the eye blog

If this is you at work, you may have what is called Computer Vision Syndrome (CVS), or Digital Eye Strain.

​CVS is a common problem in our modern digital society where a large part of our days is spent staring at a computer monitor, on a laptop or tablet or using a smartphone, both at home and at work. CVS can affect up to 90% of people who spend more than 3 hours a day concentrating on digital devices.

Typical symptoms of CVS include headaches, blurred vision, sore eyes, red eyes, tiredness, neck pain, difficulty refocusing from near to far and occasionally could also include dizziness and double vision.

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​Why do we get Computer Vision Syndrome?

Prolonged periods of focusing on a near object causes the eye's focusing muscles to become tired. For some people when this happens their eyes start to lose focus up-close, making near vision blurry. And when they try to focus even harder to read their computer screen they can end up straining their eyes and getting a headache. Or they may lean forward towards their screen and getting neck pain from improper posture.

For other people, their far-distance vision can become blurred. This can occurs because their focusing system has become 'locked' at close-range, then when they look away into the distance their eyes are unable to relax, causing blurred vision. Some people can mistake this for 'short-sightedness' — where far-distance vision is always blurred relative to near — but in these cases it's actually the near work that causes the symptoms and far-distance glasses won't necessarily help. Some young adults, however, do develop true short-sightedness (myopia) from prolonged computer use. An experienced optometrist can distinguish between true short-sightedness and near-work-induced distance blur and recommend the most appropriate solution to the problem.

Staring at a computer screen can often also cause dry eye. This is because when we stare at a computer our blink rate is reduced. When we don't blink frequently enough our eye surface becomes dry. Common symptoms of dry eyes are redness, irritation and burning sensation. Some people experience watery eyes, thinking if their eyes are watering they can't be dry, when in fact the cause of the watery eyes is actually dry eyes, as strange as it may seem. When our eyes become too dry and irritated they can start to produce tears as a reflex response. Dry eye can also be exacerbated by environmental factors such as air conditioning in summer and heating in winter.
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How to get help for Computer Vision Syndrome?

​If you have symptoms of CVS, the first thing to do is to book an eye test with an experienced optometrist for a comprehensive assessment of your eyes' focusing and eye health. Sometimes it can be a simple focusing issue such as slight long-sightedness (increased focusing effort at near) or astigmatism (irregular eye surface curvature) that a pair of prescription glasses with anti-reflective coating will make a big improvement to your symptoms.

Often, a more specialised type of lens called an anti-fatigue lens will be what you need for your Computer Vision Syndrome. An anti-fatigue lens is like a mini-progressive lens with two power zones that help you relax your eyes when focusing up-close. Here at Eyecare Concepts, we offer the Essilor Eyezen and the Nikon Relaxsee​ anti-fatigue lenses, both specifically designed to relieve digital eye strain. The blue light protective coating of these lenses also help to reduce eye strain from brightly-lit digital devices. Our optometrist will recommend the optical solution tailored to your personal vision needs. Prescription glasses and anti-fatigue lenses are rebatable on your private health optical cover.

For individuals with dry eyes, we can also assess your dry eye condition with our special instrument that analyses the quality of your tears and how quickly your natural tear film evaporates in-between blinks. With this analysis we can treat your dry eye condition more effectively. As a therapeutically-endorsed optometrist we can prescribe medicated eye drop treatments if necessary for more severe cases of dry eye. And if you have oily or blocked tear glands we have in-office eyelid warming therapy to treat the underlying cause of your dry eyes.

Here at Eyecare Concepts, a family optometry practice with a focus on children's vision, I test a lot of kids' eyes. Kids of all ages and from different family backgrounds. Many children come in for their routine eye checkups and have normal eyesight and healthy eyes, which is always great to see. Some children’s cases are more challenging, but it’s very satisfying and professionally rewarding when I'm able to help them and enhance their lives with better vision.

​Lazy eye is a condition that most parents have heard of and are often concerned about. Sometimes the term ‘lazy eye’ gets confused with a turned eye or crossed eye. In optometry speak, lazy eye is called amblyopia, while a turned eye is called strabismus. They are often related, but quite different conditions. A lazy eye is usually a healthy eye but the eye and the brain are not working together properly. The visual processing system and nerve pathway associated with this eye is under-developed, from the brain becoming accustomed to 'ignoring' this eye in favour of the stronger eye. Without proper neural stimulation, the suppressed eye falls behind the good eye in eye-to-brain development.

The majority of cases of lazy eyes in Australian children are associated with long-sightedness (hyperopia). Some children are born highly long-sighted in one or both of their eyes. A long-sighted eye is an eye that is physically shorter in length than normal, or has a lens that is too powerful, so that light entering the eye is focused behind the retina instead of on it. Most children are mildly long-sighted when young, that is perfectly normal, but when an eye is significantly long-sighted (usually +4.00 or above) the eye is unable to fully compensate for this and the result is blurred vision both in the distance and up close. Normal development of the visual system is hindered by blurred vision from the affected eye/s. A lazy eye can also result if a child has one eye that is significantly more short-sighted (myopic) than the other, or has a high degree of astigmatism (uneven eye surface shape).

