Computer Vision Syndrome: Management through Eye Relaxation Practices

Computer Vision Syndrome: Management through Eye Relaxation Practices

Lekshmi.K, Research Scholar, University of Kerala, Trivandrum. & Dr. Asha Balagangadharan, Principal, Sree Narayana Guru College, Coimbatore.

Abstract Computer Vision Syndrome is a condition among those working on computers for long periods of time. It is characterized by blurred vision, eye aches and pains, dryness or excessive watering of the eye and musculoskeletal discomforts. In view of the greater prevalence of computer vision syndrome among the prolonged users of computers, in the present study an attempt is being made to device strategies for alleviating the visual problems through a set of practices involving relaxing of the eyes. The sample included 30 myopic (blurred distant vision) patients, 15 in the experimental group (constituted individuals working on computers for 5 or more hours per day) and the remaining 15 served as the control group. The experimental and control group were decided upon as per the principles of matched control group design. The intervention involved eye relaxation exercises. Analysis of results indicated improvement in visual acuity in both the groups, with experimental group taking a more favorable turn. Associated symptom (astigmatism) also is found to have reduced considerably. Key words: Computer usage, Myopia, Relaxation, Visual strain. Introduction Vision and eye related problems at computer displays are very common and have collectively been named computer vision syndrome (Sheedy & Shaw Mc Minn, 2003). The prevalence of eye symptoms ranges from 25% to 93% as reported by various investigators. Self report questionnaires by data operators in UK reveal 25% visual strain symptoms (Woods, 2001). Temporary myoptization was observed among 64% Italian video display terminal workers during assessment of vision at the culmination of a shift (Leberto, F., Gobba, F. & Broglia, A., 1988). Survey on visual and musculoskeletal symptoms conducted in Japan reveal a prevalence of eye strain or pain of 72% (Iwakiri, K., Mori, I., Sotoyama, M., Horiguchi, K., Ochiai, T., Jonai, H. & Saito S., 2004). A study on the association between asthenopia and psycho physiological indicators of visual strain conducted in Lithuania indicates 86% of the workers complained various visual disorders (Ustinaviciene, R. & Januskevicius, V., 2006). A study in Sweden indicates that occurrence of eye discomfort is seen to increase in relation to the number of hours spend in video display terminal (Bergqvit, U.O., Knave, B.G., 1995). Study on 209 Italian video display terminal workers with myopia across a period of 6 to 9 years revealed a variation from 46% to 50%, but the variation does not differ from the natural progression of myopia (Basso, A., Di Lorenzo, L., Gamarossa, A. A., Corfiati, M., Ria, W., Bellino, R., Givellini, S., Lofrumento, M. & Soleo L., 2006). The study reveals

Computer Vision Syndrome: Management through Eye Relaxation Practices

that induced myopia is similar to normally occurring myopia and positive results may lead from relaxation. Conventional maintenance of computer vision syndrome includes optical intervention, surgery and administration of medication for dryness of the eye. Many studies have pointed to the fact that relaxation also helps in the management of myopia. Blurred vision can also be described as a pattern of pronounced tension in the forehead, jaws, neck, shoulders, upper arms and lower back. It can be described as a reduced peripheral awareness and prolonged fixation time or staring (Schneider, M., Larkin, M. & Schneider, D., 1994). A combination of yoga practices administered on 146 Indian computer professional reveal an improvement in self rated discomforts (Telles, S. , Naveen, K.V., Dash, M., Deginal, R. & Manjunath, N.K., 2006). A study conducted using holistic methods on a patient with myopia proved an effective cure (Bambridge, A., 2002). A study conducted among the medical students in Denmark suggested that physical activities have a protective effect on development and progression of myopia (Jacobsen, N., Jensen, H. & Goldschmidt E., 2008). A study conducted to compare the prevalence of myopia among 6 and 7 year old Chinese school children in Sydney and Singapore indicated lower prevalence in Sydney, associated with the increased hours of outdoor activities (Rose, K.A., Morgan, I.G., Wayne, S., Burlutsky, G., Mitchell, P., & Saw, S., 2008). A study on Australian school children revealed that more than the hours spend on near work the intensity of the work was seen to have significant effect on the progression of myopia (Ip, J.M., Saw, S., Rose, K.A., Morgan, I.G., Kifley, A., Wang, J.J., & Mitchell, P., 2008). Visual acuity was observed to improve in 29 patients who under went visual training (Rosen, R.C., Schiffman, H.R. & Mayers, H., 1984). Qi-Qong ocular exercise training on accommodation demonstrated slight improvement in amplitude (Shih, Y.F., Lin, L.L. & Hwang, C.Y., 1995). A study on 17 patients with myopia and astigmatism under going computer based visual training incorporating biofeedback for an average 35 session revealed an average visual acuity change of 3.4 lines and 2.12D (Balliet, R., Clay, A. & Blood, K., 1982). Theory formulated in 1900s by an ophthalmologist Dr. William Bates states that oblique muscles of the eye play a significant role in vision, strengthening of which can be achieved through certain relaxation techniques. He further stressed on the fact that eyesight is 10% physiological and 90% psychological. Strain reduced vision and relaxation promotes vision (Bates, W., 1912). Gottlieb used Bates method of exercises to cure his own myopia (Gottlieb, R.L., 1982). A comparative study on 80 patients with myopia trained in Bates method of treatment with a control group of 60 patients revealed that 93% of the patients had improvement in visual acuity in the experimental group and 98% of the patients had loss in visual acuity (Berens, C., Girard, L.J., Fonda, G. & Sells, S.B., 1957). The effectiveness of Bates method on 54 patients with myopia of -0.5D to -3.00D, found 22% improved one to two lines in Snell ens chart, 55% showed no change in visual acuity and 22% showed questionable improvement of one line or less in Snell ens chart (Hildreth, H.R., 1947). The results of an optometric training technique in 103 myopic patients shows 29% showed small improvement in visual acuity, 30% inconsistent improvement in visual acuity, 31% had no change in visual acuity and 9% had a decrease in visual acuity (Woods, A.C., 1946).

