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

BCLA CLEAR Presbyopia: Management with contact lenses and spectacles

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

Computer vision syndrome 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.

Ocular surface changes following computer use in post-LASIK patients

PURPOSE

To assess the impact of computer use on the ocular surface of individuals after laser in situ keratomileusis (LASIK).

METHODS

The dry eye symptoms and ocular surface of 18 post-LASIK young individuals and 18 controls were evaluated before and after performing a 30-min task on a computer without (Visit 1) and with (Visit 2) initial instillation of artificial tears. Symptoms were assessed using the Ocular Surface Disease Index (OSDI), Symptom Assessment in Dry Eye questionnaire version two (SANDE II) and Computer Vision Syndrome Questionnaire (CVS-Q). The ocular surface was assessed by measuring corneal higher order aberrations, tear meniscus height (TMH), conjunctival redness, blink rate and incomplete blinking, lipid layer thickness (LLT) and non-invasive keratograph break-up time (NIKBUT).

RESULTS

SANDE II scores were >0 after the computer task in both groups (p ≤ 0.01). SANDE II and CVS-Q scores did not differ between LASIK and controls (p ≥ 0.43). Greater bulbar-temporal conjunctival redness, TMH and LLT and shorter NIKBUT were found after computer use in the LASIK group (p ≤ 0.04), whereas no changes were observed in the controls (p ≥ 0.20). Lower SANDE II and CVS-Q scores were reported at Visit 2 compared with Visit 1 in both groups (p ≤ 0.01). Likewise, no worsening of dry eye signs was observed at Visit 2 (p ≥ 0.11).

CONCLUSIONS

Ocular symptoms reported during computer use were comparable between the groups. However, a worsening of dry eye signs was mostly observed in post-LASIK individuals. The instillation of artificial tears was effective in preventing the effects of computer use on the ocular surface in post-LASIK patients.

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.

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Assessment of Visual Quality Improvement as a Result of Spectacle Personalization

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

Relationship between mental fatigue and burnout syndrome in remote workers during the COVID-19 pandemic: an integrative review

This study aimed to analyze the scientific evidence available in the literature addressing the relationship between mental fatigue and burnout associated with teleworking during the COVID-19 pandemic through an integrative review. This review searched the following databases: PubMed, Scopus, Taylor & Francis, Embase, ScienceDirect, and SciELO using the DeCS and MeSH health sciences descriptors. The included articles were published between March and December 2021, during the pandemic. Of a total of 224 results, 215 articles were excluded and 9 were considered for the preparation of this integrative review. Mental fatigue was related to technostress, somatic symptoms such as anxiety and insomnia (p < 0.05), and loss of motivation (p < 0.05). Burnout was positively associated with work overload, high interdependence, and lower role clarity. The presence of a stressful factor and a protective factor was evidenced in burnout: intrusive leadership and workaholism, respectively. Greater exhaustion was observed in workers belonging to generation X (41 to 55 years old). Mental fatigue is related to exhaustion in the productive, physical, and psychological dimensions of individuals. Addiction to work has moderated this phenomenon, however, it is urgent to limit and optimize work hours as well as promote disconnection and rest among workers within the framework of a healthy work policy.

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

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

Computer vision syndrome-related symptoms in presbyopic computer workers

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

The effects of breaks on digital eye strain, dry eye and binocular vision: Testing the 20-20-20 rule

PURPOSE

To evaluate the benefits on the eyes of taking breaks based on the 20-20-20 rule.

METHODS

Bespoke computer software using the laptop webcam to assess user breaks, eye gaze and blinking, and emitting personalized reminders of breaks based on the 20-20-20 rule, was downloaded onto the laptops of 29 symptomatic computer users. Digital eye strain (DES), binocular vision and dry eye were assessed before and after two weeks of using the reminders and one week after the discontinuation of the strategy. Binocular measurements included visual acuity, accommodative posture, stereopsis, fixation disparity, ocular alignment, accommodative facility, positive/negative vergences and near point of convergence. Symptoms were evaluated using the computer vision syndrome questionnaire, ocular surface disease index (OSDI), and symptom assessment in dry eye questionnaire (SANDE) versions one and two. Dry eye signs were assessed by measuring tear meniscus height, conjunctival redness, blink rate and incomplete blinking, lipid layer thickness, non-invasive keratograph break-up time, corneal and conjunctival staining and lid wiper epitheliopathy.

