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Melanie:  Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And what a great topic we have today, taking care of your eyes when you're spending long hours staring at a screen. This is really in this work-from-home environment that we're all in. This is huge because so many people are noticing, myself included, that we're having eye issues as a result of how these jobs have evolved since the COVID pandemic.

Joining me is Dr. Nathan Abraham. He's an ophthalmologist on the medical staff of Henry Mayo Newhall Hospital. Dr. Abraham, it is a pleasure to have you join us again today and tell us a little bit about what you've been seeing. So we are working from home, we're staring at screens, our kids are staring at their phones all day. What have we been doing to our eyes that maybe we weren't doing two years ago?

Dr Nathan Abraham: Melanie, thank you again for this invitation to speak and to share some of my experience with you and all the listeners. To begin with, I thought one of the titles that I would give this talk is "I scream, you scream, we all scream from eye screen." Eye screen or eye issues related to screen use are one of the most common reasons people come in and see me nowadays in the post-COVID world.

The main issue and common denominator with this is dry eyes. Now, dry eyes is an umbrella term that describes a lot of different issues that all can give you the symptoms of dryness, gritty eyes, tearing, it feels like there's sand in the eye, burning. And all these are very kind of life-altering for people that are using screens a lot. So this is definitely a very relevant topic and I'd love to share some of my insights on how we can help fix this.

Melanie: One thing I've noticed myself personally is even though I don't feel tired, sometimes by five or six o'clock at night, I feel like my eyes are trying to close and they feel fatigued. So why don't you tell us, Dr. Abraham, how we can care for our eyes while we're spending this time on screens, whether it's for work or socializing, whatever we're using them for, and how we take scheduled breaks or what you want us to do to make it so that they don't feel those things?

Dr Nathan Abraham: Very common complaint that I hear all the time, "Doc, my eyes feel tired and it's only like 4:00 or 5:00 PM." And I asked the patient, you know, "Do you spend a lot of time on the screen?" And the answer is always yes. So the key here is to lubricate the eyes. And so making your own healthy tears is very important.

Now, we had talked previously about dry eyes and another condition called blepharitis. Well, that's important here because tears are made of two things, water and oil. The water are made by tear glands that are kind of up and outside of the eye. And that creates the water portion of tears. Well, the oil portion is extremely important because that's what lubricates and insulates the tears so they don't evaporate. And those oil glands are located all along the eyelid margins. So keeping those eyelids clean by using things like baby shampoo and warm compresses really helps to get the oils flowing. In addition to that, supplementing with preservative-free artificial tears helps lubricate the eyes until our bodies can get back to making normal healthy tears.

So lubrication is the most important. The second most important thing is taking breaks from screens. I call it the 20/20 rule. For every 20 minutes that you're working on a screen, you've got to get up and walk around for at least 20 seconds and look at stuff far away and that'll help kind of break the focusing we have on all the near work and that'll give our irises and pupils a chance to relax. So lubrication and frequent breaks, I think are the two most important things when dealing with eye screen.

Melanie: What great advice. And I am going to get some of those tears to put in my eyes as soon as we are done with this conversation, because I think that's exactly what I probably need. So now, we hear about other things in the media, on the internet. Blue light glasses, do they actually work? Can you tell us about any accessories that are intended to help reduce some of those effects of the long screen exposure times? Are there any that actually work?

Dr Nathan Abraham: That's a good question. And I get asked that question frequently by my patients, especially those that work in front of screens all day. In my experience, I haven't found one particular technology or one particular brand or accessory that really helps a big amount. I mean, our first job is to do no harm as physicians. So, you know, if patients say, "Doc, I want to try these blue glasses out. I saw an infomercial or I saw an advertisement on the internet. I want to try them out. What do you think?" And I say, "As long as it doesn't hurt, you can give it a try." But I would manage the expectations that I don't think they'll make a big difference, but as long as they don't hurt, that's fine. There are other kinds of screen filters you can put on the actual computer screen, some people like those.

One thing I can say, especially now that we're entering the summertime season, I think very good quality sunglasses, meaning UVA and B filtering as well as polarized sunglasses are extremely important. And that's kind of off topic because today we're talking about screen time, but I think that's equally important now that we're entering summer, is to protect our eyes from harmful UV radiation.

So I haven't found one technology, one blue light filtered glasses that helps over another. I would say if you're going to do anything, start with the things we mentioned, the lubrication and the eyelid cleaning, and then go from there.

Melanie: So I'm glad you brought up sunglasses, Dr. Abraham, because it would seem to follow that if we are out in the sun and we're not using sunglasses, that our eyes could be damaged and thereby the screens are going to make them worse and they can affect each other. So that's a really good bit of advice because it's going to help us all around. What else would you like us to know about taking care of our eyes and the fact that some people have been putting off their eye exams or, you know, not really wanting to go in because of COVID, but tie all this together for us?

