Interventions for the Management of Computer Vision Syndrome: A Systematic Review and Meta-analysis.

TOPIC: To evaluate the efficacy and safety of interventions for treating eye strain related to computer use relative to placebo or no treatment. CLINICAL RELEVANCE: Computer use is pervasive and often associated with eye strain, referred to as computer vision syndrome (CVS). Currently, no clinical guidelines exist to help practitioners provide evidence-based advice about CVS treatments, many of which are marketed directly to patients. This systematic review and meta-analysis was designed to help inform best practice for eye care providers. METHODS: Eligible randomized controlled trials (RCTs) were identified in Ovid MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and trial registries, searched from inception through November 23, 2021. Eligible studies were appraised for risk of bias and were synthesized. The certainty of the body of evidence was judged using the Grading of Recommendations, Assessment, Development, and Evaluation system. Standardized mean differences (SMDs) were used when differently scaled measures were combined. RESULTS: Forty-five RCTs, involving 4497 participants, were included. Multifocal lenses did not improve visual fatigue scores compared with single-vision lenses (3 RCTs; SMD, 0.11; 95% confidence interval [CI], -0.14 to 0.37; P = 0.38). Visual fatigue symptoms were not reduced by blue-blocking spectacles (3 RCTs), with evidence judged of low certainty. Relative to placebo, oral berry extract supplementation did not improve visual fatigue (7 RCTs; SMD, -0.27; 95% CI, -0.70 to 0.16; P = 0.22) or dry eye symptoms (4 RCTs; SMD, -0.10; 95% CI, -0.54 to 0.33; P = 0.65). Likewise, berry extract supplementation had no significant effects on critical flicker-fusion frequency (CFF) or accommodative amplitude. Oral omega-3 supplementation for 45 days to 3 months improved dry eye symptoms (2 RCTs; mean difference [MD], -3.36; 95% CI, -3.63 to -3.10 on an 18 unit scale; P < 0.00001) relative to placebo. Oral carotenoid supplementation improved CFF (2 RCTs; MD, 1.55 Hz; 95% CI, 0.42 to 2.67 Hz; P = 0.007) relative to placebo, although the clinical significance of this finding is unclear. DISCUSSION: We did not identify high-certainty evidence supporting the use of any of the therapies analyzed. Low-certainty evidence suggested that oral omega-3 supplementation reduces dry eye symptoms in symptomatic computer users.

[COMPUTER VISION SYNDROME].

INTRODUCTION: Computer vision syndrome (CVS) is a very common phenomenon amongst computer users. A total of 90% of computer users, who spend more than 3 hours a day in front of the computer screen, suffer from CVS. CVS is also known as digital eye strain or visual fatigue and includes symptoms that are a result of continuous work in front of the different types of computer screens or other types of digital screens. An updated differentiation divides the cause of the symptoms into three separate categories which include visual symptoms, symptoms resulting from the digital screen itself and symptoms resulting from the ocular surface. CVS includes a wide range of symptoms which are non-specific (asthenopia), which include eye fatigue, eye strain, pain in and around the eye, blurred vision, headaches and even diplopia (double vision). Asthenopia and dry eye are the core symptoms of CVS. There are many solutions and ways to treat the different symptoms related to the vision, the screen and ocular surface and especially the symptoms related to the issue of dry eye. The treatment of CVS is focused around the different groups of symptoms and it is recommended to give a combined treatment for all the symptomatic groups. The correction of residual astigmatism, accommodation issues, base-in or base-up prisms and the correction of vergence reserves to maintain vision aspects. Changing the lighting, correct positioning of the screen and correcting the direction of gaze in relation to symptoms which are connected to the screen and artificial tears, as well as increasing the blink rate and increasing the level of moisture of the air in the room, all assist in treating the symptoms of dry eye. Blue light also has some effect on CVS and as a precaution it is recommended to reduce, as much as possible, blue light radiation that enters the eye or is emitted from the computer screen.

Effects of a blue-blocking screen filter on accommodative accuracy and visual discomfort.

