Digital Vision

THEME DIGITAL VISION

DE SP 72 EN AUTUMN 2015 - BI-ANNUAL - OFFERED FR © 2015 ESSILOR INTERNATIONAL WWW.POINTSDEVUE.COM Points de Vue, the International Review of Ophthalmic Optics created by Essilor in 1979, is committed to providing prescribers (all eye care professional involved in prescription throughout the world) with forward-looking and useful information for their practices and effective patient care.

Points de Vue is an expert-to-expert publication, sharing the latest knowledge on scientific evidence, clinical practice, market insights, patient needs and innovative solutions.

ÁNGEL MERINO ROJO Luis BENOIT Céline D’ERCEVILLE Sophie ADAMOPOULOS Dora DE LARRARD Brieuc CAVANAGH Maureen JARROUSSE Marie DALEY Mike KÖHLER Joachim HILDRETH Erin MARX Sebastian LAPIERRE François PAILLÉ Damien MENICACCI Armando SUTTON Jeremy

This 72nd issue welcomes 25 experts FITZPATRICK Liam sharing their perspectives on LIANG HWEE Koh “Digital Vision”. SRINIVASAN Aravind

SUMMERS Helen

BERNAL ESCALANTE Jaime DE JESÚS ESPINOSA GALAVIZ José CASILLAS Elizabeth SAFADY Marcus KRUGER Murray VELÁZQUEZ Berenice

IF YOU HAVE COMMENTS OR QUESTIONS, CONTACT US AT: [email protected] We strive to answer within 24 hours. We are at GMT+01 summer (Paris / France)

Points de Vue - International Review of Ophthalmic Optics cl2 Number 72 - Autumn 2015 Eva Lazuka-Nicoulaud Director of the Publication EDITO DIGITAL VISION

Between the time spent drafting an editorial on your tablet, looking at your smartphone, checking traffic on your GPS, then arriving at the office and answering e-mails on your laptop, reading a few e-documents, attending e-conferences via hangouts, always with your eyes riveted to the screen - then returning home and checking the news and social media on your PC or leafing through your e-book, you can spend several hours a day in front of screens of various sizes. These days it’s perfectly common to live in this ultra- connected and multi-screen environment.

If we’re to believe the latest research, nearly 61% of Americans spend more than five hours a day in front of a screen*. On average we use four different screens per person, either simultaneously or in succession**. That’s certainly a widespread practice, but it’s poorly suited to how our vision system operates. Human eyes aren’t bio- “These days it’s perfectly logically designed for near vision, which is supposed to be limited to a brief accommodation reflex. Staring common to live in this ultra- wide-eyed into digital devices while maintaining a rigid connected and multi-screen and largely unnatural posture is bound to have physiological repercussions. Digital asthenopia affects up environment” to 90% of all users**, and reports of physical pain, ophthalmic disorders and endocrine disruption affecting melatonin or cortisol secretion*** - all potentially the result of overexposure to displays - are multiplying. These findings underscore the paradox between a digital society and physiological reality, and prompt the question: can we live (well) in a connected world?

The vision health sector is offering a wide range of solutions for tackling that question: new diagnostic tools, personalized protocols and treatments, advances in ophthalmic optics and lens technology, patient education and awareness, and so on. The new technology itself is making a contribution, thanks to mobile apps, connected devices, big data, professional networks and sites that publish scientific studies and help in education, coordination and collaboration between stakeholders. And since the ophthalmic optics industry is first and foremost a field of innovation, there is a continuing focus on research and development, both to design innovative devices and to conduct clinical studies that will help us identify risks and outline new preventive or curative strategies.

In this 72nd issue of Points de Vue, we try to make sense of these latest trends and developments by once again calling on experts from around the world as well as digital artists, to give us a multi-faceted perspective on digital technology and its implications.

Our multi-screen existence is opening up a host of technical, cultural, social and entertainment possibilities that are changing the way we view the world and redefining our societies... and their relationship with vision health. It’s our role to anticipate needs and face up to the major challenges posed by the digital world, to live well while being Zen and connected!

*2015 report from The Vision Council, USA; see article on page 14 ** 2014 international Ipsos study; see article on page 38 *** Experts’ voice; see article on page 06

03 EDITORIAL 37 MARKET WATCH 38. THE WORLD OF MULTIPLE SCREENS: A REALITY 06 EXPERTS’ VOICE THAT IS AFFECTING USERS’ VISION AND POSTURE Sophie D’Erceville 06. THE CHALLENGES OF CONNECTED VISION 45. WILL “DIGITAL VISION” MEAN A BLURRY FUTURE? IN A MULTI-SCREEN WORLD Maureen Cavanagh Jaime Bernal Escalante, Elizabeth Casillas, José de Jesús Espinosa Galaviz, Pr Joachim Köhler, Dr Koh Liang Hwee, Sebastian Marx, Luis Ángel Merino Rojo, Dr Aravind Srinivasan, Helen Summers, Berenice Velázquez 14. DIGITAL EYE STRAIN IN THE USA: OVERVIEW BY THE VISION COUNCIL 53 PRODUCT Mike Daley, Dora Adamopoulos, Erin Hildreth 54. NEW OPHTHALMIC LENSES FOR A CONNECTED LIFE: EYEZEN™ FOR AMETROPES AND EMMETROPES, AND VARILUX® DIGITIME™* FOR PRESBYOPES Céline Benoît, Marie Jarrousse 21 SCIENCE 68. THE NEW RANGE OF EYEZEN™ LENSES: 22 IMPACT OF NEW DIGITAL TECHNOLOGIES WHAT ARE THE BENEFITS PERCEIVED BY WEARERS ON POSTURE DURING SCREEN USE? Damien Paillé Brieuc de Larrard

31 CLINIC 75 ART AND VISION 32. THE DIGITAL ENVIRONMENT AND ASTHENOPIA 76. DIGITAL ART: A NEW WAY OF LOOKING Interview with Marcus Safady AT THE WORLD Liam Fitzpatrick, Murray Kruger, François Lapierre, Armando Menicacci, Jeremy Sutton

WE THANK ALL AUTHORS AND CO-AUTHORS FOR THEIR VALUABLE AND VOLUNTARY (UNPAID) CONTRIBUTION TO POINTS DE VUE. TO ENSURE BOTH CREDIBILITY AND IMPARTIALITY OF THE CONTENT, WE DO NOT FUND SIGNED ARTICLES, AND IN THE SAME WAY WE OFFER THE MAGAZINE FOR FREE TO READERS, BOTH THROUGH PRINT AND ONLINE.

Points de Vue - International Review of Ophthalmic Optics 5 Number 72 - Autumn 2015

“DISPLAYS EXACERBATE “ THE HUMAN EYE AND BRAIN WERE EXISTING VISUAL NOT DESIGNED FOR DEFECTS AND ALSO EXTENDED NEAR AFFECT THOSE WHO DO VISION.” NOT WEAR GLASSES.” ARAVIND SRINIVASAN page 07 MARCUS SAFADY page 33 “THE LONGER AND MORE FREQUENTLY ONE USES DIGITAL DEVICES, THE “OVEREXPOSURE TO BLUE LIGHT EMITTED BY SCREENS MORE ONE IS AFFECTED CAN DISRUPT THE SECRETION

VERBATIMS BY OCULAR OR PHYSICAL OF MELATONIN AND THUS SYMPTOMS” AFFECT THE QUALITY OF SLEEP.”

SOPHIE D’ERCEVILLE page 41 KOH LIANG HWEE page 08 ““DIGITAL VISION” WILL LIKELY “WE HAVE A REAL HAVE A SOCIO-ECONOMIC ROLE TO PLAY IN IMPACT ON THE WORLD.” THE TREATMENT OF DISORDERS RELATED TO DIGITAL DISPLAYS.” MAUREEN CAVANAGH page 52 ELIZABETH CASILLAS page 10

“WHEN INTERACTING WITH DIGITAL DEVICES, THE SUBJECTS HAVE A HIGHLY STATIC, SOMEWHAT RIGID POSTURE.” DAMIEN PAILLÉ page 30

“THE INCREASE IN OPHTHALMIC DISORDERS IS LINKED TO THE PROLIFERATION OF SCREENS AND THE TIME SPENT WATCHING THEM” HELEN SUMMERS page 07

Points de Vue - International Review of Ophthalmic Optics 4 Number 72 - Autumn 2015 THE CHALLENGES OF DIGITAL VISION IN A MULTI-SCREEN WORLD

In this new digital era, there are new risks for user eyes and new challenges for vision care professionals. Ten experts, optometrists, ophthalmologists and researchers have addressed this broad topic and offer us their experience and thoughts in the form of verbatim comments. This overview has been divided into three main thematic areas: risks and prevention, professional practices, and projections and expectations. EXPERT’S VOICE EXPERT’S

Jaime Bernal Escalante, OD 1. RISKS AND PREVENTION Optometrist – Aguascalientes, Mexico Elizabeth Casillas, OD What effects do digital displays have on health? Department of Optometry – Autonomous University of Aguascalientes, Mexico The main risks, whether they are known, José de Jesús Espinosa Galaviz, OD, FCOVD-I, FCSO, MSc Optometrist – Centro visual integral, Ciudad Victoria, Mexico suspected or potential, primarily concern vision, Pr. Joachim Köhler but may also affect other functions. Experts are Professor of Optometry – Beuth Hochschule für Technik Berlin, reassuring however: good visual hygiene, regular University of Applied Science, Germany eye exams by professionals, appropriate optical Dr. Koh Liang Hwee Optometry Bsc(Hons), PhD (UK) solutions and enhanced public awareness pro- Optometrist – Pearl’s Optical, Singapore vide effective prevention. Sebastian Marx, Dipl.-Ing. (FH) AO, FIACLE JENVIS Research c/o Ernst-Abbe-University of Applied Sciences Jena, Germany Impact of digital displays on vision

Luis Ángel Merino Rojo, OD Optometrist – Central Óptica Burgalesa, Burgos, Spain “Our visual system is biologically designed for Dr. Aravind Srinivasan, MD distance vision. Near vision is only an accom- Director, Projects Aravind Eye Care System, India modation reflex that helps us quickly identify Helen Summers, Master Optom; Grad Cert Oc Th; Fellow ACBO; GAICD Optometrist – Darwin, Australia objects close at hand. Our eyes are not designed to stare at screens for hours on end.” Berenice Velázquez Behavioral Optometrist, Mexico José de Jesús Espinosa Galaviz

KEYWORDS digital devices, connected vision, multi-screen environment, computer, smartphone, tablet, video games, blue light, ametropia, emmetropia, digital displays, posture, digital tools, connected life, eye strain, vision health, prevention, visual hygiene, accommodative effort, asthenopia, headaches, sensitivity to the light, diplopia, sleep, cortisol, melatonin, ergonomics, protection, child, myopia.

Points de Vue - International Review of Ophthalmic Optics 6 Number 72 - Autumn 2015 EXPERTS’ VOICE EXPERTS’

“OUR VISUAL SYSTEM IS BIOLOGICALLY DESIGNED FOR DISTANCE VISION. OUR EYES ARE NOT DESIGNED TO STARE AT SCREENS FOR HOURS ON END.”

JOSÉ DE JESÚS ESPINOSA GALAVIZ

“A reduction in the frequency of blinking during screen use increases “No clinical study to date has demonstrated that the severity of such symptoms as dry eye or irritation and blurred overexposure to digital displays is the cause of vision. Smartphone users tend to hold their phones very close to the early macular degeneration. However, blue light face, thus requiring an intense accommodative effort causing eye emissions are a reality and over time we are strain or headaches.” bound to see a clinical impact. Concerning the Sebastian Marx increase in cases of myopia, various studies point to the possible influence of digital displays “In such rapidly developing cities as Singapore, we see concomitant used at ever closer distances. We still need to growth in the number of people working in offices and cases of asthe- understand why certain subjects develop myopia nopia, sensitivity to light, transient diplopia and so on.” and others don’t, even among twins.” Koh Liang Hwee Sebastian Marx

“The increase in ophthalmic disorders is linked to the proliferation of “The main risk for the younger generation is screens and the time spent watching them: in the classroom (from myopia, perhaps not true myopia, but rather an primary school to postgraduate courses, including tablets, computers, ‘accommodative spasm’ (i.e. near point stress electronic tables, etc.), but also at all ages via the social networks, according to Skeffington), since the human eye television and e-books, which are becoming increasingly popular.” and brain were not designed for extended near Helen Summers vision.” Aravind Srinivasan

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 7 EXPERTS’ VOICE EXPERTS’

Consequences beyond vision “Ever more pervasive video gaming is associated with player immersion and strong screen flicker. These two situations “In the medium and long term, digital displays can eventually stimulate systemic and endocrine functions, affect people in different ways. The impact is resulting in elevated cortisol levels. The main repercussions not solely ophthalmic. The symptoms are varied, have been found to affect sleep, behavior, mood, motivation suggesting both physical disorders (neck and and learning.” back pain, etc.) and psychological disorders Helen Summers (fatigue, irritability, poor concentration, memory problems and so on).” Preventive solutions Aravind Srinivasan “Consumer awareness campaigns are an important means of “Overexposure to blue light emitted by screens highlighting the risks and symptoms related to digital displays can disrupt the secretion of melatonin and thus and offer an opportunity to stress the need for regular eye affect the quality of sleep. Eye strain can also exams.” have an effect on productivity and lead to other Aravind Srinivasan disorders, such as stress, anxiety or mood swings.” Koh Liang Hwee

“OVEREXPOSURE TO BLUE LIGHT EMITTED BY SCREENS CAN DISRUPT THE SECRETION OF MELATONIN AND THUS AFFECT THE QUALITY OF SLEEP.”

KOH LIANG HWEE

Points de Vue - International Review of Ophthalmic Optics 8 Number 72 - Autumn 2015 “Every person consulting a vision care professional should be “For people who rely heavily on their near vision, informed of the impact of digital devices and blue light, as well as I apply a protocol based on behavioral optome- the importance of good visual hygiene and the availability of optical try. This approach is important when prescribing solutions. A wide range of high-quality solutions are available; it is the best lenses for a particular type of activity.” regrettable, however, that current prices limit their use primarily to José de Jesús Espinosa Galaviz adults rather than children.” Helen Summers “My approach? First I exclude ocular pathology and perform a refraction. Then I evaluate the “A new specialty, ergo-optometry, could be created. The ergo- patient’s visual faculties (accommodation, con- optometrist would counsel patients on how to take better care of their vergence, ocular mobility and sensory aspects visual health, explain what products to use to treat dry eye and such as stereoscopic vision, etc.). Once all these provide personalized information with regard to lenses and frames, criteria have been evaluated, the treatment

even for patients without refractive error. Overweight people can strategy can be defined.” VOICE EXPERTS’ contact Weight Watchers. People with ophthalmic problems should Elizabeth Casillas be able to contact Eyes Watchers.” Joachim Köhler “Far vision refraction is often performed using cyclopegic eye drops with a refractometer. Near “We are not usually aware of our posture; our organism chooses the vision is examined with trial frames equipped most appropriate position for a given situation, without worrying with interchangeable lenses to better evaluate about potential physiological repercussions. It is essential to adopt posture, head position and reading distance in good posture. For reading, I recommend the Harmon distance at a relation to a support, computer or digital device. minimum; this is the distance from the tip of the elbow to the middle Instruments such as ‘Capture I’ or “Visioffice®” of the index finger.” are used to measure frame parameters and such José de Jesús Espinosa Galaviz individual parameters as pupillary distance and the eye’s center of rotation.” “Good visual hygiene also includes: an ergonomic work space; good Helen Summers posture, a straight head and back; good lighting, with lower lighting for screens and adequate room lighting; breaks every 20 minutes; “My staff has slightly modified their refraction alternating between near and far screen distances, and suitable methods to adapt to digital technologies. We ophthalmic lenses.” placed a smartphone and tablet in the consul- Helen Summers ting room and, after the examination, we ask patients to read what is written on the screen. If 2. PROFESSIONAL PRACTICES they are unable to do so, we orient them towards specific lenses. Otherwise, all is well! By using How are digital devices influencing the everyday lives of vision care digital devices to test near vision, we fit in more professionals? New consultation protocols, near vision refraction and closely with our patients’ digital lifestyles.” control methods appropriate to digital displays, personalized coun- Joachim Köhler seling and more frequent continuing education are the main developments cited by experts. Many professionals are incorporating Prescriptions and counseling digital tools into their practices to better assess users’ needs. In the context of overexposure to digital devices, experts are also beginning “There are several complementary approaches. to take more interest in children and emmetropic people (without The first involves optical correction, with high- refractive error). tech lenses offering optimal vision quality and protection. The second approach involves trai- Protocols and refraction ning, consisting of various exercises designed to improve visual capabilities. The third approach “Just a few years ago, protocols were established on the basis of the involves education in visual hygiene (posture, symptoms one should look for rather than on patients’ needs depen- breaks, a good work environment, etc.). The final ding on their environment. This approach is now changing. Currently, prescription depends on the age and issues of in addition to patients’ histories, we are also interested in their each patient.” concerns, expectations, environment and so on, and we are adapting Elizabeth Casillas protocols accordingly.” Luis Ángel Merino Rojo

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 9 “WE HAVE A REAL ROLE TO PLAY IN THE TREATMENT OF DISORDERS RELATED TO DIGITAL DISPLAYS”

ELIZABETH CASILLAS

“The patient’s age affects the proposed treat- “We must be attentive to each of our prescriptions, always

EXPERTS’ VOICE EXPERTS’ ment. People with presbyopia will be advised follow the same consultation protocol, compare feedback to wear progressive lenses, with a coating (i.e. a from each patient and keep a record of all results.” filter) suited to the specific issues posed by Berenice Velázquez digital devices. For younger children, with or without a correction, lenses must primarily meet “Information provided by researchers, universities, specia- the objective of protecting their vision against lized societies, suppliers and the like, helps us stay on top of the harmful effects of screens.” new developments and provide increasingly personalized Aravind Srinivasan solutions. We must make an effort to step out of the ‘comfort zone’ of standardized options and adapt them to individual “People working on computers are advised to needs.” have regular exams, in order to identify any Sebastian Marx symptoms of ophthalmic stress. The prevention aspect is particularly stressed for children, espe- “We have a real role to play in the treatment of disorders cially for children under 10.” related to digital displays and must devote more time to Helen Summers informing and educating ourselves and to testing new solutions. In this regard, it could be useful to reinforce the sharing of experiences and dissemination of information through forums and professional networks.” Elizabeth Casillas

Points de Vue - International Review of Ophthalmic Optics 10 Number 72 - Autumn 2015 “There is a paradox. On the one hand, we have more and more technological tools available to us (auto-refractometers, digital phoropters, photo and video sharing capability to improve diagnosis, etc.), but on the other hand, we have a new generation of professionals who no longer know how to perform an exam without these devices. The right balance must be found between the assimilation of new technologies and basic knowledge.” José de Jesús Espinosa Galaviz

3. PROJECTIONS AND EXPECTATIONS

How do we anticipate future issues and respond

to the realities of a multi-screen world? Between VOICE EXPERTS’ increased research efforts and the development of technological innovations that will facilitate customized products and services, the various ideas outlined offer a glimpse of the future of The place of emmetropes the ophthalmic optics sector, which is in a position to turn the digital challenge into a real “My colleagues and I feel that emmetropes (i.e. people without growth engine. refractive error) have been completely forgotten by our profession. During screen use, they are exposed to the same risks as glasses Clinical studies and R&D wearers. So it is important to educate them about the existence of simple solutions and practices to fight against asthenopia and other “Technological progress is making rapid head- disorders related to digital devices.” way, but the ophthalmic optics industry should Luis Ángel Merino Rojo be further ahead than it is if it is to adequately meet the health challenges associated with “It would be useful to mount a major information campaign on the digital displays. It is important to invest more risks of overexposure to digital displays. And explain that vision care in health research in general and vision health in professionals have solutions to respond to these issues, even for particular.” emmetropes.” José de Jesús Espinosa Galaviz Berenice Velázquez “New studies on the relationship between blue Digital devices and professional practice light and macular degeneration and the connec- tion between the development of myopia and “For vision care professionals, digital technologies make it possible digital displays could provide clinical responses to share cases and experience, to the benefit of patients.” to current hypotheses based solely on interpre- Jaime Bernal Escalante tation.” Sebastian Marx “Digital tools and certain applications can be used to take a number of different measurements: asthenopia, the quantity of blue light “We must continue research efforts on myopia emitted by screens, etc. They can also be used to disseminate recom- and its development, solutions to amblyopia, eye mendations aimed at optimizing visual comfort and participate in the reactions during screen use, night vision, light therapeutic education of users.” radiation, etc.” Berenice Velázquez Luis Ángel Merino Rojo

“EMMETROPES HAVE BEEN COMPLETELY FORGOTTEN BY OUR PROFESSION. DURING SCREEN USE, THEY ARE EXPOSED TO THE SAME RISKS AS GLASSES WEARERS. ”

LUIS ÁNGEL MERINO ROJO

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 11 “ALL STUDIES FOCUSING ON THE EXACT RELATIONSHIP BETWEEN CONNECTED LIFE AND OPHTHALMIC DISORDERS SHOULD PROVE USEFUL.”

JAIME BERNAL ESCALANTE

“All studies focusing on the exact relationship

EXPERTS’ VOICE EXPERTS’ between connected life and ophthalmic disorders should prove useful. And in my opinion, the development of shared databases would be a real “plus” for all vision health players.” Jaime Bernal Escalante

Expected innovations

“More precise measuring equipment. The fact of having 20/20 (10/10) vision reveals nothing about the way patients’ use their eyes while watching a screen.” Elizabeth Casillas

“Tools to measure the impact of luminous digital displays on the eye.” Aravind Srinivasan

“New products, particularly ophthalmic lenses capable of protecting the eyes against technological ‘radiation’.” Jaime Bernal Escalante

“The ideal lens: a product capable of integrating all treatments and filters on demand, based on the individual needs of each patient.” Koh Liang Hwee Indeed, technological and societal developments are opening “A completely innovative approach, with ‘flexi- up new fields of practice that offer our industry an oppor- ble’ smart lenses capable of adapting their tunity to evolve! Personally, however, I prefer direct contact optical properties to specific situations. A high with patients, to show them that I am indispensable as a level of modularity that could involve the use of specialist.” electronic components.” Joachim Köhler Sebastian Marx “New visual needs concern a large number of everyday acti- Vision health in the future vities; therefore growth opportunities for the vision health sector can only increase. The solutions developed must “The multi-screen environment is part of daily provide added value: filters to prevent eye strain or blue light- life. This environment can potentially pose related risks, lenses capable of stimulating peripheral areas certain risks, particularly for the eyes, and it is of the retina to fight against myopia or stimulate amblyopic up to us as vision care professionals to concern eyes and improve their performance. There are still many ourselves with these risks and provide some little exploited or untapped areas that will undoubtedly drive answers, either directly or via the Internet. development in the future. The response to digital issues is part of this.” Luis Ángel Merino Rojo

Points de Vue - International Review of Ophthalmic Optics 12 Number 72 - Autumn 2015 Conclusion EXPERTS’ VOICE EXPERTS’ The new digital era is witnessing new societal, sensorial and behavioral transformations. This brief survey of the situation worldwide highlights the increased overall level of awareness of the ophthalmic optics sector confronted with the rapid, wide-scale changes driven by the emergence of digital technology and, more particularly, its impact on users’ vision and posture. From stronger prevention efforts to personalized treatment options, without forgetting projections for the future, the vision health sector is joining forces to adapt to developments, anticipate upcoming challenges and provide better KEY TAKEAWAYS performing solutions for ametropic and emmetropic patients of all ages. • The human eye is not designed for near vision over a Insights collected by Oliver Vachey, long period. Spending too much time in front of screens science journalist. results in asthenopia, dry eyes, red or irritated eyes and other ophthalmic symptoms. • The medium-term impact on users’ general physical condition and behavior is correlated with overexposure to blue light and screen flicker. • Preventive solutions exist for each situation, but public awareness needs to be improved. • Professional practices are evolving and adapting with the goal of providing increasingly personalized treatment options designed specifically for users of multiple screens. • Efforts are still needed in the area of clinical studies, R&D and innovation, to enhance the already substantial offer, provide new solutions and anticipate upcoming issues. • The satisfactory integration of digital vision issues is a major factor affecting the growth and development of the ophthalmic optics sector.

