UNIVERSITY OF GONDAR

COLLEGE OF MEDICINE AND HEALTH SCIENCE

DEPARTMENT OF OPTOMETRY

COMPUTER VISION SYNDROME AND PREVENTIVE MECHANISMS

1
Outline
Introduction
Causes of CVS
Clinical features
Diagnosis
Management
Literatures about CVS
References

2
 Introduction
Over the past 20 years, there has been a great
advancement in the information technology.

Today ,computer is one of the most developed

technologies which are used presently by all age
groups

Globally, personal computers are one of the

commonest office tools that made life easier and
increase output.

3
Cont…
Even if technological revolution has made our
lives with so much convenient, their prolonged
usage lead to some health disorders(≥3hrs. /day)

Computer vision syndrome

Mental stress (depression and obsession )
Musculoskeletal disorders
 Carpal Tunnel Syndrome
 Muscle strains (e.g., neck tension syndrome)

 Tendon disorders

4
CVS
“Computer vision syndrome is a complex of eye
and vision-related problem that results from
prolonged computer usage “

American optometric association

5
Cont…
Nearly 60 million people suffer from CVS
globally and a million new cases occur each
year.

The prevalence of CVS ranges from 64% to 90%

among computer users

Thus ,CVS is the number one occupational

hazard of the 21st century that involves all age
groups.

6
But, who are more susceptible for CVS?

School age children and old persons

Children can experience many of the same

symptoms related to computer use as adults.

However, some unique aspects of how children

use computers may make them more susceptible
than adults to the development of these
problems.

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Because children
 often have a limited degree of self-awareness
 are very adaptable
 are not the same size as adults.

 often use computers in a home or classroom with

less than optimum lighting

8
How is reading at the monitor screen different from reading a printed page?

Differences in:
Viewing distance
Gaze angles
Degree of symptoms
Blink rate
VDU is made up Pixels!!
VDU is a Charged surface!!
Differences in accommodation

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Degree of symptoms(N=104)

10
 Blink Rates(N=104)
When relaxed: 22 per min
When reading a book: 10 per min
Viewing text on a computer: 7 per min

(Tsubota and Nakamori New Eng J Med 1993; 328: 584-585)

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 Pixelated vs printed text contrast

The VDU is made up of pixels rather than solid lines

as on a printed page.

Because our eyes cannot “lock” focus on these dots, the

eyes must continually focus and refocus to keep the
image sharp.

This focusing and refocusing results in stress to the eye

muscles

12
Printed Text Contrast Pixelated Text Contrast

13
VDU is a charged surface!!
Most computers will build up an electrostatic charge
in the vicinity of the screen surface.

Static charges can cause the attraction and

accumulation of dust and other airborne particles

It has been suggested that these charges may be

related to the development of skin rash or eye
irritation in some very sensitive people.

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 Difference in accommodation

Some suggestion of a larger lag of accommodation

when viewing computer screens, compared with
printed text, although findings are not consistent
across studies.

15
Cont….

16
 Cont…
 In general, the visual demands of the computer task
exceed the visual abilities of the individual to
comfortably perform the task as compare to printed
page

17
 Causes of CVS
Eye related factors (2/3)
Decreased rate of blinking
Poor eye movement
Unable to take mini breaks
Uncorrected refractive errors
Any ocular surface disorder e.g. Dry eye
Any vergence and accommodative anomalies
Incorrect glass/contact lens/

18
 Cont…
Environmental factors (1/3)
Poor workstation ergonomics
 Incorrect screen position
 Incorrect sitting posture

Improper workstation lighting/Glare/

Dry office or Low humidity

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20
Symptoms
Headache
Eye strain
Blurred vision
Double vision
Discomfort to light
Redness,
Itching,
burning of eyes
Neck/shoulder pain
watering of eyes

21
 Cont…
The symptom of CVS can be categorized in three:
Eye -related symptoms (e.g. “dry eyes, watery
eyes, irritated eyes, burning eyes”)

Vision -related symptoms (e.g. “eyestrain,

headache, blurred vision, double vision”)

Posture -related symptoms (e.g. “sore neck,

shoulder pain, sore back”).

