Journal of Occupational
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Rafsanjan university Of medical sciences
Volume 12, Issue 4 (Autumn 2023)
J Occup Health Epidemiol 2023, 12(4): 278-288 |
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Abbaslou H, Alaei Z, Safari M, Alboghobeish A, Salehi Sahlabadi A. The Effect of Computer Vision Syndrome on Sleep Quality in Users of Digital Displays: A Systematic Review. J Occup Health Epidemiol 2023; 12 (4) :278-288
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1- M.Sc. in Occupational Health Engineering, Dept. of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
2- Assistant Prof., Dept. of Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3- Ph.D. Student in Occupational Health, Dept. of Occupational Health and Safety at Work, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
4- Assistant Prof., Safety Promotion and Injury Prevention Research Center, Dept. of Occupational Health and Safety at Work, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ,asalehi529@gmail.com
2- Assistant Prof., Dept. of Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3- Ph.D. Student in Occupational Health, Dept. of Occupational Health and Safety at Work, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
4- Assistant Prof., Safety Promotion and Injury Prevention Research Center, Dept. of Occupational Health and Safety at Work, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ,
Article history
Received: 2023/06/10
Accepted: 2023/10/8
ePublished: 2023/12/15
Accepted: 2023/10/8
ePublished: 2023/12/15
Subject:
Occupational Health
Keywords: Vision Disorders [MeSH], Digital Screens [MeSH], Sleep Quality [MeSH], Systematic Review [MeSH]
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Table 1. Search queries in each of the databases
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Fig. 1. Cloud of words presented in the complete texts of the articles
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Fig. 2. Search Strategy
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Introduction
Computers and displays have become an indispensable aspect of daily activities for individuals. They have evolved into essential devices for all areas of life, and currently, their extensive utilization as an instrument for teaching and learning is prevalent in schools and universities (1, 2).
The COVID-19 pandemic has led to a rapid shift towards digitalization worldwide, resulting in a significant increase in the number of users of digital display devices. This change in perspective has been driven by the guidelines for social distancing by the World Health Organization, which in turn have prompted the development of various digital innovations such as teleconferencing and online commercial platforms (3, 4). The pandemic has also significantly impacted the education sector, leading most countries to adopt online classes as a preventive measure (5). Consequently, individuals affected by the pandemic have shifted most of their work activities online, resulting in prolonged usage of computers and mobile phones for online purposes (5, 6).
The increased use of cell phones, including Smartphone, has raised concerns about potential health risks, as several studies have linked cell phone usage with health outcomes such as malignant melanoma of the eyes, headaches, and brain tumors (7). Moreover, prolonged and continuous use of computers and digital screens has resulted in a condition known as CVS. The American Optometric Association (AOA) defines CVS as a collection of vision and eye problems experienced during or after using digital devices (8). Common symptoms of CVS include headaches, blurred vision, double vision, eye fatigue, watery eyes, light sensitivity, and dry eyes (9).
CVS is widely regarded as one of the most significant occupational hazards of the 21st century, and its symptoms impact a significant proportion of computer users, depending on the studied population (7, 9-11). The prevalence of CVS varies based on the group studied, and the methods used to evaluate CVS range from 25% to over 90%. Approximately 60 million individuals who utilize computers around the globe are afflicted with Computer Vision Syndrome (CVS), and nearly one million additional cases are identified annually (5, 9, 12, 13).
The symptoms of CVS can be attributed to ocular causes, such as uncorrected refractive errors and visual abnormalities. Additionally, they may arise from ergonomic causes, such as poor sitting position, unsuitable screen distance and angle, poor display resolution and contrast, insufficient brightness, and an imbalance between the display and environmental lighting (5, 9, 14-16).
The AOA recommends limiting the continuous use of digital devices to two hours per day to prevent eye and vision problems. The protracted utilization of these instruments not solely engenders tension in the visual system but can also induce musculoskeletal
compression and disturbance of the circadian cycle. (17).
Long-term exposure to electronic devices such as computer screens and mobile phones can disrupt normal sleep patterns, leading to insufficient sleep, poor performance at work and school, reduced productivity, lack of energy, increased risk of weight gain, and depression (9, 18, 19). Numerous studies have shown that exposure to artificial light at night can negatively impact sleep quality and daytime alertness. Additionally, the adverse effects of disrupted sleep quality and alertness can manifest physically as neck and eye tension, eye fatigue, headache, and impaired cognitive function (20 -24).
Most studies have focused on investigating the impact of screen use on eye health. However, some studies have explored the relationship between sleep quality and the occurrence of symptoms related to CVS. Notably, no comprehensive review has been conducted on the connection between CVS and sleep quality. So, this study aims to review the existing literature on the relationship between CVS and sleep quality and summarize recent findings in this area.
Materials and Methods
A systematic review is a method used to address specific research questions by comprehensively identifying and summarizing all relevant studies in a given topic area, thereby providing an up-to-date synthesis of the existing knowledge.
