Digital eye strain: prevalence, measurement and amelioration

Perception and awareness of the public about presbyopia and its corrective approaches in Saudi Arabia: a population-based survey

BACKGROUND

This study investigated patients' awareness of presbyopia and its management approaches and their preferred methods for near vision correction.

METHODS

In Saudi Arabia, 785 participants (aged between 35 and 60 years) completed a structured survey online, consisting of hard copies and direct interviews. The survey consisted of twenty-eight items divided into three parts. It was designed to record participants' awareness of and preferences for presbyopia and its refractive corrections. Nonparametric tests and descriptive analyses were conducted to analyse participants' responses.

RESULT

Approximately half of the participants had difficulty with near vision activities, such as reading newspapers or using mobile phones. Among all the participants, 76% were not aware of presbyopia. The prevalence of uncorrected presbyopia was 48% of the 785. The majority (82%) felt that spectacles were acceptable for correction of presbyopia. Most reported that they did not experience social stigma when using reading spectacles (87% of participants). When asked if they were aware of management approaches other than spectacles, 72% responded with not at all. Most participants had no earlier knowledge of the use of multifocal contact lenses or eye drops for presbyopia correction (67% and 82%, respectively). In the present study, some tendencies to use corrective approaches to presbyopia other than spectacles were noted. Finally, participants' age, sex, region, education, and income had a statistically significant impact on essential parts of their responses (p < 0.05).

CONCLUSION

Presbyopia is a highly prevalent age-related ocular disorder, and a significant percentage of cases are uncorrected due to a lack of awareness or reluctance to wear spectacles. More efficient health education about presbyopia and its corrective alternatives is urgently needed.

Choroidal vascularity index in patients with computer vision syndrome combined with accommodative lead

BACKGROUND

This study aimed to investigate the choroidal vascularity index (CVI) in patients with computer vision syndrome (CVS) combined with accommodative lead.

METHODS

This retrospective case-control study enrolled patients diagnosed with CVS and accommodative lead at the XXX Hospital affiliated to XXX University between July 2022 and May 2023. The control group included individuals without any ocular diseases. Ophthalmic assessments included basic visual acuity, refraction, ocular biometric parameters, and CVI.

RESULTS

A total of 85 participants were included in the study, with 45 in the CVS group and 40 in the control group. The central corneal thickness of CVS group was found to be significantly thinner compared to the control group in both the right eye (532.40±30.93 vs. 545.78±19.99 µm, P=0.019) and left eye (533.96±29.57 vs. 547.56±20.39, P=0.014). In comparison to the control group, the CVS group exhibited lower CVI in the superior (0.40±0.08 vs. 0.43±0.09, P=0.001), temporal (0.40±0.08 vs. 0.44±0.10, P<0.001), inferior (0.41±0.08 vs. 0.46±0.08, P<0.001), and nasal (0.41±0.08 vs. 0.44±0.08, P=0.001) quadrants. Similar differences were observed in all four quadrants within the 1-3 mm radius, and in the temporal (P=0.004) and inferior (P=0.002) quadrants within the 1-6 mm and 3-6 mm radii (all P<0.05).

CONCLUSION

Compared to individuals without ocular issues, patients with CVS and accommodative lead were found to have thinner corneal central thickness and lower CVI.

Comparing health risks and musculoskeletal issues between professional and casual mobile esports players: a cross-sectional descriptive study in Jakarta

Mobile gaming poses significant health risks, such as musculoskeletal (MSK) and eye problems, as players maintain the same posture for long periods. The objective of the current study is to describe the prevalence and assess the association of musculoskeletal and eye problems among professional gamers (PG) and casual gamers (CG) with their physical activity level and physical fitness. A total of 94 mobile-gaming athletes (43 PG, 51 CG) were prospectively recruited in this study. Descriptive analysis was performed for BMIs, fatigue scores, musculoskeletal problems profile, and eye problems profile. The associations between physical activity level, BMI, grip strength, flexibility, and MSK injury were tested with a Chi-square test. A total of 65.96% of the players experienced MSK complaints, with the shoulder (26.2%), neck (25.4%), and hand (21.3%) being the top three affected regions. This study also found ocular issues among the players, with eye fatigue (n = 50) as the most frequent complaint. Differential outcomes were observed between the PG and CG groups regarding physical activity (p = 0.001) and flexibility (p = 0.02). Conversely, no statistically significant variances were detected between the PG and CG concerning musculoskeletal (MSK) disorder indicators (p = 1.000), body mass index (BMI) (p = 0.132), body fat (BF) percentage (p = 0.317), grip strength (p = 0.006 for the right side, p = 0.116 for the left side), or waist circumference (p = 0.680). Furthermore, a significant association was observed between physical activity and BMI (p = 0.029). Study results showed that two-thirds of players experienced MSK injury, with the most common complaints being neck, shoulder, hand, and wrist pain. All participants reported at least one eye problem, with the majority reporting multiple complaints. There were significant differences observed in physical activity and flexibility between the PG and CG groups; however, no correlation was found between musculoskeletal injury incidence and the players' physical fitness variables. This lack of correlation may be attributed to the relatively short career span of gamers.

Impact of online learning during COVID-19 pandemic on digital device related ocular health

Objective

The aim of this study was to evaluate the impact of the COVID-19 pandemic on ocular health related to digital device usage among university students in Lebanon.

Design

A cross-sectional design was utilized to examine the association between the pandemic and ocular health.

Participants

A total of 255 university students in Lebanon participated in the study, selected based on their enrollment during the pandemic.

Methods

An online survey assessed participants' digital device usage, awareness of digital eye strain, and experienced symptoms. The study addressed the relationship between symptom frequency and screen time, especially in their connection to the pandemic and online learning.

Results

Prior to the pandemic, the majority of participants (73.0 %) were unaware of digital eye strain. Following the transition to online learning, nearly half of the participants (47.0 %) reported using digital devices for 12 or more hours. The majority (92.0 %) experienced a substantial increase in daily digital device usage for learning, with an average increase of 3-5 h. Symptoms of digital eye strain, including headache, burning of eyes, blurry vision, sensitivity to light, worsening of vision and dryness of the eyes intensified in both frequency and severity during the pandemic and online learning period.

Conclusions

The study emphasizes the importance of promoting healthy habits and implementing preventive measures to reduce the prevalence of digital eye strain symptoms among university students. Healthcare professionals and public health authorities should educate individuals on strategies to alleviate digital eye strain, considering the persistent reliance on digital devices beyond the pandemic.

Dry eye in primary care: the relationship between digital display device usage and dry eye syndrome (DES) in medical students

OBJECTIVE

As digital display devices become more and more indispensable, associated health problems have started to increase. We aimed to investigate the frequency and relationship of digital display device usage behaviours and dry eye syndrome (DES) in medical students.

METHODS

An observational, cross-sectional study was conducted on medical school students who voluntarily participated in our study online, about the duration and variety of their digital screen use, usage patterns, and protective measures, together with the Ocular Surface Disease Index (OSDI) questionnaire. Where necessary, the Schirmer-I, tear break-up time, and fluorescein staining tests were carried out.

RESULTS

Of the 255 participants, 75.3% (n = 192) were female, 63.1% (n = 161) had no refractive vision defects, and 45.9% used smartphones for more than 5 h a day. According to the OSDI scores for DES screening, only 36.1% of the participants were normal, 17.3% had mild DES, 20.4% had moderate DES, and 26.3% had severe DES. A positive correlation was found between digital display usage time in hours per day and a high OSDI score. As the distance between the eye and the screen decreased, the DES score increased, which is significant for computer, e-book, and tablet use (P < 0.005). The DES rate of the 25 participants who underwent further evaluation was 40% for the tear break-up time test and 52% for the fluorescein staining test.

CONCLUSION

The high prevalence of DES due to digital screen use among medical school students highlights the importance of DES screening as a preventive measure in family medicine.

Effects of brightness variations on a smartphone-based version of Radner reading charts

OBJECTIVE

The purpose of this study was to evaluate the equivalence of smartphone-based measurements of near visual acuity under different screen brightness conditions with a standard near visual acuity test.

METHODS

On a sample of 85 participants, we have evaluated near visual acuity with a smartphone-based version of the Radner reading chart at three distinct screen brightness levels. Results have been compared with those obtained with classical Radner paper charts.

RESULTS

We have found that, when a sufficient screen brightness is employed, the smartphone-based version of the Radner reading chart produces results that are in line with the paper Radner charts while low brightness levels lead to a significant underestimation of reading acuities. This result was consistent across different refractive conditions.

CONCLUSIONS

In conclusion, we have shown that handheld devices, such as smartphones, can be potentially exploited for remote measurements of near visual acuity provided a correct control of brightness screen is employed.