INTRODUCTION: The prescription of blue-blocking (B-B) filters for the management of visual symptoms and signs associated with the use of electronic devices is routinely performed by eye care specialists. However, the utility of B-B filters is a matter of debate and discussion by the scientific community due to the lack of evidence supporting their use. Here, we aimed to determine the effects of using B-B filters on the dynamics of the accommodative response and pupil size and perceived levels of visual discomfort, while performing a 30-min reading task at a close distance in subjects who routinely use electronic devices. METHODS: Nineteen healthy young adults (22.0 ± 2.7 years) read two 30-min passages on a computer screen placed at 50 cm, either while using a commercially available B-B filter or without any filter on two different days. The magnitude and variability of both the accommodative response and pupil size were dynamically measured for 60 s using the WAM-5500 open field autorefractometer at 4-5, 9-10, 14-15, 19-20, 24-25, and 29-30 min into the trial. The perceived levels of visual discomfort were also obtained. RESULTS: The lag and variability of accommodation were insensitive to the blue light level (p = 0.34 and 0.62, respectively). There was a time-on-task effect for the variability of accommodation, showing greater instability over time regardless of the blue light level. The use of the B-B filter was associated with improved reading speed (p = 0.02), with an increase of 16.5 words per minute. However, it was not associated with any significant change in pupil dynamics or the perceived levels of visual discomfort (p> 0.05 in both cases). CONCLUSIONS: Our data showed that the use of a B-B filter had no effect on accommodative dynamics or visual symptomatology. Based on these findings, there is no support for the prescription of B-B filters to attenuate the visual symptoms and signs associated with the use of electronic devices in healthy young adults.

A Randomized Trial to Evaluate the Effect of Toric Versus Spherical Contact Lenses on Vision and Eyestrain.

OBJECTIVES: To compare the effect of toric versus spherical soft contact lenses on objective measures of visual performance using visual acuity and electromyography of the orbicularis oculi muscle. METHODS: Current soft contact lens wearers with -0.75 to -1.75 D astigmatism in each eye were binocularly fitted with toric (1-Day ACUVUE MOIST for astigmatism) and spherical (1-Day ACUVUE MOIST) contact lenses in random order. After each fitting and at 1-week follow-up, high- and low-contrast visual acuities were measured. Electromyography was used to objectively evaluate eyestrain. Linear mixed models were used to assess differences between toric and spherical contact lenses. RESULTS: The mean age (±SD) of the 60 participants was 27.5±5.0 years, spherical refractive error was -3.68±2.01 D, and cylinder was -1.28±0.36 D. High- and low-contrast visual acuities with toric lenses were better than with spherical lenses at both fitting (toric high-contrast: -0.065±0.078 and low-contrast: 0.133±0.103 vs. spherical high-contrast: 0.001±0.104 and low-contrast: 0.224±0.107) and follow-up (toric high-contrast: -0.083±0.087 and low-contrast: 0.108±0.107 vs. spherical high-contrast: -0.015±0.095 and low-contrast: 0.211±0.104) (all P<0.0001). Electromyography-measured eyestrain was less with toric versus spherical contact lenses at fitting (least-square ratio of toric over spherical=0.72; P=0.0019) but not at follow-up (ratio=0.86; P=0.11). CONCLUSION: These results suggest that toric contact lenses provided improved objective measures of vision in a low-to-moderate astigmatic population.

Short-term effect of a developed warming moist chamber goggle for video display terminal-associated dry eye.

BACKGROUND: Video display terminal (VDT)-associated dry eye (DE) patients are the rising group worldwide, and moisture goggles are the preferable treatment since they are capable of improving tear film stability and DE discomfort. The current study aims to evaluate the short-term efficacy and safety of the developed warming moist chamber goggles (WMCGs) for VDT-associated DE patients. METHODS: In this prospective self-control study, 22 DE patients (22 eyes) working with VDTs over 4 h daily were enrolled and instructed to wear WMCGs for 15 min. Sodium hyaluronate (SH, 0.1%) eyedrops were applied as a control on another day on these same patients, however 4 subjects denied the eyedrop application. The symptomatology visual analog scale (VAS) score, tear meniscus height (TMH), noninvasive tear film break-up time (NI-BUT), tear film lipid layer thickness (LLT), and bulbar conjunctival redness were assessed with Keratograph 5 M at baseline, 5, 30 and 60 min after treatment. The WMCGs wearing comfort was also evaluated. RESULTS: The ocular discomfort evaluated by VAS decreased in the WMCGs group throughout 60 min (P<0.001), better than the control group levels (P ≤ 0.015). TMH, NI-BUT (including the first BUT and average BUT) increased than baseline level accross 60 min in the WMCG group (P ≤ 0.012), while those in the control group only showed temporary improvements in 5 min. LLT also increased obviously after WMCGs wear, while the change in the control group was nearly innoticeable. No adverse responses were detected. CONCLUSIONS: Temporary use of the WMCGs is able to relieve ocular discomfort, and improves tear film stability in DE patients for at least 1 h, making it a promising alternative to other treatments.

