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1. CVS affects over 70 percent of computer users.

2. CVS was predicted by monthly income, occupation, daily computer usage, regular health breaks, knowledge, and prior eye condition.

3. Computer vision syndrome (CVS) is the most common occupational hazard of the twenty-first century, affecting over 70% of all computer users.

4. Despite the fact that several studies have reported the frequency of CVS and risk factors such as prolonged computer use and improper workstation postures, the majority of them focused on Western adult individuals.

5. It has nearly become an indispensable piece of equipment both at work and at home as a result of technological advancements.

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Abstract

Background

Globally, computer is one of the common office tools used in various institutions. Using computer for prolonged time led to the users at greater health risk of computer vision syndrome (CVS). Computer vision syndrome is the leading occupational health problem of the twenty-first century. About 70 percent of computer users are suffered from CVS. Besides the health problems, CVS causes inefficiency at workplace and deteriorate quality of work. The problem of CVS and its risk factors are not well known in Ethiopia.

Method

A cross-sectional study was conducted to assess the prevalence of CVS and associated factors among computer user government employees in Debre Tabor town from February to March, 2016. Multistage random sampling method was applied to select 607 study participants, and the data were collected by using a structured questionnaire. Computer vision syndrome was measured by self-reported method. Bivariate and multivariable binary logistic regression analyses were performed using SPSS version 20. Significance level was obtained at 95% CI and p value < 0.05.

Results

The prevalence of CVS was 422 (69.5%) with 95% CI of 65.60, 73.0%. Blurred vision, eyestrain, and eye irritation were the commonest reported symptoms of CVS with proportion of 62.60%, 47.63%, and 47.40%, respectively. Occupation: officer (adjusted odds ratio (AOR) = 4.74) and secretary (AOR = 9.17), daily computer usage (AOR: 2.29), and preexisting eye disease (AOR = 3.19) were risk factors for CVS. However, computer users with high payment, who took regular health break, and with good knowledge on computer safety measures were less impacted by CVS.

Conclusion

The prevalence of computer vision syndrome was found to be higher in Debre Tabor town. Monthly income, occupation, daily computer usage, regular health break, knowledge, and preexisting eye disease were predictor variables for CVS. Optimizing exposure time, improving awareness on safety measures, and management support are important to tackle CVS.

1. Introduction

Globally, personal computers were one of the commonest office tools. It had become a necessity in the 21st century and has been regularly used in various institutions such as government offices, academic institutions, and banking systems [ 1]. A continuous use of computer for an extended time causes vision problem called computer vision syndrome [ 2]. Computer vision syndrome (CVS) is defined by the American Optometric Association as a complex of eye and vision problems related to the activities which stress the near vision and which are experienced in relation to or during the use of computers [ 3]. It encompasses a group of visual symptoms which crop up from the extended viewing of the digital screen, when the demands of the task exceed the abilities of the viewer. Symptoms of CVS which are referred to as digital eye strain include dry and irritated eyes, eye strain/fatigue, blurred vision, red eyes, burning eyes, excessive tearing, double vision, headache, light/glare sensitivity, slowness in changing focus, and changes in color perception [ 4].

Computer vision syndrome (CVS) is the leading occupational hazard of the 21st century and its symptoms affect nearly about 70 percent of all computer users [ 5]. Globally, CVS is one of the major public health problems and reduced productivity at work, increased error rate, reduced job satisfaction, and impaired visual abilities. A worldwide data show nearly 60 million people suffering from CVS and 1 million new cases occurred each year [ 6]. Given the low availability and utilization of personal protective equipment, the high workload, and the limited break time while using computer in developing countries, the burden of CVS is very high [ 7].

The public health burden of CVS was becoming the concern of policy makers and attracts the attention of researchers. A study conducted in Abuja, Nigeria, reported that 40% of computer users engaged as security and exchange commissioner has suffered from at least one symptom of CVS [ 8]. A nationwide study in Sri Lanka reported that more than two-thirds of computer office workers were suffering from CVS [ 9]. A couple of studies conducted in Gondar, Ethiopia, reported that more than 73% of computer users who are working as secretaries, data processors, and bankers were developing CVS [ 10, 11].

Duration of computer usage, poor lighting, glare, screen brightness, vision problems, and improper workstation setup are risk factors for CVS [ 12]. Though there is no evidence that CVS symptoms lead to permanent eye damage on top of visual impairment, it causes inefficiency at workplace. Hence, CVS is growing public health issue that can significantly affect the workers' quality of life and their work productivity [ 5].

Although many studies have reported the prevalence of CVS and the risk factors such as prolonged computer use and poor postures at workstations, most of them were focused on Western adult subjects [ 13, 14] and few Asian countries [ 15- 18]. Paucity of information found on the problem of CVS and determinant factors in sub-Saharan African Countries, including Ethiopia. The couple of studies conducted in Ethiopia attempted to determine the prevalence of CVS and associated factors among computer users in academic institutions and financial institution, but their focus was on academic institutions and bank workers [ 10, 11]. However, these studies are not sufficient to explore the nature of CVS and predictor variables at different groups of computer users.

Over the past 30 years, there has been a great advancement in computer technology. It has become almost an indispensable piece of equipment both at office and at home. It is certain that computer has dramatically benefited the society and makes the working condition easier and producing fast output [ 19]; however, it does associate with health-related problems [ 2, 4, 5, 8, 9, 11, 13]. Owing to the technological advancement and growing socioeconomic development observed in the world, the use of computer increased dramatically. Sub-Saharan Africa is not an exception on the rate of computer use; however, the users had inadequate knowledge on safety precautions during use of computer. The standard of computers is also poor and not equipped with protective devices from CVS [ 20]. Therefore, the aim of this study was to assess the prevalence of computer vision syndrome (CVS) and associated factors among computer users of government office workers in Debre Tabor town, northwest Ethiopia. This study shed light on the adverse effect of computer use and its prevention and control methods among computer users in government offices in Ethiopia.

2. Methods and Materials

2.1. Study Design and Period

A cross-sectional study design was employed from February to March, 2016.

2.2. Study Area and Period

The study was conducted in Debre Tabor town, northwest Ethiopia. Debre Tabor, which is the capital of south Gondar Administrative Zone, Amhara regional state, is located 99 km from the capital city of the regional state and 667 km from Addis Ababa. The town consists of sixty government offices with a total of 2752 computer user employees.

