Digital Eye Strain; a Whole-Brain Energy Issue

THE HIDDEN ENERGY TAX OF SCREENS:

How Digital Light Drains the Modern Mind and Body

By Lennard Goetze, Ed.D / Roberta Kline, MD & Adam Karp

 

Imagine staring into a computer screen that pulses light into your eyes 60 times per second (60 Hz). This is the unseen reality of modern digital work: a constant rhythmic assault of light signals entering the visual system and taxing the brain. Over time, this continuous stimulation contributes to mental fatigue, visual strain, and a cascade of downstream health effects. Like a deer frozen in headlights, we remain largely unaware of how prolonged screen exposure quietly undermines our energy and well-being.

The Quiet Fatigue No One Talks About

By the end of a long workday, many people feel an exhaustion that sleep alone does not seem to fix. The body hasn’t lifted heavy objects or run miles, yet the fatigue is real—often accompanied by headaches, dizziness, irritability, blurred vision, or a vague sense of being “fried.” In the digital era, this exhaustion is increasingly linked not to physical labor, but to prolonged exposure to screens: computers, tablets, and—most relentlessly—smartphones.

What makes this form of fatigue particularly insidious is that it feels invisible. Light has no weight, screens don’t hum loudly, and the eyes appear passive. Yet behind the scenes, the visual system and nervous system are working continuously to interpret millions of rapid light pulses, stabilize images, suppress motion conflicts, and maintain focus. This process consumes energy—neurological, muscular, and metabolic. Over time, that demand adds up. This article explores how digital light interacts with the eye and brain, why certain screen characteristics quietly drain energy, and how modern screen habits create a form of chronic neurological fatigue that is only now being fully appreciated.

 

---

 

THE EYE IS NOT A CAMERA: IT IS AN ENERGY-CONSUMING ORGAN

The human eye is an extension of the brain. The retina alone contains over 120 million photoreceptors and a dense network of neurons that begin visual processing before information ever reaches the visual cortex. Unlike a camera sensor that passively records light, the retina is metabolically active tissue with one of the highest oxygen demands in the body.

Every time light strikes the retina, photoreceptors convert photons into electrical signals through a process called phototransduction. This biochemical cascade requires energy. When light input is natural and variable—as with sunlight reflected from real-world objects—the system evolved to handle it efficiently. Screens, however, present a very different stimulus.

---

 

THE “BEATS” OF DIGITAL LIGHT: FLICKER, REFRESH, AND NEURAL LOAD

Most digital displays do not emit steady light. Instead, they refresh images many times per second, measured in hertz (Hz). Common refresh rates include 60 Hz, 90 Hz, 120 Hz, and higher. Additionally, many screens regulate brightness using pulse-width modulation (PWM), rapidly turning light on and off—sometimes hundreds or even thousands of times per second.

Although these fluctuations are often too fast to be consciously perceived, the retina and visual pathways still register them. Some displays flicker in the range of roughly 200–1,000 cycles per second, depending on hardware and brightness settings. This creates what some researchers describe as a “temporal noise” signal—constant micro-adjustments that the visual system must process and stabilize. The result is subtle but cumulative strain. Eye muscles work continuously to maintain fixation. Retinal neurons fire repeatedly. The brain expends energy filtering out instability that never fully resolves into rest. Over hours, this effort translates into fatigue, reduced concentration, and mental depletion.

 

---

WHY THE BRAIN GETS TIRED BEFORE THE EYES

Many people assume eye strain is purely a muscular problem. In reality, the deeper issue is neurological. The brain must integrate visual input with balance (vestibular signals), proprioception, and cognitive context. Screens—especially scrolling feeds, fast-cut videos, or virtual environments—often signal motion without corresponding physical movement.

This mismatch can create a phenomenon known as cybersickness, a digital cousin of motion sickness. The eyes report movement; the inner ear reports stillness. The brain attempts to reconcile conflicting information, activating stress and nausea pathways originally designed as evolutionary defenses. Even mild versions of this conflict consume energy and increase cognitive load.  Over time, the nervous system responds with symptoms such as dizziness, mental fog, irritability, and profound tiredness—despite minimal physical effort.

