Protecting Eyes From Strain and Injury

Jennifer Ottowitz: Welcome to OIB-TAC’s monthly webinars, where our presenters share valuable information and helpful resources to support professionals working with older adults who are blind or vision impaired. Let’s check out this month’s webinar.

Lindsey Angst: Good afternoon. My name is Lindsey Angst, and I will be teaching the webinar entitled Protecting Eyes from Strain and Injury today.

Thank you for taking the time out of your day to take this webinar. I hope everyone learns a lot, specifically techniques and strategies that you can utilize to adapt the environment to protect your eyes and also optimize visual functioning on a daily basis.

My name is Lindsey Angst, and I'm an occupational therapist and certified low vision therapist, and I am thrilled to be teaching this webinar today. A little bit about my background. I always think it's nice to kind of know a little bit about the person you're going to listen to for the next 45 minutes, in this case.

I am from Green Bay, Wisconsin, so the upper Midwest part of the country. Big Packers fans up here, and we’re not playing that great this year, but hopefully they can turn it around. I love the weather this time of year. Living in Wisconsin, the leaves are changing colors, so lots of people are outside in their yards, raking leaves and doing lots of yard work, and just taking in the beautiful colors.

If you ever visit the Green Bay, Wisconsin area in general, fall is a beautiful time of year to do that, so I would highly recommend it. I've been practicing as an occupational therapist and also a certified low vision therapist. Fourteen years as an occupational therapist, and 11 years now as a certified low vision therapist.

I practice in a dual area, treating outpatient orthopedics in the hand and upper extremity and then also serving the low vision population as well. Within the low vision population I also treat concussion patients primarily for their light sensitivity, teaching them how to adapt their environment and to reduce strain on their eyes.

When I was putting this course together, my concussion caseload came to mind quite a bit, actually because I'm constantly teaching them how to decrease eye strain and fatigue specifically, which is what this course is primarily on today. And the use of technology specifically because that can trigger a lot of symptoms for concussion patients.

So, just to keep in the back of your mind, if you yourself or you know of a client or a friend or family member that has had a concussion, a lot of what you're going to hear as far as tips and techniques and strategies in this webinar, you can pass along to them as well.

On a personal note, I am married, and I have two sons, and I love watching them play sports. That pretty much consumes all my free time I feel like these days. I also love to exercise and also thrift shop.

So, who is at risk for eyestrain and fatigue? Well, we're going to start with the population that we serve. Our clients, our patients. They are at risk. If they are spending a lot of time in front of a computer during the day and then they are going home and reading their emails at night or watching TV.

I mean, they're at risk for eyestrain and fatigue because they are spending just oodles and oodles of time in front of the computer and using their vision and not even aware for the duration of time that they're using their vision and eyesight.

So, this is something you can educate for sure your clients and patients on. The professionals ourselves as clinicians or as providers, we are at risk for eyestrain and fatigue. I spend a lot of time during my day documenting on a computer.

I look at patient charts on a computer. I am on a computer on and off throughout my entire day, as I'm sure all of you are. So, we ourselves also have to kind of take a step back and recognize what are symptoms and signs of eyestrain and fatigue so we can prevent them and do the best that we can to really protect our vision long term.

Students, for sure, are at risk. They spend more time in front of a computer or a Chromebook now than I think ever before. Back when I was younger, I don't think there was a computer lab that we went to like once or twice a week. My youngest is in second grade, and as he started the school year, he was given his own Chromebook. So, all students have their own Chromebook or access to one at this point, and they're on it throughout the day constantly.

My kids are logging on from home and doing their homework. A lot is done on the computer now. And COVID, the whole COVID pandemic really put a lot of people in the position to use technology for longer periods of time than they probably ever have before. You know, we were on computers to communicate with loved ones for work, for the virtual school that a lot of the students were having to do. So, they're at a huge risk.

College students, you name it. I mean, they're always going to be in front of technology, smartphones, all of that. So, students are definitely at a high risk. And anyone really that uses their vision for a prolonged period of time, no matter what the task or what they're doing.

Is there a certain age for eyestrain and fatigue that it may be more common, or you're at a higher risk? Not really, just because nowadays there's children from, like I said, grade school age, and I have patients and clients all the way up to 100 plus years old that still use technology and read and use their vision quite a bit. They're on the computer. So, at every age and stage of your life, you are at risk for developing eyestrain or fatigue.

Nearly 70% of Americans experience eyestrain and fatigue, which is kind of a huge number. So, it's important to be preventative and proactive with your vision and implementing a lot of these strategies and techniques into your day-to-day so that number doesn't go on the increase or rise.