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 13 DIGITAL EYE STRAIN IN THE USA: OVERVIEW BY THE VISION COUNCIL*

With its annual survey, Hindsight is 20/20/20: Protect Your Eyes from Digital Devices1, The Vision Council monitors usage trends related to digital displays EXPERTS’ VOICE EXPERTS’ and their impact, as regards both eye strain and exposure to blue light. The report’s 2015 edition highlights the growing pervasiveness of digital displays in the United States and the stakes in raising awareness of the actors involved in the visual health sector like the general public.

Mike Daley Dr. Dora Adamopoulos Erin Hildreth Chief Executive Officer (CEO), Medical advisor, The Vision Marketing and Communication The Vision Council, USA Council, OD in Alexandria, USA Manager, The Vision Council, USA

Mike Daley began his optical career as Dr. Adamopolous graduated as a Doctor Erin Hildreth has great past experience in an instructor with Ferris State University of Optometry from the New England College communication, marketing and education. in 1975. He joined Essilor in 1976. of Optometry in 1998. During her last few She served as the Education Manager for With consolidated skills in sales, marketing, academic years, she had the opportunity the Health Industry Distributors Association technical services, laboratory operations, to sharpen her clinical skills through a (HIDA), coordinating and providing he served as the President of Varilux series of rotations in different types of contents for trainings. She led several Corporation (1989-1995). After 32 years medical settings on the East Coast. After editorial projects including advertising, with Essilor, he retired in 2008 as the graduation she worked in the private content management and online President and CEO of the Lens Division of practice arena, treating and managing development. Today, she is responsible Essilor of America. Throughout his career, ocular pathology in a geriatric population. for marketing and communication at he has been recognized by his peers and Today, she devotes her expertise to The Vision Council. She develops and has served in a leadership position for an welcome and treat patients suffering from implements programs that educate impressive number of optical organizations dry eyes, allergies, diabetes, cataracts consumers about eyewear trends, lens including National Academy of Opticianry and glaucoma. Involved in the development technology and health aspects. Keeping (NAO) Hall of Fame; Prevent Blindness of visual health in the United States, strong focus on eye health benefits, America, Board of Directors; AOA she collaborates with the Vision Council she works on UV awareness, protection Optometric Charity Board; SoloHealth as medical advisor. and prevention necessity (including digital Board of Directors; The Vision Council eye strain), aging and low vision. of America, Board of Directors, and past Vice Chairman. He holds Ferris State University Honorary Doctorate (2006).

KEYWORDS * The Vision Council displays, posture, ergonomics, e-reading, digital devices, connected life, Serving as the global voice for vision care products and services, The Vision Council Internet, new technologies, computer, smartphone, tablet, e-book, represents the manufacturers and suppliers of the optical industry. The Council posi- e-reader, TV, console, connected lifestyles, blue light, LED, digital eye tions its members to be successful in a competitive marketplace through education, strain, visual health, eye health. advocacy, consumer outreach, strategic relationship building and industry forums.

Points de Vue - International Review of Ophthalmic Optics 14 Number 72 - Autumn 2015 “FROM THE MOMENT PEOPLE GET UP UNTIL THE TIME THEY GO TO BED AGAIN – INCLUDING WHEN THEY ARE EATING, EXERCISING AND READING – THEY ARE USING ONE DIGITAL DEVICE AFTER ANOTHER AND THUS EXPOSING THEMSELVES TO RISKS RELATED TO PROLONGED EXPOSURE TO LIGHT EMITTED BY SCREENS”

M. DALEY EXPERTS' VOICE EXPERTS'

Digital eye strain is more than a reality; it is a public health priority consumption and paperless contacts, etc.) and in the United States. This is the warning published by The Vision options made possible through innovation. Council*, which has just released its latest survey on this issue: “Digital technologies offer ever increasing Hindsight is 20/20/20: Protect Your Eyes from Digital Devices1. The options and opportunities to simplify consumers’ document is based on an analysis of 9,749 questionnaires completed daily lives. This growing trend is not likely to by a representative sample of adult U.S. residents. Its aim is to deter- be reversed any time soon. Nor are the related mine the broad outlines of behavioral changes with respect to digital ophthalmic problems,” Daley predicts. displays, be they smartphones, tablets, computers, laptops or other electronic devices, such as game consoles. This state of play confirms Screens as a source of eye strain the trend that has emerged in recent years: “From the moment people The main effect of prolonged exposure (greater get up until the time they go to bed again – including when they are than two hours per day) to light emitted by eating, exercising and reading – they are using one digital device after screens is digital eye strain. Described as a pas- another and thus exposing themselves to risks related to prolonged sing discomfort, it manifests itself in different exposure to light emitted by screens,” sums up Mike Daley, chief forms with symptoms such as red, dry or irritated executive officer of the Vision Council. eyes, blurred vision, pain in the neck, shoulders In concrete terms, more than 95% of American adults spend at least or back, headache, etc. “We blink 18 times a two hours a day in front of a screen and almost three out of ten spend minute on average. However, staring at a screen over nine hours. Even though people working on computers are the for an extendedHINDSIGHT period can result IS 20/20/20: in less frequent PROTECT YOUR EYES FROM DIGITAL DEVICES most concerned by a potential “overdose”, the study stresses that one blinking that could dry or even irritate the eyes2”, child out of four is exposed to screens over three hours a day. These Erin Hildreth reminds us. The Vision Council’s constantly increasing figures can Digitalbe explained eyeby both strainnew societal is themarketing physical and communication eye discomfortmanager relates felt by many individuals patterns (i.e. a decrease in physical activity, an increase in passive that a recent study3 concluded that employees after two or more hours in front of a digital screen

Activities Associated with Digital Device Use:

Work 44% 30% Nearly one-third of adults (30%) 38% spend more than half their waking hours (9+) using a digital device. Waking up 43%

Recreational reading 26% 32% 72.5% of adults are unaware of

Travel Meal preparation 72.5% the potential dangers of blue light to eyes. Digital Devices Most Commonly Used:

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 15 Symptoms Commonly Associated with Overexposure to Digital Devices:

• Eye strain, 32.8% • Neck/shoulder/back pain, 32.6% • Headache, 24% • Blurred vision, 23.3% • Dry eyes, 22.8%

More than 30% of parents who say they are very concerned 31.9% of adults do not take any action to reduce about the impact of digital devices on children’s eyes allow 30.6% 31.9% symptoms of digital eye strain more than 3 hours of screen time daily

Kids (Born 1997-2014) Millennials (Born 1981-1996) Gen X (Born 1965-1980) Boomers (Born 1946-1964) 23.6% Nearly 37.4% Nearly 32% Nearly one-third 26% One in one in 4 kids four in 10 of Gen X spends at four boomers spend more millennials spend least nine hours on spend at least than 3 hours at least nine hours digital devices each nine hours on a day using on digital devices day digital devices digital devices each day each day 63% Six in 10 Gen 22% of parents say they are very 68% Nearly seven in 10 report Xers report symptoms of digital eye strain 57% Experience fewer symptoms concerned about the potential symptoms of digital eye strain of digital eye strain than 48% Gen Xers own more tablets or harmful impact of digital devices millennials and Gen Xers do 84% Most millennials own e-readers compared to other age groups on developing eyes smartphones 81% of Boomers are more likely More likely than the other two groups to own a TV compared to other 57% Nearly six in 10 millennials take to use digital devices for work and age groups their smartphones to bed and use recreational reading them as alarm clocks Source: 2014 Vision Watch data

thevisioncouncil.org PAGE 1 Kids (Born 1997 - 2014) Millenials (Born 1981 - 1996)

23.6% Nearly one 37.4% Nearly four in 4 kids spend in 10 millennials more than 3 hours spend at least nine a day using digital hours on digital devices. devices each day.

22% of parents say 68% Nearly seven they are very concerned about the potential in 10 report symptoms of digital eye strain. harmful impact of digital devices on developing eyes. 84% Most millennials own smartphones.

EXPERTS' VOICE EXPERTS' 57% Nearly six in 10 millennials take their smartphones to bed and use them as alarm clocks.

working all day on a computer could present and causes photochemical reactions likely to damage retinal physiological changes of the lacrimal system cells, with a cumulative effect. The retina cannot be replaced; similar to those found in dry eye syndrome. its alteration therefore leaves the eye vulnerable to harmful “This is not surprising when one considers that light and environmental factors, thereby increasing the risk of the work environment is often characterized by early development of ophthalmic disorders, such as AMD.” multiple or split screens, small fonts, poor However, blue light is not an enemy that must be fought at all posture and LED or fluorescent lighting.” costs. The blue-turquoise spectrum participates in the regulation of natural circadian rhythms (i.e. sleep-wake cycles) The blue light paradox among other things, and stimulates the pupillary reflex and In addition to eye strain, overexposure to digital such cognitive functions as alertness, memory and emotion displays is linked to the issue of blue light. Eye regulation. “Blue light is both unavoidable and indispensable. doctor and medical advisor to the Vision Council, So it is important to understand its repercussions on the Dora Adamopoulos, recalls that “a great deal of organism and vision, and be familiar with the tools and recom- research is currently underway to determine its mendations for minimizing exposure, particularly from digital precise impact on the eyes and vision. One thing displays,” the expert advises. is certain: the blue-violet spectrum (415-455 nm) is particularly harmful4. It penetrates deeply

“ A QUESTIONNAIRE HANDED OUT PRIOR TO A CONSULTATION CAN HELP TO CLARIFY AT WHAT DISTANCE EACH SCREEN IS BEING USED, HOW THE OFFICE IS ORGANIZED, THE MOST COMMON POSTURAL POSITIONS ASSUMED AND SO ON, AND THIS INFORMATION CAN THEN SERVE AS A BASIS FOR DISCUSSING PROBLEMS AND POSSIBLE SOLUTIONS ”

E. HILDRETH

Points de Vue - International Review of Ophthalmic Optics 16 Number 72 - Autumn 2015 Gen X (Born 1965 - 1980) Boomers (Born 1946 - 1964)

32% Nearly one- 26% One in four third of Gen X boomers spend spends at least nine at least nine hours hours on digital on digital devices devices each day. each day.

63% Six in 10 Gen 57% Experience Xers report symptoms of digital eye strain. fewer symptoms of digital eye strain than millennials and Gen Xers do. 48% Gen Xers own more tablets or e-readers compared to other age groups. 81% of Boomers are more likely to own a TV

compared to other age groups. VOICE EXPERTS' More likely than the other two groups to use digital devices for work and recreational reading.

Source : 2014 Vision Watch data

Digital childhood and myopia related to exposure to digital displays and espe- Prevention and protection are equally important for both adults and cially how to fight them, should be a major focus young people, who now use computers and smartphones in all aspects for mobilizing our sector.” To optimally publicize of their schooling and social life. The latest Digital Eye Strain report the issue, The Vision Council is diversifying its points to intensive screen use and a lack of data on the medium-term strategy and seeking to strengthen its communi- consequences. “The phenomenon is recent, so it is impossible to cation in schools and during ‘key’ events: film foresee the impact of emitted light on children’s eyes. But in our releases, TV marathon broadcasts, new techno- opinion, myopia is one the main risks that must be evaluated,” logy launches, or international trade fairs, Erin Hildreth hypothesized. “The causes of myopia are related to a including the celebrated CES (Consumer combination of genetic and environmental factors, and since the Electronics Showcase), an unmissable event pervasiveness of digital devices stimulates ocular accommodation at for new technology fans. This is a good way to very close reading distance, this could well be part of the problem.” reach a large number of users and instill in them The Vision Council therefore calls for vigilance and a complete eye a desire to safeguard their eye health. And to exam every year to ensure the best possible development of children's faci-litate the assimilation of prevention, the eyes. “A professional can evaluate symptoms or visual disorders organization is relying on its flagship slogan: resulting from the use of digital devices and suggest solutions and “20-20-20”. Every 20 minutes, look 20 feet in make recommendations,” she affirms. However, this approach comes front of you (approximately 6 meters) for 20 sec- up against one of the main findings of the study: the majority of onds. This rule is easy for both adults and parents are not worried about the effect of the digital environment on children to remember and use. “The Think About their offspring. 15% of respondents place no limits on the amount of Your Eyes campaign (www.thinkaboutyoureyes. time spent in front of screens, and 30% are not concerned about com) is also a great way to inform people about the potentially harmful impact of digital devices on the development the benefits of an annual ophthalmic exami- of the visual system. nation,” adds Daley, who sees in consumers’ appetite for connected information an excellent Think and act “awareness” opportunity to use these media, including web- This finding of disregard for risk highlights one of the major chal- sites and social networks, and connect with other lenges of the Vision Council’s action: public awareness. Its CEO industry players about the importance of eye confirmed this focus: “For us, education is the key. The transmission health in the digital environment. of information about the nature of digital eye strain, including risks

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 17 “WE HAVE A DUTY TO EXPLAIN TO CONSUMERS THAT THEY DO NOT HAVE TO LIVE WITH DISCOMFORT OR PAIN WHILE USING DIGITAL DEVICES. CUSTOM GLASSES, WITH OR WITHOUT CORRECTIVE LENSES, CAN ALLEVIATE OR PREVENT SHORT-TERM SYMPTOMS AND PROTECT

EXPERTS' VOICE EXPERTS' AGAINST LONG-TERM DAMAGE.”

D. ADAMOPOULOS

Vision professionals and new preventive mea- Preventive recommendations for the users of digital displays sures Eye care professionals have a big responsibility 1) Design your work space in such a way as to alleviate – and a good opportunity – to lead the fight external stressors, with ideal lighting, an “eye-gonomic” against the deleterious effects of digital displays. setting (ergonomics for the eyes) and good posture. In addition to the development of new health and technical solutions, Erin Hildreth encour- 2) Increase character size in relation to the device used. ages “ophthalmologists, optometrists and opticians to adopt simple and pragmatic mea- 3) Observe the 20-20-20 rule. Every 20 minutes, look 20 feet sures to help their patients in their everyday in front of you (about 6 meters) for 20 seconds. activities.” Some ideas and recommendations include: promoting continuing education and 4) Consult a health professional on a regular basis to obtain keeping abreast of the latest findings in this counseling and prescriptions for ophthalmic lenses designed area; taking an interest in public opinion and for multiple screen use. consumer perceptions; taking charge of consultations by systematically interviewing patients The importance of prevention about their use of digital devices and finding out Advances in ophthalmic optics have already made possible a not only what type of devices are being used, but wide range of options for lenses capable of reducing glare and also how they are used and for how long. “A filtering out blue light. These two indispensable options to questionnaire handed out prior to a consultation optimize visual comfort while using digital displays should can help to clarify at what distance each screen encourage opticians to add them to prescriptions to more is being used, how the office is organized, the most common postural positions assumed and so on, and this information can then serve as a basis for discussing problems and possible solutions,” she suggested. This should be accompanied by some key preventive recommendations.

Points de Vue - International Review of Ophthalmic Optics 18 Number 72 - Autumn 2015 DIGITEYEZED: THE DAILY IMPACT OF DIGITAL SCREENS ON THE EYE HEALTH OF AMERICANS

Nearly 70% of American adults experience some form of digital eye strain due to prolonged use of electronic devices

Daily device use:

Desktop computer 58% Adults are most likely to experience digital eye strain in Laptop computer 61% the early evening (6 - 9 p.m.) EXPERTS' VOICE EXPERTS' 9 closely Tabletmeet theiror e-reader clients’ 37% needs. “Many manufacturers also offer multifocal lenses for people who need to relieve eye strain and correct both near and far vision,” Dora Adamopoulos added. The medical Television 81% advisor feels that “the optical/ophthalmic industry must continue to engage in research and development for new products, but also educate Videothe community game console of vision 17% care professionals and the general public. We have a duty to explain to consumers that they do not have to live with discomfort or pain while using digital devices. Custom Smartphone 62% glasses, with or without corrective lenses, can alleviate or prevent 6 short-term symptoms and protect against long-term damage.”

It is more important than ever to disseminate this message, inasmuch as scientific advances are increasingly confirming the link between Time spent in front of digital devices: digital displays, eye strain, age-related eye diseases Issuesand the commonly importance ofassociated prevention and protection.with over-exposure to “The newdigital digital devices: era is more stressful on our eyes and we must all adapt accordingly, professionals 28% and users• eye alike. strain The optical/ophthalmic industry 10+ hours has already identified the major issues raised by 33% digital• devicesdry eyes and during the last several years, 3–5 hours we have• witnessedblurred vision a boom in innovation capable of reducing disorders related to the light emitted 32% by screens.• headache These products and technologies do 6–9 hours much more than protect our eyes: they improve • neck/shoulder/back pain the quality and precision of our vision,” Mike Daley concluded. •

of adults do not know that electronics of adults have never tried – or don’t know 63% emit high-energy visible or blue light how – to reduce their digital eye strain

SOURCE: The Vision Council reports on digital eye strain, 2012 & 2013

thevisioncouncil.org PAGE 2

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 19 Some key figures • In 2015, 69% of American adults use a smartphone and 42.5% a tablet or e-book reader on a daily basis, versus 45% and 26% respectively in 2012. • 60.8% spend more than five hours a day in front of a screen.

EXPERTS' VOICE EXPERTS' • 31.9% do not make any effort to reduce symptoms of digital eye strain. • 72.5% are not aware of the potential damage caused by overexposure to blue light and do not know that digital displays emit blue light. • 22% of parents say that they are concerned by the impact of digital device use on their children’s vision. • 30.6% of the same parents allow children to use digital devices for over three hours daily despite their concern.

KEY TAKEAWAYS

• Americans (both adults and children) are spending more and more time in front of digital displays on all types of devices. • Disorders and risks related to light-emitting screens (i.e. eye strain and retinal pathologies) are either unrecognized or underestimated by the general public, the majority of whom neglect prevention and protection. • Simple solutions exist to fight against digital eye strain and overexposure to blue light.

REFERENCES • The Vision Council recommends following the 20-20- 1. Hindsight is 20/20/20: Protect Your Eyes from Digital Devices, The Vision Council, USA http://www.thevisioncouncil.org/sites/default/files/VC_DigitalEyeStrain_Report2015.pdf 20 rule (every 20 minutes, take a 20 second break while 2. Optometry and Vision Science. “Effect of Visual Display Unit Use on Blink Rate and Tear Stability.” November 1991. http://journals.lww.com/optvissci/Abstract/1991/11000/Effect_of_Visual_Display_Unit_ looking 20 feet away) and using ophthalmic lenses Use_on_Blink_Rate.10.aspx 3. JAMA Ophthalmology. “Alteration of Tear Mucin 5AC in Office Workers Using Visual Display Terminals.” designed for screen use. June 2014. http://archopht.jamanetwork.com/article.aspx?articleid=1878735 4. Arnault, E., Barrau, C. et al. Phototoxic action spectrum on a retinal pigment epithelium model of Age-related • Vision care professionals all have a role to play in Macular Degeneration exposed to sunlight normalized conditions. PlosOne, 2013; 8(8), http://journals.plos.org/ plosone/article?id=10.1371/journal.pone.0071398 terms of advocacy, awareness-raising and counseling.

Points de Vue - International Review of Ophthalmic Optics 20 Number 72 - Autumn 2015 Science is focusing greater attention on how new digital technology is affecting the vision health and motor and postural behaviour of its users. Analysis of postural data could spur innovations in the field of ophthalmic optics. SCIENCE

P.22 What impact is the new digital technology having on posture?

Points de Vue - International Review of Ophthalmic Optics 21 Number 72 - Autumn 2015 IMPACT OF NEW DIGITAL TECHNOLOGIES ON POSTURE SCIENCE

New technologies and the use of digital media are undeniably changing the postural and behavioural patterns of users. However, there is still little data on the scientific characterization of these new postural habits. Recently, Essilor International’s R&D teams have developed a specific experimental setup that has delivered original results. Through the analysis of postural data measured in this context, they were able to establish a specification for the design of a new class of ophthalmic lenses.

1 Introduction During the last decade, we have seen an explosion in smartphones, tablets, e-readers and other hybrid devices that concentrate the functions of a computer in a portable device. In France, smartphone purchases increased by 7% in one year, reaching 46% in 2014. Three out of ten people state that they are equipped with a touch tablet, a statistic that nearly doubled in one year, from 17% in 2013 to 29% in 2014 . Moreover, most users do not seem Damien Paillé particularly attached to a single device, but move easily R&D Optics, Vision Sciences, Essilor from one device to another (using a tablet at home, a International, Paris, France. smartphone while commuting, a computer at work and so After practicing as an optician, Damien, who holds a on) (Fig. 1). degree in optometry, completed and defended a doctoral thesis in 2005 in cognitive sciences at the University of All these devices represent a great step forward, since they Paris VIII in collaboration with the College de France and dramatically increase possibilities for exchange, inter- the Renault company. He then pursued post-doctoral studies at the Laboratory for Perception and Motion action and cooperation, and facilitate access to knowledge. Control in Virtual Environments (a joint Renault-CNRS The information dispensed by these devices is much the laboratory), before joining Essilor International’s R&D same, in content, as that of traditional books, but is pre- teams in 2007. Damien currently works in the Vision sented in a very different form. While books require a Sciences department. linear reading mode punctuated by pages, electronic text can be navigated freely by the reader, using hyperlinks; moreover, the ability to scroll text on the screen, using a keyboard or touch screens, eliminates the notion of page.

KEYWORDS digital screens, posture, ergonomics, e-reading, digital devices, connected life, Internet, new technologies, NCIT, computer, smartphone, tablet, e-book, e-reader, TV, console, Essilor, occupational lenses, eye-screen distance, eye declination, rotation of the head, rolling of the head, motion capture.

Points de Vue - International Review of Ophthalmic Optics 22 Number 72 - Autumn 2015 Electronic reading requires the reader to interact with his distance from their computer and then measured the eye- SCIENCE or her device. screen distance for each of them. He obtained a mean

Furthermore, the vast majority of these devices are distance of 63 cm (standard deviation 13 cm, CI95%[38; “mobile” or “handheld” devices and can be used in a wide 88]). The act of lowering one’s eyes when viewing a com- range of everyday situations: while standing in public puter screen has been the subject of numerous studies in transport, sitting on a sofa, or lying in a bed. recent years and has led to sometimes contradictory ergo- These new habits are revolutionizing the way we interact nomic recommendations. Indeed, a group of researchers with traditional media and we can expect our postures believe that a downward viewing angle of 40° is more suit- to differ from those we adopt with paper media. Since able than an angle of 15° (Ankrum, 1997)7, because the ophthalmic lenses are traditionally designed to respond to the constraints of paper media, it is critically important to take an interest in these new behaviours. With this in «The smaller the screen, the closer mind, we undertook a study in 2013 to collect data on the distance of use» posture during the use of these new devices.