22
Cont…
The severity of CVS symptoms may be:
Mild (transient symptoms persist for few minutes
to hrs.)

Moderate (persist for few hours and subsides after

rest or sleep)

Severe (visual problems during or after computer

use)

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Effects of CVS on job performance
Lowered productivity
Increased error rate
Reduced job satisfaction
Absence from work

 It is estimated that CVS can reduce

performance on specific task by 40% (Aaras A.
et al )

24
Diagnosis
General systemic & ocular history
Specific history related to computer use
VA distance and “near”
Refraction distance and “near”
Accommodative testing
Eye coordination/movement
External and internal health

25
General history
Normal history questions
Dry eyes
Glare
Light sensitivity
Flicker sensation
Color vision

26
Specific history
Hx pertaining to vision related symptoms
Neck or shoulder pain and Back pain
Pain in wrists or arms
How many hours a day do you work on the computer?
How long before symptoms occur?
Are the symptoms present when you are not working?
Are your eyes higher than the computer screen? By how
much?
How far is the screen from your eyes?
Where is your hard copy?
What is the lighting like? Windows?

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Management
Protocols
Treat eye related symptoms
Treat vision related symptoms
Treat posture related symptoms

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Treat any eye related symptoms

Dry eye
Other eye disease

29
Cont..
Treatment of workstation dry eye
 Advice to blink frequently
 Artificial tears
 Drops for computer eyes
 Humidifier

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 Drops for computer eyes:

Similasan eye drops

two to three drops in
each eye as needed.

Prepared in a 0.33-
ounce bottle costs
about $10.

31
 Cont…
Bausch & Lomb
drops one or two
drops in the eyes as
needed.

Prepared in a 0.5-
ounce bottle that costs
about $7.

32
Treat vision related symptoms
Treat any refractive errors if any
Treat any accommodative and vergence strain
 Program fitness eye exercise
 Computer eye glass
 Upgrade monitor display quality
Adjust workstation lighting

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Treat any accommodative and vergence strain

Program fitness eye exercise

 Eye comfort exercises

 Blinking

 Eye squeeze (5x/25 seconds)

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 Palming

Brace elbows on the desk and close to the desk edge.

Let weight fall forward.
Cup hands over and close eyes.
Inhale slowly through nose and hold for 4 seconds.
Continue deep breathing for 15-30 seconds.

35
Cont….
 Eye Massage
 To increase the blood flow

 Eye Movements
 Eye rotation( 7 cycles)
 Figure of eight ( )
8
 Focus change
 Follow moving object with eyes
 Apply 20/20/20 rule

 Take mini break every an hour for 5-10 minute

36
Cont…
Computer glass
 Computer glasses are special prescription task specific
glasses that are designed to wear when doing computer
work.

They will eliminate the constant refocusing effort

that your eyes go through when viewing the
screen.

37
Cont….
 Computer lens design

Depending on the individual's vision and type

of work, there are several options :

Monofocal
Bifocals
Trifocals
PADS

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Cont….
Monofocal glass

No special consideration except the WD/power

For intensive VDU work
Have a focus range from 40 to 90 cm

39
Cont ….
 Bifocal
General purpose bifocals are not designed for
computer work.

Rather occupational bifocal will be recommended

40
Cont…
 Trifocal glasses
Another option for presbyopic computer
users is a trifocal, with a larger intermediate
zone than regular trifocals

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Cont …
Progressive Lenses
Progressive lenses for computer use have a larger
intermediate zone than regular progressive lenses
for a wider, more comfortable view of the computer
screen

42
Cont…
The computer glasses prescription is calculated
by splitting the patient's normal Add in half.

One-half of the Add is incorporated into the top

part of the lens, leaving the remaining half of
the Add at the bottom part of the lens

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 FAQ regarding computer glass
Does every computer user need computer glass?

More than 70% of computer user need computer glass.

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 If I don't have symptoms of CVS, do I still need computer eyewear?

May be.

