Subjective Dry Eye Symptoms in Pregnant Women-A SPEED Survey.

Aim: Multisystemic physiological changes in pregnancy can result in tear film and refractive changes in the eye. We report dry eye prevalence in pregnant women using Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire. Methods: The SPEED questionnaire was self-administered cross-sectionally to 428 pregnant women (mean age: 26.8 ± 4.4 years) with clinically confirmed pregnancy from two obstetric clinics in Chennai, India. Subjects with predisposing risk factors for dry eye were excluded from the study. Subjects were categorized as normal, moderate, and severe dry eye based on the SPEED score. Results: Among the women, 48.5% of the subjects had symptoms like dryness, grittiness or scratchiness, soreness or irritation, burning or watering, or eye fatigue. About 2.3% had moderate dry eye according to SPEED questionnaire criteria. Eye fatigue was the most reported symptom and was present in 76.4% of women. The symptom frequency score and severity score had a strong and significant correlation (r = 0.95, P < .001). No significant correlation was noted among SPEED score vs age (r = -0.02, P > .05). No significant correlation was found between symptoms of dry eye and gravidity (ρ = -0.006, P > .05) and trimester (ρ = 0.38, P > .05). Binary logistic regression showed that only occupational status and systemic condition was significantly associated with dry eye symptoms. Conclusion: About half the pregnant women at the visit reported having one or more dry eye-related symptoms. As per the composite SPEED questionnaire score, dry eye was not prevalent among pregnant women irrespective of their age, gravidity, and the trimester, but we found a majority of pregnant women reported to have experienced dry eye-related symptoms, though tolerable. Awareness about dry eye during pregnancy will improve eye care seeking behaviour in pregnant women.

Comparison of the influence of light between circularly polarized and linearly polarized smartphones on dry eye symptoms and asthenopia.

This paper aims to investigate the efficacy of circularly polarized light smartphones in affecting dry eye symptoms and asthenopia through a comparison with linearly polarized smartphones. One hundred twenty participants were randomly divided into four groups. Dry eye and asthenopia symptoms were evaluated using the Ocular Surface Disease Index (OSDI), Computer Vision Syndrome Scale 17 (CVSS17), Convergence Insufficiency Symptom Survey (CISS), and visual analogue scale (VAS). Objective ocular examinations were assessed by confusion flicker frequency (CFF), tear meniscus height (TMH), noninvasive break-up time (NIBUT), conjunctiva redness, fluorescein tear break-up time (FTBUT), corneal fluorescein staining, and the Schirmer I test. Tests were performed before and after a reading task. Subjective evaluations including the OSDI, CVSS17, and CISS were all significantly increased after reading on a linearly polarized smartphone, whereas no change was observed in the circular polarization groups in both light and dark environments. A significantly enlarged VAS was shown in all of the four groups, but a significant increase in ΔVAS only appeared in the linear polarization groups. There were significant decreases in TMH, NIBUT, conjunctiva redness, FTBUT, and CFF after reading on a linearly polarized smartphone but the circularly polarized smartphone had lesser effects on these parameters. Our study indicated that reading on linearly polarized smartphones may cause dry eye disorder, asthenopia, and ocular discomforts, whereas circularly polarized smartphones appears to minimize these adverse effects on eye dryness and visual fatigue in light and dark environments.

Digital Screen Use and Dry Eye: A Review.

Prolonged and continuous daily use of digital screens, or visual display terminals (VDTs), has become the norm in occupational, educational, and recreational settings. An increased global dependence on VDTs has led to a rise in associated visual complaints, including eye strain, ocular dryness, burning, blurred vision, and irritation, to name a few. The principal causes for VDT-associated visual discomfort are abnormalities with oculomotor/vergence systems and dry eye (DE). This review focuses on the latter, as advances in research have identified symptomology and ocular surface parameters that are shared between prolonged VDT users and DE, particularly the evaporative subtype. Several mechanisms have been implicated in VDT-associated DE, including blink anomalies, damaging light emission from modern devices, and inflammatory changes. The presence of preexisting DE has also been explored as an inciting and exacerbating factor. We review the associations between digital screens and DE, mechanisms of damage, and therapeutic options, hoping to raise awareness of this entity with the goal of reducing the global morbidity and economic impact of screen-associated visual disability.