2.3. Source and Study Population

All computer users who worked in government institutions in Debre Tabor town were the source population, whereas all workers who were using computer in their day-to-day working life for at least one year were taken as study population [ 9]. The types of tasks performed by the computer users are word processing, spreadsheet processing, data entry and processing, preparing learning and teaching materials, and reading texts on computer.

2.4. Sample Size Determination

The sample size was determined by using single population proportion formula with the following assumptions: margin of error 5%, proportion of CVS 73.9% [ 10], 95% confidence interval, and design effect of 2 and 10% of nonresponse rate to come up with a sample size of 652 respondents.

2.5. Sampling Procedure

A multistage random sampling technique was used to select participants from governmental offices. We have used two stages to select the final study participants in this study. In the first stage, twenty government offices were selected randomly from a total of 60 offices in Debre Tabor town. Then, from each selected office, study subjects were selected proportionally to their size by random sampling technique.

2.6. Operational Definition

1. Computer vision syndrome (CVS): having the symptoms of computer vision syndrome either intermittently or continuously for at least one week during the last twelve months was defined as computer vision syndrome. Presence of pain in and around the eyes, headache, blurred near vision, blurred distant vision, dry eyes, sore/irritated eyes, red eyes, excessive tearing, double vision, twitching of eyelids, and changes in visualizing colors were assessed as symptoms of CVS in this study. The worker who reported one of the above symptoms was considered as positive for CVS [ 9, 11, 21, 22].

2. Knowledge: participants were asked to answer 10 knowledge questions about safety measures of CVS. Graded as having "Good knowledge" if they had answered correctly (≥70%) 7-10 questions and (<70%) 0-6 as "Poor knowledge" [ 9].

3. Computer users: workers who use computer for their day-to-day working life.

4. Income: monthly salary of the study participants was used as proxy to measure their income.

2.7. Data Collection Method

A self-administered questionnaires supplemented by observational checklists were used to collect sociodemographic data, symptoms of CVS, details of computer usage, potential risk factors (environmental and behavioral factors), and knowledge of computer users on safety measures of CVS. The data collection was carried out by six optometry BSc degree graduates. Two supervisors were also involved in monitoring data collection and checking the completeness of the questionnaires.

2.8. Data Quality Control

Training was given for data collectors and supervisors for 3 days on procedures, techniques, and ways of collecting the data. The tool was pretested among 33 (5% of the sample size) government office workers in Nefas Mewcha town, prior to the actual data collection. Afterwards, the necessary modification on the tool was made.

2.9. Data Processing and Analysis

The data were entered using Epi-Info version 7 and analyzed using SPSS statistical package for Windows, version 20.0. All assumptions for binary logistic regression were checked. To determine predictor variables for CVS, binary logistic regression model was fitted and variables significant at p value < 0.2 in the bivariable analysis were included in the multivariable analysis. Finally, variables found to be significant at p value < 0.05 in the final model were declared as predictor variables. Crude odds ratios (COR) and adjusted odds ratios (AOR) with 95% confidence interval were reported in the result.

2.10. Ethical Consideration

Ethical clearance was obtained from the Institutional Review Board of the University of Gondar. The purpose of the study was clearly explained to the study subjects, and their verbal consent was obtained. Confidentiality of the information had been maintained at all levels of the study.

3. Results

3.1. Sociodemographic Characteristics of Respondents

A total of 607 study participants were included in this study with response rate of 93.1%. The median (interquartile range (IQR)) age of the respondents was 29 years (25-35 years). More than half (335 (55.5%)) of the respondents were male, 345 (56.8%) were married, and 308 (50.7%) participants had monthly salary of >3000 ETB (140.16USD) ().

Table 1

3.2. Environmental and Behavioral Characteristics

Two hundred sixty-six (43.8%) of the participants worked in their current position for more than 5.7 years and 273 (45.0%) used computer for >4.6 hours per day. Two hundred fourteen (35.3%) of the participants were taking regular break during working time. Of which, their mean (±SD) break time was found to be 24.93 ± 11.76 minutes. More than two-thirds (70.7%) of the participants usually used desktop computers. Nearly two-thirds of the participants (61.6%) used ergonomically comfortable sitting chair and nearly quarter of them (23.6%) reported the brightness of their computer screen was dull. Five hundred forty-four (89.1%) of the participants did not wear eyeglass/spectacle. Their major reported reasons were eyeglass can worsen the symptoms, social unacceptability, and not knowing its importance; feeling uncomfortable while wearing it; not to afford to buy; and not prescribed by doctors. On the other hand, 85 (14%) respondents had previous history of eye illness ().

Table 2

3.3. Prevalence of Computer Vision Syndrome (CVS)

The self-reported prevalence of computer vision syndrome among computer users was 69.5 % (95% CI; 65.60, 73.0). Blurred vision, eyestrain, and eye irritation were the most common reported symptoms of CVS with prevalence of 62.60%, 47.63%, and 47.40%, respectively ().

3.4. Factors Associated with Computer Vision Syndrome

The multivariable analysis showed that monthly salary, occupational status, daily computer usage, history of previous eye problem, and knowledge on safety measures of CVS and its adverse effect were found to be determinant factors for CVS.

The odds of developing CVS among computer users who earned a monthly salary in the range of 1500 and 3000 Ethiopian birr (ETB) and greater than 3000 ETB were 74% (AOR = 0.26, 95% CI (0.07, 0.88)) and 89% (AOR = 0.11, 95% CI (0.01, 0.95)) less than computer users who earned less than 1500 ETB. The odds of developing CVS among officers and secretaries were 4.75 (AOR = 4.75, 95% CI (1.77, 12.70)) and 9.17 (AOR = 9.17, 95% CI (2.63, 31.90)) more than the coordinators by occupation.

Participants who used computer for >4.6 hours per day were 2.29 times more likely to develop CVS compared to workers who used computer for 4.6 hours or less (AOR: 2.29, 95% CI (1.43, 3.66)). The study also showed that workers who had previous history of eye illness were 3.19 times more likely to develop CVS than their counterparts. Moreover, workers who had good knowledge on safe use of computer and prevention mechanisms of adverse effect of computer were 42% less likely to develop CVS than their counterparts (AOR: 0.58, 95% CI (0.37, 0.92)). The odds of developing CVS among computer users who regularly adjusted the brightness of their computer screen and who took regular break decreased by 27% (AOR: 0.73, 95% CI (0.58, 0.91)) and 16% (AOR: 0.84, 95% CI (0.53, 0.97)), respectively ().