2 Experimentation for the collection of postural data Before starting our experimentation, we reviewed the former would be preferred for intensive tasks (Ankrum et literature on the postural data of users while viewing al., 1995)8. It also seems that a significant lowering of the various types of screens. eyes reduces the risk of dry eye by decreasing the exposed ocular surface (Jainta & Jaschinski, 2002)9. However, 2.1 Literature review numerous studies have sought to test the relevance of a 2.1.1 Data on computers lowered screen. An angle of view of 40° below the hori- In a study on visual fatigue, Jaschinski (2002)6 asked zontal causes one to incline the head more sharply, forty subjects to position themselves at a comfortable resulting in increased muscle activity in the neck, shoulders and back than an angle of 15° (Turville et al., 1998; Straker & Mekhora, 2000)10, 11. Furthermore, it seems that operators prefer a screen positioned so that the axis of

Device Preferences Throughout the Day in Europe Most Weekend Tablet Usage Peaks at 9pm Tablets popular at night

Mobiles peak PCs during the late day

Share of Device Page Traffic on a Typical Weekend PRIME DAYTIME LATE AT NIGHT EARLY MORNING EARLY EVENING (8PM - 12AM) (12AM - 7AM) (7AM - 10AM) (10AM - 5PM) (5PM - 8PM)

FIG. 1 Digital device use preferences according to time of day in Europe. Source: comScore Device Essentials, Sunday, 17th February th 2013, Europe © comScore, Inc. Proprietary. Source: comScore Device Essentials, Sunday, 17 February 2013, Europe 19

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 23 WHO IS AND ISN'T ACCESSING THE INTERNET

% ACCESSING THE INTERNET BY GENDER AND SOCIAL GRADE IN 2013

SCIENCE All 15-24 25-34 35-44 45-54 55-64 65+ Males 86 98 97 94 89 80 63

Females 81 92 95 94 92 77 48

0-49% 50-79% 80-100%

FIG. 2 Percentage of people accessing the Internet according to age and gender. Source: Adapted from Tech Tracker quarterly release Q3 2013 IPSOS Media CT (data on 4,000 adults in the United Kingdom over 15 years of age)

gaze is horizontal or slightly inclined (Bauer & Wittig, 2.2 Review of surveys 1998)12. In the current state of research, the preferred Before starting the measurement campaign, we reviewed viewing angle can be considered to fall within a range of a number of opinion surveys on the use of digital 8-16° (Seghers, Jochem & Spaepen, 2003)13. For a review technologies for the purpose of defining the age group of the literature on this topic, see Cail & Aptel (2006)14. of our population, selecting the devices to be tested Given the uncertainty of ergonomic recommendations, we and to ensure that we cover as completely as possible the decided to conduct an internal campaign to measure eye conditions under which these devices are likely to be used declination (i.e. lowering of the eyes), intended to serve as in everyday life. the basis for the development of our range of occupational lenses. Our measurements show an eye declination of 4° 2.2.1 Who accesses the Internet? (SD 1.53°) during computer use. If we look at the age of people accessing the Internet, We noted a wide variability between individuals in their according to the results of the Ipsos Tech Tracker study in way of positioning themselves relative to a computer the third quarter of 2013, we can see that all age groups screen, and we therefore recommend that this parameter are represented and, even though the percentage of be taken into account when developing occupational lens Internet users is lower in the over-65 age group (55.5% designs. on average), this percentage remains very high in the other categories (> 80%) (Fig. 2). Moreover, we can easily 2.1.2 Data on television screens assume that the percentage of people over 65 years It is very difficult to find postural data in the literature on accessing the Internet will increase in coming years, in television screen viewing postures. We know, however, view of the fact that digital technologies are playing an that the average size of LCD television screens sold world- increasingly important role in our everyday lives. So we did wide in 2013 is between 36 and 37 inches measured not set an age limit for the recruitment of our subjects. diagonally. For this size screen, the recommended distance from the screen is about 1.90 m (between 1.40 and 2.40 m). Since the television set may be placed flat 2.2.2 Equipment in the home on the floor, on a low cabinet, a dresser or wall-mounted, Regarding electronic devices, according to the same study, it is not easy to find data on viewing angles. We none- in 2013, the percentage of laptop owners in the house- theless recommend a zero-degree gaze angle for our hold remained stagnant at about 63%, and the number of occupational lenses inasmuch as the television set is most connected TVs stood at 14%. It is noteworthy that the often located at eye level. number of latest-generation consoles fell slightly, from 40% to 37% in one year, presumably in favour of smart- 2.1.3 Data on new technologies phones, which grew strongly, moving up from 37% to Through a review of the literature in this area, we deter- 55%. Similarly, there was a sharp rise in the number of mined that there is a real lack of postural data related to tablets (11 to 30% in one year) and e-book readers (12 to the use of recent digital devices, hence the need to under- 17% in one year) (Fig. 3). We chose to focus on the latter take a measurement campaign. three devices in our study.

Points de Vue - International Review of Ophthalmic Optics 24 Number 72 - Autumn 2015 SCIENCE

EQUIPMENT IN THE HOME

WHICH OF THE FOLLOWING DO YOU OWN/HAVE IN YOUR HOUSEHOLD?:

Laptop 64% 62%

Digital TV via aerial/Freeview 53% 51% TV with internet built in 14% 14%

Latest generation games console 37% 40%

Smartphone 5 5% 37% Tablet computer 30% 11% ebook reader 17% 12%

FIG. 3 Progression of digital equipment. Source: Adapted from Tech Tracker quarterly release Q3 2013 IPSOS Media CT (data on 1,000 adults in the United Kingdom over 15 years of age)

TABLET USAGE – WHAT FOR?

WHAT DO / WOULD YOU USE A 100 100 Email 85 TABLET FOR? (%) Social networking Accessing information Watching videos Update on news Reading newspapers Shopping Researching Listening to music Video games 55 53

48 48 47 45 43 42 40 46

12 10 19 9 15 8 18 32 7 13 17 6 15 5 15 4 3 TABLET OWNERS 2 NON-TABLET OWNERS 1 -What do? 0 0 -What would?

FIG. 4 Main activities on tablets. Source: Tech Tracker quarterly release Q3 2012 IPSOS Media CT (data on 98 adult tablet owners and 909 adults not owning tablets in the United Kingdom over 15 years of age)

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 25 WHERE DO YOU USE YOUR TABLET DEVICE?

% LOCATION OF TABLET USAGE – JULY 2012 In vs. out of home use HOW DO YOU CONNECT TO THE INTERNET SCIENCE ON YOUR TABLET? At Home 100% 89 Living room Outside of home 56%

92% Bedroom 33 40% 65% 1

Never Access Via 3G Via Wi-Fi On holiday Kitchen Another internet area Work/place of 47% Other place away Cafe/bar/ education from home restaurant 37% Whilst Whilst travelling commuting 28% 26% (other) 27% 15% 23%

FIG. 5 Main locations of tablet use. Source: Tech Tracker quarterly release Q3 2012 IPSOS Media CT (data on 98 adult tablet owners in the United Kingdom over 15 years of age)

2.2.3 Use of equipment 2.3 Experimental setup and procedure In 2012, according to the Ipsos Tech Tracker study, Twenty-two subjects participated in the study. The average tablets were used for relatively traditional activities, which age was 36.2 (with a range of 22 to 51). Since the goal have not changed substantially to date. These activities was to collect reference data, only three subjects with include: consulting emails and social networking, looking presbyopia were included in the study, since it has been up information, watching videos, reading newspapers, shown that progressive lenses influence natural posture playing video games, checking the weather forecast, etc. (Mateo B, Porcar-Seder R, Solaz JS & Dürsteler JC., (Fig. 4). 2010)5. The subjects all wore their usual prescription These are nearly the same activities practiced on mobile lenses and were all familiar with the digital device being phones. We selected seven of the most representative tested (questionnaire). activities for our study. 2.3.1 Experimental setup and calibration In order to record data on the posture of people in move- 2.2.4 Location of digital device usage ment, Essilor acquired a technical platform called MoViS According to the same study, in 2012, the three main (Motion and Vision Science) equipped with a motion locations in which tablets are used are: the living room capture system (VICON©) comprising eight synchronized (92%), the bedroom (65%) and the kitchen (47%) (Fig. 5). We can assume that in the living room, people tend to be sitting, in the bedroom they are probably lying down, and in the kitchen, they are usually standing. The same assumptions can be made for smartphones. We therefore decided to focus on these three positions (standing, seated and lying down). System VICON©

Infrared Cameras

FIG. 6 MoViS motion capture room

Points de Vue - International Review of Ophthalmic Optics 26 Number 72 - Autumn 2015 Helmet equipped with retro-reﬂ ective markers SCIENCE

Trunk Markers LSHO: Left Shoulder RSHO: Right Shoulder CLAV: Clavicle TORSO: Torso

FIG. 7 Fitting out the subject prior to experimentation FIG. 8 Measurement of the reference position

infrared cameras that can capture the coordinates (X, Y, POSITION DEVICE ACTIVITY Z) of retro-reflective markers in real time (Fig. 6). 1 Standing Smartphone Check the weather 2 Standing Smartphone Read an email Each subject was first fitted with a headset equipped with 3 Standing Smartphone Write an email four markers, and we placed four other markers on the 4 Standing Smartphone Play a video game upper part of his or her body to mark the position of the trunk (Fig 7). 5 Seated Smartphone Play a video game 6 Seated Smartphone Read an email Before starting the experiment, we took a series of photo- 7 Seated Tablet Watch a video graphs of the subject’s head, which were used to calculate 8 Seated Tablet Search for information the position of the axis of rotation of each eye15 in the 9 Seated Tablet Write an email headset’s reference point. Then, to be able to measure head and eye movements, we needed a reference position 10 Seated Tablet Play a video game looking straight ahead. For this, the subject had to stand 11 Lying down Tablet Read an email about 2 m in front of a mirror and look at the root of his or 12 Lying down Tablet Watch a video her nose in the mirror (Fig. 8). Once the subject was in 13 Lying down E-reader Read a passage this position, we proceeded with the acquisition of the 14 Seated E-reader Read a passage markers’ coordinates. TAB. 1 The three devices used by the subjects were also equipped with markers. As a result, during the course of the expe- 1): riment, we were able to calculate the exact position, in For each of the fourteen activities, we processed the data real time, of the subject’s head, and the centers of rotation on the positions of the axis of rotation of the eyes, the of their eyes and trunk, as well as the exact position of device and the trunk so as to extract such data as: eye- the object being manipulated. screen distance, eye declination, rotation of the head relative to the trunk and rolling of the head. 2.3.2 Procedure Once the calibration phase was completed, the subject 2.4 Results had to follow a specific scenario in which he or she During the experiment, the data acquisition frequency of ++performed fourteen activities one after the other, on the VICON© system was set at 100 Hz. For each subject, three different devices, in three different positions (Tab. we measured the mean and standard deviation data (eye-

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 27 SCIENCE Number of observations

FIG. 9A Eye-screen distance Eye-smartphone distance (cm) FIG. 9B Dispersion of eye-Smartphone distance measurements for 22 subjects and 6 activities.

vertical plane containing the cylopean eye and the middle point of the device

Head declination

Eye declination Number of observations

Plane containing the ERCs and the middle point of the device Eye declination angle (°) Smartphone FIG. 10B Dispersion of eye-Smartphone distance measurements for 22 subjects and 6 activities.

FIG. 10A Eye declination.

screen distance, eye declination, rotation of the head smartphone (SD 5.1 cm) Fig. 9; 38 cm for the e-book relative to the trunk and rolling of the head) over the dura- reader (SD 6.5 cm) and 39.7 cm for the tablet (SD 6 cm). tion of the activity. The standard deviation provided Analysis of variance shows that there are significant diffe- information on the subject’s stability during the activity. rences between activities (F(14.294)=11.662 and We then processed the data via analysis of variance p<0.05). Planned comparison analysis showed a signi- (repeated measures ANOVA). And to delve further, we ficant difference (t(21)=7.358; MSE= 0.727; P=3.06E-7

conducted planned comparisons to identify differences < 0.05; d=1.56 ; CI95%[3.9; 6.8]) between small screens between groups: comparisons by device (smartphone, (4 inches for the smartphone) versus large screens (6 tablet, e-book reader) or by position (standing, sitting, inches and 9.7 inches respectively for the e-book reader lying down). and the tablet). The smaller the screen, the closer the distance of use. These results were subsequently 2.4.1 Eye-screen distance confirmed by Maniwa et al. (2013)16. Ko et al. (2012)17 The mean distance from the screen was 33.8 cm for the show that users reduce their viewing distance when the

Points de Vue - International Review of Ophthalmic Optics 28 Number 72 - Autumn 2015 SCIENCE

Head in Truck Planned comparison analysis showed a significant differ- Trunk declination ence (t(20)=5.872; MSE= 0.920; P=4.96E-7 < 0.05; d=1.58 ; CI [4.9; 8.5]) between standing and seated declination 95% positions. But since the device most frequently used Head standing is the smartphone, we also found a significant declination difference between the smartphone and the two other devices (t(20)=6.942; MSE= 0.773; P=9.67E-7 < 0.05;

d=1.51; CI95%[3.8; 6.9]). (Fig. 10a and Fig. 10b)

By comparison, a study conducted internally on forty subjects showed that the mean eye declination angle for reading on paper is 18.7° (SD 6.1°) and for writing on paper is 13.8° (SD 8.8°). Eye declination in the use of recent digital devices is thus much more pronounced than FIG. 11 Angle of rotation of the head relative to the trunk. is the case during use of paper media.

2.4.3 Other data 2.4.3.1 Head rotation relative to the trunk We measured the angle in a horizontal plane between the font size is smaller. But the font size of our devices head and the trunk. Analysis of variance shows that there was also related to their size: 1.5 mm for the smartphone, are no significant differences between activities: 2 mm for the e-book reader and 3 mm for the tablet. F(14.266)=1.7223 and p=0.051. The mean angle Our results were thus consistent with their work. (Fig. 9a between the head and the trunk is -0.3° (SD 5°) where and Fig. 9b) a negative angle indicates head rotation to the left. Since the mean angle is very small, we can conclude that By comparison, a study conducted internally on forty when using digital devices, the head remains perpendi- subjects shows that the mean distance for reading on cular to the trunk (Fig. 11). paper is 41.8 cm (SD 9.6 cm) and for writing on paper is 41.8 cm (SD 11.4 cm) or approximately 8 cm more than 2.4.3.2 Roll angle of the head for smartphone use. We also measured the roll angle of the head. Analysis of variance shows that there are significant differences 2.4.2 Eye declination between activities: F(14.238)=2.4875 and p=0.026 The mean eye declination angle was 25.6° for the smart- < 0.05. However, planned comparison analysis shows phone (SD 7.2°) (Fig. 10); 20.2° for the e-book reader (SD no difference between devices or positions. The mean 7.2°) and 20.3° for the tablet (SD 7.7°). Analysis of roll angle for all activities combined is -2.9° (SD 3.6°) variance shows that there are significant differences where a negative angle indicates head rotation to the left. between activities (F(14.280)=15.641 and p<0.05). Since the mean angle is very small, we can conclude that when using digital devices, the head remains vertical.

2.4.3.3 Standard deviation of data during each activity “Eye declination in the use of recent Since the data acquisition frequency of the VICON© system is set at 100 Hz, a datum is received every 10 ms. digital devices is much more The standard deviation of each datum gives us an idea of pronounced than is the case during use of paper media”

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 29 SCIENCE

the subject’s stability. The mean standard deviations for the 22 subjects and 14 activities is 0.8 cm for the eye- screen distance; 2.6° for the eye declination angle; 1.2° for head rotation relative to the trunk and 1.4° for the roll angle of the head. All these values are very low, indicating KEY TAKEAWAYS that, when interacting with digital devices, the subjects have a highly static, somewhat rigid posture. • The use of digital devices is conducive to specific 3 Conclusion postural behaviours. Our review of the literature showed a highly significant • Postural data (eye-screen distance, eye declination variability between individuals in how they positioned angle, head rotation and roll angle) were measured themselves relative to their computer screen. and analyzed in Essilor’s R&D centers. Moreover, our results confirmed a modification of our postural behaviours relative to such traditional media as • The results show that subjects maintain a highly paper. We found that, when handling recent digital static, even rigid posture, when interacting with devices, our posture is very stable, or even rigid. The head digital devices. remains vertical and perpendicular to the trunk. • On a smartphone or tablet, the eye-screen distance We also showed that, when using such devices as the is shorter and the gaze is lowered more sharply than smartphone, tablet and e-book reader, the eyes are is the case with paper media. lowered more sharply and the viewing distance is closer than is the case for paper. • A precise understanding of these new requirements These parameters must be taken into account in the deve- has paved the way for the design of a new class of lopment of occupational lenses to offer the wearer optimal ophthalmic lenses at Essilor. visual and postural comfort. •

REFERENCES 10. Turville K, Psihogios, J., Ulmer, T., Mirka G. (1998). “The effects of video display terminal height 1. Centre de Recherche pour l’Etude et l’Observation on the operador: a comparison of the 15° and 40° des Conditions de Vie : La diffusion des technologies recommendations”. Applied Ergonomics, 29, de l’information et de la communication dans la pp239-246. société Française (2014). http://www.cgeiet.economie. gouv.fr/Rapports/DTIC-2014-rapport.pdf 11. Straker L., Mekhora K. (2000). “An evaluation of visual display unit placement by electromyography, 2. Quarterly worldwide FPD shipments and forecast, posture, discomfort and preference”. International (http://www.displaysearch.com/cps/rde/xchg/ Journal of Industrial Ergonomics, 26, pp389-398. displaysearch/hs.xsl/quarterly_worldwide_fpd_ 12. Bauer W., Wittig T. (1998). “Influence of screen forecast_report.asp) and copy holder positions on head posture, muscle 3. Tech tracker quarterly release Q3 2013 IPSOS activity and user judgement”. Applied ergonomics, Media CT https://www.ipsos-mori.com/ 129, pp185-192. researchspecialisms/ipsosmediact/customresearch/ 13. Seghers J., Jochem A. & Spaepen, A. (2003). technology/techtracker.aspx “Posture, muscle activity and muscle fatigue in 4. Tech tracker quarterly release Q3 2012 IPSOS prolonged VDT work at different screen heights Media CT https://www.ipsos-mori.com/ settings”. Ergonomics, 46, pp714_730. researchspecialisms/ipsosmediact/customresearch/ 14. Cail F., Aptel M. (2006). “Facteurs de risqué technology/techtracker.aspx pour le membre supérieur dans le travail sur écran : 5. Mateo B., Porcar-Seder R., Solaz J.S., Dürsteler Synthèse bibliographique”. Travail Humain, 69(3), J.C. (2010). “Experimental procedure for measuring pp230-268. and comparing head-neck-trunk posture and 15. Chauveau J.P. (2009). “Visioffice, an instrument movements caused by different progressive addition serving innovation in ophthalmic lenses”, Points de lens designs.” Ergonomics; 53(7):904-13. Vue, International Review of Ophthalmic Optics, No. 6. Jaschinski W. (2002). “The proximity-Fixation- 60, Spring 2009. Disparity curve and the preferred viewing distance at 16. Maniwa H., Kotani K., Suzuki S., Asao T. (2013) a visual display as an indicator of near vision fatigue”. “Changes in Posture of the Upper Extremity Through Optometry and Vision Science; Vol. 79, No. 3, pp158- the Use of Various Sizes of Tablets and Characters”. 169 Human Interface and the Management of Information. 7. Ankrum D. (1997). “Integrating neck posture and Information and Interaction Design. Lecture Notes in Vision at VDT workstations”. Proceedings of the 5th Computer Science Volume 8016, 2013, pp 89-96 international scientific conference: work with Displays 17. Ko P., Mohapatra A., Bailey I., Sheedy J., Rempel Unit, 63-64. Tokyo, Japan, November. D. (2012). “Effects of Font Size and Reflective Glare 8. Ankrum D., Hansen E., Nemeth K. (1995). “The on Text-Based Task Performance and Postural Change vertical horopter and the angle of view”. In A. Grieco, Behavior of Presbyopic and Nonpresbyopic Computer G. Molteni, B. Piccoli & E. Occhipinti (Eds), Work Users”. Proceedings of the Human Factors and with Display Units 94(pp. 131-136). Amsterdam, Ergonomics Society Annual Meeting 2012 56: 2378 North-Holland: Elsevier. 9. Jainta S., Jaschinski W. (2002). “Fixation disparity: Binocular vergence accuracy for a visual display at different positions relative to the eyes”. Human Factors, 44, pp443-450.

Points de Vue - International Review of Ophthalmic Optics 30 Number 72 - Autumn 2015 Vision care professionals are observing higher rates of asthenopia during examinations. The main culprit is: the increasingly wide-ranging and intensive use of digital displays. CLINIC

P.32 What is the link between the digital environment and asthenopia?

Points de Vue - International Review of Ophthalmic Optics 31 Number 72 - Autumn 2015 interview

THE DIGITAL

CLINIC ENVIRONMENT AND ASTHENOPIA

The incidence of asthenopia is steadily increasing. The main culprit is the increasingly varied and intensive use of digital displays. This dual trend, however, is far from being a foregone conclusion. The observations and ideas for preventive solutions presented below were expressed during an interview with Dr. Marcus Safady, an ophthalmologist practicing in Rio de Janeiro and the 2013-14 president of the SBO - Sociedade Brasileira de Oftalmologia (Brazilian ophthalmology society).

Dr. Marcus Safady Points de vue: What are Brazilian ophthalmologists ophthalmologist, chairman of the Sociedade seeing during consultations? Brasileira de Oftalmologia (S.B.O.), Rio de Janeiro, Brazil Dr. Marcus Safady: We are seeing more and more patients suffering from asthenopias in our practice. Nowadays, Marcus Safady graduated in medicine in 1980 from Universidade symptoms such as dry eyes, red eyes, eye strain sen- Federal do Rio de Janeiro. sations, blurred near vision, headache, peri-, intra- or Ophthalmologist with the Associaçao Médica Brasileira in 1984. retro-ocular pain, and glare sensations are extremely Teacher of the ophthalmology specialization course of Sociedade common. The origins of these symptoms may be refractive Brasileira de Oftalmologia. (uncorrected or poorly corrected), accommodative or Head of the glaucoma department of Hospital Federal de muscular, and clinicians must consider their true cause Bonsucesso, Rio de Janeiro. to treat them effectively. Currently chairman of the Sociedade Brasileira de Oftalmologia (S.B.O.).

KEYWORDS Asthenopia, eyestrain, postural fatigue, glare, headache, dry eye, contrast perception, adaptation, comfort, posture, digital displays, ergonomics, e-reading, digital devices, connected life, computer, smartphone, tablet, Essilor® Eyezen™, ophthalmic lenses, protocol, eye examination.

Points de Vue - International Review of Ophthalmic Optics 32 Number 72 - Autumn 2015 interview CLINIC

Photographer © João Salamonde / joaosalamonde.com.br

What correlation do you see between asthenopia Does this type of disorder affect some populations and digital displays? more than others?

If the patient is properly corrected and presents no parti- These displays exacerbate existing visual defects and also cular abnormality in binocular vision, asthenopia affect those who do not wear glasses. Studies show that symptoms are generally related to external causes. 60% to 90% of people using digital displays have more Foremost among them is the intensive use of digital or less troublesome symptoms of eye disorders, regardless devices, now ubiquitous in of their visual correction. our daily lives. When we work Ophthalmic consultations in front of a screen our eyes “Asthenopia symptoms are generally reveal this problem in adults, blink less often, resulting in children and adolescents. dryness of the ocular surface. related to external causes correlated In fact, young people, who The effort of accommodation with the ubiquitous use of digital often keep their eyes glued and convergence is also to video games, cell phones more sustained due to the devices in our daily activities.” and computers all day long, increased proximity of even at school, are a particu- multiple displays (e.g. the larly vulnerable population. smartphone and tablet are used at closer distances than the computer). Our eyes make an effort to focus and converge on more or less pixel- lated targets, whose quality and contrast vary, while remaining exposed to high screen brightness levels. The light emitted is characterized by a predominant dazzling white light that peaks in the blue at short wavelengths. An ophthalmic impact is unavoidable.

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 33 interview CLINIC

Photographer © João Salamonde / joaosalamonde.com.br

“Displays exacerbate existing visual defects and also affect those who do not wear glasses.”

What are the most common solutions best practices for the use of digital devices) and the pres- and recommendations? cription of a treatment (i.e. eye drops to relieve ocular dryness) or a preventive solution such as appropriate Patients may not be aware of the causes. When they ophthalmic lenses. consult, they usually come in for a refractive problem. They complain of eyestrain and subjective symptoms. How is treatment for this problem handled in Brazil? Ophthalmologists need to be attentive and play an active role in the fight against this very real scourge. In Brazil, as in the other countries, eye problems related Recommendations are simple: a good visual examination to the ubiquity of digital displays are widespread. Vision (including visual acuity, binocular vision and accommo- care professionals are increasingly aware and a "standard" dation), a refractive correction, ergonomic advice (i.e. protocol is beginning to emerge. It is organized into four

Points de Vue - International Review of Ophthalmic Optics 34 Number 72 - Autumn 2015 interview CLINIC

Photographer © João Salamonde / joaosalamonde.com.br

“Young people, who often keep their eyes glued to video games, cell phones and computers all day long, even at school, are a particularly vulnerable population.” main points and is potentially very beneficial for the What are the desired characteristics for these preventive patient. First point: increasingly frequent consultations lenses? with age, arriving finally at an annual rate (eye check once a year). Second point: ergonomic advice (on posture, They are two in number. The first is the provision of addi- lighting, rest, etc.) to avoid exacerbating the problem. tional refractive power at the bottom part of the lens to Third point: better lubrication of the ocular surface, simply relieve the eye’s accommodative effort. A few fractions of by blinking more frequently or via artificial tear solutions. additional diopter are invaluable when working for hours Finally, the fourth and central point of the prevention in front of a digital display. The second is the presence of plan for asthenopia related to digital device use involves a filter blocking blue light and the glare effect: a selective the prescription of ophthalmic lenses adapted to the anti-reflective treatment reduces screen brightness and specificities and pervasiveness of digital displays. blocks harmful blue light.

