Eyeing computer vision syndrome: Awareness, knowledge, and its impact on sleep quality among medical students

The Impact of Optimized Blinking on Vision and Related Parameters in Individuals With Computer Vision Syndrome: A Single-Blind Randomized Controlled Trial

INTRODUCTION

Computer vision syndrome (CVS) has become a significant issue for individuals working on computers and digital devices for extended periods. The ocular and periocular symptoms and signs associated with CVS are a major concern, affecting individuals physically and financially. Additionally, CVS has been linked to the rapid progression of myopia, exacerbating the situation. Blinking has been one of the major treatment methods for the treatment of CVS. This study presents a unique and novel randomized controlled therapeutic trial that evaluates the impact of extended blinking therapy on eye health and vision, along with other related parameters. Materials and methods: The present study is a randomized controlled trial conducted from September 2022 to April 2024. Participants aged 18-40 with CVS and a computer vision syndrome questionnaire (CVS-Q) score of ≥6, with mild to moderate refractive error (between -6D and +4D), were included. The sample size was determined based on a pilot study, resulting in a minimum required sample size of 36 patients (18 cases and 18 controls). Participants were randomly assigned to either the case (interventional) or control (conventional) group and were followed up for six months. Cases received conventional CVS treatment plus optimized blinking exercises, while controls received conventional therapy only. Comprehensive ocular assessments were conducted bi-monthly over six months, evaluating changes in uncorrected visual acuity (UCVA), refractive error, near point of accommodation (NPA), near point of convergence (NPC), Schirmer's test, and tear film breakup time (TBUT).

RESULTS

The study included 20 patients in the case group and 18 in the control group, primarily aged 20-29 (60.5%). Most patients used laptops for their activities (55.26%). The CVS-Q score significantly decreased in both groups following treatment, with both cases and controls showing significant improvement (p<0.001 for both groups). UCVA in the right eye (RE) and left eye (LE) of the cases improved significantly post-treatment in the interventional group (RE: p=0.002; LE: p<0.001). A significant change in refractive error, which is measured as spherical equivalent (SE), was seen among cases following treatment (RE: p<0.001; LE: p=0.021). Controls showed no significant changes in visual acuity or refractive error. The NPA in the cases improved significantly in the RE (p=0.027) but not in the left. The NPC in the intervention group showed no significant change, while controls showed considerable improvement (p=0.042). Schirmer's test results showed no significant change in either group. However, TBUT in the cases improved significantly (RE: p<0.001; LE: p<0.001). In the controls, TBUT decreased significantly, indicating a deterioration in tear film stability. Asthenopia grades improved considerably in cases, while controls showed only some improvement. Severe symptoms still remained in the control group, emphasizing the potential benefits of the blinking exercise in reducing asthenopia symptoms.

CONCLUSION

Optimized blinking therapy significantly improves vision and refractive error, tear film stability, and discomfort, making it beneficial for chronic computer users to maintain ocular health and enhance productivity and quality of life.

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

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

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.

Poor sleep quality and associated determinants among textile and garment manufacturing workers in Addis Ababa, Ethiopia

Background

Sleep is a physiological process that is essential to human physical, emotional, and mental health. Sleep difficulties affect an estimated 150 million individuals globally, with roughly 17% of the population in developing countries. As a result, the purpose of this study was to determine the prevalence and associated factors of poor sleep quality among textile and garment manufacturing workers in Addis Ababa, Ethiopia, in 2022.

Methods

A facility-based cross-sectional study was done from July 15th to August 15th, 2022, using a simple random sample technique. The degree of self-reported poor sleep quality was quantified using a validated, interviewer-administered, standardized Pittsburgh Sleep Quality Index. To determine the relationship between independent variables and poor sleep quality, multivariable logistic regression analysis was carried out with a p-value of less than 0.05 and a 95% confidence interval (CI).