RESULTS

A decrease in the duration of computer work and the duration of breaks, along with an increase in the number of breaks taken per day was observed as a result of the 20-20-20 rule reminders (p ≤ 0.015). No changes on any binocular parameter were observed after the management period (p ≥ 0.051), except for an increase in accommodative facility (p = 0.010). Dry eye symptoms and DES decreased with the rule reminders (p ≤ 0.045), although this improvement was not maintained one week after discontinuation (p > 0.05). No changes on any ocular surface and tear film parameter were observed with the rule reminders (p ≥ 0.089).

CONCLUSIONS

The 20-20-20 rule is an effective strategy for reducing DES and dry eye symptoms, although 2 weeks was not enough to considerably improve binocular vision or dry eye signs.

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).

Computer visual syndrome in university students in times of pandemic

INTRODUCTION

One of the consequences of prolonged use of bright screens such as those of the computer or cell phone, is the computer visual syndrome where characteristic symptoms are presented that normally disappear after a couple of hours when you stop using electronic devices. The prevalence is high due to multiple risk factors.

OBJECTIVE

To determine the prevalence of computer vision syndrome in medical students at the University of Boyacá in times of pandemic.

METHODOLOGY

Descriptive and cross-sectional observational study. The study population were medical students, the data were collected in September and October of the year, an electronic survey was carried out for data collection.

RESULTS

A total of 300 participants were invited to participate in the study. 78% (234) of participating students suffer from SVI. 67.09% (157) of the participants who reported suffering from SVI were female and 32.91% (77) were male.

CONCLUSIONS

Computer visual syndrome is very common among medical students at the University of Boyacá. This study has shown that the presence of SVI has been significantly associated with exposure factors that were triggered during the pandemic period, where frequent virtual classes and long hours led to high exposure to screens. In addition, in the era of virtuality, communication through social networks increased the use of cell phones, which increases the possibility of the appearance of this syndrome.

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.

Prevalence and risk factors of computer vision syndrome-assessed in office workers by a validated questionnaire

Background

Computer vision syndrome (CVS) is a common occupational health problem, but its clinical definition, prevalence and risk factors are not well defined. In general, non-validated diagnostic instruments have been used to assess its prevalence. For this reason, the aim of this study is to estimate the prevalence and potential risk factors for CVS using a validated questionnaire.

Methods

A cross-sectional study (n = 238) was carried out in Italian office workers using digital devices. All participants responded to an anamnesis, a digital exposure questionnaire, and the validated Italian version of the Computer Vision Syndrome Questionnaire. A battery of 3 ocular surface and tear ophthalmic tests (break-up time, BUT), Schirmer II and corneal staining) was performed.

Results

The mean age (±SD) was 45.55 (11.02) years, 64.3% were female. 71.4% wore glasses to work, whose design was monofocal (for distance) in 47.6%, monofocal (for near) in 26.5%, general progressive in 16.5% and occupational progressive in 8.8% of cases. 35.7% used digital devices >6 hours/day in the workplace. The prevalence of CVS was 67.2%. In the multivariate model, female sex (aOR: 3.17; 95% CI [1.75-5.73]), the use of digital devices >6 hours/day at workplace (aOR: 2.07; 95% CI [1.09-3.95]) and the use of optical correction at work (aOR: 2.69; 95% CI [1.43-5.08]) significantly increased the odds of CVS. Association was observed between presenting CVS and having abnormal BUT (χ2 = 0.017).

Conclusions

The prevalence of CVS in Italian office workers, especially among females, was high. Intensive use of digital devices at work (>6 hours/day) and the use of optical correction at work significantly increased the odds of CVS. There is an association between poor tear stability and CVS. Further research is needed on the influence of wearing optical correction on CVS. The use of a validated questionnaire in health surveillance of digital workers is strongly recommended.