Some of the symptoms of having eyestrain and fatigue include dry eyes. When you spend a lot of time looking at a computer screen or a TV screen for a long period of time, then you kind of start to forget to blink. And when you forget to blink, your eyes essentially get dry. So, that's something that you want to keep in mind. And you want to make patients or any of your clients aware to just blink on a frequent basis because we tend to forget that.

And then that can create or lead to dry eye. Also, in Wisconsin, where I live, the air gets very, very dry, especially in the winter. So, adding a humidifier is a really good idea to keep moisture in the air and also prevent dry eyes. Headaches are very common. If your visual system, your brain is interpreting what your eyes see.

So, if you're spending a lot of time in front of a computer or in front of a screen or just visually looking at something if you're starting to notice headaches, that can be a symptom of actually what you're doing with your vision. If your eyes water a lot and you're having to constantly wipe them, diplopia is when you have double vision.

So, if you're starting to see two of things, you know something's off and you need to kind of just step back and take a break. Itchy eyes. If you're rubbing your eyes and itching them a lot more frequently, that can be a cue to you that you need to take a break and close your eyes or just stop looking at whatever you're looking at and just get away from it because that is just going to lead to some of these other symptoms.

If your vision feels blurred and then having light sensitivity, you can have light sensitivity from the screen itself. So, being really aware of what your environment looks like in regards to lighting. If you have overhead lighting or a lamp next to your computer or your TV screen, you want to kind of ask yourself, is this set up correctly, or is there glare on the screen?

A lot of people develop light sensitivity under fluorescent lights. So, being mindful that if you spend a lot of your day under fluorescent lighting, you can become even more sensitive. And then also natural light, like when you step outside after being inside that dark to light adaptation, a lot of people get more and more light sensitive if they've used their vision a lot during the day and for long periods of time.

So, if patients or clients or anyone starts reporting these symptoms to you, the first thing you want to be kind of thinking of is how long have you been in front of a computer screen or how long have you been using your eyes?

And just start with simply taking rest breaks and doing some of the things we're going to talk about in this webinar to kind of reduce the strain that you're putting on your eyes and then see if some of these symptoms clear up.

But if you have or notice one or more of these symptoms and they're not going away, then you definitely want to go and see your eye doctor and get an eye exam to make sure there's nothing more serious underlying.

Cause of eyestrain. Prolonged use of digital devices. And this is also known as digital eyestrain or DES. So, examples of this would be watching TV, being on your phone, computer use, iPad, tablet use, or even gaming or video game playing.

I have had multiple patients that I've seen as a hand therapist and they'll come to me with wrist or thumb pain and when I'm going through their client profile questions with them and gathering their history and I'll ask them what they'd like to do in their leisure free time, they'll tell me they like to game.

And when I asked them for what duration of time they play their games, they'll say three, four plus hours at a time without taking a break. So, that is commonly a factor contributing to their thumb and wrist pain. So, prolonged use of any digital device can have an effect on the musculoskeletal system as well as the visual system.

So, that's important to keep in mind. The increase in the duration and use of any digital device has been on the rise, especially in the last three years following COVID restrictions. A lot of jobs had people working from home remotely.

A lot of students were doing schoolwork and communicating with their friends and family on digital devices. So, I think people were almost glued to their devices and didn't even think twice about taking a break for their body and for their vision.

How long does it take for digital eyestrain to set in? Well, according to the American Optometric Association, the usage of digital devices for two hours without any break can actually trigger the onset of eyestrain.

In general, you want to be proactive, not reactive. I always tell my patients and coworkers that even if you notice the symptoms of eyestrain like headache, blurred vision, dry eyes, any of those symptoms, if you notice them at, let's say, one hour or at a half hour, you want to set a timer and you want to take a break prior to the onset of any symptoms of eyestrain.

General energy conservation strategies also can apply here. I think people think of energy conservation techniques for their joints or their body, but you can also apply them for your vision. And an example would be eliminating unnecessary tasks that you don't need to do in a day with your vision.

If you know you're going to be on a computer for a long period of time, maybe then later in the day you don't do the reading that you had planned from a book or magazine. You put that to another day. Maybe you're combining necessary tasks so that they're not spread out throughout longer periods of time, but you can kind of consolidate those.

Maybe you rearrange the sequence of tasks so that you don't have a lot of visual use in the morning and then not so much in the afternoon. Maybe you're doing it so that it's broken up throughout the day. And simplifying tasks as much as possible is a great way to just generally conserve energy for your eyes.

Visual strain can also have an impact on the musculoskeletal system, so on your physical body. So, everybody right now do me a favor and just close your eyes and give your eyes a break from staring at the screen and just do some upper body stretching and movement to kind of give your neck and back a break. Okay.

