EricN
EricN

Computer Vision Syndrome

A modern day phenomena, computer vision syndrome has emerged to be one of the predominant side-effects of prolonged computer usage.  Follow my journey of what is often a painful experience, yet gain from my experience and that of many others.

 

  • A Painful Journey
  • It Has a Name
  • Common Remedies
  • Other Remedies
  • Conclusion

 

A Painful Journey


Before 2008 I had only an intellectual understanding of chronic pain. I came from a culture where pain was a given, whether it be sore knees or stiff backs. In my case, it was literally a “pain in my neck.” But I, and my doctors, recommended that I learn to deal with it and see how that goes. Mitigating measures such as diet, exercise and more care in how I moved usually resolved the problem drug free.

Chronic pain, however, was something that happened to other people. Interestingly enough, I never connected the dots until decades later when I realized the road I had traveled. Long ago, when a young man, I played football. I had to give up the sport I loved because of incessant pain. My knees were always a problem, but I compounded that with twisted ankles, unending back pain and a growing pain in my left shoulder. I spent every day in pain. When asked, I declined an offer to play on the college team simply because I could not see how I could get through a difficult academic regimen and do so in constant pain. Pain, or fear of it, determined what path I would follow in life.

Fast forward thirty years and you begin to see the pattern of thousands of athletes. Like me, they play in constant pain. Unlike me, they begin to use prescribed pain killers and then add to that “growth enhancers”. The next thing you know they are drug-dependent. The smart ones overcome the addiction but usually at the cost of their sport careers. The rest become the sad tales of sports documentaries. Chronic pain inflicts a heavy price. It goes beyond physical health. It affects our mental health and it can have a dramatic effect on our careers.

Yes, I dodged a bullet in my college years but I did so by avoiding high-risk sports activities that I had loved. There is so much more to life than sports and it is those many, many things that made life worth living. I continued to be active and I realized that pain was often a gatekeeper. It reminded me of my limits. And every athlete will tell you that the challenge is knowing how far you can press beyond your limits, yet knowing those limits is what makes us human. So I went through life without major surgeries or painkillers.

That would end in 2008.

Before 2008 I was your typical computer geek, the new breed that emerged in the 1980’s, the kind that never went to school in computer science. I loved the IT field. I designed database systems like authors and poets write, often getting up in the middle of the night to pour out innovative solutions. I read constantly and spent hours on computer systems day and night.

In 2002 I took a position teaching at the University of Alaska Southeast. It was a great opportunity and I loved the job. UAS was innovative in that it was aggressively developing on-line courses. So aside from regular use of computers to do research and course development, I added to that hours of computer time developing on-line content which included integration of document libraries, on-line quizzes and exams, and viewing on the computer hundreds of papers (after all, I was environmentally friendly and did not want to use printers). It was also technically challenging, having to develop virtual labs as well, much of it the first time ever done on the campus.

It was in the spring of 2008 when I went to bed, very tired and quite late. My eyes were sore, as usual. I laid down and closed my eyes -- well, I tried to close my eyes. My eye lids convulsed. The pain was greater than I had noticed before. I took some pain medicine and eye drops. Eventually I dropped off to sleep. But the episode was frightening. What had just happened?

I was learning what the word “chronic” meant. Chronic pain does not go away. You begin to realize that the over-the-counter remedies you have used in the past no longer work. Even when you are not in pain, you can sense it lurking in the background. And it began to shape my mental health, even causing a reconsideration of my career. I realized that I needed some serious help. A friend recommended I contact an ophthalmologist in town. His diagnosis was that I had dry eyes. My tear ducts were not producing adequate liquid, resulting in a large part of my eye surface being dry. That being said, he recommended adjustments to my diet and a tear duct recovery prescription. Surgery was always an option, but he recommended steps that were not invasive. Six weeks later the tear duct prescription was not effective. I gave up on the prescription, but followed the other steps. The supplements of fish oil would take months, if not years, to rebuild fluid around my eyes. After about two years the eye fluid levels returned to normal. But the pain remained.

Yes, since 2008, I have been in constant pain. It is no longer a question of having pain, but rather managing pain. I also discovered that my doctor walked this journey alongside me. I even had another doctor check on his findings and they were both exactly the same. I had a riddle that was tough to solve. Yet it was a medical condition that had begun to emerge with the advent of the personal computer. It had a name -- Computer Vision Syndrome.