A Delphi study to develop practical diagnostic guidelines for visual stress (pattern-related visual stress) / Estudio Delphi para el desarrollo de pautas diagnósticas para el estrés visual (estrés visual relacionado con patrones)

Purpose: Visual stress (VS) is characterised by symptoms of visual perceptual distortions and eyestrain when viewing text, symptoms that are alleviated by individually prescribed coloured filters. A recent review supports the existence of VS and its treatment, but noted that controversy remains, in part due to inconsistencies in the diagnosis of the condition. The present paper reviews the diagnostic criteria for VS in the literature and reports a Delphi analysis of the criteria currently used in clinical practice. Methods: Twenty-six eyecare practitioners were invited to participate in a Delphi study. They were selected because they were frequent prescribers of precision tinted lenses. In the first round they were sent a list of the indicators for which there is literature to suggest a relevance in the diagnosis of VS. The practitioners were invited to rank the indicators and add any additional criteria they use in diagnosis. In the second round a revised list was circulated, including items added from the responses in the first round. Results: The respondents included optometrists, orthoptists and opticians. In the first round the response rate was 85%. Ninety-one percent of those who participated in the first round also responded in the second round. Strong indicators in the second round included the symptom of words moving when reading, voluntary use of an overlay for a prolonged period, improved performance of 15% with an overlay on the Wilkins Rate of Reading test, and an abnormally high score on the Pattern Glare Test. Conclusions: The strongest diagnostic criteria are combined in a diagnostic tool. This is proposed as a guide for clinical practice and further research (AU)

Objetivo: El estrés visual (EV) se caracteriza por síntomas de distorsión perceptual visual y astenopía, que pueden aliviarse mediante filtros coloreados de prescripción individual. Una revisión reciente respalda la existencia de EV y su tratamiento, aunque hay que resaltar que persiste la controversia, debido en parte a las inconsistencias en cuanto a diagnóstico. El presente documento revisa los criterios diagnósticos del EV en la literatura, y reporta un análisis Delphi sobre los criterios utilizados en la actualidad en la práctica clínica. Métodos: Se invitó a participar en un estudio Delphi a veintiséis facultativos. Éstos fueron seleccionados debido a su elevada prescripción de lentes tintadas de precisión. En la primera ronda, se les envió un listado de los indicadores a los que la literatura aporta relevancia para el diagnóstico del EV. Se solicitó a los facultativos que clasificaran los indicadores, y que añadieran cualquier criterio adicional que ellos utilizaran en su diagnóstico. En la segunda ronda, se hizo circular un listado revisado, incluyendo los ítems añadidos a partir de las respuestas de la primera ronda. Resultados: Entre los facultativos participantes se hallaban optometristas, ortoptistas y ópticos. En la primera ronda el índice de respuesta fue del 85%. El 91% de los participantes en la primera ronda aportaron también sus respuestas en la segunda. Los indicadores sólidos en la segunda ronda incluyeron: síntoma de movimiento de las palabras al leer, uso voluntario de filtros durante un periodo prolongado, mejora del desempeño de 15% en el índice de la prueba de lectura de Wilkins con el uso de filtros, y puntuación anormalmente elevada en la prueba PatternGlare. Conclusiones: Se combinan los criterios diagnósticos más sólidos en una herramienta diagnóstica. Ello se propone como pauta en la práctica clínica y la investigación futura (AU)

Occupational exposure to fluorescent light in a pathologist with myopic complications and asthenopia onset. / Esposizione professionale alla luce fluorescente in una patologa con complicanze miopiche ed insorgenza di sintomi astenopici.

