Computer vision syndrome: A review

Rejecting small! Accepting larger? Optimizing the font size of Chinese characters basing legibility and visual fatigue in OST-HMDs

Font size is highly related to the legibility and visual fatigue in OST-HMDs, but the effects of font size on these factors remain further explored. An experiment was conducted to investigate the effects of a wider range of Chinese character font size (0.32°-1°) on legibility and visual fatigue, as well as to determine the optimal font size. Results showed that 0.32° had the worst legibility, but there was no continuous improvement as font size increased. A larger font size was found to be beneficial in reducing visual fatigue until it reached 0.95°, beyond which visual fatigue would relatively increase. Font size smaller than 0.32° should be rejected while a larger font size does not always provide more benefits. Considering legibility, visual fatigue and efficiency of text presentation, 0.84° is a relatively optimal Chinese character font size.

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.

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.

Perceived Physical Discomfort and Its Associations With Home Office Characteristics During the COVID-19 Pandemic

OBJECTIVE

The goal of this study was to evaluate the prevalence and change in perception of physical discomfort, including musculoskeletal discomfort, during the COVID-19 pandemic and to determine associations of demographic factors, telework activity, and home office characteristics with the highest prevalence of discomfort.

BACKGROUND

The COVID-19 pandemic forced a substantial increase in telework in many countries. The sudden change from a regular workplace to an improvised "home office" may have an impact on working conditions and physical symptoms of office workers. However, investigations in this area remain limited.

METHOD

A cross-sectional study design was used to compare self-reported complaints of physical discomfort perceived from before with those during the pandemic. Associations between complaints and home office characteristics were investigated from 150 faculty and 51 administrative staff of an academic institution with an age range of 41.16 ± 10.20 (59% female).

RESULTS

A significant increase of physical discomfort was found during the pandemic period for head, eyes, hand, and upper back for both staff and faculty and neck, shoulders, elbows, and lower back for faculty only. Logistic regression analyses point to associations with the lack of a laptop stand, uncomfortable desk, poor lighting, and sitting time, among others.

CONCLUSION

A high prevalence of physical discomfort was reported by teleworkers during the COVID-19 pandemic. Some home office characteristics were associated with these discomforts.

APPLICATION

Some telework characteristics seem to be risk factors for physical discomfort. Consideration should be given to teaching best practices for workstation setup and/or conducting other preventive interventions in the work environment.

Lifestyle modification for mental health and well-being

Background

Unhealthy life-style leads to mental ill-health and poor quality of life and is the major determinant of a wide range of lifestyle disorders. The aim was to 1) review the work relating to life style modification for promoting mental health and 2) Present recommendations on life-style modification for mental health and wellbeing.

Material and Methods

The work on life style changes for promotion of mental health was retrieved from the scientific literature and critically reviewed.

Conclusions

Recommendations on 'Life-style modification for mental health and wellbeing' are presented. 20 specific components of healthy life style included are: Routine, time management, prayer, basic activities, reading newspaper, study/work, exercise, recreation/ relaxation/ talent promotion, education, cognitive activities, social networking, guidelines for behavior, peer group, social group, marriage/family, life skills, physical health, health education, mobile use, and digital media. The lifestyle modification package is comprehensive and geared to promote mental health and well-being.

Ergonomic intervention program for office workers: a case study about its effect in computer vision syndrome and musculoskeletal discomfort

This study aims to develop and implement an ergonomic intervention program at the workplace of knowledge workers, and to evaluate its impact on the reduction of Computer Vision Syndrome (CVS) and musculoskeletal symptoms. 84 workers were part of the study (mean age 43.2 ± 9.7 years). The intervention included training, delivery of a packaging of artificial tears, and adjustments in workstations. It was conducted intensively along 6 weeks. Data was collected on-site, with questionnaires administered pre-intervention, 2 months after, and 4 months after. Participants exhibited behavioural changes, especially in workplace adjustments and visual rest. By the intervention's end, over 90% had correctly adjusted screens and adopted appropriate postures, while 42.7% adhered to the 20x20x20 rule. CVS severity and prevalence decreased, but not significantly across the three time points. Significant improvements were observed in upper back and neck musculoskeletal symptoms at the end of workdays. Findings suggest that an ergonomic intervention program can benefit employees by reducing visual and musculoskeletal symptoms.

Impact of 10-Min Daily Yoga Exercises on Physical and Mental Discomfort of Home-Office Workers During COVID-19

OBJECTIVE

Evaluate the effects of 10 min/day of yoga for 1 month on musculoskeletal discomfort and mood disturbance of home-office workers.

BACKGROUND

The COVID-19 pandemic forced many people to switch to teleworking. The abrupt change from an office setting to an improvised home-office may negatively affect the musculoskeletal and emotional health of workers. By providing mental and physical exercises, yoga may be effective in reducing adverse effects.

METHOD

Fifty-four participants (42 women, 12 men) followed a 1-month yoga program, while 40 participants (26 women, 14 men) continued with their common work routine. The Cornell Musculoskeletal Discomfort Questionnaire was used to evaluate severity, interference with work and frequency of pain, and to obtain a total discomfort score for 25 body areas. Mood disturbance was evaluated with the Profile of Mood States questionnaire. Both groups completed both questionnaires, before and after the experimentation period.

RESULTS

After 1 month, for the yoga group only, significant reductions were observed in the discomfort of eyes, head, neck, upper and lower back, right wrist, and hips/buttocks, as well as reductions in discomfort severity, frequency and interference for the neck, upper and lower back. Total mood disturbance was also significantly reduced for the yoga group only. No favorable changes occurred for the control group.

CONCLUSION

The yoga intervention program appears to reduce musculoskeletal discomfort and mood disturbance of home-office workers.

APPLICATION

Sedentary workers may benefit from 10 min/day of yoga during the workday to attenuate potential physical and emotional discomfort during the current pandemic and beyond.

Trapezius activity during personal computer work with progressive addition lenses for general purpose and for computer work in neophytes

INTRODUCTION

This study analysed the impact of general purpose progressive addition lenses (GP-PALs) and computer progressive addition lenses (PC-PALs) on the activity of the trapezius muscle during computer operation.

METHODS

In this randomised, single-blinded, crossover study, surface electromyography (SEMG) signals were recorded bilaterally from the trapezius muscle during a 30-min computer task performed wearing different presbyopic corrections. The amplitude probability distribution function and its percentiles, gap frequency, muscular rest time and sustained low-level muscle activity periods were analysed in 32 subjects with artificially induced presbyopia. Subjectively perceived differences in vision and postural load between lenses were evaluated using a seven-item questionnaire (non-standardised, visual analogue scale ranged from 1 [bad] to 100 [good]).

