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Computer Vision Syndrome Survey among the Medical Students in Sohag

University Hospital, Egypt

Article · January 2018

DOI: 10.9734/OR/2018/38436

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 Ophthalmology Research: An International Journal

8(1): 1-8, 2018; Article no.OR.38436

ISSN: 2321-7227

Computer Vision Syndrome Survey among the

Medical Students in Sohag University Hospital,
Egypt
Mohammed Iqbal1*, Ahmed El-Massry2, Mohammed Elagouz1
and Hosam Elzembely3
1
Department of Ophthalmology, Faculty of Medicine, Sohag University, Egypt.
2
Department of Ophthalmology, Faculty of Medicine, Alexandria University, Egypt.
3
Department of Ophthalmology, Faculty of Medicine, Minia University, Egypt.

Authors’ contributions

This work was carried out in collaboration between all authors. Author MI designed the study,
designed the study survey questionnaire and wrote the first draft of the manuscript. Authors AEM and
ME performed the statistical analysis and wrote the protocol. Author HE managed the analyses of the
study. All authors read and approved the final manuscript.

Article Information

DOI: 10.9734/OR/2018/38436
Editor(s):
(1) Stephen G. Schwartz, Department of Clinical Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller
School of Medicine, USA.
Reviewers:
(1) Anil Kumar Verma, India.
(2) Gabor Nemeth, University Teaching Hospital, Hungary.
(3) Joseph Eldor, Israel.
Complete Peer review History: http://www.sciencedomain.org/review-history/22611

Received 27th November 2017

Accepted 15th December 2017
Original Research Article th
Published 5 January 2018

ABSTRACT

Purpose: To analyze and describe the quantitative data of a specially designed well-structured
questionnaire to survey the Computer Vision Syndrome (CVS) among the medical students in
Sohag University, Egypt.
Design: A prospective descriptive non-comparative cross-sectional study.
Methods: 100 medical students included in this study (50 males and 50 females). After explanation
of the nature of the CVS to the medical students, they fulfilled a specially designed form for CVS
survey which included 20 questions of high validity and reliability.
Results: The most remarkable result in this study was recording that 86% of the medical students
sample was used to spend 3 hours or more on a daily basis thus were complaining of one or more
of CVS manifestations. Dry eye, headache, blurred vision, eye strain, neck and shoulder pain,
_____________________________________________________________________________________________________

*Corresponding author: E-mail: [email protected];

 Iqbal et al.; OR, 8(1): 1-8, 2018; Article no.OR.38436

fatigue and eye redness were recorded in 28%, 26%, 31%, 16%, 24%, 21% and 15% respectively.
Conclusion: This study proved that CVS was a common syndrome that was simply misdiagnosed.
Based on the survey performed in this study, 86% of the medical students were complaining of one
or more of the CVS manifestations. This study recorded that dry eye, blurred vision, eye strain and
headache were the most common CVS symptoms. This study recommended performing larger
studies including many universities in Egypt, provided that the future studies should include both
objective and subjective examination tools.

Keywords: CVS; digital eye strain; dry eye disease; digital screens; smart phones.

