Assessing the role of visual dysfunctions in the association between visual symptomatology and the use of digital devices

PURPOSE

To evaluate the association between visual symptoms and use of digital devices considering the presence of visual dysfunctions.

METHODS

An optometric examination was conducted in a clinical sample of 346 patients to diagnose any type of visual anomaly. Visual symptoms were collected using the validated SQVD questionnaire. A threshold of 6 hours per day was used to quantify the effects of digital device usage and patients were divided into two groups: under and above of 35 years old. A multivariate logistic regression was employed to investigate the association between digital device use and symptoms, with visual dysfunctions considered as a confounding variable. Crude and the adjusted odds ratio (OR) were calculated for each variable.

RESULTS

57.02 % of the subjects reported visual symptoms, and 65.02% exhibited some form of visual dysfunction. For patients under 35 years old, an association was found between having visual symptoms and digital device use (OR = 2.10, p = 0.01). However, after adjusting for visual dysfunctions, this association disappeared (OR = 1.44, p = 0.27) and the association was instead between symptoms and refractive dysfunction (OR = 6.52, p < 0.001), accommodative (OR = 10.47, p < 0.001), binocular (OR = 6.68, p < 0.001) and accommodative plus binocular dysfunctions (OR = 46.84, p < 0.001). Among patients over 35 years old, no association was found between symptoms and the use of digital devices (OR = 1.27, p = 0.49) but there was an association between symptoms and refractive dysfunction (OR = 3.54, p = 0.001).

CONCLUSIONS

Visual symptoms are not dependent on the duration of digital device use but rather on the presence of any type of visual dysfunction: refractive, accommodative and/or binocular one, which should be diagnosed.

Computer vision syndrome and ergonomic risk factors among workers of the Commercial Bank of Ethiopia in Addis Ababa, Ethiopia: an institutional-based cross-sectional study

Background

Computer vision syndrome (CVS) is the most pressing public health concern that affects vision and reduces quality of life and productivity, particularly in developing countries. Most of the previous studies conducted in Ethiopia focus on the knowledge and personal risk factors of bank workers. Moreover, ergonomic workstation design was not objectively assessed, which could hinder the implementation of effective intervention strategies. Therefore, this study aimed to determine CVS and ergonomic factors among commercial bank workers in Addis Ababa, Ethiopia.

Methods

An institutional-based cross-sectional study was carried out among 466 study participants from May 26 to July 24, 2022. A multistage sampling technique was applied to select the study participants. Data were collected via a standardized tool of CVS (CVS-Q). Besides, workstation ergonomics were pertinently assessed. The collected data was entered into EpiData version 3.1 and exported to SPSS version 26 for data analysis and cleaning. Multivariable logistics regression analysis was performed to identify factors associated with CVS. The variables with a p-value < 0.05 were considered statistically significant factors.

Results

Prevalence of CVS was 75.3% (95% CI: 71.2-79.2%). Blurred vision, eye redness, and headache, 59.8%, 53.7%, and 50.7%, respectively, were frequently reported symptoms. Glare (AOR = 4.45: 95% CI: 2.45-8.08), 20-20-20 principle (AOR = 1.98, 95% CI: 1.06-3.67), wearing non-prescription eyeglasses (AOR = 4.17; 95% CI: 1.92-9.06), and poor workstation (AOR = 7.39; 95% CI: 4.05-13.49) was significantly associated with CVS.

Conclusion

The prevalence of CVS was found to be high. Glare at work, ignoring the 20-20-20 principle, wearing non-prescription eyeglasses, and poor workstation ergonomic design were independent predictors of CVS. Therefore, comprehensive interventional activities like adhering to the 20-20-20 principle, avoiding the use of non-prescription glasses, minimizing glare, and improving workstation ergonomic setup are essential to prevent CVS.

Computer vision syndrome among Sudanese medical students: a growing medical issue in the digital world

Computer vision syndrome (CVS) refers to a set of eye-related symptoms that arise from prolonged computer usage. A survey was conducted to investigate the demographic characteristics, factors contributing to, and preventive measures against CVS. Out of 159 participants, 31.0% experienced seven or more symptoms, indicating a notable prevalence. The study found no significant correlation between age or academic years and CVS occurrence (P values of 0.481 and 0.392, respectively). However, gender exhibited a statistically significant relationship, with females students showing a higher prevalence than males (P=0.018; τ=0.105*). Notably, the distance from the screen had a highly significant inverse correlation with CVS occurrence (P=0.000; τ=-0.207**), indicating that greater distance reduced the risk. Additionally, using a screen filter (P=0.000; τ=0.184**) and adjusting screen brightness (P=0.017; τ=0.101*) were associated with CVS occurrence. Among preventive measures, only the use of an anti-glare screen showed a significant association with reducing CVS risk (P=0.018; τ=-0.099*). Given these findings, raising awareness about CVS among medical students is recommended, especially as curricula in medical colleges evolve.

Visual display terminal syndrome and its associated factors among university students during the COVID-19 pandemic

BACKGROUND

Ever since the start of the coronavirus disease 2019 (COVID-19) pandemic, students have been spending an increasingly longer time staring at electrical devices to take online courses.

OBJECTIVE

This study aimed to investigate the effect of the virtual class environment on eye and musculoskeletal problems in university students during the COVID-19 pandemic.

METHODS

A total of 365 university students were enrolled in this study. They completed an online survey to examine the effects of online learning on eye and musculoskeletal health during the COVID-19 pandemic. The questionnaires consisted of four sections: demographic and general information, environmental and work factors, device-related factors, and visual display terminal syndrome (VDTS).

RESULTS

Participants have been taking online classes of 14.5 hours per week during the COVID-19 pandemic. They reported the mean daily usage of digital devices of 4.8±2.2 hours before the pandemic but this increased to 8.1±2.9 during the pandemic. Eye fatigue and neck, shoulder, and back pain have also been reported. The mean VDTS score was significantly influenced by gender, obesity, daily exercise, regular breaks, wear of blue light-blocking glasses, daily hours of electronic device use, and illumination of room.

CONCLUSION

The results of this study showed that university students taking online classes suffered more from VDTS, especially in eye fatigue and neck, lower back, and shoulder pain during COVID-19 pandemic than prior. This study suggests that it is necessary to take breaks in online classes and regularly provide appropriate eye exercise and physical activity to prevent VDTS.

Prevalence of computer vision syndrome: A systematic review and meta-analysis

PURPOSE

This review aimed to estimate the prevalence of computer vision syndrome (CVS) in the general population and subgroups.

METHODS

A search was conducted in the following the databases: PubMed, SCOPUS, EMBASE, and Web of Science until February 13, 2023. We included studies that assessed the prevalence of CVS in any population. The Joanna Briggs Institute's critical appraisal tool was used to evaluate the methodological quality. A meta-analysis of the prevalence of CVS was done using a random-effects model, assessing the sources of heterogeneity using subgroup and meta-regression analyses.

RESULTS

A total of 103 cross-sectional studies with 66 577 participants were included. The prevalence of CVS was 69.0% (95% CI: 62.3 to 75.3; I2: 99.7%), ranging from 12.1 to 97.3% across studies. Point prevalence was higher in women than in men (71.4 vs. 61.8%), university students (76.1%), Africa (71.2%), Asia (69.9%), contact lens wearers (73.1% vs. 63.8%) in studies conducted before the COVID-19 pandemic (72.8%), and in those that did not use the CVS-Q questionnaire (75.4%). In meta-regression, using the CVS-Q scale was associated with a lower prevalence of CVS.

CONCLUSION

Seven out of ten people suffer from CVS. Preventive strategies and interventions are needed to decrease the prevalence of this condition which can affect productivity and quality of life. Future studies should standardize a definition of CVS.

Computer vision syndrome and associated factors in university students and teachers in Nampula, Mozambique

BACKGROUND

Computer Vision Syndrome (CVS) is a complex of eye and visual problems that arise while using a computer or other Video Display Terminal (DVT). With the advent of the COVID-19 pandemic, the use of these DVTs has become indispensable in the lives of students and teachers. This study aims to identify the prevalence of CVS and associated factors in students and teachers at Lúrio University, in Nampula, during the pandemic period.

