1. Better Health. No Hassles. Diagnosis and Treatment Computer Vision Syndrome Presentation of the American Optometric Association

2. Better Health. No Hassles. Increase in Computer Usage Source: US Census Bureau

3. Better Health. No Hassles. 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

4. 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

5. 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.”

6. 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

7. 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

8. Better Health. No Hassles. Effects on job performance Lowered productivity Increased error rate Reduced job satisfaction

9. Better Health. No Hassles. Two Major Categories Contributing to CVS Complaints Vision problems (2/3) Environmental issues (1/3)

10. 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)

11. 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

12. Better Health. No Hassles. General history Normal history questions Dry eyes Flickering sensations Glare Light sensitivity Color vision

13. 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?

14. 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.

15. 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.

16. Better Health. No Hassles. Accommodation Accommodative in-facility Reduced amplitude of accommodation Lag Again, minor problems may be exacerbated Consider VT

17. Better Health. No Hassles. Accessories for Accommodative Testing PRIO VDTS Gulden Others

18. Better Health. No Hassles. Printed Text Contrast

19. Better Health. No Hassles..28 Dot Pitch VDT Active Matrix Laptop Pixilated Text Contrast

20. Better Health. No Hassles. 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 Vision Evaluation - PRIO

21. Better Health. No Hassles. Focusing Instability

22. Better Health. No Hassles. PRIO Testing Device

23. Better Health. No Hassles. PRIO Testing Device Testing performed at patient’s computer working distance Patient’s eyes respond same as when viewing computer

24. Better Health. No Hassles. PRIO Similar to “Book” retinoscopy Presents a target similar to a computer screen Could use another form of near retinoscopy

25. Better Health. No Hassles. Binocular vision Exophoria Esophoria Convergence insufficiency Again, minor problems may be exacerbated Consider VT

26. Better Health. No Hassles. Internal ocular health Rule out Macular degeneration Cataract Diabetes Others

27. Better Health. No Hassles. External ocular health Usually related to Ocular Surface Disease: – Blepharitis – Dry Eye Investigate lid issues, systemic problems, medications, contact lenses

28. Better Health. No Hassles. Spectacle Options Single vision for computer distance Intermediate/Near bifocals Occupational trifocals Traditional PALs Near PALs PC Peekers

29. Better Health. No Hassles. PC Peekers

30. Better Health. No Hassles. Interview 0.80 Range, +1.50 Add Near to midrange transition at +1.00 D Unwanted Astigmatism > 1.00 D Power <0.25 D, too weak for mid-range (within 0.50 of add power)

31. Better Health. No Hassles. Office 1.25 Range, +1.50 Add Near to midrange transition at +1.00 D Unwanted Astigmatism > 1.00 D Power <0.25 D, too weak for mid-range (within 0.50 of add power)

32. Better Health. No Hassles. Technica +1.50 Add Near to midrange transition at +1.00 D Unwanted Astigmatism > 1.00 D Power <0.25 D, too weak for mid-range (within 0.50 of add power)

33. Better Health. No Hassles. Technica +2.00 Add Near to midrange transition at +1.50 D Unwanted Astigmatism > 1.00 D Power <0.25 D, too weak for mid-range (within 0.50 of add power)

34. Better Health. No Hassles. Technica +2.50 Add Near to midrange transition at +2.00 D Unwanted Astigmatism > 1.00 D Power <0.25 D, too weak for mid-range (within 0.50 of add power)

35. Better Health. No Hassles. Technica Power (D) Position relative to G.C. (mm) distance near power change Fitting 4 o 31 o Add +2.00 Add 1.50 -0.50.00.51.01.52.0 -20 -15 -10 -5 0 5 10 15 20 mid range

36. Better Health. No Hassles. 0.75 Range, +1.50 Add Access Near to midrange transition at +1.00 D Unwanted Astigmatism > 1.00 D Power <0.25 D, too weak for mid-range (within 0.50 of add power)

37. Better Health. No Hassles. 1.25 Range, +2.00 Add Access Near to midrange transition at +1.50 D Unwanted Astigmatism > 1.00 D Power <0.25 D, too weak for mid-range (within 0.50 of add power)

38. Better Health. No Hassles. Access

39. 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”

40. Better Health. No Hassles. Other spectacle considerations UV Coating Anti-Reflection Coating Tinting

41. Better Health. No Hassles. Environmental Factors Workstation ergonomics Workplace lighting General lighting Glare Workstation ergonomics Low humidity and other factors leading to dry eye

42. Better Health. No Hassles. Environmental Factors Glare

43. 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

44. Better Health. No Hassles. Recommended Workstation

45. Better Health. No Hassles. Workstation Ergonomics Chair Height adjustment Back support Tilt Armrests Keyboard

46. Better Health. No Hassles. Workstation Ergonomics In a word: ADJUSTABLE!

47. 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

48. Better Health. No Hassles.

50. AOA Seal of Acceptance

51. Better Health. No Hassles. Workstation Lighting Consider brimmed hat Monitor hood Flicker

52. Better Health. No Hassles. Workplace Dry Eye

53. 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

54. Better Health. No Hassles. Dry Eyes - The Solution Rest eyes and blink forcefully Correct monitor placement Humidifier Artificial tears

55. Better Health. No Hassles. Especially formulated for Computer Users? Dry Eyes - The Solution

56. Better Health. No Hassles. Meeting the Needs of the CVS Patient Comprehensive eye and vision care Appropriate optical correction Good visual ergonomics

57. 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

58. Better Health. No Hassles. References / Resources Occupational Safety and Health Administration OSHA Workstation Checklist: www.osha-slc.gov/SLTC/etools/ computerworkstations/checklist.html

59. Better Health. No Hassles. References / Resources Dr. Ergo – www.doctorergo.com Ergoweb site – www.ergoweb.comwww.ergoweb.com PRIO Corporation – www.prio.comwww.prio.com

60. Better Health. No Hassles. Thank You!