Computer Vision Syndrome (CVS) and Dry Eyes - Interview with Dr Juliet Menakaya, Optometrist

[00:00:01.080] - Paul
Welcome to the Dry Eye Treatment podcast. We interview eye care industry professionals who have experience in treating dry eye disease. Please remember that the content shared on this podcast is based on personal experiences and opinions. It is not intended as medical advice. Always consult your health care professional for any medical concerns. Now sit back and enjoy the podcast. If you suffer from dry, itchy or irritated eyes, you could be experiencing dry eye syndrome. If that's the case, then stick around because on this podcast, we interview eye care professionals who specifically deal with dry eye disease. Welcome to the Dry Eye Treatment podcast. Over the next 20 to 30 minutes, you're going to get actionable tips on what you can do to manage your dry eyes. Who am I? My name is Paul Sallaway. I am the owner of Optics Digital, which is a digital marketing agency that helps eye care practitioners to grow with your business. I'm not an optometrist, but as a dry eye sufferer myself, I'm here to ask all the questions to the experts, so you don't have to. And my guest today is the owner and principal optometrist of Junic Eye Care, an optometry practice and low vision Clinic in Canberra.

[00:01:16.530] - Paul
She obtained her doctor of optometry degree in 2006. She completed a master's degree in public health at the University of Sydney in 2014. And following that, she obtained a master of orthoptics from the University of Technology in Sydney in 2017. She regularly treats patients of all ages who come to her practice suffering from dry eyes. Welcome to the Dry Eye Treatment podcast, Dr Juliet Menakaya. Hello, Juliet.

[00:01:40.690] - Juliet
Hi, Paul. How are you?

[00:01:42.210] - Paul
Very good, thanks. Thanks for coming on the podcast. So can you give us the 30 second Juliet Menakaya story so we know a little bit more about your background?

[00:01:52.250] - Juliet
Thank you for that. So this is me, Juliet, a young lady that came to Australia from Nigeria, but in 2008. So I did my degree or doctor of optometry degree in Nigeria. I came to Australia. I have ever seen seeing the eye health sphere. I started off in Melbourne. I have been in Sydney where I got my extra education, if you like. And I currently live in Canberra with my three beautiful kids and my husband. I call him my fourth child. So Canberra is home now. And I like to refer to myself as eye care practitioner. I like to be the best point of contact for my patients if they have anything to do with their eye. So I think that's me in a nutshell.

[00:02:47.420] - Paul
So, yeah, I've been to Canberra once and it seemed like a very nice place to be. It's a beautiful city. And as our nation's capital, it's got all the federal departments there. And I think also a lot of other industries have been moving to Canberra in recent times as well. So which means, of course, that there are a lot of office workers in Canberra. And one of the issues with office work these days is something called computer vision syndrome or CVS for short. So in this podcast, I'd like to talk to you, Juliet, about computer vision syndrome and how that interplays with dry eye disease and dry eye symptoms. So maybe could you tell us What is computer vision syndrome and what are the symptoms of CVS?

[00:03:34.600] - Juliet
So Paul, you're right. Canberra is... We have a lot of Australian public servants, lots of different departments. So most of my patients I see, they work in an office environment. And to answer your question, what is computer vision syndrome and its symptom? So computer vision syndrome is a term used to describe a collective of ocular symptoms that is related to prolonged computer use. These symptoms are, you have your eye strain, tired eye station, redness, lured vision. Some people complain of double vision. That is amongst others. It is a repetitive, strained disorder. That seems to be going rapidly amongst office workers that use a three hours day. These symptoms are usually temporary and some will disappear at the end of the day of the working day. I have a minority of workers that may experience continuity of symptoms after work. What we found is no intervention is initiated. Majority of these symptoms will reoccur and also worsen.

[00:04:41.210] - Paul
So you said it's a repetitive strain injury. So could you explain that a little more? I mean, within your eye, you've got the lens and there are muscles that control the focus of the lens, aren't there? Is that the strain? Are these what's being strained through continuous office work?

[00:05:03.890] - Juliet
So I think we're going to... So there's a lot of factors that cost me a vision, continue me a vision. So we have a reputation in this order. I want people to think about it in terms So you can't do without going to work without using our screen or the computer now. So we over time, every day, expose ourselves to this computer and the mechanism and some other things that are invariably you affect our eyes or ocular health. That's why we say it's a repetitive stream. We thought it was more something... Some people will come in and say, I've got a foreign body in my heart. So it's on a peak. But this is something It's continuous. Some people cannot help, but you use the computer every day because that's the nature of their job. So that's what I mean or meant by a repetitive stream disorder.