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 35 interview CLINIC

Photographer © João Salamonde / joaosalamonde.com.br

“The central point of the prevention plan for asthenopia related to digital device use is the prescription of ophthalmic lenses adapted to the specificities and pervasiveness of digital displays”

The perfect ophthalmic lens must combine both features to fight effectively against asthenopia generated by digital device use. KEY TAKEAWAYS

These characteristics seem to be consistent with the ophthalmic lens offer called Eyezen and designed • Intensive use of digital displays increases the by Essilor research centers? incidence of asthenopia. Absolutely! • The problem affects all age groups and as many people not wearing glasses as those with visual defects. • In Brazil, an easy-to-use four-point protocol is helping to fight effectively against this type of disorder. • Glasses combining additional refractive power in the bottom part of the lens and a blue light filter are the main preventive solution prescribed for asthenopia related to digital device use.

Points de Vue - International Review of Ophthalmic Optics 36 Number 72 - Autumn 2015 Market research institutes and observatories that study socioeconomic impacts are providing invaluable insights into how people use digital devices and how those devices are affecting the health of users around the world. WATCH MARKET MARKET

P.38 How have multiple screens become the new reality worldwide? P.45 Is there a link between the digital environment and myopia?

Points de Vue - International Review of Ophthalmic Optics 37 Number 72 - Autumn 2015 THE WORLD OF MULTIPLE SCREENS: A REALITY THAT IS AFFECTING USERS’ VISION AND POSTURE

Just a few years after their market introduction, digital devices are abundantly present in people’s everyday lives. We now live in a multiple-screen environment and may use up to ten different devices with screens in a single day (laptop, desktop, tablet, console, digital TV, GPS, e-book reader, digital code device, smartphone or smartwatch). Users today want to be connected at all times. However, these new media are affecting their vision and posture. To measure this impact, the Ipsos institute conducted a broad survey on four continents with four thousand people. The results show the growing

MARKET WATCH challenges posed by this new digital reality to public health.

Cross-generational use of digital devices is accelerating Today, digital devices have become an accepted part of everyday life, irrespective of age, social class or geographical area. After years of undisputed reign, the supremacy of television and computers has now been challenged by a massive influx of small screens – smartphones, tablets, e-book readers and game consoles – that have truly revolutionized digital practices. In less than Sophie D’Erceville ten years – the launch of the iPhone barely dates back Research director at Ipsos, Paris, France to late 2007, and the tablet to 2010 –, these new After earning a degree in marketing and communication media devices have emerged as essential everyday tools, (Masters 2) from CELSA, Sophie worked for seven years generating new habits and new needs. in the quantitative research sector. She joined Ipsos in 2011, where she is responsible for numerous studies on SURVEY marketing issues and trends for various sectors, including To measure the impact of the use of these new devices on the optical sector. She has been assisting Essilor for a users’ vision and posture, Ipsos conducted a broad survey number of years with the implementation of international on an international scale in four countries (Brazil, China, surveys aimed at better understanding and anticipating France and the United States), with four thousand people trends in the area of visual health and optics. aged 18 to 65.

KEYWORDS digital screens, posture, ergonomics, e-reading, digital devices, connected life, Internet, new technologies, computer, smartphone, tablet, e-book, e-reader, TV, console, connected lifestyles, blue light, visual fatigue, computer vision syndrome.

Points de Vue - International Review of Ophthalmic Optics 38 Number 72 - Autumn 2015 Among those who use the device:

97% Laptop or Desktop (n=3892) 64% 93%

90% TV (n=3641) 36% 84%

70% Smartphone (n=2730) 29% 95% MARKET WATCH

47% Tablet or e-reader (n=1866) 17% 64%

16% Video game (n=594) 13% 32%

Total Daily use Total use 4h or more a day (heavy users)

Base: Digital device users Question a: On average, how often do you use these digital devices? Question b: How often do you use digital devices per day ?

1 FIG.1 Usage of digital screens

The use of digital screens is now a daily reality for a very New digital uses are causing visual and physical dis- large majority of the population. Young and old alike use comfort them several hours a day, and 29% of smartphone owners The increasingly intensive daily use of digital devices, have their eyes riveted on their phone screens for more particularly small screens – the smartphone is the most than four hours a day. Opportunities for use are varied and frequently used device on a daily basis –, involves a include reading, writing, watching videos, taking photos or certain amount of discomfort, and users are well aware of videos and much more. Fig. 1. this: 89% have felt discomfort or pain in their eyes, which they associate, at least in part, with their use of screens. Multiple-screen use is intensifying But most of the time, their symptoms seem to be tempo- Devices are no longer used just sequentially; they are rary and fairly harmless: they complain of eyestrain (74%), increasingly used simultaneously. Combined, they exact a itchy eyes (50%), dry eyes (46%), rather than report that heavy toll on the eyes at any distance, whether viewed their eyes sting (34%) or hurt (35%). from afar or close-up: for example, 72% of people sur- Their eye symptoms, especially eyestrain (which 51% veyed have watched television while using a smaller describe as moderately or highly bothersome) are consi- screen, such as a smartphone, tablet, e-book reader or dered just as uncomfortable as the bodily pain affecting game console, forcing them to constantly look back and the neck and shoulders (54%) or back (51%) Fig. 3. forth from one screen to the other. 69% have used a com- In addition to these visual and physical symptoms, puter while alternating with a smaller screen(s). 46% of respondents report they have difficulty sleeping, This intensified use is reported by users themselves: 89% including 35% for whom this is a real problem. of them confirm that they seem to spend more time using screens, and 82% say they are watching screens for longer Even though these symptoms cause little or no concern on periods than two years ago. Fig. 2. the part of users of digital devices, several factors should nonetheless alert healthcare professionals, leading them to monitor their development over time:

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 39 Differences in habits with digital screens between now and 2 years ago

You spend more time on digital devices 59% 89% now than 2 years ago

Whenever you use digital devices, you look at digital 44% 82% devices for a longer period of time now than 2 years ago

You read text more often on digital devices now than 2 years ago 40% 76%

You switch more often from one digital device to

MARKET WATCH another now than 2 years ago 39% 76%

You look at digital devices at close distances more often now than 2 years ago 32% 67%

You look at digital devices at closer distances now than 2 years ago 31% 65%

Total Yes (yes a lot more, yes slightly more) Yes, a lot a more Base All Respondents (n=4034) Question a: If you had to compare the way you used digital devices 2 years ago to your actual habits, would you say that…

FIG.2 Intensification of multi-screen use 2

Level of discomfort experienced for each symptoms

TiredTired eyes eyes 51%51% 74%74% NeckNeck and shoulderandTired shoulder eyespain pain 51%54%54% 70%74%70% Neck and shoulder Back Backpain pain 51%54%51% 66%70%66% HeadacheBackHeadache pain 39%51%39% 55%66%55% ItchingHeadacheItching eyes eyes29%39%29% 50%55%50% ItchingDry eyesDry eyes29%31%31% 46%50%46% Far blurredFar blurredDry vision eyes vision 31%32%32% 46%46% Difficulties DifficultiesFar blurred to fall to asleep visionfall asleep 32%35%35% 46%46% Difficulties to Tearyfall asleepTeary eyes eyes25%35%25% 44%46%44% IrritatedTearyIrritated eyes eyes25%25% 41%44%41% CloseClose up blurredIrritated up blurred vision eyes vision25%26%26% 40%41%40% Close up blurredRed vision eyesRed eyes21%26%21% 37%40%37% PainfulRedPainful eyes eyes21%21%35%37%35% BurningPainfulBurning eyes eyes21%20%20%34%35%34% Total Experienced the symptom Total BurningScreenScreen glareeyes glare20%19%19%34%34% Total Experienced the symptom Total ScreenDizziness glareDizziness19%16%16%30%34%30% TotalHigh/Medium High/MediumExperienced level the oflevel discomfortsymptom of discomfort Total High/Medium level of discomfort Base: All Respondents Dizziness 16% 30% Question a: Have you ever experienced these symptoms, even rarely? Question b: How would you evaluate the level of discomfort when you experience these symptoms?

3 3 FIG.3 Body and viual discomfort linked to multiscreen uses (including difficulty falling asleep) 3

Points de Vue - International Review of Ophthalmic Optics 40 Number 72 - Autumn 2015 Solution tried to relieve symptoms

% of success of the solution among those who tried it

Taking a break 68% 86% 79% Changing your posture 47% 78% 60% Looking away times to times from the digital devices 47% 70% 67% Adapting the environment lighting 37% 62% 60% Modifying your work station 36% 62% 58% Changing the lighting of the digital devices 37% 60% 62% MARKET WATCH Using digital devices for a shorter period of time 41% 58% 71%

Using less frequently digital device 37% 53% 70% Wearing dedicated eyewear 26% 40% 65% Changing your food habits or taking food supplements 18% 36% 50% Taking medicines 19% 32% 60%

Total Yes (yes and it worked, yes but it didn’t work) Yes, and it worked

Base: Think the symptoms are caused by the usage of digital devices (n=3463) Question: Have you tried the following solutions to relieve your symptoms linked to the usage of digital devices? 4 FIG.4 Solution tried to relieve symptoms

afar (46%), which may be perceived as getting worse over time (31% for distance vision, and 29% for near vision). - Despite these specific signs, few envisage spending less time viewing screens: over 40% of those surveyed state - There already seems to be a very strong link between that they have simply not considered reducing the length intensity of screen use and the symptoms felt. In other of time or frequency they use their digital devices to relieve terms, the longer and more frequently one uses digital their symptoms, illustrating by this attitude their increa- devices, the more one is affected by ocular or physical singly strong dependence on these everyday objects. Most symptoms. Small screens, especially those found on of the time, users opt for quick, simple solutions, such as smartphones, tablets, or game consoles, seem to cause taking a break, changing position or looking away from the more problems for the eyes, due in particular to difficulty screen from time to time. It is also noteworthy that 60% reading small type: people using these devices heavily have already tried to change the brightness of their screen, (i.e. more than four hours a day) seem to feel that they and that 40% wear dedicated eyewear during screen use. have dry eyes more often than others (62% had already Fig. 4. experienced this symptom, versus 46% for all users) or experience sore eyes more often (46% versus 35%). And Everyone is concerned, particularly young people as the use of digital devices continues to expand, it is Since they use these devices for longer periods and more likely that more and more people will face these symptoms intensively than those over fifty, young people are the in coming years. primary victims of damage related to digital device use, - Moreover, more than half of those reporting one of these even before they become presbyopes, they now seem to symptoms feel that their symptom(s) are worsening over suffer from a greater number of ocular and physical time, and becoming increasingly troublesome. symptoms than their elders. Tired or sore eyes, headaches - Users of digital devices also encounter the problem of and blurred distance vision are felt far more frequently by blurred vision, when viewing them close-up (40%) or from those under forty year of age. These symptoms are also

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 41 “The longer and more frequently one uses digital devices, the more one is affected by ocular

MARKET WATCH or physical symptoms”

accompanied by a greater awareness by those under forty is a topic that comes up regularly in the news without of the link that may exist between the use of screens and provoking much of a reaction from the public (in France, visual discomfort. ANSES published reports in 2009 and 2013, that Everyone is concerned by eye problems, including wearers were widely reported in the press; and a law governing of corrective lenses, and particularly contact lens wearers. public exposure to electromagnetic waves was adopted A significant proportion of non-wearers are also affected: on 29 January 2015). 61% of them have the impression that they must make Similarly, users of digital devices do not yet clearly per- more of an effort to see well when using digital devices ceive (or do not wish to perceive) the possible link between (versus 66% of corrective lens wearers). increased exposure to screens and a potential decline in Finally, countries like Brazil and China, which are expe- their eye health. Regardless of the digital device used, riencing an unprecedented boom in the use of these those surveyed see the screen more as a source of new digital media, are also particularly exposed to this eyestrain than as a potential danger for their eyes. For situation, due to their usage practices: in China, 45% of example, smartphones are considered by 27% as a device smartphone users say they use their phone over four hours that could damage the eyes, while 39% consider instead a day (versus 29% for all countries), and for activities that that it is simply responsible for visual fatigue. Fig. 5. are often more time-consuming than average (i.e. watching a film or a video, reading for long periods, etc.). Currently, sunlight and exposure to UV radiation are still considered the main risk for the eyes. As for blue light and What are the potential risks of digital screen use and what its potential dangers, this remains an elusive concept for solution(s) are available to prevent them? most people: only 47% consider spontaneously that they Even though they are aware of being “addicted” to are familiar with the principle of blue light but, in fact, screen use, people still seem to be insensitive to the risks when it is explained to them, over half realize that they are inherent in prolonged use of digital devices. For example, not familiar with this phenomenon. the danger to the brain of increased exposure to electro- Awareness of the potential dangers of the intensive use magnetic waves, supported by numerous scientific studies, of screens and the cumulative effect over time is more

Points de Vue - International Review of Ophthalmic Optics 42 Number 72 - Autumn 2015 Negative effects linked to screens and other light sources

"Can cause ++“Can damage + TOTAL "HAS my eyes” visual fatigue" NEGATIVE EFFECTS"

At least one source of light quoted 73% 84% 92% Sun, when clear weather 43% 30% 71% A laptop or desktop screen 33% 45% 77% Neon light 32% 31% 62% Video game handheld system screen 31% 38% 67% MARKET WATCH A smartphone screen 27% 39% 65% An halogen lamp 27% 29% 55% A Tablet or e-reader screen 26% 43% 68% A TV screen 24% 45% 67% Sun, when cloudy weather 21% 33% 53% An incandescent light bulb/ LED 21% 33% 54% No answer 27% 16% 8% % Agree

Base: All Respondents (n=4034) Question: There can be many sources of light, which can have various effects on ocular health. For each source of light, please indicate if you think it can be harmful to your eyes or if you think it has little negative effect to your eyes.

FIG.5 Negative effects linked to screens and other light sources

important than ever, particularly among young people, in marketing this new type of eyewear will be to convince who are by far the most intensive users of digital displays. people of its effectiveness and, more importantly, to cre- Healthcare professionals have an important support role ate a desire for it, particularly when we understand that to play in their education. the populations most concerned are those most averse to Faced with these new uses for digital devices, a dedicated wearing glasses on a daily basis (i.e. people under forty eyewear range, designed to relieve the eyes and protect and contact lens wearers, in particular). them would appear to be quite relevant: 77% of those For this reason, an appropriate educational effort must surveyed state that they would consider purchasing be made to really convince the different target groups of this type of eyewear, particularly the most intensive users the tangible benefits of this type of eyewear. In view of the of small digital displays. And those who do not wear visual and physical discomfort reported by those surveyed, corrective lenses should not be ignored, since 65% of an improvement in visual comfort and a decrease in them also state that they are interested. fatigue and headaches are the benefits expected by digital Despite this positive reception in principle, the challenge device users.

“Young people are the primary victims of damage related to digital device use, they now seem to suffer from a greater number of ocular and physical symptoms than their elders”

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 43 “Awareness of the potential dangers of the intensive use of screens and the cumulative effect over time is more important than ever” MARKET WATCH

Conclusion With rapidly changing digital use practices, everyone is or will be concerned by the potential dangers represented by these screens. But increased awareness of the inherent KEY TAKEAWAYS risks is slow to develop; certainly, physical and ocular discomfort are increasingly felt by digital device users in their daily lives, but the long-term effects remain poorly • The increasing use of digital devices is a understood. Healthcare professionals therefore have an important role to play in heightening people’s awareness transgenerational, global reality. and helping them protect themselves, in the face of this • 72% of respondents report that they use a growing public health challenge. • combination of several different screen-based devices. • The use of digital devices causes visual and physical discomfort (including difficulty falling asleep). • Half of respondents consider their visual and physical symptoms bothersome. • Half of respondents are bothered by strong screen brightness. • Two out three people feel that they must make an additional visual effort when using screens. • Three out of four people suffer from visual fatigue • Everyone is affected by this discomfort, particularly young people. • 77% of users report that they are interested in purchasing dedicated eyewear to relieve this discomfort. • Healthcare professionals have an important role to play in raising awareness and providing treatment.

Points de Vue - International Review of Ophthalmic Optics 44 Number 72 - Autumn 2015 WILL “DIGITAL VISION” MEAN A BLURRY FUTURE? MARKET WATCH Research points to the growing use of digital devices. In parallel, myopia is at epidemic levels in countries around the globe. Taking the longer view, this epidemic could have a negative impact on the lives of the myopic people, especially as they age, and will increase the economic burden that poor vision creates on the world around us.

Myopia widespread and growing; links to near vision demanding tasks and small digital screens

It’s been reported that of the approximately 7 billion people in the world, more have access to a mobile phone than a toothbrush.1

Maureen Cavanagh That astonishing statistic speaks to the power and President of the Vision Impact Institute, pervasiveness of digital communication and information. USA Millions of people on this earth can use the technology to text or make a phone call, yet may not have running water In 2014, Maureen Cavanagh accepted the role of president and electricity in their residences. of the Vision Impact Institute. She joined Essilor in 2005 and has held various executive leadership positions within Let’s admit that there is a hypnotic quality to the digital the company. Cavanagh has extensive experience in vision screens that inhabit our lives. Follow someone into an healthcare, having worked for Johnson & Johnson’s Vistakon and Spectacle Lens divisions before joining Essilor. elevator as they are absorbed in what they’re reading on Cavanagh earned her bachelor’s degree from Bridgewater the phone. Stop to watch people on a busy street corner, State University. She is a long-time member of the Optical exiting an office building or on public transportation – it’s Women’s Association and has received numerous industry a safe bet that a large number will have a smartphone or awards of distinction, including the OWA Pleiades Award in other digital device in their hands. 2015 and Jobson’s Most Influential Women in Optical 2012. We are turning more and more of our daily routine over to our digital devices. From getting the news, to paying for coffee, to receiving directions to reminding us of appointments – digital devices have become the personal www. visionimpactinstitute.org assistants for 21st-century lives.

KEYWORDS We are living multi-screen lives and are more productive digital devices, digital screens, digital media, digital vision, because of it. However, have we stopped to consider how connected life, computer, smartphone, tablet, socio- economic impact, myopia, shortsightedness, myopia spending so much time squinting at small screens is epidemics, impaired vision. impacting our vision? Eye health professionals are increa-

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 45 singly worried about “digital vision” and the consequences According to researchers, rates of myopia have doubled, resulting from spending so much time focused on small even tripled, in many eastern Asia countries during the screens. In addition to failing eye sight, there are the past 40 years. Hong Kong, Singapore and Taiwan have related health issues and socio-economic impacts to experienced rate increases hovering around 80 percent. consider. While users aren’t abandoning their digital Professor Kathryn Rose of the University of Technology

MARKET WATCH screens, eye health professionals should be aware how to Sydney and Ian Morgan with the Australian National better advise them to be productive and retain their University mentioned the prevalence of myopia in East healthy vision. Asia as ranging from 82% to 96% depending on age groups and countries.2 Published studies confirm those Myopia increasing in Asia figures: In parallel, we observe a rise of myopia in developed and PERCENTAGE OF YEAR OF THE developing nations worldwide. It’s at epidemic levels. LOCATION AGE GROUP MYOPIA STUDY Eastern Asia, Europe and the United States have all seen 3 a dramatic increase in the number of people who are Seoul 96.5% 19 yo 2010 experiencing shortsightedness. Taiwan 86.1% 18-24 yo 20104 Guangzhou, China 84.1% 17 yo 20075 Myopia is an elongation of the eyeball. While not being Singapore 81.6% 17-29 yo 2009-20106 able to see distances can be frustrating, even dangerous when driving, it can be corrected with spectacles, contact lenses and refractive surgery. However, high myopia has Since 1963, Chinese students have participated in a been associated with a higher risk for ocular disorders, daily routine designed to relieve eye fatigue. While seated including retinal detachment and glaucoma. at their desks, they massage the pressure points around their eyes. It doesn’t seem to be working. Rates of myopia have been soaring in Chinese cities, nearing almost 90 percent in places.2

Points de Vue - International Review of Ophthalmic Optics 46 Number 72 - Autumn 2015 MARKET WATCH

Myopia prevalence in Europe In a news release about a King’s College London research European countries have been experiencing the impact of project, Katie Williams from the university’s Department digital vision and myopia as well. The European Eye of Ophthalmology, said, “We knew myopia was becoming Epidemiology (E3) Consortium has done an extensive study more common in certain parts of the world – almost 8 in of meta-data associated with eye health research which 10 young people are affected in urban East Asia – but it estimates that refractive error affects more than half of the is very interesting to find that the same pattern is being continent’s adult population – myopia being the leading seen here in Europe. This has major implications for the type with 227.2 million people based on 2010 population future burden from this eye disease which can threaten estimates. Based on this study, the prevalence of myopia sight in older age, particular in very shortsighted people.” suggests that about 20.1 million Europeans are therefore at higher risk for associated complications such as retinal The same rise in myopia is happening in the United detachment.7 States. The American Academy of Ophthalmology estimates that the current rate of myopia has risen to The E3 study also shows that younger people are more 40 percent from 25 percent in the 1970s.8, 9 affected by myopia than their parents. According to the study, about one-half of younger Europeans are affected. Link between myopia and education After analyzing the data, the study uncovered that overall Another interesting finding in several research studies is levels of myopia have increased about one-third for adults the association between level of education and the inci- born after 1940 as compared to those born before that dence of myopia. The research suggests that the more year. educated the person – regardless of where they live – the more likely they are to suffer from shortsightedness.

“Eye health professionals are increasingly worried about “digital vision” and the consequences resulting from spending so much time focused on small screens”

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 47 MARKET WATCH

This is significant because it points to lifestyle factors as having a role in the rise of myopia. no study has shown a direct link, it has been shown that when using handheld video games, children adopt a The E3 analysis of studies, which looks at more than closer working distance which in turn may favor Myopia 60,000 people, shows that the rate of myopia is about onset and progression.7 Indeed, near work behavior twice as much higher in people with college degrees com- appears to be highly linked to myopia prevalence. pared to those whose education stopped with primary Epidemiological studies showed that higher amount school.9 of near work results in a high prevalence of myopia in children.10,11,12 One of the studies included in the E3 analysis was what is known as the Gutenberg Health Study from the University The digital vision “antidote” Medical Center in Mainz, Germany. By examining 4,685 This rapid rise in myopia is alarming, especially as it people ranging in age from 35-74 without cataracts or affects younger people the most. Are we raising a global refractive surgery, the results show that myopia increases generation that will suffer from poor vision throughout as education increases.9 their lives?

LEVEL OF EDUCATION PREVALENCE OF MYOPIA There is research that indicates that sunshine can be an No high school or other training 24 percent antidote to digital vision. An Australian research project High school or vocational school graduates 35 percent from 2003-2005 shows that time spent outdoors in University graduates 53 percent natural light significantly affected the presence of myopia in children.13 Longer time of outdoor activity, such as The question is then natural: Is there a link between myo- sports and leisure activities, were associated with more pia development and the use of digital devices? Although hyperopic refractions and lower myopia rates in the 12-year-old students studied. Those who combined longer time of near work with shorter time of outdoor activity

“In addition to failing eye sight, there are the related health issues and socio-economic impacts to consider”

Points de Vue - International Review of Ophthalmic Optics 48 Number 72 - Autumn 2015 “With the increased use of digital devices and rising rates of myopia, an annual exam is the best way for parents to have poor vision diagnosed – and then corrected as needed – in their children.”

had the least hyperopic mean refraction, while the prevent the eyeball from elongating, thus preventing from students who combined low levels of near work with high myopia. These wavelengths are also protective to vision levels of outdoor activity had the most hyperopic mean and other health functions. And the cumulative effect of

refraction. The lowest odds for myopia were found in the damaging wavelengths of blue-violet light (the bad MARKET WATCH groups reporting the highest levels of outdoor activity. blue) has been linked to retinal cell death, and possibly to AMD. The sources such as artificial light (cold LED), Chinese schools are testing various methods to improve computer screens and handheld devices are rich in harm- that country’s myopia epidemic. Some schools are experi- ful blue-violet light and may source potential risks. menting with transparent classrooms – the walls and ceilings are constructed of see-through material to allow In addition to good old-fashioned outdoor playtime for for as much light as possible – to determine if that helps children, the importance of an annual eye examination by improve the students’ eyesight. a trained vision professional can’t be over emphasized. With the increased use of digital devices and rising rates Other schools are forcing children to be outside more of myopia, an annual exam is the best way for parents to during the day and away from near vision demanding tasks have poor vision diagnosed – and then corrected as including small digital screens. Students are sent outside needed – in their children. during lunch and recess with the doors locked to keep them there.14 Promising research Promising researches from specialized centers in Australia The role of sunlight in our eye health is not completely and China do offer hope. The Vision Cooperative Research understood as of yet. A theory suggests that the healthy Center (Vision CRC) is a partnership between the Brien wavelengths on the blue light spectrum from the sun (the Holden Vision Institute at the University of New South good blue) releases dopamine in the retina which would Wales and the University of Houston College of Optometry.

