Overview: What is Computer Vision Syndrome?
Computer vision syndrome (CVS) is a form of a repetitive stress disorder of the visual and musculoskeletal systems. CVS is associated with prolonged digital screen use and the recurring stress it can cause on the eyes, the head, back and the neck. Spending extended hours in front of radiation-emitting devices can cause significant strain on the body. Similarly, the repetitive movement of our eyes, neck and shoulders, from a screen to a keyboard, and often to papers, or even between multiple screens, is supremely taxing on the eyes. Currently, there is no permanent cure for CVS. However, there are effective, proven ways to manage it by disrupting the repetitive nature of our work. First, let’s take a look at some of the symptoms of CVS to understand how it manifests in our bodies.
Common Symptoms of CVS:
- Tension headaches
- Eye strain – Eye pressure
- Burning sensation
- Dry eyes
- Transient or blurry vision
- Double vision
- Strain on the back, neck or shoulders.
Get it Checked!
It is advisable to get an assessment to rule out any other ocular/visual issues and create a more targeted treatment plan. Uncorrected refractive errors (i.e., farsightedness, astigmatism, presbyopia), inadequate binocularity (eye teaming), ocular surface and eyelid disorders can all contribute to the symptoms of computer vision syndrome.
How to Manage CVS Symptoms
The most effective way to manage CVS is to drastically reduce or completely stop the use of digital devices, however in today’s world that is practically impossible. With that said, what we can do is implement specific practices throughout the day using visual and auditory cues in our environment. These practices will help create daily habits and will help manage CVS. The key here is to form positive work habits that will eventually become a part of daily routine. As James Clear states in his bestselling book, Atomic Habits: Tiny Changes, Remarkable Results, over time the effect of these habits compounds (just like interest) and the net benefit is far greater than we can imagine. We can use Clear’s formula to hack into our environment and help us create healthy habits. Clear provides a four-step framework1 to developing habits, starting with “cues”. Setting
*Clear uses the following formula to define his four step framework: “cue-craving-response-reward”. When the brain detects a cue, it triggers a desire to take action leading to a reward. For example, if I feel thirsty (cue), I crave a drink, and fetch a glass of water (response). When I drink the glass of water, my thirst is quenched (reward).
up a cue, or a reminder, prompts the brain to perform an activity. For example, I may set a vibrating alarm to go off every 20 minutes in order to remind me to look away from the screen. Another method is to implement a timed application called the “Pomodoro” technique, which teaches us how to take organized breaks that lead to improved productivity. The 20,20,20 technique is quite simple. Every 20 minutes, gaze 20 feet away at a distant object or scene for 20 seconds. As discussed below, this technique is a simple but strategic way of refocusing, to be able complete certain tasks in a timely manner. Without making a conscious effort to create good habits, even the most well-intentioned people will eventually return to their old patterns of behavior. It’s easy to become immersed in the day-to-day repetitive routines of our busy lives and forget important self-care rituals, such as taking breaks to re-energize the eyes, stretch our muscles, or eat a healthy snack. Besides wearing proper prescription computer eyeglasses, the only way to reduce eye strain and to combat the symptoms of CVS is to develop and implement a good daily routine and follow a protocol that eases the cycle of repetitive visual and physical stress. The first step is to create the right work environment, whether at home or at the office. Once a fitting workstation is prepared, our focus can then be placed on the various daily habits to implement. An important thing to keep in mind when working from home, is to set physical boundaries between work and personal space.
Setting up an effective Workstation
The Ergonomic Workspace
It is imperative to have a designated work environment when working with digital devices. Some tips on setting up that space are:
- Ensure your table or desk is spacious and decluttered. It should have adequate space for your computer as well as other devices and paperwork.
- Set the computer monitor at a minimum distance of 18-24 inches from your body. The ideal minimum distance can be measured by stretching out your arm to touch the screen. Follow the 1,2,10 (One to Ten) rule to keep devices at a distance from your eyes: mobile phones at 1 foot, desktop and laptops at 2 feet, and 10 feet for TV.
