Digital device use is changing the way people live and is now beginning to change the way the eye care profession prescribes.
Research from the Vision Council has left no one in any doubt about the effects of screen over-use, multiple screen use and the prevalence of problems. While spectacle lens makers have typically looked at blue light filters products such as Essilor’s Eyezen have also explored adding plus powers from 0.4 to 0.85 to ease the burden of constantly refocusing. Contact lens makers have concentrated on comfort.
The latest contact lens for the digital age to hit the market is CooperVision’s Biofinity Energys which is aimed squarely at an increasingly square-eyed patient base. Unlike previous contact lenses, which have majored on the compromised ocular surface or targeted the pre-presbyopic eye, Energys is looking at technology’s heaviest users – millennials.
Millennials are those aged between 18 and 29 whose formative years have spanned the dawn of the internet and mobile digital age. This new generation of contact lens wearers is in need of a next generation contact lens, says the firm. According to YouGov Eye Fatigue Research conducted this year over half of millennials use digital devices for more than nine hours a day. This leads to 86% of that group reporting symptoms of digital eye fatigue (DEF).
Defining DEF, elsewhere described as computer vision syndrome or digital eyestrain, Mark Chatham, professional services consultant, goes back to research conducted by the Vision Council. The document of its original work on the topic has had more than 850 million hits giving an indication of its relevance to today’s world. ‘Digital Eye Fatigue is the ocular discomfort or stress felt after more than two hours in front of a screen,’ he says.
DEF is a multifactorial issue which is vision, screen and ocular surface related, he says. The last of these, adds Chatham, has really been embraced by the profession in recent years through education into dry eye, the other topics less so.
‘In an office the screen is at the right height but you don’t get that on the school bus. Innovation has given us portability so you can take them [digital devices] anywhere.’ This leads to screens being viewed at a range of distances and angles, it has also been accompanied by an explosion of multi-screen use. In addition to a reduced blink rate this raises the issue of the increased accommodative burden. Multi-screening increases ciliary muscle over-action and squinting due to screen glare and font size.
These symptoms are not confined to contact lens wearers, as presented to last year’s American Academy by the research group of Pete Kollbaum, Indiana University. His work showed that three-quarters of people reported fatigue when using technology and the findings were similar among soft contact lens wearers and non-lens wearers. Those symptoms fall into three groups, says Chatham, around surface effects, general sensations of tiredness and visual disturbance.
Professional services manager Krupa Patel says Energys tackles all three of those issues thanks to the material it is made from and multiple front surface aspheric optical design it calls Digital Zone Optics (DZO).
Biofinity’s Aquaform technology uses a long chain silicone structure which offers a water content of 48%. This creates a breathable, comfortable, low modulus material, she says, which is proven by its use elsewhere in the Biofinity family.
‘Digital Zone Optics has multiple front surface aspheric curves,’ says Patel. ‘This distributes power across the optical zone and creates a positive power in the middle of the lens. This eases the accommodative burden without affecting distance vision.’
Patel is at pains to point out that Energys is a single vision lens and, although targeted at millennials, suitable for any single vision spherical contact lens wearer. She is also keen to stress this is not a multifocal lens and does not act like a multifocal lens but ‘simulates’ a plus power in the region of 0.75 dioptres. The lens is aimed at single vision spherical contact lens wearers and is fitted like one. The plus power is not included in the prescription.
Testimonials for the lens are positive with CooperVision claiming eight out of 10 wearers feeling no eye strain when using digital devices. Practitioners trying out the lens at the launch event also reported not noticing any effect on distance vision.
After introducing delegates to Energys the CooperVision team then turned their attention to the potential opportunity for practices. Regional sales manager Gina Harris outlined the number of millennials who could benefit from the lens. Current contatc lens wearers in this age group total 2.7 million while a further 4.4 million need some form of correction, she says.
Lara Drury, senior marketing manager, says the job is not just to educate practitioners but also to make the public aware. To support the launch CooperVision has launched a range of support tools to interest customers, create a desire for the product and then spark them into action.
Biofinity Energys aims to address surface effects, sensations of tiredness and visual disturbance
To generate interest CooperVision has developed an easy to understand scrolling website which leads patients through some of the main issues around digital device use and vision. A second tool, in the form of a smartphone app, walks the customer through their digital lifestyle and screen usage. The Digital Eye Fatigue Indicator then benchmarks their usage against a European average. In store awareness is further raised through cards which are handed out to patients. The first provides patients with a link and QR code to take the DEF Indicator test. The second offers a link to a website which covers topics such as insertion and application and offers a direct link to a contact lens practitioner. This direct link is designed to help support the wearer in the crucial early days where many drop outs can occur.
Harris said a large proportion of drop-outs are in the first few weeks and the cards were a way of supporting wearers in those early days. ‘It’s making sure that when they go out through the door at the first bump in the road they don’t just say, “This isn’t for me”.’ She also announced a two-week trial challenge which will gather feedback from wearers to evaluate the lens. Practices are also being offered posters, cubes and videos to show in store and being encouraged to create links from their new media platforms to the online tools.
One particularly novel aid is an elastic band-like demonstration tool which customers are being encouraged to place around their fingers. This is then continually flexed throughout their consultation to mimic the muscle fatigue induced by constant changes in accommodation the ciliary muscles would experience when using multiple screens. Not having to flex the band is then compared to the accommodative burden removed when the DZO are employed through Biofinity Energys.
At the launch event practitioner education was continued through a series of CET accredited workshops which explored the way ECPs elicit information on digital use from patients and looked at other ways to encourage them to open up. Professional services consultant Shail Patel asked what ECP do to extract information about patients’ lifestyles and how they could be educated to understand that DEF was not an inevitability of modern life. The ECPs in attendance agreed that questionnaires have their place but need to be designed well and their completion backed up and supported. The best method of understanding the patient remained personal interaction. ‘You have to read your patients so they don’t feel like they are being questioned,’ says Shail Patel. ‘Skilled dispensers can make it feel conversational.’
CooperVision clearly believes the Biofinity Energys lens will then be the natural choice to solve or prevent any issues identified as a consequence of long hours in front of a digital device, multi-screening and constant accommodative strain.
Summing up, Krupa Patel came back to the topic of lifestyles. Research highlights the visual issues people have with modern digital life, she says, practitioners need to get patients to open up about the eye related issues that result. Practitioners need to get the message across that it doesn’t have to be like that. ‘We have actually got something new to talk about,’ she says. ‘Suddenly we can say this is the next step. There is also a benefit for the profession. Thinking about people’s digital lives makes us think twice about our routines and the way we do things.’
As with all new lenses Biofinity Energys’s success will rely on the willingness of practitioners to fit it. ECPs at the meeting were open to the concept of a ‘simulated’ addition that helped accommodation without affecting distance vision. Some at the meeting did ask where the clinical trial data to back up this claim was. CooperVision encouraged ECPs to try Energys for themselves and promised feedback on the two-week trial announced by Drury.
Messages need to be repeated seven times before they sink in say marketing experts, a fact that will not have escaped delegates at the Biofinity Energys launch meeting. It is shocking that 90% of adults spend more than two hours a day in front of digital devices, perhaps more shocking that 50% of millennials spend more than nine hours a day in front of a screen. In reality these stats are unlikely to change. The other worrying statistic was that 90% of patients do not talk about digital device use with their practitioner. That is a statistic that can and must change.