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 49 “Let’s not give up the digital devices, but let’s be sure to take care of users’ eye health while advising both an annual comprehensive eye examination and frequent breaks from MARKET WATCH “digital vision” to take in a longer view.”

It has announced a new technology that slows the pro- The laboratory works on three different approaches. The gression of myopia in children. Vision CRC has been first is to gain a clearer understanding of the mechanisms conducting large-scale clinical trials in Australia and that cause children to develop myopia. The second focus China designed to control in participating children the for research relates to the predictability of myopia, and position of the central and peripheral retinal image points. more particularly involves a study conducted with a group Therefore, corrective lenses can be made to control of 1,000 children from urban and rural environments. myopic progression by changing the retinal image position Lastly, the laboratory is working to identify new ways of at the periphery without affecting the image at the center controlling the development of myopia through a clinical of the retina. Professor Brien Holden (1942 - 2015) has trial involving 210 children. been quoted saying, “What we need are treatments that effectively slow the progress of myopia which will “Ultimately, the new knowledge gained will enable us to significantly reduce the prevalence of high myopia. make our products more effective in terms of slowing the A reduction in the rate of myopia of 33% could produce development of myopia with offerings that are suitable for a 73% reduction in myopia above 5.00 D.”15 all children and are attractively designed, as well as enabling the development of innovative solutions to coun- To strengthen research on myopia, Essilor International ter the myopia pandemic,” summarizes Dr. Björn Drobe. and the Wenzhou Medical University in China, opened in 2013 a joint research laboratory: the Wenzhou Medical Socio-economic impact of myopia University-Essilor International Research Center (WEIRC). Impaired vision is the most common disability in the world, affecting 4.3 billion around the globe.16 The good “What makes it all the more important is that the link news is that 80 percent of those impairments can be between the severity of myopia and the risk of associated avoided or cured. However, that much vision impairment conditions is exponential. Slowing the development of comes with a price tag. myopia by only 50% reduces the risk of conditions that can lead to blindness (retinopathy, retinal detachment, While the global direct socio-economic impact of myopia etc.) by a factor of 10,” explains Dr. Björn Drobe, Essilor hasn’t been determined yet, the effect of poor vision on Group Researcher and Associate Director of WEIRC. the global economy is well documented. A 2012 review by the Boston Consulting Group and Essilor found that:17

• Approximately 33 percent of the world’s working population has uncorrected vision problems that result in a $272 billion loss of productivity to businesses globally.

Points de Vue - International Review of Ophthalmic Optics 50 Number 72 - Autumn 2015 MARKET WATCH

• Poor vision slows the education of school-aged children, increasingly rely on them to connect with friends, get resulting in academic under-achievement and risk of our news, make financial transactions, and simply make reduced adult literacy. In fact, 30% of children worldwide our lives easier and more productive. As a planet, we need vision correction and don’t have it. spend 3 billion hours a week playing video games.10 • Impaired vision is associated with 60 percent of driving That means that we will spend more time in “digital accidents around the world. vision” mode - fixated on small glowing screens using our • Globally, poor eyesight multiplies by seven the risk of eyes for near vision more often. falls and hip fractures in the elderly. There will be consequences. The National Medical Research Council of Singapore Yes, the majority of myopia cases can be corrected with commissioned a study on the economic cost of myopia. In spectacles, contact lenses or refractive surgery. And the 2009, the mean annual direct cost of myopia for school- research centers such as Vision CRC and WEIRC, as well aged children in Singapore was $148 (U.S. dollars), with as the technology development, give us hope for a better- the median cost at $83.33 (U.S. dollars) per student.18 seeing future. However, with so many young people It also showed that the cost of refractive surgery equaled dealing with shortsightedness, as they age the cost and the cost of buying and wearing contact lenses for 10 years. impact of poor vision is likely to increase from such things Beyond the cost for children, with a myopia rate of 39% as loss of productivity,21,22 motor vehicle accidents, falls, in adults over 40, a 2013 study estimates the total cost of and social isolation. Add to that the significant increased myopia for this population to be approximately SGD$959 risk people with high myopia have for related vision (USD$755) million per year in Singapore.19 diseases.

What it means for the future Let’s not give up the digital devices, but let’s be sure to Research has indicated that myopia is rapidly rising in take care of users’ eye health while advising both an East Asia, Europe and the United States, especially among annual comprehensive eye examination and frequent younger people. And research points to factors other than breaks from “digital vision” to take in a longer view. • genetics, such as behavior and environment, as causing this epidemic. Is the common denominator among these the time spent using digital devices at near? The global use of these devices is only going to grow as we

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 51 KEY TAKEAWAYS

• An epidemic of myopia is circling the globe, with Eastern Asia, Europe and the United States seeing rising rates of shortsightedness, especially in young people. • Research shows that there is a link between education level and myopia rates – those with more MARKET WATCH education are more likely to be myopic. • Corresponding to the increase of myopia is also an increase in near vision demanding tasks including the use of small digital devices as people rely on them more not only to communicate, but also to access news, information and entertainment. • “Digital vision” will likely have a socio-economic impact on the world, especially as young people with myopia grow older.

REFERENCES 1. “More Mobile Phone Access than Toothbrushes, says Google,” Mobile Marketing Magazine, Oct. 1, 2012 2. “The simple free solution to Asia’s myopia epidemic,” CNN, April 6, 2015 (Professor Kathryn Rose, University of Technology Sydney, and Ian Morgan, Australian National University) 3. Jung SK, Lee JH, Kakizaki H, Jee D., Prevalence of myopia and its association with body stature and educational level in 19-year-old male conscripts in seoul, South Korea. Invest Ophthalmol Vis Sci. 2012 Aug 15;53(9):5579-83. 4. Lee YY, Lo CT, Sheu SJ, Lin JL. What factors are associated with myopia in young adults? A survey study in Taiwan military conscripts. Invest Ophthalmol Vis Sci 2013;54:1026Y33. 5. Xiang F, He M, Zeng Y, Mai J, Rose KA, Morgan IG. Increases in the prevalence of reduced visual acuity and myopia in Chinese children in Guangzhouover the past 20 years. Eye (Lond). 2013 Dec;27(12):1353-8. 6. Koh V, Yang A, Saw SM, Chan YH, Lin ST, Tan MM, Tey F, Nah G, Ikram MK. Differences in prevalence of refractive errors in young Asian males in Singapore between 1996-1997 and 2009-2010. Ophthalmic Epidemiol. 2014 Aug;21(4):247-55. 7. Williams KM, Verhoeven VJ, Cumberland P, et al. Prevalence of refractive error in Europe: the European Eye Epidemiology (E3) Consortium. Eur J Epidemiol. 2015 Apr;30(4):305-15. 8. Vitale S, Sperduto RD, Ferris FL 3rd. Increased prevalence of myopia in the United States between 1971-1972 and 1999-2004. Arch Ophthalmol. 2009 Dec;127(12):1632-9. 9. Williams KM, Bertelsen G, Cumberland P, et al. Increasing Prevalence of Myopia in Europe and the Impact of Education. Ophthalmology. 2015 Jul;122(7):1489-97. 10. Bao J, Drobe B, Wang Y, et al. Influence of Near Tasks on Posture in Myopic Chinese Schoolchildren. Optom Vis Sci. 2015 Jun 26. [Epub ahead of print]. 11. Saw SM, Wu HM, Seet B, et al. Academic achievement, close up work parameters, and myopia in Singapore military conscripts. Br J Ophthalmol. 2001 Jul;85(7):855-60. 12. Saw SM, Hong RZ, Zhang MZ, et al. Nearwork activity and myopia in rural and urban schoolchildren in China. J Pediatr Ophthalmol Strabismus. 2001 May-Jun;38(3):149-55. 13. Rose KA, Morgan IG, Ip J, et al. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology. 2008 Aug;115(8):1279-85.. 14. By Madison Park, “The simple free solution to Asia’s myopia epidemic”, CNN, April 6, 2015 15. Brien Holden Vision Institute, Predicted reduction in high myopia for various degrees of myopia control. BCLA: 2012. 16. Vision Impact Institute, “Discover the Impact of Vision Impairment,” http://visionimpactinstitute.org/ wp-content/uploads/2015/03/VII_leaflet_14117-pages.pdf 17. “The Social and Economic Impact of Poor Vision,” Boston Consulting Group and Essilor, May 2012, https:// vii-production.s3.amazonaws.com/uploads/research_article/pdf/51356f5ddd57fa3f6b000001/ VisionImpactInstitute-WhitePaper-Nov12.pdf 18. Lim MC, Gazzard G, Sim EL, et al. Direct cost of myopia in Singapore. Eye (Lond). 2009 May;23(5):1086-9. https://visionimpactinstitute.org/research/direct-costs-of-myopia-in-singapore/ 19. Zheng YF, Pan CW, Chay J, et al. The Economic Cost of Myopia in Adults Aged Over 40 Years in Singapore. Invest Ophthalmol Vis Sci. 2013 Nov 13;54(12):7532-7 20. http://www.ted.com/conversations/44/we_spend_3_billion_hours_a_wee.html 21. Daum KM, Clore KA, Simms SS, et al. Productivity associated with visual status of computer users. Optometry. 2004 Jan;75(1):33-47. 22. https://visionimpactinstitute.org/research/real-world-workplace-return-on-investment-of-a-computer-specific- vision-intervention-benefit-for-presbyopes/

Points de Vue - International Review of Ophthalmic Optics 52 Number 72 - Autumn 2015 Vision care professionals already offer numerous preventive solutions for users of digital displays. Recent technological innovations in the field of ophthalmic lenses provide a host of new benefits for both those who wear eyeglasses and those who don’t.

P.54 What are the latest innovations for PRODUCT people with eyeglasses and those without, using digital devices? P.68 Is it possible to live a zen lifestyle while staying connected? A study measuring the performance of the Eyezen® lens offer brings proofs.

Points de Vue - International Review of Ophthalmic Optics 53 Number 72 - Autumn 2015 NEW OPHTHALMIC LENSES FOR A CONNECTED LIFE: EYEZEN™ FOR AMETROPES AND EMMETROPES, AND VARILUX® DIGITIME™*

PRODUCT FOR PRESBYOPES

The advent of digital technology has not only changed methods of communication and information management, but also the visual and postural-motor habits of users. To respond to these emerging needs, the ophthalmic industry has taken the path of innovation in the area of physical chemistry and optical design. This article presents a twofold technological breakthrough, which gave rise to a new category of ophthalmic lenses for a connected life. Designed by Essilor, a world leader in ophthalmic optics, these lenses are dedicated to users of all types of digital devices.

Céline Benoît Marie Jarrousse R&D Optics, Essilor international, France. Global Marketing, Essilor International, France.

Céline, holds a French engineering degree from Ecole Marie holds a French engineering degree from Chimie Centrale Marseille and Paul Cézanne University in Paris Tech and a Masters in marketing from Essec Marseille (where she obtained her Master in Optics and Business School. She joined Essilor International in Photonics). In 2010 she defended her thesis in optics in the Global Marketing team in 2011. Marie is in charge collaboration with Essilor International and Charles Fabry of projects targeted at lens wearers with specific laboratory. After working one year as a research engineer needs, such as pre and emerging presbyopes. She at ONERA (a French aerospace research center), she develops innovative marketing offers, such as the new definitively joined Essilor International’s R&D Optics ophthalmic lenses aimed at users of digital devices. department in 2011. Céline develops designs to meet the emerging needs of wearers.

KEYWORDS EyezenTM, Varilux® DigitimeTM, mid-distance lenses, Crizal® Prevencia®, power distribution technology, light filtering technology , blue light, blue-violet light, blue-turquoise light, UV, AMD, LED, ametropia, emmetropia, presbyopia, pre-presbyopia, digital screens, posture, digital devices, connected life, eyestrain, photobiology. * Product availability date may vary depending on the country

Points de Vue - International Review of Ophthalmic Optics 54 Number 72 - Autumn 2015 PRODUCT “The use of these devices creates new visual and postural behaviours and modifies our light environment”

he last ten years were marked by the emergence of Specific needs digital devices, such as smartphones and tablets. Indeed, the use of these devices creates new visual and T Already indispensable to our daily lives, they are rev- postural behaviours and modifies our light environment. olutionizing the way we communicate, learn, stay Ten years ago, there was only one reading distance: the informed, work, entertain ourselves and relax. With an distance at which we held a book or newspaper. On paper, average of four different devices (computer, smartphone, characters have always been fixed in size and highly tablet and TV), we tend to switch between them more contrasted. Today, in addition to reading books, we also frequently and at times even use them simultaneously read on smartphones, tablets and computers at different (Fig. 1). The time spent using these devices has increased distances (some of them quite short) and in various significantly and continues to grow: indeed, nine out of postures, as a study undertaken by the Essilor R&D has ten people state that they spend more time using them shown (page 22). On screens, characters are becoming today than they did two years ago. Our daily lives have smaller and more pixelated. been turned upside down by this digital revolution, but everything has also changed for our eyes.

FIG. 1 Various usage of digital devices

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 55 “Essilor designed EyezenTM,

PRODUCT a new category of lenses for a connected life”

Furthermore, our light environment has changed. A complete range designed for connected life Ten years ago, our eyes were exposed to natural light or To meet these new visual needs, Essilor designed a new artificial light emitted by incandescent lamps. Now, our category of lenses for a connected life. This all-new range eyes are constantly exposed to the bright light of screens of ophthalmic lenses provides a correction for each read- and other light sources, such as LED or CFL bulbs, ing distance required by digital devices, relaxes users’ which strongly emit of diffusing and potentially harmful eyes and protects them against the potential dangers of blue-violet light. blue-violet light:

As a result, our eyes must focus more intensely and more • Advanced single-vision lenses combined with Crizal® often to adjust to the varying distances of use and to small Prevencia® coating, called EyezenTM, for young adults pixelated characters found on screens. This not only (aged 20-34), pre-presbyopes (aged 35-44) and emerg- causes eyestrain, but also postural aches and pain. In fact, ing presbyopes (aged 45-50), available for all a study1 conducted in 2014 by the Ipsos institute on four prescriptions, and even for emmetropes, thousand people in France, the United States, Brazil and • Mid-distance lenses combined with Crizal® Prevencia® China revealed that: coating Essilor® DigitimeTM, for presbyopes (aged 45 and over), specifically designed for digital devices use. • Two out of three people feel that they must make an additional effort in front of screens to see well, EyezenTM lenses are meant to replace standard single- • Three out of four people suffer from eyestrain, vision lenses for wear by ametropic patients, but are also • 70% complain of neck and shoulders pain intended for occasional wear by emmetropes during their • Over one out of two people are bothered by the strong on-screen activities. brightness of their screens. There are three different products optimized for three Lastly, the harmful blue-violet light emitted by screens user profiles depending on their age (Fig. 2): can contribute to premature aging of the eyes. • For young adults (aged 20-34): Eyezen™ 0.4 • For pre-presbyopes (aged 35-44): Eyezen™ 0.6 This study showed that all users of digital devices – regard- • For emerging presbyopes (aged 45-50): Eyezen™ 0.85 less of their age, the type of device used and the frequency of use, feel the same discomfort, related to the difficulty of reading small characters and screen brightness. However, the level of discomfort varies depending on the user’s age. In fact, for younger users, the main discomfort is screen brightness, while for older users, it is the effort required to decipher the small characters.

Points de Vue - International Review of Ophthalmic Optics 56 Number 72 - Autumn 2015 NEW EYEZEN™ LENSES RANGE: DESIGNED FOR A CONNECTED LIFE.

YOUR PATIENTS SPEND A LOT OF TIME LOOKING AT SCREENS.

Smartphones, tablets, computers and TV are now an indispensable part of their lives, to socialize, inform, learn, educate, work, play, relax and see the world. 64%Ê

4 DIFFERENT DIGITAL DEVICES ARE 2 OUT OF 3 PEOPLE DAILY USE A OF PEOPLE SPEND 4 HOURS OR MORE USED ON AVERAGE FOR WORK, SMARTPHONE. ON A COMPUTER PER DAY. EDUCATION AND LEISURE*.

* Consumer quantitative study conducted in 2014 among 4000 individuals in France, Brazil, China and the US by Ipsos for Essilor.

EVEN WHEN PEOPLE RELAX IN FRONT OF SCREENS, THEIR EYES NEVER STOP WORKING.

TODAY’S CONNECTED LIFE GENERATES NEW OPTICAL NEEDS

Due to their new multi-screen lives, wearers’ environments and behavior have changed:

Eyes have to focus more intensively and repeatedly to adjust to close and variable distances with frequent switching between devices and increasingly smaller and pixelated characters displayed by screens.

Eyes have to endure screen glare and are exposed to harmful Blue-Violet light.

ESSILOR RESEARCH: PATIENT DIAGNOSIS

Essilor’s R&D study shows the impact of digital devices vs. traditional paper use: different postures, higher eye declination when using tablet or smartphone, new distances of use.

DISTANCE AND POSTURE

ED D D ED

NEWSPAPER SMARTPHONE

33ÊcmÊonÊaverage

95% of people use a smartphone between 23 and 43 cm. This creates the need to take into account a new viewing zone: ultra near vision.

Consumer research over 4000 individuals aged between 20 and 65 years old in France, Brazil, China, and the US* reveals that: 70 %Ê

2 OUT OF 3 PEOPLE FEEL THAT DIGITAL 3 OUT OF 4 PEOPLE SUFFER FROM OF PEOPLE COMPLAIN ABOUT NECK SCREENS REQUIRE ADDITIONAL EFFORT TIRED EYES. AND SHOULDER PAIN. TO SEE WELL.

3 MAIN PROFILES OF DIGITAL USERS IDENTIFIED

YOUNG ADULTS PRE-PRESBYOPES PRESBYOPES 20 - 34 years old 35 - 44 years old 45 - 65 years old

HEAVY E-SWITCHERS INTENSIVE E-WORKERS ACTIVE E-ADOPTERS Digital natives, they frequently Mobile devices like laptops, More sedentary than the other use several digital devices smartphones and tablets are profiles, they use even more simultaneously and like to stay their #1 working tools and they traditional desktop computers connected in real time with use them before, during and and TV. They increase their their peers. after working hours. digital usage every day. _ EFFORTS MADE TO READ SMALL CHARACTERS +

+ EYES BOTHERED BY SCREEN BRIGHTNESS _ They experience the same main discomforts but at different levels.

WHAT IF YOU COULD ALLEVIATE YOUR PATIENTS’ DISCOMFORT?

ESSILOR INNOVATES AND INTRODUCES

A COMPLETE RANGE OF NEW DIGITAL LENSES DESIGNED FOR A CONNECTED LIFE.

RELAX YOUR PATIENTS’ EYES FROM THEIR CONNECTED LIVES TODAY WHILE PROTECTING THEIR VISION HEALTH FOR TOMORROW

TWO TECHNOLOGIES INSIDE

LightÊScanªÊtechnology: PROTECTS AGAINST HARMFUL BLUE-VIOLET LIGHT

EyezenªÊFocusÊtechnology: SUPPORTS EYE FOCUS EFFORTS

AN EXCLUSIVE POWER DISTRIBUTION TECHNOLOGY

With a specific extra power for each consumer profile in the specially designed bottom part of the lenses.

BENEFITS FOR WEARERS

VISUAL FATIGUE REDUCTION EVEN FOR PROLONGED USE OF A SMARTPHONE. BETTER READABILITY OF SMALL CHARACTERS. NATURAL POSTURE FOR PRESBYOPES IN FRONT OF SMARTPHONES.

A UNIQUE LIGHT FILTERING TECHNOLOGY

From Crizal® Prevencia™, filtering selectively bothersome and harmful blue-violet light emitted in particular by screens, but letting essential light pass through.

BENEFITS FOR WEARERS

GLARE REDUCTION. CONTRAST IMPROVEMENT. CONTRIBUTING TO PREVENT PREMATURE AGING OF THE EYES.

EYEZEN: 1 RANGE, 2 FAMILIES PRODUCT THE NEW SINGLE VISION LENSES AS PRIMARY PAIR FOR AMETROPES OR IN PLANO FOR EMMETROPES. WITH 3 OPTIMIZATIONS DEPENDING ON PROFILES:

EMERGING PRESBYOPES YOUNG ADULTS PRE-PRESBYOPES Without near vision correction 20 - 34 years old 35 - 44 years old 45 - 50 years old

EYEZENEYEZENTM 0.40.4 EYEZENEYEZENTMTM 0.6 0.60.4 EYEZENEYEZENTM 0.80.85

STANDARD CORRECTION STANDARD CORRECTION STANDARD CORRECTION

WITH +0.4D WITH +0.6D WITH +0.8D+0.85D TO RELAX EYES OF TO RELAX EYES OF TO RELAX EYES OF 20-34 YO FROM 35-44 YO FROM 45-50 YO FROM DIGITAL STRESS DIGITAL STRESS DIGITAL STRESS

PROTECTION FROM UV & HARMFUL BLUE-VIOLET LIGHT EMITTED BY SCREENS. REDUCED SCREEN GLARE & IMPROVED CONTRASTS.

THANKS TO CRIZAL® PREVENCIA™ THANKS TO CRIZAL® PREVENCIA®

FIG. 2 Eyezen TM lens range for 20- to 50-year-olds,Eyezen segmented™ focus by age relieves (advanced single-visionpatients lenses with combined digital with usage:Crizal® Prevencia® coating)

Natural eye focus decreasing with age is mostly sufficient to see clearly at near distances but digital usage requires stronger eye focus efforts.

The extra powers of Eyezen Focus are distributed in the bottom zone of the Essilor® Eyezen™ lens and calculated to support eye focus efforts when using digital devices according to physiological needs of each age group:

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com FOR 20-34 YEARS OLD: +0.4D FOR 35-44 YEARS OLD: +0.6D FOR 45-50 YEARS OLD: +0.85DNumber 72 - Autumn 2015 57

THE NEW MULTI-FOCAL LENSES AS OCCASIONAL PAIR FOR PRESBYOPES' DIGITAL ACTIVITIES. WITH 3 OPTIMIZATIONS DEPENDING ON PRESBYOPES PROFILES:

PRESBYOPES With near vision correction 45 - 65 years old

KEEN ON KEEN ON KEEN ON SMARTPHONES COMPUTERS LARGE SCREENS & TABLETS

NEAR MID ROOM

EXTENDED VISION

INTERMEDIATE VISION

NEAR VISION

RELAXED RELAXED RELAXED VISION FOR VISION FOR VISION FOR NEW SMARTPHONE SMARTPHONE SMARTPHONE ULTRA NEAR VISION

PROTECTION FROM UV & HARMFUL BLUE-VIOLET LIGHT EMITTED BY SCREENS. REDUCED SCREEN GLARE & IMPROVED CONTRASTS.

THANKS TO CRIZAL® PREVENCIA™

Eyezen™ focus relieves presbyopes with smartphone usage:

Near vision correction is needed due to insufficient natural eye focus. A smartphone nearer than 40 cm (standard near vision correction distance) creates a strong stress on eyes or is seen blurred.

ULTRA-N S

EAR DISTANCE VISION DISCOMFORT FOR PRESBYOPIC DIGITAL DEVICE USER Ultra-near distance visionUltra-near comfort distance with Varilux vision Eyezen discomfort lenses for presbyopic digital device users WITH STANDARD NEAR VISION CORRECTION AT 40CM With EyezenUltra-near Focus With distance standard vision near visioncomfort correction with Varilux at 40 Eyezencm lenses 45 yo 45 yo With Eyezen Focus 45 yo Age Age � ��

Age � ��

With Eyezen Focus With 60 yo 60 yo Eyezen Focus 60 yo 33 33 10 cm 20 cm 30 cm 40 cm 10 cm 20 cm 30 cm33 40 cm 10 cm 20 cm 30 cm 40 cm Comfortable eye focus Comfortable eye focus Uncomfortable eye focus Comfortable eye focus Uncomfortable eye focus Uncomfortable eye focus ULTRA-NEARUltra-near DISTANCE distance VISION vision COMFORT comfort WITH with VARILUX Varilux Eyezen EYEZEN lenses LENSES WITH WithEYEZEN Eyezen FOCUS Focus 45 yo

Age � ��

With Eyezen Focus 60 yo 33 10 cm 20 cm 30 cm 40 cm

Comfortable eye focus Uncomfortable eye focus The extra power of Eyezen™ Focus is calculated and distributed in the very bottom part of Varilux® Eyezen™ lenses below near vision to support eye focus efforts needed for smartphone usage.

