Computer Vision Syndrome
Diagnosis and Treatment
Presentation of the American Optometric Association
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Increase in Computer Usage
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
1984
1989
1993
Source: US Census Bureau
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1997
2001
Epidemiology
• 60 million Americans spend 3+ hours a day “working” on
computers
• 140 million Americans spend part of the day using
computers
• 95% of schools have internet access.
• Problems range from 25-93% of computer users
• 1 of 6 eye exams for computer use
• 10 million exams annually by ODs for vision problems
related to computers.
• Cost of eye health care and glasses related to computers:
$2 Billion/year
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What is Computer Vision Syndrome?
“The complex of eye and vision
problems related to near work
which are experienced during or
related to computer use.”
–American Optometric Association
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What is a Syndrome?
“A group of symptoms that
collectively indicate or
characterize a disease,
psychological disorder, or
other abnormal condition.”
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Eye/Vision Related Complaints
• Majority of computer users have symptoms
• > 14% of patients present with symptoms related to
computer use
• Eyestrain
• Headache
• Blurred vision
• Neck or shoulder pain
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Visual Demands of Computer Use
• Screen resolution, contrast
• Screen glare and reflections
• Environment too bright for computer
• Image refresh rates and Flicker
• Working distances and angles
• General Rx not adequate
• Repetitive and stressful tasks
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Effects on job performance
• Lowered productivity
• Increased error rate
• Reduced job satisfaction
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Two Major Categories Contributing to CVS Complaints
• Vision problems (2/3)
• Environmental issues (1/3)
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CVS is Related to Musculoskeletal Disorders
• Eye and vision problems are the most frequently reported
health care problem among computer workers. (75%)
• Demanding elements:
– Ocular motility
– Accommodation
– Vergence
• All involve repetitious muscular activity
• CTD/RSI/MSD (See AOA Position Paper)
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Eye Examination for Computer Users
• 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
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General history
• Normal history questions
• Dry eyes
• Flickering sensations
• Glare
• Light sensitivity
• Color vision
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Specific history
• Neck or shoulder pain
• 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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VA distance and near
• Consider computer working distance.
• Test at hard copy distance and screen distance.
• Remember to adjust acuity for intermediate distance.
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Uncorrected Refractive Error
• Even minor problems affect comfort and performance.
• No difficulty with less demands.
• High demands of computer use cause them to become
manifest.
• Prescribe more aggressively than in other cases.
• Astigmatism of > 0.50D is significantly associated with
discomfort.
• Consider myopes and hyperopes needs at this distance.
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Accommodation
• Accommodative in-facility
• Reduced amplitude of accommodation
• Lag
• Again, minor problems may be exacerbated
• Consider VT
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Accessories for Accommodative Testing
• PRIO
• VDTS
• Gulden
• Others
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Printed Text Contrast
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Pixilated Text Contrast
.28 Dot Pitch VDT
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Active Matrix Laptop
Vision Evaluation - PRIO
• Focusing system most efficient with high definition target
• Computer screens and LCDs do not provide edge definition
required
• Result is that eyes must work to stay focused
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Focusing Instability
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PRIO Testing Device
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PRIO Testing Device
• Testing performed at patient’s computer working distance
• Patient’s eyes respond same as when viewing computer
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PRIO
• Similar to “Book” retinoscopy
• Presents a target similar to a computer screen
• Could use another form of near retinoscopy
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Binocular vision
• Exophoria
• Esophoria
• Convergence insufficiency
• Again, minor problems may be exacerbated
• Consider VT
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Internal ocular health
• Rule out Macular degeneration
• Cataract
• Diabetes
• Others
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External ocular health
• Usually related to Ocular Surface Disease:
– Blepharitis
– Dry Eye
• Investigate lid issues, systemic problems, medications,
contact lenses
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Spectacle Options
• Single vision for computer distance
• Intermediate/Near bifocals
