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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 14  |  Issue : 1  |  Page : 124-130

Digital devices; a boon or bane: Ocular and musculoskeletal manifestations during lockdown in COVID-19 pandemic among general population of North India


1 Department of Community Medicine, ESIC Medical College and Hospital, Faridabad, Haryana, India
2 Department of Ophthalmology, VMMC and Safdarjung Hospital, New Delhi, India

Date of Submission05-Jun-2020
Date of Acceptance15-Oct-2020
Date of Web Publication09-Feb-2021

Correspondence Address:
Dr. Mitasha Singh
Department of Community Medicine, ESIC Medical College and Hospital, Faridabad - 121 001, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_172_20

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  Abstract 

Introduction: During the lockdown in COVID-19 days, excessive usage of digital devices leads to various consequences of ocular and musculoskeletal problems, mainly in the form of computer vision syndrome (CVS) and repetitive strain injury (RSI).
Objectives: The objective of this study is to estimate the prevalence of symptoms of CVS and RSI and their association between the duration of use of electronic devices among the general population of North India during the period of lockdown (March–May, 2020).
Methodology: The present study was a cross-sectional, descriptive, population-based study conducted during the 2 months period of lockdown between April and May 2020. The general population of all age groups of North India who were using any form of digital device with internet connectivity was included in the study. Sample size of 255 was achieved. Convenience and snowball sampling technique was applied. Study tool was pretested, structured, self-administered online survey forms using the Google forms.
Results: One or more symptoms of CVS were reported by 69% of the study population while 21.6% reported repetitive strain injuries. Around ten times significantly higher probability of having CVS was observed among those with more than 9 h of usage of electronic devices per day (odds ratio [95% confidence interval]; 9.94 [3.07–32.16]) as compared to those using it for < 2 h a day.
Conclusions: It is the need of the hour that there should be extensive dissemination of information, education, and communication services regarding the symptoms of CVS and RSI and their preventive measures among the general population.

Keywords: Computer vision syndrome, ergonomics, general population, North India, repetitive strain injury


How to cite this article:
Kumari S, Ranjan P, Singh M. Digital devices; a boon or bane: Ocular and musculoskeletal manifestations during lockdown in COVID-19 pandemic among general population of North India. Indian J Health Sci Biomed Res 2021;14:124-30

How to cite this URL:
Kumari S, Ranjan P, Singh M. Digital devices; a boon or bane: Ocular and musculoskeletal manifestations during lockdown in COVID-19 pandemic among general population of North India. Indian J Health Sci Biomed Res [serial online] 2021 [cited 2021 Feb 25];14:124-30. Available from: https://www.ijournalhs.org/text.asp?2021/14/1/124/308951




  Introduction Top


To prevent widespread community transmission of COVID 19 pandemic; in exercise of the powers under section 6 (2) (i) Of the Disaster Management Act, 2005, Government of India imposed a complete lockdown of the country from March 25, 2020.[1] This step was taken to strengthen the social distancing advisory by the government. The schools, colleges, and various offices are closed except for essential services till May 3, 2020. However, due to the advancement of technology the school and colleges have been running through online mode in form e-classes or live webinars. Various information technology and corporate sectors have allowed their employees to work from using their laptops or electronic devices. Others who were at home during this lockdown period were left with their television and mobile phone devices for information and entertainment. Hence, suddenly, the population from all classes of society was in one form or other spending much of their time of day on the electronic gadgets.

“Computer vision syndrome” (CVS) is defined by the American Optometric Association as a complex of eye and vision problems related to the activities which stress the near vision and which are experienced in relation to or during the use of computers.[2] The symptoms of CVS include headache, blurred vision, eye fatigue, strain to eye, neck pain, dry eyes, diplopia, polyopia, and difficulty in refocusing the eyes.[3] CVS has been seen to affect around three fourth of the people who work on computers, most markedly among those who work for more than 3–4 h on computers. Most of the literature related to CVS is on software professionals and IT professionals as these are the people who use computers for long time.[4],[5] Hands are the second most commonly involved portion of the body while working on these devices. A repetitive strain or stress injury repetitive strain injury (RSI) is a gradual damage to muscles, tendons, and nerves from repetitive motions. RSIs are common and may be caused by many different types of activities, including: using a computer mouse, typing, swiping items at a supermarket checkout, grasping tools, working on an assembly line, and training for sports. The next commonly involved portion in the body is back and neck while working in sitting posture on computer or laptop screen.[6]

These occupational hazards were reported by the class of people who spent much of their time on screen or students who used to study using their gadgets. With the emerging situation of this pandemic and lockdown being one of its consequences, there has been an increased usage of electronic devices for entertainment, information, connecting with family and friends, formal source of earning, and knowledge. Technology is a double-edged sword, and human beings have become slaves to the digital devices as these may impact our future generations in an irreversible and dangerous way.

Objectives:

  1. To estimate the prevalence of symptoms of CVS and RSI among the general population of North India during the period of lockdown (March–May, 2020)
  2. To determine the association between the duration of use of electronic devices and symptoms of CVS during the lockdown period
  3. To determine the association between the preventive measures and symptoms of CVS during the lockdown period.



  Methodology Top


Study design

The present study was a cross-sectional, descriptive, population-based study.