Table 3

4. Discussion

This study was aimed at assessing the prevalence of CVS and its predictors. The self-reported prevalence of CVS among Debre Tabor town government office workers was 69.5% (95% CI = 65.60, 73.00). The finding is in line with other studies: 73.9% in University of Gondar, Ethiopia, among secretaries and data processors [ 10]; 74% in Nigeria [ 8]; 73% in Gondar, Ethiopia, among bank workers [ 11]; 74% in Abuja, Nigeria [ 8]; 67.4% in Sri Lanka among office workers [ 9]; 72% in Ajman, United Arab Emirates [ 23]; and 63% in Public University of Putra, Malaysia, among administrative staffs [ 15]. On the other hand, this study result was less than the findings in Malaysia, which was reported to be 89% [ 24], and in Chennai, India, which was 80.3% [ 25]. The possible reason might be either due to the study participants in these areas being university students using computers for a longer time than government office workers or due to students using computers for a long time without eye break for studying rather than office workers who relatively taking most bank workers taking frequent breaks. Regarding the study conducted in India, neck and shoulder pain was included to define CVS, whereas in this study, only ocular and visual symptoms including headache were used to measure CVS. On the other hand, in this study, the eye/visual symptoms which lasted at least 1 week were considered to define CVS, whereas they had no specification on duration of symptoms [ 25]. These discrepancies might be a possible justification for the reported higher prevalence of CVS in Chennai, India, than our study.

Highly paid computer users were less likely to develop CVS than their low-paid counterparts. This might be due to the fact that high-paid computer users may have greater opportunity to use antiglare and good computers that could reduce the development of CVS. Conversely, low-paid ones were suffering from this disease because they could not afford these facilities. High-paid computer users might have good awareness on computer ergonomics and can optimize safe duration of computer exposure. Income was mentioned as a protective factor for health by different studies [ 26- 28] because high-paid workers can have a better access to health care, which could have alleviated their symptoms. On top of that, these groups were managers and academicians (lecturers and teachers) in this study, who are engaged in less repetitive work such as checking emails and briefly reading notes. A chi-square test shows highly paid computer users took break significantly higher than their counterparts ( X ² = 5.2, p value = 0.08), which supported the above argument. Their daily duration of computer use was also significantly less than low-paid computer users (Pearson correlation test between income and computer exposure time: r = −0.24, p value ≤ 0.001).

This study indicated that officers and secretaries were found to be significantly impacted by CVS compared to managers and coordinators. The possible reason might be officers and secretaries are usually used computer for a long time. A one-way ANOVA and multiple comparison tests confirmed that the daily exposure time of computer was significantly higher among secretaries and officers in this study ( p value < 0.01).

Daily exposure time was another factor that was statistically significant in this study. Workers who used computers for >4.6 hrs per day were more likely to develop CVS as compared to those who used computers <4.6 hrs (AOR: 2.29, 95% CI (1.43, 3.66)). A computer emits electromagnetic radiation or high-energy blue light, which enables that high energy to stress the ciliary muscle in the eye; ultimately, a prolonged exposure to computer screen led to eye strain. The finding was in line with a study conducted in University of Gondar, Ethiopia [ 10]. Other similar studies were also reported an increase in the number of hours spent on computer increases the risk of CVS significantly [ 9, 17, 25, 29, 30]. Hence, reducing the amount of time spent on computer is important to prevent CVS [ 12].

The odds of developing CVS were higher among computer users who had less frequent or no break. This might be due to the fact that the eyes normally cannot remain focused on the pixel-generated images on a computer screen for a long time, and as such, the eyes must focus and refocus thousands of times by taking frequent breaks for adequate time while viewing the screen, and if the refresh rate is too slow, it causes a high flickering screen, which leads to suffer from symptoms of CVS [ 11]. The result was in concordance with previous similar studies who reported that taking break is a protective factor for CVS [ 11, 18, 21, 25]. After working for one hour, taking short breaks for 5 min has been recommended to decrease eye problem without undue influence of work productivity [ 31].

Previous history of eye illness was found to be significantly associated with CVS (AOR: 3.19, 95% CI (1.49, 6.84)). This finding was supported by a study conducted in Sri Lanka, which indicated preexisting eye diseases were associated with severe CVS [ 9]. Similarly, a study conducted in India showed that computer users with history of eye problems were at higher risk of developing CVS [ 32]. Another study in São Paulo, Brazil, showed that headache was high among computer users who worked in poor ergonomic design and lacks adequate eye strain protection mechanisms since sign and symptoms were nonspecific [ 33]. This might be long-lasting effect of previous illness; the illness may exist till now to feel each other with CVS, lack of care, and treatment related to previous illness, and some of the previous problems are chronic and may exist till now.

Computer users who had good knowledge on safety measures of computer use and its adverse effect were found to be less impacted by CVS (AOR: 0.58, 95% CI (0.37, 0.92)). The result was in agreement with a study conducted in University of Benin, Nigeria [ 34] and Malaysia [ 15]. The possible reason might be the workers who have good knowledge are more likely to implement protective measures and will adhere to safe computer use. In general, there is a direct relationship between knowledge and applying safety measures that potentially tackle work-related injuries and diseases. In contrast, a study conducted in Sri Lanka revealed that ergonomics practices knowledge was associated with increased risk of developing CVS [ 9]. The discrepancy might be in some cases there could be correlation between ergonomics practices knowledge and higher daily computer usage; the later indicated as risk factors for CVS in various studies and the current study.

5. Limitation of the Study

The main limitations of this study were ophthalmic examination was not done to measure CVS and the symptoms reported were self-reported. Symptoms that might not be recognized by users would be left unreported. To minimize the unduly effect of self-reported measurement, we have adopted and used standard protocol. Though we have used a protocol that measures CVS symptoms that can be occurred while using computer, some of the symptoms of CVS including blurred vision and eye strain might be caused by uncorrected refractive error that could potentially overestimate the prevalence [ 35]. According to the current study, the prevalence of CVS among risk groups for refractive error such as aged population and who do not use eyeglass/spectacle was not significantly different compared to their counterparts that show the influence of the bias was not significant. But in the future study, we recommend that the influence of uncorrected refractive error should be addressed methodologically and the measurement of CVS can be supported by ophthalmic examination.