Some people have used screens, whether they're TV screens, your monitor, your phone screen from inappropriate distances. So, they may be too close or too far away. The angle may be awkward and setup not ideally. This can lead to the adaption of tense posturing. So, especially in like your neck, your shoulders, your back.

So, if you're leaning in to try to see the screen or read something in smaller print, you're putting a lot of stress on your upper neck and your body. And that's going to then have an effect on your body, not just on your visual system. So, keeping that in mind is really important. There was a study that found that the blinking rate actually decreases dramatically when someone is viewing a screen of any kind.

So, again, we come back to setting timers on your phone or watch and kind of avoiding prolonged screen use and keeping in mind that two-hour rule. We don't want to be on for more than two hours straight, not just for your eyes, but for your body as well.

Blinking keeps your eyes lubricated. So, super important to blink continuously or to be mindful of it. I sometimes put a Post-it note on my computer and I'll just say blink, just to remind me to blink. And it prevents dry eyes. Now we're getting like the cooler weather setting in where I live in the Midwest, up in Wisconsin.

And so, winter will be coming and the air gets extremely dry. So, I will add a humidifier a lot of times in my kid's room and in our bedroom just to add more moisture to the air and to kind of prevent dry eye and everything else that happens with the cold winter weather. But that's also a good recommendation that I give my low vision patients as well.

Other factors that can contribute to eyestrain, poor posture. We've been starting to touch on that a little bit. And the next slide, I'm going to have some recommendations for that, specifically in front of a computer or a monitor, something like that, or screen. Limited blinking, which we've also touched on.

That's the way your eyes are going to stay lubricated. It's a way to give your eyes a visual break. We want to remember that your eyes move up and down, side to side because of muscles. You have muscles in your eyes just like the rest of your body. And just like any other muscle group in your body, if you overuse a muscle or you use your eyes in a different way, or for a long period of time, they are going to get fatigued.

So, to prevent this, always plan to take rest breaks throughout your day before your eyes get tired. You're going to hear me like a broken record say that over and over throughout this webinar. Lack of correction, which means glasses. If you have not had a complete eye exam in the last year, maybe two years, it's highly recommended.

And that's also supported by the AOA, the American Optometric Association. If you have a lack of correction and there is some refractive error, which means the way the light is entering your eye is not ideal or the light is not entering your eye and converging where it's supposed to on the back of your retina that needs and can be corrected typically with glasses or a new prescription or updated prescription.

If that isn't corrected, you can get a lot of eyestrain because you're squinting a lot more and you can have blurred vision and a lot of other symptoms. So, that is something that can really help relax your eye muscles and take a lot of stress off of them.

Screen glare. You want to be mindful of the setup of your computer or technology that you're using in association to the room that you're sitting or working in. If you are able to, you want to kind of limit ambient room lighting. You don't want to have a lot of reflective glare directly off the screen.

Ambient room lighting is like the overall room lighting that you're using from the ceiling typically or from a light fixture hanging down. You want to be mindful. A lot of people and I encourage my patients to add task lighting, which is lighting that is positioned between you and whatever you're trying to read or see.

You can have task lighting, but maybe angle it down more at the keyboard, not at the screen, because reflective glare is going to make the contrast of the print from the background harder to see and make your eyes do a lot more work.

Those eye muscles are going to work a lot harder to decipher what you're trying to see, and you're going to have eye fatigue set in a lot sooner. If you have a window in the room, you also want to make sure that the computer, if you can, isn't facing the window because then you're also going to get secondary glare.

The contrast in print size. If the print size is really small, that makes your eyes work a lot harder to see the print. If anyone listening to this webinar right now is of the age of 40 or older, there is something that's called presbyopia, which means your eye loses that elasticity to accommodate as print gets smaller.

So, when I see people out at a store or even at my work, and I see them with their arms constantly moving the print forwards and backward, like trying to figure out where to hold it, to see it better, that can be due to their eye muscles just not adjusting and accommodating. And again, they would need to go and possibly get glasses.

The bigger the print size, typically it's going to be easier for your eyes to read it and see it. If the print is in good contrast from the background. So, if it's a white background with black print or black background with white print, there's good contrast there and your eyes will be able to identify and see what you want to see a lot easier. If it's maybe black on gray or blue on gray or blue on black, your eyes are going to work a lot harder to try to differentiate the print from the background.

So, applying good contrast is a good way to kind of help your eyes read what they want to read with less stress or strain. Another idea, if you're going to read a lot of continuous text on the computer, if you just simply double space the print, now your eyes have less strain because you're not having to discriminate the text between line after line being so close, if you double space it, you give your eyes more ease with reading the text and it's not so cluttered.

So, those are things that you can do that are real simple and can help alleviate eyestrain. The angle position of your monitor and screen that also will be addressed with recommendations on the next slide as well.