Results

The prevalence of poor sleep quality was 75.4% (95% CI: 70.8, 80). Working more than 8 h per day (AOR = 2.83, 95% CI: 1.01, 7.94), work dissatisfaction (AOR = 3.27, 95% CI: 1.52-7.05), and using electronic materials before sleeping (AOR = 2.08, 95% CI: 1.01-4.30) were all associated with poor sleep quality.

Conclusion

Poor sleep quality was common among garment and textile industrial workers. Work dissatisfaction, working hours, and the utilization of electronic materials before bedtime were all substantially related to poor sleep quality, which should be taken into account and addressed early to reduce poor sleep quality.

Association of Computer Vision Syndrome with Depression/Anxiety among Lebanese Young Adults: The Mediating Effect of Stress

Computers have become indispensable in daily activities. With this excess use of electronics, computer vision syndrome (CVS), a highly prevalent condition, is associated with various symptoms. Although understanding the relationship between CVS and mental health has been reported, the impact of CVS has not been explored on more than one psychological aspect. We hypothesize that higher CVS symptoms could be associated with higher levels of anxiety and depression, mediated by higher stress. Therefore, the objective of this study was to determine the association between CVS and depression and anxiety among a sample of Lebanese young adults, along with evaluating the mediating effect of stress on these associations. Between August 2020 and April 2021, 749 participants completed an online questionnaire for this cross-sectional study. Females compared to males (Beta = 3.73) and those with CVS compared to those who did not (Beta = 3.14) were significantly associated with more anxiety, whereas having a university level of education compared to secondary or less (Beta = -3.02) was significantly associated with less anxiety. Females compared to males (Beta = 2.55) and those with CVS compared to those without (Beta = 2.61) were significantly associated with more depression, whereas being of an older age (Beta = -0.18) was significantly associated with less depression. Stress partially mediated the association between CVS and anxiety and between CVS and depression. More CVS was significantly associated with more stress (Beta = 3.05). Higher stress was significantly associated with more anxiety (Beta = 0.70) and depression (Beta = 0.71), whereas more CVS was significantly and directly associated with more anxiety (Beta = 3.14) and depression (Beta = 2.61). This study is the first worldwide to evaluate an association between CVS and mental health. Our results serve as a starting point for healthcare providers (psychiatrists and psychologists, most importantly) to look deeper into CVS when looking for reasons behind mental health issues. Further studies are warranted to confirm our results and look for more factors and mediators in such associations.

The Worldwide Prevalence of Sleep Problems Among Medical Students by Problem, Country, and COVID-19 Status: a Systematic Review, Meta-analysis, and Meta-regression of 109 Studies Involving 59427 Participants

Abstract

Purpose of Review

Several studies have found that medical students have a significant prevalence of sleep issues, such as poor sleep quality, excessive daytime sleepiness, and inadequate sleep duration. The purpose of this review is to carefully evaluate the current research on sleep problems among medical students and, as a result, estimate the prevalence of these disturbances. The EMBASE, PsychINFO, PubMed/MEDLINE, ScienceDirect, Scopus, and Web of Science and retrieved article reference lists were rigorously searched and rated for quality. Random effects meta-analysis was performed to compute estimates.

Recent Findings

The current meta-analysis revealed an alarming estimated pooled prevalence of poor sleep quality (K = 95, N = 54894) of 55.64% [95%CI 51.45%; 59.74%]. A total of 33.32% [95%CI 26.52%; 40.91%] of the students (K = 28, N = 10122) experienced excessive sleepiness during the day. The average sleep duration for medical students (K = 35, N = 18052) is only 6.5 h per night [95%CI 6.24; 6.64], which suggests that at least 30% of them get less sleep than the recommended 7-9 h per night.

Summary

Sleep issues are common among medical students, making them a genuine problem. Future research should focus on prevention and intervention initiatives aimed at these groups.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40675-023-00258-5.

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

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

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).