6. Conclusion

This study demonstrated that the prevalence of CVS was found to be higher in Debre Tabor town government institutions. Monthly salary, daily exposure time, type of work, and knowledge were the most determinant factors for CVS. Hence, optimizing the exposure time and improving the awareness of users by rigorous training and management support are important to tackle the problem. In the future, it is recommended to determine the additive or synergistic effect of using smartphone and computer tablets on CVS on or off working time.

Acknowledgments

The authors are pleased to acknowledge the data collectors, study participants, and Debre Tabor town administration for their unreserved contributions to the success of this study. They are also grateful for University of Gondar for logistic support. The authors received the data collection fee and logistic and stationery support from University of Gondar.

Data Availability

Data will be made available from the primary author upon request.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Authors' Contributions

AD, FA, and AN participated during inception of the research idea, development of a research proposal, data collection, analysis and interpretation, and writing various parts of the research report. AD designed the study protocol and supervised the quality of data, analyzed the data, and prepared the manuscript. FA and AN designed the study protocol and supervised the quality of data and analyzed the data; SDW analyzed the data, interpreted the result, and prepared the manuscript; DHC interpreted the result and prepared the manuscript. All authors read and approved the final manuscript.

References

20. Mbuyisa B., Leonard A. ICT adoption in SMEs for the alleviation of poverty. Proceedings of International Association for Management of Technology, IAMOT 2015; June 2015; Cape Town, South Africa. University of Pretoria; [ Google Scholar]

24. Reddy S. C., Low C., Lim Y., Low L., Mardina F., Nursaleha M. Computer vision syndrome: a study of knowledge and practices in university students. [[ PubMed] [ CrossRef] Google Scholar]

34. Chiemeke S. C., Akhahowa A. E., Akhahowa B. O., et al. Evaluation of vision-related problems amongst computer users: a case study of University of Benin, Nigeria. Proceedings of the World Congress on Engineering; July 2007; London, UK. [ Google Scholar]

# data[].attributes.attachment_link.title
Computer Vision Syndrome and Associated Factors among Computer Users in Debre Tabor Town, Northwest Ethiopia

# data[].attributes.attachment_link.description
Globally, computer is one of the common office tools used in various institutions. Using computer for prolonged time led to the users at greater health risk of computer vision syndrome (CVS). Computer vision syndrome is the leading occupational health ...

# data[].attributes.body
ethnicity, the researchers found that there was a higher prevalence of myopia in people who were Chinese. In fact, Chinese participants had a 240% greater risk of developing short-sightedness in childhood compared to white participants. Interestingly, all other ethnicities appeared to have a reduced risk of developing myopia in childhood – though this might be due to the fact that UK Biobank data has fewer participants from ethnic minority backgrounds.

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This study found women had a 24% increased risk of developing myopia in childhood – but were 12% less likely to develop myopia in adulthood. It’s uncertain why this is – but it might be due to differences in lifestyle or the hormonal changes men and women experience.

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Global rates of short-sightedness are rising rapidly, study shows

# data[].attributes.subject
Global rates of short-sightedness are rising rapidly, study shows

# data[].attributes.body
A study has found that rates of short-sightedness (myopia) are rising dramatically.

Research shows a connection between years in education and levels of myopia; those with a university-level education were eight times more likely to develop myopia.

Spending time outdoors, specialised spectacles and contact lenses all work to protect and prevent the progression of short-sightedness

there was a jump in the number of people with short-sightedness when they compared participants born between 1965-1970 with those born between 1939-1944 – going from 20% of the population having myopia to nearly 30%. They also found that a greater number of people were developing short-sightedness in adulthood.

Myopia: What causes short-sightedness and why is it rising? | World Economic Forum (weforum.org)

# data[].attributes.attachment_link.readable_text
A study has found that rates of short-sightedness (myopia) are rising dramatically.

Research shows a connection between years in education and levels of myopia; those with a university-level education were eight times more likely to develop myopia.

Spending time outdoors, specialised spectacles and contact lenses all work to protect and prevent the progression of short-sightedness.

We've known for years now that rates of short-sightedness (scientifically known as myopia) are rising globally. Some estimates even suggest that half of the world's population will be short-sighted by 2050. In the UK and Europe alone, rates of short-sightedness have doubled in the last 50 years.

But we still aren't completely sure why these rates are rising so significantly - and who might be most at risk. This is what a recent study set out to understand. Looking at data from 107,442 participants aged 40-69, the researchers confirmed that rates of myopia have increased significantly in the UK in all age groups - and showed that education level and ethnicity may also be linked to greater risk.

They found that there was a jump in the number of people with short-sightedness when they compared participants born between 1965-1970 with those born between 1939-1944 - going from 20% of the population having myopia to nearly 30%. They also found that a greater number of people were developing short-sightedness in adulthood. Those who developed short-sightedness in childhood were also shown to become highly short-sighted and at greater risk of developing serious eye conditions in adulthood.

To get a better picture of whether certain groups were more at risk than others, the researchers compared participants by sex, ethnicity and education level.

While previous studies have found that women are more short-sighted on average - particularly at younger ages - others have found no difference between men and women.

This study found women had a 24% increased risk of developing myopia in childhood - but were 12% less likely to develop myopia in adulthood. It's uncertain why this is - but it might be due to differences in lifestyle or the hormonal changes men and women experience.

Looking then at ethnicity, the researchers found that there was a higher prevalence of myopia in people who were Chinese. In fact, Chinese participants had a 240% greater risk of developing short-sightedness in childhood compared to white participants. Interestingly, all other ethnicities appeared to have a reduced risk of developing myopia in childhood - though this might be due to the fact that UK Biobank data has fewer participants from ethnic minority backgrounds.

These findings relate to what previous studies have shown, with research suggesting there's a greater prevalence of myopia in east Asia and in people of Asian descent. One study looking at young men in Seoul found that almost 97% of 19-year-olds were myopic. Again, it's not certain why this group has higher rates of short-sightedness. Some theorise it could be caused by lifestyle factors during childhood, such as greater focus on education.

