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 Table of Contents    
Year : 2022  |  Volume : 15  |  Issue : 3  |  Page : 279-283  

Knowledge, attitude, and practice on digital eye strain during coronavirus disease-2019 lockdown: A comparative study

1 Department of Ophthalmology, Regional Institute of Ophthalmology, Kolkata, India
2 Susrut Eye Hospital and Research Centre, Baharampur, West Bengal, India

Date of Submission01-May-2021
Date of Decision11-Aug-2021
Date of Acceptance21-Oct-2021
Date of Web Publication02-Nov-2022

Correspondence Address:
Aindrila Roy
871, Rabindranath Tagore Road, P.O. Bediapara, Kolkata - 700 077, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ojo.ojo_135_21

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BACKGROUND: Computer vision syndrome is a group of eye and vision-related problems that result from prolonged computer use. The worldwide pandemic of coronavirus disease-2019 (COVID-19) lockdown has led to an increase in the digital screen exposure as jobs as well as academic learning have majorly shifted online. This has caused an increase in digital eye strain (DES) globally. The aims and objectives of this study were to compare the knowledge, attitude, and practices among medical and nonmedical professionals with regard to DES in a background of COVID-19 lockdown.
MATERIALS AND METHODS: A cross-sectional, observational, online questionnaire-based research survey analysis was conducted among medical professionals with age- and sex-matched nonmedical professionals. Responses were collected over a week and analyzed. The level of significance was set at a P < 0.05. Statistical Package for the Social Sciences software version 23.0 was used for the result analysis.
RESULTS: Our study included 353 (50.4%) medical and 347 (49.6%) nonmedical personnel. It was noted that 266 (75.4%) of medical professionals and 268 (77.2%) of nonmedical professionals experienced eye problems after prolonged digital screen exposure. A significant proportion of respondents experienced an increase in symptoms following COVID-19 lockdown with 140 (52.6%) being medical professionals and 163 (60.8%) nonmedical professionals (P = 0.015).
CONCLUSIONS: DES is a preventable lifestyle-associated disorder. Awareness among the masses can reduce the adverse effects. Proper lighting, adequate viewing distance, voluntary blinking, and using lubricating eye drops are a few ways to reduce the chances of DES. Further studies are needed to formulate standardized guidelines for the management of DES.

Keywords: Computer vision syndrome, coronavirus disease-2019 lockdown, digital eye strain

How to cite this article:
Jain S, Das O, Roy A, Das A. Knowledge, attitude, and practice on digital eye strain during coronavirus disease-2019 lockdown: A comparative study. Oman J Ophthalmol 2022;15:279-83

How to cite this URL:
Jain S, Das O, Roy A, Das A. Knowledge, attitude, and practice on digital eye strain during coronavirus disease-2019 lockdown: A comparative study. Oman J Ophthalmol [serial online] 2022 [cited 2023 Jan 27];15:279-83. Available from: https://www.ojoonline.org/text.asp?2022/15/3/279/360392

   Introduction Top

The advent of technology related to electronic display devices has brought along with it several health-related issues. Computer vision syndrome (CVS) from prolonged exposure to computer screens has been well known in the medical literature for a long time and currently is a global problem. American Optometrist Association (AOA) describes CVS as “a group of eye and vision-related problems that result from prolonged computer use.”[1] Apart from computers, electronic devices such as laptops, mobile phones, and tablets are contributing to the problem collectively named as digital eye strain (DES).[2],[3]

The worldwide pandemic of coronavirus disease-2019 (COVID-19) has changed our lifestyle. One of the most important is “social distancing” which has replaced human contact with a digital connection. Jobs have moved online with an increasing number of web meetings and video conferences, classes are being held online, doctors are going for teleconsultations. Online webinars have seen a sudden surge.[2] Binge-watching, gaming, social media usage all contribute to DES with screen time more than 3 h/day which is the cutoff for the symptoms of DES.[3],[4] This led to a spike in the already existing DES among the population with the medical profession not being an exception.

In the background of this current scenario, it is a matter of concern to medical practitioners and ophthalmologists to create the awareness among the general population regarding the consequences of prolonged digital exposure and advise them regarding the preventive measures.[5]

Most of the previous studies on CVS were on Information technology (IT) professionals, engineers or bankers.[6],[7] However, COVID-19 lockdown has affected all the strata of the society irrespective of the profession.[8] This survey was conducted to find out the knowledge, attitude, and practice among medical professionals regarding the impact of nationwide lockdown on ocular health and compare it with that of nonmedical professionals.

   Materials and Methods Top

A cross-sectional, observational, online questionnaire-based research survey analysis was conducted among medical professionals with age- and sex-matched nonmedical professionals as controls. Individuals between 20 and 40 years of age were included who sufficed the criteria of a minimum of 3 h/day exposure to the digital screen with no previous history of ocular disease that is likely to affect ocular surface health. Informed consent obtained with the assurance of confidentiality of data and only those who completed the questionnaire were considered for the study.

