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Computer Vision Syndrome

Computer Vision Syndrome. Diagnosis and Treatment. Presentation of the American Optometric Association. Increase in Computer Usage. Source: US Census Bureau. Epidemiology. 60 million Americans spend 3+ hours a day “working” on computers

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Computer Vision Syndrome

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  1. ComputerVision Syndrome Diagnosis and Treatment Presentation of the American Optometric Association

  2. Increase in Computer Usage Source: US Census Bureau

  3. 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

  4. 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

  5. What is a Syndrome? “A group of symptoms that collectively indicate or characterize a disease, psychological disorder, or other abnormal condition.”

  6. 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

  7. 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

  8. Effects on job performance Lowered productivity Increased error rate Reduced job satisfaction

  9. Two Major Categories Contributing to CVS Complaints • Vision problems (2/3) • Environmental issues (1/3)

  10. 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)

  11. Eye Examination for ComputerUsers 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

  12. General history Normal history questions Dry eyes Flickering sensations Glare Light sensitivity Color vision

  13. 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?

  14. VA distance and near Consider computer working distance. Test at hard copy distance and screen distance. Remember to adjust acuity for intermediate distance.

  15. 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.

  16. Accommodation • Accommodative in-facility • Reduced amplitude of accommodation • Lag • Again, minor problems may be exacerbated • Consider VT

  17. Accessories for Accommodative Testing • PRIO • VDTS • Gulden • Others

  18. Printed Text Contrast

  19. Pixilated Text Contrast Active Matrix Laptop .28 Dot Pitch VDT

  20. 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 Vision Evaluation - PRIO

  21. Focusing Instability

  22. PRIO Testing Device

  23. PRIO Testing Device Testing performed at patient’s computer working distance Patient’s eyes respond same as when viewing computer

  24. PRIO Similar to “Book” retinoscopy Presents a target similar to a computer screen Could use another form of near retinoscopy

  25. Binocular vision • Exophoria • Esophoria • Convergence insufficiency • Again, minor problems may be exacerbated • Consider VT

  26. Internal ocular health Rule out Macular degeneration Cataract Diabetes Others

  27. External ocular health • Usually related to Ocular Surface Disease: • Blepharitis • Dry Eye • Investigate lid issues, systemic problems, medications, contact lenses

  28. Spectacle Options Single vision for computer distance Intermediate/Near bifocals Occupational trifocals Traditional PALs Near PALs PC Peekers

  29. PC Peekers

  30. 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 Interview 0.80 Range, +1.50 Add

  31. 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 Office 1.25 Range, +1.50 Add

  32. 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

  33. 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 Technica +2.00 Add

  34. 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 Technica +2.50 Add

  35. 20 distance 15 10 mid range 5 o 4 Fitting Position relative to G.C. (mm) 0 power o 31 -5 change Add +2.00 -10 -15 Add 1.50 near -20 -0.5 0.0 0.5 1.0 1.5 2.0 Power (D) Technica

  36. 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 Access 0.75 Range, +1.50 Add

  37. 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 Access 1.25 Range, +2.00 Add

  38. Access

  39. 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”

  40. Other spectacle considerations UV Coating Anti-Reflection Coating Tinting

  41. Environmental Factors • Workstation ergonomics • Workplace lighting • General lighting • Glare • Workstation ergonomics • Low humidity and other factors leading to dry eye

  42. Environmental Factors Glare

  43. Workstation Ergonomics • Monitor positioning: • 20-26” from eyes • Top tilted away 10-20° angle • Center 10-20° (4-9”) below eyes • Hard copy position

  44. Recommended Workstation

  45. Workstation Ergonomics • Chair • Height adjustment • Back support • Tilt • Armrests • Keyboard

  46. Workstation Ergonomics • In a word: ADJUSTABLE!

  47. 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

  48. AOA Seal of Acceptance

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