Risk Factors of Computer Vision Syndrome among College Students and Employees in Jeddah
2 Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, Kingdom of Saudi Arabia, Email: [email protected]
3 Department of Medicine, IbnSina National College for Medical Sciences, Jeddah, Kingdom of Saudi Arabia, Email: [email protected]
4 Department of Medicine, King Abdul-Aziz University, Jeddah, Kingdom of Saudi Arabia
5 Department of Medicine, Taif University, Taif, Kingdom of Saudi Arabia
Citation: Al-Manjoumi AM, et al. Risk Factors of Computer Vision Syndrome among College Students and Employees in Jeddah. Ann Med Health Sci Res. 2021;11:1540-1545.
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Background: Computer Vision Syndrome (CVS) described by the American Optometric Association (AOA) as “The complex of eye and vision problems related to near work experience during computer use.” The current study aims to evaluate the prevalence of CVS and the association between CVS symptoms with age and behavior’s, among college students and employees in Jeddah, Saudi Arabia. Subjects & Methods: This was a cross-sectional analytic study conducted in Jeddah, Saudi Arabia from July to August 2020. The study targets college students and employees living in Jeddah, Saudi Arabia, from July 2020. The target sample size was a minimum of 377 that was calculated using raosoft. Data entry was performed by Microsoft Excel 2019, and analysis was done using Statistical Package for the Social Sciences (SPSS) software, version 25. Frequency, descriptive analysis, Chi-square, and One-way ANOVA was performed. P-value of <0.05 was considered statistically significant. Results: Overall, 786 responses were received, only 459 met the criteria of which 277 (60.3%) were college students and 182 (39.7%) were employees. Pain in and around the eyes 288 (66.5%) and sore eyes 247 (57%) were the most commonly reported ocular symptoms among participant and in terms of extra-ocular symptoms; headache 355 (82%) and neck and shoulder pain 237 (55%) recorded highest. The highest number of symptoms was reported by IbnSina National College (ISNC) students with approximately a mean number of symptoms 7 ± 3.443. Conclusion: Computer Vision Syndrome is a common syndrome among college students and employees.
Computer vision syndrome; Prevalence; Risk factors; Jeddah; Saudi Arabia; Computer users; Ocular symptoms
Computer Vision Syndrome symptoms are classified into ocular symptoms such as eye strain, blurry vision, and dry eyes, and extraocular symptoms which includes pain in the neck or shoulders or numbing in the hands or fingers.  CVS is a growing public health problem that is not clearly understood.  The usage of computers and other digital devices for an extended period causes the rise of CVS symptoms later on in the future. [1,3] AOA found that 14% of patients who visit the ophthalmology clinic for visual examinations have CVS.  On average more than 50% of the work environment now uses computers in their job; thus, nearly 60 million people experience ocular problems.  The most frequently occurring health problem among computer users are CVS, [6–9] followed by wrist and shoulder pain and overuse syndrome to musculoskeletal injuries. [10,11]
Subjects and Methods
The study was approved by Dr. Soliman Fakeeh Hospital Scientific Research Review Committee (DSFH IRB). It was a cross-sectional analytic study conducted in the Jeddah region of Saudi Arabia from July to August 2020.
The study targets college students and employees in Jeddah, Saudi Arabia. Those diagnosed with underlying systemic diseases (diabetes, hypertension, hypothyroidism, hyperthyroidism), who had pre-existing eye diseases (such as Glaucoma, Sjogren syndrome, LASIK surgery done less than a year), they’re not employees nor college students and those who wear contact lenses were excluded.
The target sample size was a minimum of 377 that was calculated using Raosoft software.
A validated electronic questionnaire was taken from a study conducted in Sri Lanka that was used for measuring the CVS symptoms. 
The used survey was translated into Arabic and subjected to a process of forward and backward translation.
All information in this study was confidential, and the participants’ privacy was protected with no access to data other than those authorized. The survey was legally permitted and socially accepted.
