Visual Fatigue Syndrome The Price of The Price of Today’s Today’s Near and Near and Intermediate Intermediate World World Dr. Kris Kerestan.

Visual Fatigue SyndromeVisual Fatigue Syndrome

The Price of The Price of Today’s Today’s Near and Near and IntermediateIntermediate WorldWorld

Dr. Kris Dr. Kris KerestanKerestan

Fundamental Shift in Fundamental Shift in Use of VisionUse of Vision

Past: Primarily used Distance visionPast: Primarily used Distance vision Today: Primarily use Today: Primarily use

Intermediate/NearIntermediate/Near

Fundamental Shift in Use Fundamental Shift in Use of Visionof Vision

Most professionals Most professionals require extended require extended intermediate and near intermediate and near viewingviewingAccountantsAccountantsAttorneysAttorneysEngineersEngineersBusiness administratorsBusiness administratorsArchitectsArchitectsComputer technologyComputer technologyDesignersDesignersMedical/allied health Medical/allied health

Widespread Widespread Computer UseComputer Use

Work, Home, School:Work, Home, School:

• Over 55% use computers at workOver 55% use computers at work• Out of 100 million in US – 50% of Out of 100 million in US – 50% of

workday is spent at a computer workday is spent at a computer

Widespread Computer Widespread Computer UseUse

73% of U.S. adults use computers73% of U.S. adults use computers

71% access the internet71% access the internet

In a recent study of more than 1,000 patients 25 In a recent study of more than 1,000 patients 25 years and older, respondents averaged between years and older, respondents averaged between 6 and 7 hours per day at a computer6 and 7 hours per day at a computer

In the past decade, computer use amongIn the past decade, computer use among

children in the United States has increasedchildren in the United States has increased

dramatically… Consider these statistics:dramatically… Consider these statistics:

94 percent of American families with children 94 percent of American families with children have a computer in the home with access to have a computer in the home with access to

the Internetthe Internet

Widespread Computer Widespread Computer Use Use

Widespread Computer Widespread Computer UseUse

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

Widespread Computer Widespread Computer UseUse

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

Visual FatigueVisual Fatigue

Today’s visual demands place greater Today’s visual demands place greater stress on near and intermediate vision than stress on near and intermediate vision than ever before…ever before…

More than 70% of 143 million Americans who work More than 70% of 143 million Americans who work on a computer are affected by visual fatigue on a on a computer are affected by visual fatigue on a daily basis according to the AOAdaily basis according to the AOA

Studies show that eye strain and bothersome Studies show that eye strain and bothersome visual symptoms occur in up to 83% of computer visual symptoms occur in up to 83% of computer usersusers

Visual FatigueVisual Fatigue

Approximately 10 millionApproximately 10 million eye exams are performedeye exams are performed annually in the U.S. due toannually in the U.S. due to vision problems related tovision problems related to computer use, making it acomputer use, making it a major public health issuemajor public health issue

71% of those patients 71% of those patients examined already wearexamined already wear corrective lenses for corrective lenses for myopia, hyperopia,myopia, hyperopia, astigmatism or presbyopiaastigmatism or presbyopia but still have visual fatigue but still have visual fatigue and eye strain and eye strain

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

A visual condition consisting of a sum of A visual condition consisting of a sum of TREATABLE symptoms including:TREATABLE symptoms including:

HeadacheHeadache Loss of focusLoss of focus Blurred visionBlurred vision Burning of the EyesBurning of the Eyes Tired EyesTired Eyes

What is Visual Fatigue Syndrome?

What is Visual Fatigue Syndrome?

A visual condition consisting of a sum of A visual condition consisting of a sum of TREATABLE symptoms including:TREATABLE symptoms including:

Red EyesRed Eyes Dry EyesDry Eyes Neck and Shoulder PainNeck and Shoulder Pain Overall general FatigueOverall general Fatigue

““The complex of eye and The complex of eye and vision problems related to vision problems related to near work which are near work which are experienced during or related experienced during or related to computer use.”to computer use.”

--American Optometric --American Optometric AssociationAssociation

What is Visual Fatigue Syndrome?