Research has shown that even computer users who are

not experiencing symptoms of CVS may benefit from
wearing computer eyewear

45
 I already wear glasses. Do I really need computer
glasses?

Not necessarily

46
Will glare screens prevent CVS?

Glare filter for computer screen may help

somewhat, but they will not solve your computer
vision problems related to the constant
refocusing of your eyes

Filters can reduce glare from overhead lights or

outdoor sunlight reflecting off the surface of your
computer screen.

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 Will ARC on my eyeglasses eliminate glare?

Yes

ARC can reduce glare from light reflecting off the

front and back surfaces of your eyeglass lenses, but
they do not address the primary cause of most
CVS symptoms.

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Should computer lenses be tinted?

 Light tint
If you work in a brightly lit office, you may
benefit from a light tint applied to your
computer lenses.

Tinted computer lenses also are

recommended to block short-wavelength,
"blue" light emitted from computer screens.

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Cont….
Generally ,Plano tinted or filters glasses don’t
address the underlying cause of computer eye
strain

Therefore ,to tackle computer related eye

strain ,we have to consider tinted or coated
computer glass with adjusting workstation
lighting

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 Cont…
Upgrade monitor display quality
• VDU quality depends on:
 Refresh rate( fast)
 Resolution
• Pixels density(high density is desirable)
• Dot pitch(< 0.28 mm is desirable)
• Font/ Size of stimuli/ (3x rule is
recommended)

51
 Cont..
To minimize symptoms, it has been suggested
that a 3x acuity reserve should be adopted, i.e., the
visual acuity should be 3 times better than that
required to read the text on the display

52
Adjust workstation lighting

Reduce room lighting (300 to 500 lux i.e. ½ of normal

classroom)

Position monitor perpendicular to windows

Close shades, curtains, or blinds on windows

Adjust display contrast and brightness. The screen

should be the brightest object you see

Clean your screen to maximize clarity

Consider brimmed hat and monitor hood

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54
Treatments for posture related symptom s

Adjusting workstation ergonomics

Musculoskeletal exercise

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Workstation design and adjustment
 Seat height adjustment
 Backrest angle and height adjustment
 Armrests and adjustment
 Forearm support
 Computer screen adjustment
 Document placement
 Keyboard design & placement
 Laptop adjustment

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 Cont…
 Seat height adjustment

Sit in the chair, relax, and position your shoulders,

elbows and wrist in a neutral position
Avoid reaching out to the side
Avoid forward/backward/upward reaching
Avoid elevated or hunched shoulders
Shoulders, elbows and hips in a straight line
90 degree angle at the elbows and knees
Wrists in a neutral posture (20 degrees extension)

57
Cont…
 Backrest angle and height adjustment

The backrest angle should be 90-100 degrees,

relative to the horizontal seat.

Adjust the backrest height so that the lumbar

support in the lower part of the backrest
supports the lumbar curve of your back.

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 Cont …
 Armrests and adjustment

When adjusting armrest height the arms should be

supported without pushing the elbow or shoulder
upward.

In other words, armrests should be adjusted to 0.5-

1cm below the elbow when the shoulder is relaxed

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Cont…
 Forearm support
Sitting close to the work surface will allow your
forearms to be supported by the desk whilst
operating the keyboard/mouse/pen or when
reading.

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Cont….
A keyboard gel wrist rest encourages
support of the forearm, can facilitate a
neutral wrist posture, and reduces
contact stress between the forearm and
the desk edge.

61
cont…

 Computer screen adjustment

 Position : 20-26 inches from eyes

 Top tilted away 10-20° angle
 Center 10-20° (4-9”) below eyes
 To allow the neck to relax
 To lessen the exposed surface area of the eye

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Cont…
 Document placement

Placing reference materials as close to the screen

as possible to lessen the need to constantly
refocus the eyes and so as too not to swing the
head back and forth

63
 Cont…
 Keyboard and Mouse design and placement

The keyboard, mouse and any other controls should

be placed within a comfortable reach distance(35-45
cm from the elbow to the fingertips.)