Data was collected through an online questionnaire constructed on Google Forums from the month of June to July 2020. A link to the questionnaire was provided through social media platforms such as Twitter and WhatsApp.
Data entry was performed by Microsoft Excel 2019, and analysis was done using Statistical Package for the Social Sciences (SPSS) software, version 25. Frequency, descriptive analysis, Chi-square and One-way Anova was performed. P value of <0.05 was considered statistically significant.
Overall, 786 responses were received in this study, only 459 met the criteria of which 277 (60.3%) were college students and 182 (39.7%) were employees.
The majority of 261 (56.9%) of the study population belonged to the age category of 20 years-29 years, with a mean age of 2.30 years ± 0.8 years.
King Abdul-Aziz University (KAU) students represent the majority of the included students 99 (35.7%), followed by IbnSina National College (ISNC) for Medical Science 37 (13.4%).
Regarding the ocular symptoms of CVS, it was noted that pain in and around the eyes 288 (66.5%) and sore eyes 247 (57%) were the most commonly reported ocular symptoms among participant and in terms of extra-ocular symptoms; headache 355 (82%) and neck and shoulder pain 237 (55%) recorded highest. The frequency of reported behaviors were as follow: Spending 6-9 hours on a computer 207 (48%), using both postures; laying and sitting 270 (62.6%), using a light bulb 272 (63.1%), and adjusting computer brightness 325 (75.4%) [Tables 1 and 2]. Association between number of symptoms with age and college/ university Participant aged 20 years-29 years old and those more than 40 years of age reported experiencing the most symptoms.
|Table 1: Frequency of variables.|
|Age||less than 20 years||54||11.80%|
|more than 40 years||47||10.20%|
|Dar Al-Hekma university||9||3.20%|
|Using computer during work/study||yes||433||94.30%|
|Time during LASIK surgery||less than a year||0||0.00%|
|more than a year||59||100.00%|
|Number of working hours you spend on the computer||less than 2 hours||50||11.60%|
|more than 9 hours||67||15.50%|
|Breaks between work||every 30 minutes or less||162||37.60%|
|every 30-60 minutes||154||35.70%|
|every 60 minutes or more||115||26.70%|
|Posture while using the computer||sitting||155||36.00%|
|Source of light||natural light||159||36.90%|
|Adjust computer brightness||yes||325||75.40%|
*KAU: King Abdul-Aziz University; *ISNC: IbnSina National College for Medical Science; *FCMS: Fakeeh College for Medical Science; *BMC: Batterjee Medical College; *CBA: College of Business and Administration; *KSU: King Saud University
|Table 2: Frequency of CVS Symptoms.|
|Pain in and around the eyes||yes||288||66.50%|
|Blurred near vision||yes||158||36.50%|
|Blurred distant vision||yes||216||49.90%|
|Twitching of eyelids||yes||130||30.00%|
|Changing in visualizing colour||yes||37||8.50%|
|Neck and shoulder pain||yes||237||55.00%|
|Numbing in hands and fingers||yes||177||41.10%|
Of the study sample, 261 participants were between 20 years and 29 years old with a mean number of symptoms 6.24 ± 3.58.
While the mean number of symptoms affecting those more than 40 years of age was 6.255 ± 3.36. The difference was statistically insignificant (p=0.26, one-way anova) [Table 3].
|Table 3: Number of symptoms associated with age.|
|Less than 20 years||54||4.8704||3.11446||0.26|
|20 years-29 years||261||6.2452||3.58002|
|30 years-39 years||97||5.4536||3.44607|
|More than 40 years||47||6.2553||3.36522|
These values were calculated using One-way ANOVA
Significant association was found with headache and age with (p=0.012, chi-square) and it was the most common associated symptom overall, especially with individuals more than 40 years old with 43 (95.6%). Pain in and around the eyes was common among individuals between 20 years-29 years with 165 (67.9%). Blurred near vision was more common in individuals above 40 years of age 26 (57.8%) with a significance of p=0.018. Back pain was reported highest among participant aged more than 40 years old 27 (60%) with a significant association of (p=0.002) [Table 4].