​It is important to diagnose lazy eye in a child from an early age. Amblyopia occurs in around 2-3 in every 100 children, so it's not a rare condition. Some children have mild forms of amblyopia, and some have more severe forms. If a lazy eye is not detected, corrected or treated before age 8, permanently reduced vision in the affected eye can result and which will affect the child for the rest of his or her life. Lazy eyes are usually not treatable, or are extremely difficult to treat, in adulthood. Loss of vision in one eye means the child has impaired stereo (3D) vision and depth perception, and can affect potential future career ambitions as an adult, as some professions require good vision from both eyes.

One tell-tale sign that your child may have a lazy eye is a turned eye (strabismus). An eye that is highly long-sighted will have a greater tendency to turn inwards toward the nose (termed esotropia), especially when the child is tired. Some children may have an eye that turns outwards (termed exotropia). An inward-turning strabismus is more common in Caucasian children, while an outward eye turn is more common in kids from Asian backgrounds. If you suspect your child may have a eye that turns or wanders, whether it affects one eye or both eyes, turns inwards or outwards, and even if it happens only occasionally, you should have your child examined by an eye care practitioner — an optometrist or an ophthalmologist — as soon as possible.

With some infants and toddlers their eyes may give the appearance of being turned or crossed but are in fact straight. This is an optical illusion called pseudostrabismus caused by facial features and eyelids that are not yet fully developed. As trained professionals, we can differentiate between a true strabismus and a pseudostrabismus. We suggest seeking a professional opinion if you have any concerns at all about your child's eyes.

Our recommendation is that all parents should bring their children to an optometrist for their first eye test by the age of 3, even if they show no signs or symptoms and seem to be perfectly fine. Young children do not realise anything is wrong with their sight, they are not aware of what blurred vision is, and can appear to be functioning perfectly, especially when a problem affects only one eye. Often it's only at their first eye test that significant issues are discovered.

​Children will usually have a basic vision screening test by their maternity nurse when they reach 3.5 years of age. This test is called the Melbourne Initial Screening Test (MIST). While these tests are helpful they are not always reliable and are not a substitute for a proper comprehensive eye examination. We believe all kids should be tested by an optometrist even if they have passed their screening test, for a more in-depth assessment of their eyesight, visual functions and eye health.

In our children's clinic we have special instruments and sophisticated eye measuring equipment to test young children, and objective tests that do not require any responses from the child if they are too young to read letters, identify symbols or give reliable responses. We also use dilating eye drops to more thoroughly assess your child's eyes and focusing. The presence of a lazy eye, turned eye, long-sightedness, short-sightedness and astigmatism can be detected. Where a lazy eye is found we can diagnose the cause of it and implement a treatment plan to gradually build up the vision in this eye and to make both eyes work together as a team. This usually involves glasses (sometimes contact lenses), eye patching or eye drops, and vision therapy. With timely and appropriate treatment the visual outcome for a child with a lazy eye is usually very good.

As an eye care professional, to see a child's face light up and smile when given glasses for the first time and being able to see better is always such a delight. And I'm reminded of what a privilege it is to have the opportunity, and to be entrusted with this responsibility, of looking after young children's eyes and enhancing their lives through eye care.

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​If you have eyesight problems with short-sightedness (myopia) there's a good chance your children will develop the same vision issues as they grow up. Statistically there's a 3 times risk of a child having myopia if one parent is myopic, and 6 times risk if both parents are myopic. Genetics is certainly a strong predisposing factor for myopia development.

​We can't do much about the genetic makeup of your child, but we can reduce the risk of your child having short-sighted eyes, or worse, highly short-sighted eyes — a condition known as 'high myopia', conventionally defined as myopia with a glasses prescription of -6.00 or over (600 degrees +).

Many people, particularly of Asian descent, have even higher levels of myopia. -10.00 and above (1000 degrees short-sighted) are not uncommon. The highest we have seen in our practice is -16.00. Not only is having high myopia hugely inconvenient (nothing in front of your nose is clear without glasses) but the risks of developing serious eye diseases and blindness are exponentially higher.

Previously there wasn't a lot that could be done to slow down short-sightedness progression. But now there is, and all parents should know about these options available to preserve your child's eyesight. With the current medical and optical treatments no child today should grow up to have high myopia anymore. Early intervention and treatment is key to maintaining good eyesight. Treatments and strategies to prevent children's eyes from getting worse with myopia is called 'myopia control'.

Our myopia control clinic website (www.kidsorthok.com.au) goes into more detail about all the current options available to manage childhood myopia. Here is a summary:

REGULAR EYE TESTS

We recommend all children have yearly eye tests from the age of 3. Kids' eyes can change quickly and often without symptoms. Early detection of vision problems means earlier intervention. Undiagnosed and uncorrected short-sightedness can accelerate progression. And if there is significant progression, myopia control treatment should be initiated as early as possible. We monitor children with myopia progression every 6 months.
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ORTHOKERATOLOGY (ORTHO-K)

Ortho-K are overnight lenses that correct vision while your child sleeps. The two benefits of OK lenses are: (1) They correct your child's eyesight so that daytime glasses and regular contact lenses are not needed for them to see. This gives them complete freedom for all their schooling, sports and recreational activities without worrying about breaking or losing glasses or contacts. (2) They are clinically effective in slowing down your child's eyesight deterioration by around 50%, and sometimes more.