METHODS

This is a cross-sectional study, carried out between November 2020 and March 2021. The validated CVS questionnaire (CVS-Q) and another semi-structured questionnaire on ergonomic risk factors were applied. Odds ratios (OR) and adjusted odds ratios (aOR) were calculated to measure the association between CVS and computer use conditions.

RESULTS

The prevalence of CVS was 76.6%, and the female gender, age ≤ 20 years, levels I, II, III of course, lack of knowledge about ergonomics, use the computer to study, use more than 6 hours daily, absence of anti-reflex treatment, use of other devices and sitting in an inappropriate chair were risk factors for the occurrence of CVS, while being a teacher was a protective factor.

CONCLUSION

The prevalence of CVS found in this study was high, due to several factors, especially not using ergonomic principles when using computers and other DVTs. There is a need to adopt intervention strategies focused on the most vulnerable groups such as women, age group ≤20 years and students, especially at the first year level, right after entering the University.

Computer Vision Syndrome Among the General Population in the Eastern Region of Libya: Prevalence and Risk Factors

Aim To assess the prevalence and determine the risk factors of computer vision syndrome among the general population in the Eastern region of Libya. Methods This study used a descriptive cross-sectional design and comprised a random sample of 407 Libyan adults from Eastern Libya. Data were collected using an online-based questionnaire. Statistical analysis of all the datasets was performed using SPSS software, version 21.0 (IBM Corp., Armonk, NY). Results The mean age of the participants was 32.1 years (SD=12.8), and most participants 281 (69%) were female. As for employment status, 261 (64.1%) were students, 70 (17.2%) were non-healthcare workers, and 46 (11.3%) were healthcare workers. The majority of participants, 353 (86.7%), used a computer seven days a week, with 187 (45.9%) of those participants using a computer for over six hours daily. Over one-third of participants, 157 (38.6%), had computer vision syndrome. Being over 45 years of age, being a student, and using a computer for over six hours a day were the main factors associated with computer vision syndrome. Neck pain was the most commonly reported complaint in 235 (57.5%). Conclusion Increased use of electronic devices is leading to a higher prevalence of computer vision syndrome. Our study emphasizes the need to raise awareness regarding computer vision syndrome among the general public and medical professionals.

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.

Computer Vision Syndrome Among Medical Students at the University of Khartoum, Sudan: Prevalence and Associated Factors

Background and aims Regular continuous uninterrupted use of electronic devices, such as smartphones, tablets, and computers, can result in a spectrum of vision-related symptoms known as computer vision syndrome. Students today can readily access information and books on their smartphones and computers, which reduces their reliance on printed texts. Numerous muscle-related and ocular complaints could arise from this. The primary objective of this study was to estimate the prevalence of computer vision syndrome symptoms among medical students at the University of Khartoum and to identify its contributing factors. The secondary objective was to evaluate practices and knowledge related to computer vision syndrome prevention. Methods This study is a facility-based cross-sectional observation aimed at describing medical students' characteristics at the University of Khartoum. The sampling strategy employed was stratified random sampling, and a structured online questionnaire was used to collect the data. A total of 149 students completed the self-administered questionnaire. The questionnaire included questions on sociodemographic data, validated symptoms of computer vision syndrome, and factors associated with the syndrome's development. Data were analyzed using SPSS Statistics (Armonk, NY: IBM Corp.), simple descriptive statistics were calculated, and odds ratios and Pearson's chi-square test were employed to examine and quantify the association between variables. Results Of the 149 participants, 58.4% were female, while males made up 41.6% of the study sample. The prevalence of computer vision syndrome has been found to be 94%, and 72.4% of the students reported experiencing at least three symptoms of computer vision syndrome. Neck and shoulder pain was the most commonly reported symptom (78.5%), followed by headache (70.5%), while the least reported symptom was eye redness (36.2%). The majority of students (81.2%) used electronic devices for five or more hours a day, and the most common posture while using electronic devices was lying down, as reported by 54.4% of the students. A total of 68% of the medical students in this study reported keeping a distance that was shorter than the suggested 40 centimeters from the screen, and only 18.1% were aware of the 20-20-20 rule (every 20 minutes look at an object 20 feet away for 20 seconds). The seating position has been found to be significantly associated with the number of symptoms experienced (p=0.012); sitting with a bent back was 4.6 times more likely to cause more than three symptoms when compared to sitting upright with a straight back (OR=4.643; 95% CI: 1.63-13.21; p=0.004). Conclusion There was a very high prevalence of computer vision syndrome among medical students at the University of Khartoum. Most students had poor awareness and bad practices regarding the safe use of electronic devices. Awareness campaigns to encourage good practices and enable the safe use of computers and other digital devices are strongly recommended.

The Prevalence and Knowledge of Digital Eye Strain Among the Undergraduates in Riyadh, Saudi Arabia

Aim/background Digital eye strain, also called computer vision syndrome (CVS), is a group of symptoms resulting from prolonged computer, tablet, e-reader, and cell phone use. The level of discomfort and the severity of these symptoms appear to increase with the amount of digital screen use. These symptoms include eyestrain, headaches, blurred vision, and dry eyes. This study aims to assess the changes in the prevalence of digital eye strain among college students in Riyadh, Saudi Arabia. Methods A cross-sectional study was conducted among university students at different college institutions in Riyadh, Saudi Arabia. Subjects were interviewed, and the data were collected using an online questionnaire. The questionnaire was composed of student demographic data, students' general knowledge and risk perception of digital eye strain, and the assessment of CVS symptoms questionnaire. Results Of the 364 university students, 55.5% were females, and 96.2% were aged between 18 and 29 years. A significant proportion of university students (84.6%) were using digital devices for five hours or more. The proportion of university students who were aware of the 20-20-20 rule was 37.4%. The overall prevalence of positive for CVS symptoms was 76.1%. Independent risk factors for CVS symptoms were gender female, ocular disorders, and using digital devices at a shorter distance. Conclusion There was a high prevalence of CVS symptoms among university students in our region. Female students with an ocular disease were more likely to exhibit CVS symptoms than other university students, but using a digital device at a longer distance could alleviate the symptoms of CVS. A longitudinal study is needed to establish the effect of CVS symptoms among university students, especially during the post-pandemic era.

TFOS Lifestyle: Impact of the digital environment on the ocular surface

Eye strain when performing tasks reliant on a digital environment can cause discomfort, affecting productivity and quality of life. Digital eye strain (the preferred terminology) was defined as "the development or exacerbation of recurrent ocular symptoms and/or signs related specifically to digital device screen viewing". Digital eye strain prevalence of up to 97% has been reported, due to no previously agreed definition/diagnostic criteria and limitations of current questionnaires which fail to differentiate such symptoms from those arising from non-digital tasks. Objective signs such as blink rate or critical flicker frequency changes are not 'diagnostic' of digital eye strain nor validated as sensitive. The mechanisms attributed to ocular surface disease exacerbation are mainly reduced blink rate and completeness, partial/uncorrected refractive error and/or underlying binocular vision anomalies, together with the cognitive demand of the task and differences in position, size, brightness and glare compared to an equivalent non-digital task. In general, interventions are not well established; patients experiencing digital eye strain should be provided with a full refractive correction for the appropriate working distances. Improving blinking, optimizing the work environment and encouraging regular breaks may help. Based on current, best evidence, blue-light blocking interventions do not appear to be an effective management strategy. More and larger clinical trials are needed to assess artificial tear effectiveness for relieving digital eye strain, particularly comparing different constituents; a systematic review within the report identified use of secretagogues and warm compress/humidity goggles/ambient humidifiers as promising strategies, along with nutritional supplementation (such as omega-3 fatty acid supplementation and berry extracts).