RESULTS

Considering the SEMG data, no significant difference in the muscular activity of the trapezius muscle was observed when using GP-PALs or PC-PALs for computer operation. However, PC-PALs showed statistically and clinically significantly higher results for subjectively perceived visual quality (78.4-31.3; p < 0.001), spontaneous tolerance (79.2-31.3; p < 0.001) and field of view (75.9-23.5; p < 0.001) compared with GP-PALs.

CONCLUSIONS

Even though the electromyographic approach did not show a significant differentiation between the lenses, the subjective evaluation was clearly in favour of PC-PALs. Eye care practitioners should always take an occupational history of presbyopes, ask about the workplace situation and consider the use of PC-PALs.

Screen Time at 6 Years Old and Visual Function in Early Adolescence

Excessive screen time has been linked to adverse health outcomes in children, including vision-related problems such as myopia. However, very few studies have evaluated the effect of moderate screen exposure on the development of visual functions. This study aimed to examine the association between screen time during middle childhood and color discrimination, contrast sensitivity, and short-range visual acuity in 12-year-old children (n = 305) from the mother-child PELAGIE cohort (France) for the whole sample and for boys and girls separately. Visual functions were assessed using the Freiburg Acuity and Contrast Test and an adapted version of the Cambridge Color Test. Screen exposure was documented using a parent self-report questionnaire. Regression models showed that screen exposure at 6 years of age was significantly associated with higher contrast sensitivity across the entire sample at 12 years of age. However, when controlling for covariates, this association remained statistically significant in girls only. Sex-stratified analyses also showed that moderate screen exposure was linked to improved tritan-axis color vision in boys only. These findings suggest that moderate screen exposure in middle childhood is not harmful to visual function development and as such, provide new insights into the impact of digital technology on children's visual health and development.

A survey on the degree of eye discomfort caused by video terminal use among college students in different altitudes

OBJECTIVE

To analyze the risk factors associated with different levels of eye discomfort due to video terminal use among college students at different altitudes.

METHODS

This cross-sectional study was conducted to assess the prevalence and extent of eye discomfort by distributing an questionnaire to university students via the Internet. To analyze the causes and risk factors of eye discomfort among college students at different altitudes after using video terminals.

RESULTS

A total of 647 participants who met the criteria were included in this survey, of whom 292 (45.1%) were males and 355 (54.9%) were females. The results of the survey showed 194 (30.0%) participants without eye discomfort and 453 (70.0%) participants with eye discomfort. The results of the univariate comparison of the degree of eye discomfort in the study subjects with different characteristics showed that the differences in the degree of eye discomfort were statistically significant (P < 0.05) for the 7 groups of indicators: gender, region, wearing corneal contact lenses for more than 2 h per day, frequent use of eye drops, sleep time, total time of VDT use per day, and total time per VDT use, while the remaining indicators, including age, profession, and whether refractive surgery or other eye surgery was performed, whether frame glasses were worn for a long time, and duration of daily mask wear were not statistically significant. The results of multi-factor logistic analysis of the degree of eye discomfort in the study subjects with different characteristics showed that gender, region, frequent use of eye drops, sleep time, and total time of VDT use per day were the risk factors affecting the degree of eye discomfort.

CONCLUSIONS

Female, high altitude, frequent use of eye drops, shorter daily sleep duration and longer daily VDT use were associated risk factors for the development of severe eye discomfort, where the severity of eye discomfort was significantly negatively correlated with increased sleep duration and significantly positively correlated with increased total time of VDT use.

Relationship between visual display terminal working hours and headache/eyestrain in Korean wage workers during the COVID-19 pandemic: the sixth Korean Working Conditions Survey

Background

Prolonged use of visual display terminal (VDT) can cause eyestrain, dry eyes, blurred vision, double vision, headache and musculoskeletal symptoms (neck, shoulder, and wrist pain). VDT working hours among workers have greatly increased during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, this study aimed to investigate the relationship between VDT working hours and headache/eyestrain in wage workers using data from the sixth Korean Working Conditions Survey (KWCS) (2020-2021) conducted during the COVID-19 pandemic.

Methods

We analyzed the sixth KWCS data of 28,442 wage workers aged 15 years or older. The headache/eyestrain that occurred in the last year was assessed. The VDT work group included workers who use VDT always, almost always, and three-fourth of the working hours, while the non-VDT work group included workers who use VDT half of the working hours, one-fourth of the working hours, almost never, and never. To analyze the relationship between VDT working hours and headache/eyestrain, the odds ratios (ORs) and 95% confidence interval (CI) were calculated using logistic regression analysis.

Results

Among the non-VDT work group, 14.4% workers experienced headache/eyestrain, whereas 27.5% workers of the VDT work group experienced these symptoms. For headache/eyestrain, the VDT work group showed adjusted OR of 1.94 (95% CI: 1.80-2.09), compared with the non-VDT work group, and the group that always used VDT showed adjusted OR of 2.54 (95% CI: 2.26-2.86), compared with the group that never used VDT.

Conclusions

This study suggests that during the COVID-19 pandemic, as VDT working hours increased, the risk of headache/eyestrain increased for Korean wage workers.

The 20/20/20 rule: Practicing pattern and associations with asthenopic symptoms

Purpose

The present work style and lifestyle have increased the digital device use. Therefore, an increase in digital eyestrain is to be expected. We undertook a survey during coronavirus disease 2019 (COVID-19) pandemic to investigate the practice of 20/20/20 rule and its association with digital device use and asthenopic symptoms. While this rule is commonly advised, little is known about its validity.

Methods

An online survey form was disseminated through social media and emails. The questions for eye-related symptoms were similar to the convergence insufficiency symptom survey (CISS). Participants with age ≥5 years were included, with parents completing the survey for children (≤16 years).

Results

A total of 432 participants (mean ± standard deviation [SD]: 26.06 ± 13.92 years) were enrolled, of which 125 responses were for children. The 20/20/20 rule was practiced only by 34% of the participants either regularly (n = 38) or occasionally (n = 109). Those who had complaints of burning sensation and headache tended to practice this rule. Among adult participants, more females (47%) practiced this rule when compared to males (23%). Also, adult females significantly (P = 0.04) had more symptoms score when compared to males. In children, no such gender difference was found.

Conclusion

Only one-third of participants practice the 20/20/20 rule at least occasionally. More number of adult females being symptomatic and practicing in greater number could be due to higher prevalence of dry eye condition in females. While the symptom of burning sensation could be related to dry eye, that of headache could be related to refractive error or binocular vision dysfunctions.

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).