BACKGROUND: Pathologic myopia is often associated with many complications, e.g. retinopathy, vitreous detachment and glaucoma. To date, occupational exposure of workers suffering from myopic co-morbidities to fluorescence light is not clearly linked to a worsening of retinal damage and eye symptoms. CASE REPORT: A 56-year-old pathologist, suffering from myopic retinopathy and other ocular comorbidities, asked for medical examination due to worsening vision and burning eyes, after occupational exposure to fluorescence microscope. Eye examination performed by an ophthalmologist detected a severe chorio-retinal atrophy in peri-papillar region and scotopic-photopic reduced voltages at electroretinogram. Moreover, a workplace inspection noted high light intensity from power source (9600 lux). Considering severity of the retinopathy, frequency of the ocular symptoms and steady occupational exposure both to low-intensity fluorescent light and high intensity light, we decided to declare the worker only fit for specific tasks which do not include the use of a fluorescence microscope. Almost six months later, the worker was recalled for a new examination and she reported the absence of the ocular discomfort that had led her to request the previous examination. CONCLUSION: In this unconventional case, we considered appropriated to use great caution, to avoid ocular fatigue and prevent possible retinal damage in the worker.

[Focal Point "Reading Animal". Hermann Cohn and the Emergence of the Fin de Siècle Hygiene of Reading]. / Brennpunkt "reading animal". Hermann Cohn und die Genese der Lesehygiene.

From the 1860s onward, 'eye experts' increasingly fretted the alleged surge of myopia attributed to an increase of reading matter circulating in schools. In order to avert the inauspicious prospects, revised school desks designed to prevent children from becoming myopic were introduced. During the 1880s, said experts turned to printed matter, maintaining that books must become more reader friendly. Along with the turn to books, a peculiar shift within the hygiene discourse occurred: While the ill addressed by school desk-revisions was myopia, the goal of revising book design was to make reading less tiring. This paper explores both the shift from the hygiene of the eye to the hygiene of reading as well as the materialization of the stipulations and claims made by reading hygienists. In doing so, the paper demonstrates that optimizing the reading process was closely linked to a fear of overburdening and fatigue which expressed itself in the psychopathological discourse of the time.

Neck pain brought into focus.

A time honored dictum states that the eyes "lead the body", i.e., that the body typically adjusts its position to compensate for an impoverished retinal image (e.g., as due to optical blur, and/or inappropriately sized visual target). But only moderate or low level of evidence exists in support of this view. Inconclusive evidence does not, however, equal negative evidence. The accommodation/vergence system does exhibit signs of overload in contemporary working life, including eye discomfort, transient myopia, altered pattern of eye-lens oscillations, and associated phoria. Accommodation/vergence overload, caused by non-ergonomic near work, may also emerge as quickly as within one regular workday. Long-term musculoskeletal consequences of high accommodation/vergence demands have nevertheless not yet been studied in any detail. A research agenda which aims to provide multi-scientific evidence for eye-neck/shoulder interactions with public health implications and which also, in addition, study the eye-neck/shoulder mechanisms and elucidates the operating characteristics, should consequently be highly warranted. This new knowledge would be useful for physiotherapists, ergonomists and opticians, who in their profession treat patients experiencing vision- and musculoskeletal disorders. If both visual and the musculoskeletal aspects are given full and equal weight in the design and evaluation of work places, it is predicted to lead to an improved quality of life for the individual worker, and an enhanced productivity for the employer.

Problemas de visión causantes y no causantes de impedimento visual en una población laboral de Cataluña / Vision problems causing and not causing visual impairment in a working population in Catalonia

Objetivos. Analizar la distribución de los problemas visuales causantes y no causantes de impedimento visual en una población laboral y su relación con la clase social. Métodos: Estudio transversal de una población de trabajadores por cuenta ajena de Catalunya, de 16 a 65 años sometidos al examen de salud de la Sociedad de Prevención Asepeyo del año 2009 (86.831 personas, 59.397 hombres, 27.421 mujeres)Se calcularon las prevalencias de problemas visuales causantes y no causantes de impedimento visual por edad, sexo y clase social basada en la ocupación y se analizaron las relaciones con modelos de regresión logística. Resultados: Un 2,2% (IC95% 2,1-2,3) de la población activa ocupada estudiada, padece problemas visuales que originan impedimento visual incluso con su corrección habitual. Después de ajustar por edad, se obtiene en los trabajadores de clase V un riesgo de impedimento visual 2,4 veces mayor que en la clase I. Conclusiones: Las mayores prevalencias y riesgos de impedimento visual afectan a las mujeres, los trabajadores de edad avanzada y los grupos sociales más desfavorecidos. Por el contrario, los problemas de visión resueltos con corrección y no causantes de impedimento visual se concentran en los trabajadores no manuales(AU)