[00:05:57.110] - Paul
Okay. And so why does computer vision syndrome often lead to dry eyes, or why does it aggravate the symptoms of dry eyes?

[00:06:06.520] - Juliet
So the computer vision syndrome has different mechanisms or causes, or what would lead to, or what is going to cause it. You have your osteoocular mechanisms, you have your accommodative mechanisms, and then you have the ocular surface mechanism. If you allow me, let me just delve in a little bit about this order, different causes of drug, computer vision syndrome. In the extraocular mechanisms, it's caused by the most post-skeletal symptoms such as your stiff neck pain, headache, backache, shoulder ache. These are associated in improper placement of computer screen when the patient is working or the individual is working. Then you have the accommodative mechanism. So changes in accommodative and vergence function of the eyes have been reported after a prolonged use of the computer. So there's a reduction in ability for our eyes to accommodate effectively. There's a reduction in our near point of convergence, which is our ability to effortlessly pull our eyes and ears together, and there is a reduction in Functional Convergence measurement. These changes, they have been proposed as an objective indicator of subjective visual fatigue. Invariably many people, a lot of people will have slight problems, accommodative problems or binocular problem.

[00:07:39.910] - Juliet
But because of prolonged use of the computer, these accommodative issue which means it will cause blurry of the vision, will now cause double vision, and will cause a bit of slowness in changing focus when people are working at that station. Then let's talk about the ocular surface mechanism. You have symptoms like dryness of the eyes, redness, greater sensation, burning sensation after prolonged computer use. That leads me to my... If I can answer the question when you asked me, how does tears lead to dry eyes? This is multifactorial. You have different factors that come together and cause dry eyes from using the computer. Firstly, you have tonia dryness. Most times this comes from environmental factors. So think about the offices where these workers are working. The office air, ventilation fans at the workplace. Some workplace will have airborne paper dust. There was a patient, a young girl I saw, I've been seeing for the past four weeks now. And while I was taking the case history, I said, Where do you work? She worked in one of these government departments and arranging paper. And guess what? She came back last week, she was down with flu.

[00:09:06.380] - Juliet
She didn't go to work. Because I've asked her, Could you tell your workplace if you could get protective eye wear? And for the fact that she didn't go to work for a couple of days, she came back smiling because some of our workplaces, the air is not actually good for the ocular surface. Then you have reduction in blink rate. Normally, individuals will blink for about 10 to 15 times per minute, but this is sometimes reduced with continuous staring at the computer while working. Then you have the increased surface of cornea exposure, which is caused by, for horizontal gain at the computer screen. So think about when you're reading a text on a paper, you do that by looking downwards. But a worker who is always working at the computer has this horizontal gaze Yes, looking at the computer. Therefore, invariably, the cornea is more exposed than you think. Then you have the issues of reduction in tear production due to ageing. You have contact lens use. You have some systemic medications as well that affect the quality of your tears. Then you have the ocular condition. When people already have meibomian gland dysfunctions or anterior blepharitis, and then you put them in those environments or other factors I've already mentioned, obviously, they're going to have dry eyes and forcing their condition and computer vision syndrome.

[00:10:43.910] - Juliet
So All these, and again, you have some cosmetics. When people apply cosmetics not properly, they plug up the mebumium glands, and invariably, all these factors will tie in together and will lead to dry eyes in office worker or someone using the computer often more than 30 hours every day.

[00:11:08.830] - Paul
So it sounds like our eyes were just not meant to operate inside modern offices. There's a lot of... There's some things there you mentioned I didn't even think of, like people are working around paper all day. So there's probably a lot of dust and debris from the paper themselves that's in the air that can irritate people's eyes. And the horizontal gaze thing, that's something I never considered either. So you said your cornea is exposed a lot more when you're looking at something that way as opposed to looking down at a book. And I think in previous podcasts, we have talked about meibomium glands and what they do. So just to refresh our memory on that. So Juliet, can you tell us again, what are meibomium glands and what role do they have in dry eye syndrome?

[00:11:58.590] - Juliet
So the meibomium glands around your lid, inferior and superior eyelid, we have a number of meibomium glands or openings. So they are meant to excrete the lipid or oily material which is necessary for the briquette in our eyelid. If for any reason your leads are not clean, if you have the variety, if you have any issues around the leads, that will plug up the mebumium gland. Think about it, you don't have that moisture. It's just like when you apply cream on your body. If you don't, it looks a bit dry. So if those lipids or those oily layer of fluid is not properly relieved, your eyes are going to be dry.