BCLA CLEAR presbyopia: Mechanism and optics

With over a billion adults worldwide currently affected, presbyopia remains a ubiquitous, global problem. Despite over a century of study, the precise mechanism of ocular accommodation and presbyopia progression remains a topic of debate. Accordingly, this narrative review outlines the lenticular and extralenticular components of accommodation together with the impact of age on the accommodative apparatus, neural control of accommodation, models of accommodation, the impact of presbyopia on retinal image quality, and both historic and contemporary theories of presbyopia.

Digital eye strain and its impact on working adults in the UK and Ireland

CLINICAL RELEVANCE

Digital eye strain (DES) is a condition encompassing visual and ocular symptoms that may arise due to the prolonged use of digital devices. The 2023 Tear Film Ocular Surface Lifestyle report defined DESas"the development or exacerbation of recurrent ocular symptoms and / or signs related specifically to digital device screen viewing". Studies vary as to the prevalence of DES with some reporting values as low as 10 % and some reporting values over 90 %, however no study has examined the prevalence of DES in the UK or Ireland (UK&I).

PURPOSE

To determine the prevalence of DES amongst adults who work with digital devices in UK&I, their symptoms and ameliorative approaches taken by those affected.

METHODS

A web-based survey of digital device users was conducted. Adults who used a device for at least 1 h per day for work purposes were eligible to participate. The questionnaire was designed to determine the prevalence of DES, daily device usage, musculoskeletal and ocular symptoms, how they manage their symptoms and eye care history.

RESULTS

Based on a Computer Vision Syndrome Questionnaire score ≥ 6, the occurrence of DES was high at 62.6 %. The mean number of hours devices were used for was 9.7 h. Musculoskeletal symptoms were reported by 94.3 % of users and ocular symptoms by 89.5 % with symptoms most likely to occur with those working from home. 8.1 % of respondents considered their symptoms significant enough to affect their work.

CONCLUSION

This study provides a valuable insight into DES in digital device users in UK&I and is the first of its kind to be completed. It shows, that while the level of DES is high in device users, at 62.6 %, the actual effect or consequences of it on many does not appear to be significant.

Painful Eyes in Neurology Clinic: A Guide for Neurologists

Eye pain is a common complaint among patients presenting to the neurology clinic. It can be related to neurologic diseases, but it can also be a localized eye condition. Such disorders can be misleading, as their benign appearance might mask more grave underlying conditions, potentially leading to misdiagnoses or delayed treatment. Clinicians should be aware of the specific neurologic or systemic disorders (eg, demyelinating diseases or vascular abnormalities) that might first manifest as eye pain. Formal ophthalmic consultation is recommended for patients presenting with eye pain as the predominant complaint especially when red flags for more serious pathology are present.

Digital Eye Straining: Exploring Its Prevalence, Associated Factors, and Effects on the Quality of Life

BACKGROUND

Digital eye strain (DES) has become a pervasive issue in contemporary society due to increased reliance on electronic devices. This study aims to comprehensively explore the symptoms, severity, and associated factors of DES, considering demographic, behavioral, and health-related variables.

METHODOLOGY

A cross-sectional study was conducted among participants with diverse demographic backgrounds. A structured questionnaire collected data on participant characteristics, electronic device usage patterns, symptoms of DES, and its impact on various aspects of quality of life. Statistical analyses, including chi-square tests, were employed to assess associations and significance.

RESULTS

The majority of participants reported symptoms of DES, with eye dryness, headache, and eye redness being the most prevalent. Symptom severity varied, with age, daily device usage, adherence to the 20-20-20 rule, and studying with electronic devices demonstrating statistically significant associations. Participants diagnosed with eye diseases exhibited higher symptom severity. While disagreement was common regarding DES increasing stress, a substantial proportion acknowledged its impact on productivity and attention.

CONCLUSION

The current study showed that there is a significant correlation between the incidence of digital eye straining and longer screen exposure time. The findings underscore the importance of age, behavior, and ocular health in understanding and addressing DES. The results contribute to the broader discourse on digital eye health and emphasize the need for targeted interventions to alleviate the impact of DES on daily life.

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.

Decoding visual fatigue in a visual search task selectively manipulated via myopia-correcting lenses

Introduction

Visual fatigue resulting from sustained, high-workload visual activities can significantly impact task performance and general wellbeing. So far, however, little is known about the underlying brain networks of visual fatigue. This study aimed to identify such potential networks using a unique paradigm involving myopia-correcting lenses known to directly modulate subjectively-perceived fatigue levels.

Methods

A sample of N = 31 myopia participants [right eye-SE: -3.77D (SD: 2.46); left eye-SE: -3.75D (SD: 2.45)] performed a demanding visual search task with varying difficulty levels, both with and without the lenses, while undergoing fMRI scanning. There were a total of 20 trials, after each of which participants rated the perceived difficulty and their subjective visual fatigue level. We used representational similarity analysis to decode brain regions associated with fatigue and difficulty, analyzing their individual and joint decoding pattern.

Results and discussion

Behavioral results showed correlations between fatigue and difficulty ratings and above all a significant reduction in fatigue levels when wearing the lenses. Imaging results implicated the cuneus, lingual gyrus, middle occipital gyrus (MOG), and declive for joint fatigue and difficulty decoding. Parts of the lingual gyrus were able to selectively decode perceived difficulty. Importantly, a broader network of visual and higher-level association areas showed exclusive decodability of fatigue (culmen, middle temporal gyrus (MTG), parahippocampal gyrus, precentral gyrus, and precuneus). Our findings enhance our understanding of processing within the context of visual search, attention, and mental workload and for the first time demonstrate that it is possible to decode subjectively-perceived visual fatigue during a challenging task from imaging data. Furthermore, the study underscores the potential of myopia-correcting lenses in investigating and modulating fatigue.

Exploring the Effect of Trataka (A Yogic Cleansing Technique) and Cold Eye Pack on Eye Strain During COVID-19 Pandemic: A Randomized Three-Arm Trial

Objective: Computer vision syndrome is a major global public health concern affecting >60 million individuals globally. Yoga and naturopathy practices can reduce visual fatigue and strain. The present study attempted to explore the effect of trataka that is, a yogic cleansing technique and cold eye pack on visual strain and fatigue. Subjects: Three hundred volunteers from an IT company were recruited following inclusion and exclusion criteria. Intervention: The subjects were randomly distributed in three groups, that is, trataka, cold eye pack, and waitlist control group with an allocation ratio of 1:1:1. Outcome measure: Visual Fatigue Scale and Visual symptoms checklist (VSC) was administered at baseline and end of 2 weeks. Repeated measures analysis of variance (RM-ANOVA) with Bonferroni corrections was used to test the difference across the groups. Results: All the variables were similar at the baseline among the groups. Significant changes in the within-group analysis occurred in both the trataka and cold eye pack groups. The RM-ANOVA revealed significant differences in the VAS and VSC (p = 0.001) and the post hoc analysis suggested that there were significant differences in both the trataka and cold eye pack group when compared with the control group (p = 0.001); however, there was no differences between the trataka and cold eye pack group in both the scales (p = 1). Conclusions: The results of the present study suggest that a trataka and cold eye pack for 14 days improves self-rated visual strain and fatigue among IT professionals with computer vision syndrome. Clinical Trial registration number: CTRI/2020/11/029003.

Vision Correction Habits After COVID-19 Onset in Spectacle and Contact Lens Wearers

PURPOSE

To determine how vision correction habits changed after the 2019 coronavirus disease (COVID-19) pandemic onset.

METHODS

Participants reported vision correction habits, refractive error, screen time, mask wearing time, and dry eye symptoms since the COVID-19 pandemic onset through email survey.

RESULTS

A total of 133 participants completed the survey. Worsening dry eye symptoms were associated with increased screen time ( P =0.04). Hours per day of spectacle wear increased by approximately 1 hr ( P =0.001) and was associated with increased screen time ( P =0.002). Worsening dry eye symptoms were associated with increased days per week of spectacle wear ( P =0.02). Participants wore contact lenses about one day per week less than before the pandemic ( P =0.0001). Increased mask wearing time was associated with increased days per week of contact lens wear ( P =0.03).

CONCLUSIONS

After pandemic onset, hours per day of spectacle wear increased, and days per week of contact lens wear decreased. Increases in hourly spectacle wear were associated with increased screen time, whereas increased daily contact lens wear was associated with increased mask wear time, suggesting that spectacles may be preferred for screen time activities and contact lenses for mask wear.

Assessing electronic device use behaviours in healthy adults: development and evaluation of a novel tool

BACKGROUND

Chronic exposure of the macula to blue light from electronic devices has been identified as a potential macular health concern. The impacts remain poorly investigated as no validated methods to capture usual device use behaviours exist.

PURPOSE

The aim of this study was to develop and validate the Electronic Device Use Questionnaire (EDUQ) against multiple 24-h electronic device use diaries in healthy Australian and United Kingdom adults.

METHODS

The EDUQ and diaries were developed to capture device use across categories (television, computer and handheld devices). Over eight weeks 56 Australian and 24 United Kingdom participants completed three questionnaires and eight diaries via online platforms. Tool validity was determined through Bland-Altman plot analysis of mean daily hours of device use between the tools.

