ORIGINAL INVESTIGATION

Blue-blocking Filters and Digital Eyestrain

Tatsiana Palavets, BA1 and Mark Rosenfield, MCOptom, PhD, FAAO1*

SIGNIFICANCE: Many manufacturers are currently marketing blue-blocking (BB) filters, which they claim will reduce
the symptoms of digital eyestrain (DES). However, there is limited evidence to support the proposal that DES results
from the blue light emitted by these devices.
PURPOSE: The visual and ocular symptoms commonly experienced when viewing digital screens are collectively
termed DES. The emission spectrum of modern digital displays frequently includes a high percentage of blue light.
Being higher in energy, these short wavelengths may contribute to DES. This study examined the effect of a BB filter
on symptoms of DES during a sustained near-vision task.
METHODS: Twenty-three young, visually normal subjects were required to perform a 30-minute reading task from a
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tablet computer. The digital screen was overlaid with either a BB or neutral-density (ND) filter producing equal screen
luminance. During each session, the accommodative response, pupil diameter, and vertical palpebral aperture di-
mension were measured at 0, 9, 19, and 29 minutes after the start of the reading task. Immediately following each
session, subjects completed a questionnaire to quantify symptoms of DES.
RESULTS: The BB filter blocked 99% of the wavelengths between 400 and 500 nm. The mean total symptom
scores (±1 SEM) for the BB and ND filter conditions were 42.83 (3.58) and 42.61 (3.17), respectively (P = .62).
No significant differences in accommodation or vertical palpebral aperture dimension were observed between the
two filter conditions, although the magnitude of the mean accommodative response did increase significantly during
the first 9 minutes of the task (P = .02).
CONCLUSIONS: A filter that eliminated 99% of the emitted blue light was no more effective at reducing symptoms Author Affiliations:
1
of DES than an equiluminant ND filter. There is little evidence at this time to support the use of BB filters to minimize SUNY College of Optometry,
near work–induced asthenopia. New York, New York
*Rosenfield@sunyopt.edu
Optom Vis Sci 2019;96:48–54. doi:10.1097/OPX.0000000000001318
Copyright © 2018 American Academy of Optometry
Supplemental Digital Content: Direct URL links are provided within the text.

A number of previous studies have examined the potentially dam-
aging effect of blue light (typically defined as wavelengths between
400 and 500 nm).1–3 This part of the visible spectrum may be re-
sponsible for damage to photoreceptors in the retina,4,5 as well as
altering the circadian rhythm of the body.3,6,7 Certain groups may
be particularly susceptible to blue light damage, such as children
(because of the transparency of their crystalline lens) and both
aphakic and pseudophakic individuals, who may fail to filter out
short wavelengths adequately.
The impact of blue light on the eye has gained increased interest
in recent years owing to the high proportion of these wavelengths
emitted by light-emitting diodes.8 These are commonly found in
digital screens such as desktop, laptop and tablet computers, elec-
tronic reading devices, and smartphones. This is particularly pertinent
nowadays given the substantial number of hours being spent by many
(or perhaps most) individuals viewing these screens in contemporary
life. In addition, there is a high prevalence of both ocular and visual
symptoms associated with viewing these displays. These have been
described collectively as digital eyestrain.9,10
Several optical manufacturers are currently marketing spectacle
lenses, which include a blue-blocking filter, which they claim will
reduce the symptoms of digital eyestrain. However, there is very lim-
ited evidence to support the proposal that digital eyestrain results
from the blue light emitted by these devices.11,12 To date, we are
aware of only two studies that have examined this effect directly.
For example, Cheng et al.13 tested the effect of low-, medium-, and
high-density blue filters (in the form of wraparound goggles) worn
during computer work in groups of dry-eye and normal subjects
(n = 20 for each group). Unfortunately, the transmission character-
istics of the three filters were not provided. The authors observed a
significant reduction in digital eyestrain symptoms in the dry-eye
group but not in the non–dry eye subjects. This significant effect was
seen for all filter densities. However, the study did not include a
control condition, and so a placebo effect, where the subjects were
aware that they were receiving treatment, cannot be ruled out. Fur-
thermore, the wraparound goggles may have reduced tear evapora-
tion in the dry eye subjects, thereby increasing ocular comfort.
More recently, Lin et al.14 evaluated the effect of blue-blocking
lenses on both symptoms of digital eyestrain and critical fusion fre-
quency following a 2-hour computer task. Critical fusion frequency
has previously been associated with eye fatigue.15,16 During the
trial period, subjects were required either to “view videos or engage
in games.” Unfortunately, no specific details of the task, such as
viewing distance, cognitive demand, or the duration spent on each
of the two assignments, that is, passive viewing versus performing a
more active task, were described. The authors determined that the
“high-blocking filter,” which blocked around 60% of the blue light,
produced a significantly higher post-task change in critical fusion
frequency, when compared with either a low-blocking blue filter
(which blocked approximately 24%) or control lenses that blocked