[00:12:55.160] - Paul
So there are little oil glands that you've got just inside the Just inside your eyelids, which secrete these good oils that keep the front of your eye covered and stop your eyeballs from drying out. That's essentially it. So what are some of the things that we can do then within our work environments to address dry eye? I've heard some people talk about the 2020-20 rule. Are you familiar with that one?

[00:13:27.320] - Juliet
Yeah. You have your 2020 rule for every 20 minutes. So you work find a spot that is 20 feet away from you and look away for 20 seconds. Just take a break away from staring at the computer. All One modifiable external environmental factor people have tried to reduce the symptoms of CVS. One important factor is light. Bright lights, windows, overhead fluorescent lights, they often contribute to this comfort, glad patients were coming complaining about. These bright light sources, they need to be controlled with proper blinds, philtres, adjusting the room arrangements. I've had this conversation multiple times with my patients. I was just like, Okay, how do you see it? I need to know. Can we move things around? They come back saying, Thank you, Juliet. I didn't think about that. We can do all that. Another important Another factor is the imbalance of light between the computer screen and the surroundings. We can fix this by adjusting our digital or computer device setting to dark mode. What it does is provide the balance between the room light and give you maximum visibility and make it easier for you to work. The muscle, musculoskeletal problems that people have from the neck pain and all that, we can prevent that by proper workstation adjusting.

[00:15:06.490] - Juliet
So computer users, often, they assume on comfortable position in order to have a good view of the screen without realising that the posture they have might lead to muscular stress after prolonged duration of work. I advise my patients to have proper distance from the screen, proper adjustments of the image side Most screens, you can be like 77 to 110 centimetres away from your heart. Very important. The level of where you place the computer as well, about 20 degrees low eye level. That's very important. Overall, there's been some studies that found that physical economics of computer workstation have actually proven to reduce discomfort, so-called discomforts have obviously improved performance. But let's delve in deeper from the eye care professional or practitioner perspective. Like I said before, 20, 20, 20. Take every 20 minutes, find a spot, look at 20 feet away for 20 seconds. Another thing is blink. It's very simple, but I find a lot of people don't blink enough.

[00:16:27.230] - Paul
And sometimes people don't blink completely, do they? That's another issue I've heard is that if you're working intently on something that you might not do a full blink and you don't realise it. So that could be something else as well to consciously remember to do a full blink.

[00:16:46.540] - Juliet
I've had some patients behind this sleep lamp, and when you say blink, just realise that they do have links. So I always say to them, you need to consciously And sometimes I say, put a sticky note on your computer. I think there might also be apps you can download that give you an alert every 20 minutes to do a blink.

[00:17:14.620] - Paul
So I haven't tried them, but it sounds like it's worth a go. 

[00:17:19.760] - Juliet
Anything that works, really. And then another low hanging fruit is your artificial tears. Use your artificial tears, refresh your eyes when they feel dry. And we now have computer eye glasses. Professional computer glasses are very, very helpful. They reduce eye strain and they allow you to focus your eyes specifically at the computer screen distance and obviously help in shifting your focus in at near things and looking at computer as well.

[00:18:02.960] - Paul
Are you talking here about blue light glasses?

[00:18:06.780] - Juliet
So some of the, specifically, computer prescription glasses will have the blue light protection, great inside the lensing as well. So we try to differentiate the two. Some people will say blue light glasses You have many websites online promising, I don't have anything against that. But when a patient comes in, we put everything into perspective. How many screens do you work with? Then we tell her that and give them a four-part computer prescription glasses. I think When a patient adhere to all these things I've mentioned, I think it will help to mitigate the ocular symptoms. That would definitely arise because, like I said earlier, our lives we can't do without digital devices. But if we can help ourselves doing some of those things I've mentioned, it will help to reduce the But sometimes they'll come out of this.

[00:19:34.340] - Paul
Okay, all right. Well, some great ideas there. So Juliet, in general, what dry eye treatments do you provide within your clinic? You've got different treatments that you offer there at Junic Eyecare. Could you tell us about those?