RESULTS

The EDUQ demonstrated poor validity in both cohorts with poor agreement when compared with the diaries. When the device categories were combined, a mean difference between the tools of 1.54 h/day, and 95% limits of agreement between -2.72 h/day and 5.80 h/day was observed in the Australian cohort. Across both cohorts and all device categories the mean differences indicated individuals were more likely to report higher device use through the questionnaire rather than diaries.

CONCLUSIONS

The EDUQ is a novel tool and demonstrated the difficulty for participants of accurately recalling usual behaviour of device use. Poor agreement in reported device use occurred across all device categories. The poor agreement may be related to factors such as memory recall bias, and the number of diaries captured not being reflective of usual use. Future studies should look to address these factors to improve validity of device use capture.

Impact of feed, light and access to manipulable material on tail biting in pigs with intact tails

BACKGROUND

Tail biting (TB) is a welfare issue with economic consequences due to infections and ill-thrift. This study aimed to reduce tail injuries in a high-performing non-tail-docking pig herd.

RESULTS

During eleven years preceding the trial, the annual incidence of tail injuries registered at slaughter in pigs from the herd increased from 3% (equivalent to the national mean) to 10%. It was positively correlated to a high weight gain and negatively correlated to daylight length. The overall incidence of tail injuries during the four years preceding the trial was 9.2% with significant differences between four identically structured buildings for fatteners (I < II < III < IV). The feed was enriched with amino acids, minerals and fibres. The buildings used different illumination strategies, I: standard fluorescent tubes with an invisible flickering light of 30-40% for 14 h daily, II: non-flickering led light for 14 h daily, III (control) and IV: standard fluorescent tubes for 2 h daily. IV had free access to manipulable material (hay-silage), while I-III was offered 100-200 g daily. During the adaptation period (6 months), the incidence of tail injuries decreased significantly in all buildings to a mean of 5.4%. The largest decrease (from 11.4 to 4.3%) was obtained in IV. During the trial period (12 months), the mean incidence of tail injuries decreased in all groups to a mean of 3.0%. There were no differences in treatment incidences of individual pigs due to TB between groups, but the use of enriched pellets due to TB in pens was lowest in II. The low incidence of tail injuries was retained during the post-trial period (6 months) when all buildings used artificial illumination for two hours per day.

CONCLUSIONS

The incidence of TB in fast growing non-tail-docked pigs in the herd was successfully reduced by supplementing the feed with amino acids, minerals, vitamins and fibres. Additional manipulable material accelerated that process and non-flickering illumination may have had an impact in preventing TB. The results obtained do not support the need for tail-docking of pigs, provided that the needs of the pigs in terms of feed ingredients, stocking density and access to manipulable materials are fulfilled.

Impact of Neurolens Use on the Quality of Life in Individuals With Headaches: A Randomized Double-Masked, Cross-Over Clinical Trial

Purpose

Vision-related disorders, such as refractive errors and binocular vision issues, can cause headaches. The current study evaluates the impact of Neurolens (NL) on individuals with headaches, assessed using the Headache Impact Test (HIT) questionnaire.

Methods

Subjects (18-60 years) with good stereoacuity and a HIT score of ≥56 points were enrolled. Each subject wore both control lens and NL for 30 ± 10 days each. The primary outcome of the study was to assess the difference in the HIT score between the two treatments.

Results

Of the subjects randomized, 88% (170/195) completed the study. Overall, subjects reported a greater improvement in HIT score improvement with NL compared with control (mean difference, -1.53 points; 95% confidence interval, -2.8 to -0.26; P = 0.01). In the subgroup with reduced NPC, subjects reported a larger improvement in HIT score improvement with NL but was not statistically significant (mean difference, -1.89 points; 95% confidence interval, -4.27 to -0.47; P = 0.11).

Conclusions

NL produced a statistically significant decrease in the impact of headaches on individuals' quality of life compared with placebo. Although the overall magnitude of the decrease was not clinically significant, a clinically meaningful improvement with NL cannot be ruled out with high certainty in the current study.

Translational Relevance

Headache is one of the most experienced symptoms by individuals worldwide with vision-related disorders being a primary reason. It is, therefore, critical to screen these disorders before providing a pharmacological intervention, which may have side effects. NL provides an objective way to diagnose and treat digital eyestrain-related headaches.

2022 Glenn A. Fry Award lecture: Enhancing clinical assessment for improved ophthalmic management

ABSTRACT

Detailed clinical assessment is critical to allow sensitive evaluation of the eye and its management. As technology advances, these assessment techniques can be adapted and refined to improve the detection of pathological changes of ocular tissue and their impact on visual function. Enhancements in optical medical devices including spectacle, contact, and intraocular lenses have allowed for a better understanding of the mechanism and amelioration of presbyopia and myopia control. Advancements in imaging technology have enabled improved quantification of the tear film and ocular surface, informing diagnosis and treatment strategies. Miniaturized electronics, large processing power, and in-built sensors in smartphones and tablets capacitate more portable assessment tools for clinicians, facilitate self-monitoring and treatment compliance, and aid communication with patients. This article gives an overview of how technology has been used in many areas of eye care to improve assessments and treatment and provides a snapshot of some of my studies validating and using technology to inform better evidence-based patient management.

Digital eye strain among medical students associated with shifting to e-learning during COVID-19 pandemic: An online survey

PURPOSE

This study aimed to determine the prevalence, risk factors, symptoms, and awareness of computer vision syndrome (CVS) among medical students during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

A cross-sectional observational study was conducted among 283 undergraduate medical students at a tertiary healthcare center. An electronic survey was conducted to collect the data. Data were analyzed using Statistical Package for Social Sciences (SPSS version 23). The Chi-square test (Fisher's exact test when required) was used to study the significance of associations. A P value <0.05 was considered statistically significant.

RESULTS

A high prevalence of CVS was observed in which 92% reported at least one symptom while using a digital device, the most frequent being eye strain (49%). Among extraocular complaints, joint pain in the wrist and fingers was most frequent. Significant association (P < 0.05) of CVS was found with increased duration of digital device usage, refractive error, use of glasses or contact lens, preexisting dry eye disease, and use of topical eye drops. 37% of the participants were aware of the 20-20-20 rule, while only 11% followed it.

CONCLUSION

CVS is a common health concern among medical students. Hence, to increase the productivity of work, significant risk factors need to be addressed and awareness must be raised.

Prevalence and determinants of asthenopia among ophthalmologists in China: a national cross-sectional survey

Introduction

The role of ophthalmologists is defined by tasks requiring visual effort, emphasizing the importance of examining their condition within the realm of occupational visual health. Our goal was to explore the occurrence of asthenopia among Chinese ophthalmologists and identify contributing factors through the use of a reliable and validated survey instrument.

Methods

A national cross-sectional online survey was carried out in June 2017, involving 6,220 practicing ophthalmologists in China. Utilizing an 11-item Asthenopia Survey Questionnaire with established reliability and validity. Prevalence rates of asthenopia among subgroups categorized by age, gender, hospital classification, physician level, daily near vision activity duration, sleep duration, sleep quality, presbyopia status, and history of eye surgery were determined using the independent t-test, chi-square test and bonferroni test. Multiple logistic regression analysis was employed to pinpoint independent factors linked to asthenopia.

Results

Out of the 5,009 ophthalmologists who completed the survey, a 40.7% prevalence of asthenopia was identified. Multivariate analysis revealed that good sleep quality (OR: 0.24, 95%CI: 0.20-0.30), moderate sleep quality (OR: 0.47, 95%CI: 0.38-0.59), engaging in daily near vision activities for less than 7 h (OR: 0.76, 95%CI: 0.68-0.86), having daily sleep duration exceeding 7 h (OR: 0.87, 95%CI: 0.77-0.98), and working in tertiary hospitals (OR: 0.88, 95%CI: 0.78-0.99) were protective factors against asthenopia. Conversely, presbyopia was identified as a risk factor (OR: 1.33, 95%CI: 1.04-1.70). All calculated p values were below 0.05. Age, gender, physician level, and eye surgery history were not related factors.

Conclusion

Asthenopia is prevalent among Chinese ophthalmologists, with employment in tertiary hospitals providing a protective effect and presbyopia is a risk factor. Preventive strategies include improving sleep quality, restricting daily near vision activity to under 7 h, and extending daily sleep duration to over 7 h. Further investigation is needed to explore the protective implications of working in tertiary hospitals.