It Has a Name

 

I am one of those people who roll their eyes whenever someone says “syndrome.” Another “syndrome” that usually has attached to it a disability claim (and fraud), more doctor visits (that we pay for in higher insurance premiums), and more prescription drugs (with another bevy of side-effects). There seems to be a syndrome for everything. So when I heard about Computer Vision Syndrome (CVS) I thought it was a joke!

I found out about CVS through my own research over the web beginning in 2015. Year after year I had the same steady stream of symptoms: eye dryness, convulsing eye lids on rare occasions, with a steadily worsening level of migraines. What was going on? Starting with Wikipedia I discovered that CVS was in the common knowledgebase.  The references pointed me to two other resources.

First, WebMD.1 There it was in black and white. I found what had been my life for the past seven years.  Computer Vision Syndrome is any one of a list of symptoms derived from frequent use of computers: dry eyes, problems focusing, and headaches. Some of these things are nothing new and the common-sense remedies the article provides are measures ergonomic consultants have been advancing for decades (see Remedies below).

For me personally, it removed a subliminal thought that most people with chronic pain often consider -- that this is just me. Reading the WebMD article made me realize that this is a problem for millions! The article noted that many of these symptoms emerge after the age of 40 (at least for my generation). I was 53 when I first experienced chronic pain.

To re-enforce the determination and remedy of CVS, there is an article from the American Optometric Association2 that expands on the definition of CVS and provides a more technical explanation of what is occurring with our eyes, as well as the scope of the problem. Both WebMD and AOA noted that the age in which CVS is encountered has dropped significantly with the advent of tablets and smartphones.

Common Remedies

 

If there is good news about CVS it is the word “temporary”. But as my life story testifies, “temporary” is a matter of perspective. Objectively, CVS is remedial. Alarming articles documenting CVS in children, for example, usually present behavior modification as a simple way to overcome CVS. But some affects can be permanent. Our behavior may explain why some of us have bi-focal lenses, or may explain why some of us have been near-sighted. These changes to our eye sight do not go away. If they are resolvable, it may take decades to repair. Remedies described below are frequently listed and will prove helpful in mitigating the chronic pain.

  • Location of Computer Screen -- Some remedies are now commonly understood ergonomic habits that can improve the health of your eyes. For example, computer screens should be in a comfort range where your face and your eyes are viewing the computer screen with the least amount of strain and movement. In most cases, a screen should be below your normal eye level.

  • Use glasses as designed. I wear computer-range glasses when I work on computers or similar office functions. It is a mid-range vision correction that makes working on computers much easier on the eyes. If you are finding that reading glasses do not focus without bending over your work, then see an optometrist and procure computer glasses.

  • Reference materials should be placed near the keyboard and below the monitor. In other words, your eye movement should be minimal and your head not moving. This is a frequent problem and is resolved through a proper design and use of your office space.

  • Lighting is probably the most controversial and frequently mentioned issue in the press. Part of this is due to the technological and ecological changes in the past fifty years. First, incandescent lights were replaced by fluorescent tubes. Then they were replaced beginning about 2010 with LED lights. Unfortunately, each has their own drawbacks. Incandescent are high-energy consumers and are being banned in many countries. Fluorescent lights have a pronounced cycle that pulsates light 40-60 times per second. LEDs solve this through cycle rates 1000 times a second, but the type of LED light (or “temperature”) can cause eye strain.


The solution is to avoid what is called “competitive lighting,” where the image displayed on the screen is compromised by outside lighting. A great example of that is when you are trying to use your tablet or smartphone in bright sunlight. Moving to the shade solves that problem. But we may have degrees of outside glare affecting our work environment. Position the screen and window shades so that the image is clear and easy to view.

  • Screen Filters -- Can’t believe that these things are coming back. Screen filters became the rage back in the days of the cathode-ray-tube displays. With the bubble surface, glare and reflection were a real problem. Screen filters “flattened” the display, adding contrasts and filtering out harmful emissions in some cases. It also added security, making it more difficult for people to casually glance at the screen. Only the person immediately in front of the screen could see the image.

    Today’s LCD screens do not pose the same type of problem. Screens are not only flat, but some are actually convex. Not all filters work effectively. Best approach, if working in a larger office, is to experiment with different types of filters and see what works best for your environment. Personally, I find LCD screens very easy on my eyes without any filters. But that only holds true if I work on removing “competitive light.”

  • 20-20-20 Rule -- This, more than any other remedy, is mentioned by safety officials, unions and doctors. Take frequent breaks, ideally looking away from your computer every 20 minutes for 20 seconds, and work at blinking 20 times a minute. I find that rule tough to follow, so what I do is divide up the day a bit more than I had before. I now take breaks mid-morning and mid-afternoon away from the computer. I literally walk away from it. I often take reading material or work on functions that are not computer-related.