So, here is some recommendations and kind of the ideal computer setup. And obviously, this isn't 100% what would work for everybody. But I work with another OT who does ergonomic consults for where I work, and these were kind of the key things she said to focus on.

So, number one, a 90-degree bend in the knees and adding a footrest if your feet do not hit the floor flat. Sometimes, people like an elevated footrest, so you'll see those sometimes under people's feet.

Number two, positioning a computer at arm length away and a screen so, your eyes are in line with the top of the screen. This one, I think, is the most important because if the screen is positioned too high or too low, that's going to put a lot of strain on your neck. And everybody that you talk to these days, a lot of my patients that I see in ortho, they all complain of upper neck pain, which is actually your upper trap muscles.

And that can be from a lot. When I asked them what they do for their occupation, they'll say, I work on a computer, which a lot of people do to some degree. And so, this one is key because this one can have such an impact on the musculoskeletal system, like we talked in prior slides.

So, really pay attention to that. And if your work is good at for, I mean, for the most part for making recommendations or trying to like make your computer set up more ergonomically friendly, these are easy, very low-cost things to accommodate. So, feel free to ask your HR department or whoever, because it’s well worth it to prevent. I mean, carpal tunnel symptoms, you name it, along with the eyestrain and all of that.

Number three is keeping your shoulders down and relaxed. So, you don't want to have elevated shoulders and forward shoulders. So, if you think about when you cruch down to tell someone a secret or when you lean in, that's kind of what you don't want to do.

So, right now, if everybody wants to practice, lift your shoulders up to your ears and then drop them down, so you can kind of feel the difference. A lot of people already have them sitting upright, just at rest. They're just so tight up in their upper muscles of their neck and shoulders.

So, it's a nice reminder to just drop them down. And then you want to kind of picture pulling your elbows back behind you. And that's kind of what you want to do. Roll your shoulders back and down. So, maybe if you're setting the timer to give your eyes a break, you're also doing this for posture realignment, too.

And number four, keeping your elbows bent at a 90-degree position. But it's always good to take a stretch break. I always tell my patients about every 20 minutes or so, stretching for the upper extremity, stretching your fingers, your wrists, because, you know, I'll just speak to this just for a quick moment.

Keeping your elbows bent for a long period of time for some people can aggravate nerve compression, specifically the ulnar nerve, which is like your funny bone nerve. So, if you type with your arms and elbows at a 90-degree position, maybe for a couple of minutes, you kind of stretch them out and you type with them a little more straight.

So, like I said, these are kind of recommendations, but it's always good to kind of change things up for a couple of minutes and take breaks. So, this is a good baseline, though, to kind of follow and to kind of look at your own setup at home. And then you can also tell clients and patients or give these recommendations as you feel fit.

I thought it would be appropriate to put a slide in about tips for watching TV, because I'm assuming everyone that is taking this webinar watches TV, and I'm assuming that a lot of your clients and patients watch TV. So, I thought this would be a good area to spend a couple of minutes on.

So, tips for watching TV in regards to reducing eyestrain and fatigue, of course, number one is to sit closer to the TV. Moving closer to the TV, I tell my kids can hurt their eyes and it's just one of those little fibs you tell as a parent so that they back up a little bit.

In fact, that does not hurt your eyes. Moving closer is one of the easiest and cost-effective methods of actually magnifying what you're trying to see. If you move closer, it will appear bigger to you and it won't hurt or harm your eyes to do so. So, sitting closer is actually recommended in most cases.

As long as, again, you're being mindful about not sitting too close so that the screen is way above eye level, and you're having to tilt your head upward for a long period of time because that will give you neck pain. But moving closer with everything else in mind is a good idea.

Number two is remembering to blink often. Staring at the TV screen for long periods of time is just like any other screen, it can cause eyestrain and fatigue, and dry eyes. So, making sure to do that is important. Giving your eyes frequent rest breaks. So, however long you're planning to watch TV, maybe every 15 minutes again, you're setting an alarm, and it's simple.

You can just turn your head and look in a different direction to give your neck a break. If you have something in the distance, you can kind of look at to give those eye muscles a break. Those are all things that will just help give your eyes a quick little rest break. I always tell patients on commercials, that's ideal.

There's a commercial, I swear, every one or two minutes sometimes. That's a great cue for you to look in the distance or to kind of just move your body and neck and eyes around to take a break.

Number four is avoid positioning your TV directly in front of a window. This can create glare, which we have talked about a little bit already, and glare can be bothersome when it's reflecting off a screen. If you cannot move your TV itself, try either closing your shades or curtains or blinds or just redirecting the light off of the TV. And that can be a lot, a lot easier for your eyes to focus on what you're trying to see.