Objectives. To analyze the distribution of visual problems which cause and do not cause visual impairment in a working population, and their relation to social class. Methods: This was a cross-sectional study of 86,831 employed workers (59,397 men, and 27,421 women) in Catalonia ages 16 to 65 years who, in 2009, underwent health surveillance exams at the Asepeyo Health Prevention. The prevalence of visual problems that cause and do not cause visual impairment was calculated by age, sex and occupational social class, and associations were analyzed using logistic regression. Results: 2.2% (95%CI 2.1-2.3) of the active working population studied had vision problems that cause visual impairment, even while wearing corrective lenses. After adjusting for age, workers in Class V show a 2.4-fold greater risk of visual impairment than those in Class I. Conclusions: Women, older workers and disadvantaged social groups showed the highest prevalence and risk of visual impairment. Conversely, problems resolved by vision correction that do not cause visual impairment are concentrated in non-manual workers(AU)

VDU workstations and vision in post office and bank operators.

A cross-sectional study was carried out on a sample of 26 VDU operators in a post office and a bank, working regularly on video display units. The study aimed at (1) determining the physical working conditions, particularly lighting conditions, (2) assessing employees' complaints, (3) measuring visual defects among operators in VDU workstations. The following results are revealed: (a) ergonomic shortcomings in workplace and work station design were clearly noticed (b) noise level was between 60 db and 78 db, (c) illumination parameters did not much the task and caused ocular symptoms and visual fatigue, (d) visual tests revealed vision defects in 84.6% of the cases, (e) visual fatigue was noticed at the end of the working day. The abnormal frequency of operators' complaints can be explained by the association of visual defects and inadequate working conditions.

A visual ergonomics intervention in mail sorting facilities: effects on eyes, muscles and productivity.

Visual requirements are high when sorting mail. The purpose of this visual ergonomics intervention study was to evaluate the visual environment in mail sorting facilities and to explore opportunities for improving the work situation by reducing visual strain, improving the visual work environment and reducing mail sorting time. Twenty-seven postmen/women participated in a pre-intervention study, which included questionnaires on their experiences of light, visual ergonomics, health, and musculoskeletal symptoms. Measurements of lighting conditions and productivity were also performed along with eye examinations of the postmen/women. The results from the pre-intervention study showed that the postmen/women who suffered from eyestrain had a higher prevalence of musculoskeletal disorders (MSD) and sorted slower, than those without eyestrain. Illuminance and illuminance uniformity improved as a result of the intervention. The two post-intervention follow-ups showed a higher prevalence of MSD among the postmen/women with eyestrain than among those without. The previous differences in sorting time for employees with and without eyestrain disappeared. After the intervention, the postmen/women felt better in general, experienced less work induced stress, and considered that the total general lighting had improved. The most pronounced decreases in eyestrain, MSD, and mail sorting time were seen among the younger participants of the group.

Desprendimiento de retina asociado a síndrome de morning glory / Retinal detachment associated with morning glory syndrome

Caso Clínico: Mujer de 23 años con anomalía papilar de morning glory con agudeza visual (AV) de 1. Nueve años después presenta disminución de AV (0,4) por desprendimiento seroso macular confirmado por tomografía de coherencia óptica (OCT). Tratado con inyección de gas intraocular C2F6, posicionamiento y láser, conseguimos la desaparición del líquido subretiniano y una AV final de 0,7.DiscusiónEl síndrome de morning glory suele diagnosticarse precozmente debido a la mala AV. Un 38% de los casos presentan desprendimiento de retina. Mostramos un caso inusual de síndrome de morning glory con desprendimiento seroso tratado con éxito mediante gas y láser (AU)