Effects of Progressive Addition Lens Wear on Digital Work in Pre-presbyopes.

SIGNIFICANCE: Growing popularity of handheld digital devices imposes significant challenges to our visual system and clinical management. This study aimed to determine the effects of lens design on parameters that may influence the refractive management of pre-presbyopic adult computer users. PURPOSE: To determine the effects of wearing conventional single-vision lenses (SVL) versus progressive addition lenses (PAL) on the working distance and refractive status. METHODS: Adult computer users, recruited from two age cohorts (18 to 25 years, n = 19; 30 to 40 years, n = 45), were prescribed SVLs and PALs designed for use with handheld digital devices. For each lens type, the working distance and refractive shift (post-task - pre-task) were measured immediately after lens delivery (T0) and after 1 month of lens wear (T1). Working distances were recorded with an automatic ultrasound device while the participants were playing a video game. Refractive status through the subjects' glasses was measured before (pre-task) and after playing the game (post-task). Questionnaires assessing the frequencies of 10 digital work-related visual symptoms were conducted for both lens types at T1. RESULTS: Switching from SVL to PAL increased the working distance in both cohorts (mean ± SEM = 1.88 ± 0.60 cm; P = .002) and induced a small but significant positive refractive shift (+0.08 ± 0.04 D, P = .021) in the older cohort at T1. In the younger cohort, the changes in working distance due to the switching lens design were correlated with myopic error (r = +0.66, P = .002). In the older cohort, the changes in refractive shift due to switching lens design were correlated with amplitude of accommodation at both time points (r for T0 and T1 = -0.32 and -0.30, respectively; both P < .05). Progressive addition lens was rated as causing less "increased sensitivity to light" compared with SVL. CONCLUSIONS: Switching from SVL to PAL increased the working distance and induced a positive refractive shift in the majority of pre-presbyopic adults.

Exploring the Effect of Trataka (A Yogic Cleansing Technique) and Cold Eye Pack on Eye Strain During COVID-19 Pandemic: A Randomized Three-Arm Trial.

Objective: Computer vision syndrome is a major global public health concern affecting >60 million individuals globally. Yoga and naturopathy practices can reduce visual fatigue and strain. The present study attempted to explore the effect of trataka that is, a yogic cleansing technique and cold eye pack on visual strain and fatigue. Subjects: Three hundred volunteers from an IT company were recruited following inclusion and exclusion criteria. Intervention: The subjects were randomly distributed in three groups, that is, trataka, cold eye pack, and waitlist control group with an allocation ratio of 1:1:1. Outcome measure: Visual Fatigue Scale and Visual symptoms checklist (VSC) was administered at baseline and end of 2 weeks. Repeated measures analysis of variance (RM-ANOVA) with Bonferroni corrections was used to test the difference across the groups. Results: All the variables were similar at the baseline among the groups. Significant changes in the within-group analysis occurred in both the trataka and cold eye pack groups. The RM-ANOVA revealed significant differences in the VAS and VSC (p = 0.001) and the post hoc analysis suggested that there were significant differences in both the trataka and cold eye pack group when compared with the control group (p = 0.001); however, there was no differences between the trataka and cold eye pack group in both the scales (p = 1). Conclusions: The results of the present study suggest that a trataka and cold eye pack for 14 days improves self-rated visual strain and fatigue among IT professionals with computer vision syndrome. Clinical Trial registration number: CTRI/2020/11/029003.