- Vertically adjust the monitor so it is 15-20 degrees on a slight downward angle from your horizontal line of sight. The monitor should be set at eye level, this will help prevent slouching and body and neck strain. If using a laptop, consider a stand to keep the monitor at eye level with a separate keyboard or consider a larger, vertically
- Use a chair with adequate lumbar support and armrests. Adjust the seat to position your hips slightly higher than your knees, allowing your feet to stay flat on the floor, or alternatively you can use a footrest.
- Maintain good posture. Keep your back straight and avoid slouching, with your head balanced above your neck, your shoulders relaxed and arms resting at your sides comfortably.
- Place the keyboard and mouse close to each other and on the same level and position your elbows at 90 degrees. Your wrists should be straight as you type. 7. Avoid overreaching and place phones or other frequently used items, like a document stand and stationary, near you.
The well-lit workspace
The most suitable lighting for the workspace is overhead fluorescent lighting with no glare or reflections bouncing off the monitor. Key points to keep in mind for correctly lighting the workplace:
- Illuminate both the desk and the surrounding area. Ensure to position lamps so that the light does not reflect off the screen in order to prevent glare.
- Use an adjustable desk lamp that can be angled and tilted to concentrate light on the keyboard and paperwork and away from the monitor display. The lamp should be placed on the same side as any papers from which you are working.
- Maintain a low level of general illumination. Floor lamps that reflect light off the ceiling are recommended.
- To reduce contrast of displayed text, neither you nor the computer should be facing a window.
- Set the brightness of the computer monitor so that it balances with the ambient lights in the work area. If the monitor is near a window, adjust the brightness as needed throughout the day to account for changes in ambient light. The brightness of the screen should always feel comfortable to your eyes.
Workplace or Home-office Habits
Below are the habits to implement that should lead to behavioral change to help prevent symptoms of CVS. The likelihood for success in establishing these habits is much greater with cues in place.
- If you have prescription eyewear, keep a pair at your workstation that is always readily accessible. Use your prescription glasses with the anti-reflection coating and blue light filter for optimal vision. If you work on a computer for extended hours speak to you optometrist and optician, they can better recommend you the right lenses and coatings for your eyeglasses.
- Take frequent breaks. This is the key to disrupting repetitive eye strain (follow the Pomodoro 20/20/20 rule). As we tend to get enthralled in our work, breaks become nonexistent. A cue or a change in habit can help in taking these crucial breaks. For example, set up an auditory cue like vibrating alarm that snoozes every 20 mins. When you hit snooze, consciously gaze at a distance of at least 20 feet for 20 seconds (count in your head). The 20/20/20 rule is simply a remembering tactic to take these
breaks. You can even look at the time and tell yourself that my next break will be at such and such time. Writing in or scheduling these breaks is also useful.
- Hydration. Keep a bottle of water beside your monitor to remind you to drink water. You can use your 20 second breaks to drink during regular intervals. Keeping the body hydrated helps prevent headaches and keeps the eyes from drying out.
- Blinking exercises. Use your 20 second break to incorporate 4-5 blinking exercises (see below). We often do incomplete blinks, meaning the top and lower eye lids do not come in contact with each other. This can eventually become an issue with tear stability and dry eyes.
- How to perform blinking exercises? Squeeze your eyelids so they are completely shut but do it gently – as if you are rolling them shut like two rugs rolling towards each other. You can even do rapid blinks in between these gentle eyelid squeezes.
- Take longer but less frequent breaks. Along with the shorter breaks discussed above, it is essential to take a longer break of at least 10-20 mins when in front of a computer for 2 hours continuously. Use these breaks for stretches, getting a snack and other tasks that do not involve focusing up close. See figure 3 for an illustration of basic stretches that can be done while sitting and standing.
- Perform neck, shoulder, back and leg stretches during your longer breaks. See the attached visual examples of stretching exercises you can perform at your desk.