ESSILOR ALSO INNOVATES ON PERSONALIZATION

Because each person has their own average distance from computer screens.

63ÊcmÊonÊaverage

But 95% of people use it between 38 and 88 cm

A brand new personalization parameter exclusive to Varilux Eyezen lenses is now available:

SCREENÊDISTANCE DISTANCE BETWEEN YOUR PATIENT AND THE COMPUTER SCREEN

Screen distance personalization allows for individualized intermediate vision thanks to fully personalized inset and degression.

BENEFITS FOR WEARERS

MAXIMUM COMFORT. NATURAL POSTURE IN FRONT OF A COMPUTER.

TECHNICAL INFORMATION

RANGE AVAILABILITY

ESSILOR®

Materials Spheres Materials Spheres

1.5 +6D; -10D 1.5 +6D; -10D

1.56 +6D; -10D 1.56 +6D; -10D 1.59 +6D; -10D 1.59 +6D; -10D 1.6 +8D; -12D 1.6 +8D; -12D 1.67 +9D; -14D

1.74 +13D; -20D 1.67 +9D; -14D

Up to cylinder 6D Up to cylinder 6D Addition from 0.75D to 3.50D Transitions® VII available Transitions® VII available soon Personalization options: - Azio, India Personalization options: - Fit - Plus: Screen distance + PDs - Fit + - - Fit (incl. screen distance) - Fit (incl. screen distance) +

ORDERING

ESSILOR® lenses are ordered with Far Vision prescription lenses are ordered with far vision + addition like every single vision lens. prescription like progressive lenses.

CONTROLLING

ESSILOR® lenses have to be controlled at far vision point. lenses have to be controlled at near vision point.

FITTING are trademarks of Essilor International. Frames: LAFONT - FACE A FACE. Images: Getty Images Shutterstock. Concept: HEREZIE. ™ ESSILOR®

The fitting cross of the lens has to be aligned with the pupil center when looking far away. Focus and Light Scan ™ , Eyezen ™ , Eyezen ®

There is no minimum fitting height. The minimum fitting height is 18 mm to ensure sufficient Eyezen Focus benefit. © Essilor International – January 2015 Varilux

www.essilor.com

YOUR PATIENTS SPEND A LOT OF TIME LOOKING AT SCREENS.

Smartphones, tablets, computers and TV are now an indispensable part of their lives, to socialize, inform, learn, educate, work, play, relax and see the world. 64%Ê

4 DIFFERENT DIGITAL DEVICES ARE 2 OUT OF 3 PEOPLE DAILY USE A OF PEOPLE SPEND 4 HOURS OR MORE USED ON AVERAGE FOR WORK, SMARTPHONE. ON A COMPUTER PER DAY. EDUCATION AND LEISURE*.

* Consumer quantitative study conducted in 2014 among 4000 individuals in France, Brazil, China and the US by Ipsos for Essilor.

EVEN WHEN PEOPLE RELAX IN FRONT OF SCREENS, THEIR EYES NEVER STOP WORKING.

TODAY’S CONNECTED LIFE GENERATES NEW OPTICAL NEEDS

Due to their new multi-screen lives, wearers’ environments and behavior have changed:

Eyes have to endure screen glare and are exposed to harmful Blue-Violet light.

ESSILOR RESEARCH: PATIENT DIAGNOSIS

Essilor’s R&D study shows the impact of digital devices vs. traditional paper use: different postures, higher eye declination when using tablet or smartphone, new distances of use.

DISTANCE AND POSTURE

ED D D ED

NEWSPAPER SMARTPHONE

33ÊcmÊonÊaverage

95% of people use a smartphone between 23 and 43 cm. This creates the need to take into account a new viewing zone: ultra near vision.

Consumer research over 4000 individuals aged between 20 and 65 years old in France, Brazil, China, and the US* reveals that: 70 %Ê

2 OUT OF 3 PEOPLE FEEL THAT DIGITAL 3 OUT OF 4 PEOPLE SUFFER FROM OF PEOPLE COMPLAIN ABOUT NECK SCREENS REQUIRE ADDITIONAL EFFORT TIRED EYES. AND SHOULDER PAIN. TO SEE WELL.

3 MAIN PROFILES OF DIGITAL USERS IDENTIFIED

YOUNG ADULTS PRE-PRESBYOPES PRESBYOPES 20 - 34 years old 35 - 44 years old 45 - 65 years old

+ EYES BOTHERED BY SCREEN BRIGHTNESS _ They experience the same main discomforts but at different levels.

WHAT IF YOU COULD ALLEVIATE YOUR PATIENTS’ DISCOMFORT?

ESSILOR INNOVATES AND INTRODUCES

A COMPLETE RANGE OF NEW DIGITAL LENSES DESIGNED FOR A CONNECTED LIFE.

RELAX YOUR PATIENTS’ EYES FROM THEIR CONNECTED LIVES TODAY WHILE PROTECTING THEIR VISION HEALTH FOR TOMORROW

TWO TECHNOLOGIES INSIDE

LightÊScanªÊtechnology: PROTECTS AGAINST HARMFUL BLUE-VIOLET LIGHT

EyezenªÊFocusÊtechnology: SUPPORTS EYE FOCUS EFFORTS

AN EXCLUSIVE POWER DISTRIBUTION TECHNOLOGY

With a specific extra power for each consumer profile in the specially designed bottom part of the lenses.

BENEFITS FOR WEARERS

VISUAL FATIGUE REDUCTION EVEN FOR PROLONGED USE OF A SMARTPHONE. BETTER READABILITY OF SMALL CHARACTERS. NATURAL POSTURE FOR PRESBYOPES IN FRONT OF SMARTPHONES.

A UNIQUE LIGHT FILTERING TECHNOLOGY

From Crizal® Prevencia™, filtering selectively bothersome and harmful blue-violet light emitted in particular by screens, but letting essential light pass through.

BENEFITS FOR WEARERS

GLARE REDUCTION. CONTRAST IMPROVEMENT. CONTRIBUTING TO PREVENT PREMATURE AGING OF THE EYES.

EYEZEN: 1 RANGE, 2 FAMILIES

THE NEW SINGLE VISION LENSES AS PRIMARY PAIR FOR AMETROPES OR IN PLANO FOR EMMETROPES. WITH 3 OPTIMIZATIONS DEPENDING ON PROFILES:

EMERGING PRESBYOPES YOUNG ADULTS PRE-PRESBYOPES Without near vision correction 20 - 34 years old 35 - 44 years old 45 - 50 years old

EYEZEN 0.4 EYEZEN 0.6 EYEZEN 0.8

STANDARD CORRECTION STANDARD CORRECTION STANDARD CORRECTION

WITH +0.4D WITH +0.6D WITH +0.8D TO RELAX EYES OF TO RELAX EYES OF TO RELAX EYES OF 20-34 YO FROM 35-44 YO FROM 45-50 YO FROM DIGITAL STRESS DIGITAL STRESS DIGITAL STRESS

PROTECTION FROM UV & HARMFUL BLUE-VIOLET LIGHT EMITTED BY SCREENS. REDUCED SCREEN GLARE & IMPROVED CONTRASTS.

THANKS TO CRIZAL® PREVENCIA™

Eyezen™ focus relieves patients with digital usage:

Natural eye focus decreasing with age is mostly sufficient to see clearly at near distances but digital usage requires stronger eye focus efforts.

FOR 20-34 YEARS OLD: +0.4D FOR 35-44 YEARS OLD: +0.6D FOR 45-50 YEARS OLD: +0.85D

THE NEW MULTI-FOCAL LENSES AS OCCASIONAL PAIR FOR PRESBYOPES' DIGITAL ACTIVITIES. WITH 3 OPTIMIZATIONS DEPENDING ON PRESBYOPES PROFILES:

PRESBYOPES With near vision correction 45 - 65 years old

KEEN ON KEEN ON KEEN ON SMARTPHONES COMPUTERS LARGE SCREENS & TABLETS PRODUCT NEAR MID ROOM

EXTENDED VISION

INTERMEDIATE VISION

NEAR VISION

RELAXED RELAXED RELAXED VISION FOR VISION FOR VISION FOR NEW SMARTPHONE SMARTPHONE SMARTPHONE ULTRA NEAR VISION

PROTECTION FROM UV & HARMFUL BLUE-VIOLET LIGHT EMITTED BY SCREENS. REDUCED SCREEN GLARE & IMPROVED CONTRASTS.

® ™ THANKSTHANKS TO TO CRIZAL CRIZAL® PREVENCIA PREVENCIA®

FIG. 3 The Varilux® DigitimeTM mid-distance lens range for presbyopes aged 45 and over, segmented according to digital device use ™ (occupational lenses, for occasionalEyezen wear focus during on-screen relieves activities presbyopes or other activities withrequiring smartphone near or intermediate visionusage: correction, combined with Crizal® Prevencia® coating) Near vision correction is needed due to insufficient natural eye focus. A smartphone nearer than 40 cm (standard near vision correction distance) creates a strong stress on eyes or is seen blurred. Points de Vue - International Review of Ophthalmic Optics 58 Number 72 - Autumn 2015

ULTRA-N S

Age � ��

With Eyezen Focus 60 yo 33 10 cm 20 cm 30 cm 40 cm

ESSILOR ALSO INNOVATES ON PERSONALIZATION

Because each person has their own average distance from computer screens.

63ÊcmÊonÊaverage

But 95% of people use it between 38 and 88 cm

A brand new personalization parameter exclusive to Varilux Eyezen lenses is now available:

SCREENÊDISTANCE DISTANCE BETWEEN YOUR PATIENT AND THE COMPUTER SCREEN

Screen distance personalization allows for individualized intermediate vision thanks to fully personalized inset and degression.

BENEFITS FOR WEARERS

MAXIMUM COMFORT. NATURAL POSTURE IN FRONT OF A COMPUTER.

TECHNICAL INFORMATION

RANGE AVAILABILITY

ESSILOR®

Materials Spheres Materials Spheres

1.5 +6D; -10D 1.5 +6D; -10D

1.56 +6D; -10D 1.56 +6D; -10D 1.59 +6D; -10D 1.59 +6D; -10D 1.6 +8D; -12D 1.6 +8D; -12D 1.67 +9D; -14D

1.74 +13D; -20D 1.67 +9D; -14D

ORDERING

ESSILOR® lenses are ordered with Far Vision prescription lenses are ordered with far vision + addition like every single vision lens. prescription like progressive lenses.

CONTROLLING

ESSILOR® lenses have to be controlled at far vision point. lenses have to be controlled at near vision point.

FITTING are trademarks of Essilor International. Frames: LAFONT - FACE A FACE. Images: Getty Images Shutterstock. Concept: HEREZIE. ™ ESSILOR®

The fitting cross of the lens has to be aligned with the pupil center when looking far away. Focus and Light Scan ™ , Eyezen ™ , Eyezen ®

There is no minimum fitting height. The minimum fitting height is 18 mm to ensure sufficient Eyezen Focus benefit. © Essilor International – January 2015 Varilux

www.essilor.com

Essilor International is the world leader in the design, manufacture and customization of ophthalmic lenses. Active on ﬁve continents, Essilor offers a wide range of lenses under the ﬂagship Varilux®, Crizal®, Optifog®, Xperio® and Essilor® brands to correct myopia, hyperopia, presbyopia and astigmatism. In addition to providing perfect correction for ametropia, EyezenTM lenses also provide the necessary accommodative support to relieve eyes from stress while using digital devices, which differs depending on age. On top of

that, they protect eyes from the harmful light emitted by PRODUCT screens, reduce glare and improve contrast thanks to their Crizal® Prevencia® coating. Finally, Varilux® DigitimeTM Room mid-distance lenses are Lastly, the mid-distance lenses are intended for occa- optimized for large screens use with wider extended vision sional wear by presbyopes during their on-screen activities fields (delimited by room size) and offer intermediate or during any other activity requiring near or intermediate vision and near vision fields suitable for computer, smart- vision correction. phone or tablet use respectively. The minimum guaranteed depth of field is 220 cm, regardless of the prescription. There are three different products optimized for three different categories of presbyopes, depending on the Response to emerging needs in the design of this new device they use most frequently (Fig. 3): range of lenses for a connected life To respond to the emerging needs of wearers, Essilor • For presbyopes keen on smartphones and tablets: brings its expertise in two areas: first, in optical lens Varilux® DigitimeTM Near design, to provide a perfectly suited correction, and • For presbyopes keen on computers: Varilux® DigitimeTM secondly, in the area of protective lens coatings, to protect Mid the eyes against the potential dangers of the blue-violet • For presbyopes keen on large screens (TV or video light emitted by screens. The range originated with a projectors): Varilux® DigitimeTM Room twofold technological breakthrough.

Varilux® DigitimeTM Near mid-distance lenses are optimized A unique technology of power distribution for smartphone or tablet use with wide near vision fields, Essilor R&D conducted a study on the emerging visual and but they also provide an intermediate vision field suitable postural behaviors engendered by the use of digital for computer use. The minimum guaranteed depth of field devices. The study revealed that the average reading is 80 cm, regardless of the prescription. distance is nearer on these devices than when reading on traditional paper media (33 cm for smartphones and Varilux® DigitimeTM Mid mid-distance lenses are optimized 39 cm for tablets versus 40 cm for paper). Researchers for computer use with wide intermediate vision fields, also noted an average increase in the eye declination angle while also providing a near vision field suitable for while reading on a smartphone (25° for smartphones smartphone or tablet use. The minimum guaranteed depth versus 18° for a reading task on paper). These data of field is 100 cm, regardless of the prescription. (Fig. 4) reveal the need for a new Ultra-Near Vision field.

FIG. 4 Comparison of reading distances (D, D’) and eye declination angles (Ed, Ed’) between a paper medium (newspaper) and a digital screen (smartphone)

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 59 8

de (in Dio pter s) 5

PRODUCT 4 amp li tu

3 dat ion +0.4D

mm o 2 +0.6D acc o

ve 1

ect i +0.85D

Ob j 0 20 30 40 50 60 70 80 Wearer’s age (in years)

FIG. 5 Change in the amplitude of objective accommodation as a function of age

A unique power distribution technology was designed to This technology creates an additional field of vision: respond to emerging needs. This technology distributes the Ultra-Near Vision zone, which provides additional the power over the lens, including additional power in the power. This zone, located under the near-vision zone, bottom part of the lens to support the eye’s accommo- allows users to lower than gaze more than when they are dation effort when using digital devices, according to the reading on paper media. This additional power allows physiological needs of each identified group of wearers. users to use their device at closer distances.

It is important to point out that this additional power The additional power provided by the lens reflects users’ respects the physiological functioning of the visual specific characteristics, as well as their prescriptions and system, without inhibiting the accommodative function the widths of the fields of view of the target product. of the wearer’s eyes. So the additional power will not exceed 0.50D depending on the chosen lens and prescription. How is this technology managed on Eyezen™ lenses? The additional power values selected are related both to Finally, the near-vision zone is not impacted by the addi- the fact that the objective amplitude of accommodation tional power. The eye health practitioner’s prescription is decreases with age2 (Fig. 5), and that accommodative therefore always respected. power drops after sustained and prolonged near-vision work3. For example, a drop in accommodative power of Since using a smartphone at a distance of less than 40 cm 0.4D was observed after 20 minutes of near-vision work (Fig. 6) is likely to generate a substantial degree of dis- for a traditional reading task3. For this reason, the addi- comfort and difficulty in focusing (i.e. blurred vision), tional refractive power provided is 0.4D for the 20-34 age the additional power under the near-vision zone provides group, 0.6D for the 35-44 age group, and 0.85D for the support for accommodative effort, giving the wearer’s 45-50 age group. vision more clarity.

How is this technology implemented on Varilux® DigitimeTM What are the benefits of this technology for the wearer? mid-distance lenses for presbyopes? The additional power helps to reduce visual fatigue for the Most near-vision exams are performed at a distance of 40 wearer, even during prolonged smartphone use. It also cm for reading tasks. This data is taken into account in the improves the readability of small characters. Finally, it design of the new ophthalmic lenses for presbyopes con- allows presbyopes to adopt a more natural posture when nected life, so that wearers can effortlessly find their using their smartphone. near-vision zone while reading. However, when using their smartphone, they bring it closer and naturally lower their Ergonomics of visual field positioning on Varilux® gaze. At that point, their eyes encounter the additional DigitimeTM mid-distance lenses for presbyopes power under the near-vision zone, thus relieving accommodative excess. Positioning of visual zones on mid-distance Varilux® DigitimeTM lenses. The ultra-near, near, intermediate and

Points de Vue - International Review of Ophthalmic Optics 60 Number 72 - Autumn 2015 Ultra-near distance vision discomfort for presbyopic digital device user PRODUCT

Ultra-near distance vision comfort with Varilux® DigitimeTM mid-distance lenses

Additional power in the lower part of mid-distance lenses located under the near vision zone

FIG. 6 Benefits of the Ultra-Near Vision zone provided by additional power. Smartphone use without additional power (above). With additional power (below).

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 61 Height (mm) Power Meridian

Intermediate vision for the computer PRODUCT

4 Power (D)

-8 Near vision Regression

Ultra near vision -20

Height (mm) Power Meridian

Extended vision for TV 14

Intermediate vision 4 for the computer Power (D)

Near vision -8 Regression

Ultra near vision -20

FIG. 7 Schematic diagram of the (meridian) power profile for Near and Varilux® DigitimeTM Mid mid-distance lenses (above) and Varilux® DigitimeTM Room mid-distance lenses (below)

extended visual zones are positioned optimally – in view of is a variation in power known as degression (Fig. 7). design constraints (fields of view width, prescription, min- This helps to ensure a given minimum depth of field imal guaranteed depth of field, etc.) natural gaze lowering (Fig. 3). The value of this degression is set according of the wearer and average use distances for each specific to the prescribed addition value, the desired minimum digital device (Fig. 6). With the exception of the ultra-near guaranteed depth of field and the wearer’s subjective vision zone, which includes a progressive zone followed by accommodation. an area of stable power, all zones are stable in power, therefore improving wearer comfort. Customization of intermediate vision on Varilux® DigitimeTM mid-distance lenses The positioning of these zones is customized to the pre- The average distance of use for a computer is 63 cm, but scription to follow the wearer’s natural convergence and a wide variation has been observed: 95% of people use a provide good binocular vision. In this regard, the zones are computer at distances between 38 and 88 cm. It is there- properly positioned in the lens, vertically and horizontally, fore recommended to customize intermediate vision for to minimize visual fatigue for the wearer. each individual. To customize intermediate vision, Essilor has taken into Characteristics of the intermediate vision zone. Between account a new parameter known as “Screen Distance”, the near vision zone and the intermediate vision zone, which corresponds to the distance between the eye and or extended vision zone depending on the case, there the computer screen. When calculating the lens, this

Points de Vue - International Review of Ophthalmic Optics 62 Number 72 - Autumn 2015 Customization for a MAX distance to screen

Height (mm) Power Meridian

Extended vision for TV 14

B PRODUCT Intermediate vision 4 for the computer Power (D)

Near vision -8 Regression

Ultra near vision -20

Customization for a MIN distance to screen

Height (mm) Power Meridian

Extended vision for TV 14 B’ < B

Intermediate vision 4 for the computer Power (D)

Near vision -8 Regression

Ultra near vision -20

FIG. 8 Principle of degression of the intermediate vision field customized relatively to the “Screen Distance” parameter for Varilux® DigitimeTM Room mid-distance lenses and a given fixed degression. The left-hand image represents the power variation along the meridian sectional view, and the right-hand image the location of the meridian on the lens seen from the front. For the same prescription and two different ”Screen Distance”, the lateral position of the near vision zone remains unchanged, but the lateral position of the intermediate vision zone for the computer is customized.

parameter is used to customize the degression and the The benefits provided by this parameter are a natural horizontal positioning of the intermediate vision zone posture in front of the computer and maximum comfort relatively to the near vision zone. for intermediate vision use. Taking the “Screen Distance” into account does not change the vertical position of the intermediate vision New light environment zone in the lens. The length of the degression is therefore In addition to the optical design of lenses, it is essential fixed. A general illustration of customized degression to define an appropriate treatment for new light environ- as a function of “Screen Distance” is given in Fig. 8 for ments and for the spectral characteristics of the light Varilux® DigitimeTM Room mid-distance lenses. emitted by screens.

The default “Screen Distance” value is set to 63 cm The role of light is essential, but can also be harmful at which is the average distance of use for a computer (in times the event that the optician do not indicate this parameter Visible light plays a crucial role in our everyday lives. It is when the order is placed). It may range between 35 and essential, in particular, for the perception of colours, 99 cm (as a reminder, 95% of people use their computer at a distance ranging between 38 and 88 cm).

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 63 PRODUCT

contrast and for visual acuity. Besides vision, certain Protection provided by Crizal® Prevencia® frequencies of the visible light spectrum are even more Photobiological studies demonstrated an average 25% important for our health. For example, blue-turquoise reduction in cell death by apoptosis comparatively light, around 480 nm (465-495 nm) is known as “good between Crizal® Prevencia® lenses and exposure without blue” light because it is responsible for synchronizing a filter over the spectral range [400 nm ; 450 nm]. Fig. our circadian rhythms (our biological clock) in charge 10 illustrates the comparative levels of apoptosis between of regulating our waking and sleep cycles, as well as our the naked eye (grey) and a Crizal® Prevencia® lens for body temperature and mood4, among other things. each blue light bandwidth. This level of protection over the long term would mitigate the risk related to harmful Chronic exposure to light also presents some risks for our blue light, and therefore the onset of AMD. visual health. Blue light is the highest energetic light to reach the retina, since ultraviolet radiation (UV), which is Blue-violet light is everywhere even higher in frequency, is blocked by the anterior ocular Today, our eyes are confronted with potential new media. There is a rich literature on the harmful effects of dangers, both at home and at work. Several independent blue light on the retina, the first articles dating back over studies conducted by health agencies are now taking an forty years. But it was only recently that the precise interest in risks related to new sources of artificial light, spectrum of toxic action of this light on a cellular model such as light emitting diodes (LEDs)6, since the latter, of AMD was demonstrated. particularly cool white LEDs, present an emission peak in the harmful blue-violet band (Fig. 11) and have a more Identification by Essilor and the Paris Vision Institute elevated luminance/brightness than traditional sources. of the toxicity of blue light on the retina Yet, LEDs are now present in most modern lighting Joint research conducted by the Paris Vision Institute systems and in a large number of screens, especially (see inset) and Essilor International led to the identifi- computer, tablet and smartphone screens. cation of the most dangerous part of the blue light spectrum for retinal cells involved in the development A unique light filtering technologyand wearer benefits of AMD5. The light inducing the highest mortality rate Concerned about the amount of time we spend in front of in retinal cells corresponds to a narrow band of 40 nm screens, Essilor has made protection one of its priorities centred on 435 nm5. These wavelengths correspond to the for its new range of lenses designed for a connected life. blue-violet light bordering on the blue-turquoise light To protect our eyes, Crizal® Prevencia® coating, the pro- that is essential to our health (Fig. 9). The research was duct of a unique light filtering technology, was therefore conducted on retinal pigment epithelium (RPE) cells, the integrated into the entire range. first cells to degenerate in AMD. These cells were photosensitized, to form a model of aging and AMD, and exposed This technology selectively filters out harmful blue-violet to narrow 10-nm bands of illumination in the blue-green light, emitted especially by screens, while allowing spectral range, between 390 nm and 520 nm, under beneficial light (including blue-turquoise light necessary physiological conditions of solar radiation on the retina to the proper regulation of circadian rhythms) to pass (with a control band centred on red at 630 nm). through. This technology also provides the best protection against reflected light, smudges, scratches, dust and water for optimal vision and lasting transparency.

Points de Vue - International Review of Ophthalmic Optics 64 Number 72 - Autumn 2015 PRODUCT

FIG. 9 Visible and ultraviolet light spectrum

• For Varilux® DigitimeTM Near, Mid and Room mid- distance lenses, the distance vision prescription and addition is required: the prescriber does not need to worry about selecting the design.

“For the prescriber, the new lens As for the optician, Essilor can provide a “Screen Distance” range stands out for its simplicity measurement tool for in-store use so that the customer can also enjoy the benefits of a customized version of of implementation” mid-distance lenses. All that the optician need do, when placing the order, is indicating the “Screen Distance” value obtained via this measurement tool in addition to the customer’s prescription.