Visual fatigue a comprehensive review of mechanisms of occurrence, animal model design and nutritional intervention strategies

When the eyes work intensively, it is easy to have eye discomfort such as blurred vision, soreness, dryness, and tearing, that is, visual fatigue. Visual fatigue not only affects work and study efficiency, but long-term visual fatigue can also easily affect physical and mental health. In recent years, with the popularization of electronic products, although it has brought convenience to the office and study, it has also caused more frequent visual fatigue among people who use electronic devices. Moreover, studies have reported that the number of people with visual fatigue is showing a trend of increasing year by year. The range of people involved is also extensive, especially students, people who have been engaged in computer work and fine instruments (such as microscopes) for a long time, and older adults with aging eye function. More and more studies have proposed that supplementation with the proper nutrients can effectively relieve visual fatigue and promote eye health. This review discusses the physiological mechanisms of visual fatigue and the design ideas of animal experiments from the perspective of modern nutritional science. Functional food ingredients with the ability to alleviate visual fatigue are discussed in detail.

Self-reported visual symptoms and high visual demand activities in professional football players: a cross-sectional survey

Background

Vision is crucial for football players, impacting decision-making and athletic performance. Despite its global popularity, football lacks comprehensive evaluations of the impact of digital device use on ocular symptoms during high-demand activities.

Purpose

To gain knowledge about the time spent by football players in high visual demand activities, the symptoms associated with binocular vision dysfunction, and their relationship with sports performance.

Methods

A cross-sectional observational study was conducted in 2020 using an online survey targeting football players from Portugal, England, Spain, and Saudi Arabia. The survey, distributed over 5 weeks, aimed to collect data from approximately 5,000 football players. Information on player profiles, competitive levels, vision habits, and symptoms related to binocular vision dysfunctions was collected. The Convergence Insufficiency Symptom Survey (CISS) employed a 5-point Likert scale to indicate the average frequency of each symptom. Due to non-normality, non-parametric tests were used (p < 0.05). Specifically, Mann-Whitney U, Kruskal-Wallis, Chi-square, and Spearman's rank correlation tests were used as appropriate.

Results

Analyzing male professional football players (mean age: 27.4 ± 5.0 years, 95% CI, 26.7-28.1), it was found that 38.1% of the players had been called up to the national team and 6.9% had played over 50 games. Self-rated last season's performance had a mean score of 6.5 ± 2.1 (95% CI, 6.2-6.8)(on a scale of 1 to 10). Smartphone use exceeded 1 h daily for all players, with 36.0% surpassing 4 h. Visual symptoms, notably associated with smartphone use (35.5%), were observed. Regarding the CISS score, the mean was 7.1 ± 7.7 (IC95%: 6.6 to 8.8). A weak negative correlation (rho = -0.215, p = 0.003) emerged between CISS scores and self-perceived sports performance. Football players using prescription lenses had significantly higher CISS scores (11.9 ± 10.4, 95% CI, 12.3-7.7) compared to non-users (6.2 ± 6.8, 95% CI, 7.8-5.7) (p < 0.001).

Conclusion

This study reveals that professional football players engage in high visual demand tasks, notably on smartphones. One-third of the players link smartphone use to ocular symptoms. The Convergence Insufficiency Symptoms Survey indicates that 6.3% exhibit binocular vision dysfunction symptoms. Those with fewer ocular symptoms perceive that they have better sports performance than their counterparts.

Subjective dry eye symptoms and associated factors among the national general population in China during the COVID-19 pandemic: A network analysis

Background

The coronavirus disease 2019 (COVID-19) pandemic has presented numerous challenges to public health, including the emergence of subjective dry eye symptoms among individuals. However, there is currently a dearth of comprehensive knowledge regarding the associated factors with subjective dry eye symptoms in the general population.

Methods

A nationwide survey in China was carried out from 20 June to 31 August 2022, involving 21 916 participants. Subjective dry eye symptoms were assessed using the Ocular Surface Disease Index-6. We employed random forest classification to select potential associated factors based on the socioecological model. We also conducted univariate and multivariable logistic regression analyses to explore the factors associated with subjective dry eye symptoms. Network analyses were employed to explore the network structure of subjective dry eye symptoms and associated factors.

Results

The item "watching TV (or similar task)" displayed the highest node strength and exhibited the highest predictability within the network. The results of the multivariate logistic regression analysis demonstrated significant associations between subjective dry eye symptoms and several factors, including loneliness (odds ratio (OR) = 1.29; 95% confidence interval (CI) = 1.26 to 1.32), problematic Internet use (OR = 1.08; 95% CI = 1.08 to 1.09), family communication (OR = 1.01; 95% CI = 1.00 to 1.01), the presence of depression (OR = 1.53; 95% CI = 1.39 to 1.68) and anxiety (OR = 1.31; 95% CI = 1.17 to 1.47) symptoms, older age (OR = 1.01; 95% CI = 1.01 to 1.01), self-rated health status (OR = 0.99; 95% CI = 0.98 to 0.99), family health (OR = 0.97; 95% CI = 0.96 to 0.97), health literacy (OR = 0.98; 95% CI = 0.97 to 0.99) and the agreeableness personality trait (OR = 0.97; 95% CI = 0.95 to 0.99).

Conclusions

These findings have important implications for public health interventions targeting the prevention and management of subjective dry eye symptoms in the general population. Strategies addressing individual risk factors and supporting psychological well-being may prove beneficial in mitigating the burden associated with subjective dry eye symptoms.

The influence of large-diameter multifocal contact lens on ocular surface, visual quality, and visual function for presbyopic adults with dry eye syndromes

This study investigated the influence of large-diameter multifocal contact lenses on the ocular surface, visual quality, and visual function for presbyopic adults with dry eye syndromes. The study enrolled 40-55-year-old adults with presbyopia and dry eye syndromes (DES). The subjects were randomly assigned to three groups wearing different designs of contact lenses (Proclear, SMR, and Optimum) for 6-8 h a day for two weeks. Ocular surface health, tear quality, visual quality, and visual function were measured before and after lens wear. No significant difference was observed across all three groups for the amount of conjunctival redness, blink frequency (lens on), and stereopsis vision before and after wearing. Although there seemed to be a significant declining trend for corneal staining and limbal redness, non-invasive tear break-up time (TBUT), and lipid layer thickness while lens wear, the measured values were all within the normal range. Vice-versa after lens removal, results also showed significant improvement on lipid layer thickness, blink frequency (lens off), and contact TBUT. A significant improvement was observed in the modulation transfer function (MTF) of the total area ratio after wearing contact lenses. In contrast, the MTF of the high-order aberration area ratio resulting from lens wear was lower than that of the baseline measurement. There are also significant improvements observed for SMR and Optimum regarding near visual acuity, near point of accommodation, and the subjective questionnaire (OSDI and VBP) scores. Although it is difficult to avoid a specific negative impact on the ocular surface and tear film, visual function and visual quality can still be positively improved, especially shown on larger diameter and distance-center designed multifocal contact lenses.

Tear and Saliva Metabolomics in Evaporative Dry Eye Disease in Females

Accurate diagnosis of dry eye disease (DED) is challenging, and even today there is no gold standard biomarker of DED. Hypothesis-free global metabolomic studies of tears from DED patients have great potential to discover metabolites and pathways affected in the pathophysiology of DED, and to identify possible future biomarkers. These metabolites and biomarkers could be important for diagnosing and monitoring disease as well as for new therapeutic targets and strategies. As DED is associated with dry mouth, this study aimed to perform metabolomic analyses of tears and saliva from patients with decreased tear film break-up time but normal Schirmer test, and age-matched controls with both tear production and stability within physiological range. We applied strict inclusion criteria to reduce sampling bias in the metabolomic analyses and selected only age-matched females with Schirmer test values between 10-15 mm/5 min. The tear film analysis arm included 19 patients (with tear film break-up time 0-5 s) and 12 controls (with tear film break-up time 10-30 s), while the salivary analysis arm consisted of a subset which included 18 patients and six controls. Metabolomic analyses were performed using liquid chromatography and high-resolution mass spectrometry. Analyses using a global database search detected a total of 56 metabolites in tear samples that were significantly different between the groups. Of these, several have known associations with DED. These metabolites are present in meibum and have anti-oxidative characteristics or associations with the ocular microbiome, and altered concentrations suggest that they may play a significant role in DED associated with decreased tear film stability. In saliva, hypotaurine levels were lower among patients with tear film instability. In this pilot study, we found different levels of several metabolites in patients with decreased tear film break-up time that may have associations with DED. Future studies are required to replicate our findings and clarify the exact roles of these metabolites.

Evaluating the ergonomic deficiencies in computer workstations and investigating their correlation with reported musculoskeletal disorders and visual symptoms among computer users in Bangladeshi university

Nowadays, computer users are facing musculoskeletal disorders (MSDs) and visual symptoms. Prolonged sitting in inappropriate, awkward, and static postures on the computer workstation may cause musculoskeletal disorders (MSDs). Similarly, inappropriate placement of monitors, illumination, and other factors such as prolonged usage of computers are related to visual symptoms.

OBJECTIVE

This study aims to evaluate the ergonomic deficiencies of computer workstations and their correlation with MSDs and visual symptoms.