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approximately 3.2% of blue light. Indeed, based upon the critical fu-
sion frequency findings, the authors reported that subjects wearing
high-blocking filters had less fatigue after the 2-hour task than before
they started the trial. With regard to reports of subjective symptoms,
the high-blocking filters produced a significant reduction in three
specific symptoms, namely, pain, heaviness, or itchy eyes, but not
in other previously noted digital eyestrain symptoms such as tired
eyes.17 An additional concern with this study was that the various
filter conditions were performed on different groups of subjects,
and so the reduced symptoms observed in the high-blocking filter
group may have been a consequence of those particular individuals
rather than being owing to the effect of the filters.
Accordingly, the aim of this study was to examine the effect of a
blue-blocking filter on symptoms of digital eyestrain induced dur-
ing a 30-minute reading task. An equiluminant neutral-density filter
was selected as a control for comparison purposes.
METHODS
The experiment was carried out on 24 subjects (7 males, 17 fe-
males) between 22 and 27 years of age (mean, 24.3 years; standard
deviation, 1.01 years). Using data from a previous study,18 the es-
timated effect divided by the standard deviation of the effect gave a
value of 1.76. Taking α and β values of 0.05 (two-tailed) and 0.1,
respectively, this indicated a sample size of 21 subjects.19 Accord-
ingly, the sample of 24 subjects used here should be adequate.
All subjects had best-corrected distance visual acuity of at least
20/20 in each eye. Five subjects did not wear a refractive correction,
whereas 8 and 11 subjects were habitually corrected by contact
lenses and spectacles, respectively. The mean spherical equivalent
refractive error was −2.96 D (standard deviation, 2.37 D; range,
+3.13 to −7.00 D). None had strabismus or manifest ocular disease.
Subjects were not asked if they were habitual computer users before
performing the study (although as young students, it was highly
likely that all of them were regular users), nor were they questioned
about their knowledge of blue-blocking filters. The study followed
the tenets of the Declaration of Helsinki, and informed consent was
obtained from all subjects after an explanation of the nature and pos-
sible consequences of the study. The protocol was approved by the
Institutional Review Board at the SUNY State College of Optometry.
Before each session, subjects viewed a distant visual acuity chart
at a distance of 5 m for a continuous 5-minute period to minimize
the effect of any previous near-visual activities.20,21 While viewing
the far target, five readings of the refractive state of the left eye were
recorded using an open-field, infrared, Grand Seiko WAM-5500
optometer (Grand Seiko, Hiroshima, Japan). These values served
as the baseline reading for the within-task measurements of the ac-
commodative response. After this interval, subjects performed a
cognitively demanding reading task for a 30-minute period. They were
required to read material aloud (to ensure compliance) from a tablet
computer (Apple iPad Mini, model A1432; Apple Inc., Cupertino,
CA) at a viewing distance of 43.5 cm. An example of a page of text
is shown in Fig. 1. A chin rest was used to maintain the viewing dis-
tance and gaze angle. The reading material comprised paragraphs
of unrelated words produced by copying the first and last word of
each line from a number of fiction novels. Subjects were allowed to
scroll through the text as required. The computer text was displayed
using Microsoft Word software (Microsoft Inc., Redmond, WA). The
text was single-spaced, black, Times New Roman font of approxi-
mately 90% contrast. The vertical height of a lowercase letter without
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Blue-blocking Filters and Digital Eyestrain — Palavets and Rosenfield
ascenders or descenders was approximately 1 mm (equivalent to
0.7 M). This reading task has been used in previously published stud-
ies from our laboratory and shown to be sufficiently demanding to pro-
duce symptoms after relatively short tasks (around 20 minutes).22,23
At the end of each session, subjects were asked to complete a
questionnaire regarding symptoms experienced during the reading
task.24 This questionnaire has been used in previous studies and
shown to be repeatable,18 with a repeatability coefficient25,26 of
13.46. This latter number indicates the value below which the ab-
solute differences between two measurements would lie with 0.95
probability.27 Post-task symptoms were reported on a scale from
0 (none) to 10 (very severe), with a score of 5 representing a mod-
erate response. The total symptom score was quantified on a scale
from 0 to 100. The questions are shown in Appendix 1, available
at http://links.lww.com/OPX/A366.
Subjects were required to participate for two sessions (i.e., a
crossover design), with the two trials being separated by a period
of at least 24 hours. Although every effort was made to schedule
the second session at the same time of day as the first, this was
not always possible, as it was considered to be more important to
schedule the two sessions close together. During each session, either
a blue-blocking filter (Zzz iPad Pro 9.7; LowBlueLights, University
Heights, OH) or a 0.3-log unit neutral-density gel filter (Lee Filters,
Burbank, CA) was placed directly on top of the tablet computer
screen. In either case, the filter covered the entire screen area. The
order of performing the two filter conditions was alternated between
subjects. Subjects were not told which was the test versus the control