Computer Vision Syndrome: Management through Eye Relaxation Practices

The above research studies advocate eye exercises, muscle relaxation techniques, biofeedback, eye patches, eye massages, alone or in combinations and may also be recommend under corrected prescription lenses and nutritional supplements for enhancement of visual acuity. Aim: The aim of the study is to assess the effectiveness of relaxation techniques on myopia and associated symptoms among computer users. Methodology: A. Sample: 30 myopic patients constitute the sample of the present study, 15 subjects in experiment group and 15 subjects in control group. The allotment of which was based on matched control group design. The matching variables were gender, number of years of using spectacles, age, refractive condition, associated complaints, and initial visual acuity. An associated symptom included in the study is astigmatism (6 subjects in experimental group and 6 in control group). Astigmatism is a condition were a point of light cannot be made to produce a punctuate image up on the retina by any spherical correcting lens. It produces defect in visual acuity and causes the worst form of eye strain. The strain is usually worse in lower degrees of astigmatism. Aching of the eyes and head aches are common symptoms. Detailed sample distribution is provided in Table (1). B. Tools and Techniques 1. Optic lenses: This consists of a series of lenses, both concave and convex, of varying gradation starting from 0.25D. This is used to assess the visual capacity of the subject before the intervention. The minimum power of lens required to attain 6/6 and F14 vision is noted. The power of the lens is assessed with the assistance of an optician. 2. Snell ens test chart for distant vision: The chart consists of a series of letters arranged in lines each diminishing in size. A person with average visual acuity will be able to read the top letter at 60 meters, the second line at 36 meters, the third line at 24 meters, fourth line at 18 meters, fifth line at 12 meters, sixth line at 9 meters and the last line at 6meters. Vision is checked by seating the subject 6 meters away from the chart and is asked to read the chart. Depending on the number of lines the subject is able to read, the vision is graded at 6/60, 6/36, 6/24, 6/18, 6/12, 6/9, 6/6, here 6/6 vision represents normal eyesight. In our study two versions of Snell ens chart are provided, one to do the exercises and other to record vision ( this is to avoid familiarity to the chart). 3. Fine print booklet: The letters of the fine print booklet is of the same size as the smallest letters in the Fundamental test type (F14). This is one of the eye relaxation exercises. It helps in promoting attention, imagination and mobility of the eyes. The fine print is read both in candle light and bright light. 4. Ohm chart: Ohm chart has an ohm written on the centre; around it is a circle with angular projections around it. The subject is made to follow the lines in these projections