A comparison of muscle activity, posture and body discomfort during the use of different computer screen sizes

This study aims to compare changes in neck angles, muscle activities, ergonomic risk and body discomfort caused by use of two different computer screen sizes. The 36 female users who participated used displays with 46.99 and 58.42-cm screen sizes and were assessed for craniocervical angle (CCA), craniovertebral angle (CVA), upper trapezius (UT) and sternocleidomastoid (SCM) muscle activity, ergonomic risk and body discomfort for a duration of 1 h. The results showed there were no significant differences when comparing usage between both computer screen sizes (p > 0.05). However, there were significant differences in the CCA, UT muscle activity and body discomfort when comparing before and after usage for both computer screen sizes (p < 0.05). The results indicate that computer users can select different screen sizes for working but should be concerned with neck angle, muscle activity and body discomfort when using for long periods of time.

Spotlight on Digital Eye Strain

Digital Eye Strain (DES) is a clinical syndrome manifested with visual disturbances and/or ophthalmic dysfunction related to the usage of screen-enabled digital equipment. This term is gradually replacing the older term computer vision syndrome (CVS) that focused on the same symptoms found on personal computer users. DES is encountered more frequently during the past years due to the explosive increase in the usage of digital devices and subsequent increase in time in front of any screens. It presents with a series of atypical symptoms and signs stemming from asthenopia, dry eye syndrome, preexisting untreated vision issues and poor screen ergonomics. This review summarizes research data to date to determine whether the concept of DES has been conclusively defined and demarcated as a separate entity and if sufficient guidance is offered on professionals and the lay public. The maturity of the field, grouping of symptoms, examination techniques, treatment and prevention modalities are summarily presented.

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

Although computer vision syndromes are becoming a major public health concern, less emphasis is given to them, particularly in developing countries. There are primary studies on different continents; however, there are inconsistent findings in prevalence among the primary studies. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of computer vision syndrome. In this study, the review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Online electronic databases, including PubMed/Medline, CINAHL, and Google Scholar, were used to retrieve published and unpublished studies. The study was conducted from December 1 to April 9/2022. Study selection, quality assessment, and data extraction were performed independently by two authors. Quality assessment of the studies was performed using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tool. Heterogeneity was assessed using the statistical test I². STATA 14 software was used for statistical analysis. A total of 7,35 studies were retrieved, and 45 studies were included in the final meta-analysis. The pooled prevalence of computer vision syndrome was 66% (95% CI: 59, 74). Subgroup analysis based on country was highest in Pakistan (97%, 95% CI: 96, 98) and lowest in Japan (12%, 95% CI: 9, 15). Subgroup analysis based on country showed that studies in Saudi Arabia (I² = 99.41%, p value < 0.001), Ethiopia (I² = 72.6%, p value < 0.001), and India (I² = 98.04%, p value < 0.001) had significant heterogeneity. In the sensitivity analysis, no single study unduly influenced the overall effect estimate. Nearly two in three participants had computer vision syndrome. Thus, preventive practice strategic activities for computer vision syndrome are important interventions.

Improving Visual Comfort during Computer Gaming with Preservative-Free Hyaluronic Acid Artificial Tears Added to Ergophthalmological Measures

Digital asthenopia (DA) or Computer Vision Syndrome can occur after prolonged use of digital devices and is usually managed with ergophthalmological measures and the use of artificial tears. This prospective, controlled study evaluated the use of hyaluronic acid artificial tears on the signs and symptoms of DA in participants of a videogame convention. Subjects (n = 56) were randomized into a control group (CG, n = 26), which followed ergophthalmological measures, and a study group (SG, n = 30), which followed ergophthalmological measures and instilled 1 drop of artificial tears with hyaluronic acid 0.15% four times a day. Subjects were evaluated before and after playing for three consecutive days for eye dryness (SPEED questionnaire), conjunctival hyperemia, corneal fluorescein staining, conjunctival lissamine green staining, tear breakup time, Schirmer I test, near convergence and accommodation, and using questionnaires for DA symptoms. After 3 days of intense videogaming, the SPEED score of CG increased significantly (p = 0.0320), while for the SG it was unchanged. Similarly, the CG presented significant increases in ocular fatigue (p = 0.0173) and dryness (p = 0.0463), while these parameters decreased significantly in the SG (p = 0.0149 and p = 0.00427, respectively). This study confirms the protective effect of hyaluronic acid artificial tears against DA symptoms associated with prolonged visual display terminal use.

The relationship between visual display terminal usage at work and symptoms related to computer vision syndrome

Background

Although it is well known that the usage of visual display terminal (VDT) at the workplace causes computer vision syndrome (CVS), previous studies mainly focused on computer use and the health of white-collar workers. In this study, we explored the relationship between the usage of VDT including various devices, and symptoms related to CVS in a large population including pink-collar workers and blue-collar workers.

Methods

21,304 wage workers over the age of 20 years were analyzed from the 6th Korean Working Conditions Survey. To investigate the association between VDT use at work and symptoms related to CVS among wage workers, odds ratios (ORs) and 95% confidence interval (CI) were calculated by multivariate logistic regression models.

Results

In the group with the highest VDT usage at work, the OR of headache/eyestrain was 2.16 (95% CI: 1.86-2.52). The OR of suspected CVS patients was significantly increased in the highest group of usage of VDT at work (OR: 1.69; 95% CI, 1.39-2.06). Compare with the reference group, the OR for headache/eyestrain in the highest group of VDT usage was 2.81 (95% CI: 2.13-3.70) in white-collar workers, 1.78 (95% CI: 1.32-2.40) in pink-collar workers, and 1.59 (95% CI: 1.18-2.15) in blue-collar workers.

Conclusions

We observed a relationship in which the use of VDT in the workplace increases the risk of headache/eyestrain regardless of occupational classification. Our findings emphasize the importance of paying attention to the health of VDT workers and making plans to improve their working conditions.

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.

Prolonged Computer Use by Office Workers Induces Ocular Symptoms Associated With Tear Film Alterations and Overexpression of Mucin 5 AC and Catalase

OBJECTIVE

The aim of the study was to evaluate office workers for symptoms of computer vision syndrome (CVS) and alterations in the tear film relate to the hours of daily computer use.

METHODS

Sixty-seven volunteers were divided into 2 groups: 2 to 6 and 7 to 12 hours of daily computer use. Computer vision syndrome symptoms, tear film stability by tear film break-up time test, and composition of mucin 5 AC, catalase, and IL-6 was assessed by relative gene expression of conjunctival impression cytology samples were examined.

RESULTS

All participants exhibited moderate symptoms of CVS, whereas 90% showed reduced tear film stability. For the 7- to 12-hour (vs 2- to 6-hour) group, these effects were more pronounced and overexpression of mucin 5 AC and catalase was detected.