Association between time spent on smartphones and digital eye strain: A 1-year prospective observational study among Hong Kong children and adolescents

Prolonged electronic screen use can cause digital eye strain. It can be difficult to rectify due to increasing smartphone reliance, potentially leading to serious public health problems. To investigate the association between time spent on smartphones and digital eye strain (DES) among Hong Kong Chinese school-aged children. Of a total of 1,508 students (748 males, 49.6%) from 8 to 14 years old (mean age = 10.91 years, SD = 2.01) who provided valid data on DES, the 1,298 (86%) who completed the DES questionnaire at 1-year follow-up were included in the analysis. DES was measured using a 10-item scale, and the sum of the 10 dichotomised scores was used as the DES total score. The most commonly reported symptoms were eye fatigue (n = 804, 53.3%), blurred vision (changing from reading to distance viewing) (n = 586, 38.9%), and irritated or burning eyes (n = 516, 34.2%). The DES total scores at baseline and 1-year follow-up were 2.91 (SD = 2.90) and 3.20 (SD = 3.19), respectively. Linear regression controlling for demographic and socio-economic confounders showed that participants with baseline smartphone usage of 241 + min/d had a significantly higher baseline total DES score than those with baseline smartphone usage of 0-60 min/d (2.44 vs 3.21, P < 0.001), and participants with baseline smartphone usage of 181-240 min/d had a significantly higher 1-year follow-up total DES score than those with baseline smartphone usage of 0-60 min/d (2.80 vs 3.50, P = 0.003).

Digital Eye Strain among Peruvian Nursing Students: Prevalence and Associated Factors

There has been a high prevalence of digital eye strain (DES) among students who have received distance-learning lessons due to COVID-19. However, in low- and middle-income countries, there are few studies that have analyzed its associated factors. This study aimed to determine the prevalence of DES and its associated factors among nursing students during COVID-19 distance learning. This was a cross-sectional analytical study conducted between May and June 2021 in six Peruvian universities. The sample comprised 796 nursing students. DES was measured using the Computer Vision Syndrome Questionnaire (CVS-Q). A bivariate logistic regression analysis was performed. DES was found in 87.6% of nursing students. Sitting upright (OR, 0.47; 95% IC, 0.30-0.74), using electronic devices for more than four hours a day (OR, 1.73; 95% IC, 1.02-2.86), not following the 20-20-20 rule (OR, 2.60; 95% IC, 1.25-5.20), having the screen brightness very high (OR, 3.36; 95% IC, 1.23-11.8), and not wearing glasses (OR, 0.59; 95% IC, 0.37-0.93) are factors associated with DES. The prevalence of DES among nursing students is high. Improving the ergonomics of study environments, reducing the time of exposure to electronic devices, adjusting the screen brightness, and taking eye-care measures are key to controlling computer vision syndrome in virtual learning.

Effect of illuminance and colour temperature of LED lighting on asthenopia during reading

PURPOSE

A self-controlled study to determine the influence of illuminance and correlated colour temperature (CCT) of light-emitting diode (LED) lighting on asthenopia.

METHODS

Twenty-two healthy postgraduates (nine women) were recruited to read under eight LED lighting conditions with four illuminances (300 lx, 500 lx, 750 lx and 1000 lx) and four CCTs (2700, 4000, 5000 and 6500 K) for 2 h. A subjective asthenopia questionnaire, the optical quality analysis system (OQAS) and an inflammatory cytokine assay were used to assess the levels of asthenopia.

RESULTS

Increased asthenopia was observed after reading, but the degree varied with lighting conditions. There were significant differences among the groups in terms of subjective symptoms (inattention, eye pain, dry eye and total score), optical performance parameters (modulation transfer function [MTF] cut-off frequency, Strehl ratio [SR], objective scattering index [OSI], mean OSI and accommodative amplitude [AA]) as well as inflammatory cytokines in the tears (epidermal growth factor [EGF], transforming growth factor [TGF]-α, interleukin [IL]-6, IL-8, macrophage inflammatory protein [MIP]-1β, tumour necrosis factor [TNF]-α, TNF-β and vascular endothelial growth factor [VEGF]-A). All of the subjective and objective measurements collectively suggested that asthenopia was lessened for the 500 lx-4000 K condition. However, asthenopia was significantly worse for 300 lx-2700 K and 1000 lx-6500 K in terms of subjective symptoms and objective optical performance, respectively.

CONCLUSIONS

LED illuminance and CCT do have a significant effect on asthenopia during reading. 500 lx-4000 K lighting resulted in the lowest level of asthenopia. Conversely, low illuminance at low CCT (300 lx-2700 K) and high illuminance at high CCT (1000 lx-6500 K) promoted more severe asthenopia.

Computer Vision Syndrome in Undergraduate and Medical Students During the COVID-19 Pandemic

Purpose

The purpose of this study was to evaluate Computer Vision Syndrome (CVS) in undergraduate and medical students since transitioning to online learning during the COVID-19 pandemic.

Patients and Methods

This was a cross-sectional single center survey-based study using a validated CVS questionnaire (CVS-Q). The survey was distributed to 20,080 undergraduate students and 680 medical students at the University of Illinois at Chicago. The primary outcome measures were prevalence of CVS (based on CVS severity score of 6 or more), frequency of CVS and intensity of CVS symptoms.

Results

The survey was completed by 2300 undergraduate students (11.4% response rate) and 154 medical students (22.6% response rate). The prevalence of CVS was 77.1% in undergraduate students and 69.1% in medical students. CVS-Q severity scores were highest for headaches and eye dryness, with over half of students reporting worsening of symptoms since March 2020. Increased time spent on online learning (undergraduate: P <0.001, medical: P = 0.018), blue light glasses usage (undergraduate: P <0.001, medical: P = 0.0015), and increased number of device usage were associated with higher CVS severity scores (undergraduate: P <0.001, medical: P = 0.0032).

Conclusion

CVS among undergraduate and medical students has increased since the start of the COVID-19 pandemic. More focus should be placed on the management of CVS for students in higher education. Physicians should be cognizant of the consequences of online learning and be proactive about providing advice regarding preventative measures.

Prevalence of Computer Vision Syndrome among School-Age Children during the COVID-19 Pandemic, Saudi Arabia: A Cross-Sectional Survey

Background: Computer vision syndrome (CVS) can be described as ocular-related symptoms that result from prolonged exposure and use of computers, smartphones, tablets, and other devices with digital displays. The main objective of this study was to investigate the prevalence of CVS among school-age children, the associated signs, risk factors, and the association between the disease before and during the COVID-19 pandemic in the Jazan region of Saudi Arabia. Methods: The study employed a descriptive cross-sectional research design. The targeted population was school-going children aged 6 to 18 in the Jazan region in the Southwest of Saudi Arabia. A sample of 440 participants was selected to represent the population under study. Data were collected using self-administered questionnaires. Sociodemographic characteristics were recorded, such as age, gender, education level, parents’ education, occupation, frequency, and intensity of eye symptoms if present. Results: Most of the participants were adolescents between 16 and 18 and at a high-school education level. According to the total symptoms score, the CVS prevalence was 35.4%. Prevalence of CVS significantly affects age, gender, and school level (p < 0.05 for all). A similar significant association was reported between the symptoms experienced before and during COVID-19 and the CVS (p < 0.05). Conclusion: A total of 407 adolescents aged 16−18 responded to the questionnaire (response rate of 92.5%; 407 out of 440). The study estimated the prevalence of CVS among school-going children in Jazan to be low. The main signs associated with CVS included headache, tearing, itchiness, blurred vision, eye redness, eye pain, and dryness. The attitude of children toward their health condition during the COVID-19 pandemic and the prevalence of CVS have a significant relationship.

AMEE Guide to ethical teaching in online medical education: AMEE Guide No. 146

The Covid-19 pandemic necessitated Emergency Remote Teaching (ERT): the sudden move of educational materials online. While ERT served its purpose, medical teachers are now faced with the long-term and complex demands of formal online teaching. One of these demands is ethical online teaching. Although ethical teaching is practiced in face-to-face situations, online teaching has new ethical issues that must be accommodated, and medical teachers who wish to teach online must be aware of these and need to teach ethically. This Guide leads the medical teacher through this maze of complex ethical issues to transform ERT into ethical online teaching. It begins by setting the context and needs and identifies the relevant fundamental ethical principles and issues. It then guides the medical teacher through the practical application of these ethical principles, covering course design and layout (including the curriculum document, implementation, on-screen layouts, material accessibility), methods of interaction (synchronous and asynchronous), feedback, supervision and counselling, deeper accessibility issues, issues specific to clinical teaching, and assessment. It then discusses course reviews (peer-review and student evaluations), student monitoring and analytics, and archiving. The Guide aims to be a useful tool for medical teachers to solidly ground their online teaching practices in ethical principles.