1. INTRODUCTION mechanism, accommodative mechanism and

ocular surface mechanism [1].
In general, the definition of the computer vision
One or more factors could be responsible for the
syndrome (CVS) was referred to the American
development of CVS. These factors are
Optometric Association (AOA) which defined the
infrequent blinking, uncomfortable siting position,
CVS as a complex of eye and vision problems
prolonged continues looking at the digital
resulting from the activities which stress the near
screens, improper lightening conditions,
vision during the use of the computers and digital
ammetropia, glare and incorrect distances
screens. Vision affection results from interaction
between the eye and the computer [5].
with digital screens, computer display or their
environment [1]. In Africa, unfortunately the studies on CVS are
limited. Furthermore the use of preventive
The daily use of personal computers and digital measures of CVS is still handicapped thus
screens for 3 hours or more makes the person is augmenting the manifestations of CVS
at high risk of developing CVS, Occupational experienced by the computer users [6].
Overuse Syndrome (OOS), headache and
psychosocial stress [2]. Actually, several studies reported CVS as a
serious problem associated with long-term ocular
In modern life today, millions of people including and musculoskeletal complains that affects the
children and students are unfortunately health of the eyes and the body. Furthermore,
accustomed to use the digital screens and CVS has a negative influence on the life style,
computers for very long hours. A video display work and family relationships. Many authors
terminal (VDT) is now considered as a computer suggested several measures to treat or at least
screen. What make things worse are the new alleviate the severity of CVS manifestations.
bad habits of the school and university students These measures included treatment of any
to study their subjects using the computers refractive errors with glasses, treatment of the
instead of the classic book studies. In addition dry eye disease with tears substitutes and
they are playing games and watching movies on lubricants, use of specially designed glasses for
the digital screens [3]. the digital screens and use of screen filters. In
addition, it was also recommended that the use
Computer Vision Syndrome is also known as of the digital screens should be in an interrupted
Digital Eye Strain (DES). CVS or DES is usually short several screen time periods distributed
related to watching the computers or digital along the day not exceeding 1 hour in each
screens that make the near work of the eye more period. Another recommendation was to have at
difficult. The high visual requirements and visual least 15-20 minutes break every 2 hours of
attention makes any computer user susceptible continuous digital screen usage. The proper
developing VCS or DES [4]. room lighting, people education, periodic ocular
examination and adequate adjustment of the
The main symptoms of CVS are eyestrain, distance between the eye and the digital screens
headache, dry eyes sensation, blurred vision, were other measures to guard against CVS [7-
tearing, burning of eyes, watering of eyes, photo 16].
phobia, red eyes, burning, itching, neck and
shoulder pain, and contact lens troubles [1,5]. 2. METHODS
The possible pathophysiological mechanism The aim of this study was to perform a survey to
of CVS is three mechanisms: extra ocular detect the prevalence and severity of the CVS

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 Iqbal et al.; OR, 8(1): 1-8, 2018; Article no.OR.38436

among a sample of 100 medical students in 2.2 CVS Excel Sheet and Statistical
Sohag University, Egypt. The design of this study Analysis
was a prospective descriptive non-comparative
cross-sectional study. The approval of the ethical Microsoft Excel (Microsoft Office 2010) was used
committees in faculty of medicine in Sohag to get the CVS Excel sheet that was used by
University was taken. The survey was performed authors for data input to enter the answers of the
among medical students after full explanation of CVS questionnaire form fulfilled by the medical
the CVS questionnaire form to be fulfilled students. Thereafter, the data in the CVS Excel
according to the personal habits of every medical sheet was used for statistical analysis of the
student shared in this survey. results of the CVS questionnaire form. Data were
analyzed using the statistical package for social
2.1 CVS Survey Questionnaire Form sciences software (SPSS version 22 for
Windows). Quantitative data were described
The authors in this article created a new survey using median, mean and standard deviation. .
questionnaire which was an own-made one Qualitative data was presented as number and
designed especially for this study for the first time percentage. Paired Samples T-test was used for
ever introduced in a study concerning the CVS normally distributed data while Wilcoxon test was
survey. The questionnaire form included 20 used for non-normally distributed data.
questions designed by the authors and related to
the personal data and habits of the medical 3. RESULTS
students. To facilitate the recording and the
interpretation of results the authors used the This study included 100 medical students (50
term (screen-hours) to describe the number of males and 50 females). Age ranged from 18 to
hours the student spend every day on his 24 years.
computer or smart phone screens. Meanwhile,
the authors use the term (screen-years) to So, this study included 20 questions. The
describe the number of years the student structure of many questions of this questionnaire
previously spent watching his computer or allowed the medical students to choose more
smart phone screens with his/her routine screen- than one answer for the same question which
hours. explains the presence of different percentages
for the same question.
These 20 questions included age, gender, the
frequent computer digital screen use, the hours The first question was about the age of the
the student spend every day on his screen, the medical students and the results were 18 years
hours the student spend on his screen in dark old (7%), 19 years old (14%), 20 years old
room, whether the student screen-hours are (31%), 21 years old (18%), 22 years old (21%),
continuous or interrupted, the illumination level of 23 years old (7%) and 24 years old (2%). The
the screen in room light, the screen-hours the second question was about the gender and the
student spend more during the day or at night, results were 50 medical students were males
the presence of any symptoms of complaints (50%) and 50 students were females (50%).
related to CVS, whether the student using eye
drops or not, is the student suffering from dry eye The third question was about the frequent
disease or not, the presence or absence of the computer digital screen used by the medical
refractive errors, whether the student is using students and the results were 9% of the students
glasses or contact lenses, whether the student is were using the ordinary computer screen, 73% of
seeing the details of objects clear or hazy after the students were using laptops, 43% of the
prolonged screen-hours, any complains in the students were using Tablets/iPads/Notes, and
fingers, wrists or shoulders of the student using 81% of the students were using Android mobiles
smart phones, the number of screen-years the (eg. Samsung) while only 7% of the students
student spent on his screen, whether the were using Apple mobiles (iPhone). This is
student is using touch screen, touch pad, because most of the medical students were
not pen or the mouse and keyboard, whether the using more than one type of digital screens.
student believes that CVS affects his life style
and eye health or not and finally whether the The fourth question was about how many hours
student is willing in the future to decrease the medical students usually was spending on
his screen-hours. Fig. 1 shows the CVS their digital screens. The results were 5% of the
questionnaire form. students used to spend < 1 hour, 9% of the