Image: UNSPLASH/Kyle Gregory Devaras

The researchers also looked at the impact that education had on short-sightedness. They found that the more years spent in education, the greater the risk a person had of developing short-sightedness in both childhood and adulthood. They also showed that the youngest participants (those born between 1965-1970) who had a university education were eight times more likely to develop myopia in childhood compared to those that had no formal education qualifications. Previous studies have also shown that people who spent more years in education are more likely to develop myopia.

The nuanced relationship between ethnicity and education was also explored. Having no formal educational qualifications was linked with lower risk of becoming short-sighted, as expected. This was most visibly shown in Chinese participants, where having no qualifications did not change their risk of developing myopia. However, Chinese participants that had higher level qualifications (such as a University degree) had the largest risk of myopia across the whole study.

How is the World Economic Forum bringing data-driven healthcare to life?

Although it's clear that education has a large hand in the development of myopia, the direct cause is unknown. Some argue that more time spent reading and using screens may be to blame. There's now evidence even suggesting a link between home-schooling during COVID-19 lockdowns and greater amounts of myopia in Chinese children - potentially because more time is being spent indoors.

But the significant increase in short-sightedness is concerning for a number of reasons. For a person with myopia, having to wear glasses or contact lenses can be costly. More significantly, it also puts them at greater risk of eye diseases - such as myopic maculopathy and retinal detachments, which can both permanently affect eyesight. Not only could this seriously impact a person's way of life, it would also put a greater financial strain on healthcare systems. Short-sightedness in children is even more concerning, as they're more likely to develop into severe myopia - which is more likely to lead to these eye problems as a result.

While you can't change genetics - which is one of the causes of myopia - there are a number of actions you can take to lower the risk of developing short-sightedness during childhood. Spending time outdoors has continued to demonstrate a protective effect against developing short-sightedness. But for children who may already be short-sighted, specialised spectacles and contact lenses are available that have demonstrated success in reducing myopia progression.

This article is published in collaboration with The Conversation.

The views expressed in this article are those of the author alone and not the World Economic Forum.

# data[].attributes.attachment_link.title
Global rates of short-sightedness are rising rapidly, study shows

# data[].attributes.attachment_link.description
A study has found that rates of short-sightedness (myopia) are rising dramatically. Research shows a connection between years in education and levels of myopia; those with a university-level education were eight times more likely to develop myopia. Spending time outdoors, specialised spectacles and contact lenses all work to protect and prevent the progression of short-sightedness.

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Screen time linked to risk of myopia in young peopleHigh levels of exposure can increase risk of short-sightedness by up to 80

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Screen time linked to risk of myopia in young peopleHigh levels of exposure can increase risk of short-sightedness by up to 80

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the authors revealed that high levels of smart device screen time, such as looking at a mobile phone, is associated with around a 30% higher risk of myopia and, when combined with excessive computer use, that risk rose to around 80%.

Professor Bourne, Professor of Ophthalmology in the Vision and Eye Research Institute at Anglia Ruskin University (ARU), said: "Around half the global population is expected to have myopia by 2050

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A new study published in one of the world's leading medical journals has revealed a link between screen time and higher risk and severity of myopia, or short-sightedness, in children and young adults.

The open-access research, published this week in The Lancet Digital Health, was undertaken by researchers and eye health experts from Singapore, Australia, China and the UK, including Professor Rupert Bourne from Anglia Ruskin University (ARU). The authors examined more than 3,000 studies investigating smart device exposure and myopia in children and young adults aged between 3 months old and 33 years old.

After analysing and statistically combining the available studies, the authors revealed that high levels of smart device screen time, such as looking at a mobile phone, is associated with around a 30% higher risk of myopia and, when combined with excessive computer use, that risk rose to around 80%.

The research comes as millions of children around the world have spent substantial time using remote learning methods following the closure of schools due to the COVID-19 pandemic.

Professor Bourne, Professor of Ophthalmology in the Vision and Eye Research Institute at Anglia Ruskin University (ARU), said: "Around half the global population is expected to have myopia by 2050, so it is a health concern that is escalating quickly. Our study is the most comprehensive yet on this issue and shows a potential link between screen time and myopia in young people.

"This research comes at a time when our children have been spending more time than ever looking at screens for long periods, due to school closures, and it is clear that urgent research is needed to further understand how exposure to digital devices can affect our eyes and vision. We also know that people underestimate their own screen time, so future studies should use objective measures to capture this information."

Journal Reference:

Joshua Foreman, Arief Tjitra Salim, Anitha Praveen, Dwight Fonseka, Daniel Shu Wei Ting, Ming Guang He, Rupert R A Bourne, Jonathan Crowston, Tien Y Wong, Mohamed Dirani. Association between digital smart device use and myopia: a systematic review and meta-analysis. The Lancet Digital Health, 2021; DOI: 10.1016/S2589-7500(21)00135-7

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Screen time linked to risk of myopia in young people: High levels of exposure can increase risk of short-sightedness by up to 80%

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A new study published in one of the world's leading medical journals has revealed a link between screen time and higher risk and severity of myopia, or short-sightedness, in children and young adults.

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COVID-19 and eyesight: Myopia on the rise during lockdown

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COVID-19 and eyesight: Myopia on the rise during lockdown

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In most cases, nearsightedness begins in primary school and it increases as children grow up. The earlier it starts, the more severe it becomes. The grown eye does not shrink again.

The better the education, the worse the eyesight

According to the Brien Holden Vision Institute, by the middle of the century around five billion people, or roughly half of the world's population, will be nearsighted. Especially in industrialized countries, the number of nearsighted people has risen rapidly in recent decades

Asian countries have above-average rates of nearsighted children and adolescents. For example, after World War II, about 20-30% of 20-year-olds in Hong Kong, Taiwan and South Korea were nearsighted; today the figure is more than 80%. In China, four out of five young people are now nearsighted. In other Asian countries, the rate is as high as 95%. In Europe too, about half of young adults are nearsighted.

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COVID-19 and eyesight: Myopia on the rise during lockdown | DW | 21.01.2021

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Due to coronavirus lockdowns, less time outdoors and more time on screens is leading to significantly more people suffering from myopia, especially children.