VFS- On the RiseVFS- On the Rise

50-90% of computer users 50-90% of computer users experience visual symptomsexperience visual symptoms

22% of computer users experience 22% of computer users experience musculoskeletal disordersmusculoskeletal disorders

Contributing Factors – Contributing Factors – The PatientThe Patient

Condition of the patient’s eyes and Condition of the patient’s eyes and visual systemvisual system

Working environmentWorking environment Work habitsWork habits The eyes leading the bodyThe eyes leading the body Too much staring, not enough Too much staring, not enough

blinkingblinking

Contributing Factors – Contributing Factors – The ComputerThe Computer

Position of the monitor Position of the monitor • Distance from the eyesDistance from the eyes• Location relative to eye levelLocation relative to eye level

Nature of the imageNature of the image• Difficult to focus on pixel imagesDifficult to focus on pixel images• Eyes tend to relax to a point beyond the Eyes tend to relax to a point beyond the

screen (resting point of accommodation)screen (resting point of accommodation)• Constant refocus needed, tiring the eyesConstant refocus needed, tiring the eyes

Contributing Factors – The Contributing Factors – The OfficeOffice

EnvironmentEnvironment

Inappropriate lightingInappropriate lighting Reflections from the computer Reflections from the computer

screenscreen

or outside sources or outside sources Poor ergonomicsPoor ergonomics Dry and poor quality of office airDry and poor quality of office air

During eye health exam, During eye health exam, must screen must screen every every patientpatient by asking by asking specific questions specific questions regarding their regarding their computer use, hobbies, computer use, hobbies, reading and any reading and any visual visual fatiguefatigue symptomssymptoms that that may accompany these may accompany these activities activities

May use a specificMay use a specific patient questionnairepatient questionnaire or add to caseor add to case history formhistory form

Detection and Diagnosis of VFS Detection and Diagnosis of VFS based on patient based on patient SYMPTOMSSYMPTOMS……

What Specific Questions should we What Specific Questions should we

ask our patients?ask our patients? 1. 1. How many hours per day are you on a computer How many hours per day are you on a computer or other electronic device at work and/or home?or other electronic device at work and/or home?

2. Do you have any hobbies that require you to use2. Do you have any hobbies that require you to use your eyes up close?your eyes up close?

3. Do your eyes ever feel tired or strained while on 3. Do your eyes ever feel tired or strained while on the computer?the computer?

4. Do you ever have blurred or out of focus vision 4. Do you ever have blurred or out of focus vision while on the computer?while on the computer?

What Specific Questions should we What Specific Questions should we

ask our patients?ask our patients?

5.5. Do your eyes ever feel dry or get red while using Do your eyes ever feel dry or get red while using the computer?the computer?

6. Do you experience headaches with computer or 6. Do you experience headaches with computer or electronic device use or while engaging in your electronic device use or while engaging in your hobby?hobby?

7. Do you experience neck or shoulder pain while 7. Do you experience neck or shoulder pain while using the computer?using the computer?

8. Do you feel overall fatigue during or after 8. Do you feel overall fatigue during or after computer use?computer use?

Detection and Diagnosis of VFS Detection and Diagnosis of VFS based on based on CLINICAL CLINICAL

FINDINGSFINDINGS……

What clinical tests will aid the doctors andWhat clinical tests will aid the doctors and

staff in the diagnosis of VFS?staff in the diagnosis of VFS?

•Refractive errorsRefractive errors•Binocular visionBinocular vision•Accommodative Accommodative problemsproblems•Presbyopia and nearPresbyopia and near vision correctionvision correction•Dry eyesDry eyes

Diagnosis of VFSDiagnosis of VFS

VFS VFS

SymptomsSymptoms

++

Clinical findingsClinical findings

==

VFS diagnosisVFS diagnosis

Who is affected by Visual Who is affected by Visual Fatigue Syndrome?Fatigue Syndrome?

Emmetropes, Myopes, Emmetropes, Myopes,

Hyperopes & AstigmatsHyperopes & Astigmats Non-presbyopes & presbyopesNon-presbyopes & presbyopes Spectacle lens wearersSpectacle lens wearers Contact lens wearersContact lens wearers Refractive surgery patientsRefractive surgery patients

Visual Fatigue can affect anyone at any age…Child, Teen, Young to Mature Adult

Treating VFS using Treating VFS using Computer Eyewear Computer Eyewear

1.1. Single Vision LensesSingle Vision Lenses or Readersor Readers

2.2. ““Anti-Fatigue” LensesAnti-Fatigue” Lenses for Non-Presbyopesfor Non-Presbyopes