The Association of Screen Time, Sleep Quality, and Dry Eye Among College Students in Saudi Arabia

Background Dry eye is a serious public health issue that causes ocular discomfort, weariness, and visual disturbances that can disrupt everyday activities. Dry eye disease is one of the most common reasons people seek eye care. Therefore, this study aimed to assess the association between screen time, sleep quality, and dry eye among college students in Saudi Arabia. Methods This cross-sectional study was conducted among college students in Saudi Arabia. Data were collected through a validated questionnaire distributed via social media. Results A total of 1,593 participants were included. Many of them were aged between 18-25 years (80.7%) and females were (65.0%). Females and residents of the middle region had significantly more severe sleep-wake difficulties than other people (p<0.001). Participants with a master's degree had lower severe sleep-wake difficulties than other participants (p<0.001). Participants who spent between 4-6 hours on the screen showed high severe sleep-wake difficulties (p<0.001). Regarding eye dryness, females, participants with a bachelor's degree, and participants who spent more than six hours on screen had more severe symptoms of eye dryness. Nearly half of the participants with severe sleep-wake difficulties reported mild to moderate symptoms of dry eye (p<0.001). Conclusions Our study concluded that university students in Saudi Arabia had significant sleep-cycle difficulties and mild to moderate eye dryness symptoms. Age, female gender, sleep duration, educational level, monthly income, and excessive screen time were found to be associated with sleep-cycle problems and eye dryness symptoms.

Computer Vision Syndrome: An Ophthalmic Pathology of the Modern Era

Digital device usage has increased significantly in last decade among all age groups, both for educational and recreational purposes. Computer vision syndrome (CVS), also known as digital eye strain (DES), represents a range of ocular, musculoskeletal, and behavioral conditions caused by prolonged use of devices with digital screens. This paper reviews the principal environmental, ocular, and musculoskeletal causes for this condition. Due to the high prevalence of DES and frequent usage of digital devices, it is important that eye care practitioners be able to provide advice and management options based on quality research evidence.

Investigating the Prevalence of Computer Vision Syndrome (CVS) Among Undergraduate Nursing Students: A Cross-Sectional Study

Introduction

During the pandemic, health issues associated with using digital devices and exploring social media, such as Computer Vision Syndrome (CVS), have increased considerably.

Objectives

This study looked into CVS and its significance in Jordan and the CVS outcomes of undergraduate nursing students who used digital devices to surf social media during COVID-19.

Methods

To assess CVS, a quantitative cross-sectional research design was used. Data were collected in 2022 through an online diagnostic and formative survey utilizing the CVS-Questionnaire (CVS-Q) with 310 undergraduate nursing students from a government and a private university in Jordan. Descriptive statistics and the univariate general linear model were used to analyze the collected data.

Results

To report the prevalence of CVS among the studied sample, the median score was 1.80. The median prevalence score was 24.50 (range = 13-31), and 26.75% of participants reported having intense social media searches. For a student in this study to be diagnosed with CVS, they must receive a score of at least 5, and the current sample score was around 2, indicating they didn't have a CVS; however, it was moderate when it occurred. About 26.75% of participants reported having problematic social media searches. Back and neck pain and headaches were the typical signs of CVS. The average daily hours spent using digital devices for social media searches increased during the pandemic utilizing mobile phones, especially among male nursing students. Being a junior student with no social media account and unable to balance study and social media were among the predictors of CVS. Most students used protective tools on their digital devices, such as protective films and phone screens, to prevent or accommodate CVS.

Conclusion

There were no prior collected data about CVS in Jordan, and based on the international trend, the COVID-19 pandemic didn't directly contribute to the prevalence of CVS. However, when the CVS occurred, it was moderate, which mandates proactive and prophylactic redesigning of our educational system.

Population perceived eye strain due to digital devices usage during COVID-19 pandemic

PURPOSE

To assess the magnitude severity and determinants of eyestrain and the use of digital devices in a Saudi population during the COVID-19 pandemic lockdown.