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Why staring at screens is making your eyeballs elongate – and how to stop it

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Why staring at screens is making your eyeballs elongate – and how to stop it

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Last spring, Chinese researchers tested over 120,000 Covid-quarantined students aged six to eight and found myopia and other vision issues linked to home confinement increased up to three times compared with the previous five years – that’s with as little as 2.5 more hours of e-learning (not counting video games, social media, etc).
Poor eyes can lead to decreased work efficiency and huge loss of productivity – think money–for multinationals. That’s why nations like China are so worried about this that they have already changed their education system,

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The use of technological devices increased during the COVID-19 lockdown. More computer vision syndrome-related eye complaints were reported by participants who spent more time with electronic devices and less time outside.

Continual use of a digital display impacted the frequency and severity of symptoms, and had a positive link with impaired vision, wrist and finger joint pain, greater sensitivity to light, and other symptoms.

Because brightness is linked to daylight and room light, it should be raised in the outside for precise vision, but indoors, a high degree of brightness can harm eyes and even cause headaches after a short period of use.

When comparing males and females, it was discovered that females had a higher rate of occurrence of practically all symptoms. This gender disparity could have been exacerbated by psychological or physical concerns. Males had a higher rate of double vision, frequent blinking, eye redness, and weeping than females, while all other symptoms were mostly reported in females.

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Many individuals experience eye discomfort and vision problems when viewing digital screens for extended periods. The level of discomfort appears to increase with the amount of digital screen use.

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How can you control Myopia Progression?
Globally, myopia is on rising. There are various factors that relate to it. Currently, 30% of the world’s population is myopic.

It is predicted that 50% of the global population will be myopic by the year 2050, which would make myopia; a leading cause of permanent vision loss worldwide.

Reasons:

1. Genetics plays a vital role when one or both parents are myopic.

2. Due to increased amount of near work. The child engaged in reading or spent time on digital devices for a long time.

3. Due to decreased amount of time spent outdoors.

problems:

Cosmetical issue ,Ocular issue, Visual and economical issue,

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Myopia Control, a broad term used to explain the specific methods to apply to slow the progression of myopia. First, let me know about the details of myopia. What is myopia? Myopia, also called nearsightedness or shortsightedness is a common eye condition or refractive error in which the rays of light entering the eye focused in front of the retina rather than directly on the retina, which causes blurred distance vision. The more myopia you...

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Myopia Control, a broad term used to explain the specific methods to apply to slow the progression of myopia. First, let me know about the details of myopia. What is myopia?

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2 Extraocular symptoms include headache; neck, shoulder, or back pain; and numbness of the hands or fingers

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2 Extraocular symptoms include headache; neck, shoulder, or back pain; and numbness of the hands or fingers

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1 Ocular symptoms include dry eyes, red eye, burning sensation, foreign body sensation, blurred vision and increased sensitivity to light, excessive tearing, itching, ocular pain, change in visualizing colors, and double vision. 

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1 Ocular symptoms include dry eyes, red eye, burning sensation, foreign body sensation, blurred vision and increased sensitivity to light, excessive tearing, itching, ocular pain, change in visualizing colors, and double vision. 

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CVS symptoms are categorized into ocular and extraocular

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CVS symptoms are categorized into ocular and extraocular

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Globally, around 60 million computer workers experience discomfort from CVS

Nearly 45 million workers use computers by staring at the screen for hours continuously

Nowadays, university students including medical students are spending more time staring at the screen for studying and for research work. There have been several studies reporting an increased prevalence of CVS among computer users, specifically medical students.

Other studies in Sri Lanka, India, and the United Arab Emirates also support the significantly high CVS prevalence among female computer workers, with significantly higher headache and blurred vision incidence . In contrast, males were found to have higher risk of redness, burning sensation, blurred vision, and dry eyes among medical and engineering students in India.

a study in Chennai revealed a significantly higher risk of developing headache and blurred vision among students wearing corrective lens, including both spectacles and contact lenses.

when there is a need to increase the visual demand to the extent it exceeds the person’s visual ability

The image on the screen is produced by thousands of pixels combined to form an image, in which the margins are not sharp and is dependent on the resolution, the contrast of the background, and glare or reflection from the screen.

decreased blinking reflex while staring at the screen, leading to exaggerating dry eyes.

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Introduction. Computer vision syndrome (CVS) is "a complex of eye and vision problems related to near work experienced during computer use." It is one of the rising health concerns related to technology (cell phones and tablets) due to continuous use of computers among students. The aim of this study was to determine the prevalence of CVS, associated risk factors, and commonly associated symptoms and to assess the awareness and proper practice of using computers for studying. Methods. A cross-sectional descriptive study was conducted among 651 undergraduate medical students in King Abdulaziz University, Jeddah, Saudi Arabia. An electronic survey was conducted to collect the data. Data were analyzed using SPSS v21. The chi-square test (Fisher's exact test when required) was used to study the significance of associations. value <0.05 was considered statistically significant. Results. High prevalence of CVS was observed, in which 95% (558) reported at least one symptom during studying using computers. Most frequently reported symptoms were excessive tearing and neck, shoulder, or back pain. Female students had a higher risk of CVS ( Students who are myopic or hyperopic showed no association. Astigmatism was associated significantly with CVS ( Using spectacles or contact lens showed no association. Students with dry eye disease revealed a significant association with CVS (). The most significant risk factors related to the daily usage of computer were longer duration of studying ( short distance from the screen (), and high brightness of the screen ( The most significant preventive measure taken to relieve the symptoms was applying the 20-20-20 rule. Conclusion. CVS is common among medical students; significant risk factors need to be addressed to reduce the symptom and to ensure a better productivity of work. It is a necessity to raise awareness among medical students regarding computer-related health problems.

1. Introduction

In this modern generation, the use of computers became an essential tool to perform everyday tasks at work and at home. This holds true regardless of the user's profession or occupation. The development of technology in education made a noticeable transformation in the methods of teaching, presenting information, and sources for studying. However, this convenient lifestyle still raised a health-related concern [ 1- 3]. Among the health-related aspects is a condition known as computer vision syndrome (CVS). The American Optometric Association (AOA) defined computer vision syndrome as "a complex of eye and vision problems related to near work experienced during computer use." [ 1]

CVS symptoms occur when there is a need to increase the visual demand to the extent it exceeds the person's visual ability [ 1]. The image on the screen is produced by thousands of pixels combined to form an image, in which the margins are not sharp and is dependent on the resolution, the contrast of the background, and glare or reflection from the screen. These factors in contrary to printed documents increase the visual demand in order to perceive good images [ 1, 10, 11]. In addition, CVS can also be explained by decreased blinking reflex while staring at the screen, leading to exaggerating dry eyes [ 11]. Dry eyes have been proved to play as a major contributor to CVS symptoms [ 8, 12]. The underlying cause of dryness needs to be diagnosed and treated accordingly. Users who are known to have dry eyes are recommended to use lubricating eye drops to minimize the symptoms of CVS [ 1, 11]. Other factors such as the duration of usage, taking breaks, distance from the screen, screen brightness, and sitting posture were discussed in previous studies and were considered as known risk factors of CVS [ 8, 13- 16].

