Ординатура / Офтальмология / Английские материалы / Diagnosing and Treating Computer-Related Visual Problems_Sheedy, Shaw-McMinn_2003
.pdf214 Diagnosing and Treating Computer-Related Vision Problems
the patient is most likely to receive the appropriate care. Appendix 12-3 provides a separate form to be given to the referred employee.
Consultant Report
It is highly likely that your report will be shared with many others in the company—people whom you have not met and who have not been part of the discussions. It is therefore important that your report be both comprehensive and educational. You should define the entire process and include background and reasons for your recommendations.
As mentioned above, every consulting situation is unique. The approaches and forms in the appendices work in many situations but may need to be modified or may not work at all in others. Similarly, the organization of the report depends on the particular situation. The forms for general office and individual employee evaluation are not intended to be provided directly to the employer; they are intended for note taking and to serve as information sources for the report.
The following report organization follows from the approaches described earlier.
•Statement of the problem. This should be a succinct statement of the problem for which you were asked to consult. You may want to include a general paragraph about computer vision syndrome and its causes; a little education can be very useful.
•Procedures. Outline the steps and procedures you used to address the problem (e.g., met with specific company officers, distributed a symptom survey by e-mail, surveyed each office in general, met with individual employees who reported symptoms).
•Survey results. If you have surveyed symptoms of employees with a questionnaire, include it here to document the extent of the problem.
•General office issues. This section provides the foundation for most of the general recommendations you make to the employer. For each general area that you surveyed, include your overall analysis of the ergonomics. Include your lighting measurements, comparison to Illuminating Engineering Society recommendations, and your assessment of its adequacy. Also include your assessment of windows, work surfaces, quality of displays, general statement about furniture, and others.
The Eye Care Practitioner as a Consultant Providing Workplace Evaluations 215
•Employees evaluated. List the employees you evaluated along with a general statement about the types of problems they have had. It may be appropriate to tally the number of times each type of recommendation was made. Discuss if several employees are affected by office-wide issues such as open windows, poor lighting system, old displays, under-shelf lighting, poorly adjusted chairs, and high keyboards. Do not include analysis of or recommendations for specific employees; such information should be included in a separate report for privacy reasons.
•General recommendations. The above two sections provide the basis for the enumerated recommendations in this section. It may be appropriate to include discussion before the recommendations. For example, if you noted a lot of dry, irritated eyes and also that the air quality was low and that computer displays were generally too high, it would be appropriate to discuss this relationship before listing the recommendations. Include appropriate recommendations for lighting changes, furniture suggestions, policies on window blinds, eye care, ergonomic accessories, and others. Consider suggesting that you could give a lecture or seminar to employees about vision problems, proper workstation setup, and eye care. Be as specific as possible about your recommendations; they must be clear and actionable. As appropriate, suggest how you could assist in implementing your recommendations.
The analysis and recommendation for individual employees should be contained in a separate report. Information for each employee should be on a separate page. This enables the employer to communicate individually with each employee and also to freely distribute your report without revealing personal information.
Before finalizing your report, send a draft to your primary contact with the company. This gives the company an opportunity to suggest factual corrections and to identify any sensitive issues that you should discuss before finalizing the report.
Summary
Becoming a workplace consultant is a natural extension of your responsibilities as a computer vision specialist in your office. Follow-
216 Diagnosing and Treating Computer-Related Vision Problems
ing the suggestions in this chapter on evaluating the general office, evaluating the individual employees, and providing a report allows you to reduce office workers’ stress in their work environment. You are able to improve the productivity of nearly every employee, resulting in an overall increased performance of the company. Many eye care practitioners have discovered on-site evaluations to be a fulfilling experience. Although much can be done to improve computer vision during an eye care practitioner examination, actually evaluating the workplace can provide you with the opportunity to deal with every factor influencing the comfort of computer use.
Establishing yourself as a computer vision specialist requires the proper marketing of your abilities. In addition to positioning your practice properly as discussed in Chapter 2, Chapter 14 provides guidance on developing a marketing plan. An eye care practitioner who wishes to provide evaluations at the workplace will require few changes to the marketing plan suggested by the chapter. On-site evaluations of workstations usually involve persons aged 18–65 years. Chapter 13 gives guidance on the examination and treatment of disorders affecting computer vision in children and senior citizens.
Action Items
1.Obtain and organize the equipment necessary for a workplace evaluation.
2.Review the General Office Evaluation form in Appendix 12-1, make any changes, and print on your letterhead.
3.Review the Employee Vision and Ergonomic Evaluation form in Appendix 12-2, make any changes, and print onto your letterhead.
4.Review the Eye Examination Referral form in Appendix 12-3 and make any desired changes.
Reference
Backman HA, Haghighat F. Indoor-air quality and ocular discomfort. J Am Optom Assoc 1999;70:309–316.
Appendix 12-1 217
Appendix 12-1
General Office Evaluation
Office Location___________ Date____________ Time__________
General Room Lighting
Type
Source of glare?
Luminance
Windows
Location and treatment
Source of glare?
Sun patterns
Measurement
Illumination Levels
Locations
Conditions
Desk Lighting
Type
Glare source?
Needed?
Employee Posture
General
Specific employees
Furniture and equipment
Computer Displays
Type
Size
Reflections
Other
218 Diagnosing and Treating Computer-Related Vision Problems
Appendix 12-2
Employee Vision and Ergonomic Evaluation
Employee name________________________ Date of birth _______
Date___________
History
Symptoms
Vision correction
Eye care history
Vision
Head/neck posture
Acuity
Presbyopia
NPC, BV, accom.