filter. Target luminance was measured using a Spectra Pritchard
photometer (model 1980A; Photo Research, Burbank, CA). This pho-
tometer contains International Commission on Illumination tristimu-
lus filters, which allows measurement of the blue light output (400
to 500 nm) through the blue-blocking and neutral-density filters.
These measurements were taken through a 6° aperture. At the start
of each trial, the luminance of the digital screen through the filter
was adjusted so that the luminance for the two conditions was
within 3 cd/m2 of one another. The mean luminance for the blue-
blocking and neutral-density filter conditions was 86.7 (standard
deviation, 1.68) and 87.1 (standard deviation, 1.84) cd/m2, re-
spectively (t23 = 0.96, P = .36). During the task, subjects wore
their habitual near correction (either spectacles or contract lenses)
as required. The same correction was used for both sessions.
During each trial, the accommodative response, pupil diameter,
and vertical palpebral aperture dimension were determined at 0, 9,
19, and 29 minutes after the start of the reading task. Accommo-
dation was assessed using the WAM-5500 optometer. Subjects were
directed to stop reading and to fixate the last word that they had read
on the tablet computer. Five readings of the refractive state were
taken from the left eye, converted to spherical equivalent (i.e.,
sphere plus half the cylinder power), and subsequently averaged
after compensation for the distance refractive error. In addition,
during the reading task, the subject's left eye was video recorded using
a Samsung HMX-F90 digital camera (Samsung, Seoul, South Korea)
positioned immediately to the side of the reading material. A milli-
meter ruler was attached to the optometer headrest so that it lay im-
mediately in front of the subject's forehead. This was visible in the
recorded images to provide a calibration scale. The video recording
was downloaded and stored on a Dell Optiplex 740 desktop computer
(Dell Inc., Round Rock, TX). After the trial was completed, the re-
cording was reviewed to quantify both the horizontal pupil diameter
and the vertical palpebral aperture dimension, that is, the distance
from the lower edge of the upper eyelid to the upper edge of the lower
49
Blue-blocking Filters and Digital Eyestrain — Palavets and Rosenfield
FIGURE 1. Example of a page of random words, which subjects were required to read aloud for a continuous 30-minute period.
eyelid measured through the center of the pupil. These distances
were quantified from the downloaded images using ImageJ image
processing software. All data were saved onto a Microsoft Excel
spreadsheet (Microsoft Inc., Redmond, WA), and analysis of variance
testing (with post hoc analysis using the Tukey test as required) was
performed using statistiXL software (statistiXL, Broadway-Nedlands,
Western Australia). P < .05 was taken as the criterion for statistical
significance.
RESULTS
Photopic measurements using the Pritchard photometer indi-
cated that the blue-blocking and the 0.3-log unit neutral-density fil-
ter transmitted 0.99% and 48.6% of the blue light (400 to 500 nm)
emitted from the iPad display, respectively. Furthermore, the Inter-
national Commission on Illumination x and y coordinates for the
blue-blocking and neutral-density filters were 0.12 and 0.85, and
0.05 and 0.93, respectively. The transmission of the two filters,
as a function of wavelength, was measured using a StellarNet
Black-Comet-C-SR Spectrometer (StellarNet Inc., Tampa, FL),
and these results are shown in Figs. 2A and B.
The mean total symptom scores for the blue-blocking and neutral-
density filter conditions were 42.83 (standard error of the mean, 3.58;
range, 13 to 83) and 42.61 (standard error of the mean, 3.17; range,
13 to 77), respectively. The mean findings for each of the 10 individual
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symptoms are shown in Table 1. Two-factor (filter, symptom) analysis
of variance indicated no significant difference between the blue-
blocking and neutral-density filters (F1,459 = 0.01, P = .93).
The mean accommodation response measured during the course
of the reading task is shown in Fig. 3. Two-factor (time, filter) anal-
ysis of variance indicated that the effect of the filter was not signif-
icant (F1,175 = 0.40, P = .53). However, the effect of time was
statistically significant (F3,175 = 4.21, P = .01). Post hoc analysis
using the Tukey test indicated a significant change in the mean ac-
commodation response between time 0 and at 9 minutes (P = .02),
19 minutes (P = .01), and 29 (P = .05) minutes into the task.
Pupil and vertical palpebral aperture dimension results were ob-
tained from only 22 subjects, as the video recordings were not suf-
ficiently clear to allow reliable measurements in two cases. The
mean pupil diameter as a function of time during the course of the
near vision task for the two filter conditions is shown in Fig. 4.
Two-factor (time, filter) analysis of variance indicated that the effect
of the filter was significant (F1,175 = 14.51, P < .001). However,
neither the effect of time (F3,175 = 1.17, P = .32) nor the interac-
tion of the filter with time (F3,175 = 0.11, P = .95) was significant.
Although not significantly different, the mean values of pupil size
immediately before starting the reading task for the blue-blocking
and neutral-density filter conditions were 5.02 mm (standard error
of the mean, 0.21) and 4.67 mm (standard error of the mean, 0.16),
respectively (t42 = 1.31, P = .10). The mean values of vertical pal-
pebral aperture dimension as a function of time during the course
Optom Vis Sci 2019; Vol 96(1) 50
 Blue-blocking Filters and Digital Eyestrain — Palavets and Rosenfield