New insights in presbyopia: impact of correction strategies

Presbyopia occurs when the physiologically normal age-related reduction in the eyes focusing range reaches a point, when optimally corrected for distance vision, that the clarity of vision at near is insufficient to satisfy an individual’s requirements. Hence, it is more about the impact it has on an individual’s visual ability to function in their environment to maintain their lifestyle than a measured loss of focusing ability. Presbyopia has a significant impact on an individual’s quality of life and emotional state. While a range of amelioration strategies exist, they are often difficult to access in the developing world and prescribing is generally not optimal even in developed countries. This review identified the need for a standardised definition of presbyopia to be adopted. An appropriate battery of tests should be applied in evaluating presbyopic management options and the results of clinical trials should be published (even if unsuccessful) to accelerate the provision of better outcomes for presbyopes.

Computer vision syndrome and its determinants: A systematic review and meta-analysis

Objective:

Computer vision syndromes are becoming a major public health concern. Inconsistent findings existed on computer vision syndrome. This systematic review and meta-analysis aimed to estimate the pooled prevalence of computer vision syndrome and identify its determinants.

Methods:

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 studies from 1 December to 9 April 2022. Quality assessment of the studies was performed using the JBI-MAStARI. RevMan and STATA 14 software were used for statistical analysis.

Result:

A total of 725 studies were retrieved, and 49 studies were included. The pooled prevalence of computer vision syndrome was 66% (95%, Confidence interval: 59, 74). Being female (Odd Ratio = 1.74, 95% Confidence interval [1.2, 2.53]), improper body posturing while using electronic devices (Odd Ratio = 2.65, 95% Confidence interval [1.7, 4.12]), use of electronic devices out of work (Odd Ratio = 1.66, 95% CI [1.15, 2.39]), no habit of taking breaks (Odd Ratio = 2.24, 95% Confidence interval [1.13, 4.44]), long duration of visual display terminal use (Odd Ratio = 2.02, 95% Confidence interval [1.08, 3.77]), short distance screen (Odd Ratio = 4.24, 95% Confidence interval [2.33, 7.71]), and general ergonomic practice (Odd Ratio = 3.87, 95% Confidence interval [2.18, 6.86]) were associated with increased odds of computer vision syndrome. However, good knowledge (Odd Ratio = 4.04, 95% Confidence interval [2.75, 5.94]) of computer vision syndrome was associated with decreased odds of computer vision syndrome.

Conclusion:

Nearly two in three participants had computer vision syndrome. Being female, improper body posturing, use of electronics devices out of work, no habit of taking a break, long-hour duration of visual display terminal use, short-distance screen, and general ergonomic practice were associated with increased odds of computer vision syndrome.

Concurrent Rising of Dry Eye and Eye Strain Symptoms Among University Students During the COVID-19 Pandemic Era: A Cross-Sectional Study

PURPOSE

Students spend extended hours using electronic devices due to online teaching. Digital eye strain (DES) and dry eye disease (DED) symptoms are both associated with prolonged screen exposure time and may co-occur. This study aimed to evaluate the correlation between DES and DED symptoms and determine the prevalence of DED according to the severity of DES.

PATIENTS AND METHODS

This cross-sectional study was conducted among international students in Chinese universities. The survey was built using Wenjuan Mini Program and distributed using the WeChat platform. The questionnaire assessed participants' screen exposure, the 20-20-20 rule, ED practices, and DED awareness. Computer Vision Syndrome Questionnaire (CVS-Q) and Dry Eye Questionnaire (DEQ-5) were used to diagnose DES and DED symptoms, respectively.