The benefits of Eyezen™ lenses and mid-distance lenses combined with Crizal® Prevencia® coating have been con- Naked eye firmed by numerous tests. When evaluated under actual Crizal® Prevencia® conditions of use, 89% of wearers reported that they experienced reduced glare and better contrast during screen use. In addition, in vitro tests have shown that blocking 20% of blue-violet light would reduce the rate of retinal cell (RPE) death by apoptosis by 25%7. This should contribute to longer-term health benefits, and particularly to the prevention of premature aging of the eyes.

Recommendations concerning the mode of prescription For the prescriber, the new lens range stands out for its simplicity of implementation. We have made no changes to the prescriber’s usual practices. He or she conducts the eye exam to obtain the prescription in the usual manner. FIG. 10 Comparative results between a lens with Crizal® Prevencia® coating and the naked • For Eyezen 0.4, 0.6, 0.85 lenses, the only prescription eye on cell death by apoptosis of photosensitized RPE cells, exposed for 18 hours required is for distance vision: the prescriber does not in vitro to sunlight normalized for a 40-year-old human eye. need to worry about selecting additional power.

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 65 Daylight Incandescent Fluorescent PRODUCT

wavelength ( nm) wavelength ( nm) wavelength ( nm)

Halogen Cool white LED Fluorescent Light Bulbs

wavelength ( nm) wavelength ( nm) wavelength ( nm)

FIG. 11 Emission spectrum of various light sources including LEDs

Conclusion Institut de la Vision de Paris - is linked to Pierre & Marie Curie University, the Paris Vision Institute is By continually placing end users at the heart of its inno- considered one of Europe’s foremost integrated research vation process, Essilor closely studied how new digital centres of excellence on eye diseases and vision. 200 researchers and medical doctors and 15 industry devices and their use are impacting vision and posture, players work together for the discovery and clinical thus making it possible to identify and characterize new evidence of new therapeutic approaches and preventive visual needs. solutions, as well as innovative compensatory technologies for vision impairments. www.institut-vision.org This in-depth understanding of the users of digital devices led to a combination of two cutting-edge technologies of power distribution and light filtering. This patented technology alliance (several patent applications have been filed and are currently under consideration), the basis of both Eyezen™ lenses for ametropes and emmetropes and of Varilux® DigitimeTM mid-distance lenses for presbyopes, is a perfect fit with our new connected lifestyles.

These new lenses underwent performance testing under actual conditions of use and prescription before they were placed on the market. This approach was adopted to confirm their benefits and measure wearer satisfaction. •

Points de Vue - International Review of Ophthalmic Optics 66 Number 72 - Autumn 2015 NEW EYEZEN™ LENSES RANGE: DESIGNED FOR A CONNECTED LIFE.

YOUR PATIENTS SPEND A LOT OF TIME LOOKING AT SCREENS.

Smartphones, tablets, computers and TV are now an indispensable part of their lives, to socialize, inform, learn, educate, work, play, relax and see the world. PRODUCT 64%Ê

4 DIFFERENT DIGITAL DEVICES ARE 2 OUT OF 3 PEOPLE DAILY USE A OF PEOPLE SPEND 4 HOURS OR MORE USED ON AVERAGE FOR WORK, SMARTPHONE. ON A COMPUTER PER DAY. EDUCATION AND LEISURE*.

* Consumer quantitative study conducted in 2014 among 4000 individuals in France, Brazil, China and the US by Ipsos for Essilor.

EVEN WHEN PEOPLE RELAX IN FRONT OF SCREENS, THEIR EYES NEVER STOP WORKING.

TODAY’S CONNECTED LIFE GENERATES NEW OPTICAL NEEDS

Due to their new multi-screen lives, wearers’ environments and behavior have changed: KEY TAKEAWAYS

• Connected life has changed our light environment and visual and postural behaviours. • Essilor internal and external research centers have achieved a detailed comprehension of these needs. • The new range of lenses for a connected life is the result of this research and was designed to respond Eyes have to focus more intensively and repeatedly to adjust to close and variable distances with frequent switching between devices and increasinglyto these smallernew needs. and pixelated characters REFERENCES displayed by screens.• It is available in several products to specifically 1. Ipsos, Digital devices users: behaviours and needs, May 2014. Quantitative consumer survey conducted in France, United States, China, Brazil, 4 000 respondents. meet each user’s needs. 2. Anderson H. A., Hentz G., Glasser A., Stuebing K.K, Manny R.E., “Minus lens stimulated accommodative amplitude decreases sigmoidally with age: a study of objectively measured accommodative amplitude from age 3”. Investigative Ophthalmology and Visual Science, 2008, Vol. 49, N°7, pp 2919-2926. • They are suitable for all users starting at age 20. 3. Chi and Lin, A comparison of seven visual fatigue assessment techniques in three data acquisition tasks. Human Factors, 1988, 40 (4), 577-590 • The range was tested and approved by wearers 4. Gronfier C., Lumière et fonctions non-visuelles : la bonne lumière bleue et la chronobiologie, Points de Vue, International Review of Ophthalmic Optics, N68, Spring 2013. before it was placed on the market. 5. Arnault E., Barrau C. et al. Phototoxic action spectrum on a retinal pigment epithelium model of Age-Related Macular Degeneration exposed to sunlight normalized conditions. PlosOne, 2013; 8(8) 6. Martinsons Ch ., Les diodes électroluminescentes et le risque de la lumière bleue, Points de Vue, International Review of Ophthalmic Optics, N68, printemps 2013. 7. Barrau C., Kudla A., Lazuka-Nicoulaud E., Le Covec C., Crizal® Prevencia™: The first preventive non-tinted daily wear glasses to protect from UV and harmful blue light, Point de Vue, International Review of Ophthalmic Optics, N69, Fall 2013.

Eyes have to endure screen glare and are exposed to harmful Blue-Violet light. Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 67

ESSILOR RESEARCH: PATIENT DIAGNOSIS

Essilor’s R&D study shows the impact of digital devices vs. traditional paper use: different postures, higher eye declination when using tablet or smartphone, new distances of use.

DISTANCE AND POSTURE

ED D D ED

NEWSPAPER SMARTPHONE

33ÊcmÊonÊaverage

95% of people use a smartphone between 23 and 43 cm. This creates the need to take into account a new viewing zone: ultra near vision.

Consumer research over 4000 individuals aged between 20 and 65 years old in France, Brazil, China, and the US* reveals that: 70 %Ê

2 OUT OF 3 PEOPLE FEEL THAT DIGITAL 3 OUT OF 4 PEOPLE SUFFER FROM OF PEOPLE COMPLAIN ABOUT NECK SCREENS REQUIRE ADDITIONAL EFFORT TIRED EYES. AND SHOULDER PAIN. TO SEE WELL.

3 MAIN PROFILES OF DIGITAL USERS IDENTIFIED

YOUNG ADULTS PRE-PRESBYOPES PRESBYOPES 20 - 34 years old 35 - 44 years old 45 - 65 years old

+ EYES BOTHERED BY SCREEN BRIGHTNESS _ They experience the same main discomforts but at different levels.

WHAT IF YOU COULD ALLEVIATE YOUR PATIENTS’ DISCOMFORT?

ESSILOR INNOVATES AND INTRODUCES

A COMPLETE RANGE OF NEW DIGITAL LENSES DESIGNED FOR A CONNECTED LIFE.

RELAX YOUR PATIENTS’ EYES FROM THEIR CONNECTED LIVES TODAY WHILE PROTECTING THEIR VISION HEALTH FOR TOMORROW

TWO TECHNOLOGIES INSIDE

LightÊScanªÊtechnology: PROTECTS AGAINST HARMFUL BLUE-VIOLET LIGHT

EyezenªÊFocusÊtechnology: SUPPORTS EYE FOCUS EFFORTS

AN EXCLUSIVE POWER DISTRIBUTION TECHNOLOGY

With a specific extra power for each consumer profile in the specially designed bottom part of the lenses.

BENEFITS FOR WEARERS

VISUAL FATIGUE REDUCTION EVEN FOR PROLONGED USE OF A SMARTPHONE. BETTER READABILITY OF SMALL CHARACTERS. NATURAL POSTURE FOR PRESBYOPES IN FRONT OF SMARTPHONES.

A UNIQUE LIGHT FILTERING TECHNOLOGY

From Crizal® Prevencia™, filtering selectively bothersome and harmful blue-violet light emitted in particular by screens, but letting essential light pass through.

BENEFITS FOR WEARERS

GLARE REDUCTION. CONTRAST IMPROVEMENT. CONTRIBUTING TO PREVENT PREMATURE AGING OF THE EYES.

EYEZEN: 1 RANGE, 2 FAMILIES

ESSILOR® THE NEW SINGLE VISION LENSES AS PRIMARY PAIR FOR AMETROPES OR IN PLANO FOR EMMETROPES. WITH 3 OPTIMIZATIONS DEPENDING ON PROFILES:

EMERGING PRESBYOPES YOUNG ADULTS PRE-PRESBYOPES Without near vision correction 20 - 34 years old 35 - 44 years old 45 - 50 years old

ESSILOR EYEZEN ESSILOR EYEZEN ESSILOR EYEZEN INITIAL 0.4 ACTIVE 0.6 ACTIVE+ 0.85

STANDARD CORRECTION STANDARD CORRECTION STANDARD CORRECTION

WITH +0.4D WITH +0.6D WITH +0.85D TO RELAX EYES OF TO RELAX EYES OF TO RELAX EYES OF 20-34 YO FROM 35-44 YO FROM 45-50 YO FROM DIGITAL STRESS DIGITAL STRESS DIGITAL STRESS

PROTECTION FROM UV & HARMFUL BLUE-VIOLET LIGHT EMITTED BY SCREENS. REDUCED SCREEN GLARE & IMPROVED CONTRASTS.

THANKS TO CRIZAL® PREVENCIA™

Eyezen™ focus relieves patients with digital usage:

Natural eye focus decreasing with age is mostly sufficient to see clearly at near distances but digital usage requires stronger eye focus efforts.

FOR 20-34 YEARS OLD: +0.4D FOR 35-44 YEARS OLD: +0.6D FOR 45-50 YEARS OLD: +0.85D

THE NEW MULTI-FOCAL LENSES AS OCCASIONAL PAIR FOR PRESBYOPES' DIGITAL ACTIVITIES. WITH 3 OPTIMIZATIONS DEPENDING ON PRESBYOPES PROFILES:

PRESBYOPES With near vision correction 45 - 65 years old

KEEN ON KEEN ON KEEN ON SMARTPHONES COMPUTERS LARGE SCREENS & TABLETS

VARILUX EYEZEN VARILUX EYEZEN VARILUX EYEZEN NEAR MID ROOM

EXTENDED VISION

INTERMEDIATE VISION

NEAR VISION

RELAXED RELAXED RELAXED NEW VISION FOR VISION FOR VISION FOR ULTRA NEAR VISION SMARTPHONE SMARTPHONE SMARTPHONE

PROTECTION FROM UV & HARMFUL BLUE-VIOLET LIGHT EMITTED BY SCREENS. REDUCED SCREEN GLARE & IMPROVED CONTRASTS.

THANKS TO CRIZAL® PREVENCIA™

Eyezen™ focus relieves presbyopes with smartphone usage:

Near vision correction is needed due to insufficient natural eye focus. A smartphone nearer than 40 cm (standard near vision correction distance) creates a strong stress on eyes or is seen blurred.

ULTRA-NEAR DISTANCE VISION DISCOMFORT FOR PRESBYOPIC DIGITAL DEVICE USERS Ultra-near distance visionUltra-near comfort distance with Varilux vision Eyezen discomfort lenses for presbyopic digital device users WITH STANDARD NEAR VISION CORRECTION AT 40CM With EyezenUltra-near Focus With distance standard vision near visioncomfort correction with Varilux at 40 Eyezencm lenses 45 yo 45 yo With Eyezen Focus 45 yo Age Age � ��

Age � ��

With Eyezen Focus 60 yo 33 10 cm 20 cm 30 cm 40 cm

ESSILOR ALSO INNOVATES ON PERSONALIZATION

Because each person has their own average distance from computer screens.

63ÊcmÊonÊaverage

But 95% of people use it between 38 and 88 cm

A brand new personalization parameter exclusive to Varilux Eyezen lenses is now available:

SCREENÊDISTANCE DISTANCE BETWEEN YOUR PATIENT AND THE COMPUTER SCREEN

Screen distance personalization allows for individualized intermediate vision thanks to fully personalized inset and degression.

BENEFITS FOR WEARERS

MAXIMUM COMFORT. NATURAL POSTURE IN FRONT OF A COMPUTER.

TECHNICAL INFORMATION

RANGE AVAILABILITY

ESSILOR®

Materials Spheres Materials Spheres

1.5 +6D; -10D 1.5 +6D; -10D

1.56 +6D; -10D 1.56 +6D; -10D 1.59 +6D; -10D 1.59 +6D; -10D 1.6 +8D; -12D 1.6 +8D; -12D 1.67 +9D; -14D

1.74 +13D; -20D 1.67 +9D; -14D

ORDERING

ESSILOR® lenses are ordered with Far Vision prescription lenses are ordered with far vision + addition like every single vision lens. prescription like progressive lenses.

CONTROLLING

ESSILOR® lenses have to be controlled at far vision point. lenses have to be controlled at near vision point.

FITTING are trademarks of Essilor International. Frames: LAFONT - FACE A FACE. Images: Getty Images Shutterstock. Concept: HEREZIE. ™ ESSILOR®

The fitting cross of the lens has to be aligned with the pupil center when looking far away. Focus and Light Scan ™ , Eyezen ™ , Eyezen ®

There is no minimum fitting height. The minimum fitting height is 18 mm to ensure sufficient Eyezen Focus benefit. © Essilor International – January 2015 Varilux

www.essilor.com

PRODUCT PERCEIVED BY WEARERS DURING SCREEN USE?

With recent technological advances, ophthalmic lenses can now offer more than just good everyday vision. They are also aiming to meet emerging needs arising from connected life. Innovations are put to the test by specialized research institutes to measure user satisfaction and the effects of lenses on postural and visual fatigue during screen use. The new Essilor® Eyezen™ lenses were tested in an independent study before they were placed on the market. This article describes the results obtained with a population of ametropic patients wearing single vision lenses.

Essilor® Eyezen™ lenses were defined according to Essilor’s R&D programme: LiveOptics. This programme includes four major steps for the introduction of a new design. Tests conducted with consumers known as “wearer testing” constitute the fourth part of this programme.

Because the best evidence is provided by the wearer, it was essential that this new class of Eyezen™ lenses be Brieuc de Larrard tested and approved by the final consumer. Consumer & Sensory research Director – Eurosyn, France To ensure the impartiality of this type of test and lend As a product testing specialist, Brieuc de Larrard is credibility to the key role assigned to the wearer in the contributing in large measure to the development of quality process, testing protocols are validated by inde- Eurosyn’s Research department and to the introduction pendent research institutes. The latter, which hold large of sensory testing in numerous business sectors. consumer databases, are in charge of implementing Today, he actively participates in the development questionnaires for the purpose of evaluating the objective and validation of innovative product testing methodologies and subjective performance of Essilor® products. on a national and international scale.

KEYWORDS Eyestrain, postural fatigue, glare, headaches, dry eye, contrast perception, adaptation, comfort, posture, digital screens, ergonomics, e-reading, digital devices, connected life, computer, smartphone, tablet, Essilor® Eyezen™, Crizal® Prevencia®, ophthalmic lenses, wearer test, protocol.

Points de Vue - International Review of Ophthalmic Optics 68 Number 72 - Autumn 2015 “To ensure the impartiality of this type of test and lend PRODUCT credibility to the key role assigned to the wearer in the quality process, testing protocols are validated by independent research institutes.”

INTRODUCTION for their previous pair of glasses, to avoid any bias related To focus attention on the consumer benefits of the new to the new refraction. class of Eyezen™ ophthalmic lenses, Essilor contacted Eurosyn, a French market research institute specializing At the end of the wear period, the consumers evaluated in sensorial analysis. In cooperation with this institute, the performance of the Essilor® Eyezen™ lenses by com- Essilor established a test protocol for the purpose of vali- pleting an online questionnaire. This questionnaire was dating the performance of Essilor® Eyezen™ lenses with a used to quantify wearers’ satisfaction in terms of visual target group of ametropic subjects. comfort during the performance of everyday tasks, and more specifically, during tasks related to the use of digital The purpose of this study was to verify whether or not devices. an effortless transition from standard single-vision lenses to Essilor® Eyezen™ lenses was possible for persons POPULATION with refractive error. More specifically, the goal was to Inclusion criteria were: 1/ Be between 20 and 55 years of determine the perceived benefits of this new range of age. 2/ Be a user of digital devices (for at least 6 hours a lenses during digital device use. day), 3/ Alternate between different screens. 4/ Present symptoms of visual fatigue and/or postural discomfort. 5/ METHODOLOGY Be ametropic and wear standard single vision lenses to The Essilor® Eyezen™ range comprises three new correct distance vision (DV) with or without anti-reflective products: Essilor® Eyezen™ 0.4, Essilor® Eyezen™ 0.6 coating. 6/ Have a prescription less than 1 year old. 7/ and Essilor® Eyezen™ 0.85. These three additional refrac- Have a correction of: -4Anisometropia greater than 1.5 dioptre. 3/ Diabetes, optically centred on the height of the pupil, taking into glaucoma or other eye diseases. Wearers were recruited account the measurement of the pupillary distance for online by Eurosyn. The institute then contacted each far vision. Before beginning the wear period, each of the subject to discuss their availability for appointments: testers answered a quantitative questionnaire to assess the first to select the test frame and take all necessary their general satisfaction and the level of visual fatigue measurements; and the second, to be fitted with the eye- experienced (if any) with their usual eyeglasses (standard glasses to be tested. During this appointment, visual single-vision lenses). Each tester was asked to wear acuity testing for distance vision (Monoyer scale) and near Essilor® Eyezen™ lenses instead of their main pair of vision (Parinaud) was performed. For this wearer test, usual eyeglasses for four weeks. These tests were per- the sample population was divided into three groups, formed “blind”, i.e. the subjects were given no information depending on the wearer’s age: The first group of 25 on the type of lenses being tested, and the prescription wearers, aged 20 to 34, were equipped with Essilor® for these lenses was exactly the same as the prescription

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 69 Figure 1 shows that ametropia distribution is representative of non-presbyopic wearers of single-vision lenses PRODUCT

FIG. 1 Ametropia distribution (right mean sphere)

-2,25 -2,00 -1,75 -1,50 -1,50 -1,00 -0,75 -0,50 -0,25 plano

FIG. 2 Cylinder distribution (right eye cylinder)

Eyezen™ 0.4 lenses; the second group of 31 wearers, aged 35 to 44, were equipped with Essilor® Eyezen™ 0.6 lenses; and the last group of 20 wearers, aged 45 to 55, were equipped with Essilor® Eyezen™ 0.85 lenses. Q. On average, how long did you wear (Figure 1). these new lenses each day?

Cylinder distribution is shown in Figure 2. It indicates a high percentage of low astigmatism values with 75% of the sample having a cylinder of less than 0.5 dioptre.

RESULTS The results concern the entire Essilor® Eyezen™ range, including all three additional refractive powers (0.4, 0.6 and 0.85). They are consolidated over the complete sample. Seventy-six wearers tested the Essilor® Eyezen™ ophthalmic lenses for four weeks.

In this type of test, the first criterion to be verified is adaptation. The wearers reported that adaptation to these new Essilor® Eyezen™ lenses was easy (“fairly easy” to “very All day long from 4 to 8 hours from 2 to 4 hours easy”), and 83% were satisfied, all additional refractive powers combined. As regards rapidity of adaptation, 79% FIG. 3 Daily wear time rated it as rapid (“fairly rapid” to “very rapid”).

The testers wore the Essilor® Eyezen™ lenses on a con- tinuous basis throughout their activities (including during their use of digital devices). In fact, 94% of them wore the

Points de Vue - International Review of Ophthalmic Optics 70 Number 72 - Autumn 2015 Q. With these new glasses, what grade would you put to qualify the following visual discomfort PRODUCT

Difficulty to Stinging eyes/ Glare Headaches Eye strain Dry eyes Itching eyes stare Tearing eyes

FIG. 4 Reduction of visual fatigue symptoms

Essilor® Eyezen™ lenses more than four hours a day and The remainder of the analysis was aimed at identifying the over one out of two testers wore Essilor® Eyezen™ all day benefits perceived by the subjects while wearing Essilor® long (see Figure 3). Eyezen™ lenses.

A first observation was made on visual fatigue symptoms Due to the additional refractive power provided at the and postural pain felt by subjects. All wearers recruited bottom of the lens, they are perfectly suited to wearers for the test previously experienced ocular or postural dis- who make demands on their near vision throughout the comfort during screen use. day, particularly while using digital devices. Figures 6 and 7 highlight the performance of Eyezen™ lenses: At the end of the wear period, all wearers reported that At the end of the day, 90% of wearers state that their eyes they felt less visual and postural discomfort while using are less tired (‘somewhat less tired’ to ‘much less tired’), their digital devices. They stated that this discomfort was in comparison with how they felt with their old eyeglasses less frequent and less intense with the test lenses (Figure (standard single-vision lenses). 4 and 5).

Q. With these new glasses, please grade postural discomfort

with standard SV with Essilor Eyezen

Neck pain Shoulders pain Back pain

FIG. 5 Reduction of postural symptoms

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 71 Q. With these new lenses, does your ability to read small characters seem to be… Q. With these new lenses, are your eyes… PRODUCT

Somewhat less Somewhat more Much less tired Less tired More tired Much more tired tired tired Significantly Better ABB.Somewhat 7 Lesbarkeit better kleinerSomewhat Schriftzeichen worse Worse Significantly worse better FIG. 6 Reduction in feelings of eye fatigue FIG. 7 Readability of small characters

Q: With this new pair of glasses, the glare sensation facing screens is: Q: With this new pair of glasses, contrast perception is:

Significantly lower Lower Somewhat lower Somewhat Stronger Significantly Much better Better Somewhat better Somewhat worse Worse Much worse stronger stronger

FIG. 8 Glare during digital screen use FIG. 9 Improved contrast perception

In addition, 91% of wearers who tested Essilor® Eyezen™ (see Figure 10). 83% of wearers were very satisfied with lenses felt that they had less difficulty reading small cha- the level of on-screen comfort provided by these new racters, particularly during smartphone use (see Figure 7: lenses. On average, 72% of wearers were satisfied with “somewhat better” to ‘significantly better’) their visual comfort using a computer compared to their previous eyeglasses. Moreover, 90% of wearers reported that light from screens caused less glare, as indicated in Figure 8. The final result, at the end of four weeks of testing, indicates that 91% of ametropic wearers were satisfied with It is also noteworthy that 89% of wearers had improved Essilor® Eyezen™ (see Figure 11), with a satisfaction level perception of contrasts with Essilor® Eyezen™ Crizal® ranging from 7-10 on a scale of 10. It is also noteworthy Prevencia®, in comparison with their previous eyeglasses that 78% of wearers reported being very satisfied with the (see Figure 9). new Essilor® Eyezen™ lenses (with a score of 8-10 on a scale of 10). Visual comfort = outcome of benefits This demonstration of performance over the entire Essilor® In addition, the study evaluated visual comfort during the Eyezen™ range was verified for each of the additional use of digital devices, as well as the general satisfaction refractive powers (0.4, 0.6 and 0.85). All three oph- level. thalmic lenses provided an equivalent level of satisfaction for the individual testers, as indicated in Figure 12. Indeed, 91% of wearers reported having comfortable vision during screen use with Essilor® Eyezen™ lenses

Points de Vue - International Review of Ophthalmic Optics 72 Number 72 - Autumn 2015 Visual comfort before and after using Essilor Eyezen lenses (1= Highly uncomfortable to 10= Highly comfortable)

4% 5% 91% from 7 to 10 18% 8% 83% from 8 to 10

29% 25% 0 to 4 5 and 6 7 25% PRODUCT 24% 8 9 10 17% 33% 8% 4% Before With Essilor Eyezen

FIG. 10 Visual comfort while using digital devices

Q: What was your general level of satisfaction with this new pair of lenses? (1= Highly unsatisfactory to 10= Highly satisfactory)

91%

78%

10 9 8 7 5 and 6 0 to 4

FIG. 11 General satisfaction

Q: What was your general level of satisfaction with this new pair of lenses? (1= Highly unsatisfactory to 10= Highly satisfactory)

96% 90% 85%

7 to 10 5 and 6 1 to 4

4% 5% 4% 6% 10% EyezenTM 0,4 EyezenTM 0,6 EyezenTM 0,85

FIG. 12 General satisfaction relative to additional refractive power

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 73 PRODUCT

CONCLUSION Essilor® Eyezen™ lenses were tested and approved by KEYTAKEAWAYS ametropic wearers, who previously wore standard single- vision lenses, with very good results. Indeed, 91% of them were satisfied with the new Essilor® Eyezen™ lenses, ® regardless of their additional refractive power. • Essilor Eyezen™ ophthalmic lenses combined with Crizal® Prevencia® coating were approved during Throughout the testing, we observed that wearers pre- a wearer test conducted by an independent institute. ferred Essilor® Eyezen™ lenses to their previous eyeglasses by a wide margin. They reported that their eyes were less • The results showed a reduction in all symptoms of tired and that they had less difficulty reading small cha- visual and postural fatigue. racters. Finally, during on-screen use, their impression • A reduction in glare and improved contrast were of glare also seemed to have decreased while their perception of contrast increased. demonstrated during the use of digital devices. • 91% of wearers reported having comfortable vision In addition, this new type of lens can completely replace during screen use, and 91% expressed satisfaction a standard single-vision lens, throughout the day for all ® types of activity. In fact, 94% of wearers, all prescriptions with Essilor Eyezen™. combined, wore these new ophthalmic lenses for a mini- • Essilor® Eyezen™ lenses are proving to be an mum of four hours a day. appropriate solution for the emerging constraints In conclusion, Essilor® Eyezen™ lenses, combined with arising from connected life. They are a suitable Crizal® Prevencia® coating, were truly appreciated by replacement for standard single vision lenses. wearers. Today, 93% of them continue to wear their new eyeglasses, and 88% would recommend this new type of ophthalmic lens to their families and friends. •

Points de Vue - International Review of Ophthalmic Optics 74 Number 72 - Autumn 2015 Digital art offers a new way of looking at the world. As digital technology continues to evolve, it has been incorporated into new fields of artistic expression. Photography, sculpture, design, dance, painting... digital art is now being embraced in every discipline. VISION ART AND AND ART

P.76 What creative doors have been opened by digital technology? What new challenges does it pose?