Fixed Distance, Fixed Focus, and Muscle Fatigue

Another overlooked factor is distance fixation. When working on a computer or phone, the eyes often remain focused at a single near distance for hours. The ciliary muscles responsible for lens accommodation stay contracted, rarely relaxing.

In natural environments, vision constantly shifts—near to far, wide to narrow. Screens collapse this dynamic range into a single focal plane. Prolonged contraction leads to muscular fatigue and discomfort, but more importantly, it deprives the visual system of its natural rhythm. The absence of visual variability contributes to a sense of stagnation and exhaustion.

 

 

BLINKING LESS, WORKING MORE

Humans blink approximately 15–20 times per minute under normal conditions. During screen use, that rate can drop by as much as 50%. Reduced blinking destabilizes the tear film, leading to dryness, irritation, and inflammation.

Dry eyes force the visual system to work harder to maintain clarity. The brain compensates by increasing attentional effort, which further drains energy. What begins as eye discomfort often escalates into full-body fatigue because the nervous system is continuously compensating for degraded visual input.

 

BLUE LIGHT AND CIRCADIAN DISRUPTION

Screens emit a high proportion of short-wavelength blue light. While blue light is not inherently harmful and plays a role in alertness, excessive exposure—especially in the evening—can disrupt circadian rhythms by suppressing melatonin production.

Disrupted sleep compounds daytime fatigue, creating a feedback loop: tired individuals rely more on screens, which further impair sleep, which then worsens energy depletion. Over weeks or months, this cycle contributes to chronic exhaustion that feels disproportionate to daily activity.

Energy Drain as a Systemic Issue: What emerges is a broader picture: screen-related fatigue is not just an eye problem. It is a whole-system energy drain involving visual processing, muscle tension, neural integration, hormonal rhythms, and posture. Poor ergonomics amplify the problem by adding neck and shoulder strain, further taxing the nervous system. The cumulative effect is subtle but powerful. Digital work environments demand constant vigilance from systems that evolved for intermittent, varied sensory input—not unbroken streams of artificial light.

---

 

Practical Strategies to Reduce the Energy Cost

While screens are unavoidable, their energetic toll can be reduced:

·   Adopt visual breaks: The 20-20-20 rule helps reset accommodation and reduce neural load.

·   Increase refresh rates: Higher refresh rates and flicker-free displays reduce retinal stress.

·   Optimize lighting: Match screen brightness to ambient light; avoid harsh contrast.

·   Encourage blinking: Conscious blinking or lubricating eye drops can restore tear stability.

·   Limit evening exposure: Blue-light filters and screen curfews protect circadian health.

·   Vary visual distance: Regularly look out windows or across rooms to restore depth variation.

These interventions don’t eliminate digital fatigue, but they meaningfully reduce its energetic cost.

 

 

 

Part 2:

Cognitive Fatigue and the Brain Cost of Digital Eye Strain

 

Beyond dry eyes and headaches, prolonged screen exposure is increasingly associated with cognitive symptoms—including mental fatigue, slowed thinking, reduced attention span, irritability, and what many describe as “brain fog.” Importantly, these effects are not best understood as isolated eye problems, but as the downstream consequence of sustained visual–neurological overload.

 

The visual system is one of the brain’s most energy-intensive networks. When screens create suboptimal viewing conditions—such as prolonged near focus, reduced blinking, glare, low contrast, motion-heavy content, or temporal light modulation—the brain must allocate additional resources simply to maintain stable perception. This phenomenon is often described as increased cognitive load: mental energy is diverted from higher-order tasks (decision-making, memory, creativity) toward the basic act of seeing clearly.

 

Research on Digital Eye Strain (DES) and Computer Vision Syndrome (CVS) consistently reports not only ocular discomfort, but also reduced work efficiency, attentional fatigue, and difficulty sustaining concentration over time. In practical terms, the brain is forced to “work overtime” to compensate for degraded or uncomfortable visual input, accelerating mental exhaustion even in the absence of physical effort.

 

Another contributor is visual–vestibular mismatch, particularly during scrolling, rapid video playback, gaming, or immersive digital environments. When the eyes signal motion while the body remains still, the brain must resolve conflicting sensory information. This mismatch—well documented in studies of cybersickness and visually induced motion sickness—can produce cognitive aftereffects such as slowed reaction time, impaired focus, and lingering mental fatigue long after screen exposure ends.