CONCLUSIONS

Prolonged computer use induced an overexpression of mucin 5 AC and catalase and instability of the tear film, associated with ocular symptoms.

Correlation between Eye Movements and Asthenopia: A Prospective Observational Study

Purpose: To analyze the correlation between eye movements and asthenopia so as to explore the possibility of using eye-tracking techniques for objective assessment of asthenopia. Methods: This prospective observational study used the computer visual syndrome questionnaire to assess the severity of asthenopia in 93 enrolled college students (age 20−30) who complained about asthenopia. Binocular accommodation and eye movements during the reading task were also examined. The correlations between questionnaire score and accommodation examination results and eye movement parameters were analyzed. Differences in eye movement parameters between the first and last reading paragraphs were compared. The trends in eye movement changes over time were observed. Results: About 81.7% of the subjects suffered from computer visual syndrome. Computer visual syndrome questionnaire total score was positively correlated with positive relative accommodation (p < 0.05). In the first reading paragraph, double vision was positively correlated with unknown saccades (all p < 0.05). Difficulty focusing at close range was positively correlated with total fixation duration, total visit duration, and reading speed (all p < 0.05). Feeling that sight was worsening was positively correlated with regressive saccades (p < 0.05). However, visual impairment symptoms were not significantly correlated with any accommodative function. In a total 20 min reading, significantly reduced eye movement parameters were: total fixation duration, fixation count, total visit duration, visit count, fixation duration mean, and reading speed (all p < 0.01). The eye movement parameters that were significantly increased were: visit duration mean and unknown saccades (all p < 0.001). Conclusion: Eye tracking could be used as an effective assessment for asthenopia. Among the various eye movement parameters, a decrease in fixation duration and counts may be one of the potential indicators related to asthenopia.

Video display terminal use and dry eye: preventive measures and future perspectives

BACKGROUND

Dry eye disease (DED) is a common cause of ocular pain and discomfort. Dry eye disease (DED) stems from a loss-of-tear film homeostasis and is frequently seen in video display terminal (VDT) users. Video display terminal (VDT) use reduces blink rates and increases incomplete blinks, leading to tear film instability and ocular inflammation, promoting DED.

PURPOSE

To assess and evaluate the methods for preventing VDT-associated DED and ocular discomfort.

METHODS

Studies were found using PubMed and Embase with the search terms: (digital visual terminal* OR computer use OR screen use OR smartphone OR display OR visual display terminal* OR computer vision syndrome OR tablet OR phone OR screen time) AND (dry eye OR DED).

RESULTS

Thirty-one relevant articles were found. Ten described single-visit studies, whereas 21 had a prolonged follow-up. Most preventive measures of VDT-associated DED aimed to increase blink rate or directly prevent tear film instability, ocular inflammation, mucin loss or ocular surface damage. Using an adjustable chair and ergonomic training, blink animations and omega-3 supplementation improved signs and symptoms of VDT-associated DED. Taking frequent breaks was associated with fewer symptoms, but no study assessed the commonly suggested 20-20-20 rule.

CONCLUSION

Preventive measures, such as blink animation programmes, oral intake of omega-3 fatty acids and improved ergonomics act on different parts of the vicious cycle of dry eye and could supplement each other. A comparison of the efficacy of the different interventions as well as more evidence of the effect of increased humidity, VDT filters and ergonomic practices, are required.

The Impact of Repetitive and Prolonged Eye Rubbing on Corneal Biomechanics

PURPOSE

To evaluate the effect of simulated repetitive eye rubbing on the corneal biomechanics of porcine eyes using an ex vivo model system.

METHODS

The average rubbing force that patients with keratoconus apply to their eyelids was previously determined. Fresh porcine eyes with eyelids were either exposed to 10,500 rub cycles from a custom-built eye rubbing machine that rubbed with a similar force to knuckle human eye rubbing (n = 33) or no rubbing at all (control; n = 37). A total of 10,500 rubs are equivalent to 1 year of rubbing six times daily, five movements per rub. The corneal biomechanical properties of these eyes were then tested by measuring the elastic modulus of 5-mm strips.

RESULTS

The elastic modulus at the range of 1% and 5% of strain was 1.219 ± 0.284 and 1.218 ± 0.304 N/mm² in the eye rubbing group and the no-rub control group, respectively. Corneal stiffness was similar in both groups (P = .984).

CONCLUSIONS

The threshold to induce biomechanical changes (purely by eye rubbing) must be higher than 10,500 rubbing movements, suggesting that occasional eye rubbing may not affect corneal biomechanics in normal eyes, and likely only triggers keratoconus progression in predisposed corneas. Further in vivo studies assessing the impact eye rubbing has on inflammatory activity and the biomechanical properties of weakened corneas is warranted. [J Refract Surg. 2022;38(9):610-616.].

Visual ergonomics, performance and the mediating role of eye discomfort: A structural equation modelling approach

The purpose of this study was to model the visual ergonomic factors affecting the performance in human computer interaction. A cross-sectional study using structural equation modelling was performed with a sample of 200 participants. The measuring instruments included Office Lighting Survey Questionnaire, performance assessment questionnaires, visual ergonomics assessment, and an eye discomfort assessment. The hypothetical model evaluated workplace lighting status and visual ergonomics as precursors, performance as the output, and eye discomfort as a mediator. The results showed that eye discomfort directly affected performance. Visual ergonomics also had a significant direct effect on eye discomfort. The final model suggested a significant new path between the quality of lighting and visual ergonomics. Also, the quality of lighting had an indirect effect on eye discomfort and performance, and the effect of visual ergonomics on performance was the same. Improving the lighting quality and visual ergonomics can reduce eye discomfort and increase performance.

Prevalence and Associated Factors of Computer Vision Syndrome Among Academic Staff in the University of Gondar, Northwest Ethiopia: An Institution-Based Cross-Sectional Study

INTRODUCTION

Computer vision syndrome (CVS) is the leading occupational hazard of the 21st century, which causes the critical public health issues in the present era. In developing countries, including Ethiopia, data on the proportion and the causes of CVS are scarce among academic staff for policy conclusions. Accordingly, this study was conducted to determine the prevalence and factors associated with CVS among academic staff at the University of Gondar.

METHODS

Institution-based cross-sectional study design was conducted from March to April, 2021. A simple random sampling technique was used to select 525 study participants. Data were collected using a pre-tested self-administered structured questionnaire. The collected data were then entered into EpiData version 4.6 and analyzed using STATA version 14 software. The association between dependent and independent variables was computed with a binary logistic regression.

