This is my story, experience and things i’ve tried. I’m not super technical, and so I don’t have recommendations for monitors or device setups specifically. I am not a doctor, and this does not constitute medical advice - but I hope to share my story and experiences in hopes of serving as stepping stone for someone going through a similar situation.

I have been dealing with this for about 2 years, on and off, I have a history of migraine with aura, historically have great vision especially long distance, but have also always been sensitive to light. About 2 years ago, I was experiencing visual snow, and after images, and noticed something weird when using a monitor for work - when I’d scroll an article on screen would leave a ghost image of the text.

My issues got worse after a migraine from hell - long story, that left me with dizzyness and significant eye pain when using screens and just wouldn't go away. Since then I’ve tried a variety of stuff, done a ton of research, and am back to being able to work from home. Am I back to normal? No - I’d say 80% right now, but I’m managing. I still get eye strain easily, and have trouble reading for long periods of time.

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FACTORS I'VE INVESTIGATED

Dry eye

How to test: see an optometrist or dry eye clinic.
Why is this worth considering: LED bulbs can potentially exacerbate already dry eyes - in my case I have mild dry eye in the same eye that’s worsened
What can you do: there are a few medical options such as natural eye drops (if you do use these be careful they became habit forming for me)
Another hack is to force yourself to yawn 3-4 times which will cause your eyes to tear - when i’ve done this it seems to help with reducing the strain in the eyes, and to relax muscles of the face

Migraine: There are different types of migraine, such as vestibular (generally feeling dizzy) which can be brought about by motion, and potentially light flicker. I recommend the audiobook Migraine by Oliver Sacks as a way to learn a bit more

What can you do?
- For vestibular migraine you can do vestibular physio to help with dizzyness / nauseous need - I think it helped a lot in my case (check out epleys maneuver). They also recommend 75hz+ monitors for those with issues with motion sickness / dizziness (I haven’t tried this though)
- What about for general migraine? - there are medications you can take (many are heavy duty and aren’t to be considered lightly), you can also get special migraine glasses like theraspecs, or use green light migraine therapy) - I tried a bunch of migraine medications and it didn’t work out for me but might be something to consider.

Light Sensitivity / Sensitivity to Contrast: I am very light sensitive, and also have high sensitivity to high and low contrast when in the same field of view. Screens draw my eyes like a moth to a flame.

What can you do?

I explored supplements like omega 3, lutein and zeaxanthin and still take them today, i’m not sure if they helped things for sure, but it’s possible.
I try and avoid driving at night (I tried to find night driving glasses which do help, but reduce visibility making driving more dangerous)
Consider using apps like MonitorControl and Monitarian (windows) to have quick access to brightness controls when it’s too much
You can also use the app Gamma Control and Iris to control blue light levels and brightness too - be careful with these as too little contrast may worsen eye strain
You can also try modifying your color profile on your monitor to see if it helps with contrast and strain (some folks recommend sRGB)
Reduce contrast between monitor and surrounding area: BenQ screenbar can help to raise surrounding brightness of task area, as well as ambient backlighting for the monitor (make sure it’s flicker free - not the easiest to find), and use even lighting in the room whether overhead or standing lamps
it might be worth looking into visual stress - it wasn’t a factor for me but may help you

Vision issues

I have very mild astigmatism, and have convergence insufficiency, and binocular vision disfunction. I have great vision otherwise.

What can you do:

Rule out anything serious by seeing an optometrist, and if needed an ophthalmologist / neurologist
Consider getting a test from a vision therapy clinic - be careful here too - the treatment can be very expensive - but I recommend exploring it to see if there’s something there. Ask how many sessions it typically takes and cost per session. I had to stop my vision therapy, but I did notice that my ability to complete vision therapy tasks improved over time - not sure whether this had a significant effect or not.
Prism lenses, Neurolens, vision therapy

Environmental Factors: When I first started noticing my issues, I was working at a screen in a dark corner of a room, with a window beside that resulted in extreme contrast.

What can you do?

Get a high quality pair of polarized sunglasses to wear outside in bright environments to reduce eyestrain outside the home
Improve the lighting in your home, especially in the office to ensure adequate (300-500lux) even light
Use sheer curtains and blinds to control light and spread the light evenly
Be careful of the extremes - extreme brightness or very dim environments which might make focusing difficult

On LEDs: I believe I’m very sensitive to LED flicker especially combined with the high brightness that comes along with LEDs in a concentrated point. LED strips, and LED arrays are the most troublesome for me, with monitors being less problematic, and projectors being the least bad of the bunch.

What can you do?