Case report: A twenty three year old woman was diagnosed of a morning glory papillary anomaly, then with normal visual acuity (VA). Nine years later, the VA decreased to 0.4, secondary to a serous macular detachment, confirmed by optical coherence tomography (OCT). After treatment with C2F6 gas injection, positioning, and peripapillary laser, the VA improved to 0.7 and the foveolar area reattached.DiscussionThe morning glory Syndrome usually has an early diagnosis due to poor visual acuity. Thirty eight percent of the cases have retinal detachment. We show an unusual case of morning glory syndrome with a serous detachment, successfully treated with gas and laser (AU)

Early observations on optic neuritis and Uhthoff's sign.

For much of the 19th century, even after the discovery of the ophthalmoscope, the diagnostic clinical signs and the identity of primary optic nerve disease were confused and inaccurate. Amongst many contributions aimed at clarifying this muddle, those of Wilhelm Uhthoff and Edward Nettleship were of outstanding importance and are outlined here.

Prevalence of eye disorders in young children with eyestrain complaints.

PURPOSE: To determine whether eyestrain symptoms predict eye conditions in 6-year-old children. DESIGN: Cross-sectional population-based study. METHODS: Reports of eyestrain symptoms were sought in parental questionnaires; 1740 children (79% response) underwent eye examinations (visual acuity, cover testing, cycloplegic autorefraction, and fundus examination). RESULTS: Eyestrain information was available for 1448 children; 220 (15.2%) reported eyestrain symptoms, including 60 (3.4%) who reported near work-associated headaches. Most children (82.3%) had a normal eye examination, while refractive errors, amblyopia, and strabismus were found in 15.0%, 3.6%, and 7.3%, respectively. Corresponding rates for children without eyestrain were 9.9%, 1.4%, and 1.8%, respectively. Moreover, 78.7% of children with refractive errors, 68% with amblyopia, and 58% with strabismus reported no eyestrain. CONCLUSIONS: Most children complaining of eyestrain had a normal eye examination; whereas most children with refractive error, amblyopia, or strabismus were free of eyestrain, making this complaint a poor marker of eye conditions in young children.

[Ophthalmology].

The Headache Classification Subcommittee of the International Headache Society classifies headaches related to eyes as "Headache attributed to disorder of eyes" in the International Classification of Headache Disorders; 2nd Edition(ICHD-II). It consists of "Headache attributed to acute glaucoma", "Headache attributed to refractive errors", "Headache attributed to heterophoria or heterotropia(latent or manifest squint)", "Headache attributed to ocular inflammatory disorder". But other causes of headache related to eyes exist. For example, dry eye causes the headache. This article mentions to "Headache attributed to disorder of eyes" in ICHD-II, and additionally, describes other causes of headache associated with disease of eye.

The optometric correlates of migraine.

Migraine is a common, chronic, multi-factorial, neuro-vascular disorder typically characterised by recurrent attacks of unilateral, pulsating headache and autonomic nervous system dysfunction. Migraine may additionally be associated with aura; those focal neurological symptoms that may precede or sometimes accompany the headache. This review describes the optometric aspects of migraine headache. There have been claims of a relationship between migraine headaches and errors of refraction, binocular vision anomalies, pupil anomalies, visual field changes and pattern glare. The quality of the evidence for a relationship between errors of refraction and binocular vision and migraine is poor. The quality of the evidence to suggest a relationship between migraine headache and pupil anomalies, visual field defects and pattern glare is stronger. In particular the link between migraine headache and pattern glare is striking. The therapeutic use of precision-tinted spectacles to reduce pattern glare (visual stress) and to help some migraine sufferers is described.