METHODS

This web-based survey was conducted in September 2020 and enrolled only Saudi nationals 15 years or older. Data were collected on demographics, eye strain related symptoms, severity, and the use of optical aids during the COVID-19 lockdown. The frequency and severity of eye strain were calculated. A Computer Vision Syndrome (CVS) score was graded as none/mild moderate and severe, based on the sum of 15-eye strain related signs and symptoms. Correlation analysis was performed for determinants of CVS.

RESULTS

The study sample was comprised of 2009 individuals with median age of 20 years. Among those who used digital devices for more than 6 h daily, the main reasons for use were work and social purposes among 68.4%, and 61% of respondents, respectively. The prevalence of knowledge on CVS and the '20-20 rule for using digital devices' was 9.4% and 6.9, respectively. The most common symptoms of eye strain from digital device usage were headache, burning, itching, tearing, and redness of eyes. Six hours of daily usage of digital devices was positively associated to the grade of eye strain severity during the COVID-19 lockdown (P < 0.05)).

CONCLUSION

The Saudi population experienced eye strain during COVID-19 lockdown due to excessive digital devices usage. Longer duration of digital device usage was associated to eye strain. Health care providers should educate the general population on measures to mitigate eye strain due to digital devices. Trial registration ID None applicable.

Lifestyle-related risk factors correlated with mental health problems: A longitudinal observational study among 686 male college students in Chongqing, China

Aim

Public concerns over the mental health problems of college students are rising. Previous research show that female tend to suffer more from mental health problems than males, with few studies focusing on males. This study sought to explore the association of lifestyle-related risk factors with the prevalence of mental health problems among male college students in China.

Methods

The lifestyle information and mental health status of 686 male college students from Chongqing, China, were assessed in 2014, and 582 of them were followed up a year later. Participants completed a questionnaire assessing demographic and lifestyle factors which include sleep quality, computer usage, sedentariness, physical activity, smoking, current alcohol, coke, coffee, and milk tea drinking, and current tea/fried food/baked food consumption. Mental health problems were measured using the Depression Anxiety Stress Scale-21 (DASS-21).

Results

Univariate analyses indicated that age, sleep latency, sleep duration, computer usage time, milk tea drinking, and fried food consumption were potential risk factors for mental health problems (p's < 0.05). Multivariate analysis further revealed that, either at baseline or during follow-up, participants with (i) more computer usage time were at a higher risk of having depression symptoms (p's < 0.05) and (ii) a higher frequency of fried food consumption were associated with a higher risk of having depression, anxiety, and stress symptoms (p's < 0.05). Additionally, the cross-lagged analysis showed that (i) computer usage time in 2014 is positively correlated with depression status (β = 0.106, p < 0.05) but not anxiety (β = 0.047, p > 0.05) and stress (β = 0.019, p > 0.05) status a year later and (ii) fried food consumption in 2014 is positively correlated with depression (β = 0.129, p < 0.01), anxiety (β = 0.168, p < 0.001), and stress (β = 0.113, p < 0.01) status a year later.

Conclusions

Computer usage time and fried food consumption were lifestyle-related risk factors for mental health problems in male college students in Chongqing, China. These results might emphasize further preventive strategies for mental health problems, especially in male college students.

Risk factors for the prevalence of poor sleep quality in lecturers during COVID-19 pandemic in Ethiopia: an institution-based cross-sectional study

OBJECTIVE

This study was conducted to assess the prevalence and risk factors of poor sleep quality (SQ) among the academic staff at the University of Gondar, Northwestern Ethiopia.

DESIGN

An institution-based cross-sectional study was conducted from March to April 2021. A validated, self-administered, standardised Pittsburgh Sleep Quality Index (PSQI) was used to quantify the amount of self-reported poor SQ. The collected data were entered into EpiData V.4.6 and analysed using Stata V.14 software. Binary logistic regressions were computed to determine the association between variables. The association was determined using an adjusted OR (AOR) with a 95% CI at a p value of <0.05.

SETTING

The study was conducted at the University of Gondar, Northwestern Ethiopia.