 

Sleep disruption further compounds these effects. Evening exposure to light-emitting screens can delay circadian rhythms and suppress melatonin, resulting in shorter or poorer-quality sleep. Even modest sleep impairment has been shown to degrade executive function, working memory, and emotional regulation the following day—amplifying the cognitive toll of visual strain.

 

Crucially, these cognitive symptoms are often reversible, but only when visual stressors are reduced. Persistent exposure without mitigation may create a chronic state of low-grade neurological fatigue, where individuals feel mentally depleted yet struggle to identify a clear cause. Recognizing digital eye strain as a whole-brain energy issue, rather than merely an eye complaint, reframes prevention strategies toward protecting cognitive performance—not just visual comfort.

 

Conclusion: Seeing Fatigue Clearly

In a world where productivity is increasingly measured in screen hours, digital fatigue has become normalized. Yet this exhaustion is not a personal failure or lack of resilience—it is a physiological response to sustained, unnatural visual demands.

Understanding the relationship between digital light, the retina, and the brain reframes fatigue as a signal, not a weakness. Screens extract energy not through effort, but through constant stimulation. Awareness is the first step toward reclaiming that energy. By respecting the limits of our visual and neurological systems, we can work with technology—rather than quietly burning out under its glow.

 

---

 

 

References

1.      American Optometric Association. (2023). Computer vision syndrome.

2.      Bhandari, A., et al. (2021). Visual fatigue and display flicker: Neurological implications. Journal of Vision Science, 21(4), 1–12.

3.      Chang, A. M., et al. (2015). Evening use of light-emitting devices and sleep. PNAS, 112(4), 1232–1237.

4.      Coles-Brennan, C., Sulley, A., & Young, G. (2019). Management of digital eye strain. Clinical and Experimental Optometry, 102(1), 18–29.

5.      Hecht, S. (2018). Phototransduction and retinal energy demand. Progress in Retinal Research, 62, 1–24.

6.      Howarth, P. A. (2018). Potential hazards of viewing electronic displays. Applied Ergonomics, 67, 1–8.

7.      Kramida, G. (2016). Resolving the vergence–accommodation conflict. IEEE Computer Graphics and Applications, 36(4), 32–40.

8.      Rosenfield, M. (2016). Computer vision syndrome: A review. Ophthalmic & Physiological Optics, 36(5), 502–515.

9.      Sheppard, A. L., & Wolffsohn, J. S. (2018). Digital eye strain. Ophthalmic & Physiological Optics, 38(1), 2–25.

10.  Wilkins, A. J., et al. (2010). Flicker and visual discomfort. Vision Research, 50(23), 2381–2387.

11.  Benedetto, S., Carbone, A., Drai-Zerbib, V., Pedrotti, M., & Baccino, T. (2014). Effects of luminance and illuminance on visual fatigue and arousal during digital reading. Computers in Human Behavior, 41, 112–119.

12.  Kennedy, R. S., Lane, N. E., Berbaum, K. S., & Lilienthal, M. G. (1993). Simulator sickness questionnaire: An enhanced method for quantifying simulator sickness. The International Journal of Aviation Psychology, 3(3), 203–220.

13.  Lim, J., & Dinges, D. F. (2010). A meta-analysis of the impact of short-term sleep deprivation on cognitive variables. Psychological Bulletin, 136(3), 375–389.

14.  Lleras, A., & Enns, J. T. (2004). Negative aftereffects of attentional set: Evidence for flexible cognitive control. Journal of Experimental Psychology: General, 133(3), 342–371.

15.  Reimer, B., Mehler, B., Wang, Y., & Coughlin, J. F. (2014). A field study on the impact of visual and cognitive demands on driver fatigue. Human Factors, 56(7), 1222–1236.

 

Top of Form

 

Bottom of Form

 

HEALTHTECH 2026 BUSINESS REVIEW: ERCHONIA

Three Decades of Building a Non-Invasive HealthTech Pioneer

In an industry often driven by rapid trends and short product cycles, Erchonia has taken a markedly different path—one defined by long-term scientific commitment, regulatory leadership, and a deeply rooted belief in non-invasive medicine. Approaching its 30th year in operation, the company stands today not simply as a laser manufacturer, but as a case study in how health technology firms can build enduring credibility through research-first innovation.