RESULTS

498 students completed the survey, but 452 were considered for the study. Predictors of DES and DED symptoms were conjunctivitis, eye allergy, glares, tired eye, neck pain, back pain, PhD students, and daily spending > 9h on screen (P < 0.05 for all). We observed that an increase in DES scores also exponentially increases DED scores. Among students diagnosed with DES symptoms, 26.5% had mild to moderate DED symptoms, and 8.2% had severe DED symptoms. In contrast, only 8.4% and 0.9% of those with asymptomatic DES had mild to moderate and severe DED symptoms, respectively (P < 0.000). A strong and significant positive correlation (r = 0.695, P < 0.000) between DES and DED scores was found.

CONCLUSION

We found an extremely high prevalence of DES and DED symptoms compared to the previous studies with a similar population group. We believe that the prevalence of DED may be underestimated in the young population. Training about proper ED practices is mandatory to prevent these deleterious ocular surface conditions.

[CVS-Q teen©: computer vision syndrome in adolescents and its relationship with digital textbooks]

OBJECTIVE

To analyse the prevalence and progression of computer vision syndrome in secondary and high school students with the CVS-Q© adapted and validated for adolescents, depending on whether they use textbooks or digital books.

METHOD

The CVS-Q© will be adapted by a pilot study in adolescents and a nominal group of visual health specialists, teachers and parents. The resulting version (CVS-Q teen©) will be tested to confirm its quality and applicability and a validation study will be done with visual tests, retest and psychometric analysis. Subsequently, a prospective longitudinal study with four repeated measures will be carried out in adolescents from two secondary schools of San Juan de Alicante (one has replaced textbooks by tablets). Computer vision syndrome will be measured by the CVS-Q teen© with three follow-ups. The prevalence of computer vision syndrome will be analysed according to sociodemographic, visual and digital device use variables. Logistic regression models will be performed, with random effect by student and time of use.

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.

Risks of Digital Screen Time and Recommendations for Mitigating Adverse Outcomes in Children and Adolescents

BACKGROUND

The COVID-19 pandemic caused an unprecedented move to emergency remote learning around the world, leading to increased digital screen time for children and adolescents. This review highlights the potential risk of increased screen time to the eye and general health and makes recommendations to mitigate the risks posed.

METHODS

A narrative review of evidence of increased digital time during the COVID-19 pandemic, the risks linked to increased screen time and offer possible steps to mitigate these in students.

RESULTS

Digital screen time was found to have increased for children and adolescents in all the studies examined during the pandemic and data suggests that this has an impact on eye and general health. We discuss the associated risk factors and adverse outcomes associated with increased digital screen time.

CONCLUSIONS

This review offers evidence of increased digital time, highlights some of the well-known and not so well-known risks linked to increased screen time, and offers possible steps to mitigate these in children and adolescents during the pandemic, as well as offering schools and parents strategies to support the eye health of children and adolescents post-pandemic. We discuss a number of interventions to reduce the risk of eye strain, myopia, obesity, and related diseases that have been shown to be linked to increased digital screen time.

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.

Interventions for the management of computer vision syndrome: a systematic review and meta-analysis

TOPIC

To evaluate the efficacy and safety of interventions for treating eye strain related to computer use relative to placebo or no treatment.

CLINICAL RELEVANCE

Computer use is pervasive and often associated with eye strain, referred to as "computer vision syndrome" (CVS). Currently, there are no clinical guidelines to help practitioners provide evidence-based advice about CVS treatments, many of which are directly marketed to patients. This systematic review and meta-analysis will help inform best practice for eye care providers.

METHODS

Eligible randomized controlled trials (RCTs) were identified in Ovid MEDLINE, EMBASE, CENTRAL, and trial registries, searched from inception to November 23, 2021. Eligible studies were appraised for risk of bias, and synthesized. The certainty of the body of evidence was judged using GRADE. Standardized mean differences (SMD) were used when differently scaled measures were combined.