PARTICIPANTS

A total of 607 lecturers participated in this study.

OUTCOME MEASURES

The primary outcome is the prevalence of poor SQ, which was measured using the PSQI.

RESULTS

Overall response rate was 95.60% (N=607). The age of the participants ranges from 21 to 70 with a mean of 32.39 (SD±6.80) years. The magnitude of poor SQ during the COVID-19 pandemic in the last month was 60.30% (95% CI (56.28% to 64.21%)). Working greater than 10 hours per day (AOR=2.19, 95% CI (1.16 to 4.27)), electronic device use before bedtime (AOR=1.53, 95% CI (1.04 to 2.27)), high-risk perception of COVID-19 infections (AOR=1.60, 95% CI (1.04 to 2.46)) and perceived job stress (AOR=2.15 (95% CI (1.50 to 3.08)) were risk factors for poor SQ.

CONCLUSION

The study revealed that the prevalence of poor SQ was high during the COVID-19 pandemic. The finding highlights the importance of optimising the working hours per day, minimising electronic device use before bedtime, promoting risk perception toward COVID-19 infection and developing workplace coping strategies for stress, which play a substantial role in minimising poor SQ.

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.

Awareness and practice regarding use of digital devices and ocular health among Saudi adolescents

PURPOSE

To review the knowledge of ocular health and practices of digital device usage among adolescent Saudi Arabia population.

METHODS

This cross-sectional web-based survey was conducted in 2021 at a university in central Saudi Arabia. We asked questions regarding demographics, knowledge related to computer vision syndrome (CVS), and the use of digital devices for participants' daily activities. The acceptable grades of knowledge ("excellent" and "good") and practice scores were associated with the determinants using the nonparametric method of analysis.

RESULTS

Of 521 participating students, knowledge about CVS and its relation to digital device usage were excellent in 41 students (7.9%), good in 161 (39%), poor in 300 (57.6%), and very poor in 19 (3.6%). Twenty-eight (5.4%) students scored an "excellent" grade on practices for digital device usage, 216 (41.4%) scored "good," and 277 (53.2%) scored "poor." The knowledge score median was 1.0 (interquartile range 1.0; 2.0), and the practice score median was 6.0 (4.0; 9.0). Health studies students had better knowledge than other students (P = 0.004). Smartphone users had worse knowledge than users of other devices (P = 0.017). Females (P < 0.001) and health studies students (P = 0.004) were significantly associated with acceptable practices of using digital devices.

CONCLUSIONS

Awareness of ocular health because of abuse of digital devices was poor among participating students. The practice of digital device use was not healthy and needed improvement through preventive measures and counseling.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Digital Eye Strain and Its Risk Factors Among a University Student Population in Jordan: A Cross-Sectional Study

Background: Several ocular and visual symptoms resulting from use of digital devices are collectively known as digital eye strain (DES) or computer vision syndrome (CVS). Few studies exist on the prevalence of DES among young adults in the Eastern Mediterranean region.

Objectives: This study aimed to investigate the prevalence and severity of digital eye strain among a university student population in Jordan. 

Methods: A cross-sectional study was conducted with students enrolled at Al-Ahliyya Amman University in Jordan. DES was evaluated using the Computer Vision Syndrome Questionnaire (CVS-Q), which was filled out by students who were approached at random and signed an informed consent to participate in the study. Information related to the type, intensity of usage, settings of digital device (DD) used, and post-device use student-reported physical complaints were recorded.

Results: Data from 382 students were analyzed. Prevalence of CVS was 94.5%, with tearing being the most prevalent symptom (59%), while double vision was least reported by students (18.3%). DD use for more than six hours per day was reported by 55.5% of the sample size, and 30.7% of the students reported pain in joints of fingers and wrists after using a mobile phone.

Conclusion: CVS is highly prevalent among university students in Jordan. With the increased dependence on online education due to coronavirus disease, safe habits in digital device use are recommended.

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.