Founded in the mid-1990s as a family-owned enterprise, Erchonia emerged from a practical clinical need rather than a marketing concept. Its origins trace back to a physician using early photochemical laser therapy overseas—technology that, at the time, had yet to find a structured pathway into U.S. healthcare. Recognizing both the potential and the gap, the company’s engineering leadership began developing portable, clinically adaptable laser systems that would eventually reshape how low-level laser therapy was understood in medical settings.

What distinguishes Erchonia in the competitive landscape is not only longevity, but its pioneering regulatory achievements. The company became the first to secure FDA clearance for a non-heating laser system—effectively creating a new category within federal medical device standards. This milestone established Erchonia as more than a device supplier; it positioned the company as a regulatory trailblazer helping define how light-based therapies could be validated, standardized, and trusted in mainstream care.

Over the years, that regulatory mindset has remained central to Erchonia’s identity. With more than twenty FDA clearances and a portfolio of double-blind, placebo-controlled clinical trials, the company has built one of the most extensive evidence bases in the laser and light-therapy sector. This research-first culture has allowed Erchonia to transcend the common perception of aesthetic or wellness technologies as “adjunct tools,” instead reframing them as legitimate medical platforms capable of addressing pain management, metabolic health, neurological conditions, and functional medicine applications. 

At the business level, Erchonia operates at the intersection of healthcare, aesthetics, and performance medicine—a positioning that has enabled the company to weather multiple industry shifts. Rather than tether itself to a single vertical, Erchonia has built an adaptable ecosystem where the same core science can serve medical practices, rehabilitation centers, and wellness-focused clinics alike. This flexibility has proven especially valuable as healthcare continues its gradual pivot toward outpatient, non-pharmacologic, and patient-empowering solutions.

Leadership continuity has played a critical role in this evolution. As a second-generation executive, James Shanks represents both institutional memory and forward-looking strategy. His stewardship reflects a company culture that values engineering rigor, clinical dialogue, and long-term relationships with practitioners. Erchonia’s partnerships with functional medicine doctors, pain specialists, and integrative health leaders illustrate a business philosophy grounded less in transactional sales and more in shared outcomes.

Perhaps most telling is how Erchonia positions itself within the broader healthtech narrative. Rather than competing in the crowded space of “latest devices,” the company frames its mission around advancing the acceptance of non-invasive therapeutics as a standard of care. This aligns with a growing healthcare ethos—one that favors intervention without disruption, therapy without trauma, and innovation that reduces reliance on surgery and pharmaceuticals.

As healthcare systems worldwide grapple with cost pressures, chronic disease burden, and patient demand for gentler treatment options, Erchonia’s three-decade trajectory offers a compelling blueprint. Its story underscores that sustainable success in health technology is rarely built on novelty alone. Instead, it is forged through disciplined research, regulatory courage, and a corporate identity anchored in service to both clinicians and patients.

In a sector often driven by the next breakthrough headline, Erchonia stands out for something more enduring: a quiet, consistent commitment to reshaping how medicine heals—one wavelength at a time 

EXTRA: PRINT-ONLY VERSION:
"WHEN TECHNOLOGY LEARNS TO LISTEN: The Rise of Emerald-Light Therapeutics" - a user's report on the The Erchonia Emerald® Laser (Targeting Aesthetics and Fat Reduction)

T E C H O N O M I C   R E P O R T E R

Erchonia’s Quiet Superpower: A Family-Owned Blueprint for Non-Invasive Medicine

By Russ Allen (Wellness Now) and Robert L. Bard, MD, DABR, FAIUM, FASLMS (HealthTech Reporter / AngioInstitute)

In a healthtech landscape crowded with fast-follow gadgets and short-lived “miracle” claims, Erchonia stands apart for a rarer virtue: it built the category the right way—through time, discipline, and a family-owned insistence on doing the science first. Founded in 1996, the company is still family operated and has consistently positioned laser therapy as a serious clinical tool—not a trend. 