RESULTS

The prevalence of CVS was found to be 78.8% out of a total of 500 participants [95% CI (74.95, 82.30)], of which the majority (71.60%) of them were males. Using a computer for more than 9 years [AOR = 1.65, 95% CI (1.01, 2.71)], using visual display terminals [AOR = 2.63, 95% CI (1.60, 4.32)], and working in improper illumination levels (300 and >500 lux) [AOR = 2.47, 95% CI (1.47, 4.33)] increased the risk of CVS, whereas, Using eye droplets [AOR = 0.30, 95% CI (0.15, 0.58)] and taking rest breaks [AOR = 0.55, 95% CI (0.34-0.92)] were protective factors.

CONCLUSION

This study disclosed that CVS was common among academicians. In the current study, the manifestation of CVS was affected by years of computer use, visual display terminals use, workplace illumination level, rest breaks, and eye droplets. Taking rest breaks in between the work, reducing exposure to display screens, use of eye drops, and optimizing workplace illumination levels are recommended to reduce the problem.

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 Effect of Lockdown Due to the COVID-19 Pandemic on Digital Eye Strain Symptoms Among the General Population: A Cross-Sectional Survey

Repetitive prolonged use of digital devices without regular breaks has detrimental effects on ocular health and quality of vision. Individuals with chronic eye problems and refractive errors are at higher risk of developing digital eye strain (DES). Correction of refractive errors, adopting healthy practices will reduce its risk. The survey examined the effect of prolonged lockdown on the development and increased severity of digital eye strain (DES) symptoms among the general population. An online survey was conducted in March 2020 on social media platforms in Jordan. Data from 1,460 responders were analyzed. About half of the respondents were between 30–49 years, 28.4% were retired, 21% had chronic systemic illness, and 23% reported chronic eye problems. A rise in the use of digital devices during lockdown was reported by 957 participants, with 33% of them used digital devices more than 4 h a day. The most common symptoms before and during lockdown were headache and neck / shoulder pain have the highest associations (X² = 280.0, 271.3, df = 4, p < 0.001 respectively). Female gender, existence of chronic eye problems and systemic diseases, and duration of using digital devices were found to be statistically significant factors associated with increasing severity of eye symptoms during lockdown. Not taking enough regular breaks from digital devices showed significant association with blurred vision at distance and near (X² = 13.03, 10.74, df = 4, P = 0.011, 0.03, respectively). People with chronic eye problems and increased time using devices during lockdown developed new eye complaints three times more than before the lockdown and males were two times more likely than females to have more severe eye symptoms.

A Study of the Effects of Different Indoor Lighting Environments on Computer Work Fatigue

The indoor lighting environment is a key factor affecting human health and safety. In particular, people have been forced to study or work more for long periods of time at home due to the COVID-19 pandemic. In this study, we investigate the influence of physical indoor environmental factors, correlated color temperature (CCT), and illumination on computer work fatigue. We conducted a within-subject experiment consisting of a 10 min-long task test under two different illumination settings (300 lx and 500 lx) and two CCTs (3000 K and 4000 K). Physiological signals, such as electroencephalogram (EEG), electrocardiograph (ECG), and eye movement, were monitored during the test to objectively measure fatigue. The subjective fatigue of eight participants was evaluated based on a questionnaire conducted after completing the test. The error rate of the task test was taken as the key factor representing the working performance. Through the analysis of the subjective and objective results, computer work fatigue was found to be significantly impacted by changes in the lighting environment, where human fatigue was negatively correlated with illumination and CCT. Improving the illumination and CCT of the work environment, within the scope of this study, helped to decrease the fatigue degree—that is, the fatigue degree was the lowest under the 4000 K + 500 lx environment, while it was relatively high at 3000 K + 300 lx. Under indoor environment conditions, the CCT factor was found to have the greatest effect on computer work fatigue, followed by illumination. The presented results are expected to be a valuable reference for improving the satisfaction associated with the lighting environment and to serve as guidance for researchers and reviewers conducting similar research.

Translation, cross-cultural adaptation and validation of the Computer Vision Syndrome Questionnaire into Persian (CVS-Q FA©)

Purpose

To translate, cross-culturally adapt and validate the Computer Vision Syndrome Questionnaire (CVS-Q^©) into Persian.

Methods

This study was carried out in 2 phases: (1) the CVS-Q^© was translated and cross-culturally adapted into Persian and (2) the validity and reliability of CVS-Q FA^© were assessed in a cross-sectional validation study. An expert committee composed of 15 optometrists evaluated content validity (item-level (I-CVI) and scale-level (S-CVI) content validity index were calculated). A pretest was performed (n = 20 participants) to verify the comprehensibility of the questionnaire. A total of 102 computer users completed the final questionnaire. Criterion validity and diagnostic performance of the CVS-Q FA^© were assessed by calculating sensitivity, specificity and receiver characteristic operator curve. Cronbach's alpha was calculated for the assessment of internal consistency and 46 participants refilled the questionnaire for the second time and the interclass correlation coefficient (ICC) and Cohen's kappa (κ) were evaluated for test–retest reliability.

Results

The translation and cross-cultural adaptation process was performed successfully according to accepted scientific recommendations without any major difficulties. The I-CVI was above 0.80 for all items (symptoms) except item 15 (feeling that sight is worsening) and the S-CVI was 0.92. The CVS-Q FA^© showed good sensitivity (81.1%) and acceptable specificity (69.2%). Also, it achieved good internal consistency (Cronbach's alpha = 0.80) and test–retest reliability (ICC = 0.81 and κ = 0.65).

Conclusion

The CVS-Q FA^© was successfully translated, cross-culturally adapted, and validated into Persian. This study provides a valid and reliable tool for the assessment of computer vision syndrome among the Iranian working population.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10792-022-02340-3.

AOASM Position Statement on Esports, Active Video Gaming, and the Role of the Sports Medicine Physician

ABSTRACT

Electronic sports, or esports, has a global audience of over 300 million fans and is increasing in popularity, resulting in projected revenue of over $1 billion by the end of this past year. The global pandemic of 2020 had little to no effect on these increasing numbers because athletes have been able to continue to engage in sports because of its electronic nature and fans have been able to follow them virtually. Esports has been recognized as an organized sport by the International Olympic Committee, the US National Collegiate Athletic Association, and several secondary school athletic associations within the United States. In addition, professional teams have been established in several major cities within the United States, Canada, Europe, and Australia. With the growth of esports, the necessity of incorporating esports medicine into the practice of sports medicine physicians has become paramount. Esports can be played on a monitor or screen and played using physical activity in what has become known as active video gaming. Within both of these platforms, there have emerged certain conditions unique to esports. There are also certain conditions seen in other sports applicable to esports athletes. This document will review the evaluation of the esports athlete, introduce conditions unique to these athletes and review common conditions seen in esports, discuss diagnostics used in the evaluation of esports athletes, introduce treatment options for conditions unique to esports and review those for commonly seen injuries in esports, discuss prevention of injuries in esports, and introduce a framework for the future development of esports medicine that can be introduced into the daily practice of the sports medicine physician.