Although most of CVS symptoms are transient and no permanent visual damage was reported in previous studies, some workers still experience visual difficulty after work [ 1, 17]. The eyes and musculoskeletal discomfort associated with CVS may result in reduced productivity by 40% of users [ 10, 18]. Additionally, Shantakumari et al. noted that more than 70% of university students were having frequent interruption of computer work caused by CVS symptoms [ 16]. Therefore, this issue needs to be addressed to improve work and study productivity and avoid discomfort symptoms related to computers.

The aim of this study was to determine the prevalence of CVS among undergraduate medical students, associated risk factors, most commonly associated symptoms, and to assess the proper practice of using computers for studying among medical students. The findings of this study will help recognize the problem and will raise the awareness towards their daily practice and implement preventive measures to avoid CVS-related symptoms.

2. Methods

A cross-sectional descriptive study conducted included 651 undergraduate medical students from the second to the sixth year in King Abdulaziz University, Jeddah, Saudi Arabia. Participants were enrolled by nonprobability convenience sampling. An electronic survey adapted from previous literature research on CVS was used for data collection [ 6, 8, 16]. CVS symptoms are categorized into ocular and extraocular. Ocular symptoms include dry eyes, red eye, burning sensation, foreign body sensation, blurred vision and increased sensitivity to light, excessive tearing, itching, ocular pain, change in visualizing colors, and double vision. Extraocular symptoms include headache; neck, shoulder, or back pain; and numbness of the hands or fingers [ 6, 8, 9, 14]. The survey included demography, refractive errors, using spectacle or contact lens for vision correction, duration of studying using computers, frequency and duration of breaks, seating posture and source of lightning, using antiglare screen, frequency of CVS symptoms experienced on continuous computer work, and preventive measures taken to reduce the symptoms. The inclusion criteria were undergraduate medical students who use their laptops or tablets during studying for at least one month prior to the study. Data were analyzed using Statistical Package for Social Sciences (SPSS v21). The chi-square test (Fisher's exact test when required) was used to study the significance of associations. value <0.05 was considered statistically significant.

3. Results

A total of 651 participants were invited to participate in the study; 90.2% (587) of the students use computers for studying and were included. 54.3% (319) were females, and 45.7% (268) were males; the age ranged between 19 and 27 years, with a mean of 21.65 years. High prevalence of CVS was observed, in which 95% (558) reported at least one symptom of CVS during studying using computers. In regard to demographical data in this study, female gender (54.3%) (319) was observed to have higher risk of CVS ().

In regard to refractive errors, 22.6% (147) was known to have myopia, 14.7% (96) hyperopia, and 11.7% (76) astigmatism. 40.9% (266) of students wear spectacle, and 10.4% (68) wear contact lens for vision correction during studying. 15.3% (90) were known to have dry eye disease.

The presence of refractive errors including myopia and hyperopia was not associated with CVS, but astigmatism showed significant association with CVS ( specifically headache and increased sensitivity to light ( and 0.01, respectively). The use of spectacles or contact lens for vision correction during studying showed no significant association. Students who were known to have dry eye disease (15.3%) (90) were associated significantly with CVS (

The most frequently reported ocular symptoms were excessive tearing (20.6%) (121), eye dryness (20.3%) (119), itching (18.9%) (111), increased sensitivity to light (16.2%) (95), eye redness (15.1%) (89), burning sensation (15%) (88), pain (14%) (82), foreign body sensation (12.2%) (72), blurred vision (11.4%) (67), change in visualizing colors (6.5%) (38), and double vision (5.4%) (30). The most frequently reported extraocular symptoms were neck, shoulder, or back pain (39.7%) (233); headache (30.1%) (177), and numbness of the hands or fingers (14.8%) (87) (see Figures 1 and 2).

The association between the presence of CVS and each risk factor was analyzed in this study, in which the most statistically significant risk factors were duration of studying (), distance from the screen ( and brightness of the screen ( (see Table 1).

The correlation between each risk factor and each symptom of CVS was also analyzed; the long duration of time spent during studying (three or more hours per day) was the most significant risk factor reported in 82.3% (459), which was correlated significantly with most of CVS symptoms, burning sensation, foreign body sensation, headache, blurred vision, dryness, eye pain, itching, tearing, increased sensitivity to light, eye redness, numbness of the hands and fingers, and neck, shoulder, or back pain (

Most students were taking frequent breaks during studying (90.8%) (506), with the most reported frequency of every 30-60 minutes (43.4%) (242). Although the frequency of taking breaks was not associated significantly with CVS, those who were not taking breaks during studying (8.8%) (52) associated significantly with tearing, double vision, change in visualizing colors, and neck, shoulder, or back pain ( Short distance from the screen (less than arm and forearm length) was significantly associated with headache and neck, shoulder, or back pain ( in which 62.6% (368) of students kept a short distance from the screen during studying. The posture during studying was not associated with any CVS symptoms.

In regard to the level of the screen, a same level of the screen from the eyes or higher level in 41% (229) were associated significantly with increased sensitivity to light, double vision, and change in visualizing colors ( Only 18.3% (102) of the students were studying using sources of lightning other than the lights from the ceiling (window light, desk lamp, and screen light in a dark room), in which it was significantly associated with blurred vision, eye redness, foreign body sensation, double vision, and change in visualizing colors ( Higher brightness of the screen in 21% (97) was correlated significantly with increased sensitivity to light ( The majority of students were not using screen filter (86.7%) (484), which correlated significantly with itching, double vision, and change in visualizing colors (

The impact of preventive measures taken by students during studying using computers and the presence of CVS showed that applying the 20-20-20 rule was the most significant preventive measure ( followed by proper location of the screen (). Other measures showed no significant association (see Table 2).