A predesigned structured questionnaire framed in Google Forms was sent to randomly selected medical professionals and age- and sex-matched nonmedical professionals through online platform and responses were collected over 1 week. Ethical clearance was obtained from the Ethics Committee of the Institute before starting the survey.

All complete responses were evaluated, and descriptive statistical analysis was done. All responses were calculated in terms of the answers recorded and absolute numbers and percentages were tabulated in MS Excel. Ordinal data of the questionnaire between both medical and nonmedical professionals were analyzed using the Mann–Whitney U-test, and the nominal data were analyzed by two-sided Fischer exact test. The level of significance was set at a P < 0.05. IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. was used for the result analysis.

   Results Top

A total of 700 responses were recorded including 353 (50.4%) medical professionals and 347 (49.6%) nonmedical personnel. Out of them, 192 (54.4%) of the medical and 179 (51.6%) of the nonmedical professionals were male respondents. Most of the respondents were in the age group of 21–30 years, with 293 (83%) medical and 237 (68.3%) nonmedical professionals.

Among the medical professionals, 144 (40.8%) responses were from junior residents, followed by 65 (18.4%) undergraduate MBBS students, 59 (16.7%) interns, 50 (14.2%) senior residents, and 35 (9.9%) consultants. In the nonmedical group, majority were students (n = 70; 20.1%), followed by IT professionals (n = 31; 8.9%), teachers (n = 30; 8.6%), bankers (n = 29; 8.4%), engineers (n = 29; 8.3%), homemakers (n = 18; 5.2%), data analysts, research scholars, freelancer, etc.

It is noted that 217 (61.5%) of the medical professionals used digital devices for entertainment, 126 (35.7%) for webinars or online classes, and 10 (2.8%) for teleconsultation whereas 155 (44.7%) of the nonmedical professionals used digital devices for “work from home,” 116 (33.4%) for entertainment, and 76 (21.9%) for webinar or online classes. [Table 1] shows the general attitude and practices regarding DES among the two groups. [Table 2] shows the effect of lockdown on these attitudes and practices of the two groups.
Table 1: Comparison between awareness and practice of digital device use between medical and nonmedical professionals

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Table 2: Comparison of the pattern of digital device use among medical and non-medical professionals during COVID-19 lockdown

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Eye problem following prolonged exposure to digital screen was experienced by 266 (75.4%) medical and 268 (77.2%) nonmedical professionals, respectively (P = 0.594). Among those who experienced eye problems, 135 (50.85%) of the medical and 157 (58.6%) of the nonmedical respondents had these symptoms before lockdown (P = 0.028). A significant number noticed an increase in their symptoms following increased digital screen usage during the lockdown period with 140 (52.6%) being medical professionals and 163 (60.8%) nonmedical professionals (P = 0.015).

Although a statistically significant number of respondents experienced symptoms related to DES (P = 0.02), there was no significant difference among medical and nonmedical professionals (P = 0.29). [Figure 1] shows the different symptoms of DES experienced by the two study groups.
Figure 1: Comparison between the different symptoms of digital eye strain among medical and nonmedical professionals during COVID-19 lockdown

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A noticeable change in the duration and quality of sleep by viewing digital devices 1 h before sleep was observed by 200 (56.7%) of the medical and 186 (53.6%) of the nonmedical professionals (P = 0.447).

   Discussion Top

COVID-19 lockdown has led to a spike in the already existing CVS. The increasing use of digital devices during COVID-19 lockdown and its influence on the well-being of the users is a matter of concern to ophthalmologists.

In the present study, a total of 700 people participated, of which 353 participants were from a medical background and 347 were from a nonmedical background. This kind of segregation allows us to understand if there is a difference in the awareness among medical as compared to nonmedical professionals and if knowledge of DES has a difference in the attitudes and practices to prevent the same among them.

According to the AOA, as little as 2 h of continuous digital device usage per day is enough to bring about the development of an array of eye and vision-related problems.[1]

Our study shows 75.4% of the medical and 77.2% of the nonmedical professionals were suffering from DES during the lockdown period. It shows increased prevalence of DES during the lockdown in comparison to previous data of Jain et al. stating 55.8% of undergraduate medical students,[3] Pulla et al.[6] showing 60.3% of engineering students, and Assefa et al.[7] showing 73% of the bankers to have DES. However, no significant difference found in the prevalence of DES between medical and nonmedical professionals in our study.

