Consultation Corner

with Robert M. Kershner, MD, FACS

Refractive Eye Specialist, Eye Laser Consulting, Boston, Massachusetts

Computers Raise Eye-Straining Questions

The use of computers and visual display terminals (VDTs) in both the home and the work place has become more and more common. Today few homes and offices are without at least one computer monitor. The safety of VDTs as an exposure hazard is well established. However, those of us who use computers on a daily basis, especially for long periods of time, are at risk for developing symptoms of eyestrain. Eyestrain results in an aching or tired feeling of the eyes, difficulty focusing, headaches, red eyes or muscle spasms in the neck or shoulders. Eye strain is the result of light reflections from the screen, constant focusing at a fixed distance, and poor hand, eye and body position at the terminal.

Follow these simple rules to minimize the symptoms of eyestrain when working on a computer:

1. Position the monitor to reduce glare from existing lighting and reduce overall lighting level to allow comfortable viewing of the screen. Adjust brightness and contrast of the screen for maximum visibility.

2. Position the height of the screen and its distance from your eyes as comfortably as possible for maximum viewing. You should not need to look down, up, or strain to focus.

3. Adjust your chair to allow an easy viewing level without leaning, bending or straining.

4. Take breaks. Even brief periods of looking away from the screen to allow your eyes to relax their focus is important.

5. Use prescription computer glasses to keep the computer screen in focus. Anti-reflective coating and special tinting in the lenses can help reduce glare and minimize eyestrain.

6. Don’t forget to blink! Itching, burning and watering can be alleviated by using non-preserved artificial tear drops available without a prescription from your pharmacy. Above all, see, don’t strain!

Copyright 2004 Robert M. Kershner, M.D., F.A.C.S. All Rights Reserved.


Everyone experiences symptoms of dry eyes at one time or another. Conditions that speed up the evaporation of tears from the surface of the eye such as dry, arid climates, wind, a fan blowing, an air conditioner or heater blowing in your car, or sitting in front of a fireplace, can all bring on the symptoms of dry eye. If you have recently had LASIK or other eye surgery, you may notice symptoms of dry eye now that you no longer wear eyeglasses or contacts.

Thyroid disease, diabetes, rheumatoid arthritis, oxygen use or taking medications such as, diuretics, antihistamines and bronchodilators, can all increase the symptoms of dry eyes. Women are more likely than men to be bothered by dry eye and menopausal women are the most likely to be affected. Those who live in cold, dry or hot, arid climates are more susceptible, than those who live in moist, tropical environments where high levels of humidity reduce the symptoms considerably.

The surface of the eye requires an endless supply of moisture. Producing tears fast enough to keep up with evaporation is difficult, making dry eyes extremely common. The symptoms are easy to recognize: a scratchy or burning sensation, tearing, blurred vision or redness which usually gets worse as the day goes on. The treatment is simple: use plenty of non-preserved artificial tear supplements several times a day until symptoms improve.

Copyright 2002. Robert M. Kershner, M.D., F.A.C.S. All Rights Reserved.



SYNOPSIS:  Macular Degeneration (AMD), is a common disorder of the retina (macula) that can reduce the quality of vision as people age.  For over twenty years, Dr. Robert Kershner has been instructing his patients to wear protective sunglasses outdoors, avoid damaging exposure to sunlight, and  take a daily supplement of the antioxidant vitamins and zinc.  Recently, the results from the age-related macular disease study have demonstrated that supplements containing high levels of Vitamin C, Beta-Carotene, and Zinc reduce visual loss for people at risk for AMD.  Cigarette smoking is a well-established risk factor for the development of this disorder.  We have learned that dietary fat intake, particularly the fat found in highly processed snack foods, is as yet another risk.  Monounsaturated and vegetable fats such as the "polyunsaturated fats" may increase your risk of developing AMD.  Family history plays a role; if you have a member of your family with the disease, you are at increased risk. For a complete review of Dr. Kershner's recommendations, go to "Your Eyes" on this website.

Age-related macular degeneration (AMD) is a disorder of the back of the eye (retina) that results in a deterioration of central vision.  It is the number one cause of blindness in individuals 65 years of age and older.  Dozens of studies have been undertaken over the past 15 years to better understand this frustrating disorder.  Enthusiasm for new treatments for this disease has diminished as research studies show little progress in a medical or surgical “cure.”  Many approaches to treatment such as interferon, radiation therapy, surgery to relocate the diseased area of the retina, blood plasma filtration treatments and photodynamic therapy have not yielded an improvement in vision. The recent approval of Visudyne, a drug that is injected into the circulation and activated with a special laser applied inside the eye can prevent serious visual loss in the small number of people who have the "wet" or leaking form of the disease.

          AMD is a genetic disorder.  Some day we may understand why it occurs; why it is more common in family members with the disease; and what can be done to prevent its occurrence.