The systematic review outlined in this paper adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Search Strategy: The Scopus, PubMed, Web of Science, and Google Scholar databases were searched for relevant articles, and a combination of keywords such as sleep, sleep disorders, sleep quality, insomnia, awakening, asleep, nightmare, dreams, sleep deprivation, sleep loss, circadian, computer vision syndrome, and CVS were used. The electronic database searches were executed on May 5, 2023, encompassing publications from 1900 to 2023 to ensure the inclusion of potentially valuable studies. Title, abstract, and keywords were the fields considered in the queries. Furthermore, we limited our search to documents available in English and Persian. Table 1 indicates the search strategy in each of the databases. Search in Google Scholar was performed using its Advanced Search Feature.
Computers and displays have become an indispensable aspect of daily activities for individuals. They have evolved into essential devices for all areas of life, and currently, their extensive utilization as an instrument for teaching and learning is prevalent in schools and universities (1, 2).
The COVID-19 pandemic has led to a rapid shift towards digitalization worldwide, resulting in a significant increase in the number of users of digital display devices. This change in perspective has been driven by the guidelines for social distancing by the World Health Organization, which in turn have prompted the development of various digital innovations such as teleconferencing and online commercial platforms (3, 4). The pandemic has also significantly impacted the education sector, leading most countries to adopt online classes as a preventive measure (5). Consequently, individuals affected by the pandemic have shifted most of their work activities online, resulting in prolonged usage of computers and mobile phones for online purposes (5, 6).
The increased use of cell phones, including Smartphone, has raised concerns about potential health risks, as several studies have linked cell phone usage with health outcomes such as malignant melanoma of the eyes, headaches, and brain tumors (7). Moreover, prolonged and continuous use of computers and digital screens has resulted in a condition known as CVS. The American Optometric Association (AOA) defines CVS as a collection of vision and eye problems experienced during or after using digital devices (8). Common symptoms of CVS include headaches, blurred vision, double vision, eye fatigue, watery eyes, light sensitivity, and dry eyes (9).
CVS is widely regarded as one of the most significant occupational hazards of the 21st century, and its symptoms impact a significant proportion of computer users, depending on the studied population (7, 9-11). The prevalence of CVS varies based on the group studied, and the methods used to evaluate CVS range from 25% to over 90%. Approximately 60 million individuals who utilize computers around the globe are afflicted with Computer Vision Syndrome (CVS), and nearly one million additional cases are identified annually (5, 9, 12, 13).
The symptoms of CVS can be attributed to ocular causes, such as uncorrected refractive errors and visual abnormalities. Additionally, they may arise from ergonomic causes, such as poor sitting position, unsuitable screen distance and angle, poor display resolution and contrast, insufficient brightness, and an imbalance between the display and environmental lighting (5, 9, 14-16).
The AOA recommends limiting the continuous use of digital devices to two hours per day to prevent eye and vision problems. The protracted utilization of these instruments not solely engenders tension in the visual system but can also induce musculoskeletal
compression and disturbance of the circadian cycle. (17).
Long-term exposure to electronic devices such as computer screens and mobile phones can disrupt normal sleep patterns, leading to insufficient sleep, poor performance at work and school, reduced productivity, lack of energy, increased risk of weight gain, and depression (9, 18, 19). Numerous studies have shown that exposure to artificial light at night can negatively impact sleep quality and daytime alertness. Additionally, the adverse effects of disrupted sleep quality and alertness can manifest physically as neck and eye tension, eye fatigue, headache, and impaired cognitive function (20 -24).
Most studies have focused on investigating the impact of screen use on eye health. However, some studies have explored the relationship between sleep quality and the occurrence of symptoms related to CVS. Notably, no comprehensive review has been conducted on the connection between CVS and sleep quality. So, this study aims to review the existing literature on the relationship between CVS and sleep quality and summarize recent findings in this area.
Materials and Methods
A systematic review is a method used to address specific research questions by comprehensively identifying and summarizing all relevant studies in a given topic area, thereby providing an up-to-date synthesis of the existing knowledge.
The systematic review outlined in this paper adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Search Strategy: The Scopus, PubMed, Web of Science, and Google Scholar databases were searched for relevant articles, and a combination of keywords such as sleep, sleep disorders, sleep quality, insomnia, awakening, asleep, nightmare, dreams, sleep deprivation, sleep loss, circadian, computer vision syndrome, and CVS were used. The electronic database searches were executed on May 5, 2023, encompassing publications from 1900 to 2023 to ensure the inclusion of potentially valuable studies. Title, abstract, and keywords were the fields considered in the queries. Furthermore, we limited our search to documents available in English and Persian. Table 1 indicates the search strategy in each of the databases. Search in Google Scholar was performed using its Advanced Search Feature.