4. Discussion

Among the 587 students enrolled in the study a high prevalence of CVS 95% was reported (558). This is in accordance with a study by Hassan et al. who reported a prevalence of 90.5% among medical students in Pakistan [ 8]. Reddy et al. also provided a prevalence of 89.9% among university students in Malaysia [ 14]. However, a lower prevalence was observed in other studies among engineering and medical students (67.2% and 77.4%, respectively) [ 3, 13].

Students in this study were relatively young, with a mean age of 21.65 years. No significant associations were found between the year of medical school and the age with CVS. However, Ranasinghe et al. found a significantly higher prevalence of CVS among those aged more than 40 years compared with those aged less than 20 years [ 15]. Guillon and Maïssa also noted a significantly higher tear film evaporating rate in patients older than 45 years compared with younger individuals, which exaggerate symptoms of dryness associated with CVS [ 19].

Refractive errors including myopia and hyperopia showed no significant association with CVS. However, astigmatism was associated significantly with CVS symptoms. Previous experimental studies showed a significant increase in symptoms in individuals with uncorrected residual astigmatism [ 21, 22]. If refractive errors are uncorrected including myopia, hyperopia, and astigmatism, they contribute to the symptoms of CVS [ 1].

The use of spectacles or contact lens for vision correction during studying showed no significant association in our study. These results were contradicted by Ranasinghe et al. who found a significantly higher CVS among contact lens wearers; furthermore, contact lens wearers are more prone to dryness which exacerbate CVS symptoms [ 12, 15]. While Reddy et al. found university students who wear spectacles had significantly more CVS symptoms than those who do not wear spectacles during computer use [ 14]. Furthermore, a study in Chennai revealed a significantly higher risk of developing headache and blurred vision among students wearing corrective lens, including both spectacles and contact lens [ 9].

Students who were known to have dry eye disease (15.3%) (90) were associated significantly with CVS. This is in line with a study carried out among Japanese office workers which concluded a significantly high prevalence of dry eye disease among video display terminal users [ 23]. This is explained by the reduced blinking reflex while seated in front of the screen for a long time, which contributes to improper tear production, thus exaggerating dry eye disease [ 9]. In some patients, dryness is associated with systematic disease such as Sjogren's syndrome and rheumatoid arthritis [ 12].

Among the extraocular symptoms, neck, shoulder, or back pain was the most common symptom in 39.7%, followed by headache in 30.1%, and numbness of the hands or fingers in 14.8%. The first two were associated significantly with short distance from the screen. However, headache was the most commonly reported extraocular symptom in other studies [ 13, 14, 16]. Headache is explained in CVS patients by the constant need to adjust the eyes by contracting the extraocular muscles and ciliary muscles to maintain the lens in the accommodating phase. Throughout the time, focusing and refocusing are required repeatedly to see in different distances from the screen to the keyboard and to work documents, leading to eye muscle fatigue causing headache [ 15, 17]. Other musculoskeletal symptoms are well related to improper seating posture and placement of the screen [ 10, 17]. It is noteworthy that extraocular symptoms were reported more frequently than ocular symptoms in our study. This is in line with a study performed by Logaraj et al., in which neck and shoulder pain and headache were more frequently reported than ocular symptoms [ 9]. In contrast, a study by Noreen et al. indicated that ocular complaints (55%) were higher than headache, and neck, shoulder, or back pain (12%) in medical and dental students [ 13].

Majority of the students (64.9%) (381) viewed computers at a distance of less than arm and forearm length, which resulted significantly in more CVS symptoms. Similarly, Hassan et al. found that students who viewed at a distance of less than 50 cm were prone to higher risk of CVS [ 8]. Shantakumari et al. added that the prevalence of headache decreased in students who viewed the screen at a distance more than 50 cm [ 16]. In contrast, distance from the monitor was not associated with CVS in a study performed in Sri Lanka among computer workers [ 15].

Nevertheless, the recommended viewing distance was suggested to be 20-28 inches by the American Optometric Association [ 1].

A study carried out by Straker et al. found that musculoskeletal complaint gets worse by sitting posture [ 20]. However, no association was noted in our study. The level of the screen from the eyes was not associated with developing of CVS. More than half of the students were having good studying habit by locating the screen below the level of the eyes. Improper viewing angles are reported as a risk factor for CVS in previous studies [ 10, 24]. It is recommended to place the screen 10-20° below the level of the eyes. Higher gaze angles expose more area of the cornea and conjunctiva, resulting in more ocular surface-related symptoms with an increased tear evaporation rate [ 10- 12, 15]. Strengthening the fact, Reddy et al. found significant reduction in CVS symptoms when the screen is viewed below the eye level [ 14].

Limitations of this study include a cross-sectional study design conducted in a single center and CVS diagnosed based on self-reported symptoms without ophthalmic examination. No exclusion criteria were implemented, in which those with preexisting medical or ocular conditions were included, which might have resulted in overestimation of CVS prevalence.

5. Conclusion

Computer vision syndrome (CVS) is very common among undergraduate medical students, with excessive tearing, and neck, shoulder, or back pain being the most common symptoms. This study has shown that the development of CVS is associated significantly with the following risk factors: female gender, astigmatism, preexisting dry eye disease, longer duration of computer use, short distance from the screen, and higher brightness of the screen.

The most significant preventive measure taken by students was applying the 20-20-20 rule followed by proper location of the screen. Although there is no risk of permanent visual damage, it has been proved that CVS-related symptoms reduce the productivity of work. As universities continuously develop their educational methods, there is a need to raise awareness among students regarding health effects related to prolonged computer use for studying and explain preventive measures in order to reduce CVS symptoms.

Data Availability

Previously reported data were used to support the findings of this study. The prior studies are cited at relevant places within the text as references [ 1- 27].

Conflicts of Interest

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Acknowledgments

The authors would like to express their sincere gratitude to their colleagues for their great help in distributing the survey and collecting the data: Reem Alshareef, Albaraa Alabbadi, Baraa Nogali, Sarah Alessa, Alyazeed Turkistani, Abdulaziz Alsaegh, Lujain Alqurashi, Saja Alghamdi, and Razan Alturkestani.

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Computer Vision Syndrome among Undergraduate Medical Students in King Abdulaziz University, Jeddah, Saudi Arabia

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Introduction . Computer vision syndrome (CVS) is "a complex of eye and vision problems related to near work experienced during computer use." It is one of the rising health concerns related to technology (cell phones and tablets) due to continuous use of computers among students.