From a business-review perspective, the most impressive aspect of Erchonia is not one flagship device; it’s the operating philosophy behind the portfolio. Erchonia’s model is built around regulatory credibility, clinical validation, and long-horizon R&D—an approach that is increasingly valuable as non-invasive medicine expands across specialties. Their EMEA overview highlights scale (18,000+ devices in market) and emphasizes extensive FDA-clearance leadership for low-level lasers. 

Russ Allen, who works directly with patients seeking modern, non-drug solutions, frames the company’s reputation in practical terms: “Erchonia doesn’t feel like a ‘product company’—it feels like a clinical partner. When a family-owned manufacturer treats outcomes as the headline, it changes how practitioners show up and how patients trust the process.” He adds, “In wellness and functional care, trust is everything. Erchonia earned it the slow way—through proof, not hype.”

Dr. Robert L. Bard sees Erchonia through the AngioInstitute lens: technology as a public-health lever. “Non-invasive medicine is not a luxury—it’s the future default,” he notes. “Erchonia represents a mature version of healthtech: disciplined engineering, documented efficacy, and an insistence on staying aligned with patient-friendly care pathways.”

This matters because the macro trend is unmistakable. Photomedicine/photobiomodulation continues to scale as systems face chronic disease burdens and patient demand for lower-risk options. One market analysis estimates photomedicine technology at roughly $498M in 2024, projecting growth through 2033. The broader femtech ecosystem—another pillar of non-invasive, patient-driven care—was estimated around $39.29B in 2024, projecting steep growth into 2030. Neurotechnology (including neurostimulation and related platforms) is also forecast to expand rapidly. 

Even without a definitive revenue number, the business signal is clear: Erchonia has built what most healthtech companies chase but rarely achieve—durable credibility. In an era where patients want fewer drugs, fewer procedures, and more measurable outcomes, Erchonia’s family-owned, evidence-forward posture isn’t just admirable. It’s strategically inevitable.

REFERENCES

1. Coherent Market Insights. (n.d.). Photobiomodulation market. Retrieved January 14, 2026, from Coherent Market Insights website. 

2. Coherent Market Insights. (2024, December 11). Photobiomodulation market to reach USD 455.1 million by 2031, says Coherent Market Insights [Press release]. BioSpace. 

3. Grand View Research. (n.d.). FemTech market size, share & growth analysis report, 2030. Retrieved January 14, 2026, from Grand View Research website. 

4. LeadIQ. (n.d.). Erchonia Corporation: Company overview. Retrieved January 14, 2026, from LeadIQ website. 

5. Seamless.AI. (n.d.). Erchonia Corporation: Staff directory, phone & corporate office. Retrieved January 14, 2026, from Seamless.AI website. 

6. Mordor Intelligence. (2025, January 31). Photobiostimulation market: Size & trends. Retrieved January 14, 2026, from Mordor Intelligence website. 

7. Vantage Market Research. (2025, February 21). Photobiomodulation market size & share: Growth analysis. Retrieved January 14, 2026, from Vantage Market Research website. 

8. Future Market Insights. (2025, August 23). Cold laser therapy market analysis: Size, share & forecast 2025 to 2035. Retrieved January 14, 2026, from Future Market Insights website. 

How Thermology Reveals the Body’s Hidden Stories

THE INFORMATIVE FEET By Dr. Phil  Hoekstra

 

Introduction

In modern diagnostics, the body often speaks before symptoms do—through subtle physiological signals that sophisticated imaging can now detect. Among the most revealing of these signals are temperature patterns, captured through medical thermology (clinical infrared thermal imaging). While many clinicians focus on major organs, I have long maintained that the feet are among the most informative regions of the body. From microcirculation and vascular integrity to neurologic signaling and pain syndromes, the feet function as living maps of systemic health. In my clinical experience, thermographic imaging of the feet offers one of the clearest, most sensitive windows into how well the body is truly functioning

.