[00:19:53.230] - Juliet
So first and foremost, at Junic Eyecare Clinic, we believe that treatment begins with getting a thorough understanding of what's going wrong with your eyes before we offer solution. And for that, we have the very latest in advanced dry eye health diagnostic equipment. This is your oculous keratograph 5M. It's a pretty special equipment. I can't live without, I tell you. What it does is, it It also allows us to visualise and assess the health of your ocular surface and your lumbar glands. We take pictures and scans before we start any treatment. Then while you're undergoing any treatment, we take progress photos so you can see the progress, how you're progressing with the treatment. At the end of the treatment, we also You are not up to photos and scan. Some of the treatments we regularly provide, we have your... Of course, we give advice on artificial tears, lead hygiene at home, how to do them. We do therapeutic meibomian gland expressions. We use the expressor paddle to make sure the meibomian gland expressions is expressed. We do Blefex in-office clean.

[00:21:36.510] - Juliet
Blefex, it is a small handheld device with a disposable soft microsponge tip. It spins in very high speed. It looks like a small electric toothbrush, but it's designed to allow for precision screening of delicate angles around the eye. We used to offer Blefra steam. We're just waiting on the latest model to come in. So Blefra steam is beautiful. Think about it as your spa. You have your mini spa with your- It's like a spa bath for your eyes, right? Exactly. It's actually cold. So it provides a consistent gentle steam that hits the eyelid area and softens the oil in the meibomian glands we've been talking about, making it easier for those oil to be secreted and to come out. So it's very crucial for the healthy Those are the main treatments that we offer now. And hopefully we're hoping to add a few more in the future.

[00:22:57.730] - Paul
Do you offer those What are they called? Is it Bruda? Bruda eye masks? Do you still sell those?

[00:23:05.210] - Juliet
We give out Bruda masks. And then there's another one which is fantastic as well, eye doctor masks. Beautiful I think made in the UK. So my patients, they've read about that as well. So depending on which one the patient is used to, so we So we put a mask for the eye dust, doctor mask.

[00:23:34.370] - Paul
All right. Well, aside from those those wonderful treatments, do you have any tips for what people can do for themselves if they have severe dry eyes at home, like any home remedies that you recommend, even preventative things like staying hydrated, wearing wrap around, sunglasses. Do you think all those ideas are good suggestions for people to manage the your own dry eyes?

[00:24:02.520] - Juliet
Definitely, I think they do. But my professional advice will be, firstly, get it checked out. To get the proper diagnosis. Like you know, there are two forms of dry eyes. We want to know which one are you managing. Is it the aqueous deficiency of the one, or is it the evaporative form of dry eyes? So please get it checked by an optometrist. And of course, Paul, like you mentioned, be aware of your environment. Avoid blowing air direct into your eyes. If you can wear the wrap Down glasses to block off wind and dry air, especially when you're outdoors, it helps a lot. Proper lead hygiene, make sure you get the proper lead wipes, the cleansers, the heated eye mask we talked about. Try get omega-3 fatty acids in your diet or in form of supplements. You have very good as well. Lastly, I'll say stay hydrated. Drink lots of water throughout the day. It's going to help everywhere, including And stay hydrated by using Ophala lubricants or.

[00:25:36.430] - Paul
Yeah, well, in the last episode, I talked to Dr. Rhiannan Richer, and she said that we should cut down on caffeine and cut down on our coffee, so which is a bit of a deal breaker for me, unfortunately. But yes, staying hydrated is very, very important, right?

[00:25:52.120] - Juliet
Yes, definitely.

[00:25:55.140] - Paul
Okay, well, so for anyone in camera, if you're If you are suffering dry eyes, especially now, as we head into the dry Canberra winter, if they want to talk to you, Juliet, what's the best way that they can get in touch with you You can check us out, check us the website.

[00:26:18.330] - Juliet
You have JuniceEyecare.com.au from there, you can book online or you can call the clinic. The number is on there. We are on social media, Facebook, Instagram, where we put out very useful content about your eye health almost every week. Yes.

[00:26:46.570] - Paul
I know you do. All right, we might wrap it up there, I think. So thanks for sharing that advice, Juliet. That was very, very informative. I know I learnt a lot of things out of today. So if you are a dry eye professional and would like to take part in this podcast project, then feel free to reach out to me directly. You can contact me via my website, that's opticsdigital.net So take care of your dry eyes, everyone out there. So thanks again, Juliet, for coming on.

[00:27:18.880] - Juliet
Thank you for having me, Paul. Thank you.

[00:27:22.500] - Paul
So until our next episode. Bye for now. Bye.bye..