Computer Vision Syndrome: Management through Eye Relaxation Practices

very slowly and blink at each intersection. This also promotes attention and mobility of the eyes. Intervention Eye relaxation practices constitute a group of exercises involving, stimulation and relaxation of eye muscles. It is a blend of Yoga and meditation. The method alternately requires concentration and relaxation on the part of the subjects. The package of exercises includes: a) Attention to - Strokes in pictures, Words or letters, Candle flame. b) Imagination of Pictures, Letters c) Mobility of the eye Side wise movement, Upward and downward movement, Diagonal movement d) Relaxation of the eye achieved using Splashing of water, Palming, Vapor, Cold pack The subjects are asked to focus on counting during the relaxation phase. This is to ensure that the mind is in a neutral state and not influenced by positive or negative thoughts. Each practice is individually explained to the subject and monitored to ensure the correctness of performance. The subject is instructed to stop the exercises immediately if any discomfort is felt. C. Procedure The initial visual acuity of the subjects is recorded using Snell ens chart and optic lenses, with and without the aid of spectacles, and then exercises are administered under supervision. One hour each in the morning and evening and are asked specifically to avoid any change in their daily routine. At the culmination of ten sessions the visual acuity is measured again. D. Data analysis The collected data were tabulated, processed and subjected to analysis using SPSS. t- Tests reveal that no significant variation is observed between the experiment and control group in the present sample regarding gender or improvement in visual acuity. Table: 2. t- Test representing the variation in improvement in visual acuity regarding the presence of associated symptoms Significant variation is revealed between the subjects in the visual acuity in the left eye regarding the presence of associated symptom. The mean and standard deviation scores indicate that the right eye of the subjects with astigmatism and the left eye of the subjects without associated symptoms are more benefited through the practices. Studies (Banquet, J. 1973) indicate that meditation induces a shift in the dominance from the left hemisphere to the right hemisphere of the brain allowing the intuitive word less thinking to express itself

Computer Vision Syndrome: Management through Eye Relaxation Practices

and stimulations from the left side of the body to have a better representation in the brain, which leads to enhanced visual acuity in the left eye. Taking the variation regarding the presence of associated symptoms into consideration the sample is further analyzed in two groups: subjects with astigmatism and subjects without associated complaints. Table: 3. t- Test representing the variation in improvement in visual acuity in the group with astigmatism regarding experimental group and the control group Significant variation is observed in the experimental group regarding the visual acuity of the right eye. The mean and the standard deviation scores indicate that the experimental group is more benefited by the practices regarding both right and left eye. It can be assumed that the strain on the experiment group by working on computers can be reduced through the eye relaxation practices. Studies indicate that the right eye acts as the dominant eye in 70% of the population (McManus, 2002) and transient changes in myopia are common among those working on computer. Yeow and Taylor (1989) showed a myopic shift on the average of -0.12D in a group of computer workers, whereas no shift occurred in a control group of non- computer workers. Transient myopia was also reported by Watten and Lie (1992). This transient change might have been overcome through the relaxation practices, which contributed to the marked enhancement of vision in the dominant right eye. Table: 4. Correlations representing the relationship among improvement in visual acuity, age and years of using spectacles in the group with associated symptom (astigmatism) Significant positive correlation is indicated between age and the years of using spectacles (0.647* at 0.05 level of significance). Studies have shown that myopia naturally progress with age (Basso, A. et al, 2006). Improvement in visual acuity in right eye and left eye shows a negative correlation to age, indicating that early detection and treatment through relaxation is more beneficial in myopia. The number of years of using spectacles indicates a positive correlation to the improvement of visual acuity of right eye and a negative correlation to the improvement in visual acuity of left eye. Stress is seen to have a positive correlation to age (Mroczek & Almeida, 2004) and stress induced visual strain naturally subsides through relaxation. Improvement in visual acuity in right eye indicates positive correlation to improvement in visual acuity in left eye indicating that both the eyes are benefited through the practice. Table: 5. Correlations representing the relationship among improvement in visual acuity, age and years of using spectacles in the group with no associated symptoms Significant positive correlation is observed between the number of years of using spectacles and the improvement of visual acuity in the right eye (.504* at 0.05 level of

