Transcription:
Taking Care of Your Eyes While Working From Home

Melanie:  Welcome to Back to Health, your source for the latest in health, wellness, and medical care. Keeping you informed, so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole and I invite you to listen as we discuss eye care in this time of working from home. Joining me is Dr. Christopher Starr. He's the Director of Refractive Surgery and Associate Professor of Ophthalmology at Weill Cornell Medicine. Dr. Starr, it's a pleasure to have you join us and what a great topic as everyone started last year telehealth, televisits, teleconference, telework. We're sitting in front of these computers all day every day. So tell us a little bit about what you have noticed in this time of COVID and tele-everything, what are we doing to our eyes and computer screens?

Dr Christopher Starr: Well, thank you so much, Melanie, for having me. This is a great topic and certainly great interest to almost everybody these days, since we're all spending so much more time on computers every single day. We've always known that computers can take a toll on eyes. That's been well known. In fact, there's a name for it. It's called the computer vision syndrome, and we knew that usually involves, in adults, eyes strain from fatigue of staring at these sort of fixed near distance targets all day long.

But also, when we're staring at computers, we don't blink as much. So the eyes tend to dry out when you're not blinking. The tears evaporate and the surface of the eye gets dry and irritated and gritty. It can affect vision. So you see fluctuations in vision, often improved by blinking and things like that. As the day goes on, that fatigue of staring at these sort of near distance targets, like a computer or a mobile device, you'll get frontal headaches and eye strain and blurry vision from the muscles getting weak as the day goes on.

So there are a lot of things that are associated with this computer vision syndrome. And in the post COVID era, when we're all tied to our computers all day and at home on Zoom and various other things, we are seeing many more patients with these symptoms.

Melanie: I imagine you are. And as an ophthalmologist during COVID and we heard about people skipping the emergency room, even if they were having heart attack symptoms, has ophthalmology been hit particularly hard? Have you noticed that people are neglecting their eyes at this point, getting their well visits and checks and things just due to the pandemic?

Dr Christopher Starr: Yeah, I would say just recently in the last month or two, people are now starting to come back in for their "routine" eye exams, you know, their yearly annual visits. Whereas during first seven to nine months of the pandemic, people were putting those off. What I usually tell patients is if there are no new symptoms, if things are stable, there's no pain, there's no change in the vision, there's no flashes or floaters or anything acutely different, then in those first six months or so when things were still pretty crazy with COVID and there was a lot of concern about going to hospitals and clinics and offices, I think that was reasonable. Now, certainly we told everybody, if there's an acute issue, you definitely should be seen.

And even though we were doing a fair amount of telehealth, you can imagine as anyone who's ever been to an eye doctor's office, there's a lot of gear in there. There's a lot of technology that we rely on to do a careful eye examine. And it's microscopes and various lenses and lights and computers and digital devices to examine eyes and get all this objective metrics, which you simply can't do remotely over FaceTime or Zoom or whatever.

That being said, there are certain things that we were successful with telemedicine. You know, a patient with a red eye, let's say, or, you know, dry eye, surface of the eye infection and conjunctivitis, certainly sties and other eyelid kind of abnormalities, swelling of the eyelid, allergic conjunctivitis, things like that, you can probably see pretty well.

And I have patients that I've done telemedicine visits with where I correctly was able to identify those things and treat them remotely. And I will say that, in the age of phones with really good cameras these days that can do macro shots and good lighting, we can see some pretty decent detail on the ocular surface, the blood vessels, the lid margin, cornea even. And so you train people to take a good macro photograph of their eye, with the right lighting, we can make some pretty decent diagnoses remotely and treat them effectively remotely.

That being said, glaucoma, retinal problems, cataracts, things like that, that involved the inside of the eye, usually one simply cannot do outside of an office. You can make an educated guess based on classic symptoms and things. But to make a definitive diagnosis, you really need all those gadgets that we use on a day-to-day basis.

Melanie: Conjunctivitis, every parent's like worst nightmare. And I imagine with the way that rages through the schools, yikes! Okay. So what can we do? We're sitting here and you Mentioned Zoom and all of the electronics and even the phones and we stare down at our phones and I myself find myself trying to figure out which glasses to wear. Do I wear my reading glasses and then switch to some other kind? What do we do about the fact that we are looking down at a phone or looking at a computer screen from who knows what distance or you're going to tell us what distance is the best to be looking at our computer screens? Tell us how we can deal with all of this while protecting our eyes.

Dr Christopher Starr: Yeah, sure. There are lots of little tricks and tips make one more comfortable when staring at these computers, which you know, for better, for worse, it's a fact of life these days. So we're all tied to our computers. The most important thing and the easiest thing to remember is something that we call the 20-20-20 rule. And I like to do a fourth 20 when I educate my patients, 20-20-20-20 rule.