RESULTS

Forty-five RCTs, involving 4497 participants, were included. Multifocal lenses did not improve visual fatigue scores compared to single-vision lenses (three RCTs, SMD: 0.11; 95% confidence interval (CI) -0.14 to 0.37; p=0.38). Visual fatigue symptoms were not reduced by blue-blocking spectacles (three RCTs), with evidence judged to be of low certainty. Relative to placebo, oral berry extract supplementation for 4 to 12 weeks did not improve visual fatigue (seven RCTs, SMD: -0.27; 95%CI -0.70 to 0.16; p=0.22), and dry eye symptoms (four RCTs, SMD: -0.10; 95%CI -0.54 to 0.33; p=0.65). Likewise, berry extract supplementation had no effect on critical flicker-fusion frequency (CFF) or accommodative amplitude. Oral omega-3 fatty acid supplementation for 45 days to 3 months improved dry eye symptoms (two RCTs, mean difference, MD: -3.36 units out of 18; 95%CI -3.63 to -3.10; p<0.00001) relative to placebo. Oral carotenoid supplementation improved CFF (two RCTs, MD: 1.55 Hz; 95%CI 0.42 to 2.67; p=0.007) relative to placebo, although the clinical significance of this finding is unclear.

CONCLUSIONS

We found no high certainty evidence supporting the use of any of the therapies analyzed. There was low certainty evidence that oral omega-3 supplementation reduces dry eye symptoms in symptomatic computer users.

Evaluation of computer workstations ergonomics and its relationship with reported musculoskeletal and visual symptoms among university employees in Jordan

OBJECTIVES

Computer workstations are considered a potential workplace hazard. This study sought to evaluate computer workstation ergonomics in a university office environment, and to determine its relationship with musculoskeletal (MS) and visual symptoms reported by employees.

MATERIAL AND METHODS

This was a cross-sectional observational study. A total of 231 university employees were recruited using a stratified random sampling technique. By means of direct observation, computer workstations were evaluated using the Occupational Safety and Health Administration (OSHA) Ergonomic Computer Workstation Evaluation Checklist. In addition, the participants reported MS and visual symptoms during the past week and 12 months by completing questionnaires.

RESULTS

Several ergonomic deficiencies in computer workstations were identified. Seating, working area, and keyboard and input devices had the most documented deficits. A significant proportion of employees reported various MS symptoms during the past 12 months. The most affected body parts were the shoulders (37%), the lower back (34%), and the neck (29%). The most prevalent visual symptom was tired eyes (68%). Logistic regression analysis indicated that MS symptoms, such as ache, pain and discomfort, were significantly associated with the total scores on the OSHA components. Deficits in monitor ergonomics and its placement, particularly the presence of glare reflected on the screen, were also associated with reported visual symptoms. Independent variables, such as gender, age, employment duration, job type, daily computer work hours, and work pattern, reliably predicted the participants' reported experience of various MS and visual symptoms.

CONCLUSIONS

Both MS and visual symptoms are associated with deficits in computer workstation ergonomics. Appropriate strategies, work practices, and preventive measures are needed to eliminate occupational hazards associated with computer workstations. Int J Occup Med Environ Health. 2022;35(2):141-56.

Computer vision syndrome in healthcare workers using video display terminals: an exploration of the risk factors

AIMS

To estimate the prevalence of computer vision syndrome (CVS) in healthcare workers and its relationship to video display terminal (VDT) exposure, sociodemographic, optical correction and work characteristics, and to analyse whether there are differences among occupational groups.

DESIGN

Cross-sectional study.

METHODS

A sample of 1179 physicians and surgeons, nurses, and nursing assistants from two hospitals in Spain between January 2017 and February 2018 were invited to participate in this study. Of these, 622 workers from both hospitals were finally included. CVS was measured using a questionnaire, the CVS-Q^© . Logistic regression was used to identify the factors associated with CVS. All the results were stratified by occupational group.

RESULTS

The prevalence of CVS was 56.75% with nurses being the most affected occupational group (61.75%). It was associated significantly with female sex (aOR = 2.57; 95% CI 1.36-4.88) and morning shifts plus on-call (aOR = 2.33; 95% CI 1.11-4.88) in the physicians and surgeons group. Among the nurses, it was associated with female sex (aOR = 2.35; 95% CI 1.03-5.37), seniority between 10 and 20 years (aOR = 2.17; 95% CI 1.03-4.59), VDT exposure at work of 2-4 h/day (aOR = 6.14; 95% CI 1.08-35.02), VDT exposure at work >4 h/day (aOR = 7.14; 95% CI 1.29-39.62) and self-perception that using the software application was not easy (aOR = 2.49; 95% CI 1.23-5.01).