METHODS

This study involved 271 university employees from a Bangladeshi engineering university. Ergonomic deficiencies were evaluated through direct observations and Occupational Safety and Health Administration checklists. In addition, the Nordic Musculoskeletal Questionnaire was used to assess the prevalence of MSDs and visual discomforts. Binary Logistic Regression (BLR) analysis was also used to examine the correlation between musculoskeletal symptoms and ergonomic deficiencies.

RESULTS

Results showed serious deficiencies in workstation setup, seating arrangement, monitor orientations, keyboard orientations, other input device orientations, and accessory setup. Employees reported that the MSDs in different body regions during the last 12 months including lower back (62 %), upper back (53 %), shoulders (47 %), and neck (25 %). Moreover, itchy eyes (69 %), tired eyes (83 %), and unclear vision (56.83 %) were the most common visual discomforts or visual symptoms among the participants. Results also revealed that monitor ergonomics and its orientation deficits were significantly associated with visual discomforts. Gender, job type, age, BMI, work experience, duration of computer work, and beak taking after 2 h were the independent variables reliably predicting the MSDs and visual symptoms.

CONCLUSION

It is evident that MSDs and visual symptoms were associated with computer workstation deficiencies and other work-related factors.

Optical Quality and Visual Performance With Different Toric Contact Lens Designs

OBJECTIVES

To evaluate the optical quality of different toric contact lens (CL) designs and compare their on-eye visual correction performance.

METHODS

Twenty soft CL wearers aged 20 to 39 years were enrolled. Two daily disposable silicone-hydrogel toric CLs were tested: the "Eyelid Stabilized Design" (ESD-CL) and prism-ballast design (PB-CL); a spherical daily disposable silicone hydrogel CL (spherical CL) was used as a control. On-eye performance was compared for corrected distance visual acuity (CDVA), astigmatism, and ocular higher-order aberrations (HOAs); astigmatism and ocular HOAs were measured with a wavefront sensor. The subjective quality of vision, rated for "blurred vision" and "double vision," lens rotation, and fitting were also compared.

RESULTS

The ESD-CLs, PB-CL, and no-CL provided better CDVA than spherical CL ( P <0.05). Compared with spherical CL and no CL, PB-CL and ESD-CLs caused significantly lesser astigmatism ( P <0.05). Coma was significantly lesser with ESD-CLs than that with PB-CL ( P <0.05); total HOAs did not differ among the four conditions. The subjective ratings for blurred and double vision were significantly lower with ESD-CLs than those with spherical CL ( P <0.05).

CONCLUSIONS

Toric CLs provide a better CDVA than spherical CLs. However, differences in coma and subjective symptoms may occur because of the design of toric CLs.

Evaluating the Performance of Verofilcon A Daily Disposable Contact Lenses in a Group of Heavy Digital Device Users

Purpose

The purpose of this study was to evaluate the performance of verofilcon A daily disposable contact lenses (CL) in CL wearers who identified themselves as heavy digital device users.

Patients and Methods

This prospective, non-masked, open-label study enrolled CL wearers who reported ≥6 hours digital device use per day. Participants were dispensed with the verofilcon A study lenses for 14±2 days, to be worn for at least 5 days a week and 10 hours per day, while continuing their normal routine of digital device use. Participants rated the lens performance at the Day 14 visit using a 0-100 (with 100 being best) scale. Ratings were completed at lens insertion, after 6 hours of digital device use, just before CL removal and for overall experience. Participants also completed a 4-point (strongly agree/disagree, slightly agree/disagree) Likert scale-based questionnaire.

Results

Thirty-two participants were eligible and completed the study (27 females; age 25.8 ± 6.0 years, ranging from 19 to 40). Overall lens performance ratings at the Day 14 visit (mean ± standard deviation) for comfort, dryness, and clarity of vision were 91 ± 11, 88 ± 11, and 92 ± 9, respectively. Subjective ratings were stable throughout the day with no significant differences after insertion, after 6 hours of digital device use and before CL removal (all p>0.05). The majority of participants agreed that the study lenses performed well, provided good all-day comfort (28/32; p<0.01) and good all-day vision (29/32; p<0.01). Participants also agreed that after ≥6 hours of digital device use they were satisfied with CL comfort (27/32; p<0.01), vision (29/32; p<0.01) and that the lenses provided good performance (26/32; p<0.01).

Conclusion

Verofilcon A lenses were found to perform well, with high ratings for comfort, dryness and vision that remained high throughout the day, during extensive digital device use.

Visualisation ergonomics and robotic surgery

Stereopsis may be an advantage of robotic surgery. Perceived robotic ergonomic advantages in visualisation include better exposure, three-dimensional vision, surgeon camera control, and line of sight screen location. Other ergonomic factors relating to visualisation include stereo-acuity, vergence-accommodation mismatch, visual-perception mismatch, visual-vestibular mismatch, visuospatial ability, visual fatigue, and visual feedback to compensate for lack of haptic feedback. Visual fatigue symptoms may be related to dry eye or accommodative/binocular vision stress. Digital eye strain can be measured by questionnaires and objective tests. Management options include treatment of dry eye, correction of refractive error, and management of accommodation and vergence anomalies. Experienced robotic surgeons can use visual cues like tissue deformation and surgical tool information as surrogates for haptic feedback.

Polysaccharides in contact lenses: From additives to bulk materials

As the number of applications has increased, so has the demand for contact lenses comfort. Adding polysaccharides to lenses is a popular way to enhance comfort for wearers. However, this may also compromise some lens properties. It is still unclear how to balance the variation of individual lens parameters in the design of contact lenses containing polysaccharides. This review provides a comprehensive overview of how polysaccharide addition impacts lens wear parameters, such as water content, oxygen permeability, surface wettability, protein deposition, and light transmittance. It also examines how various factors, such as polysaccharide type, molecular weight, amount, and mode of incorporation into lenses modulate these effects. Polysaccharide addition can improve some wear parameters while reducing others depending on the specific conditions. The optimal method, type, and amount of added polysaccharides depend on the trade-off between various lens parameters and wear requirements. Simultaneously, polysaccharide-based contact lenses may be a promising option for biodegradable contact lenses as concerns regarding environmental risks associated with contact lens degradation continue to increase. It is hoped that this review will shed light on the rational use of polysaccharides in contact lenses to make personalized lenses more accessible.

Association Between Digital Device Utilization and Asthenopia Among Medical Students at King Khalid University

Background Digital eye strain has become a serious concern due to the exponential increase in the usage of digital devices in recent years. This study aimed to assess the prevalence of digital eye strain among medical students. Methods A cross-sectional study was conducted over a period of one month, from 15th June to 15th July 2023, among undergraduate medical students at King Khalid University, Aseer Region, Saudi Arabia. An online survey was carried out using a structured questionnaire that was circulated through social media platforms (Facebook, Messenger, Instagram, Telegram, and WhatsApp). Results A total of 300 students were enrolled in this study. The prevalence of ocular problems, in descending order, was as follows: asthenopia had the highest prevalence at 30.5% (94), followed by conjunctivitis at 9.4% (29); squint, glaucoma, and cataract had lower prevalence rates of 3.9% (12), 1.6% (5), and 1.6% (5), respectively. The majority of participants used digital devices for fun (92.9% (286)) and study (95.5% (294)). Significant positive correlations were found between asthenopia and the hours spent on digital devices for studying (r = 0.161, p = 0.005), communication (r = 0.146, p = 0.011), and entertainment (r = 0.206, p < 0.001). Conclusions A substantial number of medical students are experiencing asthenopia. Prolonged usage of these devices is linked to a higher prevalence of asthenopia.

Efficacy, Safety, Predictability, and Stability of LASIK for Presbyopia Correction: A Systematic Review and Meta-analysis

PURPOSE

To determine the efficacy, safety, predictability, and stability of laser in situ keratomileusis (LASIK) in the treatment of presbyopia.

METHODS

The databases of CNKI, VIP, Wan-Fang, CBM, Chinese Clinical Registry, PubMed, The Cochrane Library, Web of Science, Embase, and ClinicalTrials.gov were searched until March 2023. The authors chose the studies of LASIK in the treatment of presbyopia. Outcomes were efficacy, safety, predictability, and stability. The review was registered in the international platform of registered systematic review and meta-analysis protocols (INPLASY202350005).

RESULTS

A total of 28 non-randomized controlled trials (15,861 eyes) were included. The results showed that after LASIK, (1) the distance efficacy decreased (mean difference [MD]: 0.02, 95% CI: 0.0 to 0.03, P < .05) and the near efficacy increased (MD: -0.01, 95% CI: -0.19 to-0.02, P < .05); (2) the distance safety decreased (MD: 0.07, 95% CI: 0.04 to 0.10, P < .0001) and near safety increased (MD: -0.19, 95% CI: -0.39 to 0.02, P > .05); (3) the predictability within ±1.00 and ±0.50 D was 94% (relative risk [RR]: 0.94, 95% CI: 0.90 to 0.98, P < .001) and 80% (RR: 0.80, 95% CI: 0.74 to 0.86, P < .001), respectively; and (4) 6 months postoperatively, the percentage of spherical equivalent changing within ±0.50 D was 95% (RR: 0.95, 95% CI: 0.89 to 0.99, P < .001).