3
 Iqbal et al.; OR, 8(1): 1-8, 2018; Article no.OR.38436

students used to spend 1-2 hours, 21% of the students used to spend 4-6 hours while 14% of
students used to spend 2-3 hours, 24% of the the students used to spend > 6 hours on their
students used to spend 3-4 hours, 27% of the digital screens.

Fig. 1. CVS questionnaire form

4
 Iqbal et al.; OR, 8(1): 1-8, 2018; Article no.OR.38436

The fifth question was about how many hours the The eleventh question was about using any
medical students used to spend watching their topical eye drops as a treatment for this
digital screens in the dark room. The results were previously diagnosis dry eye. The results of this
16% of the students used to spend < 1 hour, question were 13% of the students were suing
23% of the students used to spend 1-2 hours, topical eye drops to treat their dry eye disease
19% of the students used to spend 2-3 hours, while 87% of the students did not use any eye
17% of the students used to spend 3-4 hours, medication.
18% of the students used to spend 4-6 hours
while 7% of the students used to spend > 6 The twelfth question was about the presence of
hours on their digital screens in the dark room. any refractive errors. The results of this question
were 75% of the students had refractive errors,
The sixth question was about whether the hours 16% of the students had no refractive errors
the medical students used to spend on their while 9% of the students did not know their
digital screen continuous or interrupted. The refractive status.
results were 34% of the students were spending
continuous hours while 66% of the students were The thirteenth question was about wearing
spending interrupted hours on their digital glasses or contact lenses. The results of this
screen. question were 72% of the students were wearing
glasses or contact lenses while 28% of the
The seventh question was about the level of the students were not wearing any glasses or
illumination of the digital screens that the medical contact lenses.
students used to in the room light. The results The fourteenth question was about the
were 5% of the students were using ≤ 10% descriptions of the details of the objects after
screen brightness, 26% of the students were prolonged hours of using the digital screens. The
using 11%- 25% screen brightness, 33% results of this question were 67% of the students
of the students were using 26%-50% screen were seeing clear details of the objects after
brightness, 28% of the students were using 51%- prolonged hour on their digital screens while 33%
75% screen brightness, 8% of the students were of the students were seeing blurred details of the
using 76%-100% screen brightness. objects after prolonged hours on their digital
screens.
The eighth question was about the most
preferred time for the medical students to use The fifteenth question was about the presence of
their screens during the day or the night. The any complains after using the smart phones for
results were 13% of the students were spending prolonged hours. The results of this question
most of their screen hour during the day while were 43% of the students were complaining of
87% of the students were spending these hours joint pain in their fingers and rests after using
during the night. their smart phone for prolonged hours, 39% of
the students were complaining of shoulder pain,
The ninth question was about the symptoms 7% of the students were complaining of inability
related to CVS that the students complained to hold the objects well, 5% of the students were
of. The results were 26% of the students complaining of difficulty to write using the pen
complained of headache, 21% of the students while 6% of the students had no such complains.
complained of fatigue, 28% of the students
complained of dry eye, 31% of the students The sixteenth question was about the years each
complained of blurred vision, 16% of the students student spent this way and these hours on the
complained of eye strain, 1%% of the students digital screens. The results of this question were
complained of double vision, 24%% of the 2% of the students spent nearly 1 year, 3% of the
students complained of neck/shoulder/back pain, students spent nearly 2 years, 20% of the
15%% of the students complained of eye students spent nearly 3 years, 41% of the
redness and irritation while 8%% of the students students spent nearly 4 years, 34% of the
complained of difficulty in refocusing the eye. students spent ≥5 years on their digital screens.