Computer Vision Syndrome: Management through Eye Relaxation Practices

significance), studies indicate that stress is seen to have a positive correlation to age (Mroczek & Almeida, 2004); and a negative correlation to the improvement of visual acuity in the left eye. Age indicates positive correlation to the number of years of using spectacles and negative correlation to the improvement of visual acuity in both right and left eyes. Improvement of visual acuity in the right eye indicates a positive correlation to the improvement of visual acuity of the left eye. The results in the above correlation indicate similar trends as indicated in the correlation shown in the subjects with associated symptom (astigmatism). Conclusion Myopia is a commonly occurring refractive condition conventionally managed through ocular interventions like use of spectacles or surgery. It has a tendency to progress with age and visual strain. Early detection and administration of relaxation practices facilitates effective management of myopia. The use of computers is seen to aggravate the strain on the eyes. The administration of eye relaxation practices has initiated visual acuity improvement in both the experimental and control group subjects. The rate of improvement is seen to be more in the experiment group in both the eyes. The strain resulting from computer usage is seen to have affected both the eyes and the dominant right eye is seen to recover more rapidly through eye relaxation practices. It can be concluded that Myopia among computer users and non computer users can be effectively managed through eye relaxation practices. Acknowledgement Heartfelt appreciation goes to the staff and management of Aurobindo School for Perfect Eyesight. Special thanks to all the participants. References Bambridge, A. (2002), Approaching Myopia Holistically: A case study and Theoretical Exploration. The Journal of Alternative and Complementary Medicine, 8 (3), 371-377. Balliet, R., Clay, A. & Blood, K. (1982), The training of visual acuity in Myopia. Journal of American Optometric Association, 1982, 53, 719 24. Banquet, J. (1973), Spectral analysis of EEG in meditation. Electroenchalography and Clinical Neurophysiology, 35, 143- 151. Basso, A., Di Lorenzo, L., Gamarossa, A. A., Corfiati, M., Ria, W., Bellino, R., Givellini, S., Lofrumento, M. & Soleo, L. (2006), Evaluation of Myopia in a group of people working with Video Terminals: first results. G Italy. Med. Lav. Ergon., Apr- Jun, 28 (2), 207-9. Bates, W.(1912), Eye training for cure of functional Myopia. British Psychological Society, 78, 1029 - 32.

Computer Vision Syndrome: Management through Eye Relaxation Practices Berens, C., Girard, L.J., Fonda, G. & Sells, S.B. (1957), Effects of Tachistoscopic training on Visual functions of Myopic patients. American Journal of Ophthalmology, 44: 25 47. Bergqvit, U.O. & Knave, B.G. (1994), Eye Discomfort and Work with Visual Display Terminals. Scand Journal Work Environment Health, Feb; 20 (1):27 33. Gottlieb RL.(1982), Neuropsychology of Myopia. Journal of Optometry and Visual Development, 13 (1), 3 27. Hildreth, H.R., Meinberg, W.H. & Milder, B. (1947), The Effects of Visual Training on Existing Myopia. American Journal of Ophthalmology, 30, 1563 - 76. Ip, J.M., Saw, S., Rose, K.A., Morgan, I.G., Kifley, A., Wang, J.J. & Mitchell, P. (2008), Role of Near Work in Myopia: Findings in a Sample of Australian School Children. Investigative Ophthalmology and Visual Science, 49, 2903 2910.

Iwakiri, K., Mori, I., Sotoyama, M., Horiguchi, K., Ochiai, T., Jonai, H. & Saito, S. (2004), Survey on Visual and Musculoskeletal Symptoms in VDT Workers. Sangyo Eiseigaku Zarshi, Nov, 46 (6), 201-12. Jacobson, N., Jensen, H. & Goldschmidt, E. (2008), Does the Level of Physical Activity in University Students Influence Development and Progression of Myopia? A 2 -year Prospective Cohort Study. Investigative Ophthalmology and Visual Science, 49, 1322 1327. Luberto, F., Gobba, F. & Broglia, A. (1989), Temporary Myopia and Subjective Symptoms in Video Display Terminal Operators. Med Lav., March- April, 80(2), 155 -63. McManus, C. (2002), RIGHT HAND, LEFT HAND. The Origins of Asymmetry in Brains, Bodies, Atoms and Cultures. London, Weidenfeld & Nicolson. Mroczek, D.K. & Almeida, D.M. (2004), The effect of daily stress, personality and age on daily negative effect. Journal of Personality, Apr, 72(2), 355 78. Rose, K.A. Morgan, I.G. Wayne, S. Burlutsky, G. Mitchell, P. & Saw, S. (2008), Myopia Lifestyle and Schooling in Students of Chinese Ethnicity in Singapore and Sydney. Arch Ophthalmology, 126(4), 527- 530. Rosen, R.C., Schiffman, H.R. & Mayers, H. (1984), Behavioral Treatment of Myopia: Refractive error and Acuity changes in Relation to Axial length and Intra ocular pressure. American Journal of Ophthalmic Physiological Ophthalmology, 61,100 5. Schneider, M., Larkin, M. & Schneider, D. (1994), The Handbook of Self-Healing. London: Penguin Arakana.