The keyboard angle should be kept low. This will

help to prevent upward bending of the wrists,
which is a risk factor for wrist strain

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65
Laptops adjustment

Problems
Monitor attached to keyboard
Not adjustable
Compact keyboards
Solutions
Independent mouse, keyboard and monitor
Laptop holder
Reduce use
Desktop computer

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Recommended Workstation
design

67
Bad

68
USACHPPM
Better

69
USACHPPM
Bad

70
USACHPPM
Better

71
USACHPPM
 Workstation Ergonomics

Simply “fitting the task to the worker” rather than

forcing the worker to fit the task.

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Musculoskeletal exercise

Side Bend: Neck Stretch

Diagonal Neck Stretch
Shoulder Shrug
Executive Stretch
Foot Rotation
Hand Shake
Hand Massage (Note: Perform very gently!)
Finger Massage (Note: Perform very gently!)
Wrist Stretch

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74
75
Literatures about CVS

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77
78
CVS symptoms and average hrs. spent per day

Respondents that spend

 1-2 hrs. daily experience the least symptoms (0.7%).
 3-5 hrs. daily (23.9%).
 6-8 hrs. daily experience the highest CVS symptoms
(49.3%)
 >8 hrs. daily (26.1%)

79
CVS symptoms and years of computer use
This study further revealed that the longer the
duration in years of computer use, the more
severe the CVS symptoms.

Respondents that have been using computer for

 < 1 year experienced the least symptoms (1.5%)
 1-2 years (7.3%)
 3-5 years (27%)
 6-8 years (32.1%) and
 >8 years (32.1%)

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 Conclusion
The study concluded that 27% knowledge level
is too low and much emphasis is needed to
educate the people at risk of CVS

Duration in years of computer use and number

of hours spent on computer are factors that
influence the occurrence and severity of CVS
symptoms.

81
Article 2

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83
CVS and associated factors

This study revealed that there was significant

association b/n CVS and
Level of computer screen in relation to eye level
hrs. Spent /day
Applying 20/20/20 rule
use of eye drops

But taking rest in-between the work, use of

radiation reducing filters on the monitor did not
help in reducing the symptoms.

84
85
86
Association b/n hrs. of computer use/day and CVS
The present study found that an increase in the
number of hours spent on computer increases the
risk of CVS significantly.

Significant correlation was found between increased

hours of computer use and the symptoms redness (P
< 0.01), burning sensation (P = 0.01 ), blurred vision
(P = 0.02) and dry eyes (P = 0.04).

87
Association between frequency of break and CVS

Students who took frequent break were at lower risk

of developing symptoms of CVS compared those who
did not take (P < 0.01).

88
Spectacle/contact lens wearer and CVS

Students wearing corrective lens either spectacle or

contact lens (n = 176) showed a higher risk of
developing headache (P < 0.01) and blurred vision
(P < 0.001) and it was statistically significant.

89
 Conclusion
The present study revealed more than 3/4th of the
students complained of any one of the symptoms of
CVS while working on computers.

Engineering students were at higher risk of

developing CVS compared with medical students.

Those students who were using computer

continuously for more hours were at higher risk
developing CVS syndrome compared to students
who spend less hours and took frequent breaks

90
Article 4

91
 Conclusion
About 3/4th of computer user bank workers
were suffered from CVS with the most
experienced symptoms of blurred vision,
headache and redness of eyes.

In appropriate sitting position, Working on the

computer without break more than 20 minutes
and wearing eye glass were independently
associated with computer vision syndrome.

92
Article 5

93
94
 Cont…
The t value (19.01) in Table 3 reveals that there
was a significant difference between the
symptoms of CVS in the pre test and post test of
the experimental group.

The t value i.e. (18.78) of post test in the

experimental and control group also suggest a
considerable difference in the CVS symptoms.

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96
 Summary
CVS is the number one occupational hazard of the
21st century.
Prevalence of CVS ranges from 64% to 90% among
computer users. Headache and eye strain are the
most common symptoms of CVS

The visual ergonomics ,duration in years of

computer use and number of hours spent on
computer are the most important factors that
influence the occurrence and severity of CVS
symptoms

97
Cont…
Therefore ,to manage CVS, all of the following
areas should be considered
Eye related factors
Vision related factors
Posture relate factors

98
References

99
Thank you

100