OK lenses work by gently reshaping the front surface of the eye with individually designed oxygen-permeable lenses that fit precisely on your child's eyes. You can think of orthokeratology as a little like orthodontic braces for align teeth. Over time the surface of the eye, the cornea, is molded to the shape of the lens to correct vision as well as provide myopia control.

​Some parents have concerns about safety of overnight contacts. Wearing contact lenses of all kinds carry potential risks of infection, but any significant adverse events with diligent Ortho-K wear are actually very rare. Studies have demonstrated that Ortho-K lenses for kids are no more risky than overnight wear of soft lenses by adults. OK lenses are worn at home under parental supervision, without the risk of contamination outside. Professionally fitted lenses, good hygiene and proper lens care will help ensure your child maintains healthy eyes wearing Ortho-K lenses. At our clinic we have any no episodes of infection or adverse events for our patients treated with OK lenses.

MYOPIA CONTROL SOFT CONTACTS LENSES

​There are now daily-disposable soft contact lenses that help slow myopia progression. As these lenses are replaced daily after each use, without any need for cleaning or storage, they are the safest type of contact lenses and ideal for kids and teenagers. We have the MiSight 1 Day with ActivControl Technology available at our clinic. This lens was developed specifically for short-sighted children to prevent eye deterioration.

These soft contact lenses are a 'multifocal' design with a clear distance zone in the middle, and a different power in the periphery of the lens. This mimics the effect of Ortho-K in modifying the focusing of light in the peripheral zone of the eye's surface. One key difference is that MiSight lenses are only effective while the lens is worn, so it needs to be worn at least 6 days a week, whereas the eye surface changes that occur with Ortho-K are longer-lasting and holds its myopia control effect even with occasional short breaks from overnight lens wear. OK lenses can also correct mild to moderate levels of astigmatism, while MiSight lenses are not available with astigmatism correction.

ATROPINE EYE DROPS

​Atropine is a chemical agent that helps prevent myopia progression by strengthening the structures within the eyeball to resist eye growth and elongation that occurs concurrently with adolescent growth spurts. Although atropine has long been known to exhibit this effect, it wasn't routinely prescribed for myopia control due to its known potential side-effects on the eye and elsewhere in the body — eg. pupil dilation, light sensitivity, headache, stinging, dry mouth, dry skin, heightened irritability and increased heart rate.

​In the past 5 years, researchers discovered that even tiny concentrations of atropine, thus much safer to use, can effectively help modulate myopia progression almost as well as the full-dose form. This low-dose 0.01% atropine is just 1/100th of the original atropine concentration. 0.01% atropine eye drops are very well tolerated in kids with minimal side-effects as a long-term treatment. In our clinic we have prescribed this treatment for children as young as 4 and have had good results. We have also combined atropine treatment with Ortho-K or soft contact lenses for even greater myopia control effect in some children with more aggressive progression.

MYOPIA CONTROL SPECTACLE LENSES

​Regular single vision glasses do not help to prevent myopia progression. There are special children's glasses specifically developed for myopia control. Although clinical research shows that glasses in general are not as effective forms of myopia control compared to the other options described above, they are nonetheless still beneficial for some children, and better than wearing ordinary glasses or no treatment at all.

​The myopia control spectacle lenses available from our clinic are the Essilor Myopilux lenses — developed originally for short-sighted children in Singapore and Hong Kong. These were special bifocal or progressive lenses and most effective for children with some near focusing difficulties or inefficiencies. Our optometrist will assess your child's eye focusing system to determine if he or she could benefit from wearing this type of lens.
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REGULAR BREAKS FROM NEAR WORK

Near work — which includes reading, drawing, study, homework, tutoring and computer use — is an essential part of your child's schooling and education. Many children are required to use an iPad or laptop computer at school. This is no avoiding digital technology that are intrinsic to our modern lives. We recommend following the 20/20/20 rule in regards to near work. That means for every 20 minutes of concentrated near focusing, take 20 seconds to look at something in the far distance 20 metres away. That helps your child to relax their eyes periodically. Also, children should always keep their books at least an elbow's distance away from their eyes when reading.
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SPENDING MORE TIME OUTDOORS

​If you child has been tested and found to have normal eyesight, the best you can do to preserve their good vision and potentially delay the onset of myopia is to let them spend more time outdoors in bright light. This is good scientific evidence that more outdoor time helps to prevent against myopia development. Ambient outdoor light is many magnitudes brighter than indoor light, and is believed to help modulate proper eye growth. We recommend all children spend at least 90 minutes a day participating in outdoor activities.

If you have concerns about your child's eyes or would like to know more about our myopia control program, book a comprehensive kids' vision assessment with our experienced myopia control optometrist today.

Philip Cheng — Myopia Control Children's Optometrist · 墨爾本兒童視光師
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EYECARE CONCEPTS · THE MYOPIA CLINIC
Kew · Balwyn · Balwyn North