Points de Vue - International Review of Ophthalmic Optics 75 Number 72 - Autumn 2015 DIGITAL ART: A NEW WAY OF LOOKING AT THE WORLD

Diversity of tools and media available, straightforward access and distribution… As digital technologies continue to evolve, they provide opportunities for new forms of artistic expression, the limitations of which are not yet clear. Five international digital art experts in photography, sculpture, drawing, dance and painting share their experiences with us, illustrating new creative processes and shining a light on new issues associated with visual perception.

Liam Fitzpatrick Armando Menicacci Editor, photographer (digital Lecturer, creator-choreographer photography) - Hong Kong (dance and digital media) – Canada (born in Italy)

Liam Fitzpatrick is a senior editor for TIME magazine. A graduate Armando Menicacci has a Master’s degree in musicology and a PhD in of Christ Church, Oxford, he has always been a very enthusiastic the relationship between contemporary dance and digital technologies. photographer. He experiments with different techniques and different Between 1999 and 2009, he founded and then ran Médiadanse, a devices, and is currently looking at the opportunities provided by the research laboratory focusing on the relationships between dance and

ART AND VISION ART iPhone and its various applications. His eye for composition earned media. In 2007, he set up the Digital flesh collective which specialises him rave reviews and international recognition for his "Kinky Vicious” in interactive installations and dance pieces displayed and performed exhibition – a series of photos showcasing his native Hong Kong. in the UK, Brazil, Spain, France, Italy, the Czech Republic, Tunisia His photos have been published in TIME magazine, as well as on the and Turkey. Between 2009 and 2014, he taught in France at the Roads & Kingdoms website. Ecole Media Arts in Chalon-sur-Saone, in Turkey at Bilgi University in Istanbul, in Brazil at the Universida de Federal in Rio de Janeiro Murray Kruger and in the UK at the Bartlett School of Architecture in London. He Artist, sculptor (digital sculpture) is currently serving as a consultant, lecturer and teacher with the dance department at the University of Québec in Montréal, and is also - South Africa working on designing movement quality analysis software. Digitalflesh: www.digitalflesh.org

Jeremy Sutton Murray Kruger is a fine arts graduate who has been interested in Artist-painter, teacher (digital the potential of 3D computer animation right from its beginnings, painting) - US (born in the UK) incorporating it into his art very early on. Now a digital sculptor, he uses computer-assisted design software to create the basis for his works, while at the same time striving to maintain a pictorial approach that is similar to that used in painting. His aim is to create fantastical images that grab the viewer's attention. His website: www. Jeremy Sutton studied drawing, sculpture and engraving while earning murraykruger.com a degree in material physics. He became a full-time professional artist in 1994, experimenting with traditional and digital techniques to create François Lapierre works that harness the spontaneity, power and versatility of digital art Artist, screenwriter and digital tools with the beauty, quality and texture of traditional media. designer - Canada He also teaches digital painting, performing live event action painting, as well as undertaking commissions. His website: www.jeremysutton.com

After studying art and graphic design, François Lapierre spent a number of years working on cartoons, during which he learned how to use a computer. He then embarked on that about which he is passionate: Comics. He's involved in a number of different areas, working as a designer, screenwriter and colourist on various series, such as Sagah-Nah, Le mangeur d’âmes, and Magasin général François is currently working on a series of novels for young people: KEYWORDS Les guerriers fantômes (the Ghost Warriors). His website: www. digital art, digital creation, painting, sculpture, drawing, dance, digital flapierre.com. media, digital photography, iPhone, choreography, digital drawing, music, digital screens, posture, perception, movement, digital tools, connected life, new technologies, computer, smartphone, tablet.

Points de Vue - International Review of Ophthalmic Optics 76 Number 72 - Autumn 2015 ART AND VISION ART

Are touchscreens, smartphone apps and 3D printers all new means of producing art? In this age when digital technologies form part of the very DNA of generations brought up counting Electric Sheep*, the plastic arts are being infused with digital innovations so that they can look upon the modern world through a digital lens. Is this evolution or revolution? The question touches on just how extensive the transformation that creativity and its practices are undergoing is - a transformation driven by teacher-researcher and choreographer – who specialises in digital technologies. the relationships between dance and digital technologies – highlights the benefits of isomorphism that digital As far as tools are concerned, digital technologies serve technologies provide: "With calculations performed on a first and foremost as an extension of the more traditional computer, all of the processes involved in perception can techniques. A typical example is photography. "With digi- swap their various forms. A gesture can become an image, tal cameras, you can take risks, experiment with different an image can become a text, etc. The movements of compositions and then start again as many times as you dancers wearing sensors can, for example, be used to need to until you are satisfied. And then of course you can generate sound. So the music is what results from the edit the results – so much more quickly and simply than gesture… the gesture is transformed into music", he adds you could with film", says Liam Fitzpatrick, an enlightened as an example. The complete opposite of the conventional journalist and photographer who gets most of his inspira- approach and a means of expression that contemporary tion from the lights and contrasts of his native Hong Kong. dance is only just starting to explore, heralding future Miniaturization has revolutionised his approach to photo- pieces that will be utterly captivating. graphy, even more so than its computerisation. "My iPhone has become an extension of my gaze. I "work" in a state of As well as further extending the areas in which pre- permanent awareness. I can be taking a walk or having a existing art forms can express themselves, digital conversation with someone when suddenly a ray of sun- technologies are also paving the way to new disciplines. light will caress a wall or a whirlwind of leaves will be Augmented reality, 3D imagery and other robotic arts have whipped up into the air. So I will suddenly drop everything all been spawned by computer technologies. South African so that I can capture the moment! Something that is only born digital sculptor Murray Kruger emphasises the oppor- possible with smartphones, which are sufficiently tunity for original creativity with which information responsive and of good enough quality for my shots". technology and its related areas provide him.

Dance – the art of movement – has also been able to take advantage of new technologies. "Dance does not need digital technologies to exist. But it can gain from them in order to make it richer and to anchor it in the modern era. It has a great deal to learn from digital technologies: they can provide a new insight into the creative processes involved in it", says Armando Menicacci. The Italian-born

* Philip K Dick: “Do Androids Dream Of Electric Sheep?”, Doubleday, 1968

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 77 ART AND VISION ART

Points de Vue - International Review of Ophthalmic Optics 78 Number 72 - Autumn 2015 “My iPhone has become an extension of my gaze” - L. Fitzpatrick ART AND VISION ART

"I'm fascinated by phantasmagoric scenes and their power to evoke reactions from viewers. I'm able to use digital tools to create 3D models that would not be possible using more traditional methods. I can check their composition and the lighting from all angles and play around with them as much as I like until I end up with something that most perfectly matches my vision. The same goes for the transcribed onto a screen. It's so much more than just a colouring stages: I can experiment with textures, rendering gadget – it's a genuine technique which will completely and sensations, etc.” His work combines technology and change the way in which we create art in the future", creativity, infusing each of his works with its own special he enthuses. atmosphere and ambience and meeting one of art's foremost aims: getting the observer to ask themselves Could innovation be a way to compensate for the frus- questions. tration created by computerisation? Immersive technologies (panoramic 3D displays, force feedback, artificial Pleasures and frustrations of computerisation smells, etc.) should gradually bridge the gap between Some artists who experiment with digital media recognize traditional and digital. “But we shouldn’t forget that it is and even regret the limitations of what they do. A stylus just a tool. Lets not forget that a paintbrush at one point and a tablet computer don't feel quite the same in the in history was high technology. What is important is not so hand as a hammer and a chisel, or even a real brush. This much the interfaces used, but the relationship between raises the question "is digital art less enjoyable to create the creator and their creation", points out Murray Kruger, than "traditional" art? Or, simply, is it more frustrating? who appreciates nonetheless the way in which new tech- "Different, yes. Less enjoyable, no. I love the feel of chalk nologies – such as the 3D printer – are revolutionising art. or charcoal in my hand, but the way in which a digital "Fiction is becoming reality and we can now create models brush gently slides across a tablet is extremely pleasant", of a level of complexity and aestheticism that are on a par counters Jeremy Sutton. This painter who has made with that of traditional works of art". Above all, digital California his home – the spiritual son of artists such as sculptors are delighted that these technological advances David Hockney and Henri Matisse – appreciates the are raising the profile of their work and making it more ever-growing potential afforded by new technologies, such accessible, even helping it to break free of the confines of as air painting. "I've tried painting using leap motion – what is considered purely art. Their work is already being a motion recognition system. All you have to do is move used in jewellery-making, the food industry, architecture your hand through the air and you can see its movements and even medicine. And this is just the beginning.

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 79 ART AND VISION ART

“Dance has a great deal to learn from digital technologies: they can provide a new insight into the creative processes involved in it.” - A. Menicacci

ticularly appreciates "being able to share the creative Digital sharing process and the various stages involved in it, or being Art has become more accessible now than ever before able to document them as I work. An educational approach thanks to the opportunities afforded by digital techno- can be considered using physical media, but that is much logies and new ways to share it. Nowadays, anybody more complicated to put into practice". But the flipside to can share their own art or contemplate that of others on art being so accessible is that it can be misappropriated a website, a blog or via social networks. This is a way or reworked. Sometimes in a good way: the process of sharing that is completely different from traditional involved is genuinely creative; but sometimes it is reworked channels, which usually require some sort of cultural in a way that is damaging or intrusive. The painter intermediary or dedicated framework. Jeremy Sutton par- finds himself up against complicated issues to do with

Points de Vue - International Review of Ophthalmic Optics 80 Number 72 - Autumn 2015 “There was a time when the brush was the apogee of artistic progress. What is important is not so much the interfaces used, but the relationship between the creator and their creation” - M. Kruger ART AND VISION ART

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 81 “The human visual system is fundamentally very good at adapting. The eye can adjust and appreciate digital art in the way intended by its creator” - J. Sutton ART AND VISION ART

intellectual property: "We've opened up a Pandora's box. Anything can be recovered, used, changed, etc. A whole new paradigm that brings with it endless legal comple- xities. It is still probably best to respect everybody's original work and to strive to create and use one's own source of creativity, rather than using something that someone else has made…"

Fortunately, using somebody else's work is not always on the flagship digital medium: the screen – be it a tablet tantamount to plagiarism. It can even be an artistic screen, a computer screen, a television screen, etc. It approach in its own right: collaborative art, involving the could be that there is a debate to be had about the oppo- public in the actual creative process. The interaction sition between scattered light and emitted light. between the artist, the work of art and the general public Québec-born François Lapierre is a comic designer and results in something ephemeral which is forever being colour artist, well-known for the subtlety of his digital reinvented. In this regard, dance in particular is a field in colouring techniques. "The image displayed is often which many people are innovating. "Participatory art – the magnificent – because of the colorimetric settings. idea of co-authoring a piece with the viewer – is helping to But the result can vary tremendously from one screen to foster the emergence of new realities", says Armando another and – above all – when it is printed out, a key Menicacci. But we should not lose sight of the fact that stage in the comic production process”. This is something art must first and foremost raise questions in the minds that he finds himself pondering on a daily basis. Although of viewers – it must not simply lead them into its mecha- the colour proofs help ensure that the actual prints are a nisms so that they become one of its parts. It's all a faithful representation of what the artist had in mind, the question of control and how much freedom is granted to best solution usually involves modulating densities and contributors so that their own realities can be taken into contrasts and using as much light as possible. That way, account without losing sight of the ultimate artistic aim". the drawing is not overloaded and there is no risk of colour An investigation into the ins and outs of participatory art loss during printing. "Another thing that is very useful is a that involves specialists working on computer programmes high-quality screen that is perfectly calibrated with a that can analyse the quality of people's movements and rendering that is the same as that of the printed image", variations in muscular tension so that each person can be he adds. identified and the digital response customised (meaning that the result is also customised) so as to reflect their As far as variations from screen to screen are concerned, own individual characteristics as closely as possible. the easiest solution is for everybody to look at the same Dance of the future? one. Another option is simply to accept it, bearing in mind that the actual result is never that different to the one that Multiple screens = multiple limits? was intended. "The human visual system is fundamentally The opportunities afforded by digital technologies seem very good at adapting", says Jeremy Sutton. “The eye can limitless. But their very nature raises certain questions – adjust and appreciate digital art in the way intended by its particularly regarding the way in which the art is rendered creator – who is generally aware of the way in which colour

Points de Vue - International Review of Ophthalmic Optics 82 Number 72 - Autumn 2015 ART AND VISION ART

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 83 ART AND VISION ART

can be modulated and is not upset by this. Indeed, they create are light, almost psychedelic. The variations in incorporate these modulations into the way in which they colour, saturation and contrast that are possible with digi- conceive their own art". Liam Fitzpatrick – who is above all tal technologies mean that you can play with emotions interested in the experience – confirms this. As an aficio- more easily and more vividly than you can with traditional nado of a more retro style, the photographer even uses photography". smartphone apps to give his shots a more vintage look, accentuating certain aspects, giving them more texture, Digital art, organic fatigue adding a vignetting effect, etc. "As I get older, I am less The question that remains is the one that all ophthalmic and less interested in describing reality: instead, I'm adop- optics specialists ask themselves. The question about ting a more impressionist approach. The images that I how to maintain the artist's most important work tool:

Points de Vue - International Review of Ophthalmic Optics 84 Number 72 - Autumn 2015 “And most importantly, I do my best to display as little white on screen as possible. That is easily the most harmful colour for your eyes” - F. Lapierre ART AND VISION ART their eyes. What is clear is that this is not their primary concern. Logically, efforts to keep eye fatigue to a minimum should increase in proportion to the amount of time spent in front of the screen. François Lapierre, who spends KEY TAKEAWAYS an average of eight hours in front of a screen every day (twice that during rush periods), has developed his own strategy. "I take breaks every half hour. I regularly glance • Digital technologies are changing the way in which out of the window, to admire the landscape and rest my eyes. And most importantly, I do my best to display artists view the world. They serve as a means of further as little white on screen as possible. That is easily the developing traditional techniques and foster the most harmful colour for your eyes. I use a neutral grey emergence of original forms. background for my drawings and a dominant colour background for my colouring projects". • Digital innovation and computerised distribution help All the artists we've talked to take regular breaks and expe- make art widely available to the general public so that riment with different focal lengths. They also believe that they may appropriate it and incorporate it into the if they have to work in front of a screen, they should adopt relaxing postures and use ergonomically designed equip- creative process. ment. Although these issues cross their mind, they rarely • Digital artists have learned to control the specific go so far as to protect their eyes or correct any disorders features of the light emitted by screens and the they may have. Liam Fitzpatrick and Jeremy Sutton both confess to being shortsighted, but say that having the variations in colour to do with their quality. world around them appear blurry is actually useful for their • Although they try to improve their posture and go art – automatic impressionism! Sutton even "refuses to to efforts to combat eye fatigue, they see practical use glasses for painting or sketching. I simply squint and concentrate on the broad outlines of what I’m painting, measures that they could adopt for their eyes during instead of focusing on the details". The precision involved the creative process as being of secondary importance in the task to be carried out seems to be directly correlated (such as protecting their eyes, correcting their vision, to the extent to which the artist takes care of the quality of their vision. François Lapierre always has his contact etc.). lenses in and Murray Kruger gets new lenses prescribed every year: "I am shortsighted and I ask my ophthalmologist to work out what lenses I need for carrying out intensive work in front of a screen. But I don't go so far as to find out about filters and other technologies that can reduce the impact that the light emitted by the screen can have on my eyes…" It's up to eye care professionals to focus on their own "art" and develop more appealing solutions, bolstering the link between vision, posture and digital creation. •

Points de Vue - International Review of Ophthalmic Optics www.pointsdevue.com Number 72 - Autumn 2015 85 PAST ARTICLES IN RELATION WITH THE THEME «DIGITAL VISION» YOU MAY FIND INTERESTING...

ASTHENOPIA AND VISUAL FATIGUE RELATED Photosensitivity and blue light Visual fatigue Brigitte Girard Jim Sheedy [Points de Vue 68 – Spring 2013] [Points de Vue 70 - Spring 2014] Bad blue, good blue, eyes and vision Effect of multifocal lenses on eye and head movements Thierry Villette in presbyopic VDU users with neck and should complaints [Points de Vue 68 – Spring 2013] Michaëla Friedrich, Egbert J. Seidel, Hans-Jürgen Grein, Jeanette Kothe Hazards of Solar Blue Light [Points de Vue 70 - Spring 2014] Tsutomu Okuno [Web only – www.pointsdevue.com] Blue Light Hazard: New Knowledge, PREVENTION AND BLUE LIGHT RELATED New Approaches to Maintaining Ocular Health [Web only – White Paper – www.pointsdevue.com] Prevention of ocular pathologies in ophthalmology Marcus Safady [Points de Vue 71 – Autumn 2014] Scientific quest for personalized risk prevention PRODUCT RELATED Coralie Barrau, Denis Cohen-Tannoudji, Thierry Villette [Points de Vue 71 – Autumn 2014] Putting the medicine in the lenses : The importance Understanding risks of phototoxicity on the eye of blocking ultraviolet radiation and blue light John Marshall Ryan Parker [Points de Vue 71 – Autumn 2014] [Points de Vue 71 – Autumn 2014] AMD : Clinical protocol, prevention and outlook Protect children’s eyes every day : Crizal® Prevencia® Henrik Sagnières for kids [Points de Vue 71 – Autumn 2014] Luc Bouvier U.S. optometrists begin global initiative of eye disease prevention [Points de Vue 71 – Autumn 2014] Kirk L. Smick Crizal® Prevencia™: the first preventive non-tinted lenses [Points de Vue 71 – Autumn 2014] for everyday wear with protection from UV rays The role of blue light in the pathogenesis of Age-related and harmful blue light Macular Degeneration Coralie Barrau, Eva Lazuka, Amélie Kudla, Claire Le Covec Kumari Neelam, Sandy Wenting Zhou, Eong Kah-Guan Au [Points de Vue 71 – Autumn 2014] [Points de Vue 69 – Autumn 2013] What role science / clinical practice should play in the prevention of ocular problems generated by UV and blue violet light? NEEDS UNDERSTANDING Bret André, Rowena Beckanham, Ralph Chou, Walter Gustein, David Sliney, Randall Thomas, Kazuo Tsubota AND DIGITAL DEVICES RELATED [Points de Vue 71 – Autumn 2014] The well-being of «well-seeing» - Why are women and the Light Emitting Diodes (LEDs) and the blue light risk over 50’s more engaged with the health of their eyes? Christophe Martinsons Philippe Zagouri, Joëlle Green [Points de Vue 68 – Spring 2013] [Points de Vue 71 – Autumn 2014] Perception of blue and spectral filtering The infant’s vision and light - Françoise Vienot The role of prevention in preserving visual capacity [Points de Vue 68 – Spring 2013] François Vital-Durand The good blue and chronobiology: [Points de Vue 71 – Autumn 2014] light and non-visual functions Claude Gronfier Understanding the needs of pre-presbyopes [Points de Vue 68 – Spring 2013] and emerging presbyopes New discoveries and therapies in retinal phototoxicity Agathe Laurent Serge Picaud, Emilie Arnault [Points de Vue 70 - Spring 2014] [Points de Vue 68 – Spring 2013]

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Points de Vue - International Review of Ophthalmic Optics 86 Number 72 - Autumn 2015 EDITORIAL BOARD The Editorial Board’s role is to define relevant themes and approve content proposals for each new issue of the magazine. Its members represent 11 nationalities and speak 15 languages. They also ensure global and local relationships with authors, eye care professionals and KOLs (Key Opinion Leaders). We publish peer-recognized experts throughout the world and aim for multidisciplinary balance in the authorship of articles.

Dr. John Ang Maralen Busche Laura De Yñigo William Harris Andy Hepworth Pedro Janowitzer President, The International Vision Head of Product Marketing, Varilux Institute Director, Project Manager, Global Key BSc (hons), FBDO, Head of Marketing Vice President, Academy, Vice-President, Essilor Germany Essilor Spain Opinion Leaders and Professional Relations, Essilor Latin America Education & Professional Services, Professional Relations, Essilor UK ESSILOR AMERA Essilor International

Eva Lazuka-Nicoulaud Dominique Meslin Dr. Howard B. Purcell Alain Riveline Annie Rodriguez Dr. Rod Tahran Head of Publication Points de Director of Professional OD, FAAO, Senior Corporate Senior Vice Director of Vision Health OD, FAAO, Vice President, Vue, Global Key Opinion Relations and Technical Vice President, Customer President, Global Marketing, Essilor France Professional Relations, Leaders and Professional Affairs, Essilor Europe Development Group, Essilor International Essilor of America Relations, Essilor International Essilor of America

Louise Tanguay Tim Thurn Charles-Éric Poussin Lily Peng Zhang Special Projects, Optical Director of Professional Latin America PAL Technical Standard Manager, Schools and Events Services, Essilor Australia Development Director, Shanghai Essilor Optical Co., Professional Relations, and New Zealand Essilor International LTD Essilor Canada

SCIENTIFIC BOARD The Scientific Board is represented by international peer-recognized experts. The members of Scientific Board are not funded by Essilor for their work or for any contribution they may make to Points de Vue. The Scientific Board’s role is to ensure both the integrity and credibility of the magazine. In fulfilling this role, the Scientific Board is able to amend and reject articles.

Prof. Clifford Brooks, Prof. Julián García Sánchez, Dr. Daniel Malacara, Indiana University School of Optometry, United States Medical Faculty UCM, Spain M.Sc, PhD Optical engineering, Optic Research Centre, Mexico Prof. Christian Corbé, Prof. Mo Jalie, Invalides Institute, France Founder President of the University of Ulster, UK Prof. Yves Pouliquen, Representative Association for low vision Initiatives Member of the Académie de Médecine (ARIBa), FranceCourt Expert Farhad Hafezi, and of the Académie Française, France Professor and Chief Medical Officer, Ophthalmology Dr. Colin Fowler, Clinic, Department of Clinical Neurosciences, Geneva Dr. Marcus Safady, Director of Undergraduate Clinical, Studies Optometry University Hospitals, Switzerland Ophthalmologist, chairman of the Sociedade Brasileira & Vision Sciences, Aston University, UK de Oftalmologia (S.B.O.), Rio de Janeiro, Brazil Bernard Maitenaz, Inventor of Varilux, Essilor France

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