Prevalence of upper extremity musculo-skeletal disorders, eyestrain and stress related illnesses among video-display unit workers at the Universtiy of the West Indies, Mona Campus

Computer workers represent the fastest growing sector of the economy. All aspects of office work are now changing. The introduction of new technology and the automation of office work brings with it avenues for the improvement in the overall working conditions. They also present new challenges. The health issues related to work within these new "electronic offices" have long been a major focus of both workers and their organizations. Ergonomics as a science, has sought to bring a better fit of office work to the worker, and is expected to play a major role in the continued automation of the "electronic offices". This study represents a cross-sectional survey done among Video Display Unit (VDU) workers at the University of the West Indies, Mona campus, on the self-reported prevalence of Upper Extremities Musculoskeletal Disorders (UEMSD), Eyestrain (ES), and Stress Related Illnesses (SRI). The results show a prevalence Eyestrain (ES) at 53.3 per 100, Lower Back Pain (LBP) at 50.0 per 100, Recurrent Shoulder Pain (RSP)at 46.7 per 100, Cervical Myalgia (CM) at 40.0 per 100, Stress Related Illnesses (SRI) at 30.0 per 100, and Carpal Tunnel Syndrome at 33.3 per 100. The level of job satisfaction among workers surveyed was found to be low. The majority of workers taking part in the study had knowledge of ergonomics and its role as an instrument to improve office work and the health and well being of the worker. This level of knowledge of ergonomics was not translated into practice, and some non-ergonomic conditions were reported in some departments (AU)

Abnormal tear dynamics and symptoms of eyestrain in operators of visual display terminals.

OBJECTIVES: To clarify the relation between the prevalence of dry eye syndrome and subjective symptoms of asthenopia in visual display terminal (VDT) operators. METHOD: 722 VDT workers (242 subject workers with symptoms of asthenopia and 480 controls without such symptoms) without obvious organic ocular diseases received an ophthalmological examination consisting of refractometry and a tear function (phenol red thread) test. RESULTS: More than 30% of symptomatic workers were found to meet the criteria of dry eye, and the odds ratio compared with the controls was 4.61 (p < 0.001). This odds ratio was significantly greater than that obtained for refractive errors (2.31). CONCLUSIONS: Although this cross sectional study could not prove that dry eyes are the cause of asthenopia, the profound association of dry eyes with symptoms of asthenopia could be verified. It would be useful to carry out tear function tests in workers with symptoms of asthenopia.

Vision therapy to reduce abnormal nearwork-induced transient myopia.

After brief periods of nearwork, some younger patients complain of transient distance blur that is correlated with a transient pseudomyopic shift in their distance refraction. This phenomenon has recently been documented objectively. However, there is lack of objective documentation demonstrating the effects of conventional optometric vision therapy in symptomatic individuals manifesting this "abnormal nearwork-induced transient myopia" (ANITM). Five symptomatic subjects received 7 to 10 weeks (5 to 6 sessions) of accommodative facility vision therapy (i.e., lens flippers and Hart chart). Objective recording of their ANITM and its decay were taken before and after the vision therapy, using a Canon R-1 autorefractor. A daily log was maintained, describing qualitatively their nearwork-related symptomatology. After therapy, there was marked reduction of symptoms and considerable improvement in clinical accommodative facility measures, as well as improvement in the objective findings. These results demonstrate multi-faceted positive effects of optometric accommodative vision therapy in this diagnostic group of symptomatic individuals.

Measurement of pupillary unrest in eyestrain.

Using a computer-assisted infrared optometer with a pupillometer, we studied pupillary unrest in 20 eyes of 20 patients suffering from eyestrain, and 20 eyes of normal controls. The eyestrain patient group had smaller mean pupil area than the control group (29 mm2 vs 38 mm2; P < 0.01); showed prominent pupillary unrest, and had an increased mean coefficient of variation (CV) of the pupil area (9.2% vs 3.4%; P < 0.001). Long-duration waves of pupillary unrest (> 1 second) were frequently recorded in this group, but not in the control group. The patient group also had a significantly higher dark focus of accommodation than the control group (1.1 D vs 0.4 D; P < 0.01). These findings suggest that abnormal parasympathetic excitation of the iris and/or ciliary muscle may be a factor in the etiology of eyestrain.