ABSTRACT: Computer vision syndrome (CVS) is defined by the American Optometric Association as a “complex of eye and vision problems related to near work which is experienced during or related to computer use.” As computers are a part of our everyday life, more people are experiencing a variety of ocular symptoms related to computer, tablet, e-reader, and cellular phone use. Many people experience eye discomfort and vision problems when viewing digital screens for long periods of time. The unique characteristics and high visual demands of computer and digital screen viewing make many individuals susceptible to the development of vision-related symptoms. The level of discomfort appears to increase with the amount of digital-screen use. Signs and symptoms include digital eyestrain, tired eyes, irritation, redness, blurred vision, and double vision that are collectively referred to as CVS. However, the major contributor to CVS symptoms, by far, appears to be dry eyes. This article discusses the causes, diagnosis, and treatment modalities that are currently available.
Computer vision syndrome (CVS) symptoms may be the cause of ocular-surface abnormalities or accommodative spasms and extraocular etiologies, such as ergonomics. More research needs to be done to find out the processes that cause CVS and to develop and improve effective treatments for these causes.1,2 Uncorrected vision problems (such as farsightedness and astigmatism), eye-coordination difficulties, and aging can all contribute to the development of visual symptoms when using a computer or digital-screen device.2
Many computer users experience problems with eye focus or eye coordination that cannot be properly corrected with eyeglasses or contact lenses. A vision-training program may be needed to treat these causes. This program trains the eyes and brain to work together more effectively. These eye exercises help eye movement, eye focusing, and eye teaming and reinforce the eye-brain connection.2
Dry Eye Syndrome
Dry eye syndrome, also known as keratoconjunctivitis sicca, is an eye condition in which tear film evaporation is high or tear production is low. This will cause the eyes to dry out and become inflamed.2 The eyes produce tears all the time, not just when people weep or have emotional experiences. Healthy eyes are covered with a liquid tear film, which is designed to remain stable between each blink. This tear film prevents the eyes from becoming dry and keeps them clear and comfortable. If the tear glands produce a lower quantity of tears, the tear film can become destabilized. It can break down quickly, creating dry spots on the surface of the eyes. Dry eye syndrome is more common with older age, when the individual produces fewer tears, but it can occur at any age. In parts of the world where malnutrition results in vitamin A deficiency, dry eye syndrome is much more common.2
Symptoms of dry eyes include stinging and burning sensations in the eyes, a feeling of dryness in the eyes, eye sensitivity to smoke, eye fatigue even after reading and viewing computers for a relatively short period, sensitivity to light, blurred vision, and the sticking together of the eyelids upon waking up.2,3
Artificial tears may be a simple, effective treatment for mild dry eyes. Eye drops without preservatives can be used as many times a day as desired. Those with preservatives usually have a maximum safe dosage of four times a day. It may be a good idea to apply eye drops before activities that may exacerbate dry eye symptoms. Ointments are generally better for nighttime use because they may blur vision.2,4
Viewing a computer or digital screen is different than reading a printed page. Often, the letters on the computer or handheld device are not as precise or sharply defined, the level of contrast of the letters to the background is reduced, and the presence of glare and reflections on the screen may make viewing difficult.1,3 In addition, the presence of even minor vision problems can often significantly affect comfort and performance at a computer or while using other digital-screen devices. Uncorrected or under-corrected vision problems can be major contributing factors to computer-related eyestrain. Even people who have an eyeglass or contact lens prescription may find that it is not suitable for the specific viewing distances of their computer screen.2-4
People who spend 2 or more continuous hours at a computer or using a digital-screen device every day are at greatest risk for developing CVS.2 Additionally, uncorrected vision problems such as farsightedness and astigmatism, inadequate eye focusing or eye-coordination abilities, and aging of the eyes, such as presbyopia, can all contribute to the development of visual symptoms when using a computer or digital-screen device.4,5 All symptoms of CVS may be caused by poor lighting, glare on a digital screen, improper viewing distances, poor seating posture, uncorrected vision problems, or a combination of these factors.4
Excessive blue-light exposure through computer screens and other digital devices can also interfere with circadian rhythms, cause sleep disruption, and result in other negative lifestyle consequences.