Table 1. Search queries in each of the databases
| Database | Search query |
| PubMed | ("sleep"[Title/Abstract] OR "sleep disorders"[Title/Abstract] OR "sleep quality"[Title/Abstract] OR "Insomnia"[Title/Abstract] OR "awakening"[Title/Abstract] OR "asleep"[Title/Abstract] OR "nightmare"[Title/Abstract] OR "dreams"[Title/Abstract] OR "sleep loss"[Title/Abstract] OR "sleep deprivation"[Title/Abstract] OR "circadian"[Title/Abstract]) AND ("computer vision syndrome"[Title/Abstract] OR "cvs"[Title/Abstract]) |
| Scopus | (TITLE-ABS-KEY (sleep) OR TITLE-ABS-KEY (sleep quality) OR TITLE-ABS-KEY (sleep disorders) OR TITLE-ABS-KEY (insomnia) OR TITLE-ABS-KEY (awakening) OR TITLE-ABS-KEY (asleep) OR TITLE-ABS-KEY (circadian) OR TITLE-ABS-KEY (nightmare) OR TITLE-ABS-KEY (dreams) OR TITLE-ABS-KEY (sleep loss) OR TITLE-ABS-KEY (sleep deprivation)) AND (TITLE-ABS-KEY (cvs) OR TITLE-ABS-KEY (computer AND vision AND syndrome)) |
| Web of science | (TS= (cvs) OR TS= (computer vision syndrome)) AND (TS= (sleep) OR TS= (sleep quality) OR TS= (sleep disorders) OR TS= (insomnia) OR TS= (awakening) OR TS= (asleep) OR TS= (circadian) OR TS= (nightmare) OR TS= (dreams) OR TS= (sleep loss) OR TS= (sleep deprivation)) |
Eligibility Criteria: To evaluate the pertinence of each retrieved paper in addressing our research inquiries, we employed a set of inclusion criteria:
Original research that concurrently investigated both sleep quality and the occurrence of CVS, papers published in either English or Persian, and papers published in scientific journals.
Animal studies, studies not related to the research objective, systematic review and meta-analysis studies, theses, letters to editors, conference papers, and preprinted studies were excluded from this review.
Study Selection: Following the execution of database queries, we utilized Endnote® X8 to record references, and eliminate repeated records. Then, a manual review was conducted to eliminate any remaining duplicate entries further, creating a singular reference library.
We employed a multi-stage procedure to assess the papers in the initial database. This involved reviewing the titles, abstracts, and keywords, followed by thoroughly examining the full texts of selected papers. At each stage of the screening process, two authors independently evaluated the papers critically. Any documents selected by at least one reviewer were advanced to the next screening stage, taking an inclusive approach to reduce the likelihood of excluding pertinent papers. A third independent referee resolved any disagreements between the researchers.
In the final stage, we gathered the studies that met our inclusion criteria, which are the documents directly relevant to our research questions. To ensure complete confidence in their relevance, we thoroughly reviewed the full text of all articles initially identified as relevant. Subsequently, these selected articles were analyzed to explore the relationships between the variables of interest. Fig. 1 provides a concise overview of the intermediate selection process and the steps leading to the creation of the final database.
Results
Fig. 2 illustrates the process of article selection in this study. Initially, 1346 articles were obtained from various databases, with 345 duplicates. After screening the remaining articles based on title and abstract, 949 were excluded for being irrelevant or review articles. The eligibility of the entire texts of 52 remaining articles was assessed, resulting in 17 cross-sectional studies that met the inclusion criteria for this review. The total number of participants included in these studies was 36,192.
Original research that concurrently investigated both sleep quality and the occurrence of CVS, papers published in either English or Persian, and papers published in scientific journals.
Animal studies, studies not related to the research objective, systematic review and meta-analysis studies, theses, letters to editors, conference papers, and preprinted studies were excluded from this review.
Study Selection: Following the execution of database queries, we utilized Endnote® X8 to record references, and eliminate repeated records. Then, a manual review was conducted to eliminate any remaining duplicate entries further, creating a singular reference library.
We employed a multi-stage procedure to assess the papers in the initial database. This involved reviewing the titles, abstracts, and keywords, followed by thoroughly examining the full texts of selected papers. At each stage of the screening process, two authors independently evaluated the papers critically. Any documents selected by at least one reviewer were advanced to the next screening stage, taking an inclusive approach to reduce the likelihood of excluding pertinent papers. A third independent referee resolved any disagreements between the researchers.
In the final stage, we gathered the studies that met our inclusion criteria, which are the documents directly relevant to our research questions. To ensure complete confidence in their relevance, we thoroughly reviewed the full text of all articles initially identified as relevant. Subsequently, these selected articles were analyzed to explore the relationships between the variables of interest. Fig. 1 provides a concise overview of the intermediate selection process and the steps leading to the creation of the final database.
Results
Fig. 2 illustrates the process of article selection in this study. Initially, 1346 articles were obtained from various databases, with 345 duplicates. After screening the remaining articles based on title and abstract, 949 were excluded for being irrelevant or review articles. The eligibility of the entire texts of 52 remaining articles was assessed, resulting in 17 cross-sectional studies that met the inclusion criteria for this review. The total number of participants included in these studies was 36,192.
