Computer Vision Syndrome: A Review

Abstract

As computers become part of our everyday life, more and more people are experiencing a variety of ocular symptoms related to computer use. These include eyestrain, tired eyes, irritation, redness, blurred vision, and double vision, collectively referred to as computer vision syndrome. This article describes both the characteristics and treatment modalities that are available at this time. Computer vision syndrome symptoms may be the cause of ocular (ocular-surface abnormalities or accommodative spasms) and/or extraocular (ergonomic) etiologies. However, the major contributor to computer vision syndrome symptoms by far appears to be dry eye. The visual effects of various display characteristics such as lighting, glare, display quality, refresh rates, and radiation are also discussed. Treatment requires a multidirectional approach combining ocular therapy with adjustment of the workstation. Proper lighting, anti-glare filters, ergonomic positioning of computer monitor and regular work breaks may help improve visual comfort. Lubricating eye drops and special computer glasses help relieve ocular surface–related symptoms. More work needs to be done to specifically define the processes that cause computer vision syndrome and to develop and improve effective treatments that successfully address these causes.

Introduction

Twenty years ago, the advent of computers revolutionized the workplace. Until that time, office work had involved a range of activities including typing, filing, reading, and writing. Each activity was adequately varied in the requirements of posture and vision, posing a natural “break” from the previous activity. The introduction of computers, however, has combined these tasks to where most can be performed without moving from the desktop, thereby improving quality, production, and efficiency. In fact, it is estimated that the 75% of all jobs in the year 2000 involved computer usage.¹⁶ The popularity and affordability of personal computers with Internet capabilities at home has introduced even more computer users. In 1990, about 15% of U.S. households owned a computer, a number that has now increased to 50% of all households.⁷³

Because of this extensive use of computers many studies have been conducted in an attempt to address questions concerning safety and health for video display terminal (VDT) users. The large majority of research has addressed the question of radiation levels from VDTs, known to emit many types of radiation including x-radiation, optical radiation, radio frequency radiation, very low frequency radiation, and extremely low frequency radiation.74, 93 Studies have not clearly indicated a negative effect on the computer user (Abelson MB: How to fight Computer Vision Syndrome. Rev Ophthalmol 114–6, 1999). During the late 1980s and early 1990s, concern of possible reproductive effects from using VDTs arose following reports of adverse pregnancy outcomes among groups of women computer users. A recent review concluded that for most women in modern offices, work with VDTs does not increase their risk of miscarriage 3, 21, 30, 44, 55 Another study has even revealed that somatic disorders, depression, and obsessions are increased with computer usage, especially when operating time is more than 30 hours per week and usage of more than 10 years.⁹⁵

Studies have shown, however, that eye-related symptoms are the most frequently occurring health problems among VDT users.15, 16, 18, 80, 83, 87 The main visual symptoms reported by VDT users include eyestrain, tired eyes, irritation, burning sensation, redness, blurred vision, and double vision,4, 5, 13, 15, 18, 52, 85, 87 thus termed the phrase “Computer Vision Syndrome” (CVS). In 1992, a total of 1,307 surveys were completed by optometrists who reported that the majority of VDT patients have symptoms that are different than other near-point workers, especially as related to glare, lighting, unique viewing conditions, and spectacle requirements. Greater frequency and severity of symptoms were also noted.⁸⁰ Travers and Stanton identified a trend in symptomatology, whereby symptoms appeared to increase as duration of VDT exposure increased.⁸⁸ It is estimated according to some reports that the diagnosis and treatment of these symptoms costs almost US$ 2 billion each year (Abelson MB: How to fight Computer Vision Syndrome. Rev Ophthalmol 114–6, 1999). As computer users become more aware of CVS, it is important that ophthalmologists are attentive to this rapidly evolving disorder, as we could be facing a possible epidemic of the 21st century.

The purpose of this review is to examine the epidemiology, causes, and diagnosis of CVS; we will also present a review of the current treatments for CVS.