You do not have to reorganize furniture. I know it's a lot to ask patients or clients to rearrange a room just for watching TV. I think patients kind of look at me like I'm nuts when I ask them if they can move their chair closer to the TV sometimes. But you could simply have a folding chair or like a portable chair that you bring out if it's for certain programs where you know there's going to be a smaller print on the TV.

If everybody is a fan of some sporting event on TV, they always put the score on the top or bottom and it's teeny tiny. That's the number one thing I have patients say to me that they can't see, even if they have relatively good vision and they have glasses on and everything else. So, I simply tell them, move closer, because that's a good way to magnify what's on the screen and it will help reduce eyestrain and you'll be able to see it easier.

And number six, try adjusting the contrast and brightness on your TV screen. If you go into the settings of your TV, you should be able to increase or decrease both contrast and brightness, and that can be really helpful, especially when you're watching it at night.

You want to keep the TV screen kind of the same level of brightness as the room. You don't want to have a screen be super-duper bright when the room itself is dark because that can also cause more eyestrain. So, those are just some tips that I thought would be helpful to mention with watching TV.

So, one of the number one things that I recommend to my low vision patients and my concussion patients and to people in general, if I know they're spending a lot of time in front of a computer or a tablet or a phone is something called the 20/20/20 rule. And if you read any literature on eyestrain or fatigue, I guarantee you this will come up.

So, if you want to reduce digital eyestrain, the 20/20/20 rule is as states. So, for every 20 minutes spent on any form of technology, you set a timer and you take a 20-second break, and you look at an object that is 20 feet away from you or further.

The reason for this is that when things are closer, your eye muscles are on more of a tension. Because of that, your eye muscles are more tensed because you're not letting as much light in so that you can focus on smaller print in front of you. When you look in the distance, it's just the opposite.

The eye muscles go on slack and they're on a more rested state. So, this is just a great rule to implement in your day-to-day and a great role to teach people or clients that you work with because it's extremely helpful and it becomes a habit for people. And this is a very healthy habit that you want to reinforce.

So, more strategies and techniques to help. I'm kind of re-summarizing what we've been talking about, and I wanted to make sure that I touched on everything I wanted to touch on regarding all of this. So, some of it's repeated, and some of it, I think it's just good to hear more than once. And if you have any questions on any of this, feel free to ask me after the webinar in our Q&A.

So, sitting upright in a supported chair at a desk approximately 20 inches from the screen is a great distance between the screen and your eyes. The screen height should be slightly lower than your eyes or right at you're looking right at the top of the screen. So, that's what we talked about and kind of covered before.

The number three, blinking your eyes often, we've covered that. Number four, your screen brightness should match the environment or the room brightness. So, thinking like even lighting, you don't want to go from a dark room to a light computer screen.

And if the room is really bright, you don't want to have the screen really dark because it's going to be that much harder for your eyes to focus in and see. So, think of everything being kind of balanced. Anti-glare screens can be very helpful. You can purchase those on Amazon.

A lot of my patients utilize those and find those super helpful if they're in an environment maybe at work or even at home, and you don't have the ability to manipulate where your computer or your screen is in relationship to the window or other things around you.

Having your font size at 12-point font or larger. Most of my patients find 14 or 16 font very comfortable on their eyes, and it's just easier on your eyes as you get older in general. Considering making the font bold and double spacing it like we had talked about before, is also very helpful.

I'm looking at the screen and this slide that I made right now and thinking, why didn't I make the print a little bit bigger and my eyes are straining to read it. So, this is a good example to make note of.

Set a timer to take breaks before the eye strain has set in. So, that 20/20/20 rule we talked about. And dark mode or reverse contrast, you can set both your computer and the accessibility settings or just the settings in general and your smartphone if you have one. You can put on dark mode or reverse contrast. And for a lot of people, it's very soothing and it makes the print kind of just pop out from the background.

So, if you're going to spend a lot of time on the computer, play around with that and see if that is something that is visually comfortable for your eyes. And then you can also recommend that to others if you find it helpful. It's just another option to try because you're not going to have all of these techniques work for everybody. People can kind of pick and choose what is helpful, but you want to give them a lot of tools and techniques, and strategies to try.

I think one of the easiest things that people can do in their day-to-day environment to make their life easier and to really help reduce eyestrain is applying contrast. Think of contrast as opposites. Black on white, white on black. That's an extreme form of contrast. But an example of poor contrast would be like the newspaper. It's black text and a gray background, right?

So, that is not easy to see or read for long periods of time. But contrast in general, if you are someone or you're working with someone that is just easily losing things or misplacing things, obviously putting things in the same place consistently is very helpful, but also applying contrast makes it easier visually for you to find them a lot sooner.