Fig. 1. Cloud of words presented in the complete texts of the articles
Fig. 2. Search Strategy
The temporal distribution of the studies showed that most of them were conducted in 2020 and later. It is worth noting that most of these studies were conducted in Asia and Africa, with 15 studies in Asia and 2 in Africa and Europe. Researchers from various countries have conducted these studies, with India having the highest number of studies (5). Regarding the study population, 12 studies were conducted among students, 4 among the general public, and 1 among health center employees.
Several indicators have been employed in assessing participants' sleep quality in the studies, with three of them relying on the Pittsburgh Questionnaire. The CVS questionnaire has been utilized in eleven studies to evaluate eye symptoms. Furthermore, six studies have utilized distinct questionnaires included in this review due to their association and overlap with CVS. The details of the studies analyzed in this review are presented in Table 2.
Several indicators have been employed in assessing participants' sleep quality in the studies, with three of them relying on the Pittsburgh Questionnaire. The CVS questionnaire has been utilized in eleven studies to evaluate eye symptoms. Furthermore, six studies have utilized distinct questionnaires included in this review due to their association and overlap with CVS. The details of the studies analyzed in this review are presented in Table 2.
Fig. 3. Cloud of words presented in the complete texts of the articles
Table 2. Summary of the included papers
| Main Result | Sample size | Eye measurement tools | Sleep measurement tools/indices | Community | Country | Year | Study design | Author |
| Individuals with a family history of sleep problems have an increased risk of CVS. | 917 | CVS questionnaire | Insomnia | Postsecondary Students | Bangladesh | 2022 | Cross-Sectional | Roy et al.(5) |
| People who sleep less tend to have more eye issues. |
715 | self-reported ocular symptoms: vision blurring, redness, visual disturbance, secretion, inflammation, lacrimation and dryness |
Sleep duration | adolescent subjects | South Korea | 2015 | Cross-Sectional | Kim et al.(7) |
| Most women with dry eyes struggle with serious sleep problems. |
547 | Standard Patient Evaluation of Eye Dryness (SPEED) | 10‑item Mini Sleep Questionnaire to check the quality of sleep |
college‑going women | India | 2021 | Cross-Sectional | Gupta et al.(51) |
| The chi-square test revealed a significant association between CVS and sleep quality. | 391 | CVS questionnaire | PSQI questionnaire | Undergraduate students | Ghana | 2021 | Cross-Sectional | Akowuah et al.(9) |
| 81.4% (N = 459) had poor sleep quality 4.4% of the students did not have any CVS symptoms. |
564 | CVS questionnaire | PSQI questionnaire |
health science students | Saudi Arabia | 2021 | Cross-Sectional | Ahmad et al.(8) |
| All the components of the PSQI score, except components 1 and 6, had statistically significantly (P < 0.05) higher values in individuals with CVS than individuals without CVS. | 500 | CVS questionnaire | PSQI questionnaire |
medical students | India | 2019 | Cross-Sectional | Patil et al.(2) |
| As screen time went up, the frequency and intensity of symptoms and sleep disturbances also statistically significantly increased. | 407 | CVS questionnaire | Sleep disturbances | individuals above 18 using digital devices |
India | 2020 | Cross-Sectional | Bahkir et al.(21) |
| As visual display terminal (VDT) working times increased, so did the risk of eye discomfort, headaches, high job stress, and poor sleep quality. However, VDT working time was not associated with statistically significant differences in CVS, BSRS-5 score, burnout, overall health self-assessments, or sleep duration. | 945 + 1868 |
CVS questionnaire | BSRS-5 Self-assessment sleep quality question |
Health Care Workers | Taiwan | 2022 | Cross-Sectional | Tsou et al.(30) |
| The analysis showed that for every 1 h increase in the patients’ total daily sleep time, their likelihood of developing eye discomfort symptoms decreased by 23%; The severity of eye discomfort symptom was significantly negatively related to the increased total sleep duration |
686 | eye discomfort symptom questionnaire |
the length of daily sleep | Medical students | China | 2022 | Cross-Sectional | Liu et al.(32) |
| The study found that a lower sleeping duration is associated with CVS, and In the CVS group, the average sleep duration was shorter | 527 | CVS questionnaire | Sleep duration | students studying in a virtual classroom |
Thailand | 2022 | Cross-Sectional | Wangsan et al.(3) |
| CVS was significantly associated with insomnia. Stress mediated the relationship between CVS and insomnia. | 749 | CVS questionnaire | Lebanese Insomnia Scale (LIS-18) | all digital device users | Lebanon | 2022 | Cross-Sectional | Akiki et al.(54) |
| There is no significant relationship between disturbed sleep and CVS | 416 | CVS questionnaire | Disturb sleep | individuals visiting a shopping mall | Saudi Arabia | 2018 | Cross-Sectional | Al subai et al.(33) |
| As compared to their peers without asthenopia, those students with asthenopia tended to sleep less | 25781 | CVS questionnaire | Sleep time | 8–20 years old students | China | 2021 | Cross-Sectional | Li et al(34) |
| 30 % low vision Drowsiness: 17.86 out of 40 | 70 | Low vision | drowsiness | graduate students | Iran | 2013 | Cross-Sectional | Hesam et al(56) |