Dry Eye-Related Risk Factors for Digital Eye Strain

OBJECTIVES

To evaluate dry eye-related lifestyle and demographic factors associated with digital eye strain (DES).

METHODS

An anonymous online survey was conducted in 851 university students. Participants were classified into DES (computer vision syndrome questionnaire [CVS-Q]≥6) or non-DES (CVS-Q<6). Respondents completed three dry eye questionnaires (Ocular Surface Disease Index [OSDI]; 5-item Dry Eye Questionnaire [DEQ-5]; 8-item Contact Lens Dry Eye Questionnaire) and were surveyed on dry eye risk factors contemplated by the Tear Film and Ocular Surface Society Dry Eye Workshop II.

RESULTS

Six hundred twenty-eight participants were classified into the group with DES and 222 into the group without DES. Participants with DES slept fewer hours, spent more hours indoors with air conditioning, drank more caffeinated beverages, used the computer for longer periods, reported poorer health quality, and obtained a higher score in all questionnaires (P<0.025). A higher proportion of the participants were female, had several health disorders, and took several medications associated with dry eye (P<0.029). Multivariate logistic regression analysis revealed that stress (P=0.035), contact lens wear (P=0.011), hours of computer use per day (P=0.010), migraine headaches (P=0.013), and a higher OSDI (P<0.001) and DEQ-5 score (P<0.001) were associated with DES.

CONCLUSIONS

Several dry eye-related risk factors and health conditions are associated with suffering from DES. Clinicians should acknowledge the relevance of triaging questions and dry eye disease risk factors when dealing with patients who view screens for extended periods.

The impact of the COVID-19 pandemic on the prevalence of computer vision syndrome among medical students in Riyadh, Saudi Arabia

Purpose

Methods

Results

Conclusion

Tweenager Computer Visual Syndrome Due to Tablets and Laptops during the Postlockdown COVID-19 Pandemic and the Influence on the Binocular and Accommodative System

The aim of our study was to compare computer visual syndrome (CVS) in a tweenager student population who use tablets and laptops only to play versus CVS in tweenagers who use these digital devices at school to study, in addition to playing. The tests performed were a validated survey for children for the detection of CVS and accommodative and vergence tests. The CVS item questionnaire was divided into four main groups based on questions concerning the following: (I) the digital device usage time, (II) musculoskeletal and ergonomic nature, (III) visual symptoms, and (IV) ocular surface symptoms. The high-demand digital device group showed worse punctuation in all item groups. From the optometric perspective, when the subjects were classified according to the CVS, high-demand participants presented a clear tendency to exophoria with statistically significant differences in distance vision (−1.94 ± 4.48 Δ) and near vision (−5.78 ± 8.62 Δ) (p < 0.01). Our results establish a relationship between the increased use of electronic devices and computer vision syndrome in the preadolescent population. In addition, this situation is related to the presence of visual, accommodative, and binocular dysfunctions that could affect the efficiency of the visual system.

Prevalence of Asthenopia and Its Relationship with Electronic Screen Usage During the COVID-19 Pandemic in Jazan, Saudi Arabia: A Cross-Sectional Study

Purpose

To assess the connection between the prevalence of asthenopia and the use of electronic devices in Jazan, Saudi Arabia, during the COVID-19 pandemic.

Patients and Methods

Asthenopia prevalence and its connection to electronic screens during the COVID-19 pandemic were evaluated in an analytical, cross-sectional investigation among the Jazan population. The sample population included 784 participants. Due to the COVID-19 pandemic, a pre-tested, organized, and self-administered questionnaire was used as the study method. Social media invitations were used to contact the sample group.

Results

Of the 784 participants, 587 (74.96%) had asthenopia symptoms after using digital devices at the end of the day. A total of 56.30% used digital gadgets for > 6 hours each day, whereas 55.36% spent <2 hours per day reading papers or books or writing. Daily usage of digital gadgets did not significantly differ from asthenopia (p=0.46), as well as reading papers, books, or writing and asthenopia (p=0.098). A total of 45.92% of the study population maintained digital devices/books at a distance <25 cm, which was significantly associated with symptoms of asthenopia (p=0.048). Furthermore, 90.10% of the sample population used laptops, cellphones, and iPads before going to bed or after turning off lights. A total of 63.52% preferred using devices while lying in bed. There was no positive link between asthenopia symptoms and cellphone usage at bedtime or after turning off lights (p=0.028).

Conclusion

Digital technology is used by people of all ages for a wide range of daily activities, including education, employment, business, and recreation. We concluded that this group had a high prevalence of asthenopia, especially during the COVID-19 pandemic. The high frequency of asthenopia emphasizes the significance of conducting public awareness campaigns concerning asthenopia symptoms and prevention methods.

Threshold Segmentation and Length Measurement Algorithms for Irregular Curves in Complex Backgrounds

It is an urgent problem to know how to quickly and accurately measure the length of irregular curves in complex background images. To solve the problem, we first proposed a quasi-bimodal threshold segmentation (QBTS) algorithm, which transforms the multimodal histogram into a quasi-bimodal histogram to achieve a faster and more accurate segmentation of the target curve. Then, we proposed a single-pixel skeleton length measurement (SPSLM) algorithm based on the 8-neighborhood model, which used the 8-neighborhood feature to measure the length for the first time, and achieved a more accurate measurement of the curve length. Finally, the two algorithms were tested and analyzed in terms of accuracy and speed on the two original datasets of this paper. The experimental results show that the algorithms proposed in this paper can quickly and accurately segment the target curve from the neon design rendering with complex background interference and measure its length.

Computer Visual Syndrome in Medical Students From a Private University in Paraguay: A Survey Study

Purpose

To determine the prevalence and factors associated with computer vision syndrome in medical students at a private university in Paraguay.

Methods

A survey study was conducted in 2021 in a sample of 228 medical students from the Universidad del Pacífico, Paraguay. The dependent variable was CVS, measured with the Computer Visual Syndrome Questionnaire (CVS-Q). Its association with covariates (hours of daily use of notebook, smartphone, tablet and PC, taking breaks when using equipment, use of preventive visual measures, use of glasses, etc.) was examined.

Results

The mean age was 22.3 years and 71.5% were women. CVS was present in 82.5% of participants. Higher prevalence of CVS was associated with wearing a framed lens (PR = 1.11, 95% CI: 1.03–1.20). In contrast, taking a break when using electronic equipment at least every 20 min and every 1 h reduced 7% (PR = 0.93, 95% CI: 0.87–0.99) and 6% (PR = 0.94, 95% CI: 0.89–0.99) the prevalence of CVS, respectively.

Conclusion

Eight out of 10 students experienced CVS during the COVID-19 pandemic. The use of framed lenses increased the presence of CVS, while taking breaks when using electronic equipment at least every 20 min and every 1 h reduced CVS.

Improving office workers’ workspace using a self-adjusting computer screen

With the rapid evolution of technology, computers and their users’ workspaces have become an essential part of our life in general. Today, many people use computers both for work and for personal needs, spending long hours sitting at a desk in front of a computer screen, changing their pose slightly from time to time. This phenomenon impacts people’s health negatively, adversely affecting their musculoskeletal and ocular systems. To mitigate these risks, several different ergonomic solutions have been suggested. This study proposes, demonstrates, and evaluates a technological solution that automatically adjusts the computer screen position and orientation to its user’s current pose, using a simple RGB camera and robotic arm. The automatic adjustment will reduce the physical load on users and better fit their changing poses. The user’s pose is extracted from images continuously acquired by the system’s camera. The most suitable screen position is calculated according to the user’s pose and ergonomic guidelines. Thereafter, the robotic arm adjusts the screen accordingly. The evaluation was done through a user study with 35 users who rated both the idea and the prototype system itself highly.

The association between visual display terminal use and dry eye: a review

BACKGROUND

Dry eye disease (DED) is a multifactorial disease of the tear film and ocular surface. It causes ocular symptoms, reduced quality of life and a considerable economic burden on society. Prolonged use of visual display terminals (VDTs) has been suggested as an important risk factor for DED.

PURPOSE

This review aims to study the association between DED and VDT use with an emphasis on the prevalence of DED among VDT users and harmful daily duration of VDT use.