• Occupational trifocals
• Traditional PALs
• Near PALs
• PC Peekers
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PC Peekers
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Interview
0.80 Range, +1.50 Add
Near to midrange transition at +1.00 D
(within 0.50 of add power)
Unwanted Astigmatism > 1.00 D
Power <0.25 D, too weak for mid-range
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Office
1.25 Range, +1.50 Add
Near to midrange transition at +1.00 D
(within 0.50 of add power)
Unwanted Astigmatism > 1.00 D
Power <0.25 D, too weak for mid-range
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Technica
+1.50 Add
Near to midrange transition at +1.00 D
(within 0.50 of add power)
Unwanted Astigmatism > 1.00 D
Power <0.25 D, too weak for mid-range
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Technica
+2.00 Add
Near to midrange transition at +1.50 D
(within 0.50 of add power)
Unwanted Astigmatism > 1.00 D
Power <0.25 D, too weak for mid-range
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Technica
+2.50 Add
Near to midrange transition at +2.00 D
(within 0.50 of add power)
Unwanted Astigmatism > 1.00 D
Power <0.25 D, too weak for mid-range
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Technica
Position relative to G.C. (mm)
20
distance
15
10
mid
range
5
0
4o
Fitting
power
change
-5
-10
-15
Add +2.00
Add 1.50
-20
-0.5 0.0 0.5 1.0 1.5 2.0
Power (D)
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near
31o
Access
0.75 Range, +1.50 Add
Near to midrange transition at +1.00 D
(within 0.50 of add power)
Unwanted Astigmatism > 1.00 D
Power <0.25 D, too weak for mid-range
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Access
1.25 Range, +2.00 Add
Near to midrange transition at +1.50 D
(within 0.50 of add power)
Unwanted Astigmatism > 1.00 D
Power <0.25 D, too weak for mid-range
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Access
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New Research
James E. Sheedy, OD, PhD
Center for Ophthalmic Optic Research
The Ohio State University College of Optometry
• “Progressive Addition Lenses – Matching the Specific Lens to
Patient Needs”
• “Progressive Addition Lenses – Measurements and Ratings”
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Other spectacle considerations
• UV Coating
• Anti-Reflection Coating
• Tinting
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Environmental Factors
• Workstation ergonomics
• Workplace lighting
• General lighting
• Glare
• Workstation ergonomics
• Low humidity and other factors leading to dry eye
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Environmental Factors
• Glare
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Workstation Ergonomics
• Monitor positioning:
• 20-26” from eyes
• Top tilted away 10-20° angle
• Center 10-20° (4-9”) below eyes
• Hard copy position
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Recommended Workstation
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Workstation Ergonomics
• Chair
•
•
•
•
Height adjustment
Back support
Tilt
Armrests
• Keyboard
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Workstation Ergonomics
• In a word:
ADJUSTABLE!
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Workstation Lighting
• Reduce room illumination
• Computer screen and field of
view relatively equal
• Position monitor perpendicular
to windows or other lights
• Use glare reduction filters or
AR-coated monitors
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AOA Seal of Acceptance
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Workstation Lighting
• Consider brimmed hat
• Monitor hood
• Flicker
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Workplace Dry Eye
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Workplace Dry Eye
• Symptoms:
• Dry or irritated eyes
• Red or teary eyes
• Contact lens discomfort
• Causes:
• Dry office environment
• Decreased blink rate
• Looking straight ahead
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Dry Eyes - The Solution
• Rest eyes and blink forcefully
• Correct monitor placement
• Humidifier
• Artificial tears
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Dry Eyes - The Solution
Especially formulated for Computer Users?
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Meeting the Needs of the
CVS Patient
• Comprehensive eye and vision
care
• Appropriate optical correction
• Good visual ergonomics
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References / Resources
American Optometric Association
www.aoa.org
• The Relationship of Computer Vision Syndrome to
Musculoskeletal Disorders (position paper)
• Impact of Computer Use on Children's Vision (fact
sheet)
• The Effects of Computer Use on Eye Health and
Vision (fact sheet)
• Criteria for Determining Whether the Need for
Eyeglasses or Other Treatment is Related to
Computer Use (fact sheet)
• Recommended Components of an Eye/Vision
Examination for Computer Operators
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References / Resources
Occupational Safety and Health
Administration
• OSHA Workstation Checklist:
www.osha-slc.gov/SLTC/etools/
computerworkstations/checklist.html
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References / Resources
• Dr. Ergo – www.doctorergo.com
• Ergoweb site – www.ergoweb.com
• PRIO Corporation – www.prio.com
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Thank You!
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