---

Why the Feet Matter

The feet sit at the farthest reach of the circulatory system. Because of this distance, they are often the first place where compromised blood flow becomes visible. In conditions such as peripheral vascular disease, arterial stenosis, or early atherosclerosis, thermology frequently reveals progressive cooling patterns from the thigh downward, with the most dramatic changes appearing in the toes and forefoot

For patients with diabetes, this sensitivity becomes even more critical. Diabetes commonly affects microcirculation—the smallest blood vessels supplying tissues—and the feet are typically the earliest site of microangiopathy. Thermal imaging can show distinct temperature demarcations between toes and the body of the foot, reflecting compromised perfusion long before ulcers or neuropathy become clinically obvious

.

---

Reading Circulation Through Heat

Thermology does not measure blood flow directly; it measures heat patterns generated by circulation. Healthy perfusion produces symmetrical, evenly distributed warmth. When blood flow is impaired, asymmetries and cold zones emerge.

In vascular medicine, these patterns allow clinicians to:

• Detect early-stage peripheral arterial disease
• Monitor the effectiveness of revascularization or medical therapy
• Track small-vessel perfusion after interventions

In my early work at the USC Non-Invasive Laboratory, among all available tools, thermology consistently proved the most sensitive modality for studying perfusion in the feet. The hands, by contrast, often remain warm until disease is advanced. The feet tell the story first

Neurologic Clues Beneath the Skin

Beyond circulation, the feet are remarkably revealing for neurologic disorders. Thermal imaging can visualize dermatomal patterns—areas of skin supplied by specific spinal nerve roots. When a nerve is irritated or compressed, the temperature distribution across corresponding toes often changes.

In cases involving lumbar nerve roots (L3, L4, L5), thermology can show:

• Warmth or cooling in specific toe groupings
• Clear conformity to dermatome maps
• Objective evidence of radicular neuropathy

Traditionally, dermatome mapping relied on uncomfortable sensory testing. With thermology, clinicians can see the nervous system’s influence on circulation, offering a noninvasive, patient-friendly alternative

.

Complex Pain Syndromes and Autonomic Dysfunction

Thermology is also one of the most powerful tools for identifying complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy. These patients often present with dramatically cold, painful feet—an unmistakable thermal signature of autonomic dysfunction.

What makes thermology unique is not only its ability to detect these abnormalities, but to document recovery. As treatment restores sympathetic balance and blood flow, thermal symmetry returns. Few diagnostic tools so clearly reflect physiologic change in real time

---

Observing the Body’s Reflexes

Over decades of practice, I have witnessed fascinating demonstrations of the body’s interconnectedness through thermology. In patients with CRPS, I have observed sudden surges of heat in the foot following auricular acupuncture—stimulation of specific points in the ear associated with neural reflex pathways. While the exact mechanisms remain under study, the thermographic evidence of instant vascular response is undeniable .

These observations remind us that thermology is not only a diagnostic tool, but a real-time physiologic monitor, capable of revealing how therapies—conventional or complementary—affect the nervous and vascular systems.

Where to Scan: The Dorsal Advantage

In foot thermography, technique matters. While it may seem intuitive to image the soles, I have consistently found the dorsal (top) surface of the foot to be more reliable. The soles often vary greatly in skin thickness and callus formation, which can insulate heat and distort readings. The dorsal aspect, by contrast, offers:

• More consistent skin thickness
  
• Clearer visualization of vascular patterns
• Better reproducibility across patients

Standardizing imaging protocols in this way ensures that thermology remains both scientifically credible and clinically useful.

---

Expanding the Clinical Vision

Modern research continues to support what thermologists have long observed: thermal asymmetry correlates strongly with pathology. Studies in diabetic care, sports medicine, and vascular screening now increasingly recognize infrared imaging as a valuable adjunct for:

• Early detection of neuropathic changes
• Monitoring inflammatory conditions
• Preventing ulcer formation in high-risk patients
• Assessing rehabilitation progress after injury

As healthcare shifts toward prevention and precision monitoring, thermology of the feet stands poised to become a cornerstone of noninvasive functional diagnostics.

 Conclusion: The feet are not merely instruments of movement—they are diagnostic storytellers. Through thermology, we can read the subtle language of circulation, nerve integrity, and autonomic balance long before disease declares itself clinically. In my career devoted to thermal imaging, few regions have proven as consistently revealing as the feet. They offer clinicians a rare combination of sensitivity, accessibility, and clinical relevance. In an era that increasingly values early detection and patient-centered care, the informative feet remind us that sometimes the most profound insights into health lie at the very foundation of the body.