CONCLUSIONS

The near efficacy, predictability, and stability of LASIK for presbyopia correction were satisfactory; however, the distance efficacy and distance safety decreased. [J Refract Surg. 2023;39(9):627-638.].

Artificial intelligence enabled smart digital eye wearables

PURPOSE OF REVIEW

Smart eyewear is a head-worn wearable device that is evolving as the next phase of ubiquitous wearables. Although their applications in healthcare are being explored, they have the potential to revolutionize teleophthalmology care. This review highlights their applications in ophthalmology care and discusses future scope.

RECENT FINDINGS

Smart eyewear equips advanced sensors, optical displays, and processing capabilities in a wearable form factor. Rapid technological developments and the integration of artificial intelligence are expanding their reach from consumer space to healthcare applications. This review systematically presents their applications in treating and managing eye-related conditions. This includes remote assessments, real-time monitoring, telehealth consultations, and the facilitation of personalized interventions. They also serve as low-vision assistive devices to help visually impaired, and can aid physicians with operational and surgical tasks.

SUMMARY

Wearables such as smart eyewear collects rich, continuous, objective, individual-specific data, which is difficult to obtain in a clinical setting. By leveraging sophisticated data processing and artificial intelligence based algorithms, these data can identify at-risk patients, recognize behavioral patterns, and make timely interventions. They promise cost-effective and personalized treatment for vision impairments in an effort to mitigate the global burden of eye-related conditions and aging.

Blue-light filtering spectacle lenses for visual performance, sleep, and macular health in adults

BACKGROUND

'Blue-light filtering', or 'blue-light blocking', spectacle lenses filter ultraviolet radiation and varying portions of short-wavelength visible light from reaching the eye. Various blue-light filtering lenses are commercially available. Some claims exist that they can improve visual performance with digital device use, provide retinal protection, and promote sleep quality. We investigated clinical trial evidence for these suggested effects, and considered any potential adverse effects.

OBJECTIVES

To assess the effects of blue-light filtering lenses compared with non-blue-light filtering lenses, for improving visual performance, providing macular protection, and improving sleep quality in adults.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; containing the Cochrane Eyes and Vision Trials Register; 2022, Issue 3); Ovid MEDLINE; Ovid Embase; LILACS; the ISRCTN registry; ClinicalTrials.gov and WHO ICTRP, with no date or language restrictions. We last searched the electronic databases on 22 March 2022.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), involving adult participants, where blue-light filtering spectacle lenses were compared with non-blue-light filtering spectacle lenses.

DATA COLLECTION AND ANALYSIS

Primary outcomes were the change in visual fatigue score and critical flicker-fusion frequency (CFF), as continuous outcomes, between baseline and one month of follow-up. Secondary outcomes included best-corrected visual acuity (BCVA), contrast sensitivity, discomfort glare, proportion of eyes with a pathological macular finding, colour discrimination, proportion of participants with reduced daytime alertness, serum melatonin levels, subjective sleep quality, and patient satisfaction with their visual performance. We evaluated findings related to ocular and systemic adverse effects. We followed standard Cochrane methods for data extraction and assessed risk of bias using the Cochrane Risk of Bias 1 (RoB 1) tool. We used GRADE to assess the certainty of the evidence for each outcome.

MAIN RESULTS

We included 17 RCTs, with sample sizes ranging from five to 156 participants, and intervention follow-up periods from less than one day to five weeks. About half of included trials used a parallel-arm design; the rest adopted a cross-over design. A variety of participant characteristics was represented across the studies, ranging from healthy adults to individuals with mental health and sleep disorders. None of the studies had a low risk of bias in all seven Cochrane RoB 1 domains. We judged 65% of studies to have a high risk of bias due to outcome assessors not being masked (detection bias) and 59% to be at high risk of bias of performance bias as participants and personnel were not masked. Thirty-five per cent of studies were pre-registered on a trial registry. We did not perform meta-analyses for any of the outcome measures, due to lack of available quantitative data, heterogenous study populations, and differences in intervention follow-up periods. There may be no difference in subjective visual fatigue scores with blue-light filtering lenses compared to non-blue-light filtering lenses, at less than one week of follow-up (low-certainty evidence). One RCT reported no difference between intervention arms (mean difference (MD) 9.76 units (indicating worse symptoms), 95% confidence interval (CI) -33.95 to 53.47; 120 participants). Further, two studies (46 participants, combined) that measured visual fatigue scores reported no significant difference between intervention arms. There may be little to no difference in CFF with blue-light filtering lenses compared to non-blue-light filtering lenses, measured at less than one day of follow-up (low-certainty evidence). One study reported no significant difference between intervention arms (MD - 1.13 Hz lower (indicating poorer performance), 95% CI - 3.00 to 0.74; 120 participants). Another study reported a less negative change in CFF (indicating less visual fatigue) with high- compared to low-blue-light filtering and no blue-light filtering lenses. Compared to non-blue-light filtering lenses, there is probably little or no effect with blue-light filtering lenses on visual performance (BCVA) (MD 0.00 logMAR units, 95% CI -0.02 to 0.02; 1 study, 156 participants; moderate-certainty evidence), and unknown effects on daytime alertness (2 RCTs, 42 participants; very low-certainty evidence); uncertainty in these effects was due to lack of available data and the small number of studies reporting these outcomes. We do not know if blue-light filtering spectacle lenses are equivalent or superior to non-blue-light filtering spectacle lenses with respect to sleep quality (very low-certainty evidence). Inconsistent findings were evident across six RCTs (148 participants); three studies reported a significant improvement in sleep scores with blue-light filtering lenses compared to non-blue-light filtering lenses, and the other three studies reported no significant difference between intervention arms. We noted differences in the populations across studies and a lack of quantitative data. Device-related adverse effects were not consistently reported (9 RCTs, 333 participants; low-certainty evidence). Nine studies reported on adverse events related to study interventions; three studies described the occurrence of such events. Reported adverse events related to blue-light filtering lenses were infrequent, but included increased depressive symptoms, headache, discomfort wearing the glasses, and lower mood. Adverse events associated with non-blue-light filtering lenses were occasional hyperthymia, and discomfort wearing the spectacles. We were unable to determine whether blue-light filtering lenses affect contrast sensitivity, colour discrimination, discomfort glare, macular health, serum melatonin levels or overall patient visual satisfaction, compared to non-blue-light filtering lenses, as none of the studies evaluated these outcomes.

AUTHORS' CONCLUSIONS

This systematic review found that blue-light filtering spectacle lenses may not attenuate symptoms of eye strain with computer use, over a short-term follow-up period, compared to non-blue-light filtering lenses. Further, this review found no clinically meaningful difference in changes to CFF with blue-light filtering lenses compared to non-blue-light filtering lenses. Based on the current best available evidence, there is probably little or no effect of blue-light filtering lenses on BCVA compared with non-blue-light filtering lenses. Potential effects on sleep quality were also indeterminate, with included trials reporting mixed outcomes among heterogeneous study populations. There was no evidence from RCT publications relating to the outcomes of contrast sensitivity, colour discrimination, discomfort glare, macular health, serum melatonin levels, or overall patient visual satisfaction. Future high-quality randomised trials are required to define more clearly the effects of blue-light filtering lenses on visual performance, macular health and sleep, in adult populations.

Assessment of Visual Quality Improvement as a Result of Spectacle Personalization

Personalized spectacles customized according to an individual's facial anatomy were developed to provide enhanced visual performance and overall comfort when compared to standard spectacles. In this comparative crossover trial, each subject was randomly assigned to wear either personalized spectacles or standard spectacles for two weeks and then tried the second pair for another two weeks. Visual acuity and reading speed were measured, and visual quality and comfort were assessed using specific questionnaires. The correlation of the wearing parameters with the subjects' satisfaction was calculated. According to our results, the subjects wearing personalized glasses reported significantly less experience of swaying and significantly higher overall satisfaction compared to those wearing the control spectacles. At the end of the study, 62% of subjects preferred the personalized spectacles, and visual quality was the primary reason for their spectacle preference followed by wearing comfort. The difference from the ideal cornea-vertex distance was significantly lower when wearing the personalized spectacles compared to the control frames. In addition, the absolute value of the difference from the ideal cornea-vertex distance was significantly correlated with patient satisfaction. These results suggest that personalized spectacles, customized according to an individual's facial anatomy for the ideal wearing parameters, result in both visual and comfort advantages for wearers.

Near work symptoms and measures of accommodation in children

CLINICAL RELEVANCE

Some children experience significant symptoms while doing near work, and accommodative deficits can be a contributory factor. However, studies investigating near work symptoms in children are sparse.

BACKGROUND

To investigate the association between clinical and objective measures of accommodation and near point symptoms.

