OPINION
Take a Screen-Free Day! Robert H. Posteraro, MD, MBI, Stewart C. Bushong, ScD My (RHP) last 10 years of radiology practice was PACS based. In my current occupation I teach in a master’s-level, distance-learning program that is all computer based, with the result that I spend a minimum of 9 hours a day viewing monitor screens. With night and weekend call in radiology, and afterhours course maintenance, research, and online student communications—not to mention handling personal e-mails and watching TV or movies—that figure can increase to 14 or more hours of screen viewing per day, often continuously, and for long periods of time. I’m sure I’m not the only one who is tethered (virtually) to his screens, be they desktop monitors, laptops, tablets, or smart phones. The amount of “face time” we have with our flat panels is orders of magnitude more than we have now with real faces. Holding the sociologic effects in abeyance for the moment, are there physiologic effects we should be concerned about? A review of the literature (mostly online) suggests so. The negative effects of long-term screen viewing have been recognized and reported. In fact, there’s even a name for the condition: “computer vision syndrome” (CVS), a form of asthenopia, defined as “a group of eye and vision-related problems that result from prolonged computer use” [1]. Symptoms of CVS are divided into two categories: external (burning sensation, irritation, dryness) and internal (eyestrain, headache, eyeache, diplopia, and blurred vision). CVS can occur even when the number of hours of monitor gazing is much less than the 9-plus hours per day most radiologists experience. In one study [2], 65.5% of the 87 subjects reported dry eyes, most after more than 2.5 hours of computer
use; 36.8% reported a foreign-body sensation in the eyes, and 17.2% had symptoms of blurred vision that caused difficulty in driving after 3.5 hours of computer use. Approximately 10% of the participants had sought medical help for their symptoms. In this study, the mean daily use of computers was only 3.2 2.7 hours. The authors reported statistical significance between the frequency of visual problems and the duration of computer use (P ¼ .021). The use of artificial tears was an ameliorative remedy used by 79.3% of the subjects. Some of the purported causes of the symptoms of CVS include a decrease in the rate of blinking while viewing a computer screen, as well as a decrease in blink amplitude, resulting in dry eyes [3]. Blink rate and blink amplitude return to normal at the end of the work day, but we often don’t let our eyes rest after work. We continue to look at screens—computer, tablet, smart phone, e-reader, or television—for many hours each evening. Factors contributing to CVS include prolonged viewing time, exacerbated by the prevalence of portable computers (laptops and tablets) and uncomfortable viewing of small images and tiny print on smart phone screens that results in eyestrain. Other factors related to CVS include duration of exposure, distance from the screen, screen type (cathode ray tube vs liquid crystal display), background luminance, glare, humidity, temperature, and ventilation [4]. An interesting finding when comparing the viewing of computer monitor screens and hard-copy text and images is that the former is associated with more frequent ocular complaints than the latter, even when light levels and text size are held constant [5].
ª 2014 American College of Radiology 1546-1440/14/$36.00 http://dx.doi.org/10.1016/j.jacr.2014.01.008
Some preventive measures for reducing the incidence or severity of CVS include ensuring proper lighting, eliminating screen glare, having proper humidity, reducing air flow directed at the work area, and having correct prescription lenses (if needed). Therapeutic maneuvers include using topical eye drops or ointments for symptomatic relief and taking frequent breaks from looking at monitor screens. Breaks of 10 to 15 min after every 1 to 2 hours of computer use, or following the 20/20/20 rule of looking 20 feet away from the screen for 20 seconds every 20 min, have been recommended [6,7]. These maneuvers are almost impossible to incorporate into a busy radiology work schedule, engaging students in online discussion forums, or creating or updating online courses when one gets “in the zone.” Busy computer workers have been known to get so focused on work that they miss meals, so what are the chances they’ll remember to look away from the screen for 20 seconds every 20 minutes, or to take a break every few hours? In addition to these recommendations, I have inserted a screenfree day (SFD) into my schedule. This is 1 day each week, typically Sunday, when I refrain from screen viewing for at least a 10-hour period. Taking an SFD has benefits that are not available by taking short breaks during the work day. The block of time away from a monitor screen that the SFD provides gives you an opportunity to connect with friends and family face to face, to discuss news, share and solve problems, have casual or in depth conversations, or exchange ideas and opinions verbally instead of in blocks of 140 text characters at a time. 1
2 Opinion
An SFD gives you a chance to share a meal, a cup of coffee, or a drink, in a relaxed atmosphere; to read an article; read the news; engage in the serendipity of discovering an unexpected, interesting, article in a newspaper, magazine, or journal; engage in a “live” sport, either as fan or participant; or pursue a hobby. It allows you to get out into the fresh air and sunshine and notice and appreciate the natural environment; in short, to engage in activities that are inherent expressions of our human nature. A possible additional benefit of an SFD is the subtle influence it could have on our young friends and family members. As we regularly observe, young people today, from age 4 up, are glued to smart phones and tablets. Attend a
resident radiologist lecture, and you will see that the participants are all face-to-screen. Knowing that we, their mentors and role models, take an SFD will surely influence them positively. Computers, tablets, and smart phones have improved our lives and our efficiency in the workplace and at home, but we should consider the physical, mental, and, especially, social advantages of taking an SFD, lest we become assimilated by the Borg. REFERENCES 1. American Optometric Association. Computer vision syndrome. Available at: http:// www.aoa.org/patients-and-public/caring-foryour-vision/protecting-your-vision/computervision-syndrome. Accessed December 15, 2013.