| 63% had sleep disturbance, and 76.9% of study subjects experienced Cvs symptoms. | 108 | ocular symptoms |
sleep disturbance | students | India | 2021 | Cross-sectional | Cacodcar et al.(35) |
| (73.8%) were classified into the group with DES participants with DES slept fewer hours (P¼0.025) | 851 | (1) Computer Vision Syndrome Questionnaire, (2) Ocular Surface Disease Index (OSDI), (3) 5-item Dry Eye Questionnaire (DEQ-5), (4) 8-item CL Dry Eye Questionnaire (CLDEQ-8) |
hours of sleep | university students |
Spain | 2022 | Cross-sectional | Talens-Estarelles et al.(31) |
| 70% of students have clinical insomnia of moderate severity. More than 70% of students had severe eye symptoms in some cases |
150 | Prevalidated questionnaire on symptoms of computer vision syndrome | Insomnia Severity Index (ISI) questionnaire | medical undergraduates | India | 2020 | Cross-sectional | Lakshmi et al(29) |
Discussion
The widespread use of electronic devices has resulted in computer vision syndrome (CVS) emerging as a noteworthy health issue for individuals. In addition to its impact on ocular health, excessive use of digital screens has been found to affect other areas, such as sleep quality. The current investigation aims to extensively analyze existing scholarly literature to examine the relationship between Computer Vision Syndrome (CVS) and the quality of sleep experienced by individuals who use digital devices.
Numerous investigations have been conducted to assess CVS symptoms and sleep quality. A cross-sectional study conducted in Thailand aimed to determine the prevalence, characteristics, and associated factors of computer vision syndrome (CVS) among university students during the COVID-19 pandemic. The research revealed that the occurrence of CVS among the 527 participants was 81%, with increased screen time being suggested as the main cause. The study also found that female participants, those with atopic diseases, those with prior ocular symptoms, and those with astigmatism were more likely to develop CVS. The study suggests that students should use a desktop or laptop computer rather than a mobile phone, adjust screen brightness and environment to reduce reflection and glare and wear proper optical correction for refractive errors. The investigation additionally indicates that educational institutions ought to organize sufficient intervals between instructional sessions and communicate these guidelines to students to forestall computer vision syndrome during classes (3).
Furthermore, a recent study conducted in Bangladesh found that 68.16% of post-secondary students experienced computer vision syndrome (CVS) symptoms due to the increased usage of digital devices for online education and entertainment during the COVID-19 pandemic. The symptoms that are most frequently observed are headache, feeling of worsening eyesight, and eye pain. The study also identified various factors associated with the development of CVS, including the use of mobile or tablet devices, participating in continuous online education for a period exceeding 12 hours per day, with no breaks or insufficient breaks, while having a history of eye problems or headaches in one's family or personal background (5). Additionally, another study found that none of the samples investigated had sufficient sleep quality (25).
Studies conducted among students and general communities have reported similar findings, as indicated (5, 21). Healthcare staff also experience a high prevalence of CVS symptoms, with rates exceeding 46% despite variations in exposure hours and job categories. Furthermore, over 50% of participants reported poor sleep quality (27).
Most studies investigating the relationship between CVS and sleep quality have concentrated on student populations, possibly due to their higher exposure to electronic devices. Despite variations in reported values for CVS and sleep quality across different methods and populations studied, the incidence of CVS and poor sleep quality remains consistently high regardless of society or occupational group (28). Furthermore, with the growing use of electronic devices, the incidence of these issues will probably continue to increase.
Numerous studies have investigated the potential impact of monitor usage on CVS symptoms (21, 25, 27-32). Research has shown a positive correlation between the frequency and duration of monitor usage and the occurrence of visual discomfort and related symptoms. Liu et al. employed statistical models to investigate this relationship and found that reducing monitor usage by one hour is associated with a 16% decrease in the likelihood of experiencing vision-related disorders (29).
Extended use of monitors in non-ergonomic positions has been associated with various vision problems, including dryness and eye discomfort. For example, when users excessively elevate the height of their monitors, it alters their line of sight and increases corneal exposure to air. Consequently, there is an increase in eye fluid evaporation, reduced tear film quality, and the development of dry eyes (29, 33, 34). Furthermore, prolonged monitor use has been found to decrease the normal blinking rate, with some studies reporting rates as low as 3.6 blinks per minute compared to the average rate of 18.4 blinks per minute (26, 30, 34-36). This reduction in blinking rate may be attributed to increased screen focus and decreased secretion capacity of the eye glands, resulting in an uneven distribution of tears on the eye's surface (37, 38).