METHODS

A PubMed search was conducted and yielded 57 relevant articles based on a set of inclusion and exclusion criteria. The studies were subclassified according to study design.

RESULTS

The far majority of the studies showed an association between VDT use and DED or DED-related signs and symptoms. The prevalence of definite or probable DED in VDT and office workers ranged from 26% to 70%, with as few as 1-2 hr of VDT exposure per day being associated with DED.

CONCLUSION

VDT use is strongly associated with DED. VDT-associated DED is prevalent, but the exact prevalence needs to be further elucidated using standardized DED diagnosis criteria. Furthermore, a safe lower limit of daily VDT use has yet to be established. More research is needed on the effect of digitalization and digital transformation, which are particularly high during the time of the COVID-19 pandemic.

Effects of digital devices and online learning on computer vision syndrome in students during the COVID-19 era: an online questionnaire study

PURPOSE

Computer vision syndrome (CVS) describes a group of eye and vision-related problems that result from prolonged digital device use. This study aims to assess the prevalence and associated factors of CVS among students during the lockdown resulting from the COVID-19 pandemic.

METHODS

A cross-sectional, online, questionnaire-based study performed among high school students in Thailand.

RESULTS

A total of 2476 students, with mean age of 15.52±1.66 years, were included in this study. The mean number of hours of digital device use per day (10.53±2.99) increased during the COVID-19 pandemic compared with before its advent (6.13±2.8). The mean number of hours of online learning was 7.03±2.06 hours per day during the pandemic. CVS was found in 70.1% of students, and its severity correlated with both the number of hours of online learning and the total number of hours of digital device usage (p<0.001). Multiple logistic regression analysis revealed that the factors associated with CVS included age ≤15 years (adjusted OR (AOR)=2.17), overall digital device usage >6 hours per day (AOR=1.91), online learning >5 hours per day (AOR=4.99), multiple digital device usage (AOR=2.15), refractive errors (AOR=2.89), presence of back pain (AOR=2.06) and presence of neck pain (AOR=2.36).

CONCLUSIONS

The number of hours of digital device usage increased during lockdown. Over 70% of children had CVS, whose associated factors, including hours of digital device usage, hours of online learning, ergonomics and refractive errors, should be adjusted to decrease the risk of acquiring this condition. Online learning will remain, along with CVS, after this pandemic, and we hope our research will be taken into account in remodelling our education system accordingly.

The Effect of Online Education on Healthy Eyes of Saudi Teachers in the COVID-19 Pandemic: A Local Study

Background

Digital eye strain (DES) or computer vision syndrome (CVS) manifests as eye fatigue caused by prolonged exposure to screens and exaggerated by some attitudes. Online education plays a crucial role in helping schools, instructors, and universities ensure the continuity of the education process during the COVID-19 pandemic. There is a lack of attention given to the effects of online teaching on teachers’ eyes health during the pandemic and is nearly nonexistent. Hence, we aim to evaluate this among teachers in the Eastern Province of Saudi Arabia.

Methodology

A cross-sectional electronic self-administered questionnaire was distributed through social media applications among teachers in the eastern province of Saudi Arabia. The survey contained three main parts: biographical data, educational status, and eye health scale before and during the pandemic. All statistical analysis was done using IBM SPSS version 22 (IBM Corp., Armonk, NY).

Results

A total sample of 301 teachers was identified with ages ranging from 22 to 60 years, the majority were female (75.4%). Twenty-four point nine percent (24.9%) of the sample have a chronic disease, and 17.3% had previous LASIK surgery. Twenty-four point nine percent (24.9%) spent two to five hours teaching before the pandemic versus 60.8% with online education during the pandemic spent two to five hours daily. Fifty-two point eight percent (52.8%) of the teachers kept the distance between them and the digital screen at less than 50 cm. Eighty-one point four percent (81.4%) of teachers reported severe to moderate effects of online teaching using a computer/tablet/phone on their eye health. Fifty-two point two percent (52.2%) reported headache.

Conclusion

There is an obvious negative effect reflected by subjects’ symptomatology and complaints in their eyes. This should prompt health authorities to provide better teaching equipment and accessibility to essential eye care to teachers.

Adjusting eye aspect ratio for strong eye blink detection based on facial landmarks

Blink detection is an important technique in a variety of settings, including facial movement analysis and signal processing. However, automatic blink detection is very challenging because of the blink rate. This research work proposed a real-time method for detecting eye blinks in a video series. Automatic facial landmarks detectors are trained on a real-world dataset and demonstrate exceptional resilience to a wide range of environmental factors, including lighting conditions, face emotions, and head position. For each video frame, the proposed method calculates the facial landmark locations and extracts the vertical distance between the eyelids using the facial landmark positions. Our results show that the recognizable landmarks are sufficiently accurate to determine the degree of eye-opening and closing consistently. The proposed algorithm estimates the facial landmark positions, extracts a single scalar quantity by using Modified Eye Aspect Ratio (Modified EAR) and characterizing the eye closeness in each frame. Finally, blinks are detected by the Modified EAR threshold value and detecting eye blinks as a pattern of EAR values in a short temporal window. According to the results from a typical data set, it is seen that the suggested approach is more efficient than the state-of-the-art technique.

Digital Eye Strain Caused by Online Education Among Children in Qassim Region, Saudi Arabia: A Cross-Sectional Study

Introduction

Online learning is the educational format adopted by schools and universities during the coronavirus disease 2019 (COVID-19) pandemic. It comprises Internet-based learning, computer-based learning, virtual classrooms, and digital collaborations. This study aims to assess digital eye strain (DES) among children attending online classes in the Qassim region, Saudi Arabia.

Materials and methods

This is a cross-sectional study conducted among children aged 3 to 18 years old in the Qassim region, Saudi Arabia. We sent out a self-administered questionnaire to parents of the targeted children by using social media, such as WhatsApp (Meta Platforms, Inc., Menlo Park, California, United States), Telegram (Telegram FZ LLC, Dubai), and Twitter (Twitter, Inc., San Francisco, California, United States). The questionnaire included questions on socio-demographic profile, smart devices being used, frequency of devices used per day before and during the lockdown, and DES. 

Results 

A total of 547 children were involved (50.3% males vs. 49.7% females). During online classes, the most commonly used device was tablets (51.2%). A significant increase was noticed in the use of devices during the COVID-19-related lockdown among children (p<0.001). The prevalence of DES-positive symptoms was 69.8%. The presence of DES symptoms was associated with age group (p=0.003), school level (p=0.040), device preferred for online classes (p=0.001), number of hours spent attending online classes (p=0.010), and number of hours spent using an electronic device during the lockdown (p<0.001).

Conclusion

Our study underlines a higher prevalence rate of DES among children during this time of the COVID-19 pandemic. Children who used a digital device for more than five hours during the lockdown had a greater risk of having DES than the rest.

Self-Reported Computer Vision Syndrome among Thai University Students in Virtual Classrooms during the COVID-19 Pandemic: Prevalence and Associated Factors

During the COVID-19 pandemic, computer vision syndrome (CVS) related to online classrooms were unavoidable. This cross-sectional study aimed to explore the prevalence, characteristics and associated factors of CVS. A total of 527 students who were currently studying in a virtual classroom (70.40% female, mean (standard deviation; SD) age of 20.04 (2.17) years) were included. The prevalence of CVS assessed by an online CVS-Questionnaire was 81.0% (427/527). Comparing with those in the period before the online study, an increase in screen time (interquartile range) in students with and without CVS was 3 (0−3) and 2 (1−5) h, respectively. Overall, 516 students (97.9%) experienced at least one symptom. The most frequent symptom in CVS subjects was eye pain (96.5%). The most intense symptoms were the feeling of worsening eyesight (15.9%). The factors associated with CVS were female (p < 0.001), age (p = 0.010), atopic diseases (p = 0.020), prior ocular symptoms (p < 0.001), astigmatism (p = 0.033), distance from display <20 cm (p = 0.023), presence of glare or reflection on screen (p < 0.001), low screen brightness (p = 0.045), sleep duration (p = 0.030), inadequate break time between classes (p < 0.001) and increased screen time usage during online study (p < 0.001). Recommendations to prevent CVS based on the adjustable factors might reduce the burden of online study.