Immediate Ocular Changes After Light-Emitting Diode Displays Exposure-A Preliminary Study

Purpose

Computer vision syndrome (CVS) is one of the most frequently encountered problems among video display terminals (VDT) users, but little is known regarding the short-term effect after exposure to light-emitting diodes (LED). The purpose of this study was to determine if short-term exposure to LED leads to changes in corrected distance visual acuity (CDVA), lipid layer thickness (LLT), blink rates, partial blink ratio, and computer vision syndrome questionnaire (CVS-Q) score.

Design

Prospective, cross-sectional study.

Methods

In this study, participants were recruited at the National Cheng-Kung University Hospital, a tertiary referral center in southern Taiwan, for examination. Participants were asked to complete the CVS-Q and undergo a series of ocular examinations, including CDVA, LLT, blink rates and partial blink ratio before and after watching an LED display for 15 min. Main Outcome Measures were changes in CDVA, LLT, blink rates, partial blink ratio, and CVS-Q measurements.

Results

In total, 120 eyes from 60 participants (mean age: 35.7 ± 9.4 years) were included; 31 participants were men (51.7%), and 29 were women (48.3%). The CDVA, LLT, blink rates, and partial blink ratio did not change after watching the LED display. The CVS-Q score significantly improved after short-term LED exposure (P < 0.001). A subgroup analysis of subjects with a baseline LLT of <60 nm or ≥60 nm determined that LLT significantly decreased in individuals with a baseline LLT of ≥60 nm (P = 0.016).

Conclusion

Short-term use of LED displays reduced LLT in individuals with a baseline LLT of ≥60 nm, despite the visual symptoms of CVS improved subjectively. Therefore, digital device users should be aware of the potential negative effects of LED exposure on the eyes.

Binocular vision findings in normally-sighted school aged children who used digital devices

Purpose

To determine the binocular vision status in normally-sighted school aged children who used digital devices.

Methods

A cross-sectional study was conducted at B.P. Koirala Lions Center for Ophthalmic Studies, Kathmandu, Nepal for a duration of one year. One hundred and eighty school aged children (71 female and 109 male) aged 7 to 17 years were included in the study. All the children underwent detailed ophthalmic and binocular vision examinations. The duration of the use of digital devices by the children were asked to either the parents or guardians present at the time of the study. The study participants were divided into two groups: children who used digital devices for the last six months (users group) and those who hadn’t used digital devices for the last six months (non users group). The users group was again divided into two subgroups: children who used digital devices for less than 3 hours per day and a day per week (low digital device users subgroup) and children who used digital devices for more than 3 hours per day and all days in a week (high digital device users subgroup).

Results

Accommodative amplitudes, accommodative facility, and positive fusional vergence for both near and distance were significantly reduced in the high digital device users group than in the low digital device users subgroup (p <0.01). Stereo acuity, near point of convergence, and negative fusional vergences for both near and distance were not statistically significantly different between the two subgroups. Prevalence of accommodative and vergence anomalies (except convergence insufficiency) was more in the high digital device users subgroup than in the low digital device users subgroup (p<0.01).

Conclusions

Children who used digital devices for a significantly greater amount of time had significantly reduced amplitudes of accommodation, accommodative facility, and positive fusional vergence both at near and distance.

A New Normal: Assessment Outcomes and Recommendations for Virtual Versus In-Person Curricula in Post-COVID-19 Times

INTRODUCTION

COVID-19 response efforts that began in March 2020 prompted an urgent need to transition medical education from an in-person to a virtual format. Our aim is to provide evaluation of a virtual platform for a fully integrated curriculum to provide future guidance in teaching methods.

MATERIALS AND METHODS

We used summative assessments and course evaluations from pre- and post-transition from in-person to virtual delivery of educational content to measure the impacts of this transition on student performance and perceptions. Additionally, we surveyed students about their in-person versus online educational preferences.

RESULTS

There were no statistically significant differences in student knowledge acquisition as assessed by weighted averages of summative assessments when comparing an in-person to a virtual educational platform. While the transition to virtual learning was initially well-received by students, our studied cohorts gave lower scores for the overall learning experience after prolonged virtual learning (p < 0.001). Students had a strong preference that anatomy and other group sessions should be delivered in-person. There was no strong preference whether other learning modalities should be given in-person or virtually.

CONCLUSIONS

Although student knowledge acquisition remained stable on a virtual platform, the student learning experience varied. We recommend that when returning to a new normal after COVID-19 restrictions are lifted, sessions that require 3-dimensional or group learning should remain in-person, while other educational activities may be offered on a virtual platform and that, whenever virtual learning is employed, attention be paid to ensuring ongoing social and academic engagement between learners and faculty.

The role of trataka in ameliorating visual strain and promoting psychological well-being during prolonged use of digital displays: A randomized controlled trial

BACKGROUND: The prolonged usage of digital displays leads to visual strain and, in turn, impairs psychological well-being. The practice of Yoga is said to enhance psychological functions and reduce visual strain. OBJECTIVE: The present study assessed the effect of the trataka (Yogic visual concentration) practice on the visual strain, mind-wandering, and mindfulness. METHODS: One hundred six volunteers equally distributed in the experimental and control groups completed the study. Visual Fatigue Scale (VFS), visual symptoms checklist (VSC), mind-wandering questionnaire (MWQ), and State Mindfulness Attention Awareness Scale (SMAAS) were administered at baseline and at the end of two weeks. RESULTS: All variables were similar at the baseline in both groups, and significant differences were noted at the end of two weeks between both groups. There was a significant reduction in VFS and VSC scores, MWQ, along with an increase in SMAAS scores in the experimental group. Although there were significant changes in VFS, MWQ, and SMAAS in the control group, the magnitude of change was minimal. CONCLUSIONS: The practice of trataka was found to reduce the visual strain, mind wandering while improving the state mindfulness. The practice can be implemented to mitigate visual strain and associated psychological implications due to prolonged exposure to digital displays, which has increased during the COVID-19 pandemic.

The effect of image resolution of display types on accommodative microfluctuations

PURPOSE

To determine whether accommodative microfluctuations (AMFs) are affected by the image resolution of the display type being observed. The effect of refractive error is also examined.

METHODS

Twenty participants, (10 myopes and 10 emmetropes) observed a target on four different displays: paper, smartphone, e-reader and visual display unit screen (VDU), whilst their accommodative responses were measured using a continuous recording infrared autorefractor. The accommodative response and AMF measures comprising low frequency components (LFC), high frequency components (HFC) and the root mean square (RMS) of the AMFs were analysed.