Intervention Effect of Traditional Chinese Medicine Hot Pressing Combined with Health Education on the Adolescent's Visual Fatigue.

To explore the intervention effect of traditional Chinese medicine hot pressing combined with health education in adolescents with asthenopia, 92 adolescents with asthenopia admitted to the outpatient department of Guangming Traditional Chinese Medicine Hospital in Pudong New Area from October 2019 to January 2021 were selected and randomly divided into two groups: the control group and the test group, each with 46 cases. Both received health education. The control group was given sodium hyaluronate eye drops, and the test group was given traditional Chinese medicine hot ironing technique intervention. After 2 courses of treatment, the scores of visual fatigue symptoms, clinical curative effect, and eye refractive power of the two groups were observed. The satisfaction of treatment was compared between the two groups. The scores of asthenopia of the two groups were compared at 6 months after intervention. After the intervention, the scores of visual fatigue symptoms in the control group and the test group were reduced after one or two courses of treatment (control group: t = 4.167, 6.318, and P=0.027, 0.010; test group: t = 4.820, 6.834, and P=0.013, <0.001). The scores of asthenopia symptoms of the trial group after the intervention for one and two courses were significantly lower than those of the control group (P < 0.05); the total clinical effective rate of the trial group was 93.48%, which was significantly higher than that of the control group (80.43%). The difference between the groups was statistically significant (P < 0.05); the left and right eyes of the control group did not change significantly before and after the intervention (P > 0.05). After the intervention, the left and right eyes of the paper group were significantly reduced (P < 0.05). After the intervention, the difference of the two groups in the refractive power of the left and right eyes was statistically significant (P < 0.05). After treatment, the satisfaction of the experimental group was significantly higher than that of the control group (P < 0.05). After 6 months, there was no significant change in the visual fatigue score of the experimental group, while the visual fatigue score of the control group increased significantly. The traditional Chinese medicine ironing combined with health education intervention can improve the symptoms of adolescents' asthenopia and improve the treatment efficiency. The method is safe, and the operation is convenient. It is worthy of clinical promotion.

Computer vision syndrome: a review of ocular causes and potential treatments.

Computer vision syndrome (CVS) is the combination of eye and vision problems associated with the use of computers. In modern western society the use of computers for both vocational and avocational activities is almost universal. However, CVS may have a significant impact not only on visual comfort but also occupational productivity since between 64% and 90% of computer users experience visual symptoms which may include eyestrain, headaches, ocular discomfort, dry eye, diplopia and blurred vision either at near or when looking into the distance after prolonged computer use. This paper reviews the principal ocular causes for this condition, namely oculomotor anomalies and dry eye. Accommodation and vergence responses to electronic screens appear to be similar to those found when viewing printed materials, whereas the prevalence of dry eye symptoms is greater during computer operation. The latter is probably due to a decrease in blink rate and blink amplitude, as well as increased corneal exposure resulting from the monitor frequently being positioned in primary gaze. However, the efficacy of proposed treatments to reduce symptoms of CVS is unproven. A better understanding of the physiology underlying CVS is critical to allow more accurate diagnosis and treatment. This will enable practitioners to optimize visual comfort and efficiency during computer operation.

The role of attributional bias and visual stress on the improvement of reading speed using colored filters.

This study tested the predictions derived from two explanatory theoretical models of the effects of colored filters on reading speed: the theory of attributional bias and the theory of visual stress associated with reading. The experimental group consisted of 27 secondary school students (14 boys, 13 girls) diagnosed with the Meares-Irlen syndrome; the control group had 27 students paired in age and sex with the experimental group. The mean age of the sample was 12 years, 10 months (SD = 8.9 mo.). The effects of colored filters on reading speed and accuracy were tested using a word reading test and a visual stress induction text. The presentation method tapped individuals' visual sensitivity and response criteria. The results support some predictions of the theory of attributional bias, but more research is needed to assess each theory of reading speed.

[Digital eye strain. Symptoms, prevalence, pathophysiology, and management]. / Perturbations oculaires secondaires à l'utilisation de supports numériques. Symptômes, prévalence, physiopathologie et prise en charge.