CVS or digital eye strain can be diagnosed through a comprehensive eye examination and ocular ergonomics with a special emphasis on visual requirements at the computer or digital device. These assessments might include:
• a thorough vision history to determine any symptoms the patient is experiencing
• the presence of any general health problems and review of medications
• visual sensitivity measurements to assess the extent to which vision may be affected
• a twist to determine the appropriate lens power needed to compensate for any refractive errors (nearsightedness, farsightedness, or astigmatism)
• testing how the eyes focus, move, and work together.6
The above steps may be done without the use of eye drops to determine how the eyes respond under normal seeing conditions. With the information obtained from these tests and the results of other tests, a doctor of optometry can determine the presence of CVS or digital eyestrain and advise treatment options.6
Many American workers spend 7 hours a day on the computer, either in the office or working from home. To help alleviate digital eyestrain, people should follow the 20-20-20 rule: take a 20-second break to view something 20 feet away every 20 minutes.1,3,7
Since digital screen–related vision problems are varied, in some cases individuals who do not require the use of eyeglasses for other daily activities may benefit from lenses prescribed specifically for computer use. In addition, persons already wearing glasses may find that their current prescription does not provide optimal vision for viewing a computer.1,7
In many individuals, a multidirectional approach combining ocular therapy with adjustment of the workstation may be required. Proper lighting, antiglare filters, ergonomic positioning of computer monitor, and regular work breaks may help improve visual comfort. However, some individuals may experience continued reduced visual abilities, such as blurred distance vision, even after stopping work at a computer. If nothing is done to address the cause of the problem, the symptoms will continue to recur and perhaps worsen with future digital screen use.1,8
Lubricating eye drops and special computer glasses help relieve ocular surface–related symptoms. However, these can usually be alleviated by obtaining regular eye care and making changes in how the screen is viewed. Some other solutions to the problem are as follows:
• Eyeglasses or contact lenses prescribed for general use may not be adequate for computer work. Lenses prescribed to meet the unique visual demands of computer viewing may be needed. Special lens designs, powers, tints, or coatings may help to maximize visual abilities and comfort.
• Some computer users experience difficulties with eye focusing or eye coordination that cannot be adequately corrected with eyeglasses or contact lenses. A vision-therapy program may be needed to treat these problems. Vision therapy is a structured program of visual activities prescribed to improve visual abilities; it trains the eyes and brain to work together more effectively.
• Some important factors in preventing or reducing the symptoms of CVS have to do with the computer and how it is used. This includes lighting conditions, chair comfort, location of reference materials, position of the monitor, and the use of rest breaks.2,3,8
The problem of CVS has emerged in this century following increased usage of computers both at home and at work. There is a correlation between computer usage and ocular symptoms, such as pain, redness, dryness, blurring of vision, double vision, and other head and neck sprains. Modification in the ergonomics of the working environment, patient education, and proper eye care are important strategies in preventing CVS.
1. American Optometric Association. Computer vision syndrome. www.aoa.org/healthy-eyes/eye-and-vision-conditions/computer-vision-syndrome?sso=y. Accessed December 2021.
2. Saljoughian M. Nutrition and eye health at a glance. US Pharm. 2015;40(6):HS-11-HS-16.
3. The Vision Council. Eyes overexposed: the digital device dilemma: digital eye strain report. 2016. www.thevisioncouncil.org/content/digital-eye-strain. Accessed December 2021.
4. Rosenfield M. Computer vision syndrome (A.K.A. digital eye strain). Optom Pract. 2016;17:1-10.
5. Loh KY, Redd SC. Understanding and preventing computer vision syndrome. Malays Fam Physician. 2008;3(3):128-130.
6. Turgut B. Ocular ergonomics for the computer vision syndrome. J Eye Vision. 2018;1(2).
7. Klamm J, Tarnow KG. Computer vision syndrome: a review of literature. Medsurg Nurs. 2015;24:89-93.
8. Gowrisankaran S, Sheedy JE. Computer vision syndrome: a review. Work. 2015;52:303-314.
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