Transcript Computer Vision Syndrome Presentation

Computer Vision Syndrome
Diagnosis and Treatment
Presentation of the American Optometric Association
Better Health. No Hassles.
Increase in Computer Usage
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
1984
1989
1993
Source: US Census Bureau
Better Health. No Hassles.
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
Better Health. No Hassles.
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
Better Health. No Hassles.
What is a Syndrome?
“A group of symptoms that
collectively indicate or
characterize a disease,
psychological disorder, or
other abnormal condition.”
Better Health. No Hassles.
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
Better Health. No Hassles.
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
Better Health. No Hassles.
Effects on job performance
• Lowered productivity
• Increased error rate
• Reduced job satisfaction
Better Health. No Hassles.
Two Major Categories Contributing to CVS Complaints
• Vision problems (2/3)
• Environmental issues (1/3)
Better Health. No Hassles.
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)
Better Health. No Hassles.
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
Better Health. No Hassles.
General history
• Normal history questions
• Dry eyes
• Flickering sensations
• Glare
• Light sensitivity
• Color vision
Better Health. No Hassles.
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?
Better Health. No Hassles.
VA distance and near
• Consider computer working distance.
• Test at hard copy distance and screen distance.
• Remember to adjust acuity for intermediate distance.
Better Health. No Hassles.
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.
Better Health. No Hassles.
Accommodation
• Accommodative in-facility
• Reduced amplitude of accommodation
• Lag
• Again, minor problems may be exacerbated
• Consider VT
Better Health. No Hassles.
Accessories for Accommodative Testing
• PRIO
• VDTS
• Gulden
• Others
Better Health. No Hassles.
Printed Text Contrast
Better Health. No Hassles.
Pixilated Text Contrast
.28 Dot Pitch VDT
Better Health. No Hassles.
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
Better Health. No Hassles.
Focusing Instability
Better Health. No Hassles.
PRIO Testing Device
Better Health. No Hassles.
PRIO Testing Device
• Testing performed at patient’s computer working distance
• Patient’s eyes respond same as when viewing computer
Better Health. No Hassles.
PRIO
• Similar to “Book” retinoscopy
• Presents a target similar to a computer screen
• Could use another form of near retinoscopy
Better Health. No Hassles.
Binocular vision
• Exophoria
• Esophoria
• Convergence insufficiency
• Again, minor problems may be exacerbated
• Consider VT
Better Health. No Hassles.
Internal ocular health
• Rule out Macular degeneration
• Cataract
• Diabetes
• Others
Better Health. No Hassles.
External ocular health
• Usually related to Ocular Surface Disease:
– Blepharitis
– Dry Eye
• Investigate lid issues, systemic problems, medications,
contact lenses
Better Health. No Hassles.
Spectacle Options
• Single vision for computer distance
• Intermediate/Near bifocals
• Occupational trifocals
• Traditional PALs
• Near PALs
• PC Peekers
Better Health. No Hassles.
PC Peekers
Better Health. No Hassles.
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
Better Health. No Hassles.
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
Better Health. No Hassles.
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
Better Health. No Hassles.
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
Better Health. No Hassles.
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
Better Health. No Hassles.
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)
Better Health. No Hassles.
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
Better Health. No Hassles.
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
Better Health. No Hassles.
Access
Better Health. No Hassles.
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”
Better Health. No Hassles.
Other spectacle considerations
• UV Coating
• Anti-Reflection Coating
• Tinting
Better Health. No Hassles.
Environmental Factors
• Workstation ergonomics
• Workplace lighting
• General lighting
• Glare
• Workstation ergonomics
• Low humidity and other factors leading to dry eye
Better Health. No Hassles.
Environmental Factors
• Glare
Better Health. No Hassles.
Workstation Ergonomics
• Monitor positioning:
• 20-26” from eyes
• Top tilted away 10-20° angle
• Center 10-20° (4-9”) below eyes
• Hard copy position
Better Health. No Hassles.
Recommended Workstation
Better Health. No Hassles.
Workstation Ergonomics
• Chair
•
•
•
•
Height adjustment
Back support
Tilt
Armrests
• Keyboard
Better Health. No Hassles.
Workstation Ergonomics
• In a word:
ADJUSTABLE!
Better Health. No Hassles.
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
Better Health. No Hassles.
Better Health. No Hassles.
Better Health. No Hassles.
AOA Seal of Acceptance
Better Health. No Hassles.
Workstation Lighting
• Consider brimmed hat
• Monitor hood
• Flicker
Better Health. No Hassles.
Workplace Dry Eye
Better Health. No Hassles.
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
Better Health. No Hassles.
Dry Eyes - The Solution
• Rest eyes and blink forcefully
• Correct monitor placement
• Humidifier
• Artificial tears
Better Health. No Hassles.
Dry Eyes - The Solution
Especially formulated for Computer Users?
Better Health. No Hassles.
Meeting the Needs of the
CVS Patient
• Comprehensive eye and vision
care
• Appropriate optical correction
• Good visual ergonomics
Better Health. No Hassles.
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
Better Health. No Hassles.
References / Resources
Occupational Safety and Health
Administration
• OSHA Workstation Checklist:
www.osha-slc.gov/SLTC/etools/
computerworkstations/checklist.html
Better Health. No Hassles.
References / Resources
• Dr. Ergo – www.doctorergo.com
• Ergoweb site – www.ergoweb.com
• PRIO Corporation – www.prio.com
Better Health. No Hassles.
Thank You!
Better Health. No Hassles.