The digital revolution, which has been underway since the 1980's, is disrupting our daily routines with an exponential increase in the use of screens, which has not been without consequence to our visual system. Digital eye strain (DES), or computer vision syndrome (CVS), includes all the visual symptoms secondary to the use of digital devices. DES is present in at least 50% of regular users of digital media and is defined by blurred vision, difficulty focusing, ocular irritation or burning, dry eye, visual fatigue, headaches and increased sensitivity to light. Exposure time, age, female gender, and work environment are the main factors increasing its prevalence. Its pathophysiology, still poorly understood, is felt to be multifactorial and includes disturbances in the accommodative-convergence balance and changes in the ocular surface. Regarding accommodation and convergence, the studies are mostly old and their results heterogeneous. Conversely, many studies have shown an increase in the prevalence of dry eye in screen users. Although the retinal toxicity of blue light has been proven in in vitro models, the low level of evidence in the available studies does not allow it to be clearly correlated with the symptoms of DES. The objective of this review is to condense the knowledge available in the literature on the symptoms, prevalence, pathophysiology and management of DES.

Convergence insufficiency and its current treatment.

PURPOSE OF REVIEW: Considerable uncertainty and controversy has existed concerning the management of convergence insufficiency. Only recently there have been significant scientific studies published that compare the effectiveness of the commonly prescribed treatments. This paper reviews the most recent research and literature on convergence insufficiency and its treatment. RECENT FINDINGS: The first large-scale placebo-controlled, randomized clinical trials to study the various treatments of convergence insufficiency have recently been published. Current research compares the effectiveness of base-in prism glasses, pencil push-ups, and vision therapy in reducing the signs and symptoms of convergence insufficiency and suggests that orthoptic therapy is the most efficacious treatment for convergence insufficiency. SUMMARY: Intensive orthoptic therapy is the treatment of choice for convergence insufficiency. Pencil push-ups and use of accommodative targets have a role in the treatment of convergence insufficiency when used as part of a more intensive orthoptic program. Base-in prism glasses should be reserved for reduction of symptoms in the presbyopic population.

[Comparison of effects of periocular region dry and wet warming on visual acuity and near reflex].

PURPOSE: To investigate the influence of warming the periocular region for 10 minutes after visual display terminal (VDT) work on the near reflex, and the differences in influence between lid closure, dry and wet warming, and the amounts of water vapor. SUBJECTS AND METHODS: Subjects in the first trial were 10 healthy volunteers (10 eyes). Following VDT, subjects wore either a warming eye steamer (water vapor: 200 mg/10 min) or an eye mask with their eyelids closed for 10 minutes. Subjects in the second trial were 5 healthy volunteers (5 eyes). Following VDT, subjects applied either a dry-warming sheet (water vapor: 0 mg/10 min) or a wet-warming sheet (water vapor: 20, 35, 160 and 200 mg/10 min) to there eyelids and the periocular region for 10 minutes. In both experiments, subjective amplitude of accommodation, pupillary reaction, convergence reaction, near vision, and breakup time were measured before and immediately after VDT work and after 2 experimental settings. RESULTS: The warming eye steamer significantly improved amplitude of accommodation (p<0.05), and near vision (p<0.05). Warming the periocular region with water vapor improved subjective amplitude of accommodation, and near vision, the effect of which depended on the amount of water vapor (p<0.05). CONCLUSIONS: Warming the periocular region with water vapor improved subjective amplitude of accommodation, near vision and the effect depended on the amount of water vapor.

An investigation of low power convex lenses (adds) for eyestrain in the digital age (CLEDA).