---

 

 Epilogue

From Observation to Intelligence: The Informative Feet and the Future of Diagnostics

By Robert L. Bard, MD, DABR, FAIUM, FASLMS

 

Dr. Phil Hoekstra’s  "The Informative Feet" is more than a clinical report—it is a timely reflection of how far diagnostic medicine has come, and how much further it is poised to go. For decades, physicians relied primarily on surface observation and symptom reporting to understand disorders that were, in truth, deeply physiologic in nature. Today, we stand in a new era—one defined by quantitative imaging, data integration, and clinical intelligence that allows us to see, measure, and track disease in ways previously unimaginable.

The evolution of diagnostics has transformed medicine from reactive to proactive. Where we once waited for pathology to declare itself, we now have the tools to detect physiologic change at its earliest stages. Advanced ultrasound, Doppler flow analysis, elastography, and thermography have shifted imaging from static confirmation to dynamic clinical partnership—supporting detection, diagnosis, treatment monitoring, and long-term surveillance of patient health. 

This transformation is further accelerated by the growing role of artificial intelligence. AI does not replace the clinician—it enhances clinical vision. By identifying patterns, tracking trends, and supporting large-scale data interpretation, AI allows physicians to move beyond isolated findings and toward predictive insight. In the study of neuropathy—particularly within the endocrinology and diabetes communities—this progress could not be more urgent. Neuropathy remains one of the most underdiagnosed, undertreated, and devastating complications of metabolic disease, often discovered only after irreversible damage has occurred.

Thermal imaging stands out in this landscape as a profoundly practical advancement. It offers a non-invasive, time-efficient, and cost-effective means of screening and monitoring neuropathic and inflammatory changes in the feet—areas where early physiologic shifts often precede structural breakdown. Compared to traditional diagnostic standards such as electromyography (EMG), which is frequently painful, time-consuming, and expensive, thermography provides a compelling alternative for early-stage assessment and longitudinal monitoring.

This does not diminish the role of established tools like EMG, nerve conduction studies, biopsy, or advanced cross-sectional imaging. Rather, it strengthens the diagnostic ecosystem—allowing clinicians to triage more intelligently, intervene earlier, and reserve invasive testing for when it is truly necessary. In the battle against diabetes and its complications, time is tissue. Every advancement that shortens the path from suspicion to action carries life-altering potential.

Dr. Hoekstra’s work reminds us that the feet are not peripheral—they are informative. They tell the story of circulation, nerve health, inflammation, and metabolic balance. When we listen more carefully—through imaging, data, and interdisciplinary collaboration—we do more than improve diagnostics. We elevate care itself.

References

American Academy of Thermology. (2012). Guidelines for neuromusculoskeletal infrared imaging. AAT.

Brioschi, M. L., Macedo, J. F., & Macedo, R. A. (2015). Skin thermography: New concepts. Journal of Vascular Diagnostics, 3(2), 1–9.

Gersh, M. R., & Arora, R. (2020). Thermography in peripheral vascular disease. Vascular Medicine Review, 12(4), 233–245.

Hoekstra, P. (Interview transcript). (n.d.). Thermology and the informative feet.

Jones, B. F. (1998). A reappraisal of the use of infrared thermal image analysis in medicine. IEEE Transactions on Medical Imaging, 17(6), 1019–1027.

Lahiri, B. B., Bagavathiappan, S., Jayakumar, T., & ip, J. (2012). Medical applications of infrared thermography: A review. Infrared Physics & Technology, 55(4), 221–235.

Ring, E. F. J., & Ammer, K. (2012). Infrared thermal imaging in medicine. Physiological Measurement, 33(3), R33–R46.

Sanchis-Sánchez, E., et al. (2020). Infrared thermography in the assessment of diabetic foot complications. Diabetes Care Technology, 8(2), 145–152.

Uematsu, S. (1985). Thermographic imaging of cutaneous sensory segmental areas. Journal of Neurosurgery, 62(5), 716–720.

Vardasca, R., & Ring, E. F. J. (2014). Thermography in the assessment of peripheral neuropathy. Medical Imaging and Diagnostics, 6(1), 12–20.