The tenth question was about the presence of a The seventeenth question was about the type of
previously diagnosed dry eye disease. The the digital screen the students frequently used
results of this question were 28% of the students during these years. The results of this question
had a previously diagnosed dry eye disease were 92% of the students used the touch
while 72% of them did not. screens, 27% of the students used the

5
 Iqbal et al.; OR, 8(1): 1-8, 2018; Article no.OR.38436

touchpads, 2% of the students used the Note the Computer Vision Syndrome (CVS) or in
Pens while 36% of the students used the mouse another expression the Digital Eye Strain (DES)
and keyboard. This is because many students as a collection of ocular and extra ocular
had more than one choice in this question. manifestations resulting from using the digital
screens for prolonged hours. Most people who
The eighteenth question was about the usual tool have CVS usually complains of eye strain,
used by the students to study medicine. The headache, dry eye, pain in the neck, shoulders
results of this question were 6% of the students and or the back, eye redness and or irritation,
were using the digital screens to study medicine, fatigue and ocular discomfort. The severity of
61% of the students were using the books to CVS manifestation depends on the how much
study medicine while 33% of the students were time people spend on the digital screens. In
using both books and digital screens to study general, people who are accustomed to spend 3
medicine. hours or more regularly on a daily basis are
mostly complaining of CVS.
The nineteenth question was about the feeling
whether the digital screens affected the life style In this study, the authors were aiming hard to do
and the eye health of the students or not. The a good survey on CVS among medical students
results of this question were 91% of the students in Sohag University, Egypt thus were trying to
felt that the digital screens affected their life style reach a near close to the truth of the prevalence
and eye health while 9% of the students and severity of CVS manifestations from an
confirmed that the digital screens had no effects actual direct survey among the medical students.
on their life style or eye health.
This study was carried on a sample of the
The twentieth question was about the willing of medical students as a survey to have a
the students to decrease their screen hours to provisional idea about the percentage of the
guard against CVS. The results of this question medical students that is complaining of CVS. The
were 76% of the students were willing to sample in this study included 100 medical
decrease their screen hours to avoid CVS while students (50 males and 50 females). Age ranged
24% of the students confirmed that they will not from 18 to 24 years.
decrease their screen hours.
Surprisingly enough, 86% of the medical
4. DISCUSSION students sample was accustomed to using their
digital screens 3 hours or more daily which made
Nowadays, modern life style obliged the whole them very liable to suffer from one or more of
world to shift to the modern technology were the CVS manifestations. What's more amazing is
digital screens are the masterpiece of this life that 34% of the medical students were spending
process. The emergences of portable and these prolonged hours continuously on their
handheld digital screens have multiplied the digital screens. That’s why this study recorded a
number of devices used by human kind hundreds relatively high percentage of medical students
of times. In fact, smart phones have become so complaining of CVS manifestations. For example
popular that almost all teens and adults have one 28% of the medical students were complaining of
or more of these smart phones. In the last dry eye while 13% of the students were actually
decade, the emergences of the social medias using topical eye drops to treat the dry eye, 31%
and its applications such as Facebook, Twitter, of the medical students were complaining of
WhatsApp, YouTube and other social medias blurred vision, 24% of the medical students were
and applications have made a revolution in the complaining of neck, shoulder and or back pain
life style of all mankind who shifted his interest while 16% of the medical students were
towards entertainment, communications and complaining of eye strain. Headache and fatigue
watching audio-video medias that unfortunately were recorded in 26% and 21% of the students
have been consuming most of his spare time on respectively.
smart phones and digital screens on the expense
of his life style and relationships with his family, This study recorded a clear fact that smart
friends, colleagues and other humans. phones were mostly the main cause of CVS in
these students because this study recorded that
By far, the most important landmark in defining 88% of the medical students sample were using
CVS is the definition released officially from the smart phones, furthermore, 92% of the students
American Optometric Association which defined were using the touch screens.