Other Remedies

 

Not mentioned by the AOA or WebMD are some ideas I have encountered through my doctor, articles on the Internet and general observation.

  • Stop looking at computers and smartphones sometime during your day. This is an existential shift as research has shown how constant, 10-12 hours of computer use, has diminished our physical and mental health. It destroys relationships. In my case, I had to simply stop using the computer when I came home. Being an IT guru, I had volunteered my time for non-profits and I simply had to walk away from that type of charitable work. If you find it difficult to reduce computer usage at work, you can endeavor to do so at home.

  • Change your diet -- The most effective, long-term solution to dry eyes is changing work habits and taking fish and flaxseed oil. Work and diet go hand-in-hand.

  • Windows 98 graphic display level -- that’s a weird one, but it is truly significant. The key CVS factor is eye strain -- and having translucent, 3-D rendering of objects on your computer screen may seem cool, it is hard on the eyes. I improved my situation significantly when I went back in time to use a simpler graphic presentation from Windows 98 (explained in detail below).

  • Experiment with High Contrast -- All operating systems have tools for disabilities, one of which is “high contrast” settings for the display. Essentially, it switches your foundation color to black. Anyone old enough to remember the DOS days will immediately recognize the simple graphics. I am quite fortunate that much of my work is in terminal sessions with Linux systems, so I work with those old-fashion displays with a black background. That is quite easy on my eyes. You will find, however, that switching to High Contrast mode can be difficult if the applications you use do not adapt to the settings. I see this most frequently with web sites where fields completely disappear. I have found office applications generally adaptive, but I frequently encountered documents that were not. (Explained in more detail below).

The Heavy Hitter -- Painkillers

 

Before proceeding further, the worst aspect of CVS is pain. It is the most immediate concern and the “solutions” are tempting and readily available through your doctor. The remedies mentioned above all come into play. They diminish the pain. They make it possible to work another day at a job you love. But migraines do not play nice. The worse, for me, is getting a cold and coughing and/or sneezing. Whenever that happens, my eyes feel like they are going to explode. It sucks the life out of you. It is no wonder that the first “other remedy” people reach for is painkiller.

For me, the pain is in the back of the eyes. MRI results showed nothing, so it has baffled doctors. If you check into pain clinic sites on the web, you will notice that pain is not always something that you can point at, apply a cure and have it go away. Something is causing it. Drugs may diminish it, but it is always there.

The pain in my eyes was so great in 2008 that I thought I could not continue in my career. When the Forest Service hired me in January 2009 I entered into the office with a bit of trepidation. Could I do this? That is a terrifying thing to encounter. I not only took each day at a time, but each hour at a time! It was that bad.

What saved me? Oddly enough, it is the fact that a large share of my work is on AIX and Linux systems. While the Forest Service (where I work) uses Windows for the desktop computers, most of my screen is taken up in “shell sessions”, connections to remote AIX or Linux systems.  My screen was filled with windows of black background with amber, green or red lettering. In other words, what most users encountered in the early 80’s before the advent of color monitors. In the early 80’s, everyone did their work on black-background screens with bright lettering. The end result? It ia a lot easier on the eyes.

Example of how a shell session screen appears. Example of how a shell session screen appears.

 

 

I was so relieved to discover that I could do this work. But the migraines still lingered. It was becoming clear by 2014 that work habits and diet changes were not going to lick this problem.

Migraines are a monster. One solution was migraine pain medicine that you could purchase at the local grocery store. What I found interesting, however, is that retail migraine pain medicine is not available in Canada! It can only be prescribed. Upon researching why that is so I discovered that perpetual use of this type of medicine ( I took two pills daily ) would eventually have side-effects. Almost any over-the-counter medicine, taken on a routine basis, will have a side-effect. It was becoming apparent to me that I had to get off these pain killers.

The next level is prescribed solutions. I go back to my “old school” philosophy regarding pain. Most everyone in my extended family despises medications. And I have noticed that practitioners and some doctors are quick to take out the prescription pad. I typically balk at medications. When you do take medications, take it slow. Trust your body. See what it tells you. And learn the side-effects. Not having migraines and even feeling euphoric may sound appealing, but the costs to your kidneys, liver, bodily fluids and gut may make you think twice. Despite what doctors tell you, interactive effects of multiple medications (something older people are increasingly encountering) are hard to nail down. I carefully study the properties of the medicine being prescribed and potential side-effects. If at all possible, evaluate a medication without the use of other medications. As always, inform your doctor and seek his or hers advice before changing the use of any medications.