INTRODUCTION: Digital eye strain (DES; computer vision syndrome) is a common cause of symptoms when viewing digital devices. Low-powered convex lenses (adds) have been recommended for the condition and "accommodative support" designs developed on this premise. The present research reports the extent to which dry eye is present in this population and the effect of convex lenses on symptoms and visual performance. METHODS: The CVS-Q instrument was used to select pre-presbyopic adults with the symptoms of DES. Participants received a full eye examination including an assessment of dry eye with a modified SANDE questionnaire and using DEWS I criteria. The immediate effect of low-powered convex lenses (low adds: +0.50D, +0.75D, +1.25D) was investigated using subjective preference and a double-masked comparison with plano lenses with the Wilkins Rate of Reading Test (WRRT). Throughout this testing, participants wore their full distance refractive correction, based on non-cycloplegic retinoscopy and subjective refraction. RESULTS: The signs and symptoms of dry eye were frequently present. Most participants reported a subjective preference for low adds, with +0.75D the most commonly preferred lens. Low adds (+0.50D and +0.75D; but not +1.25D) were associated with significantly improved performance at the WRRT. One quarter of participants read more than 10% faster with these additional convex lenses. CONCLUSIONS: The study population was aged 20-40y and mostly worked on desktop computers. It is possible that +1.25D add may be more advantageous for people who are older or work more at closer viewing distances. Many symptomatic users of digital devices report a preference for low adds and use of these lenses is often associated with an improvement in reading performance.

An Eye-tracking based Evaluation on the Effect of Far-infrared Therapy for Relieving Visual Fatigue.

Far-infrared (FIR) therapy is attracting great attention in clinical applications, whereas studies on its effect to relieve visual fatigue stay exiguity. This study tried to fill the gap by utilizing two novel eye-tracking parameters, i.e., the fixation frequency (FF) and saccade amplitude (SA), along with traditional indicators (i.e., the eye blink frequency (BF) and subjective score (SS)) of visual fatigue in two eye-tracking tests, i.e., the random digit search and fixed-point gaze. Twenty healthy subjects participated in the experiment during the same period of two consecutive days. A visual stimulus program was presented to each subject before the subjective grading and eye-tracking tests, followed by the relief of eyes with either using a FIR thermal eye mask or physically closing eyes. Finally, subjective grading and eye-tracking tests were re-performed. Results showed that FF and SA, along with BF and SS, were significantly different when measured before and after the eye relief with FIR therapy mask, suggesting that FF and SA were useful in evaluating visual fatigue. In addition, FIR therapy yielded much better performance than eye-closing rest, indicating that FIR therapy had the potential in accelerating the relief of visual fatigue.

Digital Eye Strain in a Population of Young Subjects.

The main goal of our study was to prove short-term objective influence of near addition and relieving prism on accommodative and vergence facility in group of young healthy persons. Further, we wanted to prove objective and subjective difference between two types of soft contact lenses during working with digital device. We had in total 37 subjects in our study. The first group contained 37 subjects with average age 23 years without important eye pathology. The second group contained 8 subjects with the same average age without important eye pathology. In the first group of subjects, we measured binocular accommodative facility (BAF) and binocular vergence facility (BVF) with and without addition 1 D and with and without relieving prism 2 pD BO at working distance 45 cm. In the second group, we evaluated BAF, BVF and standardized questionnaire (Computer Vision Syndrome Questionnaire - CVS-Q, Sequí M. 2015) during usage of two types of soft contact lenses. The first type of contact lenses (type 1) contained relieving prism for PC working and type 2 was soft contact lens with aspheric design. In the first group of subjects, we measured these values: BAF without addition = 12.78 cpm, BAF with addition = 11.57 cpm, BVF without prism = 12.32 cpm, BVF with prism = 11.59 cpm. In the second group of subjects, we measured with contact lens type 1 these values: BAF = 12.13 cpm, BVF = 13.63 cpm and questionnaire score 9.43 points. With contact lens type 2 we measured BAF = 11.75 cpm, BVF = 11.63 cpm and questionnaire score 12.86 points. We proved statistically important different between two variable only in the first group between BAF with and without addition and BVF with and without relieving prism. In conclusion, we found statistically important decrease in variable BAF and BVF with usage of addition and relieving prism. We found that neither addition nor prism have positive influence on increase of BAF and BVF. Subjects in second group had higher BAF and BVF values with both types of contact lenses in comparison with natural values. We found that with contact lens type 1 (with addition) subjects had higher BAF and BVF values in comparison with contact lens type 2 (aspheric). Subjects with contact lens type 1 had also lower (better) questionnaire score, i.e. 9.43 versus 12.86 point. Key words: Digital eyestrain syndrome, accommodative and vergence facility, addition, relieving prism.

An Osteopathic Physician's Approach to the Esports Athlete.