CONCLUSIONS

A high prevalence of CVS among healthcare workers was observed. The risk factors that increased the likelihood of suffering from this syndrome depended on the occupation.

IMPACT

The findings may be used as a reference for occupational health services to implement specific preventive measures to reduce CVS for each occupational group. Such measures should consider both individual factors and the working conditions.

A multi-center study evaluating the correlation between meibomian gland dysfunction and depressive symptoms

Increased prevalence of depression has been found in patients with meibomian gland dysfunction (MGD); however, specific conditions of patients suffered from MGD and depression remains unclear. Our aim was to investigate the prevalence of depression in patients with MGD and analyze the risk factors of depression in MGD patients. In this multi-center cross-sectional study, we enrolled 830 MGD patients and 114 normal controls. Demographic information was collected by designed questionnaires about lifestyle habits, systemic and ocular medical history. Ophthalmic examinations were performed in a formal order. Depression symptoms were evaluated with a questionnaire survey using a modified self-rating depression scale (M-SDS). The correlations between the M-SDS score and demographic and clinical information were analyzed. The prevalence of hyperlipidemia and obstructive sleep apnea-hypopnea syndrome (OSAHS) was higher in the MGD group. There were 78 cases (9.4%) with depressive symptoms in the MGD group whereas there were 4 cases (3.5%) in controls. Similarly, M-SDS was higher in the MGD group. The characteristics of depression in the MGD group included: crying spells, sleep disturbance and depressed appetite. Some systemic diseases (OSAHS, allergy, skin disease) and the use of contact lenses was correlated with an increased risk of depressive symptoms in MGD patients.

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.

Presbyopia - A Review of Current Treatment Options and Emerging Therapies

Presbyopia is a common age-related vision disorder characterized by a progressive inability to focus on near objects. If uncorrected or under-corrected, presbyopia can significantly impact patients' quality of life. Presbyopia represents an area of considerable unmet need due to its rising prevalence worldwide as the population ages, the high proportion of under-treated individuals in some parts of the world, and the limitations of currently available corrective methods. Progressive or bifocal spectacles are associated with peripheral blur, a restricted visual field and impaired depth perception, which have been linked to an increased risk of falls in the elderly. Contact lens options can be difficult to maintain due to the development of age-related dry eye symptoms and reduced manual dexterity. Other corrective methods involve surgical interventions that modify the optics of the cornea, replace the crystalline lens, or attempt to restore active accommodation. While patients undergoing surgery report satisfactory outcomes post-operatively, many of them eventually require reading glasses. Non-invasive therapies with novel mechanisms of action are currently being investigated; these include miotic agents and UNR844, a lipoic acid choline ester. In this narrative review, available evidence on presbyopia prevalence, quality of life impact and risk factors are described, with a focus on observational studies in non-clinical settings. The diagnosis pathway and patient journey in presbyopia are outlined, and various treatment options are analyzed. The data reviewed herein reveals significant gaps in the provision of vision correction for this common condition, with a paucity of effective, non-invasive treatment options broadly accessible to presbyopic individuals.

Computer vision syndrome in presbyopic digital device workers and progressive lens design

PURPOSE

To estimate the prevalence of computer vision syndrome (CVS) in presbyopic digital device workers using two ophthalmic progressive lens designs during the working day, and to analyse the association of CVS with sociodemographic, occupational, digital device exposure and refractive factors.

METHODS

This time series, quasi-experimental design study included 69 presbyopic digital device workers (age range: 46-69 years; mean ± SD = 54.7 ± 5.0). All used desktop computers at their workplace. Progressive addition lenses (PALs) and occupational lenses were used for three months each. CVS was measured with the CVS-Q^© questionnaire before intervention (baseline) and at 1 week, 1 month and 3 months after wearing the lenses. A multivariate logistic regression model was used to identify the factors that were associated with an improved CVS-Q^© score.