Several studies have investigated the relationship between screen time and sleep quality (25, 30, 31). As instance, a review article highlighted that 90% of the studies examined found a connection between screen time and reduced sleep duration (39). Moreover, individuals who dedicate an extended period to engaging with electronic displays are more prone to encountering disturbances in their sleep patterns (9).
The impact of screen light on the circadian rhythm of individuals is well-documented. The retina comprises light-sensitive neurons called ipRGCs that estimate the brightness levels in the environment (40). The retinohypothalamic tract, which originates from these ipRGCs, regulates melatonin secretion (41). In other words, the melanopsin photoreceptors in the eye transmit information to the suprachiasmatic nucleus (SCN) of the hypothalamus, which contains neurons that regulate the circadian rhythm by controlling melatonin secretion from the pineal gland in response to
environmental conditions, particularly light and darkness (42). Melatonin, in turn, governs the physiological regulation of sleep.
Due to their durability and stability, LEDs have become the most prevalent display and light-emitting source in electronic devices such as computers and mobile phones (2). Although the emitted light is commonly perceived as white, the peak of the LED emission is in the blue light spectrum, which is similar to the peak sensitivity of melatonin suppression (43). Consequently, this light is detected by photoreceptors and transmitted via the retinohypothalamic tract to the SCN. Exposure to this light, which has a wavelength close to that of melatonin suppression, obstructs melatonin secretion, resulting in disruptions to people's circadian rhythm (2).
In addition to disturbing the circadian rhythm, using electronic devices can lead to increased engagement in virtual environments, resulting in delayed sleep and continued mental activity even after bed (44). Furthermore, prolonged exposure to digital screens can cause muscle pain, further interfering with the sleep process (45).
In a study conducted by Kim et al., the Korean adult community reported a significant relationship between the duration of sleep and the incidence of visual symptoms (7). In another study, sleep duration was lower in people with CVS (3). Gupta et al. found a similar relationship between dry eyes and sleep quality among female students (47). Notably, more than 65% of individuals reporting dry eyes also had severe sleep problems, in line with a study that linked insufficient sleep to higher rates of severe dry eyes (48). Liu et al. developed a model to examine the relationship between sleep duration and eye discomfort syndrome and found that for each hour increase in sleep duration, the likelihood of eye discomfort syndrome decreased by 23% (33). Another model demonstrated a notable correlation between reduced duration of sleep and heightened severity of eye discomfort.
Studies have shown that sleep disorders and inadequate sleep can lead to increased tear osmolarity, decreased tear film break-up time, and reduced tear secretion, all of which can cause or intensify ocular surface diseases (49). Sleep disorders also impact the function of the lacrimal glands, resulting in reduced tear secretion. Sleep disorders also affect the function of the lacrimal glands, leading to reduced tear secretion. Furthermore, discomfort and visual weakness may persist when the eye muscles do not have sufficient recovery time during sleep (3).
As previously discussed, there is a correlation between digital device usage and both CVS and sleep quality. Moreover, all studies indicate a direct relationship between CVS and poor sleep quality, which may be attributed to excessive screen time and the released blue light emission. The influence of other factors may
further intensify this correlation. For example, Akiki et al. found that the presence of stress can significantly amplify the impact of CVS on migraine and insomnia. Specifically, the relationship between CVS and migraine can increase by 53%, while the relationship between CVS and insomnia can rise to 80% (50). Furthermore, inappropriate ergonomic practices can also increase the likelihood of CVS symptoms and poor sleep quality in individuals (51).
The studies conducted among students and general communities have reported similar findings, indicating that the incidence of CVS and poor sleep quality remains consistently high regardless of society or occupational group. Furthermore, with the growing use of electronic devices, the incidence of these issues will probably continue to increase. Therefore, it is crucial to develop educational and corrective programs to mitigate CVS symptoms and promote healthy sleep habits.
Since ocular issues and sleep disruptions can have detrimental impacts on various physical and cognitive domains, resulting in work fatigue and decreased performance during tasks, neglecting to address the conditions of utilizing digital displays and devices may threaten an individual's professional or academic trajectory. Hence, raising awareness among individuals about the potential risks of excessive screen time and the importance of taking breaks, adjusting screen brightness, and using proper optical correction for their refractive errors is essential. Additionally, it is necessary to implement ergonomic practices and develop policies that promote healthy digital device usage to reduce the incidence of CVS and poor sleep quality. Therefore, it is crucial to develop educational and corrective programs to mitigate CVS symptoms and promote healthy sleep habits.
