Better Health. No Hassles. Diagnosis and Treatment Computer Vision Syndrome Presentation of the...

Better Health. No Hassles.Better Health. No Hassles.

Diagnosis and Treatment

Computer Vision Syndrome

Presentation of the American Optometric Association

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Increase in Computer Usage

0%10%20%30%40%50%60%70%80%90%

100%

1984 1989 1993 1997 2001

Source: US Census Bureau

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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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.28 Dot Pitch .28 Dot Pitch VDTVDT

Active Matrix LaptopActive Matrix Laptop

Pixilated Text Contrast

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• 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

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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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InterviewInterview 0.80 Range, +1.50 Add

Near to midrange transition at +1.00 D

Unwanted Astigmatism > 1.00 D

Power <0.25 D, too weak for mid-range

(within 0.50 of add power)

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OfficeOffice 1.25 Range, +1.50 Add

Near to midrange transition at +1.00 D

Unwanted Astigmatism > 1.00 D

Power <0.25 D, too weak for mid-range

(within 0.50 of add power)

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TechnicaTechnica +1.50 Add

Near to midrange transition at +1.00 D

Unwanted Astigmatism > 1.00 D

Power <0.25 D, too weak for mid-range

(within 0.50 of add power)

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TechnicaTechnica +2.00 Add

Near to midrange transition at +1.50 D

Unwanted Astigmatism > 1.00 D

Power <0.25 D, too weak for mid-range

(within 0.50 of add power)

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TechnicaTechnica +2.50 Add

Near to midrange transition at +2.00 D

Unwanted Astigmatism > 1.00 D

Power <0.25 D, too weak for mid-range

(within 0.50 of add power)

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Technica

Power (D)

Pos

ition

rel

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e to

G.C

. (m

m) distance

near

powerchange

Fitting 4o

31o

Add +2.00

Add 1.50

-0.5 0.0 0.5 1.0 1.5 2.0-20

-15

-10

-5

0

5

10

15

20

midrange

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0.75 Range, +1.50 AddAccessAccess

Near to midrange transition at +1.00 D

Unwanted Astigmatism > 1.00 D

Power <0.25 D, too weak for mid-range

(within 0.50 of add power)

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1.25 Range, +2.00 AddAccessAccess

Near to midrange transition at +1.50 D

Unwanted Astigmatism > 1.00 D

Power <0.25 D, too weak for mid-range

(within 0.50 of add power)

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Access

-20

-15

-10

-0.5 0.0 0.5 1.0 1.5 2.0

-5

0

5

10

15

20

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near

powerchange

Power (D)

Po

sitio

n r

ela

tive

to

G.C

. (m

m)

Fitting12o

19o

Type A

Type B

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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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Especially formulated for Computer Users?

Dry Eyes - The Solution

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Meeting the Needs of theCVS 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!