Computer Vision Syndrome: Management through Eye Relaxation Practices Sells, S.B. & Fixott, S. (1957), Evaluation of research on effects of Visual training on Visual functions. American Journal of Ophthalmology, 44, 230 - 6. Sheedy, J.E. & Shaw McMinn, P.G. (2003), Diagnosing and Treating Computer- Related Vision Problems. USA, Butterworth Heinemann. Shih, Y.F., Lin, L.L. & Hwang, C.Y. (1995), The Effects of Qi-Qong ocular exercises on accommodation. Chin Journal of Physiology, 38, 35 42.

Telles, S., Naveen, K.V., Dash, M., Deginal, R. & Manjunath, N.K. (2006), Effect of Yoga on Self rated Visual Discomfort in Computer users. Head Face Medicine, 2,46. Thompson, W.D. (1995), Effect of exercises on aspects of visual function. Ophthalmic Physiological Ophthalmology, 15, 5-12. Ustinaviciene, R. & Januskevicius, V. (2006), Association between Occupational Asthenopia and Psycho- Physiological Indicators of Visual Strain in Workers using Video Display Terminals. Med. Sci. Monit, Jul; 12 (7), CR 296- 301. Watten, R.G. & Lie, I. (1992), Time factors in VDT- induced myopia and visual fatigue: an experimental study. Journal of Human Ergol (Tokyo), 21(1), 13- 20. Woods, A.C. (1946), Report from the Wilmer Institute on the results obtained in the treatment of Myopia by Visual Training. American Journal of Ophthalmology, 29, 28 - 57. Woods, V. (2005), Musculoskeletal Disorders and Visual Strain in Intensive Data Processing Workers. Occupational Medicine, 55, 2. Yeow, P.T. & Taylor, S.P. (1989), Effects of short-term VDT usage on visual functions. Optometry and Visual Science, 66(7), 459- 466. Authors: 1. Lekshmi.K. Official Address: Research Scholar, University Library, Thiruvananthapuram. Ph: 0471 230366, 09249557222. 2. Dr. Asha. Balagangadharan. Official Address: Principal,

Computer Vision Syndrome: Management through Eye Relaxation Practices Sree Narayana Guru College, Coimbatore. Ph: 0471 2443108, 09387802284 Table: 1. Sample distribution on the basis of matching variables Gender Associated complaint Astigmatism No complaint 10 2 12 14 4 18 Group Experiment group Control group 12 3 15 12 3 15

Male Female Total

Table: 2. t- Test representing the variation in improvement in visual acuity regarding the presence of associated complaints Improvement in visual acuity Right eye Left eye Astigmatism Mean 2.50 3.00 SD .798 1.279 No associated complaints Mean SD 2.17 3.83 .985 3.502 t- values Sig.

.976 -.786

.563 .038

Table: 3. t- Test representing the variation in improvement in visual acuity in the group with astigmatism regarding experimental group and the control group Improvement in visual acuity Right eye Left eye Experimental group Mean 2.83 3.50 SD .408 1.378 Control group Mean 2.17 2.50 SD .983 1.049 1.534 1.414 .014 .687 t- values Sig.

Table: 4. Correlations representing the relationship among improvement in visual acuity, age and years of using spectacles in the group with associated symptom (astigmatism) Variables Age Age Number of years Improvement in Improvement in of using spectacles visual acuity in visual acuity in left right eye eye .647* -.041 -.248

Computer Vision Syndrome: Management through Eye Relaxation Practices Improvement in visual .647* acuity in right eye Improvement in visual -.041 .249 acuity in left eye Improvement in -.248 -.345 associated symptoms * Correlation is significant at the 0.05 level (2-tailed). .249 -.345 .356 .356

10

Table: 5. Correlations representing the relationship among improvement in visual acuity, age and years of using spectacles in the group with no associated symptoms Variables Number of years Improvement in Improvement in of using spectacles visual acuity in visual acuity in left right eye eye .354 -.052 -.226 .354 .504* -.024 .298 .298 Age

Age Improvement in visual acuity in right eye Improvement in visual -.052 .504* acuity in left eye Improvement in -.226 -.024 associated symptoms * Correlation is significant at the 0.05 level (2-tailed).