The effects of breaks on digital eye strain, dry eye and binocular vision: Testing the 20-20-20 rule

Cristian Talens-Estarelles; Alejandro Cerviño; Santiago García-Lázaro; Andrej Fogelton; Amy Sheppard; James S Wolffsohn

doi:10.1016/j.clae.2022.101744

The effects of breaks on digital eye strain, dry eye and binocular vision: Testing the 20-20-20 rule

Cristian Talens-Estarelles, Alejandro Cerviño, Santiago García-Lázaro, Andrej Fogelton, Amy Sheppard, James S Wolffsohn

Research output: Contribution to journal › Article › peer-review

Abstract

PURPOSE: To evaluate the benefits on the eyes of taking breaks based on the 20-20-20 rule.

METHODS: Bespoke computer software using the laptop webcam to assess user breaks, eye gaze and blinking, and emitting personalized reminders of breaks based on the 20-20-20 rule, was downloaded onto the laptops of 29 symptomatic computer users. Digital eye strain (DES), binocular vision and dry eye were assessed before and after two weeks of using the reminders and one week after the discontinuation of the strategy. Binocular measurements included visual acuity, accommodative posture, stereopsis, fixation disparity, ocular alignment, accommodative facility, positive/negative vergences and near point of convergence. Symptoms were evaluated using the computer vision syndrome questionnaire, ocular surface disease index (OSDI), and symptom assessment in dry eye questionnaire (SANDE) versions one and two. Dry eye signs were assessed by measuring tear meniscus height, conjunctival redness, blink rate and incomplete blinking, lipid layer thickness, non-invasive keratograph break-up time, corneal and conjunctival staining and lid wiper epitheliopathy.

RESULTS: A decrease in the duration of computer work and the duration of breaks, along with an increase in the number of breaks taken per day was observed as a result of the 20-20-20 rule reminders (p ≤ 0.015). No changes on any binocular parameter were observed after the management period (p ≥ 0.051), except for an increase in accommodative facility (p = 0.010). Dry eye symptoms and DES decreased with the rule reminders (p ≤ 0.045), although this improvement was not maintained one week after discontinuation (p > 0.05). No changes on any ocular surface and tear film parameter were observed with the rule reminders (p ≥ 0.089).

CONCLUSIONS: The 20-20-20 rule is an effective strategy for reducing DES and dry eye symptoms, although 2 weeks was not enough to considerably improve binocular vision or dry eye signs.

Original language	English
Article number	101744
Number of pages	9
Journal	Contact lens & anterior eye : the journal of the British Contact Lens Association
Early online date	11 Aug 2022
DOIs	https://doi.org/10.1016/j.clae.2022.101744
Publication status	E-pub ahead of print - 11 Aug 2022

Bibliographical note

Copyright © 2022. Published by Elsevier Ltd n behalf of British Contact Lens Association. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Funding Information:
This work was supported by the Spanish Ministry of Education [grant number FPU17/03665]; and the “Conselleria d’Educació, Investigació, Cultura i Esport de la Generalitat Valenciana” [grant number GV/2018/059].

Keywords

20-20-20 rule
Binocular vision
Computer vision syndrome
Digital eye strain
Dry eye
Dry eye symptoms

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10.1016/j.clae.2022.101744

1-s2.0-S1367048422001990-main
© 2022 The Authors. Published by Elsevier Ltd on behalf of British Contact Lens Association. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
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Cite this

Talens-Estarelles, C., Cerviño, A., García-Lázaro, S., Fogelton, A., Sheppard, A., & Wolffsohn, J. S. (2022). The effects of breaks on digital eye strain, dry eye and binocular vision: Testing the 20-20-20 rule. Contact lens & anterior eye : the journal of the British Contact Lens Association, Article 101744. Advance online publication. https://doi.org/10.1016/j.clae.2022.101744

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abstract = "PURPOSE: To evaluate the benefits on the eyes of taking breaks based on the 20-20-20 rule.METHODS: Bespoke computer software using the laptop webcam to assess user breaks, eye gaze and blinking, and emitting personalized reminders of breaks based on the 20-20-20 rule, was downloaded onto the laptops of 29 symptomatic computer users. Digital eye strain (DES), binocular vision and dry eye were assessed before and after two weeks of using the reminders and one week after the discontinuation of the strategy. Binocular measurements included visual acuity, accommodative posture, stereopsis, fixation disparity, ocular alignment, accommodative facility, positive/negative vergences and near point of convergence. Symptoms were evaluated using the computer vision syndrome questionnaire, ocular surface disease index (OSDI), and symptom assessment in dry eye questionnaire (SANDE) versions one and two. Dry eye signs were assessed by measuring tear meniscus height, conjunctival redness, blink rate and incomplete blinking, lipid layer thickness, non-invasive keratograph break-up time, corneal and conjunctival staining and lid wiper epitheliopathy.RESULTS: A decrease in the duration of computer work and the duration of breaks, along with an increase in the number of breaks taken per day was observed as a result of the 20-20-20 rule reminders (p ≤ 0.015). No changes on any binocular parameter were observed after the management period (p ≥ 0.051), except for an increase in accommodative facility (p = 0.010). Dry eye symptoms and DES decreased with the rule reminders (p ≤ 0.045), although this improvement was not maintained one week after discontinuation (p > 0.05). No changes on any ocular surface and tear film parameter were observed with the rule reminders (p ≥ 0.089).CONCLUSIONS: The 20-20-20 rule is an effective strategy for reducing DES and dry eye symptoms, although 2 weeks was not enough to considerably improve binocular vision or dry eye signs.",

keywords = "20-20-20 rule, Binocular vision, Computer vision syndrome, Digital eye strain, Dry eye, Dry eye symptoms",

author = "Cristian Talens-Estarelles and Alejandro Cervi{\~n}o and Santiago Garc{\'i}a-L{\'a}zaro and Andrej Fogelton and Amy Sheppard and Wolffsohn, {James S}",

note = "Copyright {\textcopyright} 2022. Published by Elsevier Ltd n behalf of British Contact Lens Association. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Funding Information: This work was supported by the Spanish Ministry of Education [grant number FPU17/03665]; and the “Conselleria d{\textquoteright}Educaci{\'o}, Investigaci{\'o}, Cultura i Esport de la Generalitat Valenciana” [grant number GV/2018/059].",

