Computer vision syndrome: Will it be the 21st century carpal tunnel?
Employee complaints grow as workplace computers become more common
Some ergonomics experts see it as an annoying but curable problem. Others see it as "the carpal tunnel of the next century." There is no denying that computer vision syndrome is an employee health problem that can sap productivity, and employers and health professionals must do more to combat this growing challenge.
Computer vision syndrome, or CVS, is "a complex of eye- and vision-related problems associated with using a computer," says James Sheedy, OD, PhD, director of professional development for Walnut Creek, CA-based SOLA Optical, a manufacturer of lenses for spectacles. As a professor at the University of California-Berkeley School of Optometry in the 1980s, Sheedy conducted research at a VDT eye clinic that led to the identification of CVS.
The most common eye- and vision-related complaints are eyestrain, eye fatigue, eye irritation, and blurred vision. Computer users also frequently complain of tired, burning, itching, and watering eyes; headaches; flickering sensations; double vision; and neck and backaches.
It is this constellation of symptoms and their growing frequency that led Jeffrey Anshel, OD, to predict that if the current trend continues, CVS will be the "carpal tunnel of the next century." Anshel is president of Corporate Vision Consulting in Encinitas, CA, a company that conducts work site evaluations specifically for visual stress conditions.
"When I started [looking at] this in ’91, maybe five doctors in the country were even talking about it," Anshel recalls. "In the last few years, I’d go to computer conventions and everyone would tell me that their eyes had never bothered them until they used computers. In ’91, there were about 30 million to 40 million computer users, and now there are 70 million — and we’re expecting 100 million by the turn of the century."
Anshel continues to make his case. "Carpal tunnel drove workman’s comp in the ’90s, but in the last few years it has gone down, while CVS has gone up," he says. "In 1995, about 10% of the people who came to see their optometrists complained about computers; now, it’s up to 15%. Hopefully, companies will acknowledge this."
"If you look at the research data and the epidemiology, up to 30% of the people who use computers report eye problems," adds Tom Albin, PE, CPE, manager-ergonomics services, SOSD (stationary and office supply division) of 3M, in St. Paul, MN. "We certainly see it as a problem within 3M.
"It definitely is a comfort issue," he continues. "In the literature I’ve seen, it doesn’t show a permanent effect of the same consequence as carpal tunnel, but I don’t want to minimize the discomfort it causes. And as for ubiquitousness, in that case, I would agree that even now it’s more common than carpal tunnel."
All employers and wellness professionals should see it as a problem, says Anshel. "Employees [with CVS] will be less productive, and have more sick days," he notes. "It may not be a screamer’ issue, where employees are constantly in great pain, but they certainly can develop headaches toward the end of the day. And most companies today are computer-dependent."
What causes CVS?
Sheedy says the most common cause of CVS is improper lighting.
"A clear principle [of optometry] is that bright light in your peripheral vision can lead to ocular discomfort," he says. "When you’re looking down at your desk, those [overhead] lights aren’t in your field of view. I tell people to look at their computer and shield their eyes with their hands; if they feel an immediate sense of improvement by eliminating whatever light there is, imagine the effect after eight hours."
Reflections in the computer screen decrease the contrast of what you’re looking at and make it difficult for your eyes to deal with the images on the screen, adds Sheedy. You can test for reflection problems by taking a file folder and using it as a baffle, placing it over the computer to shield light from hitting it from above or from the sides. "If that enables you to see the text better on the screen, then you’ve got a reflection problem."
The third major cause of CVS, notes Sheedy, is improper location of either the computer screen or your reference material.
"The screen should be below the eyes; ideally, the center of the screen should be four to eight inches lower than your eyes," he recommends.
The eyes, Sheedy explains, "lead" the body. "You will put your body in a position where you can see better — even if it’s bad for your body. If the screen is too far to the side, you will turn your head. If it’s too high, you’ll look up. This form of compensation can lead to neck and back strain."
Anshel agrees. "Over 80% of our learning comes through our eyes," he says. "We will change our body posture to make it easy for our eyes to see. We will squint to help us see far away."
Strategies for improvement
Poor work habits can also cause CVS, Anshel notes. He recommends that employees practice the "Three B’s": breathe, blink, and break. "If you’re looking at your computer a lot, you stop breathing, which slows oxygen to the brain and causes headaches," he explains. "Research shows we blink less when we’re at the computer, but we need to blink because it rewets the eye. So, take breaks: Every 20 minutes, take 20 seconds, breathe, and look 20 feet away."
There are some basic, "common-sense" steps you can take to help minimize the ill effects of poor lighting, excessive glare, or improper computer positioning, experts note. "Can you rotate your work station, or put in a partition to get rid of the offending light?" asks Sheedy. "If not, you could try wearing a visor."
As for glare, a "reflection screen" on the top or the sides of a computer is the best solution, he says. "As a temporary fix, you can put a file folder alongside the screen."
"We use a lot of antiglare filters," says Albin. "Also, we’re looking at what our lighting levels are. Some of the old standards for offices had them brightly lit so employees could read paper and pencil work. Quite often, our solution consists of dimming down our office lighting and supplying task lighting. It’s not that expensive, and it’s definitely worth the investment."
Albin says 3M has also done a lot of work with parabolic diffusers. These devices are put into ceiling fixtures so that the lighting, rather than spreading out over a large area, is directed in a cone-like shape. "This has also been effective," he says. His company has also been experimenting with polarized light, which seems to offer some advantages as well.
The cause of CVS can also be as simple as an incorrect prescription, says Anshel. "Employees should be encouraged to have routine eye exams, with prescriptions for the proper eyeglasses as necessary."
Check those glasses!
Anshel actually recommends specific glasses for computer use. "If you go to the beach, do you wear sunglasses? Of course you do, because it’s bright and glary. So, you need a specific lens for a specific use. Computer use can be the same, and you may need a specific lens for it," he says.
"Employees with CVS problems often have out of date prescriptions and/or corrections," adds Albin. "They should be examined every year or two."
He’s seen a few employees with glasses especially made for computer work. He’s also seen some other creative solutions. "We get a few people with reverse bifocals. They put the mid-distance reading correction on the upper part of the lens, and that way they don’t tilt their eyes as much when they use the computer." (For more strategies on eliminating CVS, see the box on p. 28.)
Technology can help
Employee education is critical to combating CVS, says Albin, and at large companies that means high technology.
"If you have a couple of thousand employees at terminals, it’s hard to get around and analyze each of them individually," he notes. At 3M, Albin and his ergonomics team developed a "Self-Help Web Site" that walks an employee through a complete evaluation of his workstation, including its visual aspects.
"It’s on both our Intranet and our Internet sites," he notes. (To sample this test, visit the 3M Web site at: www.3m.com/ergonomics, then click on "Self-help Site.")
Anshel also recommends that wellness professionals encourage employees to take a vision-screening exam.
"There’s a system developed in London called the Eye-CEE,’" he says. "It’s a Windows vision screening program that can be taken on the job. It asks the employee a series of questions, evaluates the results, and provides suggestions for improvement. It would be great for people to have this information when they walk into their eye doctor’s office."
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