TFOS lifestyle: Impact of the digital environment on the ocular surface


Eye strain when performing tasks reliant on a digital environment can cause discomfort, affecting productivity and quality of life. Digital eye strain (the preferred terminology) was defined as “the development or exacerbation of recurrent ocular symptoms and/or signs related specifically to digital device screen viewing”. Digital eye strain prevalence of up to 97% has been reported, due to no previously agreed definition/diagnostic criteria and limitations of current questionnaires which fail to differentiate such symptoms from those arising from non-digital tasks. Objective signs such as blink rate or critical flicker frequency changes are not ‘diagnostic’ of digital eye strain nor validated as sensitive. The mechanisms attributed to ocular surface disease exacerbation are mainly reduced blink rate and completeness, partial/uncorrected refractive error and/or underlying binocular vision anomalies, together with the cognitive demand of the task and differences in position, size, brightness and glare compared to an equivalent non-digital task. In general, interventions are not well established; patients experiencing digital eye strain should be provided with a full refractive correction for the appropriate working distances. Improving blinking, optimizing the work environment and encouraging regular breaks may help. Based on current, best evidence, blue-light blocking interventions do not appear to be an effective management strategy. More and larger clinical trials are needed to assess artificial tear effectiveness for relieving digital eye strain, particularly comparing different constituents; a systematic review within the report identified use of secretagogues and warm compress/humidity goggles/ambient humidifiers as promising strategies, along with nutritional supplementation (such as omega-3 fatty acid supplementation and berry extracts).

Publication DOI:
Divisions: College of Health & Life Sciences > School of Optometry > Optometry & Vision Science Research Group (OVSRG)
College of Health & Life Sciences
College of Health & Life Sciences > School of Optometry > Optometry
Additional Information: Copyright © 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license ( Acknowledgments: Sal Jivraj is acknowledged for creating the infographics (Figs. 4 and 11). The TFOS Lifestyle Workshop was conducted under the leadership of Jennifer P Craig, PhD FCOptom (Chair), Monica Alves, MD PhD (Vice Chair) and David A Sullivan PhD (Organizer). The Workshop partici- pants are grateful to Amy Gallant Sullivan (TFOS Executive Director, France) for raising the funds that made this initiative possible. The TFOS Lifestyle Workshop was supported by unrestricted donations from Alcon, Allergan an AbbVie Company, Bausch+Lomb, Bruder Health- care, CooperVision, CSL Seqirus, Domp ́e, ESW-Vision, ESSIRI Labs, Eye Drop Shop, I-MED Pharma, KALA Pharmaceuticals, Laboratoires Th ́ea, Santen, Novartis, Shenyang Sinqi Pharmaceutical, Sun Pharmaceutical Industries, Tarsus Pharmaceuticals, Trukera Medical and URSAPHARM.
Uncontrolled Keywords: Blinking,Blue-light,Computer vision syndrome,Digital display,Digital environment,Digital eye strain,Management,Nutrition,Systematic review,Visual fatigue,Ophthalmology
Publication ISSN: 1937-5913
Last Modified: 18 Jul 2024 07:24
Date Deposited: 02 May 2023 17:43
Full Text Link:
Related URLs: https://www.sci ... 542012423000307 (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2023-04
Published Online Date: 2023-04-14
Accepted Date: 2023-04-06
Authors: Wolffsohn, James S. (ORCID Profile 0000-0003-4673-8927)
Lingham, Gareth
Downie, Laura E.
Huntjens, Byki
Inomata, Takenori
Jivraj, Saleel
Kobia-Acquah, Emmanuel
Muntz, Alex
Mohamed-Noriega, Karim
Plainis, Sotiris
Read, Michael
Sayegh, Rony R.
Singh, Sumeer
Utheim, Tor P.
Craig, Jennifer P.



Version: Published Version

License: Creative Commons Attribution

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