Computer vision syndrome and predictors among computer users in Ethiopia: a systematic review and meta-analysis

Background

A computer is one of the most widely used office tools. The leading occupational health problem of the twenty-first century is computer vision syndrome (CVS). Research findings across Ethiopia on the magnitude and predictors of CVS among computer users are highly variable and inconsistent. Therefore, this study aimed to estimate the overall prevalence of CVS and its predictors among computer users in Ethiopia.

Methods

We searched articles in all databases and other sources. Cochrane Q test statistics and I² tests were used. A random-effect meta-analysis model was used. In addition, the association between risk factors and CVS among computer users was examined.

Results

Eight eligible studies were included. The pooled prevalence of CVS among computer users in Ethiopia was 73.21% (95% CI 70.32–76.11). Sub-group analysis by profession has shown that the highest prevalence of CVS was observed in bank employees [73.76% (95% CI 70.40–77.13)]. The most common reported symptoms of CVS were blurred vision (34.26%; 95% CI 22.08, 46.43). The previous history of eye disease (95% CI 2.30, 5.47), inappropriate sitting position (95% CI 1.76, 3.22), the frequent use of a computer (95% CI 2.04, 3.60), and using eyeglass/spectacles (95% CI 1.10, 3.91) were significantly associated with CVS among computer users in Ethiopia.

Conclusions

According to this study, computer vision syndrome was high among computer users in Ethiopia. Computer vision syndrome (CVS) was significantly associated with a previous history of eye disease, inappropriate sitting position, frequent use of a computer, and the use of spectacles. Based on the findings, it is suggested that efforts be made to optimize computer exposure time. It is also worth noting that employees should be properly seated when using a computer. Furthermore, people with vision problems should be extra cautious when using a computer. Finally, community awareness of the safety precautions that can be taken to reduce CVS is critical.

Prevalence rate of attention deficit hyperactivity disorder (ADHD) and computer vision syndrome (CVS) symptoms predisposition among digital device users of Bangladesh

Background

Around 5.29% of the world population is suffering from ADHD, and 60 million people are suffering from CVS, with an increasing rate of prevalence of these disorders. This study aimed to determine the prevalence rate of ADHD and CVS symptoms among the Bangladeshi population.

Results

To assess the aim of the study, a cross-sectional survey was conducted online through stratified sampling, and 197 responses were collected from the participants. Our survey method follows these criteria where the ARSV1.1 standard questionnaire was followed for the ADHD questionnaire, and a self-administered questionnaire was established based on the symptoms of CVS. The male age ranges from 18–24 have the highest value of ADHD (34%) coincided with > 6 h digital device usage (51%), and the Stroop effect is significantly correlated with the ADHD score (0.498, p < 0.01). The Stroop effect value is also higher among the males aged 18–24, digital device users for > 6 h (48%).

Conclusions

With the advent of science, it is impossible to avoid digital devices as necessary. Notwithstanding, safe and appropriate use of digital media is a must for healthy living.

Association between Psychological Stress and Neck Pain among College Students during the Coronavirus Disease of 2019 Pandemic: A Questionnaire-Based Cross-Sectional Study

The coronavirus disease of 2019 (COVID-19) greatly affected people’s lifestyles. We used an online, cross-sectional survey during a COVID-19-related lockdown in Israel, with the aim of investigating the effects of such lockdowns on students’ self-perceived stress and neck pain (NP). College students (N = 295) completed questions on sociodemographic characteristics, the Neck Disability Index (NDI), the Perceived Stress Scale, the Visual Analogue Scale (VAS), and NP frequency (four-point scale). Logistic regression models were calculated with the NDI as the dependent variable. In total, 35.6% of students experienced at least moderate NP-related disability (NDI ≥ 15), more during than before the lockdown. NP increased gradually, from a lifetime mean of 1.80 to a lockdown mean of 3.07 (χ² = 316.72; p < 0.001). Students’ self-perceived stress was moderate, and 59.3% reported experiencing study-related stress. Higher levels of self-perceived stress, study-related stress, sitting >3 h/day, and a higher VAS score were associated with a higher risk of an NDI ≥ 15 (Nagelkerke’s R² = 0.513, p < 0.001). The transition from on-campus to online learning seems to have exacerbated students’ NP, which was correlated to their study stress and lifestyles. These findings advocate for the need to promote the physical and mental health of students via e.g., mental health services and occupational and ergonomic consulting services.

Problematic Internet Use Associated with Symptomatic Dry Eye Disease in Medical Students from Peru

PURPOSE

Dry eye is a multifactorial ocular surface disease (DED) characterized by a loss of tear film homeostasis, which is widely associated with alterations in mental health. Problematic internet use (PIU) is defined as the feeling of concern about using this tool irresistibly, for longer periods than usual, accompanied by anguish that results from not doing so without reaching mania or hypomania behaviors. Both PIU and DED present a theoretical link; however, there are no published studies that report its relationship with problematic internet use. Therefore, this study aims to determine the association between PIU and symptomatic DED in Peruvian medical students.

PATIENTS AND METHODS

Analytical cross-sectional study that included human medical students from Peru. For the measurement of main variables, the Ocular Surface Disease Index (OSDI) and the Internet Addiction Test (IAT) were used. To study their relationship, the Poisson regression analysis was used, we consider a p-value <0.05 as significant.

RESULTS

Data from 844 medical students were analyzed, 35.7% male and 64.3% female, with an average age of 21.8 ± 3.3 years. Likewise, the prevalence of symptomatic DED was 70.9%, and the internet's controlled use was 85.3%. In the analysis adjusted for symptomatic DED, the men showed significant differences in the controlled use of the internet (p <0.003), of which those who had PIU, 50% had severe symptomatic DED, as well as 80% of those addicted to the internet. The adjusted model showed that the PIU increases the prevalence of symptomatic DED in men (PR = 1.17, 95% CI: 1.06-1.29); however, in women, no association was found between both variables.

CONCLUSION

PIU and symptomatic DED showed a significant association in male medical students from Peru.

Computer visual syndrome in graduate students of a private university in Lima, Perú

BACKGROUND

In recent decades, several studies have found a strong association between prolonged use of video display terminals and ophthalmological symptoms encompassed in the so-called computer visual syndrome (CVS). Few studies have addressed this syndrome in graduate students.

METHODS

Observational, cross-sectional descriptive study. A total of 106 postgraduate students were surveyed without ophthalmological pathologies. The diagnosis of CVS was made by means of the questionnaire of Seguí et al. validated in Spanish, which evaluates the frequency and intensity of 16 ocular symptoms.

RESULTS

The prevalence of CVS among graduate university students was 62.3% (95% CI: 52.3-71.5). It was found that the highest proportion of students with the syndrome was in the group of older than 40 years old (88.2%) and in the group 21-30 years old (70.0%), showing statistically significant differences (p = 0.004). According to the device and its time of use, students who used the mobile phone for 7-10 h a day showed a higher prevalence of CVS compared to those who used the device for less time (p = 0.030). The business School had the highest prevalence (75.0%).

CONCLUSION

Three out of every five graduate students presented CVS with this prevalence being like reported in other populations. There is a need to investigate possible interventions that can help reduce this entity.

Computer Vision Syndrome Prevalence and Ocular Sequelae among Medical Students: A University-Wide Study on a Marginalized Visual Security Issue

Introduction:

This study aimed to discover and document the potential of visual and ocular sequelae of computer vision syndrome (CVS) among medical students.

Methods:

This cross-sectional case-control study was conducted on medical students (n=4030) of five universities in Egypt. All students completed a specially designed and validated CVS questionnaire survey (CVS-F3). Students with ≥5 CVS symptoms constituted a risk group (n=352), while students with 1-4 CVS symptoms constituted a low-symptoms group (n=3067). Students from the control and risk groups were examined using objective methods, such as visual acuity, subjective refraction, dry eye disease tests, and anterior segment and fundus examinations. Students who complained of visual blur underwent multifocal electroretinography mfERG examinations (mfERG group).