METHODS

Twelve asymptomatic and 14 symptomatic children (mean age = 11.1 and 11.8 years, respectively) based on their Convergence Insufficiency Symptom Survey scores participated in the study. The clinical measures of accommodation were monocular amplitude of accommodation, monocular accommodative facility, and monocular estimation method. Objective measurements of the accommodative stimulus response function were recorded with a WAM-5500 autorefractor for two consecutive minutes at five viewing distances (0.33, 2, 3, 4, and 5 Dioptres [D]). Accommodative findings were compared between the groups using the Mann-Whitney U-tests. Spearman's rank correlation coefficient was used to assess the association between symptoms and clinical and objective measures of accommodation.

RESULTS

The mean CISS scores were 32.8 and 7.3 for the symptomatic and asymptomatic groups, respectively (p = <0.001). The symptomatic group showed a reduced accommodative functions compared to the asymptomatic group (p = 0.002 for accommodative facility, p = 0.04 for accommodative amplitude, p = 0.029 and 0.01 for objective measures of accommodation at 4D and 5D viewing distance, respectively). Clinical tests of accommodative amplitude and facility (correlation coefficient = -0.407 and -0.54, respectively) showed the highest correlation with the CISS scores, compared to the objective measures of accommodation.

CONCLUSION

Clinical tests of accommodation showed a greater association with symptoms than objective measures of accommodation in children aged 8-16 years. In children presenting with visual discomfort symptoms, measurement of accommodative amplitude and facility should be considered.

Perspectives of eFootball Players and Staff Members Regarding the Effects of Esports on Health: A Qualitative Study

BACKGROUND

Recently, esports have been argued to impact esports players' health, particularly for those competing at higher levels. Esports are a relatively new phenomenon, and an inside perspective regarding esports players' needs and experiences is essential to promote adequate health support for this population. Thus, in this qualitative study, we explored the perspectives of elite esports players and staff members regarding the effects of esports participation on health. Ten semi-structured interviews were performed with members of the Portuguese FIFA (i.e. FIFA EA Sports^®) eFootball National team (i.e. five elite electronic football players, one world-class electronic football player, two national team coaches, and two members of the esports department). Data analysis was undertaken following the principles of thematic analysis.

RESULTS

We identified four major superordinate themes: health definition (1), factors of esports that impact mental (2) and mental health (3), and strategies to improve esports players' health (4). Esports-related factors such as gaming, competition, and performance were said to impact mental health, while equipment, facilities, and esports-related sitting time affect physical health. To minimise those risks, four main strategies were suggested: optimising and scheduling esports training, improving lifestyle habits with an emphasis on physical health, enhancing facilities and equipment, and improving health support, particularly with a mental health professional.

CONCLUSION

Esports players and staff members are concerned and aware of esports' mental and physical demands. Understanding what esports players need and perceive about their health, complemented with the view of staff members, and their proposed strategies for health promotion might help define and prioritise healthcare needs, which could help players and the broad esports community.

Preventative Effects of Cordyceps cicadae Mycelial Extracts on the Early-Stage Development of Cataracts in UVB-Induced Mice Cataract Model

Cataracts, a prevalent age-related eye condition, pose a significant global health concern, with rising rates due to an aging population and increased digital device usage. In Taiwan, cataract prevalence is particularly high, reaching up to 90% among individuals aged 70 and above. The lens of the eye absorbs short-wave light, which can lead to oxidative stress in lens epithelial cells and contribute to cataract formation. Exposure to ultraviolet (UV) light further exacerbates the risk of cataracts by generating reactive oxygen species. Heat-shock proteins (HSPs), involved in protein maintenance and repair, have been linked to cataract development. Cordyceps cicadae (C. cicadae), a traditional Chinese medicine, has a long history of use and is known for its pharmacological effects. N6-(2-hydroxyethyl) adenosine (HEA), a bioactive compound found in C. cicadae, exhibits anti-inflammatory, immunomodulatory, and neuroprotective properties. Previous studies have shown that C. cicadae mycelial extracts improve dry eye disease and reduce intraocular pressure in animal models. Additionally, C. cicadae possesses antioxidant properties, which are beneficial for combating cataract formation. In this study, we aim to evaluate the preventive efficacy of C. cicadae mycelial extracts in UV-induced cataract development. By investigating the ameliorative effects of C. cicadae on eye diseases and its potential role in ocular health improvement, we hope to uncover new options for cataract prevention and provide insights into the mechanisms of action. The findings of this research could provide a novel approach for nutritional supplements targeting cataract prevention, offering potential benefits in the field of ocular health.

Ocular nociception and neuropathic pain initiated by blue light stress in C57BL/6J mice

To elucidate the physiological, cellular, and molecular mechanisms responsible for initiating and sustaining ocular neuropathic pain, we created a blue-light-exposure model in C57BL/6 mice. Mice were exposed to 12 h of blue or white light followed by 12 h of darkness. Before blue light exposure, baseline tear secretion, stability, and ocular hyperalgesia were assessed by measuring hyper- or hypo-osmotic solution-induced eye wiping, wind-induced eye closing, and cold-induced eye blinking. At 1 day post-blue light exposure, alterations in hypotonic/hypertonic-induced eye-wiping, and tear film abnormalities were observed. Eye-wiping behaviors were abolished by topical anesthesia. The cold-stimulated eye-blinking and wind-stimulated eye-closing behaviors began after day 3 and their frequency further increased after day 9. Blue-light exposure reduced the density of nerve endings, and increased their tortuosity, the number of beadlike structures, and the branching of stromal nerve fibers, as assessed by whole-mount confocal microscopy. Blue-light exposure also increased TRPV1, but not TRPV4 staining intensity of corneal-projecting neurons in the trigeminal ganglia, as detected by Fluorogold retrograde labeling and immunohistochemistry. TRPV1 and substance P expression was increased, whereas CGRP expression deceased at the mRNA level in isolated corneal projecting neurons. Hence, our blue-light exposure B6 mouse model for assessing tearing and ocular hyperalgesia is useful for studying ocular pain and its underlying mechanisms. Blue-light-induced alterations in tearing and ocular hyperalgesia may be related to the elevated expression of TRPV1, SP, and/or the suppressed expression of CGRP at the ocular surface.

Cross-Sectional Analyses of Factors Related to Digital Eye Strain Symptoms Among Children Using Online Learning Devices During the COVID-19 Pandemic in Thailand

Purpose

Globally, the COVID-19 pandemic has influenced academic studies. Since 2019, most schools in Thailand have implemented online learning. Thus, several students are experiencing eye problems, including stinging, blurred vision, and epiphora. This study investigated the prevalence, eye symptoms, and characteristics associated with digital eye strain (DES) in children using digital devices.

Patients and Methods

In this cross-sectional study, a self-administered electronic questionnaire via google forms was used to collect demographic data, digital device information, and DES characteristic information in children of age 8-18 years using online digital devices. The data collection was conducted between December 2021 and January 2022. Moreover, multivariable logistic regression analysis was performed to evaluate the potential characteristics associated with DES in children.

Results

From a total of 844 parents, 782 parents completed the questionnaire. The mean age of the children was 12.42 ± 2.82 years (8-18 years). During the pandemic, the most common duration of using digital devices was >8 hours (39.90%), compared to only 2-4 hours (36.70%) before. The prevalence of DES was 42.2% (330/782), divided into mild (29.8%), moderate (8.1%), and severe (4.3%) symptoms. The most common symptoms of DES included: a burning sensation in the eyes (55.24%), fear of worsening eyesight (53.07%), and excessive blinking of eyes (48.33%). The associated characteristics with DES were advanced age (OR=1.21, P<0.001), refractive error with (OR=2.04, P=0.004) and without (OR=6.11, P<0.001) correction, and unknown refractive error (OR=2.85, P<0.001).

Conclusion

The use of digital devices are inevitable; therefore, regulating the duration of study and entertainment using digital devices, especially in older ages, and correcting refractive error in children, is necessary to ameliorate DES.

Prevalence of Digital Eye Strain Among University Students and Its Association with Virtual Learning During the COVID-19 Pandemic

Introduction

The prolonged use of digital devices is a major risk factor for digital eye strain (DES) syndrome.

Aim

To estimate the prevalence of DES symptoms among students at Imam Abdulrahman University who use digital devices for virtual learning and leisure activities.

Methods

This was a retrospective cross-sectional study conducted by asking medical students of Imam Abdulrahman bin Faisal University to complete a self-administered online questionnaire. The questionnaire was used to determine the effect of the hours spent on digital devices and other factors, such as screen distance and not using artificial tears, on the development of DES. The severity (moderate or severe) and frequency (occasionally, always, or never) of 16 eye strain-related symptoms, including eye pain, headache, and itching, were evaluated by using the Computer Vision Syndrome Questionnaire.

Results

The overall prevalence of DES in the sample was found to be 68.53%. The largest proportion of students were found to have mild DES (43.20%), and only 11% had severe DES. The most common symptoms reported in our sample were headache, dryness, and burning. Female gender, using smartphones for online classes, and not using eye lubricants were significantly associated with increased severity of DES.

