BCLA CLEAR Presbyopia: Management with contact lenses and spectacles

This paper seeks to outline the history, market situation, clinical management and product performance related to the correction of presbyopia with both contact lenses and spectacles. The history of the development of various optical forms of presbyopic correction are reviewed, and an overview is presented of the current market status of contact lenses and spectacles. Clinical considerations in the fitting and aftercare of presbyopic contact lens and spectacle lens wearers are presented, with general recommendations for best practice. Current options for contact lens correction of presbyopia include soft simultaneous, rigid translating and rigid simultaneous designs, in addition to monovision. Spectacle options include single vision lenses, bifocal lenses and a range of progressive addition lenses. The comparative performance of both contact lens and spectacle lens options is presented. With a significant proportion of the global population now being presbyopic, this overview is particularly timely and is designed to act as a guide for researchers, industry and eyecare practitioners alike.

Computer vision syndrome-related symptoms in presbyopic computer workers

PURPOSE

To evaluate the prevalence of computer vision syndrome (CVS)-related symptoms in a presbyopic population using the computer as the main work tool, as well as the relationship of CVS with the electronic device use habits and the ergonomic factors.

METHODS

A sample of 198 presbyopic participants (aged 45-65 years) who regularly work with a computer completed a customised questionnaire divided into: general demographics, optical correction commonly used and for work, habits of electronic devices use, ergonomic conditions during the working hours and CVS-related symptoms during work performance. A total of 10 CVS-related symptoms were questioned indicating the severity with which they occurred (0-4) and the median total symptom score (MTSS) was calculated as the sum of the symptoms.

RESULTS

The MTSS in this presbyopic population is 7 ± 5 symptoms. The most common symptoms reported by participants are dry eyes, tired eyes and difficulties in refocusing. MTSS is higher in women (p < 0.05), in laptop computer users (p < 0.05) and in teleworkers compared to office workers (p < 0.05). Regarding ergonomic conditions, MTSS is higher in participants who do not take breaks while working (p < 0.05), who have an inadequately lighting in the workspace (p < 0.05) and in the participants reporting neck (p < 0.01) or back pain (p < 0.001).

CONCLUSION

There is a relationship between CVS-related symptoms, the use of electronic devices and the ergonomic factors, which indicates the importance of adapting workplaces, especially for home-based teleworkers, and following basic visual ergonomics rules.

Prevalence of Computer Vision Syndrome and Its Relationship with Ergonomic and Individual Factors in Presbyopic VDT Workers Using Progressive Addition Lenses

This cross-sectional study estimated computer vision syndrome (CVS) prevalence and analysed its relationship with video display terminal (VDT) exposure, as well as sociodemographic, refractive, environmental, and ergonomic characteristics in 109 presbyopic VDT workers wearing progressive addition lenses (PALs). Usual spectacles were measured with a lens analyser, and subjective refraction was performed by an optometrist. CVS was measured with the CVS-Q©. VDT exposure was collected. Ergonomic evaluations were conducted in a normal working posture looking at the screen. Air temperature and relative humidity were measured (thermohygrometer), and illumination was measured (luxmeter). Descriptive analysis and differences in CVS prevalence, as a function of the explanatory variables, were performed (chi-square test). Multivariate logistic regression was used to identify factors associated with CVS (OR and 95% CI). The mean age was 54.0 ± 4.8 years, and 43.1% were women. The mean hours of VDT use at work was 6.5 ± 1.3 hours/day. The prevalence of CVS was 74.3%. CVS was significantly associated with women (OR 3.40; 95% CI, 1.12–10.33), non-neutral neck posture (OR 3.27; 95% CI, 1.03–10.41) and altered workplace lighting (OR 3.64; 95% CI, 1.22–10.81). Providing training and information to workers regarding the importance of adequate lighting and ergonomic postures during VDT use is advised to decrease CVS and increase workplace quality of life.