So what does that mean? When you're on a computer, every 20 minutes or so take a break for 20 seconds or longer. And look into the distance at an object that's 20 feet away or further. So ideally, you'd look out a window or look down the hallway and let those eye muscles relax. The fourth 20, I usually recommend either closing the eyes completely for 20 seconds or rapidly blinking for 20 seconds, but basically to counteract that dryness that can commonly occur when we're staring at these computers and our blink rate decreases dramatically. It's estimates up to 50% fewer blinks minute, when you're staring at a computer, which leads to this dryness and the tears evaporating throughout the day. So that fourth 20 in that 20-20-20-20 rule is close the eyes and relubricate the ocular surface.

And those are good tips to remember. It's so much easier said than done, usually because once you get going and you're concentrating, you forget, you know. So I usually recommend putting out a little note, little sticky or a bottle of artificial tears next to your computer, just as a reminder. And if the eyes are getting dry and the blinking and the closing the eyes every 20 minutes or so, and you're still having these symptoms of dryness or irritation or redness or even excessive tearing, you know, the over-the-counter lubricants can help to soothe the eye and relax it a little bit and relubricate it.

The other thing that we should do when we're taking breaks, certainly adults should get up and walk around. It's very easy to sit on your butt all day long when you're staring at the computer and doing all your work from home, and it is important to get up and move the muscles and get the blood flowing and get some steps in and get a little bit of cardiovascular exercise.

Standing desks are good too, if you have them. I mean, we want to promote that in adults, but also in the kids, which we'll discuss as well. But taking those breaks, getting away from the computer, letting the eyes relax, letting the eye muscles relax, letting the eyes relubricate and ideally getting around the house and walking around a little bit to get muscles flowing.

You asked about glasses. And obviously, different ages and different people with different refractive errors, i.e, astigmatism farsightedness, nearsightedness will have different requirements when it comes to what is the ideal pair of glasses for seeing the computers. In general, those of us who are bit older, 40 years old and above, which I certainly fall into, is what we would call a generally the presbyopic age group.

And what does that mean? Well, as we get older, our eye muscles that focus up close, they get weak as time goes on. And usually that starts around age 40 and progresses to the age of 65 and beyond where we need more and more magnification to see up close. And the simple way to correct that usually is with an over-the-counter reading glass for most people, a + 1 to start and building up to 2.5, 3 as we get older and need more and more magnification.

The computer distance, depending on what you're using, if you're using a laptop, sometimes it's a little closer to the eyes. If you're on a desktop computer, sometimes that's a little further away, what we would call the intermediate distance. And depending on your age and your refractive error, we do often recommend in people who spend many, many hours a day on computers to get computer glasses.

These are glasses that are ideally suited to that intermediate arm's length distance at desktop computers usually sit at. And that will keep that distance in focus and it will alleviate a lot of that burden on the eye muscles to keep things in focus and should help people with eyestrain to overcome that as the day goes on. And hopefully, by the end of the day, you're not sitting there furrowing your brows and complaining that your head hurts because you've been straining all day. These computer glasses alleviate that. So certainly, highly recommended computer glasses in those patients who are having eye strain.

Should it be a blue light blocking lens? Well, some people recommend blue light blocking lenses. Blue light has been coming up a lot these days and questions around blue light blocking glasses. And the short answer is if you like them, if you like having a yellow filter in front of your eyes to block the blue light, great, you wear them.

Usually my recommendation to patients is that blue light is stimulating and blue light decreases melatonin release. So when at night time, when we're trying to go to bed and, of course, we've all heard the adage, "Turn off your device in the bedroom, don't put any computers or iPads or iPhones in the bedroom because you're not going to be able to fall asleep." And in a lot of ways, it's kind of true, blue light is stimulating. So the blue light blocking glasses and/or screen issues come into play at nighttime. And that's what I usually recommend to patients.

You don't necessarily need blue light glasses, because most computers these days and digital devices, at least in the Apple ecosystem, which I use daily, there's something called night shift mode where you can just set a timer that just turns off all the blue pixels at a certain time. I think I have mine set for 8:30 or 9:00 at night. And you can see the screen just kind of yellows. It turns yellow after all those blue pixels-- similar to what you would get if you put on a yellow pair of blue blocking glasses. So that's the way I do it, and it certainly helps to get a good night's sleep when you're not staring at these excitable blue pixels as you're trying to go to sleep.

Melanie: That was such great information. So Dr. Starr, if they're going to wear these computer glasses, like I'm now considering because of what you just said, what if we have to like look down at our papers? Because I do sit there sometimes with my reading glasses and then my distance glasses up above those, going back and forth watching TV or looking down at what I'm reading, if we're wearing those computer glasses, then what if we need to look down? Do we wear the little reading glasses just below those? Or how do we do that?

Dr Christopher Starr: Yeah. I mean, there are definitely many, many strategies. You can certainly get prescription blue light blocking glasses, which are let's say a progressive bifocal where the top is for the TV distance or distance vision. And the bottom is for reading or some of them are trifocals. So you have the intermediate distance for desktop computers and intermediate vision. And the very bottom is for the most magnified up-close vision, usually phones or papers or reading and writing. So there are lots and lots of options.