Conclusion

In the wake of the COVID-19 pandemic, virtual learning has become an integral part of education, leading to increased use of digital technology. The aim of this study was to investigate the impact of virtual learning on eye strain and to determine the prevalence and effects of DES. A questionnaire was administered to participants, and the findings revealed a DES prevalence of 68.53%. The use of eye drops for lubrication and smartphones for classes was significantly associated with DES. Furthermore, females were found to be more susceptible to severe DES symptoms than males. The development of a tool such as the Computer Vision Syndrome Questionnaire to predict DES prevalence could reduce clinic time and resources by minimizing unnecessary follow-up and ophthalmology referrals.

Effect of Contact Lens Design on Objective Visual Acuity-Based Parameters in Pre-Presbyopic Patients in Photopic and Mesopic Lighting Conditions

Presbyopia is often corrected by progressive soft contact lenses (CL), and the resulting visual acuity-based parameters can be affected by the lens design and pupil size under different lighting conditions. In this study, we examined the effect of CL design (spheric vs. aspheric) on objective parameters of visual acuity-based parameters under mesopic vs. photopic lighting conditions. In a prospective, double-blind study, pre-presbyopic and presbyopic patients were fitted with spheric (Dispo Silk; 8.6 base curve, 14.2 diameter) and aspheric (Dispo Aspheric; 8.4 base curve, 14.4 diameter) CLs. The low contrast (10%) and high contrast (100%) visual acuity (VA), amplitude of accommodation (AA) (push-away method, Diopters) and distance contrast sensitivity (CS) (FACT chart, cycles per degree (CPD)) were measured with both types of CLs under mesopic and photopic lighting conditions. The eye with the better visual acuity was tested and analyzed. Thirteen patients (age range: 38-45 years) were included. The mean CS was significantly better with spheric compared to aspheric lenses for low spatial frequencies (3 CPD: 81.69 ± 7.86, 67.62 ± 5.67, respectively; p < 0.05), though there was no significant difference for lower or higher spatial frequencies (1.5, 6, 12, 18 CPD). The low-contrast (10%) and high-contrast (100%) VAs were not different between the two lens designs. However, there were significant differences between near VA, distance low-contrast VA and AA obtained under mesopic (dim) vs. photopic (bright) conditions with the aspheric design correction modality. In conclusion, photopic lighting conditions improved both the visual acuity and measured amplitude of accommodation with both lens designs, though the amplitude of accommodation was significantly higher with aspheric lenses. However, contrast sensitivity demonstrated the superiority of the spheric lens at a 3 CPD spatial frequency. This suggests that the ideal lens differs from patient to patient, depending on the visual demands.

Assessment of precision and reliability of a novel computerized heterophoria test

Purpose

To assess the precision and reliability of a novel computerized heterophoria test (CHT).

Methods

One hundred and three subjects aged 20 to 48 (27.37 ± 5.15) were recruited from Wenzhou Medical University. All subjects with corrected spectacles were examined with CHT and a prism-neutralized objective cover test (POCT) in a randomized order. They were then re-examined with CHT within 1 week. Their heterophoria was measured at three different distances (3 m, 0.77 m and 0.4 m); the average was recorded after three consecutive measurements. Inter-examiner repeatability, intra-examiner repeatability of CHT and agreement between CHT and POCT were evaluated.

Results

There was no significant difference among repeated measurements using CHT (all p > 0.05). The difference between POCT and CHT was statistically significant at three distances (all p < 0.001). However, the mean absolute difference was 1.20^△, 1.93^△, and 2.41^△, all of which were significantly smaller than the permissible range of error (4^△) at three different distances (all p < 0.001).

Conclusion

The CHT demonstrated excellent inter- and intra-examiner repeatability, as well as good correlation with POCT. The differences between CHT and POCT were within the permissible range of error, indicating that CHT could provide a precise and reliable measurement for clinical applications.

Design guidelines for limiting and eliminating virtual reality-induced symptoms and effects at work: a comprehensive, factor-oriented review

Virtual reality (VR) can induce side effects known as virtual reality-induced symptoms and effects (VRISE). To address this concern, we identify a literature-based listing of these factors thought to influence VRISE with a focus on office work use. Using those, we recommend guidelines for VRISE amelioration intended for virtual environment creators and users. We identify five VRISE risks, focusing on short-term symptoms with their short-term effects. Three overall factor categories are considered: individual, hardware, and software. Over 90 factors may influence VRISE frequency and severity. We identify guidelines for each factor to help reduce VR side effects. To better reflect our confidence in those guidelines, we graded each with a level of evidence rating. Common factors occasionally influence different forms of VRISE. This can lead to confusion in the literature. General guidelines for using VR at work involve worker adaptation, such as limiting immersion times to between 20 and 30 min. These regimens involve taking regular breaks. Extra care is required for workers with special needs, neurodiversity, and gerontechnological concerns. In addition to following our guidelines, stakeholders should be aware that current head-mounted displays and virtual environments can continue to induce VRISE. While no single existing method fully alleviates VRISE, workers' health and safety must be monitored and safeguarded when VR is used at work.

Children's Internet use and physical and psychosocial development

Introduction

Internet use (IU) commonly refers to sedentary lifestyle and may be addictive, especially among children. The aim of this study was to investigate the relationship between IU and some aspects of child physical and psychosocial development.

Methodology

We conducted a cross-sectional survey by using a screen-time based sedentary behavior questionnaire and Strengths and Difficulties Questionnaire (SDQ)-among 836 primary school children in the Braničevo District. The children's medical records were analysed for vision problems and spinal deformities. Their body weight (BW) and height (BH) were measured and body mass index (BMI) was calculated as BW in kilograms divided by BH in meters squared (kg/m²).

Results

The average age of respondents was 13.4 (SD 1.2) years. The mean duration of daily Internet use and sedentary behavior was 236 (SD 156) and 422 (SD 184) minutes, respectively. There was no significant correlation between daily IU and vision problems (near sightedness, farsightedness, astigmatism, strabismus), and spinal deformities. However, daily Internet use is significantly associated with obesity (p < 0.001) and sedentary behavior (p = 0.01). There was significant correlation between emotional symptoms with total Internet usage time, and total sedentary score (p < 0.001 for both, r = 0.141 and r = 0.132, respectively). There was a positive correlation between the total sedentary score of children and hyperactivity/inattention (r = 0.167, p < 0.001), emotional symptoms (r = 0.132, p < 0.001), and conduct problems (r = 0.084, p < 0.01).

Conclusion

In our study, children's Internet use was associated with obesity, psychological disturbances and social maladjustment.

Polyunsaturated Fatty Acids (PUFAs): Sources, Digestion, Absorption, Application and Their Potential Adjunctive Effects on Visual Fatigue

When the eyes are exposed to the environment, they are easily affected by strong light stimulation and harmful substances. At the same time, prolonged use of the eyes or incorrect eye habits can cause visual fatigue, which mainly manifests as eye dryness, soreness, blurred vision, and various discomforts. The main reason for this is a decline in the function of the eye, especially the cornea and retina on the surface of the eye, which have the greatest impact on the normal function of the eye. Research has found that supplementation with appropriate foods or nutrients can effectively strengthen the eye against external and internal stimuli, thereby alleviating or avoiding visual fatigue. Among these, supplementation with polyunsaturated fatty acids has been found to be effective at protecting eye health and relieving visual fatigue. This article summarizes the sources of polyunsaturated fatty acids (including the main dietary sources and internal synthesis), the mechanisms of digestion and absorption of polyunsaturated fatty acids in the body and the safety of polyunsaturated fatty acid applications. It also reviews the mechanism of action of polyunsaturated fatty acids in aiding the relief of visual fatigue based on the mechanism of impaired function or structure of the ocular surface and fundus in the hope of providing some reference and insight into the development and application of polyunsaturated fatty acids in functional foods for the relief of visual fatigue.

A comparison of visual discomfort experienced by surgeons in wireless versus conventional endoscopy in laparoscopic surgery

Background

This study was performed to introduce a new wireless endoscopic system. Research and development were based on fifth-generation transmission technology. Eye symptoms and visual discomfort induced by the novel endoscopic system were compared with those induced by the conventional endoscopic system before and during laparoscopic pelvic surgery.

Materials and methods

Twenty surgeons successfully conducted laparoscopic pelvic surgeries using a conventional endoscopic system and a wireless endoscopic system. Subjective and objective data were measured to evaluate visual discomfort before and 2 hours after surgery.

Results

In the conventional endoscopic and wireless endoscopic system groups, no significant differences were found in the presurgical or postsurgical questionnaires. In both groups, tear film breakup times significantly decreased after surgery. However, after comparing the 2 groups, no statistically significant difference was found.

Conclusions

Compared with the conventional endoscopic system, the novel wireless endoscopic system does not cause additional visual discomfort for experienced surgeons.