Presbyopic Personal Computer Work: A Comparison of Progressive Addition Lenses for General Purpose and Personal Computer Work

SIGNIFICANCE

Computer-specific progressive addition lenses (PC-PALs) are shown to reduce computer vision syndrome (CVS) symptoms, increase visual comfort and tolerance, and improve body posture at the personal computer. They are highly preferred by computer workers. Increasing their use may aid prevention measures within the workplace health management.

PURPOSE

This study investigates whether technical differences between general-purpose progressive addition lenses (GP-PALs) and PC-PALs are subjectively manifest in CVS.

MATERIALS AND METHODS

One hundred ninety presbyopic visual display unit (VDU) workers aged 53 ± 6 years (mean ± SD) were fitted with GP-PALs and PC-PALs in a subject-masked, randomized, crossover study. Subjects tested both corrections at their personal workplace for 2 weeks each, for VDU work only. Comfort and lens type preferences were assessed using a 24-item questionnaire developed for this study.

RESULTS

Computer vision syndrome was perceived approximately seven times more often with GP-PALs compared with PC-PALs. Eighty-four percent of subjects preferred PC-PALs for their VDU work. Computer-specific progressive addition lenses ratings were statistically and clinically significantly better than GP-PALs (5.95 vs. 4.42 of 7 points; 1.53; 95% confidence interval, 1.20 to 1.85). An existing ametropia or prior experience with PALs did not influence the score. Only 14.2% of subjects had received information about specific VDU eyewear from their optician or optometrist, whereas 79% expressed the wish to be informed about these products.

CONCLUSIONS

Computer-specific progressive addition lenses reduce the perception of the CVS and are highly preferred by VDU workers.

Using evidence to support the design of submarine control console workstations

PURPOSE

This paper outlines an approach to develop practical guidelines to support the design of submarine control console workstations.

METHOD

Guideline development was undertaken for 13 physical design criteria, provided to the research team. Data was gathered from four sources: a systematic literature review, relevant standards, population specific anthropometric data, and user focus groups. The systematic review included risk of bias, quality assessment and evidence synthesis.

RESULTS & CONCLUSION

The systematic review retrieved 43 relevant articles in relation to seven of the 13 design criteria. Very few high-quality studies were identified. The combined evidence available from each of the four data sources was collated and used to provide a set of guidelines for each of the 13 criteria, highlighting the importance of the use of multiple data sources. This approach has applicability beyond this study where the need exists to collate evidence sources beyond the scientific literature.

Presbyopia: Effectiveness of correction strategies

Presbyopia is a global problem affecting over a billion people worldwide. The prevalence of unmanaged presbyopia is as high as 50% of those over 50 years of age in developing world populations, due to a lack of awareness and accessibility to affordable treatment, and is even as high as 34% in developed countries. Definitions of presbyopia are inconsistent and varied, so we propose a redefinition that states "presbyopia occurs when the physiologically normal age-related reduction in the eye's focusing range reaches a point, when optimally corrected for distance vision, that the clarity of vision at near is insufficient to satisfy an individual's requirements". Strategies for correcting presbyopia include separate optical devices located in front of the visual system (reading glasses) or a change in the direction of gaze to view through optical zones of different optical powers (bifocal, trifocal or progressive addition spectacle lenses), monovision (with contact lenses, intraocular lenses, laser refractive surgery and corneal collagen shrinkage), simultaneous images (with contact lenses, intraocular lenses and corneal inlays), pinhole depth of focus expansion (with intraocular lenses, corneal inlays and pharmaceuticals), crystalline lens softening (with lasers or pharmaceuticals) or restored dynamics (with 'accommodating' intraocular lenses, scleral expansion techniques and ciliary muscle electrostimulation); these strategies may be applied differently to the two eyes to optimise the range of clear focus for an individual's task requirements and minimise adverse visual effects. However, none fully overcome presbyopia in all patients. While the restoration of natural accommodation or an equivalent remains elusive, guidance is given on presbyopic correction evaluation techniques.