Prevalence of insomnia among university students in South Asian Region: a systematic review of studies

INTRODUCTION

Insomnia is a global health problem among university students which is associated with various psychiatric problems like depression and anxiety. While different developed and developing countries assessed the prevalence of insomnia in youth, currently there is hardly systematic review of studies found based on the prevalence of insomnia in South Asia.

AIMS

The aim of this study is to systematically review the evidence relating to the prevalence rate of insomnia in university students in South Asian countries.

METHODS

Electronic searches of three databases, PubMed, Cochrane library, and Worldwide science were performed from 2010 to 2020 before April. In total, seven studies were included for evaluating insomnia in South Asian region among university students.

RESULTS

The prevalence rates of insomnia of the seven studies ranged between 35.4% (95% CI: 32.4-38.5%) and 70% (95% CI: 65.7-74.1%). The pooled prevalence of insomnia among university students was 52.1% (95% CI: 41.1-63.1%).

CONCLUSIONS

This review emphasized that insomnia in university students might be a common health issue to give full concentration in their studies and academic performance. Thus, more attention should be given to the determinants of insomnia among university students, so that it could be helpful to identify the main causes of insomnia and effective measures could be taken.

The circadian machinery links metabolic disorders and depression: A review of pathways, proteins and potential pharmacological interventions

Circadian rhythms are responsible for regulating a number of physiological processes. The central oscillator is located within the suprachiasmatic nucleus (SCN) of the hypothalamus and the SCN synchronises the circadian clocks that are found in our peripheral organs through neural and humoral signalling. At the molecular level, biological clocks consist of transcription-translation feedback loops (TTFLs) and these pathways are influenced by transcription factors, post-translational modifications, signalling pathways and epigenetic modifiers. When disruptions occur in the circadian machinery, the activities of the proteins implicated in this network and the expression of core clock or clock-controlled genes (CCGs) can be altered. Circadian misalignment can also arise when there is desychronisation between our internal clocks and environmental stimuli. There is evidence in the literature demonstrating that disturbances in the circadian rhythm contribute to the pathophysiology of several diseases and disorders. This includes the metabolic syndrome and recently, it has been suggested that the 'circadian syndrome' may be a more appropriate term to use to not only describe the cardio-metabolic risk factors but also the associated comorbidities. Here we overview the molecular architecture of circadian clocks in mammals and provide insight into the effects of shift work, exposure to artificial light, food intake and stress on the circadian rhythm. The relationship between circadian rhythms, metabolic disorders and depression is reviewed and this is a topic that requires further investigation. We also describe how particular proteins involved in the TTFLs can be potentially modulated by small molecules, including pharmacological interventions and dietary compounds.

Impact of the COVID-19 lockdown on digital device-related ocular health

Purpose:

Since the declaration of the lockdown due to COVID-19, the usage of digital devices has gone up across the globe, resulting in a challenge for the visual systems of all ages. The purpose of this study is to assess the impact of the lockdown on digital device usage, and consequently, the ocular surface health implications and circadian rhythm abnormalities related to digital eye strain.

Methods:

An open online survey was sent through various social media platforms and was open for a period of 2 weeks.

Results:

A total of 407 usable responses were obtained; the average age of respondents was 27.4 years. Typically, 93.6% of respondents reported an increase in their screen time since the lockdown was declared. The average increase in digital device usage was calculated at about 4.8 ± 2.8 h per day. The total usage per day was found to be 8.65 ± 3.74 hours. Sleep disturbances have been reported by 62.4% of people. Typically, 95.8% of respondents had experienced at least one symptom related to digital device usage, and 56.5% said that the frequency and intensity of these symptoms increased since the lockdown was declared.

Conclusion:

The study highlighted the drastic increase in use of digital devices after the initiation of the COVID-19 lockdown, and along with it, the slow deterioration of ocular health across all age groups. Awareness about prevention of digital eye strain should be stressed, and going forward, measures to bring these adverse effects to a minimum should be explored.