In a previous study, it was seen that 45.5% of the study population were already aware of CVS.[9] In our study, we concluded that awareness was more in medical (91.2%) than nonmedical professionals (72.6%). In a study done in 2005 among 300 Indian ophthalmologists, all the respondents were aware of the prevalence of CVS.[5] Even among them, those using computers at their workplace were more aware about the symptoms of CVS.[5]

A significant difference is noted between the duration of hours spent over digital devices among the medical and nonmedical professionals which shows nonmedical personnel used digital devices for four or more hours per day in comparison to medical professionals during lockdown. Thus, the shift from office to “work from home” has greatly affected the IT professionals, teachers, and other professionals by increasing their screen hours. Previous reports show 74.3% of the bankers[7] spend more than 6 h/day over computers and 45.7% of the engineers[6] and 63.3% of the undergraduate medical students[3] have a screen duration of more than 3 h/day.

In our study, medical professionals being more aware of DES, were found to use blue filter while operating devices like smartphones or tablets (54.4%) more than nonmedical professionals (33.1%). In a previous study done exclusively among engineering students in Hyderabad, low awareness culminated with only about 4.7% of the study population using antiglare or reading modes[6] and in a study in Sri Lanka, 27.9% of the study population were using antiglare on their screens or using computer glasses.[10] Short wavelength radiation and blue light has been shown to be potentially harmful to the retinal pigment epithelial cells and have an impact on regulation of circadian rhythm and sleep cycle.[11],[12] Although manufacturers are marketing blue-light filter in digital devices for reducing DES, but studies have failed to prove the efficacy of blue-light filters in minimizing symptoms of DES.[13],[14]

Even with this increased awareness about CVS among medical professionals, it was seen that they take breaks less frequently (85.3%) than nonmedical professionals (87.5%). This showed the need of awareness among all professionals regarding methods to curb DES like frequent blinking or taking breaks in between.

AOA gave guidelines such as reducing glare by adjusting lighting at the workstation, staying at a distance of at least 20–28 inches, and after staring for 20 min looking at a distant object 20 feet away for 20 s.[15] In our study, both medical (75.4%) and nonmedical professionals (62.2%) were found to view screens with a distance of <50 cm or 20 inches. Some authors have found a lag in accommodation while viewing digital devices like laptops or computers in comparison to reading from printed materials.[16],[17] Decrease in accommodative amplitude has been reported in subjects using digital devices at a near distance for prolonged duration in comparison to nonusers.[18],[19]

In our study, 57.8% of medical and 55.3% of the nonmedical professionals were wearing prescribed glasses while viewing digital screen. Among them 159 (77.9%) medical and 144 (75%) nonmedical professionals experienced symptoms of DES. This co-related with a study done in Hyderabad where 55.6% of the study population comprising of engineering students had glasses for refractive errors.[6]

Reduced blink rate leading to poor tear film quality and dry eye has been reported in studies, although tear break up time, Schirmer test and Jones test were not significantly affected.[20],[21],[22] Use of lubricating eyedrops can help in symptomatic relief for dry eye, but it has not shown any benefit in increasing blink rate or overall improvement in ocular surface problem related to DES.[23] Among the responders most commonly, no tear substitutes were being used in both the groups. This was found despite higher awareness among medical professionals. Only 10.8% of the medical professionals and 10.4% of the nonmedical professionals were using lubricating eyedrops. In a previous study in Hyderabad, six percent of the study population were using lubricants[6] whereas, in a similar study in Sri Lanka, 13.2% of the population were using lubricants.[10]

The occurrence of ocular problems [Figure 1] after prolonged use of digital screen was reported by 77.2% of nonmedical professionals as compared to 75.4% of medical professionals. Almost all of the previous studies have reported a high prevalence of ocular surface disorders among digital device users. Prevalence in a previous study has been 30.9%.[15] A prevalence of 60.3%[6] and 76%[24] was recorded in two other studies.

In the present study, a change in the quality and duration of sleep was observed in 56.7% of medical and 53.6% of nonmedical professionals when digital screens were used 1 h before sleep due to lower melatonin release and altering sleep cycles.[8],[25] In our study, it was reported by 79.3% of medical and 78.4% of nonmedical professionals to be willing for lifestyle changes to curb DES and improve the quality of life by decreasing screen time.

   Conclusion Top

Prevention and management of digital eye strain

DES is an example of a preventable, lifestyle-associated, modifiable health problem. The management of DES should be a tailored approach, and even today, there is a lack of universal guideline for the diagnosis or management. A variety of methods can be employed to minimize the effect on ocular disorders. [Figure 2] shows the nonpharmacological and pharmacological methods for the prevention of DES.[5]
Figure 2: Nonpharmacological and pharmacological methods of prevention and management of digital eye strain

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The treatment guidelines vary even among ophthalmologists. Therefore, further evaluation is necessary to set forth uniform guidelines of management and also consider alternative methods of therapy.


The authors would like to thank Prof. (Dr.) Asim Kumar Ghosh, Director, Regional Institute of Ophthalmology, Kolkata, India.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2]


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