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   Table of Contents      
ORIGINAL ARTICLE
Year : 2017  |  Volume : 4  |  Issue : 4  |  Page : 99-103

Computer vision syndrome among mobile phone users in Al-Ahsa, Kingdom of Saudi Arabia


1 Ophthalmology Department, Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran, Saudi Arabia
2 Department of Ophthalmology, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
3 Department of Family and Community Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia

Date of Web Publication7-Jun-2019

Correspondence Address:
Dr. Majed Al Subaie
Ophthalmology Department, Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran 34257 7630
Saudi Arabia
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DOI: 10.4103/bijo.bijo_13_18

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  Abstract 


Background: The growing number of mobile phone users or video display terminals (VDTs) puts them at hazards of computer vision syndrome (CVS) resulting in ocular surface damage, eye strain, exhaustion, and muscular complaints as result of improper usage of VDTs.
Objectives: To determine the prevalence of CVS and to get a baseline data about this syndrome among inhabitants of Al-Ahsa, Saudi Arabia.
Materials and Methods: A cross-sectional study was conducted for the duration of 1 month in Al Ahsa Saudi Arabia. Convenience sampling was used with a validated questionnaire to measure the CVS symptoms and to collect data. Consequently, Chi-square test was performed to observe the prevalence of CVS with its risk factors using SPSS version 22.
Results: This study showed the prevalence of CVS among Al-Ahsa population to be 43.5% of the screened sample; this was significance results in the term of blurred vision (P = 0.002), dry eye (P = 0.011) and ocular discomfort (P = 0.013) among individuals suffer from CVS. Regarding extraocular complaint, there was a significant result seen in the presence of neck and shoulder pain (P = 0.008) and dizziness (P = 0.045) in individual developed CVS.
Conclusion: The study found significant results in term of ocular and nonocular complaints among individuals who developed CVS from Al-Ahsa. Further longitudinal studies are required to study the effect of VDTs on ocular health.

Keywords: Computer vision, dry eye syndrome, mobile phone, Saudi Arabia, video display terminals


How to cite this article:
Al Subaie M, Al-Dossari S, Bougmiza MI. Computer vision syndrome among mobile phone users in Al-Ahsa, Kingdom of Saudi Arabia. Albasar Int J Ophthalmol 2017;4:99-103

How to cite this URL:
Al Subaie M, Al-Dossari S, Bougmiza MI. Computer vision syndrome among mobile phone users in Al-Ahsa, Kingdom of Saudi Arabia. Albasar Int J Ophthalmol [serial online] 2017 [cited 2019 Oct 14];4:99-103. Available from: http://www.bijojournal.org/text.asp?2017/4/4/99/259769




  Introduction Top


Video display terminals (VDTs), including mobile phones (MP), became one of the individuals' daily needs. Like computer, the portable VDT do the same functions making it more pleasant to carry and frequently used.[1] The usage of MP is dramatically increasing since 1990; there are nearly about 500 million users around the world.[2] The internet usage estimated by continent, about 50.2% in Asia (June 2016) out of this number, about 57.4% from the Middle East (141,489,765 users) (http://www.internetworldstats.com/stats.htm). This large number puts them at high risk of VDTs hazards.

VDTs are receiving and transmitting radio frequency waves (RFW) in which it can exert a harmful effect on the body by either physical effects (thermal effect and nonthermal effect).[3],[4] Some users report nonspecific complaints such as burning sensation of head, extremities, general fatigue, muscles pain, dizziness, heart palpation, high blood pressure, disturbance of digestive system, and disturbance in sleep and mood.[5] The eye is a venerable tissue organ, in which electromagnetic radiation can be harmful by decreasing blood and nutrient supply to it. These ocular effects can be explained by computer vision syndrome (CVS) which is defined by American optometric association as “a combination of eye and vision problems associated with the use of computers.” According to CVS, the effect of VDT can be either due to ocular damage (burning sensation, irritation), due to refractive anomalies (eyestrain, diplopia, and blurred vision), or both, eventually leads to asthenopia and eye complaints.[6] To the best of our knowledge, we could not find similar studies in Saudi Arabia to estimate the risk of VDTs and MP. This study aimed to estimate the frequency of CVS among users in Al-Ahsa (KSA).


  Materials and Methods Top


A descriptive cross-sectional study was conducted for 1 month in September 2016. A convenient sampling was applied in this study. The participants were recruited from individuals visiting a shopping mall located in Al-Ahsa city. Saudi citizens of 15 years and above, residents of Al-Ahsa, who gave their verbal consent after receiving an explanation of the purpose of the study were included in this study. All participants with high daily computer usage (computer office workers) who are using computer more than 6 h/day or those with preexisting eye disease which can affect the study objectives were excluded from the current study.