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doi = "10.1016/j.clae.2022.101744",

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journal = "Contact lens & anterior eye : the journal of the British Contact Lens Association",

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T1 - The effects of breaks on digital eye strain, dry eye and binocular vision

T2 - Testing the 20-20-20 rule

AU - Talens-Estarelles, Cristian

AU - Cerviño, Alejandro

AU - García-Lázaro, Santiago

AU - Fogelton, Andrej

AU - Sheppard, Amy

AU - Wolffsohn, James S

N1 - Copyright © 2022. Published by Elsevier Ltd n behalf of British Contact Lens Association. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Funding Information: This work was supported by the Spanish Ministry of Education [grant number FPU17/03665]; and the “Conselleria d’Educació, Investigació, Cultura i Esport de la Generalitat Valenciana” [grant number GV/2018/059].

PY - 2022/8/11

Y1 - 2022/8/11

N2 - PURPOSE: To evaluate the benefits on the eyes of taking breaks based on the 20-20-20 rule.METHODS: Bespoke computer software using the laptop webcam to assess user breaks, eye gaze and blinking, and emitting personalized reminders of breaks based on the 20-20-20 rule, was downloaded onto the laptops of 29 symptomatic computer users. Digital eye strain (DES), binocular vision and dry eye were assessed before and after two weeks of using the reminders and one week after the discontinuation of the strategy. Binocular measurements included visual acuity, accommodative posture, stereopsis, fixation disparity, ocular alignment, accommodative facility, positive/negative vergences and near point of convergence. Symptoms were evaluated using the computer vision syndrome questionnaire, ocular surface disease index (OSDI), and symptom assessment in dry eye questionnaire (SANDE) versions one and two. Dry eye signs were assessed by measuring tear meniscus height, conjunctival redness, blink rate and incomplete blinking, lipid layer thickness, non-invasive keratograph break-up time, corneal and conjunctival staining and lid wiper epitheliopathy.RESULTS: A decrease in the duration of computer work and the duration of breaks, along with an increase in the number of breaks taken per day was observed as a result of the 20-20-20 rule reminders (p ≤ 0.015). No changes on any binocular parameter were observed after the management period (p ≥ 0.051), except for an increase in accommodative facility (p = 0.010). Dry eye symptoms and DES decreased with the rule reminders (p ≤ 0.045), although this improvement was not maintained one week after discontinuation (p > 0.05). No changes on any ocular surface and tear film parameter were observed with the rule reminders (p ≥ 0.089).CONCLUSIONS: The 20-20-20 rule is an effective strategy for reducing DES and dry eye symptoms, although 2 weeks was not enough to considerably improve binocular vision or dry eye signs.

AB - PURPOSE: To evaluate the benefits on the eyes of taking breaks based on the 20-20-20 rule.METHODS: Bespoke computer software using the laptop webcam to assess user breaks, eye gaze and blinking, and emitting personalized reminders of breaks based on the 20-20-20 rule, was downloaded onto the laptops of 29 symptomatic computer users. Digital eye strain (DES), binocular vision and dry eye were assessed before and after two weeks of using the reminders and one week after the discontinuation of the strategy. Binocular measurements included visual acuity, accommodative posture, stereopsis, fixation disparity, ocular alignment, accommodative facility, positive/negative vergences and near point of convergence. Symptoms were evaluated using the computer vision syndrome questionnaire, ocular surface disease index (OSDI), and symptom assessment in dry eye questionnaire (SANDE) versions one and two. Dry eye signs were assessed by measuring tear meniscus height, conjunctival redness, blink rate and incomplete blinking, lipid layer thickness, non-invasive keratograph break-up time, corneal and conjunctival staining and lid wiper epitheliopathy.RESULTS: A decrease in the duration of computer work and the duration of breaks, along with an increase in the number of breaks taken per day was observed as a result of the 20-20-20 rule reminders (p ≤ 0.015). No changes on any binocular parameter were observed after the management period (p ≥ 0.051), except for an increase in accommodative facility (p = 0.010). Dry eye symptoms and DES decreased with the rule reminders (p ≤ 0.045), although this improvement was not maintained one week after discontinuation (p > 0.05). No changes on any ocular surface and tear film parameter were observed with the rule reminders (p ≥ 0.089).CONCLUSIONS: The 20-20-20 rule is an effective strategy for reducing DES and dry eye symptoms, although 2 weeks was not enough to considerably improve binocular vision or dry eye signs.

KW - 20-20-20 rule

KW - Binocular vision

KW - Computer vision syndrome

KW - Digital eye strain

KW - Dry eye

KW - Dry eye symptoms

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DO - 10.1016/j.clae.2022.101744

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JO - Contact lens & anterior eye : the journal of the British Contact Lens Association

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M1 - 101744

ER -

The effects of breaks on digital eye strain, dry eye and binocular vision: Testing the 20-20-20 rule

Abstract

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Keywords

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