Computer Vision Syndrome Prevalence and Ocular Sequelae among Medical Students: A University-Wide Study on a Marginalized Visual Security Issue

Abstract

Introduction: This study aimed to discover and document the potential of visual and ocular sequelae of computer vision syndrome (CVS) among medical students. Methods: This cross-sectional case-control study was conducted on medical students (n=4030) of five universities in Egypt. All students completed a specially designed and validated CVS questionnaire survey (CVS-F3). Students with ≥5 CVS symptoms constituted a risk group (n=352), while students with 1-4 CVS symptoms constituted a low-symptoms group (n=3067). Students from the control and risk groups were examined using objective methods, such as visual acuity, subjective refraction, dry eye disease tests, and anterior segment and fundus examinations. Students who complained of visual blur underwent multifocal electroretinography mfERG examinations (mfERG group). Results: The CVS-F3 indicated that 84.8% of students had complaints that might be related to CVS, however, our ophthalmic examination group revealed only a 56% CVS prevalence rate. The most common single screen type used by 70.4% of students was the smartphone, and the most common complaint was headache (50.2%). Multivariate logistic regression analysis revealed that CVS was significantly associated with increased screen-hours, including >2 screen-hours daily (odds ratio [OR], 2.48; P<0.0001), >2 screen-hours at night (OR, 1.79; P=0.003), and ≥3 screen-years (OR, 1.69; P=0.006). In the mfERG group, 37% demonstrated reduced amplitudes of mfERG rings and quadrants, indicating reduced foveal responses. Conclusion: CVS-questionnaires overestimate the true CVS prevalence and sequelae, which could be accurately detected by objective ophthalmic examination. Smartphones primarily caused CVS among students, with CVS severity increasing in correlation with shorter eye-to-screen distance and frequent use. Contact lens wearing doubled the risk of CVS development and augmented its severity. CVS might affect macular integrity with screen-induced foveal dysfunction. Clinical Trials Registration: PACTR201811618954630.

Computer Vision Syndrome in Students of a Medical School in Colombia. A Cross-Sectional Study

“…In India, 82.3% of students experienced one or more symptoms of digital vision syndrome during the intensive lockdown of COVID-19 (38). Also, accommodative asthenopia has been reported in medical students from Egypt, 84.8 to 87.9% of students had complaints included in the CVS (26,39). In another study, 95 % of medical students reported having at least one symptom of CVS during their study time (40).…”

“…Furthermore, our bivariate analysis did not show differences in terms of screen time in individuals with and without CVS. Even so, there are reports that state a direct relationship between screen time and the development of CVS (26). Tawil et.…”

“…Also, in a Mexican cohort that included 406 medical students a higher prevalence of myopia compared to other demographic groups was identified (25). Furthermore, a study on medical students of five universities in Egypt reported that CVS was significantly associated with increased screen-hours with an OR of 2.48 for 2 screen hours daily and OR of 1.69 for 3 screen hours daily (26).…”

Self-Reported Student Awareness and Prevalence of Computer Vision Syndrome During COVID-19 Pandemic at Al-Baha University

“…5,11,12,16 The available evidence suggests that as little as two hours of sustained digital device usage a day is likely to develop a range of vision-related problems. 4,17,18 Reddy et al, Mohan, et al and Iqbal et al estimated that CVS affected between 50% and 90% of students taking virtual classes in the Middle East. 5,18,19 CVS is categorized into four strains: asthenopic CVS (manifests as eye strain, eye dryness, soreness, headache, and fatigue), ocular surface CVS (dryness, grittiness, irritation, redness, burning sensation, and heaviness often due to environmental factors, blinking rates, and use of lenses/ glasses), visual CVS (double or blurred vision, presbyopia, and slow focus change), and extraocular CVS (musculoskeletal pain).…”

“…In addition to the use of more than one device, older age, employment status, sedentary lifestyles, usage of re-wetting drops, gender, and optical correction. 8,17,22,[34][35][36] It's notable, however, that self-reported awareness/complaints may be misleading in the absence of clinical assessments, particularly given leading responses in the questionnaire. Iqbal et al's study of 4030 medical students drawn from five universities in Egypt, for example, found that while self-reported awareness of CVS was 84.8%, ophthalmic assessments of the same respondents showed only 56% prevalence.…”