Homoeopathy in the management of computer vision syndrome

Dr Silpa Sasi D

Introduction
The massive growth of digital devices has become an integral part of daily life, and millions of individuals of all ages are at risk of CVS.Computer vision syndrome, also referred to as digital eye strain,describes a group of eye- and vision-related problems that result from prolonged computer, tablet, e-reader and cell phone use. It is also known as Digital eye strain (DES) ,Occupational asthenopia , Digital asthenopia , Video display terminal syndrome (VDTS).

The Pandemic of COVID-19 poses an important threat to the development of computer vision syndrome. The pandemic and the related quarantine measures, has led to the increase in the number of people using digital screens, especially students for e-education purposes.CVS is a serious public health issue that results in decreased workplace productivity, higher error rates, lower job satisfaction, and compromised visual ability.

Prevelance
CVS is a significant public health problem and possible occupational epidemics of the 21st century the prevalence of CVS ranges from 64% to 90% amongst computer users with nearly 60 million people affected globally. The National Institute of Occupational Safety and Health survey has reported that visual symptoms occur in 75-90% and musculoskeletal disorders occur in 22% of the people who spend three or more hours daily at a visual display terminals .Bankers, account section workers, professionals,computer workers, excessive near work by mobile, laptop or tab users are commonly affected.

Factors contributing to computer vision syndrome:

Personal factors:

• Poor sitting posture
• Improper viewing distances
• Improper viewing angle.
• Medical diseases – Systemic diseases– Dry eye is associated with some systemic diseases.eg: Sjogren syndrome, rheumatoid arthritis, and several autoimmune diseases.
• Age – Tear production normally decreases with age so older age group is commonly  affected
• Prolonged duration of usage.
• Reduced blink rate – Normally people blink 10-15 times per minute.but the rate is significantly diminished when working at a computer.
• Sex  – slightly higher among females.

Environmental factors

• Poor lighting
• Imbalance of light between the computer screen and the surrounding.

Computer factors

• Low resolution of the screen
• Poor image stability
• Poor readability and legibility
• High brightness and high contrast
• Words with capital letters are difficult to interpret compared to sentence case
• Less than one character space between lines
• Light characters against dark background or dark characters against light background
• Low refresh rates of the screen below 30-50Hz
• Reflections

Contributing factors

Ocular and extra ocular factors

• Ocular factors: Preexisting uncorrected refractive error, astigmatism, presbyopia and binocular vision (eye coordination and eye focusing), inappropriate oculomotor responses and dry eye problems can be major contributing factors to computer related eye stress.
• Lid condition: Anterior blepharitis, Meibomian gland dysfunction.
• Extraocular factors- Workplace ergonomics like improper lighting etc
• Environmental factors: Air conditioners, Dry air, Dust, Building contaminants, Exhaust fans, Low humidity

Pathophysiology:
The symptoms experienced in computer vision syndrome are caused by three potential Mechanisms: (i) Extra ocular mechanism, (ii) accommodative mechanism, (iii) ocular surface Mechanism.

• Extra ocular mechanism- causes musculoskeletal symptoms such as neck stiffness, Pain, headache, backache and shoulder pain. These symptoms are closely linked to a strained muscle caused by an incorrectly positioned computer screen.
• Accommodative mechanism- causes Blurring of vision, double vision, presbyopia, myopia and slowness of focus change
• Ocular surface mechanism- causes Symptoms such as dryness of the eyes, redness, gritty sensation and burning after extended period of computer usage.

Clinical features

• Visual symptoms-Blurred vision,Diplopia,Presbyopia,Focus change difficulties.
• Ocular  internal symptoms – Eye strain , Light sensitivity, Double vision.
• Ocular external symptoms-Burning,Dryness,Redness,Irritation,Lachrymation
• Extra Ocular Symptoms – Headache, Depression and Musculoskeletal aches.

General symptoms
Tension, Physical fatigue, Irritability, Increased nervousness, Frequent error, General fatigue, and drowsiness.

Diagnosis
Diagnosis of computer vision syndrome is chiefly done by taking detailed history and  comprehensive eye examination.it includes Patient history to determine any symptoms the patient is experiencing and the presence of any general health problems, medications taken or environmental factors that may be contributing to the symptoms related to computer use.