|Table 4: Number of symptoms associated with age.|
|Less than 20 years||20 years-29 years||30 years-39 years||More than 40 years|
|Pain in and around eyes||33||62.30%||165||67.90%||61||66.30%||29||64.40%||0.867|
|Blurred near vision||17||32.10%||85||35.00%||30||32.60%||26||57.80%||0.018*|
|Blurred distant vision||29||54.70%||134||55.10%||37||40.20%||16||35.60%||0.016*|
|Twitching of eyelids||10||18.90%||90||37.00%||22||23.90%||8||17.80%||0.003**|
|Changing in visualizing colour||3||5.70%||27||11.10%||3||3.30%||4||8.90%||0.108|
|Neck shoulder pain||23||43.40%||139||57.70%||48||52.20%||27||60.00%||0.228|
|Numbing in hands fingers||14||26.40%||101||41.90%||41||44.60%||21||46.70%||0.121|
The mean number of symptoms affecting those college/ university students; the highest number of symptoms was reported by ISNC students with approximately a mean of 7 ± 3.443 symptoms. The difference was statistically insignificant (p=0.293) [Tables 5 and 6].
|Table 5: Number of symptoms associated with college/university.|
|Dar Al-Hekma university||9||4.4444||3.2059|
|Table 6: Association between CVS behaviours and Symptoms.|
|Categories||Number of symptoms|
|Number of working hours you spend on the computer||Less than 2 hours||4.54||2.4||11.60%|
|2 hours-5 hours||5.62||3||24.80%|
|6 hours-9 hours||6.57||3.35||48.00%|
|More than 9 hours||7.67||3.39||15.50%|
|Breaks between work||Every 30 minutes or less||6||3.2||37.60%|
|Every 30 minutes-60 minutes||6.06||3.2||35.70%|
|Every 60 minutes or more||6.92||3.46||26.70%|
|Posture while using the computer||Sitting||5.89||3.05||36.00%|
|Source of light||Natural light||5.65||3.34||36.90%|
|Adjust computer brightness||yes||6.32||3.25||75.40%|
Association between computer vision syndrome symptoms and behaviours/risk factors Participants who spent more than 9 hours on the computer had a mean symptom number of 8, while those who spent less than 2 hours had a mean symptom number of 5.
The majority of college students and employees take a break every 30 minutes, or less 162 (37.6%) have a mean of 6 symptoms, but on the other hand, those who had breaks every 60 minutes or more had mean symptoms number of 7.
Regarding the posture used during computer usage, those college students and employees who use both sitting and lying position while using the computer experience a mean symptom number of 7 compared to sitting alone with a mean number of 6. Using a light bulb showed a higher mean number of 7, while those participants who adjust their computer brightness showed a mean number of 7. Participants who don’t use contact lens experience a mean symptom number of 7.
Association between CVS Symptoms with Occupation. College students reported having higher symptoms than employees which is shown in [Table 7]. There was no significant association between CVS symptoms and occupation.
|Table 7: Association between CVS symptoms with occupation.|
|Pain in and around the eyes||yes||180||67.70%||108||64.70%||0.5899|
|Blurred near vision||yes||93||35.00%||65||38.90%||0.465|
|Blurred distant vision||yes||147||55.30%||69||41.30%||0.0064**|
|Twitching of eyelids||yes||89||33.50%||41||24.60%||0.0627|
|Changing in visualizing colour||yes||26||9.80%||11||6.60%||0.3278|
|Neck or shoulder pain||yes||147||55.70%||90||53.90%||0.7914|
|Numbing in hands or fingers||yes||103||39.00%||74||44.30%||0.3229|
The prevalence of CVS found to be (91.7%) without headaches since our definition of CVS consisted only of eye/visual symptoms apart from headache which was contrasted with a study had done by which had a prevalence of 67.4%.  The headache is a symptom that is felt in various situations regardless of whether it is due to CVS. Correspondingly, another study among medical and engineering students in Chennai has found a higher prevalence of CVS (80.3%).  Contrarily previous studies on CVS from Malaysia (68.1%) and Nigeria (74%) have demonstrated lower results. [1,14]
Those aged between 20 years-29 years and more than 40 years old found to have a high number of symptoms with a mean of 6.2 compared to those aged less than 20 years old. Similarly, Priyanka found a significantly higher prevalence of CVS among those aged over 40 years (72.7%) to those aged less than 20 years old (58%).  A possible explanation is due to those aged more than 40 years are exposed and dealt with computers more frequently than those less than 20 years of age.
