1. Visual Fatigue Syndrome
The Price of
Today’s
Near and
Intermediate
World
Dr. Kris Kerestan
Because Visual Fatigue is increasing at a very rapid rate, this is a very relevant topic for eye care practitioners and their practices

2. Fundamental Shift in Use of Vision
Past: Primarily used Distance vision
Today: Primarily use Intermediate/Near

3. Fundamental Shift in Use of Vision
Most professionals require extended intermediate and near viewing
Accountants
Attorneys
Engineers
Business administrators
Architects
Computer technology
Designers
Medical/allied health

4. Widespread Computer Use
Work, Home, School:
Over 55% use computers at work
Out of 100 million in US – 50% of workday is spent at a computer

5. Widespread Computer Use
73% of U.S. adults use computers
71% access the internet
In a recent study of more than 1,000 patients 25 years and older, respondents averaged between 6 and 7 hours per day at a computer

6. Widespread Computer Use
In the past decade, computer use among
children in the United States has increased
dramatically… Consider these statistics:
94 percent of American families with children have a computer in the home with access to
the Internet

7. Widespread Computer Use
The amount of time children ages 8 to 18 devote
to entertainment media (including computer and
video games) each day has increased from 6.19
hours in 1999 to 7.38 hours in 2009

8. Widespread Computer Use
In 2009, 29 percent of American children ages 8 to 18 had their own laptop computer, and kids in grades 7 through 12 reported spending an average of more than 90 minutes texting on their cell phones

9. Visual Fatigue
Today’s visual demands place greater stress on near and intermediate vision than ever before…
More than 70% of 143 million Americans who work on a computer are affected by visual fatigue on a daily basis according to the AOA
Studies show that eye strain and bothersome visual symptoms occur in up to 83% of computer users
I wanted to share some extremely interesting statistics regarding computer use and why visual fatigue is affecting so many individuals

10. Visual Fatigue 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

11. Visual Fatigue Computer use is the most common source of visual strain
and fatigue, but cell phones,
handheld electronic devices
and video games also may
cause visual strain

12. What is Visual
Fatigue Syndrome?
A visual condition consisting of a sum of TREATABLE symptoms including:
Headache
Loss of focus
Blurred vision
Burning of the Eyes
Tired Eyes

13. 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

14. Fatigue Syndrome? What is Visual
“The complex of eye and vision problems related to near work which are experienced during or related to computer use.”
--American Optometric Association
I didn’t make computer vision syndrome up, but I have experienced some of the symptoms. It was originally described by the American Optometric Association. It’s important to remember that CVS isn’t just one thing – it’s a complex of symptoms, and those symptoms can have a range of causes. What is certain is that all of the causes are related to using the computer. 14 3

15. VFS- On the Rise 50-90% of computer users experience visual symptoms
22% of computer users experience musculoskeletal disorders
As computer use increases, so does the frequency of CVS. This can be seen by the large number of eye exams resulting from computer-related vision problems. 15

16. 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
If we could trace all of these symptoms to a couple of factors, it comes down to the computer user’s physical interaction with the work environment. And the body could be going through some real contortions and the computer. Why? Because computing is a visually intensive activity, and that makes the visual system the boss. And the body will get into some weird positions to accommodate the eyes. 16 6

17. Contributing Factors – The Computer
Position of the monitor
Distance from the eyes
Location relative to eye level
Nature of the image
Difficult to focus on pixel images
Eyes tend to relax to a point beyond the screen (resting point of accommodation)
Constant refocus needed, tiring the eyes
What complicates this is that viewing the computer is not like reading a book. The viewing angle is usually higher. The monitor is almost always farther away from the eyes than a book would be. And the image itself is less congenial to sustained viewing than a printed page. Each letter on a screen is made up of pixels, which the eye finds it difficult to focus on. The eye’s tendency is to relax into focusing on a point beyond the screen, requiring the viewer to continually refocus on the screen. This, in turn, can cause eye fatigue. 17

18. Contributing Factors – The Office Environment
Inappropriate lighting
Reflections from the computer screen
or outside sources
Poor ergonomics
Dry and poor quality of office air
Of course, it’s not just the computer monitor that creates problems. Other factors include the way the workstation is set up, the position of the seat, the way the office is lit, even how moist the air is in the office. 18

19. Detection and Diagnosis of VFS based on patient SYMPTOMS…
During eye health exam, must screen every patient by asking specific questions regarding their computer use, hobbies, reading and any visual fatigue symptoms that may accompany these activities
May use a specific
patient questionnaire
or add to case
history form
This can be done by using a Lifestyle Questionnaire, several questions on your case history form or just discussed verbally

20. What Specific Questions should we ask our patients?
1. How many hours per day are you on a computer
or other electronic device at work and/or home?
2. Do you have any hobbies that require you to use
your eyes up close?
3. Do your eyes ever feel tired or strained while on the computer?
4. Do you ever have blurred or out of focus vision while on the computer?