FIGURE 3. Mean accommodation response as a function of time for the

two filter conditions. Error bars indicate ±1 SEM. BB = blue-blocking filter;
ND = neutral-density filter.

of the near vision task for the two filter conditions are shown in
Fig. 5. Two-factor (time, filter) analysis of variance indicated that
neither the effect of the filter (F1,131 = 0.32, P = .57) nor time
(F2,131 = 0.05, P = .95) was significant.

FIGURE 2. Percentage transmission of the blue-blocking (A) and DISCUSSION

neutral-density (B) filters as a function of wavelength.
These results demonstrate that a filter that eliminated 99% of
the blue light emitted from a tablet computer was no more effective
TABLE 1. Mean scores for each of the 10 symptoms questioned at reducing symptoms of digital eyestrain than an equiluminant
after completion of the computer task with the blue-blocking and neutral-density filter for the reading tasks conducted in this study.
neutral-density filters It should be noted that this investigation used a particularly demand-
ing task for a relatively short period (30 minutes). Although this was
Blue-blocking Neutral-
filter density filter
highly effective in eliciting symptoms of digital eyestrain, it may not
be representative of more naturalistic situations, where individuals
Blurred vision while viewing 4.78 (2.61) 3.74 (2.60) are performing less challenging tasks for much longer periods. Nev-
the computer screen ertheless, these results provide little support for the proposal that
Blurred vision when looking 2.83 (2.31) 3.57 (2.63) symptoms of digital eyestrain result from the blue light output of
into the distance these devices.
Difficulty or slowness in refocusing 4.30 (2.75) 4.04 (2.84) It is possible that the neutral-density filter, which eliminated over
my eyes from one distance 50% of the blue light, also reduced symptoms, possibly as a result
to another of reduced discomfort glare.28 The 0.3-log unit neutral-density filter
Irritated or burning eyes 3.87 (3.00) 4.09 (3.13) used here was selected to match the luminance change produced
by the blue-blocking filter. Had a less dense neutral-density filter
Dry eyes 5.43 (2.81) 5.70 (2.24)
been selected, then any differences in symptoms could have reflected
Eyestrain 5.35 (2.77) 5.48 (2.59) these luminance differences, rather than being a consequence of
Headache 2.35 (2.79) 2.61 (2.92) blocking the shorter wavelengths.
Tired eyes 6.35 (2.84) 6.13 (2.63) It should be noted that the mean total symptom scores observed
here, namely, around 42 on a scale from 0 to 100, were markedly
Sensitivity to bright lights 1.91 (1.86) 1.74 (1.94) higher than observed in previous studies using similar tasks and the
Discomfort in your eyes 5.65 (3.27) 5.52 (2.54) same symptom questionnaire.18,22,23 For example, in an earlier in-
Total score 42.83 (17.52) 42.61 (15.55) vestigation that examined the effect of induced astigmatism on dig-
ital eyestrain, the median symptom scores either with no induced
Figures in parentheses indicate 1 standard deviation.
astigmatism or when viewing through an additional −1.00 or −2.00 D