RESULTS

37.7% of the subjects were female and 78.3% were ametropes; 65.2% had advanced presbyopia. 56.2% used digital devices at work >6 h day^-1 . The prevalence of CVS at baseline, after wearing PALs for three months and after three months of occupational lens wear was 68.1%, 33.3% and 18.8%, respectively. The mean CVS-Q^© score was lower with occupational lenses than with PALs (p = 0.001). 40.6% of the digital device workers improved their CVS-Q^© score ≥2 points with the occupational lenses. Ametropes were less likely than emmetropes to improve with occupational lenses (OR = 0.27, p = 0.05). 89.8% of the sample workers were satisfied or very satisfied with the occupational lenses and 71% were similarly satisfied with the PALs. 73.9% chose the occupational lenses as their first choice of lens for digital device use, compared with 17.4% for PALs.

CONCLUSIONS

Computer vision syndrome is reduced in presbyopic desktop computer workers wearing occupational lenses compared with PALs, especially in emmetropes.

Digital Device Use, Computer Vision Syndrome, and Sleep Quality among an African Undergraduate Population

Background. The purpose of the study was to determine the prevalence of computer vision syndrome (CVS) and poor sleep quality among university students and assess the relationship between digital device usage, CVS, and sleep quality. Methods. A cross-sectional study including undergraduate students was conducted in Ghana between January–March 2020. Information on digital device use and CVS symptoms was collected using a structured questionnaire. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Logistic regression was used to determine the relationship between CVS and digital device use behavior, and linear regression analysis was used to explore the association between sleep quality and digital device use behavior. Statistical significance was set at $p$  < 0.05. Results. Mean (SD) age of participants was 20.95 (1.68) years and most (54.97%) of them were females. The prevalence of CVS was 64.36%. Factors associated with CVS included hours of digital device use per day (OR = 4.1, $p$  < 0.001), years of digital device use (OR = 3.0, $p$  < 0.001), adjustment of digital device screen contrast to the surrounding brightness (OR = 1.95, $p$  = 0.014), and presence of glare (OR = 1.79, $p$  = 0.048). Prevalence of poor sleep quality was 62.43%. There was a significant association between poor sleep quality and number of years participants had used a digital device ( $p$  = 0.015) and the number of hours they used a digital device per day ( $p$  = 0.005). Conclusion. There is a high prevalence of both CVS and poor sleep quality among undergraduate students in Ghana. This represents a significant public health issue that needs attention.

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.

Effectiveness on knowledge about computer vision syndrome among medical coding trainee in medical coding training institute in urban Chennai, Tamil Nadu - A cross- sectional study

Context:

Electronic devices, laptops, tablets, ipad and smart phones are an integral part of one's life both in work and personal space. Excessive usage of these devices had led to health-related problems of which computer vision syndrome (CVS) is at risk of becoming a major public health issue.

Aims:

Our study aimed to assess the pre-test and post-test level of knowledge regarding CVS among the medical coding trainees and also to determine the effectiveness (Video Teaching Programme) of knowledge about the CVS among them.

Methods and Material:

After obtaining ethical committee clearance using universal sampling method 480 medical coding trainees working in a firm was included in this study. A structured questionnaire was used to interview and a video teaching programme was given between the pre and post-test sessions for about 45 minutes regarding the effects of Computer Vision Syndrome.

Results:

The level of knowledge about CVS among medical coding trainees in the pre-test and post-test was 280 (58.3%) and 8 (1.7%) had inadequate knowledge, respectively. With regards to adequate level of knowledge 24 (3%) and 328 (68.3%) had in pre-test and post-test phase, respectively. The comparison of knowledge shows a very good improvement among the medical coding trainees which was significant (p < 0.001).

Conclusions:

The study highlights health education as an important factor in increasing the knowledge. From a primary care point of view, knowledge regarding CVS helps in differentiating and addressing the ocular symptoms, headache and shoulder pain symptoms of other aetiology if history is elicited properly.