          In this article, I would like to outline what we do know about the benefits of early diagnosis and preventative care, to help slow the progression of AMD.  You do not have to lose vision with AMD.



When your mother told you to eat your carrots because it was good for your eyes, she was probably right.  In fact, eating your spinach may actually be better.  The role of nutrition in the process of macular degeneration is well known.  Two substances known as carotenoids found in green leafy vegetables may significantly reduce an individual’s risk of developing AMD.  They may also help preserve vision and prevent further deterioration of the retina.  Substances, also known as anti-oxidants, exist in high concentration within the pigment of the central part of the retina in the back of the eye (macula).  We know that a large amount of macular pigment (the substance that filters blue light) reduces the risk of macular degeneration.  Absorbing blue light, acts to protect the retina by preventing oxidation.   People with light colored irises (blue as opposed to dark brown) are at greater risk for developing AMD.  Smoking is a well-established risk factor for this disease as well.  Diets high in polyunsaturated fats, such as those found in processed snack foods are also at risk.

          Two specific carotenoids, lutein and zeaxanthin, have been associated with a decreased risk of AMD.  As you might expect, these two substances also appear in high concentration within the macular pigment. The body cannot manufacture lutein on its own, and that is why an adequate dietary intake is important.  A diet high in fruits and vegetables helps increase the concentration of this substance in the blood.  A study published in 1988 showed that individuals with AMD who consume fruits and vegetables in their diet and increase their intake of beta carotene (vitamin A) had increased protection from AMD compared to those who did not.  Vitamins A, C, and E, as well as the trace mineral zinc, also play an important role.  






Broccoli, cooked



Brussels sprouts






Sweet potato






Parsley, fresh (not dried)









·        AMD is the leading cause of blindness in people over 65 years of age. 

·        As many as 13 million people in the United States have AMD

·        1.2 million Americans are visually impaired from AMD. 

·        30% of people over the age of 75 have AMD. 

·        The number of Americans over age 65 will double by the year 2050.




·        The incidence of AMD is greater in family members of people who have the disease.

·        Women are at greater risk for AMD than men.

·        People with blue eyes are at greater risk than people with brown eyes.

·        Smoking increases the risk of AMD.

·        Alcohol use may also increase the risk of AMD.

·        Sun exposure increases the risk of AMD.

·        Increased fat in the diet increases the risk of AMD.

·        A diet low in anti-oxidants is associated with increased risk of AMD.




·        Stop smoking.

·        Use ultra-violet protecting sunglasses and wear a hat when out of doors to reduce the amount of ultraviolet light entering the eye.

·        Eat generous daily helpings of spinach, kale and vegetables high in lutein and zeaxanthin.

·        Take an anti-oxidant vitamin supplement which includes the following:


Vitamin E

400 units

Vitamin A as beta carotene

5,000 units

Vitamin C

250 mg

Zinc oxide

40 mg





1.    Spectacle correction – Get a good pair of eyeglasses with proper correction which has a large reading bifocal with increased power.

2.    Use a hand magnifier and a very bright reading light to magnify the image.

3.    Use a stand magnifier when reading.

4.    Low vision aids are available through low vision services that can magnify distance and intermediate vision, such as telescopes.

5.    Closed-circuit television cameras and monitors can magnify imaging for reading and can be purchased from several sources.





The Lighthouse Inc. Information and Resource Center

111 East 59th Street, New York, NY 10022

Phone (800) 334-5497   Fax (212) 821-9705 ATTN I&R

Information on eye diseases, low vision resources


The Lighthouse Low Vision Catalog, Optical Products, Non-optical products and Educational Materials

111 East 59th Street, New York, NY

Phone (800) 453-4923   Fax (718) 786-0437


LS&S Group Catalog of products for the visually and hearing impaired

Phone (800) 468-4789   Fax (847) 498-1482   E-mail


Tech-Optics International Catalog, vision care products

59 Hanse Avenue, Freeport, NY  11520

Phone (800) 678-4277   Fax (800) 678-0002


Eschenbach Optik of America Catalog, Low Vision Rehabilitation Program

904 Ethan Allen Highway, Ridgefield, CT  06877

Phone (203) 438-7471   Fax (203) 438-1670


Designs for Vision, Inc., Optical Aids for the Partially Sighted

Custom designed telescopic and microscopic lens systems, special orders

760 Koehler Avenue, Ronkonkoma, NY  11779

Phone (800) 345-4009

About the author:  Dr. Kershner is an internationally recognized ophthalmologist.  He has written over two hundred scientific articles and eighteen textbooks, and lectures internationally to other eye surgeons on microsurgery of the eye.  He is a frequent contributor to health columns and has been a featured guest on both radio and television. He is Clinical Professor of Ophthalmology at the University of Utah School of Medicine.

If you would like a question answered by Dr. Kershner in a future column of Consultation Corner click here.


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