So, this goes back to energy conservation with your eyes again. If you're spending 5, 10 minutes scanning and looking for something, you're using your eyes. And if that's before you get on the computer, before you do reading, you're just you're compiling how much you're going to use your vision in a short period of time.

So, applying contrast just is kind of like an easy out for your eyes. You're just making it easier. Good contrast really allows for an object to be distinguished from other objects in the background or in the environment that it's in. Here's a simple example: dark coffee in a light cup.

You'd be amazed how hard it is for people to see dark coffee in a dark cup. Just the other day I grabbed my morning coffee cup and I had assumed my husband had put coffee in it because it was dark. And when I went to go drink some, I realized it was empty. Had it been a white cup, I would have noticed it right away.

So, just simple, simple things to apply to your day-to-day. But contrast is something that can easily make a huge difference. And again, take some of the stress or visual strain off of your eyes.

So, I told you guys at the beginning that I'm a low vision therapist. So, a lot of my patients come to me and say they need a magnifier or they need to make things bigger in order to see them, which in a lot of cases is true. But what I start with right away is something called relative size and relative distance magnification. 

And these two techniques can be applied essentially in a lot of different ways. You don't have to have low vision to apply these techniques. Relative size magnification is simply making it bigger. So, this was kind of what we had just talked about on prior slides with the print size on the computer screen. If it's too small, just make it bigger, right?

If your TV, if you're struggling to see your TV, a lot of times people will get a larger TV screen and make it bigger. So, those are, that's a simple, simple technique and a simple way to not have to overuse your eyes or strain your eyes. So, keep that in mind.

Another technique is relative distance magnification, simply moving closer. So, an example like I will give often with my patients is when you're up in an airplane and you're looking down and you're at a high elevation, the homes and everything around you look like little specks or little bugs, and then all of a sudden you drop in elevation and you get way closer and you're like, oh those are houses and buildings because you moved closer.

So, this was the example I gave before by putting a chair closer to the television, moving closer to it. If you can't see something, don’t squint, and strain your eyes to try to see it. Simply move closer. If you're trying to read something, move it closer to your eyes. So, those strategies can help significantly. And that's something to keep in mind as well.

So, making changes in your daily habits by using non-visual techniques can reduce eyestrain and fatigue. So, this is looking at compensatory techniques or strategies, which is a big part of being an occupational therapist in general, but also being a provider with helping clients or patients yourself.

So, some examples of what I'm speaking about would be using your sense of touch, your tactile sensation, or sense of touch to insert a key into a door lock instead of using your eyes and trying to look for it. If you feel it, you should be able to do that, so you don't have to rely on your eyesight and your vision in order to do that task.

It's simplifying the task by your sense of touch and not your sense of vision. Using your sense of touch to locate something in your purse or in a bag or in a drawer. If you have a good sense of touch and you kind of know where it should be, you don't have to use your eyes to look for it.

We do that out of habit. We're living in a very visual based society, so it's a very visually demanding society. So, we rely on our vision to really give us all the information that we need. But your sense of touch can be used a lot more if you're mindful of it. Applying a rubber band, it would be an example to your shampoo bottle.

If you have a shampoo and a conditioner bottle and they have the same labels, same print, instead of picking it up and looking at which one is which and using your eyesight, if you apply a rubber band to the shampoo, every time you grab the bottle, even with your eyes closed, if you feel the rubber band, you know you got that shampoo bottle.

So, you can apply that to anything day-to-day. If you have, I was, the number one thing I always think about is your car keys or like a set of keys in a purse or pocket or bag. Most keys are the same shape, they're the same color. So, you can apply a little bit of Velcro or a little bit of fabric paint that dries raised up or a little like raised sticky dot on one of the keys.

And the second you feel that you'll know you have the correct key without even having to visually look for it. Another example of using a non-visual technique would be listening to an audiobook or listening to a podcast instead of actually reading it. So, you're using your sense of hearing and giving your eyes a break.

When I have concussion patients that have to do a lot of reading because concussions can happen at any age of your life, obviously, I recommend them to listen to a lot of continuous text reading versus trying to actually read it because a lot of eye use and eyestrain will trigger the symptoms of their concussion, migraines, light sensitivity, headaches, nausea.

So, listening and not reading. Again, conserving your eye energy. If your vision is the strongest in the morning and you have more success with your eyesight in the morning, maybe you do a lot of visual reading in the morning if you're able to. And then in the evening when your eyes are more tired, and you also don't have as much natural light to work with as well. And light is always helpful to see, obviously.

Maybe that's when you do your audio reading, and you're just listening and letting your eyes take a break. So, I hope those are helpful techniques and strategies that you can implement in your day-to-day.