• Visual acuity measurements to assess the extent to which vision may be affected.
• A refraction to determine the appropriate lens power needed to compensate for any refractive errors (nearsightedness, farsightedness or astigmatism).
• Significant aqueous deficiency is assessed with basal or Schirmer test (objective measure of lacrimal secondary capacity). Normal– ≥10 mm wetting of the paper after 5 minutes.Tear deficiency – <5 mm wetting of the paper after 5 minutes.
• For symptomatology, the optometrists use the CVS-Q (Computer Visual Syndrome Questionnaire) which is a validated instrument that has good psychometric properties to measure the CVS in workers exposed to VDTs

Management and prevention

The managementof CVS requires a multidirectional approach due to the variety of complaints and it is important to consider both ocular therapy as well as adjustment of the user’s workstation and habits in an ergo-ophthalmologic approach.

Controlling lighting and glare on the device screen, creating appropriate working distances and posture for screen viewing, and making sure that even small vision issues are appropriately rectified are all important measures in preventing or reducing the visual issues linked to CVS or digital eyestrain.

• Location of the computer screen-the computer screen should be 15 to 20 degrees below eye level (about 4 or 5 inches) as measured from the center of the screen and 20 to 28 inches from the eyes.
• Position the computer screen to avoid glare, particularly from overhead lighting or windows. Use blinds or drapes on windows and replace the light bulbs in desk lamps with bulbs of lower wattage.
• Usage of Anti-glare screens.
• Seating position. -Chair height should be adjusted so the feet rest flat on the floor. Arms should be adjusted to provide support while typing and wrists shouldn’t rest on the keyboard when typing.
• Rest breaks–20/20/20 rule – After working on a computer for 20 minutes, the computer user should gaze into the distance in excess of 20 feet for at least 20 seconds.

Homoeopathic therapeutics

Gelsemium -can be beneficial in the management of symptoms of double vision especially when looking sideways, and is accompanied by a feeling of heaviness ,aching pain and redness as well as smoky appearance before the eyes .  Eyes feel bruised sensation; better by compression and lying with head high.

Physostigma-Ciliary muscular spasms with irritation after utilizing the eyes. Contraction of pupils; in morning; by small and rapid jerks, with sensitiveness to light and night blindness.

Jaborandi-Eye strain from Irritation of  electric or other artificial light. Pupils contracted; do not react to light and associated with Spasm of the accommodation while reading.

Ruta-Bad effects from over-straining eyes, from reading too much, esp. fine work at night. Sight confused, as if directed through a mist, and complete cloudiness at a distance. Obscuration of sight from reading too much, with clouds, or like a veil before eyes.

Pic acid-Eye symptoms aggravated by artificial light. The slightest excitement or mental strain, or overwork, causes headache. eye dryness, tingling, smarting, aggravated by constant use and light.

Cimicifuga-Deep seated throbbing and shooting pains in eyes, with photophobia from artificial light. Intense aching of eyeball and  Pain from eyes to top of head. Indicated in Asthenopia associated with pelvic trouble.

Lithium carb-Sensation of dryness and pain in eyes with sensitivity to artificial light. Dry eyelids. Light Sensitivity with lachrymation. Eye lids feel full and congested

Ars alb-severe eyelid dryness, particularly in the outermost layers, and on reading in the presence of light.there is redness of conjunctiva with burning pain .

Euphrasia-Eyes very sensitive to light, and candlelight, acrid water runs from them. Sensation as if dust or sand were in eyes. Eyes that feel dry and drowsy with frequent blinking due to burning and biting in the eyes

Glonoine-Black specks,sparks,flashes before the eyes.Eyes is dull,staring,sunken .letter appears small.intolerance of artificial light like candles,lamps.

References

1. Kumar singh Atul. Computer vision syndrome: A literature review of causes, symptoms and potential homoeopathic medicines. Int J Hom Sci 2019;3(3):77-81. https://www.homoeopathicjournal.com/artic les/96/3-3-7-980.pdf
2. Rathore I. Computer Vision Syndrome-An Emerging Occupational Hazard. Research Journal of Science and Technology. 2017;9(2):293.
3. ‌American Optometric Association. Computer Vision Syndrome [Internet]. American Optometric Association. 2023. Available from: https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/computer-vision-syndrome?sso=y.
4. Kiran Mallula S, Sravanthi J, Surya K, Mallula. Issue: 8. International Journal of Research and Review (ijrrjournalcom) [Internet]. 2023 [cited 2024 Dec 31];10(8). Available from: https://www.ijrrjournal.com/IJRR_Vol.10_Issue.8_Aug2023/IJRR68.pdf
5. Boericke William M. D, BOERICKS New Manual of Homoeopathic Materia Medica with Repertory; third revised and augmented edition 2015; published by B. Jainpublishers(p).
6. Farrington E.A. Comparative Materia Medica.

Dr Silpa Sasi D
PG Scholar, Department of Materia medica
Under the guidance of Dr Rs Patil HOD, Department of Materia medical, GHMC Banglore
Email : Shilpasasipkd94@gmail.com