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Blue-blocking Filters and Digital Eyestrain — Palavets and Rosenfield
FIGURE 4. Mean pupil diameter as a function of time for the two filter
conditions. Error bars indicate ±1 SEM. BB = blue-blocking filter;
ND = neutral-density filter.
cylinder axis 45° were 2.0, 6.5, and 40.0, respectively.18 There-
fore, the mean scores recorded in the present study for both filter
conditions were even higher than those observed after viewing a
computer screen through a −2.00 D oblique cylinder introduced
over the habitual refractive correction. Accordingly, it seems unlikely
that the neutral-density filter produced a marked reduction in symp-
toms. Nevertheless, future work should examine the effect of filters
that block less than 50% of blue light on digital eyestrain symptoms.
In addition, a previous history of digital eyestrain was not an in-
clusion criterion for the present investigation. Therefore, the blue-
blocking filters may have been less effective in those subjects who
did not habitually experience these symptoms. Questioning after
completion of the study revealed that only 7 of the 23 subjects
who responded experienced digital eyestrain routinely, although,
interestingly, 19 of the 23 encountered symptoms of dry eye on a
regular basis. Nevertheless, as noted previously, the demanding
task adopted here was successful in evoking symptoms, and there-
fore, one might have expected the blue-blocking filter to attenuate
these symptoms.
An additional limitation is that the symptom questionnaire was
only used to assess symptoms after the task. It is possible that there
was a difference in symptom levels in the two conditions before
performing the reading task. However, the symptom questionnaire
specifically asked about conditions during the trial and therefore
was not appropriate for measuring pre-task symptoms. Indeed, to
overcome this problem, a 5-minute period of distance fixation
was included immediately before the task. Previous studies have
indicated that this is sufficient to allow the effects of any previous
near work to be eliminated.20,21 Therefore, one might expect that
the level of symptoms being experienced immediately before the
reading task would be minimal. Furthermore, near visual acuity
was not assessed before starting the reading task (or used as an in-
clusion criterion), although it should be noted that none of the sub-
jects reported any difficulty reading the presented text.
Interestingly, Leung et al.29 examined the transmission of five
different blue-filtering, commercially available, spectacle lenses
and observed transmissions for wavelengths between 400 and
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500 nm ranging from 74.9 to 90.3%. Although we did not specif-
ically check the transmission of the spectacle lenses worn by the
subjects in the present study, to our knowledge, based upon obser-
vation of the glasses, none of them included tints or blue-blocking
filters. Leung et al.29 also reported that no significant reduction in
either contrast sensitivity or color vision was found when viewing
through lenses with blue transmissions of 77.5% and 82.2%.
One might predict that filters that block higher levels of blue light
could have a detrimental effect on color perception.30 This could
have a serious impact on an individual performing a task that required
the ability to distinguish between different hues at the blue end of the
color spectrum. The blue-blocking filter used in the present study,
which blocked 99% of blue light, had a bright yellow appearance.
It seems likely that many patients would be unhappy wearing lenses
with such a tint. In addition, no attempt was made after the study to
determine whether the subjects were able to identify the treatment
versus the control filter. However, given the similar findings for the
two conditions, this does not appear to have been a significant issue.
An additional point to consider is that light sensitivity changes
under scotopic conditions, when compared with photopic illumina-
tion, resulting in the Purkinje shift with peak sensitivity around
509 nm.31 Under mesopic conditions, the highest sensitivity will
lie somewhere between 555 and 509 nm. Accordingly, short wave-
lengths become increasingly important in dim illumination. Further-
more, scotopic visual sensitivity decreases faster than photopic
sensitivity with increasing age.32 Therefore, the use of blue filters
in older adults should be approached with caution, because they
may impair the ability to perform visual activities under dim condi-
tions. Furthermore, a larger average pupil diameter was observed
throughout the task (Fig. 4) when viewing through the blue filter
(mean, 5.02 mm), compared with viewing through the neutral-
density filter (mean, 4.67 mm). Although this difference was not
statistically significant (P = .10), it may have been produced by
the blue filter–blocking shorter wavelengths.33,34 Indeed, Kardon
et al.35 demonstrated that, in normal eyes, blue light evoked a greater
light-mediated pupil response, when compared with red light. This
may be at least partly owing to the relative sensitivity of intrinsically
FIGURE 5. Mean vertical palpebral aperture dimension (VPAD) as a
function of time for the two filter conditions. Error bars indicate ±1
SEM. BB = blue-blocking filter; ND = neutral-density filter.
Optom Vis Sci 2019; Vol 96(1) 52
 Blue-blocking Filters and Digital Eyestrain — Palavets and Rosenfield

