Computer Vision Syndrome, also referred to as Digital Eye Strain, is defined by the American Optometric Association (AOA) as a group of eye and vision-related problems resulting from prolonged use of computers, tablets, e-readers and cell phones. The Pandemic of COVID-19 poses an important threat to the development of computer vision syndrome. The pandemic and the related quarantine measures, made to limit the spread of the infection, has led to the increase in the number of people using digital screens, especially students for e-education purposes. Without any specific guidelines, it is now a usual routine for the students to spend most of the time attending e‑classes in front of a computer or mobile screens. These devices cause harm by emitting short high energy waves that can penetrate eyes and can eventually contribute to photochemical damage to the retinal cells, making an individual vulnerable to a variety of eye problems ranging from dry eye to age‑related macular degeneration. It is collectively known as digital eye strain (DES) or computer vision syndrome (CVS). Therefore, this computer vision syndrome is an emerging public health threat amidst the COVID-19 pandemic. It is directly proportional to the duration of digital screen exposure.
The children are at great risk, because of delayed diagnosis, as children may not complain earlier as adults. Previous studies have estimated that the prevalence of CVS ranges between 64 and 90% among computer users. It has been estimated that nearly 60 million people suffer from CVS globally and about one million new cases occur each year. About 70% of computer workers worldwide report having vision problems and there is an alarming increase in the number of people affected.
FACTORS CONTRIBUTING TO COMPUTER VISION SYNDROME:
- Poor sitting posture
- Improper viewing distances
- Improper viewing angle
- Ocular diseases
- Medical diseases – Systemic diseases and medications – Dry eye is associated with some systemic diseases.eg: Sjogren syndrome, rheumatoid arthritis, and several autoimmune diseases.
- Age – Tear production normally decreases with age. Post-menopausal women are the group of individuals who are mostly affected.
- Prolonged duration of usage.
- Reduced blink rate – Normally people blink 10-15 times per minute. Studies have shown that the rate is significantly diminished when working at a computer.
- Sex It is found that the prevalence of dry eye is slightly higher among females.
- Poor lighting
- Imbalance of light between the computer screen and the surrounding.
- Poor resolution
- Poor contrast
- Glare of the display – Glare causes delay in reading time and when it is not possible to change the surrounding lighting system anti-glare filters are used to reduce it.
- Slow refresh rate – Refresh rate is the number of times per minute the screen is repainted to produce an image (measured in Hz). If the rate is too slow characters will start to flicker. It causes annoyance fatigue and headache
PATHOPHYSIOLOGY AND CLINICAL FEATURES–
The symptoms of the digital eye strain (DES) are caused due to 3 mechanisms
- Extra ocular mechanism – causes musculoskeletal symptoms such as, neck stiffness, pain, headache, backache, shoulder pain etc.
- Accommodative mechanism – blurring of vision, double vision, presbyopia, myopia and slowness of accommodation or change of focus.
- Ocular surface mechanism– dryness of eyes, gritty sensation in eyes, redness, burning in eyes after extended periods of digital screen usage. These symptoms may be multifactorial, the common factors found to be related to dryness and redness of the eyes are cornea dryness, reduction in blink rate, increased surface of cornea exposure caused by horizontal gaze at the computer screen, reduction of tear production due to ageing process, contact lens usage, medication such as antihistamines and systemic medical illnesses such as autoimmune connective tissue disease.
Complications – When a person stares at a computer screen, the blinking rate decreases by more than 60%, such an acute decrease in blinks can acutely aggravate symptoms of Dry eye syndrome or keratoconjunctivitis sicca.
EXAMINATION AND INVESTIGATIONS:
Depends upon the symptoms reported by the patients and a complete ocular surface examination to rule out local and systemic features. The most important examination in the diagnosis of the computer vision syndrome is the detection of the dry eye by the Schirmer’s test-
Schirmer’s test procedure: The patient is instructed to look upward, and the patient’s eyelid is pulled down. The bent end of the test strip (a filter paper of 5mm*35mm) is placed in the eye such that it rests between the palpebral conjunctiva of the lower eyelid and the bulbar conjunctiva of the eye. Both eyes are tested at the same time. The eyes are closed for 5 minutes. After five minutes, the patient is asked to open both eyes and look upward so the test strips may be removed. The Schirmer test score is determined by the length of the moistened area of the strips.
Normal – ≥10 mm wetting of the paper after 5 minutes.
Tear deficiency – <5 mm wetting of the paper after 5 minutes.
The most important approach in the management of computer vision syndrome is eliminating the causative factor leading to the symptoms. Many of the symptoms in computer vision syndrome can be prevented by proper strategies at the workplace.
- Adequate breaks from computer work and limiting the screen time is believed to have dramatic effect in controlling the symptoms of CVS.
- It is recommended that the eyes should be about 35-40 inches from the screen and the screen should be placed 10-20 degrees below or that the middle of the screen be 5-6 inches below eye level.
- Use of a proper chair that provides good support to the back, legs, buttocks and arms to control the musculoskeletal issues that arise in CVS.
- Using the keyboard in such a position that the arms and wrists are in neutral position may help avoid contact stress.
- Limiting the computer and screen time is postulated to have a dramatic impact on symptoms of CVS.