Esports is gaining acceptance in the world of professional, collegiate, and high school athletics. However, there is a lack of information for osteopathic physicians about the health concerns and appropriate treatment of esports athletes. Because of the sedentary nature of the sport and accompanying poor posture, esports athletes are likely to have musculoskeletal injuries of the neck, back, and upper extremities. Additionally, these athletes may have metabolic disturbances resulting from light-emitting diode computer monitors as well as mental health concerns regarding gaming addiction and social behavior disorders. The authors explore the osteopathic physician's role in promoting health and reducing injury in this new gaming phenomenon.

Efficacy of Smartphone-based Exercises in Conjunction with Modified Glasses Prescription in the Treatment of Convergence Insufficiency and Fusion Weakness.

PURPOSE: To determine the efficacy of Smartphone-based exercises in conjunction with modified glasses prescription in the treatment of convergence insufficiency and fusion weakness. METHODS: A total of 150 patients using glasses and having asthenopia between 15 and 30 years of age were subjected to thorough eye examination including binocular vision testing and refraction. Of them 26 individuals were found to have convergence insufficiency with fusion weakness and exophoria >6 pd. Subjects with amblyopia, manifest strabismus and other ocular diseases were excluded from the study. Modified glasses (overcorrection of myopia by -0.5 D Sph & under correction of hypermetropia by +0.5 D Sph) were given along with newly designed Smartphone-based fusion exercises. RESULTS: Near point of convergence improved by 2.89 ± 1.08 cm, positive fusion vergence by -10.2 ± 3.25 pd and near phoria by 3.13 ± 0.32 pd (p < 0.001). CONCLUSION: The current study demonstrates the efficacy of Smartphone-based fusion exercises, in conjunction with modified glasses prescriptions, in the management of symptomatic convergence and fusion insufficiency. Indeed, this novel, newly designed approach for convergence insufficiency improves symptoms by reducing near point of convergence and degree of exophoria and increasing fusional vergence.

Management of digital eye strain.

Digital eye strain, an emerging public health issue, is a condition characterised by visual disturbance and/or ocular discomfort related to the use of digital devices and resulting from a range of stresses on the ocular environment. This review aims to provide an overview of the extensive literature on digital eye strain research with particular reference to the clinical management of symptoms. As many as 90 per cent of digital device users experience symptoms of digital eye strain. Many studies suggest that the following factors are associated with digital eye strain: uncorrected refractive error (including presbyopia), accommodative and vergence anomalies, altered blinking pattern (reduced rate and incomplete blinking), excessive exposure to intense light, closer working distance, and smaller font size. Since a symptom may be caused by one or more factors, a holistic approach should be adopted. The following management strategies have been suggested: (i) appropriate correction of refractive error, including astigmatism and presbyopia; (ii) management of vergence anomalies, with the aim of inducing or leaving a small amount of heterophoria (~1.5Δ Exo); (iii) blinking exercise/training to maintain normal blinking pattern; (iv) use of lubricating eye drops (artificial tears) to help alleviate dry eye-related symptoms; (v) contact lenses with enhanced comfort, particularly at end-of-day and in challenging environments; (vi) prescription of colour filters in all vision correction options, especially blue light-absorbing filters; and (vii) management of accommodative anomalies. Prevention is the main strategy for management of digital eye strain, which involves: (i) ensuring an ergonomic work environment and practice (through patient education and the implementation of ergonomic workplace policies); and (ii) visual examination and eye care to treat visual disorders. Special consideration is needed for people at a high risk of digital eye strain, such as computer workers and contact lens wearers.

[A critical view of alternative methods for treating visual complaints]. / Kritische betrachtung alternativer behandlungsmethoden bei verdacht auf visuelle beschwerden.

Irlen therapy, visual training, training of ocular motor control, and the correction method of H.-J. Haase represent a diversity of treatment methods that are mainly aimed at dyslexia, fatigue while reading, and general lack of concentration. We summarize the theoretical background of these methods, treatment approaches, and related clinical trials. None of these methods, because of incorrect theoretical concepts and an attempt to simplify the underlying causes, was found to have a specific influence on the patients' complaints. The absence of specific therapeutic effects and the high costs and time expenditure required should discourage practitioners from recommending these methods.