21. What Specific Questions should we ask our patients?
5. Do your eyes ever feel dry or get red while using the computer?
6. Do you experience headaches with computer or electronic device use or while engaging in your hobby?
7. Do you experience neck or shoulder pain while using the computer?
8. Do you feel overall fatigue during or after computer use?

22. Detection and Diagnosis of VFS based on CLINICAL FINDINGS…
What clinical tests will aid the doctors and
staff in the diagnosis of VFS?
Refractive errors
Binocular vision
Accommodative
problems
Presbyopia and near
vision correction
Dry eyes

23. Diagnosis of VFS
VFS
Symptoms +
Clinical findings =
VFS diagnosis

24. Who is affected by Visual Fatigue Syndrome?
Emmetropes, Myopes,
Hyperopes & Astigmats
Non-presbyopes & presbyopes
Spectacle lens wearers
Contact lens wearers
Refractive surgery patients
Visual Fatigue can affect anyone at any age…Child, Teen, Young to Mature Adult

25. Treating VFS using Computer Eyewear
Single Vision Lenses
or Readers
“Anti-Fatigue” Lenses
for Non-Presbyopes
Near Variable Focus
“Computer” Lenses
for Presbyopes
4. Progressive lenses

26. Single Vision Computer Lenses
In the past most lenses prescribed in computer glasses were Single Vision because not many other lens options were available
Although SV lenses sometimes are an adequate solution for near tasks, the range of focus is extremely limited to one set distance. Patients are unable to walk around or see other distances in the office, so must constantly be taking on and off

27. Single-Vision Lenses
Most presbyopes wearing single vision lenses for reading and up-close work have blurred mid-range vision
One solution is to move mid-range objects closer, but that is not always possible
Another solution is an extra pair of single vision lenses for mid-range use; usually purchased from a pharmacy
If the patient is wearing single vision, he or she can see up-close, but may have trouble with the intermediate. And it’s not always possible to move the monitor into the near – not without a lot of neck-craning, anyway.
It’s possible to purchase readers with an intermediate correction, of course. That will look fine while you’re looking at the computer, but what if you need to look at some reading material? 27

28. Single Vision Lenses
For those ages 13 to 29, add to their spherical distance correction
For those age 30 and over wearing Single Vision, add to their spherical distance correction
These glasses are intended for use at computer/intermediate distance only and will cause blur at all other distances
**Always Rx with AR coating**

29. Progressive Lenses
Distance
Zone
Near
Unwanted
Blur
General Purpose PAL
Then there are progressives. Whether progressives work well in computer vision depends on the wearer, the progressive design, and, perhaps, the amount of time the wearer spends at the computer. Progressive designs vary in the size of the intermediate. Shorter corridors will mean smaller intermediate areas.
Progressive lenses usually require more power change from top to bottom and therefore are not the best option
Consequently, they produce more blur
As adds increase, there is less stable and narrow power in intermediate area 29

30. Optometrists’ Quotes
“Up until now I basically gave up on these patients that have visual fatigue symptoms. I didn’t feel like I had anything to offer them in my clinical arsenal.”
“There really are not enough products for us to pick from for dealing with some of these accommodative disorders that we’re identifying.”
 “The progressives don’t cut it for those patients who spend great deals of time on the computer.”

31. 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

32. Newer Lens Solutions for Visual Fatigue Syndrome
Addresses the following:
Different diagnoses by the OD
such as accommodative VFS
in pre-presbyopic patients or
true presbyopic VFS
Must have lens options to treat a broad range of patient
types and ages

33. Newer Lens Solutions for Visual Fatigue Syndrome
New category of lenses under “Visual Fatigue”
Anti-Fatigue—A primary wear pair for non-presbyopes or emerging presbyopes who suffer from VFS
Variable Focus “Computer”---A task specific lens for presbyopes who suffer from VFS

34. “Anti-Fatigue” Computer Lens Solution

35. Treating VFS with “Anti-Fatigue” Lenses
Who is it for?
Non-Presbyopic patients suffering
from VFS symptoms
Emerging Presbyopes
Individuals who use near vision for
extended periods doing activities such as
reading, texting, electronic device use,
paperwork, etc.