Results:

The CVS-F3 indicated that 84.8% of students had complaints that might be related to CVS, however, our ophthalmic examination group revealed only a 56% CVS prevalence rate. The most common single screen type used by 70.4% of students was the smartphone, and the most common complaint was headache (50.2%). Multivariate logistic regression analysis revealed that CVS was significantly associated with increased screen-hours, including >2 screen-hours daily (odds ratio [OR], 2.48; P<0.0001), >2 screen-hours at night (OR, 1.79; P=0.003), and ≥3 screen-years (OR, 1.69; P=0.006). In the mfERG group, 37% demonstrated reduced amplitudes of mfERG rings and quadrants, indicating reduced foveal responses.

Conclusion:

CVS-questionnaires overestimate the true CVS prevalence and sequelae, which could be accurately detected by objective ophthalmic examination. Smartphones primarily caused CVS among students, with CVS severity increasing in correlation with shorter eye-to-screen distance and frequent use. Contact lens wearing doubled the risk of CVS development and augmented its severity. CVS might affect macular integrity with screen-induced foveal dysfunction.

Clinical Trials Registration:

PACTR201811618954630.

Clinical Performance of Samfilcon A Contact Lenses in Intensive Digital Device Users: A Multicenter, Prospective Clinical Study

Introduction

To evaluate patient satisfaction with samfilcon A contact lenses (CLs) in intensive digital device users with myopia and to compare patient satisfaction with samfilcon A lenses to prior experience with senofilcon A or lotrafilcon B CLs.

Methods

This was a comparative, prospective, national study conducted at 14 centers in Turkey. Subjects were adults aged 18 and 45 years with myopia (range −0.25 D to −6.00 D) who spend a minimum of 3 hours viewing digital devices (e.g., computer, smartphone). A subgroup of patients were habitual lens wearers (senofilcon A or lotrafilcon B lens wear for at least 6 months prior to enrollment). The primary assessment was patient satisfaction with samfilcon A lenses (0–100 Likert scale). Secondary assessments included patient satisfaction with samfilcon A lenses compared to patients’ habitual lenses, investigator satisfaction with samfilcon A lenses and investigator-evaluated slit lamp examination findings.

Results

Samfilcon A lenses were given high overall ratings from both patients and investigators, with a low incidence of ocular symptoms. Overall, patients were highly satisfied with samfilcon A lenses for comfort, vision and overall performance, and stated that they would consider wearing these lenses in the future. Among habitual senofilcon A or lotrafilcon B lens wearers, samfilcon A lenses were rated significantly better than the habitual lenses in regard to comfort, vision and overall performance. Investigator assessments were also highly favorable, both at initial fit and after 4 weeks of follow-up, with no significant findings noted on slit lamp examination.

Conclusion

Samfilcon A lenses were rated highly by investigators in regard to fit, handling and slit lamp findings, and by novice and habitual lens wearers in regard to comfort, vision and overall performance. These results support the use of samfilcon A lenses among digital device users who seek day-long comfort and good visual acuity.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40123-021-00389-4.

Prevalence of Self-Reported Symptoms of Computer Vision Syndrome and Associated Risk Factors among School Students in China during the COVID-19 Pandemic

PURPOSE

To determine the prevalence and risk factors of self-reported symptoms of Computer Vision Syndrome (CVS) in school students during COVID-19 pandemic.

METHODS

In this cross-sectional study in Nanjing, China, students (grades 1-12) from six randomly selected schools self-administered the online survey questionnaire about hours on electronic devices, outdoor activities, frequency and intensity of 17 CVS symptoms during virtual learning period of COVID-19 pandemic.

RESULTS

Among 2363 invited students, 2005 (84.8%) completed the survey. Mean (SD) age was 12 (3.0) years, 51% were male, 53% wore glasses, 56% did not know the 20-20-20 rule (take a 20 second break every 20 min of close work and gaze at objects at least 20 feet away) and 6.5% knew but never followed the 20-20-20 rule. Mean (SD) hours/day was 4.6 (3.4) for screen time and 1.2 (1.0) for outdoor activities. Total of 1543 (77.0%) students reported at least one CVS symptom (median = 4) with eye dryness and itching the most common (48%). In multivariable analysis, CVS score 4 or more was independently associated with older age (adjusted odds ratio (aOR) = 1.05 for per-year increase, p = 0.02), children with myopia not wearing glasses (aOR = 2.12, p = 0.0003), astigmatism (aOR = 1.37, p = 0.04), other ocular diseases (aOR = 1.59, p = 0.005), not complying 20-20-20 rule (aOR = 2.13, p = 0.04), more screen time (aOR = 1.53 for >6 vs. ≤2 hours, p = 0.0001) and less outdoor activities (aOR = 1.37 for ≤0.6 vs. ≥1.9 hours, p = 0.005).

CONCLUSIONS

During COVID-19 pandemic, self-reported CVS symptoms occurred in more than three-quarters of students. Besides pre-existing ocular diseases, children with myopia not wearing glasses, excessive time on screens, non-compliance of the 20-20-20 rule and reduced outdoor activities were associated with higher risk of CVS.

Dry Eye and Visual Display Terminal-Related Symptoms among University Students during the Coronavirus Disease Pandemic

Purpose: To evaluate dry eye (DE) and subjective visual display terminal (VDT)-related symptoms in university students who moved their classes online due to the COVID-19 pandemic.Methods: Cross-sectional study of students who were taking online classes. In May 2020, the participants completed a Dry Eye Questionnaire (DEQ-5) and a self-report survey, which included demographics, medical history, information on the use of VDT and presence of VDT-related symptoms. Participants were classified as having mild/moderate (7-12) or severe (>12) DE symptoms based on their DEQ-5 score. The associations between severe DE symptoms and relevant factors were also evaluated.Results: The data of 1450 eligible students were analyzed. The mean age of the participants was 21.1 (2.7) years. 42.8% of the participants had mild/moderate DE symptoms, whereas 34.7% had severe symptoms. Associated factors for severe DE were female sex (OR = 2.57, CI [1.97-3.35]), allergic disease (OR = 1.63, CI [1.24-2.13]), previous dry eye diagnosis (OR = 13.49, CI [7.10-25.63]), keratoconus (OR = 5.56, CI [1.27-24.44], contact lens use (OR = 1.77, CI [1.24-2.53]) and duration of VDT use (OR = 1.02, CI [1.01-1.05]). Prior to the pandemic, the mean reported duration of VDT use was 9.8 (4.7) hours; this increased to 15.9 (5.8) hours during the online classes (p < .001). 80.6% of the participants reported a global increase in VDT-related symptoms.Conclusion: Students taking online classes had a high frequency of DE symptoms. They also reported a significant increase in VDT-related symptoms. DE should be considered as an emerging health problem among the young population, which is probably related to the recent changes in lifestyle.

Binocular Accommodation and Vergence Dysfunction in Children Attending Online Classes During the COVID-19 Pandemic: Digital Eye Strain in Kids (DESK) Study-2

PURPOSE

To subjectively evaluate the degree of visual fatigue in children attending online classes during the coronavirus 2019 (COVID-19) pandemic and objectively evaluate accommodation and vergence dysfunction in these children.

METHODS

Children aged between 10 and 17 years with recent onset of asthenopia symptoms were included. Symptoms were evaluated using the Convergence Insufficiency Symptom Survey (CISS) questionnaire. A CISS score of 16 or greater was considered symptomatic. Binocular vergence and accommodation parameters were objectively evaluated. For ease of comparison, children were divided into two groups: children using digital devices for less than 4 hours/day and children using digital devices for 4 hours/day or more.

RESULTS

A total of 46 children with a mean age of 14.47 ± 1.95 years were evaluated. The mean duration of online classes during the COVID-19 pandemic was 3.08 ± 1.68 hours/day, which is higher than before the COVID-19 pandemic (0.58 ± 0.71 hours/day, P < .00001). The mean CISS scores were 21.73 ± 12.81 for children using digital devices less than 4 hours/day and 30.34 ± 13.0 for children using digital devices for 4 hours/day or more (P = .019). Mean near exophoria (P = .03), negative fusional vergence (P = .02), negative relative accommodation (P = .057), and accommodation amplitude (P = .002) were different between the two groups. The Spearman correlation between the symptomatic CISS score and the duration of online classes showed a linear association (coefficient r_s = 0.39; P = .007). In the multivariate analysis, only the duration of online classes longer than 4 hours was a significant risk factor (P = .07) for the symptomatic CISS score.