Dry eye
Lighting
Glare sources
Luminance ratios
Desktop lighting
Reflections
Source
Treatment
Desk surface
Computer Display
Type
Size
Adjustment
Appendix 12-2 219
Body Posture
Chair adjustment
Arms, keyboard, mouse
Display height
Furniture, Ergonomic Accessories
Chair
Keyboard
Other
Adjustments—Implemented
Additional Workplace Recommendations
Computer viewing distance is _______.
Eye examination indicated? Yes_____ No_____
If yes,
____General refractive ____Presbyopia—occupational correction
____Heterophoria |
____Single vision for intermediate |
____Convergence |
____Intermediate/near bifocal |
____Accommodation |
____Occupational trifocal (large intermediate) |
____Dry eye |
____Occupational progressive addition lenses |
Comments: |
|
220 Diagnosing and Treating Computer-Related Vision Problems
Appendix 12-3
Eye Examination Referral
Employee name________________________ Date _______
This employee was screened at his or her computer workstation and has been referred for eye care for the following reason(s):
____General refractive |
____Presbyopia—occupational correction |
____Heterophoria |
____Single vision for intermediate |
____Convergence |
____Intermediate/near bifocal |
____Accommodation |
____Occupational trifocal (large intermediate) |
____Dry eye |
____Occupational progressive addition lenses |
Computer-viewing distance is ________.
________________________
Referring doctor
13
Assisting Children and Low Vision Patients in the Use of Computers
Children
Computers are becoming a major part of the daily lives of children. A year 2000 national survey on home computer use in children showed the following (Lucile Packard Foundation, 2000):
•Ages 2–5 years: 27 minutes per day
•Ages 6–11 years: 49 minutes per day
•Ages 12–17 years: 63 minutes per day
As of 1999, the National Center for Education Statistics reported that 95% of schools and 63% of all classrooms have Internet access.
These numbers are certain to increase as computers become a more integral part of elementary education. However, even as school systems, government, and manufacturers rush to implement more computers in the schools, many others are expressing concerns about computers being harmful to children (Kelly et al., 2000; Alliance for Children, 2000); some are even calling for a ban on computers in the classroom until more is known. One group (Alliance for Children, 2000) lists the risks of computers to children as repetitive stress injuries, eyestrain, obesity, social isolation, and, for some, long-term damage to physical, emotional, or intellectual development. Obesity in children is linked to excessive time in front of a television screen— defined as 5 hours or more a day. The sedentary time spent in front of
221
222 Diagnosing and Treating Computer-Related Vision Problems
a computer screen could pose a similar risk. For most of these problems, hard evidence is not available. Very little research has been performed on children working at computers; however, given the importance of child health and learning, arguments for caution are weighty.
Some of the most significant concerns are not direct health problems, but the indirect harm caused by children viewing a computer for long periods of time instead of socializing and playing. A couple of catchy phrases include: “Two-dimension play is not as good as three-dimension play” and “For young children, seeing circles and squares is not as good as manipulating circles and squares” (Kelly et al., 2000).
Prima facie evidence supports concern for musculoskeletal problems. Although there are data and studies to support many of the ergonomic recommendations for adults, there are no studies specifically on the ergonomic requirements of children. In the absence of such studies, it is most reasonable to apply adult postural recommendations. This means that child computer workstations should be proportioned to children’s body sizes; such furniture is not commonly available. Children have smaller bodies than adults, yet they often use a computer workstation designed for adults. In most cases, the display and keyboard are much too high, resulting in awkward posture. There is also no solid evidence to support musculoskeletal injuries in children resulting from computer work. However, it is possible that poor posture early in life can predispose to adult problems.
Vision Problems
Children can be subject to most of the same vision symptoms as adults. One survey found that 43% of children reported eye-related problems working at computers. Visual problems such as eye fatigue, eyestrain, burning eyes, tearing eyes, soreness, blurred vision, and headaches are all symptoms that are noted in adults and that can also occur in children. A special issue for children is that they may avoid performing the task if it is uncomfortable. This commonly occurs when children have difficulty with their eyes at near viewing distances. When they try reading, it is uncomfortable. Instead of becom-
Assisting Children and Low Vision Patients in the Use of Computers 223
ing uncomfortable, they simply avoid reading, thereby harming their education. Of course, the symptoms are problematic, but learning avoidance because of the discomfort is potentially worse.
The development of myopia is a concern for some children. Clearly, the preponderance of myopia is genetically controlled. However, as reviewed in Chapter 4, there is reasonable research to support that some myopia development is related to performing extended near work with the eyes. No research has shown computer displays to create any more risk of developing myopia than other near tasks such as viewing paper.
Examination of Children
Symptoms in children should be assessed similarly to symptoms assessed in adults. Parents should be asked about school performance and whether the child avoids reading, other near tasks, or both.
Children who experience symptoms of discomfort or who present with a history of avoiding near work should have critical analysis of refraction, binocular vision, and accommodation. If the child is old enough to allow subjective responses, the testing, diagnosis, and management of these aspects of vision can be the same as presented in Chapters 4 and 5. In younger children, these functions can be assessed objectively with retinoscopy and cover test.
Children who begin progression into myopia should be closely observed. Binocular and accommodative function should also be assessed and treated when indicated. It is possible that esophoria, accommodative dysfunction, or both may be related to myopia development, and that treatment of these conditions may help retard the progression of myopia.
Virtual Environments
Head-mounted displays (HMDs) capable of creating virtual environments are now available and are likely to become used widely for games, entertainment, and work. HMDS are likely to become an attractive medium for children.
An issue of particular concern for most virtual environments is that the display moves with the head. As with adults, children could