36. Treating VFS with “Anti-Fatigue” Lenses
How do they work?
Use as the primary pair to replace a patients
single vision lenses
Provides a slight +0.60D “power boost” in the
lower part of the lens
Provides greater patient comfort and reduced
visual fatigue than standard single vision
correction by allowing the eye muscles to relax
thereby decreasing the accommodative effort

37. “Anti-Fatigue” Lenses How do they work?
Concept:
SV lens with distance vision (exactly as in a regular SV) w/a slight power variation (+0.6 D) in bottom part of lens to give some comfort in near vision, preventing and relieving visual fatigue
+0.6 D power variation reached at 12mm from center = down gaze of 26°
Sustains the accommodative effort
Aspheric, so little or no distortion
Compatible with all frame types => 23 mm B
***Only available with Non-glare***

38. “Anti-Fatigue” Lens

39. “Anti-Fatigue” Fitting & Mounting
Center pupil fitting height
13 mm minimum
23 mm minimum B measurement
Monocular Distance PDs

40. “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
Most of my patients have been young teens/girls who have accommodative problems who already wear glasses

41. “Anti-Fatigue” Lens Essilor Anti-fatigue is only lens
available in this
category

42. Variable Focus “Computer” Lens
Solution

43. Treating VFS with Variable Focus “Computer” Lenses
Who is it for?
Task specific wear by Presbyopes who
spend extended time at intermediate and
near viewing
Meant to be used as a second pair to
complement a patient’s primary pair of
progressives

44. Treating VFS with “Computer” Lenses
How does it work?
Intermediate Vision : Wide and comfortable
“Computer “ lenses provide full vision at intermediate
distance by accommodating a patient’s natural posture
and workplace ergonomics
Near Vision : Smooth transition
Wide near area that provides a smooth transition
for looking at the keyboard or documents
Distance Vision : Functional and efficient
Offers clear vision at full distance within an office setting
to most patients, allowing for effective sight at all distances

45. “Computer” Lens
Contains an intermediate field of vision designed to offer full coverage of the screen area.
Lens power specifically tailored for clear screen vision and frequent movements from keyboard to screen to surroundings.
The design was based on user observations; lenses let you keep a natural posture: a 30° angle between the positions for viewing keyboard and screen.
These lenses should NOT be worn for driving or other distance viewing activities.

46. “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.

47. Near Variable Focus (NVF) Lens
“Computer” Design

48. “Computer” Lens Key Patient Types
Any presbyope indicating
VFS symptoms
Also perfect lens for
activities at intermediate
and near – hobbies,
remodeling, sewing, auto
work, Optometrists,
Optometric Assistants, etc.

49. “Computer” Lenses Available
Essilor “Computer” Lens
Zeiss “Business” and “Access”
Computer Lens
Shamir “Office” Computer Lens
Specific Fitting techniques and
Lens parameters available through
Sales Reps.

50. 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

51. Additional Steps to Relieve VFS
Use Proper Lighting
Decrease both bright sunlight coming in and replace bright overhead fluorescent lighting with full spectrum bulbs or floor lamps
Minimize Glare
AR coating, Anti glare screen, paint white walls
a darker color in matte finish

52. Additional Steps to Relieve VFS
Adjust screen
Brightness, contrast, text size and color
Blink more - 5X less when using computer
Rewets eyes to decrease dryness and irritation
Artificial tears
Relax Focusing
rule - look away from computer Q 20 mins, 20 ft away for 20 sec.
Brightness should be same as work environment. High contrast between characters and background (Black text on white background best)
May need artificial tears

53. Additional Steps to Relieve VFS
Frequent breaks
Two 15 min breaks plus 4 mini 5 min breaks
through day
Stand up, walk around, stretch arms, legs, back
and neck
Modify Work Station
Copy stand next to monitor, screen inches from eyes and degrees below eyes, good posture

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Total Lens and Frame technology addressing the needs of the most demanding digital device users

55. Gunnar High Definition Lenses ***Digital Performance Eyewear***
Reduces visual stress, eyestrain and digital eye fatigue
Wrap design for maximum field of clear vision
Proprietary amber tint to increase contrast
***Considered the Ultimate***
***Gaming Lenses***

56. Gunnar High Definition Lenses ***Digital Performance Eyewear***

57. Gunnar High Definition Lenses ***Digital Performance Eyewear***

58. Thank You for your Attention!! ???