Data collection was done through a convenience sampling with a validated Arabic version which was developed and modified from CVS questionnaire to measure the CVS symptoms and to collect the required data. Respondent's personal data included sociodemographic data such as age, gender, education level, occupation, place of living, marital status, and monthly income. Other questions about symptoms of CVS and mobile usage were collected. Positive CVS was defined by the occurrence of at least one symptom for two or three times a week.[7] We used a rating scale ranging from 0 to 3 (0 = never, 1 = occasionally [sporadic episodes or once a week], 2 = often [two or three times a week], 3 = always [almost every day]). Data were collected by well-trained medical interns.

The statistical analysis of the descriptive data was presented as percentages or as means ± standard deviations or as medians for skewed data. According to the type and distribution of the variables, Pearson Chi-square, Students t–test, or Mann–Whitney test were used to observe their association with the presence of CVS. A multivariate binary logistic regression was done to identify factors independently associated with the occurrence of CVS. Adjusted odd ratios (OR) and 95% confidence interval (CI) were presented. Statistical significance was accepted at P < 0.05. Statistical analyses were performed using the Statistical package for social sciences 22.0 software (IBM SPSS Inc. PASW Statistics for Windows, Version 20; 2011: SPSS Inc., Chicago, IL, USA). The study was approved by the Research and Ethics Committee of the College of Medicine, King Faisal University KSA.


  Results Top


In total, 416 participants were included in the current study. Among them, 225 (54.1%) were females and 191 (45.9%) were males. The mean age was 27.3 ± 10.3 years [Table 1]. Out of 416 users, 257 (61.8%) had university education level and 202 (48.6%) have more than one smart device. 411 (98.8%) are using a smartphone with digital screen and 372 (89.4%) are using MP for more than 4 years. 225 users (54.1%) are using their MP for entertainment purposes (gaming, texting, or E-mail checking) more than 3 h every day. 224 users (53.8%) are exposed to other RFW sources (microwave, television, and computer) for about 1–3 h daily. The estimated prevalence of CVS among participants was found to be 43.5% (95% CI: 38.7%–48.3%). Only 99 (23.8%) MP users seek the medical advice of ophthalmologist for their complaints. There was no significant difference between gender, marital status, occupation, the level of education, and the prevalence of CVS [Table 1]. Furthermore, there was no significant association between mean age of participants with CVS and those without CVS (28.1 ± 10.5, 26.7 ± 10.1, P = 0.1). The median daily duration of phone calls in those without and with CVS was 20 min (1st quartile [Q1]–3rd quartile [Q3] =5–46.5) and 15 min (1st quartile [Q1] –3rd quartile [Q3] =5–50), respectively (P = 0.9).
Table 1: Sociodemographic data

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There was no significant association between the method of reading – soft or hard copy – and CVS (47.0% vs. 38.5%; [P = 0.08]). Factors such as keeping MP near head during sleeping, use of contact lenses or glasses, and use of antidepression, antiepilepsy, or anticoagulation drugs were not associated with the prevalence of CVS [Table 2]. A headache was the most frequent internal symptom of CVS (52.4%) followed by eye strain (44.7%) [Table 3]. None of the respondents notice eye redness as a complaint. A significant association was noted between patients with blurred vision (P = 0.002), dry eye (P = 0.011), and ocular discomfort (P = 0.013) and the prevalence of CVS [Table 3]. Furthermore, the prevalence of CVS was significantly higher in patients with neck and shoulder pain (P = 0.008) and dizziness (P = 0.045) [Table 3]. Based on the results of the multivariate logistic regression, having dry eye (adjusted OR [ORa] =1.6, 95% CI: 1.0–2.5; P = 0.03) and having blurred vision (ORa= 1.8, 95% CI: 1.1–2.7; P = 0.006) were significantly associated with the occurrence of CVS [Table 4].
Table 2: Factors may lead to ocular symptoms

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Table 3: Computer vision syndrome ocular symptoms

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Table 4: Multiple logistic regression models for predicting for computer vision syndrome ocular symptoms among Al Ahsa (Kingdom of Saudi Arabia) Population

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  Discussion Top


CVS describes different eye complaints due to the effect of VDTs on ocular health. Two main principles were proposed: eye dryness and inappropriate oculomotor response. The development of the CVS symptoms mainly depends on ocular ability of individual to accommodate; so, failing to achieve appropriate accommodation gives rise to CVS symptoms.[6]

A little experimental evidence supports inappropriate oculomotor response; but unfortunately, it cannot explain the effect since any accommodative effort to near vision regardless whether it is VDTs or not can cause inappropriate oculomotor response or convergence.[8] Eye dryness can explain CVS complaints better, due to eyelid dysfunction either in terms of quality (partial closer) or quantity (decrease blinking rate). A fixed gaze in the primary position (rather than downward gaze natural position) exposes the upper part of the cornea, leading to increasing evaporation of tear film and ultimately tear film dysfunction.[9],[10]

Ranasinghe et al. (Sri Lanka) found the prevalence to be about 67.4% among computer office workers,[11] which has similar results to other studies.[12],[13] In the current study, the researchers had checked mainly for an MP or VDTs devices and excluded computer office workers or professionals. This may give a reason why the current study had a lower prevalence than other studies.