Based on the search results, the limitations of the research on the relationship between computer vision syndrome (CVS) and sleep quality in users of digital displays are not explicitly stated. However, some studies have identified factors that increase the risk of CVS, such as decreased sleep quality, high computer use duration, and a non-ergonomic position. Other studies have found a significant association between poor sleep quality and CVS. Additionally, some studies have reported a high prevalence of both CVS and poor sleep quality among undergraduate students. Therefore, it is important to consider these factors when interpreting the study's results on the relationship between CVS and sleep quality in users of digital displays.
Conclusion
In conclusion, the literature review has shown that the extensive use of electronic devices has led to an increase in Computer Vision Syndrome (CVS) and a decline in sleep quality, which are related to the amount of digital device usage and the prolonged use of devices emitting blue light. The studies have consistently reported a direct relationship between CVS and poor sleep quality, which may be attributed to excessive screen time and the released blue light emission. The influence of other factors such as stress and inappropriate ergonomic practices may further intensify this correlation.
Conflict of interest: None declared.
The widespread use of electronic devices has resulted in computer vision syndrome (CVS) emerging as a noteworthy health issue for individuals. In addition to its impact on ocular health, excessive use of digital screens has been found to affect other areas, such as sleep quality. The current investigation aims to extensively analyze existing scholarly literature to examine the relationship between Computer Vision Syndrome (CVS) and the quality of sleep experienced by individuals who use digital devices.
Numerous investigations have been conducted to assess CVS symptoms and sleep quality. A cross-sectional study conducted in Thailand aimed to determine the prevalence, characteristics, and associated factors of computer vision syndrome (CVS) among university students during the COVID-19 pandemic. The research revealed that the occurrence of CVS among the 527 participants was 81%, with increased screen time being suggested as the main cause. The study also found that female participants, those with atopic diseases, those with prior ocular symptoms, and those with astigmatism were more likely to develop CVS. The study suggests that students should use a desktop or laptop computer rather than a mobile phone, adjust screen brightness and environment to reduce reflection and glare and wear proper optical correction for refractive errors. The investigation additionally indicates that educational institutions ought to organize sufficient intervals between instructional sessions and communicate these guidelines to students to forestall computer vision syndrome during classes (3).
Furthermore, a recent study conducted in Bangladesh found that 68.16% of post-secondary students experienced computer vision syndrome (CVS) symptoms due to the increased usage of digital devices for online education and entertainment during the COVID-19 pandemic. The symptoms that are most frequently observed are headache, feeling of worsening eyesight, and eye pain. The study also identified various factors associated with the development of CVS, including the use of mobile or tablet devices, participating in continuous online education for a period exceeding 12 hours per day, with no breaks or insufficient breaks, while having a history of eye problems or headaches in one's family or personal background (5). Additionally, another study found that none of the samples investigated had sufficient sleep quality (25).
Studies conducted among students and general communities have reported similar findings, as indicated (5, 21). Healthcare staff also experience a high prevalence of CVS symptoms, with rates exceeding 46% despite variations in exposure hours and job categories. Furthermore, over 50% of participants reported poor sleep quality (27).
Most studies investigating the relationship between CVS and sleep quality have concentrated on student populations, possibly due to their higher exposure to electronic devices. Despite variations in reported values for CVS and sleep quality across different methods and populations studied, the incidence of CVS and poor sleep quality remains consistently high regardless of society or occupational group (28). Furthermore, with the growing use of electronic devices, the incidence of these issues will probably continue to increase.
Numerous studies have investigated the potential impact of monitor usage on CVS symptoms (21, 25, 27-32). Research has shown a positive correlation between the frequency and duration of monitor usage and the occurrence of visual discomfort and related symptoms. Liu et al. employed statistical models to investigate this relationship and found that reducing monitor usage by one hour is associated with a 16% decrease in the likelihood of experiencing vision-related disorders (29).
Extended use of monitors in non-ergonomic positions has been associated with various vision problems, including dryness and eye discomfort. For example, when users excessively elevate the height of their monitors, it alters their line of sight and increases corneal exposure to air. Consequently, there is an increase in eye fluid evaporation, reduced tear film quality, and the development of dry eyes (29, 33, 34). Furthermore, prolonged monitor use has been found to decrease the normal blinking rate, with some studies reporting rates as low as 3.6 blinks per minute compared to the average rate of 18.4 blinks per minute (26, 30, 34-36). This reduction in blinking rate may be attributed to increased screen focus and decreased secretion capacity of the eye glands, resulting in an uneven distribution of tears on the eye's surface (37, 38).
Several studies have investigated the relationship between screen time and sleep quality (25, 30, 31). As instance, a review article highlighted that 90% of the studies examined found a connection between screen time and reduced sleep duration (39). Moreover, individuals who dedicate an extended period to engaging with electronic displays are more prone to encountering disturbances in their sleep patterns (9).
The impact of screen light on the circadian rhythm of individuals is well-documented. The retina comprises light-sensitive neurons called ipRGCs that estimate the brightness levels in the environment (40). The retinohypothalamic tract, which originates from these ipRGCs, regulates melatonin secretion (41). In other words, the melanopsin photoreceptors in the eye transmit information to the suprachiasmatic nucleus (SCN) of the hypothalamus, which contains neurons that regulate the circadian rhythm by controlling melatonin secretion from the pineal gland in response to
environmental conditions, particularly light and darkness (42). Melatonin, in turn, governs the physiological regulation of sleep.