Using technology features that are built into your smartphone or your computer can also help reduce eyestrain and fatigue. Pretty much every smartphone, tablet, computer these days have accessibility features, and some of those features include being able to enlarge the font size, which obviously makes it easier to see, creating the font to be bold, increasing the width of the cursor or the color of the cursor to be more contrasting.

You know, when you're typing a line, and you can't find your mouse or your cursor, and you have to really strain your eyes to look for it or find it, you can increase the width of it, and you can also increase the blinking rate of it. So, it's faster, so you don't have to scan and look and use your eye muscles as much to find it. Increasing the line spacing, which is what we talked about before. Increasing the size of the pointer arrow that you're using as well.

You can increase the screen brightness in relationship to the room, like we talked about. And then also use text-to-speech. Sometimes that's called OCR. But text-to-speech, again, is having the computer or tablet, or phone read to you what's on the screen so you can listen and just close your eyes and not have to visually read it with your eyes.

Screen reading software programs have a lot of uses and are available for people as well. Users who are blind or visually impaired to read text that is displayed on a computer or tablet with a speech synthesized display or braille display is what the software was designed for.

The software can also be used to conserve eye energy and prevent the onset of eyestrain or fatigue for prolonged reading. Like we've been talking about. The software offers different commands structures, so different voice command structures. The screen reading software programs, some of them are free, and some of them can be kind of costly.

So, there's a wide variety. So, you want to kind of do your research and see what's a good fit for you. Listening to speech output allows the user to sit and maintain good posture and not have to lean close to a screen like we have been talking about throughout this webinar. This may be helpful to implement during a day where a lot of anticipated time will be spent in front of a screen. Again, to be preventative or proactive in reducing eyestrain and fatigue.

What is a COE, and why is it important? A COE is also known as a complete eye exam, and they are recommended by the American Optometric Association to have done annually. Obviously, insurance plays a big role in this. If your insurance covers one complete eye exam a year as a preventative screening, which most insurances, I believe, do, then that's great.

If you need more than one a year, your eye doctor will let you know that. But typically, annually, is recommended. It's super important to identify and correct any potential refractive errors because if they're left untreated, it's going to make your eyes work a lot harder, and you're going to have to compensate and strain. And that's what we're trying to avoid or prevent from happening.

Refractive errors I mentioned in the last slide as a good reason to get a complete eye exam. Refractive errors can occur when the shape of the eye prevents light from focusing correctly in the back of their eye in the center of the retina, as it should.

And this can cause blurred vision, presbyopia. Presbyopia is kind of like age-related farsightedness. It tends to occur around the age of 40. It can be a couple of years after that for some people. But the lens of your eye is typically loose. It has a lot of flexibility to it, and that's what allows you to focus light.

And that flexibility of the lens gets a lot thicker and harder. And so that impacts how light is focused on your eye. So, as you bring print up closer, it's going to be blurrier and harder to see. Nearsighted and myopia, they're interchangeable terminology for the same thing, but they basically mean people can see up close but struggle to see things in the distance.

And then the other term is farsightedness or hyperopia. I want to jump back to nearsightedness and myopia really quick. That is typically diagnosed more so in childhood, but it's important to note that adults can develop it as they get older. And one reason that has been found in research is from visual stress.

So, again, know decreasing visual strain, and fatigue on your eyes can also be preventative for certain things like this. And then farsightedness and hyperopia, I just wanted to speak to really quick. That is when people can see in a distance, but they struggle to see up close. A lot of times when patients that I see are farsighted and forget their glasses, they will squint a lot, and that's to help focus light more efficiently.

And that can create eyestrain, headaches. And so again, it's super important to have that complete eye exam each year so they can correct for these refractive errors, especially if you're someone that spends a lot of time on the computer.

I wanted to do a quick slide on blue light-blocking glasses because I feel like, in the last year or two, they've had a lot of hype, so I just wanted to touch on them. I have a lot of my low-vision patients and concussion patients ask about them. There's no evidence, like empirical evidence, that supports wearing them will make a huge difference or protect your vision in any way.

So, it's one of those things you can try it if you feel like it helps or decreases symptoms that you're having. Great. And if it doesn't, that's okay. It's not for everyone. Yellow filters, however, have been proven effective in protecting your eyes.

Applying contrast and polarized sunglasses have a special filter that help reduce glare and can minimize eyestrain. Topaz are like a pinky hue Colored tinted filter has been found in one specific study to promote a calming effect on the brain, specifically in patients that have had a concussion.