Hormonal imbalance can alter the tear film stability; in females, the  Meibomian gland More Details (MG) is under the control of estrogen; so, any hormonal imbalance can alter the secretion of the tear film and result in MG dysfunction which is the most common subtype of dry eye. This may explain why females are more venerable than males to have dry eye.[14] Uchino et al., 2008 (Keio University School of Medicine,; Ryogoku Eye Clinic)[15] have done a study in Tokyo, Japan, on computer office workers and found that females developed CVS more than males. The current research results, in contrary to the above hormonal theory and the Japanese work, reported that no significant differences were found between males and females in CVS.

The average age of users who developed CVS did not show any significant correlations. However, the relation between age and development of asthenopic and eye symptoms is not so clear.[16] Although Bhanderi and colleagues (Gujarat, India; 2008) noted that the prevalence of asthenopia was noted to be quite high among computer operators, particularly in those who started its use at an early age.[17]

The duration of exposure is a high predictor of the development of CVS, and it is directly related to the development of CVS, even if the exposure has been discontinued.[18] Among users exposed more than 6 or 7 h, a significance relation has been found between time exposed to VDTs and development of CVS.[12] The current study did not show any relation between duration of MP usage and development of CVS. Reading from hard copy keeps a proper distance, downward gaze, frequent blinking, and no RFW exposure (versus VDTs with near vision distance, primary gaze, decrease blinking, and more accommodation).[19] However, in the current study, users who prefer to read from computers did not develop CVS.

Dry eye develops due to decreased blinking rate in which the corneal surface exposed to environmental factor leads to evaporation of tear film layer. Among users of VDTs, the blinking rate affected by font size, contrast, and increased cognitive demand of work leading to prolonged blinking interval period and instability of precorneal tear film.[20] MP can be used, primary gaze (palpebral fissure more open and most of the cornea is exposed) or downward gaze (upper eyelid covering the upper part of cornea providing some protection from exposures and dryness) usually the users prefers the primary gaze make them more susceptible to develop dry eye.[21] In the current study, the eye dryness was very common complaint and of significant results (P = 0.011) [Table 3]; it is an important predictor factor in CVS development and individuals having dry eye are having 1.026 times chance to develop CVS.

The digital screens represent near vision target as pixels requiring more effort to correct the refractive error and to make a single sharp and focused image. Among individuals wearing lenses or spectacles, more effort is to be made since they already have refractive problem.[12] Thus, the prevalence of CVS among lens and spectacle (L/S) users is expected to be more as seen in one study by Tauste et al. (Spain).[22] In the current work among L/S users, the majority developed CVS. Similarly, Rahman and Sanip (Malaysia)[12] found that using L/S has a significant association with the development of CVS symptoms.[12] The possible explanation of this effect is due to altering the blinking rate and irritation affecting tear film stability or refractive error correction among L/S users;[23] minimum vergence required to have a sharp image in the retina.

Headache may develop as a result of repetitive activation of accommodation system focusing and refocusing (pupil, lens, and ciliary body) leading to eye fatigue and discomfort. Headache was a frequent complaint among individual with CVS in the current study, but no significant results were obtained; this is in contrary of Shantakumari et al. in their study among students in Ajman, UAE.[24] Blurred vision to be the most important predictor of CVS development which was supported by the study of Balik et al. who report Increased in blurred vision among VDTs users on long term users.[25]

Improper position with difficulty in vision and short distance has been associated with varies muscular symptoms (the proper position of computer users is the ergonomic posture with a viewing distance of 50–70 cm). The prevalence of neck, shoulder, and arm symptoms are frequent among individuals using the computer.[26] The location of VDTs at different angles (primary, downward gaze) makes it difficult for the neck muscle to keep a sustained position of head and eyes which lead to developing muscle pain and spasms. It is reported by Lie and Watten,[27] that changing in vergence can produce electromyographic responses in the neck and shoulder muscles.[27] Some authors reported ocular and musculoskeletal symptoms to be related to each other to achieve better visual demand; changing in position is required and vice versa. In the current study, CVS users reported complaints of pain in the neck and shoulders with significant relation.

The limitation of this study was the probability of having some errors related to data collection, although actions were taken to minimize them through engagement of volunteer medical interns and developing Arabic version of the questionnaire. We were aiming to measure the prevalence, but due to lack of time and the access, we estimate the frequency instead by random collection of data from public gathering sits. Another limitation was we were not able to calculate the distance between the screen and the eye since the portable VDTs is different than stationary disc computer.

The first MP have been invented in 1973 by John and Martin Copper; since then, usage of MP is becoming the fastest growing phenomena ever, where the number of MP becoming exceeding the number of people said by Kimberlin.[28] For that reason, we recommend enhancing community awareness about CVS hazards on health and to develop criteria protects from the harmful effect of VDT.


  Conclusion Top


The study found significant results in terms of blurred vision, eye dryness, and eye discomfort. Among nonocular complaints, there were significant results in terms of experience dizziness, neck and shoulders pain among individuals suffering from CVS. Keeping proper distance, frequent breaks, and less period exposed to VDTs can help in preventing CVS developing in individuals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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