2. Moschos MM, Chatziralli IP, Siasou G, Papazisis L. Visual problems in young adults due to computer use. Klin Monatsbl Augenheilkd 2012;229:379-81. 3. Rosenfield M. Computer vision syndrome: a review of ocular causes and potential treatments. Ophthalmic Physiol Opt 2011;31: 502-15. 4. Cardona G, Garcia C, Seres C, Vilaseca M, Gispets J. Blink rate, blink amplitude, and tear film integrity during dynamic visual display terminal tasks. Curr Eye Res 2011;36:190-7. 5. Chu C, Rosenfield M, Portello JK, Benzoni JA, Collier JD. A comparison of symptoms after viewing text on a computer screen and hardcopy. Ophthalmic Physiol Opt 2011;31:29-32. 6. Tribley J, McClain S, Karbasi A, Kaldenberg J. Tips for computer vision syndrome relief and prevention. Work 2011;39:85-7. 7. Blehm C, Bishnu S, Khattak A, Bitra S, Yee RW. Computer vision syndrome: a review. Surv Ophthalmol 2005;50:253-62.
Robert H. Posteraro, MD, MBI, is from the Department of Clinic Administration and Rehabilitation Counseling, Texas Tech University Health Sciences Center, School of Allied Health Sciences, Lubbock, Texas. Stewart C. Bushong, ScD, is from the Baylor College of Medicine, Houston, Texas. Robert H. Posteraro, MD, MBI, Department of Clinic Administration and Rehabilitation Counseling, Texas Tech University Health Sciences Center, School of Allied Health Sciences, 3601 4th Street, STOP 6225, Lubbock, TX 79430-6225; e-mail: [email protected].
Take a Screen-Free Day! Robert H. Posteraro, MD, MBI, Stewart C. Bushong, ScD My (RHP) last 10 years of radiology practice was PACS based. In my current occupation I teach in a master’s-level, distance-learning program that is all computer based, with the result that I spend a minimum of 9 hours a day viewing monitor screens. With night and weekend call in radiology, and afterhours course maintenance, research, and online student communications—not to mention handling personal e-mails and watching TV or movies—that figure can increase to 14 or more hours of screen viewing per day, often continuously, and for long periods of time. I’m sure I’m not the only one who is tethered (virtually) to his screens, be they desktop monitors, laptops, tablets, or smart phones. The amount of “face time” we have with our flat panels is orders of magnitude more than we have now with real faces. Holding the sociologic effects in abeyance for the moment, are there physiologic effects we should be concerned about? A review of the literature (mostly online) suggests so. The negative effects of long-term screen viewing have been recognized and reported. In fact, there’s even a name for the condition: “computer vision syndrome” (CVS), a form of asthenopia, defined as “a group of eye and vision-related problems that result from prolonged computer use” [1]. Symptoms of CVS are divided into two categories: external (burning sensation, irritation, dryness) and internal (eyestrain, headache, eyeache, diplopia, and blurred vision). CVS can occur even when the number of hours of monitor gazing is much less than the 9-plus hours per day most radiologists experience. In one study [2], 65.5% of the 87 subjects reported dry eyes, most after more than 2.5 hours of computer
use; 36.8% reported a foreign-body sensation in the eyes, and 17.2% had symptoms of blurred vision that caused difficulty in driving after 3.5 hours of computer use. Approximately 10% of the participants had sought medical help for their symptoms. In this study, the mean daily use of computers was only 3.2 2.7 hours. The authors reported statistical significance between the frequency of visual problems and the duration of computer use (P ¼ .021). The use of artificial tears was an ameliorative remedy used by 79.3% of the subjects. Some of the purported causes of the symptoms of CVS include a decrease in the rate of blinking while viewing a computer screen, as well as a decrease in blink amplitude, resulting in dry eyes [3]. Blink rate and blink amplitude return to normal at the end of the work day, but we often don’t let our eyes rest after work. We continue to look at screens—computer, tablet, smart phone, e-reader, or television—for many hours each evening. Factors contributing to CVS include prolonged viewing time, exacerbated by the prevalence of portable computers (laptops and tablets) and uncomfortable viewing of small images and tiny print on smart phone screens that results in eyestrain. Other factors related to CVS include duration of exposure, distance from the screen, screen type (cathode ray tube vs liquid crystal display), background luminance, glare, humidity, temperature, and ventilation [4]. An interesting finding when comparing the viewing of computer monitor screens and hard-copy text and images is that the former is associated with more frequent ocular complaints than the latter, even when light levels and text size are held constant [5].