And I will speak directly to this with my clinic practice that this is true in a lot of cases. Again, you want to be open to trying different tints, different colors, and you want to really see what gives you the most visual comfort. And so, I just put in there some tints that are more popular and different tint colors that you can try. And I honestly recommend Amazon or even like Walmart. A lot of stores carry tinted-colored sunglasses, and they can be really helpful.

And then the distance again is important because of the eye muscles and just making sure a computer screen is at the appropriate distance in front of your face.

Wearing eye protection or sunglasses can prevent eye injuries 100%. They're worth wearing them. They're very lightweight. You can pick different styles, colors, all of that. But they can protect against harmful UV rays. They can prevent against wind, blowing dust, debris, sand. All of those things can irritate your eyes and essentially even scratch your cornea.

So, when you're out doing yard work or when you're out in the snow, and there's ice and snow blowing around, whatever the weather is like, it's always great to wear some form of sunglasses or eye protection. If you're cutting grass or trimming, a woodchip, a stone can reflect back and hit you in the eye.

And I've had patients that have had that happen. So, definitely want to wear some kind of protection when you're doing yard work. Sunglasses can decrease glare and prevent falls. So, the more you see, the less you fall. That's what I kind of tell my patients.

Still on sunglasses. I just think they're super important, and I'm always amazed at how many people don't wear them. So, do all polarized sunglasses have UV protection? I think there is a lot of people that assume when you get a pair of polarized sunglasses, they automatically have UV protection or vice versa.

And the answer is no. Not all polarized sunglasses offer UV protection. Polarized sunglasses have been found to reduce eyestrain and prevent disabling glare, secondary to reflective light from a surface. So, an example would be the sun reflecting off of a car or off of the water.

If you're a big fisherman or like to be at the beach, you can kind of relate to that. Polarization doesn't protect against the UV rays, which are harmful to your eyes, and lots of studies support that. So, when you're looking for sunglasses, you want to find a pair that is both UV-protective and polarized, if possible.

And what does the UV protection actually do? It helps protect from the harmful ultraviolet radiation. That's what UV stands for. It blocks out both UVA and UVB rays. And this can decrease the risk for developing cataracts, macular degeneration, and other eye problems. So, along with protecting your eyes, you're also really preventing a lot of early onset of age-related eye conditions. So, it's well worth it to wear a good pair of sunglasses and wear them often.

Wearing sunglasses can also help reduce headaches and migraines, which have both been associated with digital eyestrain. To reduce eye discomfort, think of your sunglasses or your filters like you would your jacket. You always put them on before you go outdoors and then keep them on until you get back indoors.

This will help to decrease the adjustment time that your eyes go through from changing from indoor to outdoor and different lighting conditions and different lighting levels. And it also helps your eyes just adjust and feel more comfortable. It allows you to see contrast and edges, like when you're walking on a step or a curb, a lot easier. So, that's kind of a rule of thumb. Wear sunglasses like you would a jacket.

So, in summary, paying attention to the time of day your vision is the strongest. If you have more success in the morning with activities, maybe planning multiple rest breaks and doing a lot of your reading or visual tasks with the computer or technology in the morning, and then in the evening, maybe you take more rest breaks.

Energy conservation. Remember the 20/20/20 rule, take lots of breaks, and being aware of changing environments. If you have a hard time adjusting to changes in light, be aware of it. Give yourself additional time. Wear proper eyewear to protect your eyes and reduce glare, and make sure you're thinking about your entire body when you're using your vision and how it impacts it.

I want to thank you for your time, and I hope you learned a lot and enjoyed this webinar.

Funding statement: The Older Individuals who are Blind Technical Assistance Center (OIB-TAC) is a development of the National Research & Training Center on Blindness and Low Vision (NRTC) at Mississippi State University, focused on agencies serving older individuals who are blind. This grant, H177Z200001, is funded by the Rehabilitation Services Administration (RSA) under the U.S. Department of Education.  

Contact us: To contact the presenter, Lindsey Angst, MS, OTR/L, CLVT, email lindsey.angst@hotmail.com. For more information about OIB-TAC, please visit our website www.oib-tac.org. Also, visit our other NRTC websites www.blind.msstate.edu and www.ntac.blind.msstate.edu. Visit NRTC on Facebook at www.facebook.com/theNRTC and on X/Twitter at www.twitter.com/MSU_NRTC. Our mailing address is P.O. Box 6189, 205 Morgan Avenue, Mississippi State, MS 39762. Our phone number is 662.352.2001.

Jennifer Ottowitz: This has been OIB-TAC’s monthly webinar. Thanks for tuning in. Find recordings of our past webinars on our YouTube channel, and discover all of our many resources at O I B hyphen T A C dot O R G.  That’s OIB-TAC.org. Like us on social media and share our resources with your colleagues and friends. Until next time.