I think most computers do have the automatic blue blocking adjustment that you can dig into the system preferences and things and find it on PCs -- and certainly on Macs, it's very easy -- and just do it that way so that you're not buying more glasses and various additional prescription glasses that are blue blocking glasses. But I just find it so much easier to just set the computer and let it go.

Melanie: Well, those trifocals sound like they would make me dizzy. Do they do that to some people? Even bifocals and I've tried other people's on, is it hard to kind of adjust to that, seeing two separate ways?

Dr Christopher Starr: Yeah, there's always an adjustment, especially if you've never born these progressive bifocals. They're really trifocals because there are three zones. And because there's a gradient from the distance, there's a lot of finding the sweet spot and moving your head and your eyes around and sort of get things lined up. And so it does take a little while to get used to it. Most people who are, presbyopic and over the age of 40 who do require help with the intermediate and near vision, most people do prefer those progressive bifocals and no line bifocal. But again, they're not for everybody. And a lot of people do try and just simply cannot get used to them. The visual quality is not up to snuff. And so often those people will either do contact lenses or do one pair of glasses for distance, one pair for intermediate, one for near.

Melanie: That's me. Sometimes I wear them all at the same time. So it's quite a great look. It's really a great look. So as we wrap this up, such a great episode, Dr. Starr, tell other healthcare providers, tell listeners people that are working from home all the time, just reiterate for us what you would like us to know about what this is doing to our eyes, how to protect them, you know, give us your 20-20-20-20 rule again, and just kind of reinforce why it's really important even in this time of COVID to really take good care of our eyes.

Dr Christopher Starr: Yes, absolutely. Anybody who has a change in their eyes or their vision and are thinking, "Well, you know, it's not safe to go to the hospital," definitely do not pass go. Go straight to your eye doctor, go straight to the clinic and have it checked out. In this day and age, A, most healthcare practitioners are vaccinated. B, every office that I know of, certainly my office at Cornell, has taken every single precaution that there is to make the environment as safe as possible, reducing the numbers of people in rooms and then the waiting room and in the department at any given time; social distancing, sanitizer everywhere, double masks on most people. So we have taken every precaution and I don't know of any cases of COVID that have been transmitted in the office setting. So if you have a problem with your eyes, it's better to have it evaluated in the proper fashion than sitting on it and hoping it just gets better on its own.

If you're spending time on computers, like we all are, we do recommend the 20-20-20 rule or the 20-20-20-20 rule where every 20 minutes take a break, look away for 20 seconds or longer at an object that's 20 feet away or further. And for that fourth 20, close your eyes for 20 seconds, blink your eyes rapidly 20 times, just relubricate the eyes that have dried out as the day goes on and our blink rates decrease. That will ensure that we all feel better as the day goes on, that we reduce eye strain and eye fatigue and headaches that often accompany long hours on the computers. And most of us are spending more than nine hours a day on computers when you look at the data. So it's a lot of computer time. It's a lot of eye strain. It's a lot of drying out of the eyes because of reduced blink rates and things like that. So with the 20-20-20-20 rule, we will all feel much better as the day goes on.

Melanie: What great advice. Listeners, this is what we all need to hear this. This is what a podcast should be. Please share these shows with your friends and family, because we all need to hear this great advice from the experts at Weill Cornell Medicine. And you got it here today about vision and what we're doing to our eyes when we're staring at computers every day and all day and working from home.

Thank you, Dr. Starr, for such an informative episode. And Weill Cornell Medicine continues to see our patients in person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back To Health. We'd like to thank our listeners and invite our audience to download, subscribe, rate, and review back to health on Apple podcasts, Spotify and Google podcast. For more health tips, go to weillcornell.org and search podcasts. And parents, don't forget to check out our Kids Health Cast. I'm Melanie Cole.  

Rehabilitation medicine can help patients with a wide array of disorders and diseases, including cancer. If cancer care is of interest, listen to CancerCast, Weill Cornell Medicine's dedicated oncology podcast, featuring leaders in the field and patient stories. CancerCast highlights dynamic discussions about the exciting developments in oncology.

All information contained in this podcast is intended for informational and educational purposes. The information is not intended nor suited to be a replacement or substitute for professional medical treatment or for professional medical advice relative to a specific medical question or condition. We urge you to always seek the advice of your physician or medical professional with respect to your medical condition or questions.

Weill Cornell Medicine makes no warranty, guarantee or representation as to the accuracy or sufficiency of the information featured in this podcast. And any reliance on such information is done at your own risk.

Participants may have consulting, equity, board membership, or other relationships with pharmaceutical, biotech or device companies unrelated to their role in this podcast. No payments have been made by any company to endorse any treatments, devices, or procedures and Weill Cornell Medicine does not endorse, approve or recommend any product service or entity mentioned in this podcast.

Opinions expressed in this podcast are those of the speaker and do not represent the perspectives of Weill Cornell Medicine as an institution.