ª 2014 American College of Radiology 1546-1440/14/$36.00 http://dx.doi.org/10.1016/j.jacr.2014.01.008
Some preventive measures for reducing the incidence or severity of CVS include ensuring proper lighting, eliminating screen glare, having proper humidity, reducing air flow directed at the work area, and having correct prescription lenses (if needed). Therapeutic maneuvers include using topical eye drops or ointments for symptomatic relief and taking frequent breaks from looking at monitor screens. Breaks of 10 to 15 min after every 1 to 2 hours of computer use, or following the 20/20/20 rule of looking 20 feet away from the screen for 20 seconds every 20 min, have been recommended [6,7]. These maneuvers are almost impossible to incorporate into a busy radiology work schedule, engaging students in online discussion forums, or creating or updating online courses when one gets “in the zone.” Busy computer workers have been known to get so focused on work that they miss meals, so what are the chances they’ll remember to look away from the screen for 20 seconds every 20 minutes, or to take a break every few hours? In addition to these recommendations, I have inserted a screenfree day (SFD) into my schedule. This is 1 day each week, typically Sunday, when I refrain from screen viewing for at least a 10-hour period. Taking an SFD has benefits that are not available by taking short breaks during the work day. The block of time away from a monitor screen that the SFD provides gives you an opportunity to connect with friends and family face to face, to discuss news, share and solve problems, have casual or in depth conversations, or exchange ideas and opinions verbally instead of in blocks of 140 text characters at a time. 1
2 Opinion
An SFD gives you a chance to share a meal, a cup of coffee, or a drink, in a relaxed atmosphere; to read an article; read the news; engage in the serendipity of discovering an unexpected, interesting, article in a newspaper, magazine, or journal; engage in a “live” sport, either as fan or participant; or pursue a hobby. It allows you to get out into the fresh air and sunshine and notice and appreciate the natural environment; in short, to engage in activities that are inherent expressions of our human nature. A possible additional benefit of an SFD is the subtle influence it could have on our young friends and family members. As we regularly observe, young people today, from age 4 up, are glued to smart phones and tablets. Attend a
resident radiologist lecture, and you will see that the participants are all face-to-screen. Knowing that we, their mentors and role models, take an SFD will surely influence them positively. Computers, tablets, and smart phones have improved our lives and our efficiency in the workplace and at home, but we should consider the physical, mental, and, especially, social advantages of taking an SFD, lest we become assimilated by the Borg. REFERENCES 1. American Optometric Association. Computer vision syndrome. Available at: http:// www.aoa.org/patients-and-public/caring-foryour-vision/protecting-your-vision/computervision-syndrome. Accessed December 15, 2013.
2. Moschos MM, Chatziralli IP, Siasou G, Papazisis L. Visual problems in young adults due to computer use. Klin Monatsbl Augenheilkd 2012;229:379-81. 3. Rosenfield M. Computer vision syndrome: a review of ocular causes and potential treatments. Ophthalmic Physiol Opt 2011;31: 502-15. 4. Cardona G, Garcia C, Seres C, Vilaseca M, Gispets J. Blink rate, blink amplitude, and tear film integrity during dynamic visual display terminal tasks. Curr Eye Res 2011;36:190-7. 5. Chu C, Rosenfield M, Portello JK, Benzoni JA, Collier JD. A comparison of symptoms after viewing text on a computer screen and hardcopy. Ophthalmic Physiol Opt 2011;31:29-32. 6. Tribley J, McClain S, Karbasi A, Kaldenberg J. Tips for computer vision syndrome relief and prevention. Work 2011;39:85-7. 7. Blehm C, Bishnu S, Khattak A, Bitra S, Yee RW. Computer vision syndrome: a review. Surv Ophthalmol 2005;50:253-62.
Robert H. Posteraro, MD, MBI, is from the Department of Clinic Administration and Rehabilitation Counseling, Texas Tech University Health Sciences Center, School of Allied Health Sciences, Lubbock, Texas. Stewart C. Bushong, ScD, is from the Baylor College of Medicine, Houston, Texas. Robert H. Posteraro, MD, MBI, Department of Clinic Administration and Rehabilitation Counseling, Texas Tech University Health Sciences Center, School of Allied Health Sciences, 3601 4th Street, STOP 6225, Lubbock, TX 79430-6225; e-mail: [email protected].