Due to their durability and stability, LEDs have become the most prevalent display and light-emitting source in electronic devices such as computers and mobile phones (2). Although the emitted light is commonly perceived as white, the peak of the LED emission is in the blue light spectrum, which is similar to the peak sensitivity of melatonin suppression (43). Consequently, this light is detected by photoreceptors and transmitted via the retinohypothalamic tract to the SCN. Exposure to this light, which has a wavelength close to that of melatonin suppression, obstructs melatonin secretion, resulting in disruptions to people's circadian rhythm (2).
In addition to disturbing the circadian rhythm, using electronic devices can lead to increased engagement in virtual environments, resulting in delayed sleep and continued mental activity even after bed (44). Furthermore, prolonged exposure to digital screens can cause muscle pain, further interfering with the sleep process (45).
In a study conducted by Kim et al., the Korean adult community reported a significant relationship between the duration of sleep and the incidence of visual symptoms (7). In another study, sleep duration was lower in people with CVS (3). Gupta et al. found a similar relationship between dry eyes and sleep quality among female students (47). Notably, more than 65% of individuals reporting dry eyes also had severe sleep problems, in line with a study that linked insufficient sleep to higher rates of severe dry eyes (48). Liu et al. developed a model to examine the relationship between sleep duration and eye discomfort syndrome and found that for each hour increase in sleep duration, the likelihood of eye discomfort syndrome decreased by 23% (33). Another model demonstrated a notable correlation between reduced duration of sleep and heightened severity of eye discomfort.
Studies have shown that sleep disorders and inadequate sleep can lead to increased tear osmolarity, decreased tear film break-up time, and reduced tear secretion, all of which can cause or intensify ocular surface diseases (49). Sleep disorders also impact the function of the lacrimal glands, resulting in reduced tear secretion. Sleep disorders also affect the function of the lacrimal glands, leading to reduced tear secretion. Furthermore, discomfort and visual weakness may persist when the eye muscles do not have sufficient recovery time during sleep (3).
As previously discussed, there is a correlation between digital device usage and both CVS and sleep quality. Moreover, all studies indicate a direct relationship between CVS and poor sleep quality, which may be attributed to excessive screen time and the released blue light emission. The influence of other factors may
further intensify this correlation. For example, Akiki et al. found that the presence of stress can significantly amplify the impact of CVS on migraine and insomnia. Specifically, the relationship between CVS and migraine can increase by 53%, while the relationship between CVS and insomnia can rise to 80% (50). Furthermore, inappropriate ergonomic practices can also increase the likelihood of CVS symptoms and poor sleep quality in individuals (51).
The studies conducted among students and general communities have reported similar findings, indicating that the incidence of CVS and poor sleep quality remains consistently high regardless of society or occupational group. Furthermore, with the growing use of electronic devices, the incidence of these issues will probably continue to increase. Therefore, it is crucial to develop educational and corrective programs to mitigate CVS symptoms and promote healthy sleep habits.
Since ocular issues and sleep disruptions can have detrimental impacts on various physical and cognitive domains, resulting in work fatigue and decreased performance during tasks, neglecting to address the conditions of utilizing digital displays and devices may threaten an individual's professional or academic trajectory. Hence, raising awareness among individuals about the potential risks of excessive screen time and the importance of taking breaks, adjusting screen brightness, and using proper optical correction for their refractive errors is essential. Additionally, it is necessary to implement ergonomic practices and develop policies that promote healthy digital device usage to reduce the incidence of CVS and poor sleep quality. Therefore, it is crucial to develop educational and corrective programs to mitigate CVS symptoms and promote healthy sleep habits.
Based on the search results, the limitations of the research on the relationship between computer vision syndrome (CVS) and sleep quality in users of digital displays are not explicitly stated. However, some studies have identified factors that increase the risk of CVS, such as decreased sleep quality, high computer use duration, and a non-ergonomic position. Other studies have found a significant association between poor sleep quality and CVS. Additionally, some studies have reported a high prevalence of both CVS and poor sleep quality among undergraduate students. Therefore, it is important to consider these factors when interpreting the study's results on the relationship between CVS and sleep quality in users of digital displays.
Conclusion
In conclusion, the literature review has shown that the extensive use of electronic devices has led to an increase in Computer Vision Syndrome (CVS) and a decline in sleep quality, which are related to the amount of digital device usage and the prolonged use of devices emitting blue light. The studies have consistently reported a direct relationship between CVS and poor sleep quality, which may be attributed to excessive screen time and the released blue light emission. The influence of other factors such as stress and inappropriate ergonomic practices may further intensify this correlation.
Conflict of interest: None declared.
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