RESULTS

A significant increase in LFC power was observed for the paper stimulus when compared to the VDU and smartphone conditions. Myopes demonstrated a significantly higher LFC and mean accommodative response compared to emmetropes across the four displays. A significant difference in the mean AR between the displays with the lowest and highest resolution was found. A higher mean AR was found with higher resolution of the image. The HFC and RMS accommodation were not affected by display type.

CONCLUSION

The mean accommodative response and the mean LFC power appear to respond differently depending on the type of display in use. Higher resolution devices showed a reduced lag of accommodation to the accommodative demand; however, this may cause a lead of accommodation in myopes for higher resolution display types.

Evaluation of effectiveness of eye massage therapy via classification of periocular images

This paper proposes a method to evaluate the effectiveness of the eye message therapy. The existing methods are via the diagnoses conducted by the medical professions based on the measurements acquired by the optical instruments. However, this approach is very expensive. To address this issue, this paper performs the classification between the periocular images taken before performing the eye massage therapy and those after performing the eye massage therapy to address the above difficulty. First, the median filtering is used to suppress the solitary point noise with preserving the edges of the image without causing the significant blurring. Then, the Canny operator is employed to accurately locate the edges. Next, the circle Hough transform (CHT) is used for performing the iris segmentation. Finally, various classifiers are used to perform the classification. The computer numerical simulation results show that our proposed method can achieve the high classification accuracies. This implies that there is a significant difference on the iris before performing the eye massage therapy and after performing the eye massage therapy. In addition, the comparisons with the state of art Daugman method have been performed. It is found that the classification performance achieved by the CHT based method is better than those achieved by the Daugman method.

Prevalence of binocular vision dysfunctions in professional football players

CLINICAL RELEVANCE

The extent of binocular vision dysfunction in elite soccer players needs to be determined as it may impact performance.

BACKGROUND

The purpose of the study was to investigate the prevalence of binocular vision dysfunctions in elite soccer players.

METHODS

One hundred and seven professional soccer players were evaluated. Refractive error was measured and the following binocular vision parameters were assessed: horizontal and vertical phoria for distance and near vision, the values of break and recovery for negative and positive fusional vergences at distance and near vision, vergence facility at distance and near vision, monocular accommodative facility at near vision, and near point of convergence (break and recovery points). All the athletes were men with a mean age of 24.4 ± 4.8 years.

RESULTS

No athlete was diagnosed with divergence excess, divergence insufficiency, or basic exophoria. About 13.0% of the athletes have binocular vision dysfunctions related to esophoria (0.9% with esophoria at near vision and 12.1% with esophoria at distance and near vision). About 10.3% have convergence insufficiency and 2.8% were diagnosed with fusional vergence dysfunction. The only accommodation-related parameter analysed was accommodative infacility, and 6.5% of the athletes had this dysfunction. Vertical phoria was present in 3.7% of the athletes. No statistically significant differences were found based on in athletes with respect to ethnicity, position occupied on the field, age, ametropia or laterality.

CONCLUSION

The overall prevalence of binocular vision dysfunction in elite soccer players was 36.4%. The most prevalent dysfunctions are related to the presence of esophoria (13.0%). The values found point out the need to include binocular vision assessment protocols in the visual assessment routine for athletes.

Visual fatigue induced by watching virtual reality device and the effect of anisometropia

The effect of small anisometropia on visual fatigue when using virtual reality (VR) devices was investigated. Participants (n = 34) visited three times. In the first visit, VR exposure (10 min) was conducted with the full correction of the refractive error of both eyes. Experimental anisometropia was induced by adding a + 1.0 dioptre spherical lens either on the dominant eyes in the second visit or on the non-dominant eyes in the third visit. At each visit, the participants played a predetermined video game using a head-mounted display VR for 10 min. Visual fatigue was assessed before and after playing VR game using the Virtual Reality Symptom Questionnaire (VRSQ) and high-frequency component of accommodative microfluctuation. Results showed that watching VR induced significant increase of VRSQ score, significant decrease in the maximum accommodation power and objective increase in visual fatigue. Experimental anisometropia induction either on the dominant or non-dominant eyes did not aggravate visual fatigue. Practitioner summary: Mild differences in refractive error (up to 1.0 dioptre) between both eyes do not significantly increase ocular fatigue by viewing virtual reality device (10 min). The impact of small anisometropia may be limited in developing a virtual reality device. Abbreviations: VR: virtual reality; VRSQ: virtual reality symptom questionnaire; HMD: head-mounted display; HFC: high-frequency component.

Randomised controlled trial of an accommodative support lens designed for computer users

PURPOSE

Accommodative support (AS) lenses are a low add progressive addition spectacle lens designed to ease symptoms in computer vision syndrome (CVS). The study aims to investigate if (1) AS lenses improve CVS symptoms; (2) binocular/accommodative functions predict a benefit from AS lenses and (3) wearing AS lenses for six months impacts on binocular/accommodative functions.

METHODS

Pre-presbyopic adults with symptoms of CVS (Computer Vision Syndrome Questionnaire, CVS-Q^© , score ≥ 6) were randomly allocated to wear AS lenses or control single vision (SV) lenses. The CVS-Q^© and a battery of optometric tests were applied at baseline and after three and six months. Participants and researchers were masked to participant group. After six months, the SV group were unmasked and changed to AS lenses and one week later asked to choose which they preferred.

RESULTS

The change in CVS-Q^© scores from baseline to six months did not differ significantly in the two groups. At the end of the one week period, when the control group wore the AS lenses, control group participants were significantly more likely to prefer AS lenses to SV lenses. No optometric functions correlated with the benefit from AS lenses. AS lenses did not have any adverse effects on binocular or accommodative function.

CONCLUSIONS

In pre-presbyopic adults, there was no greater improvement in CVS-Q^© scores in the group wearing AS lenses than in the control group. No adverse effects on optometric function (including accommodation) are associated with wearing AS lenses.

[Digital eye strain. Symptoms, prevalence, pathophysiology, and management]

The digital revolution, which has been underway since the 1980's, is disrupting our daily routines with an exponential increase in the use of screens, which has not been without consequence to our visual system. Digital eye strain (DES), or computer vision syndrome (CVS), includes all the visual symptoms secondary to the use of digital devices. DES is present in at least 50% of regular users of digital media and is defined by blurred vision, difficulty focusing, ocular irritation or burning, dry eye, visual fatigue, headaches and increased sensitivity to light. Exposure time, age, female gender, and work environment are the main factors increasing its prevalence. Its pathophysiology, still poorly understood, is felt to be multifactorial and includes disturbances in the accommodative-convergence balance and changes in the ocular surface. Regarding accommodation and convergence, the studies are mostly old and their results heterogeneous. Conversely, many studies have shown an increase in the prevalence of dry eye in screen users. Although the retinal toxicity of blue light has been proven in in vitro models, the low level of evidence in the available studies does not allow it to be clearly correlated with the symptoms of DES. The objective of this review is to condense the knowledge available in the literature on the symptoms, prevalence, pathophysiology and management of DES.