In our study, the most common reported ocular symptoms are pain in and around the eyes (66.5%), followed by sore eyes (57%). While in extraocular symptoms, headache (82%) was the most common followed by neck and shoulder pain (55%). In a study carried out in Saudi Arabia, Jeddah, excessive tearing (20.6%), followed by a feeling of dryness (20.3%), was observed to be the highest in extraocular symptoms by Ghufran A. Abudawood.  In Iran, the most frequent ocular problems were a pain in and around the eyes (41%), then excessive watering (18%) followed by burning, then itching in eyes (15%). 
The most commonly reported symptom in computer users and several other similar studies is a headache. [4,14,17] If a computer user needs to view the computer screen while looking at a paper on the table from time to time, the eyes constantly adjust with focusing and refocusing. These constant changes take place thousands of times when a computer user stares at a computer screen for hours, which then stresses the eye muscles leading to eye fatigue and discomfort, causing headaches. 
This study, students who spend more than 9 hours working on the computer were significantly at higher risk of CVS than those who spend less than 2 hours. In contrast, Al Rashidi and Ghassemi-Broumand reported that students who spent more than four hours were significantly at higher risk of CVS than those who spent less than four hours. [13,19] A study conducted in Malaysia stated that the hours of computer usage per day were significantly associated with CVS. Working with a computer for more than 7 hours per day was predisposing a person to get CVS.  Another study conducted by Shrestha reported that visual symptoms aggravates with increasing hours spent on the computer.  Also Rahman and Sanip in their study documented that more than 7 hours of computer usage is significantly associated with symptoms of CVS. 
The frequency of taking breaks was not associated significantly with CVS which is supported by the same finding in previous studies. [4,12,19] In contrast, Hassan et al. found that taking short breaks every 30 minutes decreases visual discomfort every hour. [21,22]
However, a study carried out by Leon Straker found that musculoskeletal complaints get worse by sitting position.  A significant association was noted regarding the source of lighting and symptoms of CVS in this study. On the contrary, a study conducted on medical students in Saudi Arabia pointed out that there was no significant association. Adjusting the computer brightness was not significantly associated with CVS. This is consistent with a study conducted in Sri-Lanka, which illustrates that no association was found between adjusting the brightness of the screen and angle of gaze. 
There are several limitations to this study first this is a crosssectional study, ophthalmic examination was not included, and the symptoms reported were self-reported. Secondly, this study was only conducted in Jeddah therefore we can’t generalize the results. Thirdly those participants’ ages 20 years-29 years were more than the rest of the age group. As well as participants from different colleges and universities were inconsistent. It is recommended that screen brightness and room lighting should be balanced. As well as limiting the number of working hours while using a computer.
Computer vision syndrome is a common syndrome among college students and employees.
This study was done during Research Summer School -Road of Change FCMS/2020. The authors declare no conflict of Interest. Also, the authors would like to express their sincere gratitude to their colleague for their help in analysis of the data: Khalid Abdulrahman Alghamdi; a medical student from King Abdul- Aziz University.
- Rahman ZA, Sanip S. Computer user: Demographic and computer related factors that pre dispose user to get computer vision syndrome. Int J Bus Humanit Technol. 2011;1:84–91.
