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In the news: 20-20-20 Rule Aids Computer Users Omega-3 for Dry AMD & Stargardt?

Testing 20-20-20 Rule in Digital Eye Strain

Prolonged computer use can cause vision problems, particularly for young people who often have ‘nonstop’ screen time. The estimated prevalence of computer-related vision problems among young adults is 74-77%.

Grouped under the term digital eye strain (DES), symptoms can include those associated with dry eye, and those linked to accommodative and/or binocular vision such as eye strain, headache, back and neck pain, double vision and trouble refocusing.

To minimize DES symptoms, frequent screen users are often advised to blink regularly and follow the visual ergonomic 20-20-20 rule: every 20 minutes look at something 20 feet away for 20 seconds. The 20-20-20 rule is widely recommended although only one study has looked at this approach, reporting benefit but providing no evidence of compliance.

To further evaluate the effect of the 20-20-20 rule, researchers developed software using a laptop webcam to assess user breaks, eye gaze and blinking, and prompting users with reminders to rest every 20 minutes. The software was downloaded onto the laptops of 29 young, symptomatic computer users. DES, binocular vision, and dry eye were assessed before and after 2 weeks of using the program and 1 week after the intervention’s end(1).

Following the rule reminders increased the number of breaks taken daily (p < 0.015), with participants taking fewer longer breaks and averaging shorter periods of continuous computer use. Binocular accommodative facility improved (p = 0.010), as did dry eye symptoms and DES (p < 0.045), despite there being no change in the blink rate of participants. The improvement in DES and dry eye symptoms was not fully maintained 1 week after stopping the rule reminders.

The authors concluded that 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 (other than accommodative facility) or dry eye signs.

Role for Omega-3 in Dry AMD & Stargardt?

Preliminary data presented at the ARVO annual meeting(2), suggest a potential role for omega-3 fatty acids in dry age-related macular degeneration (AMD) and Stargardt disease (SD).

Researchers randomly assigned 21 participants with dry AMD or SD and best-corrected visual acuity (BCVA) between 21-55 ETDRS letters to receive either 3.7 grams omega-3 fatty acids (3,000 mg EPA; 660 mg DHA) or placebo daily for 24 weeks.

The primary endpoint of the study was the number of letters gained in BCVA from baseline at 12 and 24 weeks and change in the ratio of the omega-6 fatty acid arachidonic acid (AA) to the omega-3 EPA. Participants also completed a questionnaire on perceived vision at 12 and 24 weeks.

In the omega-3 group, mean BCVA increased from 40.93 letters at screening to 46.93 letters at week 24 (p = 0.003) while no significant increase was seen in the placebo group. There was a significant difference between the two groups for letters gained at 12 and 24 weeks. (p = 0.002). The ratio of AA/EPA decreased significantly only in the omega-3 group.

Although the mean questionnaire score was similar between the two groups at week 12, the score was higher in the omega-3 group than placebo takers at the end of 24 weeks (9.38 vs 7.28 respectively).

Omega-3 fatty acids can improve objective and subjective vision in dry AMD and SD patients, the authors concluded. Longer and larger studies are needed to confirm these results, though it’s promising to note that they are consistent with previous work in animals by the same researchers.

References

1. Talens-Estarelles, C, et al. The effects of breaks on digital eye strain, dry eye and binocular vision: Testing the 20-20-20 rule. Contact Lens and Anterior Eye. Epub Aug.11, 2022.
2. Prokopiou K, et al. A prospective, multicentre, randomized, double-blind study designed to assess the potential effects of omega-3 fatty acids supple-mentation in dry age-related macular degeneration or Stargardt disease. IOVS. 63:377- F0208, 2002.