CONCLUSIONS

Online classes longer than 4 hours were more detrimental to abnormal binocular vergence and accommodation parameters than online classes shorter than 4 hours. [J Pediatr Ophthalmol Strabismus. 2021;58(4):224-231.].

Correlation between the exposure time to mobile devices and the prevalence of evaporative dry eyes as one of the symptoms of computer vision syndrome among Senior High School students in East Java, Indonesia

OBJECTIVES

Computer vision syndrome (CVS) is a group of various eye and vision-related problems from prolonged use of mobile devices. Symptoms include dry eyes, blurred vision, eye strain, headache, and also neck and shoulder pain. This study was carried out to analyze the correlation between the exposure time of High Energy Visible (HEV) from mobile devices' use and the prevalence of evaporative dry eyes in young age.

METHODS

An observational cross-sectional study was done using quota sampling method for 100 High School students. Data collection was performed using questionnaire to identify daily use of mobile devices (hours) and duration for using mobile devices (years). A classification was determined as mild, moderate, and heavy HEV exposure. Evaporative dry eyes were diagnosed using tear break-up time test (TBUT) of less than 10 s for both eyes.

RESULTS

Ninety-four students participated in this study. A total of 82 students (87.2%) experienced evaporative dry eyes. There were 11 students (11.7%) who had dry eyes with mild exposure, 18 students (19.1%) had dry eyes with moderate exposure, and 53 students (56.4%) had dry eyes with heavy exposure. A chi square analysis showed all HEV exposures have similar risk to the prevalence of dry eyes among High School students (p<0.05).

CONCLUSIONS

The risk of developing evaporative dry eyes, as one of the symptoms of CVS in young age with normal tear production, could be induced even with minimal exposure to mobile devices.

Effect of digital device use during COVID-19 on digital eye strain

CLINICAL RELEVANCE

Home-isolation and social distancing during the COVID-19 pandemic caused increased use of digital devices, posing a greater risk of developing digital eye strain-related symptoms. Eye-care professionals should educate patients about limiting screen time and managing digital eye strain symptoms.

BACKGROUND

This study aimed to evaluate the COVID-19 isolation's impact on digital device use by comparing hours spent on digital devices before and during the 24-hour curfew in Saudi Arabia, while assessing the symptoms associated with digital eye strain.

METHODS

A self-reported questionnaire was used to compare the total hours per day, either continuous or intermittent, spent on digital devices during and before curfew, and the association of these durations with digital eye strain.

RESULTS

A total of 1,939 participants, (mean ± SD: 33 ± 12.2 years and 72% women) were recruited. Results showed a significant difference between usage duration before and during curfew. Digital eye strain incidence was 78% during the curfew. Chi-squared analysis indicated most symptoms are associated with usage duration and employment status. Multivariate analysis revealed significant associations between digital eye strain and the following factors: using more than one device (odds ratio 1.208, 95% confidence interval: 1.068-1.3661), age, optical correction, employment status, gender, using rewetting drops, and usage duration.

CONCLUSIONS

In this population, prolonged use of digital devices significantly increased during home-isolation. Digital eye strain incidence increased during curfew. Regular eye exams should be encouraged to ensure the use of optimum prescription use and meet the specific visual demands required for the use of digital devices. Eye-health strategies and awareness campaigns should be employed on the importance of regular eye exams, decreasing screen time, practising the 20-20-20 rule, and the use of rewetting drops to help reduce the symptoms of digital eye strain during this period.

Computer vision syndrome prevalence according to individual and video display terminal exposure characteristics in Spanish university students

AIM

To estimate the prevalence of computer vision syndrome (CVS) in university students and its relationship with sociodemographic and optical correction factors and exposure to video display terminal (VDT).

METHODS

This cross-sectional study included 244 Spanish university students who responded to an anamnesis, a VDT exposure questionnaire and the Computer Vision Syndrome Questionnaire (CVS-Q^© ). A descriptive analysis was performed and the prevalence of CVS was calculated. Logistic regression models were used to measure the association between CVS and the variables studied.

RESULTS

The mean age was 20.7 years (SD = 2.1), 57% were women, 78.3% used VDTs ≥ 2 hours/day to study. The prevalence of CVS was 76.6%, and the most frequent symptoms were headache and itching. In the crude analysis, being a woman, using glasses daily and to study, and a longer VDT use to study and in total were associated with a higher prevalence of CVS; while in the older group, the prevalence was lower. In the multivariate model, VDT use to study was associated with a greater probability of CVS (aOR: 3.43; 95%CI: 1.03-11.42), and being between 22 and 29 years was associated with a lower probability of it (aOR: 0.36; 95%CI: 0.15-0.89).

CONCLUSION

CVS has a high prevalence amongst Spanish university students. The most affected are the younger ones and those who use VDTs for longer hours to study. It is essential to continue investigating the influence of the type of tasks conducted with VDTs on CVS and thus to establish the preventive measures to reduce this syndrome.

Computer visual syndrome in graduate students of a private university in Lima, Perú

BACKGROUND

In recent decades, several studies have found a strong association between prolonged use of video display terminals and ophthalmological symptoms encompassed in the so-called computer visual syndrome (CVS). Few studies have addressed this syndrome in graduate students.

METHODS

Observational, cross-sectional descriptive study. A total of 106 postgraduate students were surveyed without ophthalmological pathologies. The diagnosis of CVS was made by means of the questionnaire of Seguí et al. validated in Spanish, which evaluates the frequency and intensity of 16 ocular symptoms.

RESULTS

The prevalence of CVS among graduate university students was 62.3% (95% CI: 52.3-71.5). It was found that the highest proportion of students with the syndrome was in the group of older than 40 years old (88.2%) and in the group 21-30 years old (70.0%), showing statistically significant differences (p=0.004). According to the device and its time of use, students who used the mobile phone for 7 to 10hours a day showed a higher prevalence of CVS compared to those who used the device for less time (p=0.030). The business School had the highest prevalence (75.0%).

CONCLUSION

Three out of every five graduate students presented CVS with this prevalence being like reported in other populations. There is a need to investigate possible interventions that can help reduce this entity.

Accommodative and binocular disorders in preteens with computer vision syndrome: a cross-sectional study

To assess computer vision syndrome (CVS) in a preteen population through an adult-validated CVS questionnaire and to evaluate how digital devices affect accommodative and binocular vision, we enrolled 309 preteens in this cross-sectional study. An adult-validated CVS questionnaire adapted to preteens was used for all subjects. Visual acuity testing, unilateral and alternate cover tests, and tests for accommodative and vergence responses were performed for all preteens. The mean age was 10.75 ± 0.67 (10-12) years. Subjects were divided into two groups: the mild CVS group with a mean CVS score ≤2 and the severe CVS group with a mean CVS score >2. Between the mild and severe CVS groups, statistically significant differences were found in near point of convergence break and recovery (P = 0.03 and P = 0.02, respectively) and distance negative fusional vergence break and recovery (P = 0.02 and P < 0.01, respectively). More children with severe CVS developed vergence disorders than those with mild CVS. Optometric clinical screening assessments could reduce ocular symptomatology and prevent long-term effects. However, poor optometric findings might have occurred first, and the poor convergence skills resulted in the symptoms reported while using devices.

Digital Screen Use and Dry Eye: A Review

Prolonged and continuous daily use of digital screens, or visual display terminals (VDTs), has become the norm in occupational, educational, and recreational settings. An increased global dependence on VDTs has led to a rise in associated visual complaints, including eye strain, ocular dryness, burning, blurred vision, and irritation, to name a few. The principal causes for VDT-associated visual discomfort are abnormalities with oculomotor/vergence systems and dry eye (DE). This review focuses on the latter, as advances in research have identified symptomology and ocular surface parameters that are shared between prolonged VDT users and DE, particularly the evaporative subtype. Several mechanisms have been implicated in VDT-associated DE, including blink anomalies, damaging light emission from modern devices, and inflammatory changes. The presence of preexisting DE has also been explored as an inciting and exacerbating factor. We review the associations between digital screens and DE, mechanisms of damage, and therapeutic options, hoping to raise awareness of this entity with the goal of reducing the global morbidity and economic impact of screen-associated visual disability.