Dr Nathan Abraham: Absolutely. I always tell a lot of my family and friends and patients, "Hey, I don't want you to go cheap on sunglasses." And they say, "Well, Dr. Abraham, why? I can get like 10 pairs for 20 bucks, all different colors, shapes sizes." But the reason is because if we buy sunglasses that have cheap quality glass, what happens? It's basically a tinted glass that tricks our brain and our pupils into thinking that it's dark outside because the dark tint. So what happens to your pupils in the dark? They dilate. Now because they dilate, they allow more harmful UV radiation to come through and enter the eye and can contribute to bad things happening like cataracts and macular degeneration.

So the reason why cheap quality glasses are not good is because they trick us. And they trick our eyes into thinking it's dark. That's why I always recommend getting good quality sunglasses. And the things to look for are sunglass lenses that filter out UVA and UVB rays. And if you can, get polarized sunglasses, because that adds another layer of protection against harmful UV radiation.

Like we mentioned in our previous chat, seeing your eye doctor for regularly scheduled appointments is extremely important for early diagnosis and treatment of very preventable eye conditions.

And one of the main things we talked about earlier in our conversation today is dry eyes. There are things that I can see when I evaluate patients in clinic using a specialized microscope called a slit lamp that other doctors and general doctors and patients wouldn't be able to see in their own eyes, but they come in with all sorts of variety of complaints. So being able to see and diagnose dry eye and educate patients about the options they can do to help themselves at home using artificial tears, nighttime lubrication, and eyelid cleaning, as well as other treatments that I can do here in the office, including putting in punctal plugs to plug the drainage area where the tears drain out to allow the eye to get lubricated for longer or things like in-office dry eye treatment. These are all things that I offer my patients because I know that they can help. So that's one of the other reasons in addition to all the many factors that are involved in maintaining healthy eyes for why you should see your ophthalmologist regularly.

Melanie: What great information. And I have one more question before we wrap up, as we were talking about screens. Now, my computer is a few feet away from me at my eye level, I have all the ergonomics in place. But then we look down to paperwork we might be doing or our phones, which is smaller writing, and then back up to the computer. Maybe we have another monitor off to the side somewhere. Dr. Abraham, with all of these different sizes of screens emitting different light values on us, what can we do in that situation? Because I look at my kids, Dr. Abraham, and maybe they're making music on their computer, then they're looking at gaming computers, which is totally a different view and, of course, down at their phones at the same time. What can we be doing for our eyes? Because that would seem to me to make our eyes have to really go on overload to try and adjust to all those different lightings and all those different size fonts.

Dr Nathan Abraham: That's a very good point. I think that the lighting from the screens does play a factor. However, the bigger issue here is the size of the thing that we're looking at. The smaller the font, the smaller the screen, the smaller the object, the more we have to auto-focus using our pupil and iris to help clear up that image so we can read it.

Now, what do you think is going to happen if we're auto-focusing all day long and changing the amount of auto-focus based on the screen size and the distance? Well, that pupil, that iris is going to get tired. So actually in that case, oftentimes it's very helpful to have patients get evaluated for some reading glasses or intermediate glasses to kind of give the iris and pupil a chance to relax. Because we're working with so many different distances of work, really close cell phone, fine print, intermediate iPad, computer, and kind of distance, like you mentioned, TVs or other screen monitors, I think it's also helpful to maybe consider using a pair of glasses for reading or intermediate work to give our pupil and iris a chance to stop autofocusing and relax for a bit

Melanie: Wow. Great advice. So wrap it up for us. Best advice that you want people to know about our eyes and all of the screens and really how we've been working at home now, what do you want us to know?

Dr Nathan Abraham: Best advice, if you see something or feel something, say something, meaning schedule an appointment to go see your ophthalmologist or eyecare provider. And the meantime, there are some remedies you can do at home. If your eyes are feeling dry, itchy, burning, tired, you can try artificial tears, preservative-free at least two or three times a day. And that'll help lubricate the eyes.

More often than not, there's some level of blepharitis or acne around the eyelashes, so pick up some baby shampoo and use it to lather into the actual eyelashes to clean up those lids and then use some warm compresses to help the oils flow and lubricate the eyes. Those are some really simple home remedies to treat a very common condition called dry eyes.

Melanie: Thank you so much, Dr. Abraham. What a great guest you are and a great educator too. Thank you again for joining us. And to learn more, you can visit library.henrymayo.com and look for eyes in the topic pull-down menu.

And that concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. Please remember to subscribe, rate and review this podcast and all the other Henry Mayo Newhall Hospital podcasts. And remember listeners, share this show with your friends and family on your social channels. We're learning from these experts at Henry Mayo Newhall Hospital together. And this show was no exception. We all need to learn how to take care of our eyes in this work-from-home environment. So share this show far and wide. I'm Melanie Cole.