I recommend the waveform lighting bulbs which are almost entirely flicker free, which I've tested and have found to be much higher quality than Phillips bulbs
A neurologist recommended 75hz+ monitors but I’m not sure if that would address my issues specifically with light

On eye strain in general: It’s obvious probably to many of you that eye strain is the outcome of some other factors - that being said - here’s what I do to keep it manageable

Taking breaks every 30mins of computer usage, and combining that with a few mins of exercise (stair climbing, walking around the house - to get blood circulating)
20/20/20 rule of course - look at 20ft, for 20s every 20mins
Using desktop computer over a mobile phone (if you notice issues worsened at near like I did - might be worth following up with optometrist)
Forcing yawning to get the eyes to tear and the face muscles to relax
Using eye drops when necessary (preservative free)
Limiting screen time on wake-up, and before bed
Taking a warm shower upon waking up, and getting outside for a walk early on to get things warmed up and moving

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WHO CAN HELP

Optometrist: For me, finding a great optometrist was the key to getting the ball rolling, and I left my previous optometrist when things weren’t going anywhere. A good optometrist can cover the 80% of what an ophthalmologist can do, and depending on where you are can be much more accessible

Ophthalmologist / Neuro-Opthalmologist / Neurologist: These health professionals can be a huge help with diagnosis of conditions like migraine, and can prescribe medication such as eye drops / migraine meds. They can be extremely valuable to rule out known diseases of the eye and brain, but aren’t super helpful in my experience with functional issues like we are experiencing

Vision Therapist / Neuro Optometrist: Neuro optometry is a specialization of optometry that is sort of between optometry and neurology. They aren’t true doctors, but can investigate functional issues of the eyes - it’s important to find a good one if possible because the quality of their tests and care will be instrumental in evaluating vision therapy progress down the road. I saw a vision therapist and ultimately had to stop because of side effects that prevented me from working. They often recommend prism glasses to help the eyes focus together.

Physiotherapist: I have mild issues with my neck, and generally bad neck/head posture, but was referred to a vestibular physiotherapist by my neurologist. The vestibular physio therapist I saw focused on trying to strengthen the neck muscles and increase blood flow to the brain:

How they can help:

Epleys manoeuvre for vestibular issues (benign proximal vertigo)
Vestibular physio exercises / vision exercises
Hot packing the neck to relax muscles and increase blood flow

Ergonomist: Specializes in ergonomic set up of the workplace. Can help with improving posture/ setup to lessen long term issues of the body.

How they can help:

Requesting an ergonomic assessment from your workplace can potentially help to remove some of the physical strain of working at a screen for long periods of time
May or may not be able to help with lighting

Psychologists / Therapists: They can help if you have underlying anxiety. Stress exacerbated my problems, and although not the root of the problem, definitely made issues with eye strain worse.

Lighting Domain Consultants: Lighting ergonomic specialists and testers like Der Lichtpeter can be great to help understand what’s happening with lighting flicker.

When I asked him why is it that light flicker is so problematic to us, he provided the following amazing insight:
“imagine yourself in a discotheque only with the stroboscopic light on: You lose orientation, become dizzy and might feel sick. This is what happens directly. Apart from that, subconsciously, the alarming system in your brain is always active, which causes stress. The reason is simple: Fast light changes - instictively from millions of years of development - might give the system the idea this could be an archaeopteryx or a rock or anything else above your head threatening you.” His second point is that by being in exposed to that flicker, it’s putting us in a fight/flight mode, and causing heightened stress. Really interesting stuff!

Environmental Psychologists: Although not easily accessible, environmental psychologists understand the effects of light on the human body - such as Arnold Wilkins and Jennifer Veitch. I plan on reaching out to them at some point, but haven't gotten around to it.

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RESOURCES

Vision Snow Initiative https://www.visualsnowinitiative.org/
Arnold Wilkins Visual Stress https://www.youtube.com/watch?v=GBOzv9HgoWM
Der Lichtpeter’s page on light flicker https://www.derlichtpeter.de/en/light-flicker/
Relationship between photosensitivity in post-concussion patients, and aerobic exercise https://journals.lww.com/acsm-csmr/Fulltext/2018/08000/Exercise_is_Medicine_for_Concussion.5.aspx
Lighting flicker and potential side effects - Arnold Wilkins & Jennifer Veitch https://ece.northeastern.edu/groups/power/lehman/Publications/Pub2010/2010_9_Wilkins.pdf
The End of Flicker https://medium.com/@yeutterg/the-end-of-flicker-24f6169c5c7f
Ambient Backlighting May Ease Eye Strain at Night - ambient-backlight-displays-may-ease-eye-strain-at-night
Blurbusters https://forums.blurbusters.com/viewtopic.php?t=8446

Thanks for giving this, and hope that it can be of some use to you! 😀

If there are resources you've found in your travels - I'd love to know about them, or if there's any suggestions you have. Cheers!