2.2. Near Variable Focus Near Variable Focus “ “Computer” LensesComputer” Lenses for Presbyopesfor Presbyopes

4.4. Progressive lenses Progressive lenses

Single Vision Computer Single Vision Computer LensesLenses

In the past most lenses prescribed in computer In the past most lenses prescribed in computer glasses were Single Vision because not many glasses were Single Vision because not many other lens options were availableother lens options were available

Although SV lenses sometimes are an adequate Although SV lenses sometimes are an adequate solution for near tasks, the range of focus is solution for near tasks, the range of focus is extremely limited to one set distance. Patients extremely limited to one set distance. Patients are unable to walk around or see other distances are unable to walk around or see other distances in the office, so must constantly be taking on and in the office, so must constantly be taking on and offoff

Single-Vision LensesSingle-Vision Lenses Most presbyopes wearing single vision Most presbyopes wearing single vision

lenses for reading and up-close work have lenses for reading and up-close work have blurred mid-range visionblurred mid-range vision

One solution is to move mid-range objects One solution is to move mid-range objects closer, but that is not always possiblecloser, but that is not always possible

Another solution is an extra pair of single Another solution is an extra pair of single vision lenses for mid-range use; usually vision lenses for mid-range use; usually purchased from a pharmacypurchased from a pharmacy

Single Vision LensesSingle Vision Lenses

For those ages 13 to 29, add +0.50 to their For those ages 13 to 29, add +0.50 to their spherical distance correctionspherical distance correction

For those age 30 and over wearing Single Vision, For those age 30 and over wearing Single Vision, add +0.75 to their spherical distance correctionadd +0.75 to their spherical distance correction

These glasses are intended for use at These glasses are intended for use at computer/intermediate distance only and will computer/intermediate distance only and will cause blur at all other distances cause blur at all other distances

**Always Rx with AR coating****Always Rx with AR coating**

DistanceZone

NearZone

UnwantedBlur

Progressive LensesProgressive Lenses

Progressive lenses usually require more power Progressive lenses usually require more power change from top to bottom and therefore are change from top to bottom and therefore are not the best option not the best option

Consequently, they produce more blurConsequently, they produce more blur As adds increase, there is less stable and As adds increase, there is less stable and

narrow power in intermediate areanarrow power in intermediate area

General Purpose PAL

Optometrists’ QuotesOptometrists’ Quotes

““Up until now I Up until now I basically gave up on basically gave up on these patientsthese patients that have visual fatigue that have visual fatigue symptoms. I didn’t feel like I had symptoms. I didn’t feel like I had anything to offer them in my clinical anything to offer them in my clinical arsenal.”arsenal.”

““There really are notThere really are not enough products enough products for us to pick fromfor us to pick from for dealing with for dealing with some of these accommodative some of these accommodative disorders that we’re identifying.” disorders that we’re identifying.”

 “ “The The progressives don’t cut itprogressives don’t cut it for those for those patients who spend great deals of time patients who spend great deals of time on the computer.”on the computer.”

Increasing Demand for New Increasing Demand for New Computer Lens Computer Lens TechnologiesTechnologies

Despite significant regular computer use Despite significant regular computer use by over 75% of the population, only 3% to by over 75% of the population, only 3% to 4% of Americans today wear eyeglasses to 4% of Americans today wear eyeglasses to relieve vision problems at a computer.relieve vision problems at a computer.

Why??• Not receiving appropriate diagnosis

and treatment • Not aware of lens options available

Newer Lens Solutions Newer Lens Solutions for Visual Fatigue for Visual Fatigue

SyndromeSyndrome

Addresses the following:Addresses the following:

• Different diagnoses by the ODDifferent diagnoses by the OD

such as accommodative VFSsuch as accommodative VFS

in pre-presbyopic patients or in pre-presbyopic patients or

true presbyopic VFS true presbyopic VFS

• Must have lens options to treat a Must have lens options to treat a broad range of patient broad range of patient

types and agestypes and ages

Newer Lens Solutions for Newer Lens Solutions for Visual Fatigue SyndromeVisual Fatigue Syndrome

New category of lenses under New category of lenses under “Visual Fatigue”“Visual Fatigue”

Anti-FatigueAnti-Fatigue—A primary wear pair for —A primary wear pair for non-presbyopes or emerging presbyopes non-presbyopes or emerging presbyopes who suffer from VFSwho suffer from VFS

Variable Focus “Computer”Variable Focus “Computer”---A ---A task specific lens for presbyopes who task specific lens for presbyopes who suffer from VFSsuffer from VFS

““Anti-Fatigue” Anti-Fatigue” Computer Lens Computer Lens

SolutionSolution

Treating VFS with “Anti-Treating VFS with “Anti-Fatigue” LensesFatigue” Lenses

Who is it for?Who is it for?