- These longer breaks are great for stepping outside and getting a breath of fresh air. Alternatively, if you are working from home, use these breaks to catch up with your neighbors or simply go for a stroll around the block.
- Eat a healthy snack. Pre-prepare simple snacks or easy to eat meals that can be enjoyed during your longer breaks. Pre-prepared meals and snacks give you the motivation to make the right food choices and help improve your eye health as well as your general health.
- Use artificial tears. If overexposure to a screen occurs, or your eyes feel dry and irritated, administer 1-2 drops of artificial tears as needed. Consider using preservative free artificial tears if you suffer from dry eyes regularly. Artificial tears can be purchased over the counter at your local pharmacy or from the optometrist directly.
- Watch out for blowing air from vents, fans and portable heaters as well as changes in humidity. Adjust your workspace accordingly to avoid facing direct blowing air. A humidifier can make a difference for people who suffer
from dry eyes, particularly during the winter season.
- Avoid rubbing your eyes. If you suffer from ocular allergies, then apply your anti-allergy eye drops or wash eyes with cold water for symptom relief. Don’t make a habit of wearing contact lenses while working on digital devices. Doing so contributes to dry eyes and can become a nuisance over time.
Don’t make a habit of wearing contact lenses while working on digital devices. Doing so contributes to dry eyes and can become a nuisance over time.
At Home Habits
- Apply hot compresses. Use a moist, heated eye pad and apply to the eyes for 7 minutes, at least 3 times a week. Our top and bottom eye lids are lined with oil glands with pore opening at the lid margin. These glands provide oil to protect the tear film from evaporating at faster rates. The glands tend to get clogged over time, lose their function and eventually die or drop off. To keep these precious glands functioning over your lifetime, routinely apply moist heat pads as directed above. Frequent blinking exercises throughout the day also helps preserve the oil glands. Two highly recommended heated eye masks are: Bruder eye Masks or I-Relief eye Masks.
- Use blue light filters. When using a computer, tablet, or phone, remember to turn on the blue filter screen regulator on your device. We also recommend getting blue light filter on your glasses. Blue light energy is known to interfere with sleep patterns and can adversely affect the quality of your sleep.
- Get adequate sleep. A good sleep routine plays a great role in our wholistic well-being. Plan to get at least 7 – 8 hours of sleep every night. When we are asleep, our eyes stop moving to allow the surface of our eyes to heal from all the various stresses inflicted during the day. People who have incomplete eye-lid closure can also benefit from wearing a properly fitted sleep mask and a lubricating gel drop at bedtime. Even with blue light filters, we should avoid using devices an hour before going to bed to maximize the benefits of a good night sleep.
- Spend time outdoors. Aim to get 1-2 hours of outdoor time daily. This can include shopping, driving, doing outdoor chores or hobbies. Being conscious about how much time we are spending outside is not only good for our overall health, but our eyes in particular benefit greatly from exposure to the outdoors.
Habits for Smart phones and Tablets
Smartphone and tablet usage has also been on the rise for the last few years as these devices are ubiquitous. When using these portable devices, users should always be aware of how their neck is positioned. We tend to hold our phones and tablets at a low gaze angle, which puts considerable strain on our neck muscles. To counter this, try holding the devices higher up to reduce bending of the neck, especially when looking at these for long periods of time. Again, the idea is to develop a habit of holding the devices higher up or placing them on a higher platform so they end being on the eye level.
Useful Software Applications
Always turn on the blue filter application on the smart phones and tablets (i.e. night shift on Apple devices and night mode on Androids). Users can also download an application that filters blue light such as Twilight. There are also habit tracking apps such as Productive and MinimaList that can be useful in setting up cues for habit formation. Following this instructional module will provide relief from symptoms of CVS, however if any symptoms continue after 4 weeks, then we advise you to make a follow up appointment. Keeping up with regular eye exams every 1-2 years will also go a long way to maintaining optimal eye health.