6
 Iqbal et al.; OR, 8(1): 1-8, 2018; Article no.OR.38436

Akinbinu T. and Mashalla Y. [6] performed a Logaraj M, Madhupriya V and Hegde SK [13]
similar study as they reported their results in reported in their study that more than 75% of the
Abuja, Nigeria. In their study, the data was engineering students were affected with CVS.
collected from 100 (54 males and 46 females Their results were close to our results in this
respondents) bank employees aged from 18 to study on the medical students [13].
40 years. In a comparison with this study, the
survey included a sample of 100 medical Several studies demonstrated the drawbacks of
students (50 males 50 females) aged from 18 to CVS on human health and productivity. They
24 years in Sohag University, Egypt. In their revealed that CVS is a main cause of time
study, Akinbinu T. and Mashalla Y. [6] used a consuming, visual function affection and mental
semi-structured questionnaire containing 22 stress. This will end in decreasing the actual
items developed by the researcher using work-time hours, less productivity, absence from
question items from previous studies. Meanwhile, work and even lack personal life care and
this study aimed to perform a survey on a sample interests. That’s why these studies suggested the
of the medical students using a form consisted of use of special campaigns and advertisement in
20 questions designed by the authors to be of schools, universities and media to create a new
high validity and reliability. era of public awareness regarding risks and
drawbacks of CVS on health, work and life style
Reddy S et al. [3] performed a survey on [10-16].
university students in Malaysia. Their study
included 795 students aged from 18 to 25 years. The major disadvantage of this study was being
They recorded that the prevalence of the CVS an objective study that did not included any
manifestations was 89.9% among the university subjective tools to evaluate the medical students
students. They recorded headache in 19.7 of the and to link the results of the survey to complete
students and eye strain in 16.4% of the students. ophthalmological examination of the students'
Moreover, they stated that students who were eyes.
using the digital screens 2 or more hours daily
were complaining of one or more of the CVS By far, the CVS survey questionnaire form
manifestations. In a comparison with this study, included in this study is the first of its kind and its
the survey was performed on a sample of 100 unique design performed by the authors of this
medical students which was much lower than study has no match till now according to the
their survey sample. The major close result authors' knowledge.
between both studies was the recording of CVS
prevalence in 89.9% in their study based on the 5. CONCLUSION
2 hours daily basis use of the digital screens
which is so close to the prevalence recorded in This study proved that CVS was a common
this study of 86% of students based on the 3 syndrome that was simply misdiagnosed. Based
hours daily basis use of the digital screens. on the survey performed in this study, 86% of the
medical students were complaining of one or
Furthermore, this study included only medical more of the CVS manifestations. This study
students while their study included all university recorded that dry eye, blurring of vision, eye
students. In addition, in this study headache was strain and headache were the most common
recorded in 26% of the medical students which CVS symptoms. This study recommended
represented a higher percentage than their study performing larger studies including many
while eye strain was recorded in 16% which universities in Egypt, provided that the future
represented a very close percentage of their studies should include both objective and
study. However, in this study dry eye and blurred subjective examination tools.
vision were recorded in 28% and 31% of the
students respectively. Another important CONSENT
difference between both studies is that they
considered a regular 2 hours daily is the start of It is not applicable.
complaining of CVS symptoms while this study
recorded the start of CVS manifestation when ETHICAL APPROVAL
using regular 3 hours daily on digital screens.
These differences may be attributed to the large As per international standard or university
survey sample of their study versus the small standard, written approval of Ethics committee
survey sample in this study.

7
 Iqbal et al.; OR, 8(1): 1-8, 2018; Article no.OR.38436

has been collected and preserved by the Computer Vision Syndrome (CVS) Among
authors. Undergraduate Students in Chennai.
National Journal of Medical Research.
ACKNOWLEDGEMENT 2013;3(2):111-6.
8. Saurabh R, Shrivastava, Prateek S
The authors acknowledge the sincere help and Bobhate. Computer related health
support of Engineer Ahmed Saber and Engineer problems among software professionals in
Mostafa Saber in assisting and preparing this Mumbai: A cross-sectional study. Int. J
manuscript. Health Sci. 2012;1(2):74-8.
9. Rosenfield M. Computer vision syndrome:
COMPETING INTERESTS a review of ocular causes and potential
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especially for this study. Demographic and computer related factors
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© 2018 Iqbal et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License
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provided the original work is properly cited.

Peer-review history:
The peer review history for this paper can be accessed here:
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