Tagged Computer Monitors

Computer Vision Syndrome Affects Millions

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Credit Paul Rogers

Joanne Reitano is a professor of history at LaGuardia Community College in Long Island City, Queens. She writes wonderful books about the history of the city and state, and has recently been spending many hours — sometimes all day — at her computer to revise her first book, “The Restless City.” But while sitting in front of the screen, she told me, “I developed burning in my eyes that made it very difficult to work.”

After resting her eyes for a while, the discomfort abates, but it quickly returns when she goes back to the computer. “If I was playing computer games, I’d turn off the computer, but I need it to work,” the frustrated professor said.

Dr. Reitano has a condition called computer vision syndrome. She is hardly alone. It can affect anyone who spends three or more hours a day in front of computer monitors, and the population at risk is potentially huge.

Worldwide, up to 70 million workers are at risk for computer vision syndrome, and those numbers are only likely to grow. In a report about the condition written by eye care specialists in Nigeria and Botswana and published in Medical Practice and Reviews, the authors detail an expanding list of professionals at risk — accountants, architects, bankers, engineers, flight controllers, graphic artists, journalists, academicians, secretaries and students — all of whom “cannot work without the help of computer.”

And that’s not counting the millions of children and adolescents who spend many hours a day playing computer games.

Studies have indicated 70 percent to 90 percent of people who use computers extensively, whether for work or play, have one or more symptoms of computer vision syndrome. The effects of prolonged computer use are not just vision-related. Complaints include neurological symptoms like chronic headaches and musculoskeletal problems like neck and back pain.

The report’s authors, Tope Raymond Akinbinu of Nigeria and Y. J. Mashalla of Botswana, cited four studies demonstrating that use of a computer for even three hours a day is likely to result in eye symptoms, low back pain, tension headache and psychosocial stress.

Still, the most common computer-related complaint involves the eyes, which can develop blurred or double vision as well as burning, itching, dryness and redness, all of which can interfere with work performance.

One reason the problem is so pervasive: Unlike words printed on a page that have sharply defined edges, electronic characters, which are made up of pixels, have blurred edges, making it more difficult for eyes to maintain focus. Unconsciously, the eyes repeatedly attempt to rest by shifting their focus to an area behind the screen, and this constant switch between screen and relaxation point creates eyestrain and fatigue.

Another unconscious effect is a greatly reduced frequency of blinking, which can result in dry, irritated eyes. Instead of a normal blink rate of 17 or more blinks a minute, while working on a computer the blink rate is often reduced to only about 12 to 15 blinks.

But there are additional problems. The head’s distance from the screen and position in relation to it are also important risk factors. To give the eyes a comfortable focusing distance, the screen should be about 20 to 26 inches away from the face. The closer the eyes are to the monitor, the harder they have to work to accommodate to it.

In addition, when looking straight ahead, the eyes should be at the level of the top of the monitor. The University of Pennsylvania’s ophthalmology department advises that the center of the monitor should be about four to eight inches lower than the eyes to minimize dryness and itching by lessening the exposed surface of the eyes because they are not opened wide. This distance also allows the neck to remain in a more relaxed position.

Yet, in a study in Iran of 642 pre-university students reported in Biotechnology and Health Sciences last year, 71 percent sat too close to the monitor for comfort, and two-thirds were improperly positioned directly opposite or below the monitor.

Improper lighting and glare are another problem. Contrast is critical, best achieved with black writing on a white screen. The screen should be brighter than the ambient light — overly bright overhead light and streaming daylight force the eyes to strain to see what is on the screen. A bright monitor also causes your pupils to constrict, giving the eyes a greater range of focus.

You might need to reposition the desk, use a dimmer switch on overhead lights, or lower window shades to keep out sunlight. In addition, using a flat screen with an antiglare cover, and wearing glare-reducing or tinted lenses can help to minimize glare.

Be sure to use a font size best suited to your visual acuity, and have your eyes examined regularly — at least once a year — to be sure your prescription is up-to-date. This is especially important for people older than 40 and for children who are heavy users of computers because visual acuity can change with age. Make sure, too, that your monitor has a high-resolution display that provides sharper type and crisper images. And clean the monitor often with an antistatic dust cloth.

Those who work from printed materials, moving back and forth from them to the screen, could minimize neck strain by mounting documents on a stand next to the monitor. If, like me, you use many different printed documents at the same time, consider getting special computer glasses — bifocal or progressive lenses with the upper portion ideal for screen reading and the lower designed for print distance.

While prevention is most important, if you already have symptoms of computer vision syndrome, there are ways to reduce or eliminate them. Ophthalmologists suggest adhering to the “20-20-20” rule: Every 20 minutes, take a 20-second break and look at something 20 feet away.

Consciously blink as often as possible to keep eye surfaces well lubricated. To further counter dryness, redness and painful irritation, use lubricating eye drops several times a day. My ophthalmologist recommends products free of preservatives sold in single-use dispensers.

You can also reduce the risk of dry eyes by keeping air from blowing in your face and by using a humidifier to add moisture to the air in the room. And Dr. Reitano said her eye doctor also suggested applying warm moist compresses to her eyes every morning.