The Physical Learning Environment of Online Distance Learners in Higher Education - A Conceptual Model

Online distance learning is offered not only in post-secondary distance education institutions but in traditional universities as well. With advances in mobile and wireless technologies, completing academic studies anywhere anytime should become feasible. Research in distance education and online learning has focused on computer-mediated communication, instructional design, learner characteristics, educational technology, and learning outcomes. However, little attention has been given to where exactly learners do their learning and studying and how the physical and social aspects of the physical environment within which the online learner is physically embedded (e.g., the home) supports and constrains learning activities. In this paper, the author proposes a conceptual model for understanding the role that the physical environment plays in online distance learning in higher education, drawing on theories and research in environmental psychology, online learning, telework and mobile work, and higher education. Several gaps in research are identified, and suggestions for future research are proposed.

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.

Health effects of immediate telework introduction during the COVID-19 era in Japan: A cross-sectional study

Background

Telework has been widely discussed in several fields; however, there is a lack of research on the health aspects of teleworking. The current study was conducted to determine the health effects of teleworking during an emergency statement as evidence for future policy development.

Method

This was a cross-sectional study in which we administered an online questionnaire to 5,214 general workers (response rate = 36.4%) from June 2020 to August 2020. Based on working methods during the pandemic, workers were categorized into the office group (n = 86) and telework group (n = 1597), and we characterized their demographics, changes in lifestyle, telework status, physical symptoms, and mental health.

Results

The results showed that the workers’ residence, marital status, management positions, and employee status affected the choice of the work method. During the emergency, teleworkers experienced more changes in their habits than office workers. In terms of exercise habits, 67.0% of the individuals belonging to the office-telework (OT) group exercised less. Approximately half of the teleworkers were satisfied with their telework, and those in the OT group were less satisfied with their telework than those in the telework-telework (TT) group, and they reported an increase in both working hours and meeting hours. Work-family conflict was more pronounced in the TT group than in the two other groups. Only 13.2% of individuals did not experience any stress in the past 30 days, and all three groups showed varying degrees of anxiety and depressive tendencies. In addition, all teleworkers experienced adverse physical symptoms before and after the emergency.

Conclusion

Health issues associated with teleworking should be given adequate attention.

Influence of Reading on Smartphone Screens on Visual Optical Quality Metrics and Tear Film Stability

PURPOSE

To evaluate the impact of a prolonged reading session on a smartphone screen on optical quality metrics and tear film stability.

METHODS

This prospective study was conducted in 41 healthy volunteers who were asked to read an article on a smartphone screen for 20 minutes. The following tests were performed before the reading task in this consecutive order and repeated after the reading task in the same order: automated noninvasive tear break-up time, optical quality assessment including Objective Scatter Index (OSI), modulation transfer function, Strehl ratio, and tear film dynamic analysis as follows: vision break-up time (VBUT) as a function of OSI changes within 20 seconds, using a double-pass aberrometer imaging system, and fluorescein tear break-up time (FBUT) measured using the slit lamp.

RESULTS

All break-up time-related parameters (noninvasive tear break-up time, FBUT and VBUT) were significantly reduced after the reading task (P < 0.01). The OSI was significantly worsened after the reading task (P = 0.01), whereas all the other optical quality metrics (modulation transfer function and Strehl ratio) slightly deteriorated, were not statistically significant. A significant correlation was found between the shortening of the FBUT, VBUT, and the worsening of the OSI (r = -0.33, P < 0.05).

CONCLUSIONS

A reading session on a smartphone screen in healthy subjects was found to significantly affect the tear film stability and objectively worsen the retinal image quality.

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.

The Relationship Between Dry Eye Disease and Digital Screen Use

Dry eye disease is characterized by tear film instability that can result in ocular surface damage. Patients with dry eye disease may experience ocular pain/discomfort and visual disturbances that may negatively impact quality of life. Increased use of digital screens for work, communication, and entertainment, especially during times of pandemic, may contribute to dry eye. Extensive cross-sectional studies have shown that digital screen use duration is associated with an increased risk of severe symptoms and clinical diagnosis of dry eye disease in adults. Smartphone use duration has also been found to be greater in school-age children with dry eye disease than in those without dry eye disease. A commonly accepted hypothesis for the relationship between digital screen use and dry eye disease is that digital screen use changes blinking dynamics, leading to ocular dryness. This review describes evidence that digital screen use is associated with dry eye disease, that digital device use alters blinking dynamics, and that dry eye affects mental health and work productivity in digital screen users. Helpful prevention and management strategies for dry eye disease exist for those who use digital screens.

Computer vision syndrome among Saudi population: An evaluation of prevalence and risk factors

Introduction

In the recent era of technological evolution, electronic devices have become an essential part of our lives, not merely in professional work settings, but also in daily leisure activities. Although these devices have simplified our lives, they are associated with a wide variety of health complaints. Thus, the so-called computer vision syndrome (CVS) has become a growing public health problem and has gained significant attention as it plays an important role in the quality of life of each individual, which in turn has put an increased burden on the health care system. Eye symptoms are among the most reported, yet extraocular symptoms were frequently described as adding an extra load.

Method

An electronic survey was distributed randomly through social media platforms among the general population in Saudi Arabia, between the period from July to December 2017, irrespective of their sociodemographic factors, aiming to determine the prevalence of CVS and to verify the most common associated risk factors.

Results

In total, 690 participants were involved in our study, with a mean age of 33.8 years. Of these, 77.6% suffer from CVS, with eye-burning being the most common ocular symptoms (71%), as well as itching (67.5%), blurred vision (65%), tearing (62.3%), and other eye symptoms being reported. Neck/shoulder pain was found to be the most prevalent extra ocular symptom (85.2%); also back pain and headache are frequently expressed (78% and 70% respectively). A significant positive correlation was observed between CVS symptoms and time spent using the devices (P-value: 0.002).

Conclusion

As technology advances, electronic devices have become a common tool that is used for different purposes on daily basis. We found in our study that the so-called computer vision syndrome is a growing public health problem. Thus, community education about the impact of such a lifestyle for proper handling of electronic devices must be addressed to avoid such health complaints.