Dr. Jeffrey Anshel is a 1975 graduate from the Illinois College of Optometry. He has written numerous articles and 10 books regarding nutritional influences on vision and computer vision concerns. Dr. Anshel is the principal of Corporate Vision Consulting, where he addresses nutrition and eye health, as well as digital eyestrain. He lectures internationally to ergonomic professionals and eyecare providers on vision health topics. Dr. Anshel is a Fellow of the American Academy of Optometry and Founder and Past President of the Ocular Wellness and Nutrition Society. He maintains a consulting business in Kapaa, HI.
Q: What inspired you to write What You Must Know About Eyestrain?
A: Over the past 40 years in private practice optometry, I have seen a steady increase in patients who complain of “eyestrain.” While practicing near a university in the 1980s, I began to see more patients who had “unusual” complaints of eyestrain for their age. It turned out that most of these patients were working in the “computer sciences” department. I just had a sense that this significant amount of digital-display viewing had a negative effect on their visual status. However, optometry students prior to this time had no experience with patients who spent much time on displays, and so they were not taught how to examine patients who viewed display screens on an extended basis. The pandemic over the past several years has brought this issue out to the forefront, due to the increased amount of remote learning via display viewing.
Q: What is eyestrain and what are some of the identifying symptoms?
A: “Eyestrain” is a vague complaint (most people have their own description of the symptoms) but one commonality that we have seen is a steady increase in computer display viewing. Where we used to ask “If” a patient was using a computer, we now go straight to “How many hours a day do you use a computer?” Studies have shown that display viewing complaints consist of blurred vision (at near or distance), tiredness, headaches, dry eyes, color distortions, and neck and shoulder pain among other areas of discomfort.
Q: How do computers and other digital devices affect eyestrain?
A: Viewing a display screen differs from reading hard copy in several ways. First, the formation of the letters on the screen (also known as resolution) is less accurate on digitally generated images. Secondly, the original computer screens were located in a “locked” position on the desk, and so were frequently viewed at a higher-gaze angle than traditional paper-based reading. Additionally, displays have their own light source whereas paper needs reflected light. These are just a few of the “high points …”
Q: Children today grow up using more technology than ever before. How is eyestrain diagnosed in children? What signs should parents look for?
A: Eyeballs are directly connected to the brain, and are controlled by the brain. Comfortable vision (i.e., no eyestrain) is achieved by the visual system being flexible enough and nourished enough to handle the stress of near-point viewing (i.e., reading or any near viewing task). Any time we look at something closer than 20 feet, we need to re-focus our eyes as well as turn both eyes in toward each other to maintain single “binocular” vision. This requires precise coordination between several muscle groups, which a child may not have developed yet.
Most children will not necessarily assign a physical complaint to eyestrain but may act in a variety of adaptive states. I have categorized the adaptations into four categories:
A (for the Appearance of the eyes—red, tearing, crusty lids, itchy, etc.);
B (for Behavioral elements—squinting, head turning, close working distance, excessive blinking, etc.);
C (for Complaints—hungry, tiring, irrational, short-tempered, etc.);
and D (for Developmental—poor learning, “acting up” while in school, short attention span, etc.).
Q: Do you recommend dietary supplements to support eyestrain and general vision health? If so, what are your recommendations?
A: Recall that the eyes are a part of the body, so what’s good for the body is generally good for the eyes. There are specific nutrients that are especially important for eye health, and they are generally lacking in children’s diets. Essential fatty acids (omega-3s) are critical for proper tear levels in the eyes, as is lutein and zeaxanthin—both of which are called carotenoids, molecules that accumulate in the retina to protect it from high energy blue light. These nutrients can be obtained in the diet but are typically found in fish and brightly colored fruits and vegetables—which are often not a primary part of most diets for kids.
Q: In the book, you provide a number of eye exercises. What are the benefits and can you provide an example of one of them?
A: The “exercises” I mention in my book, What You Must Know About Eyestrain, are generalized for anyone with symptoms of eyestrain. I hesitate to call them exercises per se, since they are not designed to increase muscle tone as most exercise programs are targeted to do. I prefer instead to call them “techniques.” If someone has difficulty with any of these techniques, it indicates that their eyes are not functioning to their optimal ability—and a full eye exam is therefore in order. However, this exam should be more than just a test of distance viewing ability (i.e., eyechart)—it should be more of a “functional” test of how the eyes focus and coordinate while viewing near targets.
Q: Is there anything else you would like to add?
A: It’s always easier to prevent health concerns than it is to try to reverse an advanced disease. Regular eye exams, which are more than just reading letters on a chart, should be an essential part of any pre-term school year preparation—and should take place annually for everyone over 40 years old.