Non-Presbyopic patients sufferingNon-Presbyopic patients suffering from VFS symptomsfrom VFS symptoms

Emerging PresbyopesEmerging Presbyopes

Individuals who use near vision for Individuals who use near vision for extended periods doing activities such asextended periods doing activities such as reading, texting, electronic device use, reading, texting, electronic device use, paperwork, etc.paperwork, etc.

Treating VFS with “Anti-Treating VFS with “Anti-Fatigue” LensesFatigue” Lenses

How do they work?How do they work?

Use as the primary pair to replace a patients Use as the primary pair to replace a patients single vision lensessingle vision lenses Provides a slight +0.60D “power boost” in the Provides a slight +0.60D “power boost” in the lower part of the lenslower part of the lens Provides greater patient comfort and reduced Provides greater patient comfort and reduced visual fatigue than standard single visionvisual fatigue than standard single vision correction by allowing the eye muscles to relaxcorrection by allowing the eye muscles to relax thereby decreasing the accommodative effortthereby decreasing the accommodative effort

““Anti-Fatigue” Lenses Anti-Fatigue” Lenses How do they work?How do they work?

Sustains the accommodative effortSustains the accommodative effort Aspheric, so little or no distortionAspheric, so little or no distortion Compatible with all frame types => 23 mm BCompatible with all frame types => 23 mm B***Only available with Non-glare******Only available with Non-glare***

Concept:Concept: SV lens with distance vision (exactly as in a SV lens with distance vision (exactly as in a

regular SV) w/a slight power variation (+0.6 regular SV) w/a slight power variation (+0.6 D) in bottom part of lens to give some D) in bottom part of lens to give some comfort in near vision, preventing and comfort in near vision, preventing and relieving visual fatiguerelieving visual fatigue

+0.6 D power variation reached at 12mm +0.6 D power variation reached at 12mm from center = down gaze of 26° from center = down gaze of 26°

““Anti-Fatigue” LensAnti-Fatigue” Lens

““Anti-Fatigue”Anti-Fatigue”Fitting & MountingFitting & Mounting

Center pupil fitting heightCenter pupil fitting height 13 mm minimum13 mm minimum 23 mm minimum B 23 mm minimum B

measurementmeasurement Monocular Distance PDsMonocular Distance PDs

““Anti-Fatigue” Lenses Anti-Fatigue” Lenses Key Patient Types Key Patient Types

35 to 45 year olds just starting to 35 to 45 year olds just starting to need slight plus for readingneed slight plus for reading

Myopes or Hyperopes aged 13 to 34 Myopes or Hyperopes aged 13 to 34 years when they indicate VFS years when they indicate VFS symptoms of tired eyes, eye strain symptoms of tired eyes, eye strain or othersor others

““Anti-Fatigue” LensAnti-Fatigue” Lens

Essilor Anti-fatigueEssilor Anti-fatigue

is only lensis only lens

available in thisavailable in this

categorycategory

Variable Focus

“Computer” LensSolution

Treating VFS with Variable Treating VFS with Variable Focus “Computer” LensesFocus “Computer” Lenses

Who is it for?Who is it for?

Task specific wear by Presbyopes whoTask specific wear by Presbyopes who spend extended time at intermediate andspend extended time at intermediate and near viewingnear viewing

Meant to be used as a second pair toMeant to be used as a second pair to complement a patient’s primary pair ofcomplement a patient’s primary pair of progressivesprogressives

Treating VFS with “Computer” Treating VFS with “Computer” LensesLenses

How does it work?How does it work? Intermediate VisionIntermediate Vision : Wide and comfortable : Wide and comfortable ““Computer “ lenses provide full vision at intermediate Computer “ lenses provide full vision at intermediate distance by accommodating a patient’s natural posture distance by accommodating a patient’s natural posture and workplace ergonomicsand workplace ergonomics

Near VisionNear Vision : Smooth transition : Smooth transition Wide near area that provides a smooth transition Wide near area that provides a smooth transition for looking at the keyboard or documentsfor looking at the keyboard or documents

Distance VisionDistance Vision : Functional and efficient : Functional and efficient Offers clear vision at full distance within an office setting Offers clear vision at full distance within an office setting to most patients, allowing for effective sight at all distancesto most patients, allowing for effective sight at all distances

““Computer” LensComputer” Lens

Contains an intermediate field of vision designed Contains an intermediate field of vision designed to offer full coverage of the screen area.to offer full coverage of the screen area.