The 20/20/20 rule – After working on a computer for 20 minutes, the computer user should gaze into the distance in excess of 20 feet for at least 20 seconds.
- Use of proper corrective glasses.
- The lighting intensity should be half of normal room illumination when computers are used.
- Ruta – Pains in eyes when viewing an object minutely. Aching in eyes. Eyes hot like balls of fire. Feel strained. Burning sensation in eyes when reading by candlelight. Itching in inner canthi and on lower lids, which becomes smarting after rubbing them, whereupon the eye becomes filled with water. Obscuration of sight from reading too much, with clouds, or like a veil before eyes. Bad effects from over-straining eyes, from reading too much, esp. fine work at night.
- Arsenicum album – Great dryness of the eyelids, chiefly in the edges, and on reading by the light (of a candle). Dryness of eyes from artificial light. Spasmodic closing of the eyelids, sometimes from the effect of light. Aching, burning, and shooting pains in the eyes, < by light, as also by the movement of the eyes, accompanied sometimes with a necessity to lie down, or with anguish which does not permit to rest in bed. Eyes inflamed and red, with redness of the conjunctiva.
- Picric acid – Dryness of eyes. tingling and smarting, < by constant use and by lamplight. Feeling of sand in eyes, smarting pain, acrid tears. On waking and for an hour, feeling of sticks in eyes. Pressure over eyes < from studying and motion, > sitting still. Eye symptoms < from artificial light. Acrid, thick matter in corners in morning. Must bring objects close to eyes to see them. everything blurred as from looking through fog. Brain fag of literary or businesspeople. slightest excitement or mental exertion, or any overwork, brings on headache.
- Gelsemium- Gelsemium is valuable to manage complaints of double vision in computer vision syndrome cases. The double vision is most felt when looking sideways. Dimness of sight attends. Along with this heaviness of the eyes is prominent. Eyes feel sore with aching pains. Redness of the eyes along with watering is also noted with the above symptoms. Smoky appearance before eyes, with pain above them. Dimness of sight and vertigo. asthenopic symptoms not marked, but great irritability of the eye, resulting from want of tone or energy of muscular structures, constituting a passive rather than an active asthenopia. Eyes feel sore in the evening, sensitive to light, with lachrymation. lids feel full and congested
- Euphrasia- Eyes very sensitive to light, and candlelight. Dry pressure in eyes, as if sleepy. Frequent burning biting in eyes, obliging frequent winking. acrid water runs from them. Sensation as if dust or sand were in eyes. Sensation as if a hair hung over eyes and must be wiped away. Pressure in the eye when looking at light. Violent pressure in the left eye, with lachrymation, seems smaller and weaker. Burning in eyes, with lachrymation.
- Lithium carb- great pain in eyes after reading especially in artificial light. Pain as if from sand in eyes decidedly greater in the left eye. Later, stitches in the right eye Great sensitivity to artificial light. Sensation of dryness and pain in eyes after reading Eyes pain as if sore. Eyes sensitive after using them by candlelight. Half vision. invisible right half. Photophobia. Pain over eyes. Dry lids.
- PILOCARPUS MICROPHYLLUS (jaborandi)- Eye strain from whatever cause. Irritability of the ciliary muscle. Eyes easily tire from slightest use. Heat and burning in eyes on use. Headache. smarting and pain in the globe on use. Everything at a distance appears hazy. Vision becomes indistinct every few moments. Retinal images retained long after using eyes. Irritation from electric or other artificial light. Spasm of the accommodation while reading.
- Physostigma- photophobia. Contraction of pupils. Twitching of ocular muscles. Dull pain over and between eyes. Eyes feel weak. Dimness of vision. Pain after using eyes, muscæ volitantes, flashes of light, twitching of eyelids and around eyes. myopia. Profuse lachrymation. Spasm of ciliary muscles, with irritability after using eyes. Increasing myopia.
- Cina- Pains renewed by looking steadily at an object. Pain in eyes when using them at night by candlelight. Aversion to light. When looking at a thing steadily, reading, he sees it as through a gauze, which is relieved by wiping eyes. Pressure in eyes as if sand had got in, especially when reading. Looks sickly about eyes, with paleness of face. Chronic weakness of sight, with aching in eyes and photophobia.
- Senega- Aching over the orbits. eyes tremble and water when he looks at object intently or steadily. Eyes weak and watery when reading. Drawing and pressure in eyeballs, with diminution of visual power. Weakness of sight and flickering before the eyes when reading. Must wipe them often. When walking toward the setting sun, seemed to see another smaller sun beneath the first, assuming a somewhat oval shape on looking down disappearing on bending the head backward and on closing the eyes. Double vision relieved by bending head backward. Cilia hang full of hard mucus. smarting of the conjunctiva, as if soap were in the eyes. Mornings. Blepharitis. Sometimes lids stick so after sleep, they must be soaked before they can be separated.
- Duboisinum- Dryness of mucous membranes is very characteristic. Cool feeling in the eyes. Cool. Sharp pain in the upper eyeball. Eyes feel tired. Diminished accommodation. + 20 glass makes reading at normal distance possible, but eyes feel strained in using it.
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Ms. AMIRTHA RASHMI S.S
Fourth year BHMS
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