Screen Filters and Eyewear

 

I need to expand on this subject further. I thought screen filters would be an easy thing to write. I have purchased filters in the past for the old cathode-ray monitors. The filters were generally inexpensive (about $30) and did a good job at removing background glare.

Not so with the LCD screens. My usual office supply stop on the internet proved both a bit disappointing and confusing. First, one of the remedies for CVS is to use a larger screen. My screen is a 27” diagonal and, believe it or not, a screen filter of that dimension was not included by the office supplier. Second, the technical name of these add-ons is “privacy filter”. Privacy filters narrow the range of visibility of the monitor so that content can only be viewed immediately in front of the monitor. Like the old screen filters, they also deaden the light emitted from the screen.

But do they actually filter harmful light? The answer is actually no, but yes. First of all, LCD screens are by design flat screen and non-reflective, which eliminates two elements of eye stress. Second, the fact that they are called “privacy filters” seems to imply that the primary function of the add-ons is to guard confidentiality. They are not necessarily claiming that it filters out harmful light.

But as it applies to actually filtering harmful light, the solutions are basically two options:

  • Apply a UV filter over the monitor

  • Purchase filter glasses

The latter is not too pricey (~ $80). A good starting point is Gunnar for simple UV-protecting goggles (Warning, you may look like one of the X-men). Costco expands on this theme in two respects. First, it addresses the importance of procuring computer glasses, a mid-range lens that is designed to minimize stress from focusing. Secondly, you can add UV protection to your eyewear.

The other option is to purchase a blue-light filter for the monitor. It can be surprisingly expensive, often as much or more than the monitor itself. A filter worth its money will do two things. First, it will filter out blue-light emissions from the monitor. Secondly, it will eliminate reflective light, making the contrasts sharper. This is most readily evident for users of tablets and smartphones who often must deal with strong sunlight. Applying a filter will make it possible to see images clearly. A good resource on learning more about the technology is NuShield. Better yet, the costs of adding this thin sheet of material is as low as $35.

 

Example of Windows Classic Example of Windows Classic

Using Windows Classic

 

I actually tripped across this option through my Linux desktop at home. I noticed how the designers of Ubuntu (a Linux distributor) had used the KISS principle in the original install of the platform. The desktop was very easy on the eyes because it was simpler. So I returned to the Windows system I used at work and started experimenting with “Themes”.

  • Right-click over your desktop and select Personalize
  • Scroll down and you will see at the bottom “Basic and High Contrast Themes”
  • Select Windows Classic

Using the screen above, you can see how the graphics is “older” technology. The objects have sharper edges, the colors a bit bolder. Much of this is obtained by clicking the “Windows Classic” theme. I fine-tuned my theme using the “Window Color” tool. I rim the window I am in with a red border, and made menu options red. You notice how the background on the title bar is dark with white letters -- again, something that is easy to see.

If there is a drawback it is that not all applications that run on the Windows platform inherit all these properties. Not even Microsoft Office applications. Furthermore, it appears that Windows 10 may not provide a Windows Classic option.

Example of High Contrast mode. Example of High Contrast mode. Note how High Contrast is not universal, even within Windows.

High Contrast

 

High contrast display themes are rather fun -- but often impractical. I encourage everyone to try it. You may be surprised at the possibilities. Basically, you go back to the pre-VGA days where the color pixels were bigger. That red-on-black screen displayed earlier in the article becomes the rule for Word, Excel and Outlook and Internet Explorer. If the course of my day only involved what was on my computer, things would be fine. Unfortunately, many web sites are not designed for high contrast. I found that some data entry fields were invisible and controls were hard to identify. If it was not for the web sites, I would probably stick with high-contrast.

In conclusion, it is theoretically possible to switch between high-contrast and Windows Classic but you will probably find it cumbersome.

 

Conclusion

 

The conclusion is that CVS will stay with you for a long time. The good news is that many of the symptoms that accompany CVS can be mitigated through changes in work habits, diet and reducing the use of computer devices while at home. I have found working with an ophthalmologist preferable to an optometrist because how CVS generates migraines is still a mystery and they can also work with ear-nose-throat (ENT) specialists.

Most importantly -- you are not alone. I did an informal survey of colleagues in my office and I was surprised how many had experienced various aspects of CVS and that many had been walking the same path as I. It is actually through much of their input that new ideas were introduced and which I have included in this article.

Resources