Lens power specifically tailored for clear screen Lens power specifically tailored for clear screen vision and frequent movements from keyboard to vision and frequent movements from keyboard to screen to surroundings.screen to surroundings.

The design was based on user observations; The design was based on user observations; lenses let you keep a natural posture: a 30° angle lenses let you keep a natural posture: a 30° angle between the positions for viewing keyboard and between the positions for viewing keyboard and screen. screen.

These lenses should NOT be worn for driving or other distance viewing activities.

““Computer” Lens - BenefitsComputer” 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.

Near Variable Focus (NVF) Near Variable Focus (NVF) LensLens

““Computer”Computer” DesignDesign

““Computer” Lens Computer” Lens Key Patient Types Key Patient Types

Any presbyope indicatingAny presbyope indicating VFS symptomsVFS symptoms

Also perfect lens for Also perfect lens for activities at intermediate activities at intermediate and near – hobbies,and near – hobbies, remodeling, sewing, autoremodeling, sewing, auto work, Optometrists, work, Optometrists, Optometric Assistants, etc.Optometric Assistants, etc.

““Computer” Lenses Computer” Lenses AvailableAvailable

Essilor “Computer” LensEssilor “Computer” Lens

Zeiss “Business” and “Access”Zeiss “Business” and “Access” Computer LensComputer Lens

Shamir “Office” Computer LensShamir “Office” Computer Lens

Specific Fitting techniques andSpecific Fitting techniques and Lens parameters available through Lens parameters available through Sales Reps.Sales Reps.

Next StepsNext 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

Additional Steps to Relieve Additional Steps to Relieve VFSVFS

Use Proper LightingUse Proper Lighting

Decrease both bright sunlight coming in and Decrease both bright sunlight coming in and replace bright overhead fluorescent lighting with replace bright overhead fluorescent lighting with full spectrum bulbs or floor lamps full spectrum bulbs or floor lamps

Minimize GlareMinimize Glare

AR coating, Anti glare screen, paint white walls AR coating, Anti glare screen, paint white walls

a darker color in matte finisha darker color in matte finish

Additional Steps to Relieve Additional Steps to Relieve VFSVFS

Adjust screenAdjust screen Brightness, contrast, text size and color Brightness, contrast, text size and color Blink more - Blink more - 5X less when using computer5X less when using computer

Rewets eyes to decrease dryness and irritationRewets eyes to decrease dryness and irritation

Artificial tearsArtificial tears

Relax FocusingRelax Focusing 20-20-20 rule - look away from computer Q 20 20-20-20 rule - look away from computer Q 20

mins, 20 ft away for 20 sec.mins, 20 ft away for 20 sec.

Additional Steps to Relieve Additional Steps to Relieve VFSVFS

Frequent breaksFrequent breaks Two 15 min breaks plus 4 mini 5 min breaks Two 15 min breaks plus 4 mini 5 min breaks through daythrough day Stand up, walk around, stretch arms, legs, backStand up, walk around, stretch arms, legs, back and neckand neck

Modify Work StationModify Work Station Copy stand next to monitor, screen 20-24 inches Copy stand next to monitor, screen 20-24 inches

from eyes and 10-15 degrees below eyes, good from eyes and 10-15 degrees below eyes, good postureposture

Gunnar High Definition LensesGunnar High Definition Lenses ***Digital Performance ***Digital Performance

Eyewear*** Eyewear***

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

Gunnar High Definition LensesGunnar High Definition Lenses ***Digital Performance ***Digital Performance

Eyewear*** Eyewear*** Reduces visual stress, eyestrain and Reduces visual stress, eyestrain and

digital eye fatiguedigital eye fatigue Wrap design for maximum field of clear Wrap design for maximum field of clear

visionvision Proprietary amber tint to increase contrastProprietary amber tint to increase contrast

***Considered the Ultimate*** ***Considered the Ultimate***

***Gaming Lenses******Gaming Lenses***

Gunnar High Definition Gunnar High Definition LensesLenses

***Digital Performance ***Digital Performance Eyewear***Eyewear***

Gunnar High Definition LensesGunnar High Definition Lenses ***Digital Performance ***Digital Performance

Eyewear*** Eyewear***

Thank You for Thank You for your your

Attention!!Attention!!

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