photosensitive retinal ganglion cells being biased toward the blue
and blue-green regions of the visible spectrum.36
The validity of using changes in the critical fusion frequency as
a measure of visual fatigue is open to question. For example, both
Lin et al.37 and Maeda et al.16 observed a significant decrease in
critical fusion frequency after a sustained computer task, accompa-
nied by a significant increase in visual symptoms. However, neither
study found a significant correlation between the objective critical
fusion frequency changes and subjective symptoms. Lin et al.14 re-
ported a mean increase in critical fusion frequency in those subjects
wearing the high-blocking blue filters (40% transmission) but,
interestingly, no significant change in critical fusion frequency in
the low-blocking blue filters (76% transmission) or clear lenses
immediately after the task. One would expect to find increased
digital eyestrain and therefore a decrease in critical fusion fre-
quency in the latter two conditions, and the absence of a signifi-
cant change suggests that either the test was not sufficiently
demanding to produce a change in post-task critical fusion fre-
quency or task-induced changes in critical fusion frequency do
not mirror digital eyestrain symptoms in individual patients. Further
work is required to test the proposal that task-induced changes in
critical fusion frequency reflect visual fatigue after a sustained
near task. It should also be noted that the high-blocking filter used
by Lin et al.14 allowed approximately 45 to 60% transmission of
wavelengths between 450 and 500 nm, whereas the blue-blocking
filter used in the present study only allowed between 6% and 26%
transmission of these wavelengths.
In considering the role of blue light in visual fatigue, to date, no
clear mechanism has been elucidated to explain why blue light
plays a greater role in causing symptoms, when compared with
other wavelengths. In considering the visual symptoms that arise
from fluorescent lighting, Wilkins and Wilkinson38 noted that a tint
that removed short wavelengths would reduce the modulation of the
lamp. They cited four cases where a tint that removed 90% of light
between 400 and 500 nm produced increased comfort, but
none of these cases related to digital eyestrain. Interestingly, Vi-
ola et al.6 reported that the use of blue-enriched white fluores-
cent lighting (17,000 K) in an office setting produced improved
alertness, positive mood, ability to concentrate, ability to think
clearly, and decreased evening fatigue, when compared with white
fluorescent lighting (4000 K).
Accordingly, it remains unclear why blue wavelengths should
produce digital eyestrain symptoms. Simply because digital
screens emit larger percentages of blue light than standard incan-
descent light sources, and concurrently there is a higher rate
of symptoms with these electronic devices, when compared
with hard copy materials, does not prove causation. Indeed, a
recent systematic review by Lawrenson et al.12 concluded that
there is currently “a lack of high-quality evidence” to support using
blue-blocking filters to improve visual performance or alleviate eye
fatigue. It should also be noted that the output of blue wave-
lengths from digital devices is a fraction of the exposure received
from sunlight.8 Accordingly, further research into the efficacy of
blue-blocking filters is required before they can be advocated as
a treatment for digital eyestrain.

ARTICLE INFORMATION
Supplemental Digital Content: Appendix 1, the question-
naire administered to subjects immediately following the
reading task, is available at http://links.lww.com/OPX/
A366. The questionnaire is taken from Hayes et al.24
Submitted: December 1, 2017
Accepted: September 4, 2018
Funding/Support: None of the authors have reported
funding/support.
Conflict of Interest Disclosure: None of the authors have
reported a financial conflict of interest.
Author Contributions and Acknowledgments: Conceptualization:
MR; Data Curation: TP; Formal Analysis: TP; Investigation:
TP, MR; Methodology: TP, MR; Project Administration:
TP, MR; Supervision: MR; Writing – Original Draft: MR.
The authors thank Dr. David Loshin and Ms. Michelle
Merida Morgado, Nova Southeastern University, College
of Optometry, for their assistance in generating Figs.
2A and B of this article.
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