- Akinbinu TR, Mashalla YJ. Impact of computer technology on health: Computer Vision Syndrome (CVS). Medical Practice and Reviews. 2014;5:20–30.
- Assefa NL, Weldemichael DZ, Alemu HW, Anbesse DH. Prevalence and associated factors of computer vision syndrome among bank workers in Gondar City, northwest Ethiopia, 2015. Clinical Optometry. 2017;9:67.
- Reddy SC, Low CK, Lim YP, Low LL, Mardina F, Nursaleha MP. Computer vision syndrome: A study of knowledge and practices in university students. Nepal J Ophthalmol. 2013;5:161–168.
- Logaraj M, Priya VM, Seetharaman N, Hedge SK. Practice of ergonomic principles and Computer Vision Syndrome (CVS) among under graduates students in Chennai. National Journal of Medical Research. 2013;3:111–116.
- Dainoff MJ, Happ A, Crane P. Visual fatigue and occupational stress in VDT operators. Hum Factors. 1981;23:421–437.
- Dillon TW, Emurian HH. Reports of visual fatigue resulting from use of a video display unit. Comput Human Behav. 1995;11:77–84.
- Singh S, Wadhwa J. Impact of computer workstation design on health of the users. Int J Hum Ecol. 2006;20:165–170.
- Sen A, Richardson S. A study of computer-related upper limb discomfort and computer vision syndrome. J Hum Ergol. 2007;36:45–50.
- Laeser KL, Maxwell LE, Hedge A. The effect of computer workstation design on student posture. Journal of Research on Computing in Education. 1998;31:173–88.
- Atencio R. Eyestrain: The number one complaint of computer users. Computers in Libraries. 1996;16:40–43.
- Ranasinghe P, Wathurapatha WS, Perera YS, Lamabadusuriya DA, Kulatunga S, Jayawardana N, et al. Computer vision syndrome among computer office workers in a developing country: an evaluation of prevalence and risk factors. BMC Res Notes. 2016;9:1–9.
- Logaraj M, Madhupriya V, Hegde SK. Computer vision syndrome and associated factors among medical and engineering students in Chennai. Ann Med Health Sci Res. 2014;4:179–185.
- Akinbinu TR, Mashalla YJ. Knowledge of computer vision syndrome among computer users in the workplace in Abuja, Nigeria. J Physiol Pathophysiol. 2013;4:58-63.
- Abudawood GA, Ashi HM, Almarzouki NK. Computer vision syndrome among undergraduate medical students in king abdulaziz university, Jeddah, Saudi Arabia. J Ophthalmol. 2020;2020.
- Ghassemi BM, Ayatollahi M. Evaluation of the frequency of complications of working with computers in a group of young adult computer users. Pak J Med Sci. 2008;24:702–706.
- Shrestha GS, Mohamed FN, Shah DN. Visual problems among Video Display Terminal (VDT) users in Nepal. J Optom. 2011;4:56–62.
- Yan Z, Hu L, Chen H, Lu F. Computer vision syndrome: A widely spreading but largely unknown epidemic among computer users. Comput Hum Behav. 2008;24:2026–2042.
- Noreen K, Batool Z, Fatima T, Zamir T. Prevalence of computer vision syndrome and its associated risk factors among under graduate medical students of urban Karachi. Pak J Ophthalmol. 2016;32.
- Shrivastava SR, Bobhate PS. Computer related health problems among software professionals in Mumbai: A cross-sectional study. Int J Health Allied Sci. 2012;1:74.
- Hassan A, MMK B. Prevalence of Computer Vision Syndrome (CVS) amongst the students of Khyber medical university, Peshawar. Islamabad Congress of Ophthalmology. 2017;15:59.
- Straker LM, Smith AJ, Bear N, O’Sullivan PB, de Klerk NH. Neck/shoulder pain, habitual spinal posture and computer use in adolescents: The importance of gender. Ergonomics. 2011;54:539–546.