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A Reconsideration of Children and Screen Time

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Derek and Isabella Galustians play on their tablets. The siblings each have their own tablet and each have one of their parents' old phones, without a phone plan, to use apps and play games.

Derek and Isabella Galustians play on their tablets. The siblings each have their own tablet and each have one of their parents’ old phones, without a phone plan, to use apps and play games.Credit Emily Berl for The New York Times

The digital world is changing around us at a dizzying pace; parents want guidance, and pediatricians want to answer their questions with helpful and scientifically valid advice. The American Academy of Pediatrics’ policy on children and media is probably best known for two recommendations: to discourage any screen time for children under 2, and to limit screen time to two hours a day for older children.

As new technologies have transformed many aspects of daily life, new questions have arisen. Did discouraging screen time for children under 2 mean no Skyping with Grandma? Did a limit of two hours for older children mean that if a sixth-grader did her homework on her computer, as assigned, she had used up her allotment? When those guidelines were originally composed in the 1990s, screen time was essentially taken to mean time in front of the television, or time spent playing old-style computer games; by 2013, the policy had changed to limiting “total entertainment screen time” for older children, while still “discouraging” all screens for those under 2.

The children and media policy and guidelines are undergoing review and revision, but in the interim, the academy convened Growing Up Digital, a symposium of experts and researchers last May, and came up with a list of tips — “Beyond ‘turn it off’: How to advise families on media use” — published in September in AAP News, which goes to pediatricians. These suggestions were meant to expand and enhance the existing guidelines by taking notice of new technology and new science.

“We have a variety of policy statements, but technology is always faster than how we can deal with it,” said Dr. Ari Brown, an Austin, Tex.-based pediatrician who was the chairwoman of the American Academy of Pediatrics’ Children, Adolescents and Media Leadership Work Group, and the lead author of the article. “We need to be able to provide practical guidance for parents that they can use now based on science.”

Although these tips on children and media were not meant to replace the existing guidelines, they attracted a good deal of media attention themselves, some of which suggested that a major change had taken place: The collective pediatric wisdom, which had been essentially anti-screen, was now opening the door and letting in the LED light.

”When you look at the press response, this was a foreseeable response but an unfortunate response: The AAP says media is great for kids!” said Dr. David Hill, the chairman of the A.A.P. Council on Communications and Media’s executive committee, and one of the authors of the article. In fact, he continued, the message was much more nuanced: “The A.A.P. says media are diversifying, that quality of the media is critical, that there is much we still have to learn.”

The pediatric wisdom has always been that you should err on the side of protection and prevention; we advise no screens for children under 2 because there’s no evidence of benefit, and a lot of concern about harm; because we worry about what screen time may be replacing in the lives of young children, who need direct human interaction to learn and develop.

Take that Skyping-with-Grandma question (or Skyping with a deployed military parent), which keeps being raised as an example of good screen time for children under 2. Every single pediatrician I spoke with brought that up — not, I suspect, because it’s such a burning question for parents, but because it’s pretty much the best reason anyone has come up with for encouraging a very young child to look at a screen.

“There are some preliminary studies — and I emphasize preliminary — that babies as young as six months can learn from prosocial media,” said Dr. Victor Strasburger, a distinguished professor emeritus of pediatrics at the University of New Mexico School of Medicine and a co-author of the original policy statement, “but they learn 20 times better from parents. I think very judicious use of technology for under-2s may be okay, but personally I don’t see the hurry.”

I hope very much that the go-ahead-and-Skype-with-Grandma message doesn’t somehow blur into a more general sense that screens are a good idea for the very young. Grandma is a good idea for the very young, and the technology here is supporting the interacting, not displacing it.

Whatever we may learn about what young children can or cannot learn from the screens in their lives, what we know is that they need human contact and interaction — and there’s a real worry that screens may take up time and space in babies’ and toddlers’ lives and replace some of what they most need.

But Dr. Dimitri Christakis, a pediatrician who directs the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute, who was one of the authors of the existing guidelines, argued in a 2014 editorial in JAMA Pediatrics for the value of high-quality electronic experiences even for very young children, and for up to an hour a day of what might be considered playing with educational digital toys.

What we should be emphasizing for older children, he said, is that parents need to make sure that they get true nonscreen time built into their days. That means, in part, no screens in the bedroom, and cellphones left for the night in a different room. Families need to create a couple of hours of high-quality offline time each day.

Dr. Strasburger noted that the content of what children watch is very significant. “Media violence will never be good for kids; sexual content at a young age will never be good for kids; first-person shooter games will never be good for kids,” he said. “The research is very clear, and it will never change.”

Even high-quality educational electronic content shouldn’t crowd out the other parts of childhood. “Unstructured, unplugged playtime is very important for all children and especially very young children,” said Dr. Benard Dreyer, the president of the American Academy of Pediatrics and a professor of pediatrics at N.Y.U. “This does not negate the previous recommendations,” he told me. “We still don’t think kids under 2 should be watching TV; we still don’t think older kids should be spending more than two hours a day watching TV.”

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