double vision or difficulty focusing for close work (presbyopia).
Non-ocular symptoms include neck, back or shoulder pain. Patients quite often have a range of symptoms from more than one category, and the pharmacist or pharmacy team may need to work out which of these may be associated with the condition in order to recommend the most appropriate treatment.
In some patients, symptoms of dry eye disease may be accompanied by symptoms of anxiety relating to work, or even depression.
Dry Eye
An estimated 10% to 30% of the population older than 40 years suffers from some degree of dry eye disease (DED). The condition tends to affect people above 60, and it is more common in women than men.
Around one in 13 people who are in their fifties experience dry eye syndrome, and the condition becomes more common with age. Up to a third of people age 65 or older may have dry eye syndrome.
DED, which is also sometimes referred to as dry eye syndrome or keratoconjunctivitis sicca, is considered the most prevalent ophthalmic disorder that affects the anterior eye and is most often associated with the aging process, especially in postmenopausal women.
DED is a multifactorial disease of the tears and ocular surface that results in discomfort, tear film instability, and visual disturbance, with potential for damage to the ocular surface. DED can be classified as chronic or temporary. DED can be also attributed to Bell palsy, collagen disorders such as rheumatoid arthritis, corneal or eye lid defects, Sjögren syndrome, and thyroid-related eye disease.
There are two types of dry eye disease, which can occur individually or in combination:
• Evaporative dry eye is associated with an insufficient oily layer in the tear film, which can occur when the eibomian glands are damaged. Around 80% of patients with
dry eye disease are affected by this type;
• Aqueous deficient dry eye, on the other hand, occurs when the lacrimal glands do not produce enough of the watery component of tears to maintaina healthy eye surface.
Symptoms of Computer Eye Strain
• Eye discomfort
• Headaches
• Sore, tired, burning or itchy eyes
• Difficulty focusing
• Watery eyes
• Dry eyes
• Blurred or double vision
• Increased sensitivity to light
Although eye strain can cause discomfort, it usually isn’t serious and goes away once the eyes are rested. At present, many not be able to change the amount of time they are in front of a computer at work, or the factors that can cause eye strain, but they can take steps to reduce it.
Rest The Eyes
Advise sufferers to regularly look away from their computer screen and focus on distant objects, for example taking a minute to look out of the window. Looking far away relaxes the focusing muscle inside the eye, which in turn reduces eye fatigue.
Use Adequate Lighting
Eye strain is often caused by excessive sunlight coming in through the window or by bright room lighting. Advise on the use of curtains or blinds to reduce brightness, reduce the lighting in the room and avoid sitting under big, overhead fluorescent lights. If possible, sufferers should use floor lamps instead.
Myopia
Scientists are still trying to understand how myopia, or nearsightedness, develops and progresses.
It occurs when the eyeball is too long or the eye’s focusing power is too strong, causing light rays to focus in front of the retina instead of on it, which creates a blurry image. While glasses or contactlenses can correct a child’s vision, research shows that having severe myopia puts children at risk for a number of eye problems down the road, including retinal detachment, glaucoma and macular degeneration.
Some factors in whether a child develops myopia, such as genetics, are beyond a parent’s control, but research shows that other risks can be reduced.
Some studies now suggest that spending time outdoors may be able to slow the onset and progression of nearsightedness.
In Taiwan, first-grade students at schools with programs designed to increase their outdoors time to 11 hours or more each week had less progression of myopia over one year compared to their peers. Similarly, in China, researchers found that adding 40 minutes of outdoor activity a day at school reduced the development of nearsightedness in six-year-old children over the next three years.
It is not clear why outdoors time protects against myopia, or why close-up work could make it worse. One theory is that light intensity and time spent outdoors regulates the release of dopamine in the retina, which controls the growth of the eye. Other theories center on how viewing distances impact where the light is focused on the retina; shorter viewing distances indoors may promote abnormal growth of the eye.
Although there is no consensus on how much time children need to spend outside or the importance of the light intensity they are exposed to, it is possible that more outdoor time can help to balance out more close-up work.
Childhood is an important time to think about myopia because myopic children tend to become more nearsighted over time. The age of myopia onset is the most significant predictor of severe myopia later in life.
Neck/Back Pain
Some customers may present to the pharmacy with neck/back pain when using their computer.
Work stress and environmental working conditions may cause a person to adopt a posture in front of their screen to see better, while causing neck and back strain. The symptoms may present as neck, back or shoulder ache with transient headaches after long hours of computer use. Studies have shown optimal seating arrangements with a carefully considered distance from the screen, and altering image size to provide a more comfortable working environment, reduces symptoms.
Optometrists call for greater role to improve public eye-care
Outpatient eye-care waiting lists continued to increase in 2019, as Optometrists have called for a greater role in providing public eye-care.
Latest National Treatment Purchase Fund (NTPF) figures to the end of 2019 show that 41,200 people were on the outpatient eye-care waiting list – continuing an upwards trend from 40,600 at the end of 2018 and 39,800 in 2017.
Almost 17,300 of these people were waiting more than a year and 12,000 more than 18 months, up from 16,200 and 10,500 respectively a year ago. Furthermore, more than 7,700 people were awaiting inpatient eye procedures.
Association of Optometrists (AOI) Chief Executive Sean McCrave called for better eye-care to be an election issue.
“Major delays in diagnosis and treatment are compromising eye health throughout the country. In the South West people can be waiting up to five years for Cataract surgery.
“There are 700 community based Optometrists across Ireland who are trained, skilled and have the necessary equipment to make better public eye-care available.
“We have an unsustainable over-reliance on providing public eye-care in Hospitals and HSE Clinics which clearly do not have the capacity to meet demand.
AOI is calling for public eye-care services which Optometrists can provide to be increased including a new ‘National Children’s Eye-care Programme’, which is Optometrist led and ‘National Roll-out’ of the Sligo Post Cataract Scheme.
The ‘Sligo Scheme’ is a proven approach being delivered in the North West. It involves greater collaboration between Sligo hospital and Optometrists – and the region has the shortest waiting time for Cataract Surgery (which accounts for a significant volume of the capacity problems).
It is also 50% less expensive to provide appointments in the local community at an Optometrist than in Hospitals and AOI has shown how waiting times can be eliminated while saving up to €32m.