Study duration

It was conducted during 2 months period of lockdown between April and May 2020.

Study population

The population of all age groups of North India irrespective of their gender, education, occupation who were using any form of digital device was included in the study. In case of children under 7 years, parents or guardians responded on their behalf.

Inclusion criteria

They should be using android phones or laptops or I pads or tablets or any electronic devices with internet connectivity.

Sample size and sampling

Minimum sample size was calculated taking 80% prevalence of CVS from a previous literature,[5] at 95% confidence interval (CI) and 5% precision as 245. 5% was added to account for incomplete response. Hence, the sample size to be achieved was 257. Convenience and snowball sampling technique was applied.

Study tool

Informed consent was obtained before taking responses. To maintain privacy, names were kept anonymous. Study tool was pretested, structured, self-administered online survey forms using the Google forms. This survey form contains multiple-choice questions based on sociodemographic variables, use of digital device, and common problems occurred due to its use during lockdown in COVID days.

Data collection

The authors sent the link of Google form questionnaire to their contacts through social media platform of WhatsApp. Keeping in mind the inclusion criteria, the link was shared among relatives, friends, and colleagues who further forwarded it to their contacts. Parents or guardians filled the questionnaire for their children age < 11 years. The data collection was started in late April, 2020 and was closed as we reached 257 sample size. Each of the authors sent the questionnaire link to five contacts daily, and this was further forwarded by them. Each day around 15–17 responses was received.

Study variables and data analysis

Blehm et al. have divided the symptoms of CVS broadly into four categories: (1) Asthenopic–eye strain, tired eyes, and sore eyes; (2) Ocular surface related-watering, irritation, and dry eye (burning and red eyes); (3) Visual-blurred vision, slowness of focus change, double vision, and changes in color perception; and (4) Extraocular-neck pain, backache, and shoulder pain.[7] The symptoms were categorized in the above domains. One or more than one symptom of CVS was categorized as the presence of CVS. Two symptoms for RSI of the muscles of the hand were included.

Statistical analysis

After screening the responses, we excluded two of them due to incomplete response. Hence, analysis was conducted on 255. Data collected were categorical in nature and presented as proportions. Bivariate analysis was conducted between the independent variables (duration of usage and preventive measures) and dependent variable (CVS prevalence).


  Results Top


The current analysis included 62% males. Majority of the study population were in 26–35 years' age group (44.3%) and were formally literate (92.5%). By occupation, 32.2% were employed in the corporate sector and private firms, and 22.7% were health-care workers. Majority of participants (97.6%) reported of using mobile phones; 65.5% used laptops and computers; 21.9% used television and 17.6% were using Tab phone among the electronic devices. Around two-third perceived an increase in usage (65.9%) of any of these electronic devices. Nearly 70% males accepted that there was an increase in the duration of use of digital devices in this lockdown phase and 60% females also agreed for the same. About 67% literate populations also accepted that they were using digital devices for a longer period during this lockdown. The perceived increase in the usage of electronic devices was the highest by the corporate sector and private firm employees (27.2%) followed by government employees and health-care workers (20.2% each) [Table 1].
Table 1: Demographic profile of the study population (n=255)

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One or more symptoms of CVS were reported by 69% of the study population while 21.6% reported repetitive strain injuries. In the present study, it was found that the most common CVS symptoms presented were in the form of backache (36.5%) and pain/soreness in the eyes (32.9%) among the study population. Irritation of eyes (25% followed by dry eyes and watering (23% each) was the most common ocular surface-related symptoms reported. In asthenopic symptoms, tired eyes and sore eyes were reported by 32.9% participants and eye strain by 30% participants. Pain in hand and wrists (22%) was the most commonly reported RSI symptom. Majority of asthenopic and ocular surface symptoms were reported by Tab phone users and laptop/computer users. Visual symptom of blurred vision was reported maximum by television viewers and Tab phone users. More than one third each of the laptop and Tab phone users reported extra ocular symptoms. About 40% of the study population were using digital devices for 2–5 h, 32% were using for 6–9 h, and 15% were using for > 9 h in a day. An increasing trend of proportion of symptoms of all symptoms of CVS was observed with the increasing duration of usage of electronic devices. Majority of RSI symptoms were reported by laptop/computer users followed by mobile phones and Tab phone users [Table 2].
Table 2: Device and duration of usage based the presence of computer vision syndrome and repetitive strain injury symptoms

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The bivariate analysis revealed that as the duration of usage of electronic devices per day increased the odds of having CVS also increased significantly. Around ten times significantly higher probability of having CVS was observed among those with more than 9 h of usage of electronic devices per day (odds ratio [OR] [95% CI]; 9.94 [3.07–32.16]) as compared to those using it for < 2 h a day. A three times significantly higher probability of CVS was also reported by those not using ergonomically designed chair as compared to those using it (OR [95% CI]; 2.81 [1.53–5.16]). Those not taking and sometimes taking regular breaks from the electronic devices had a twice higher probability of development of CVS as compared to those taking regular breaks. Not having the knowledge of CVS had a 41% higher probability of having CVS as compared to those who have heard of it, although this was statistically not significant (OR [95% CI]; 11.40 [0.82–2.40]) [Table 3].
Table 3: Bivariate analysis demonstrating association between the predictors and prevalence of computer vision syndrome

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  Discussion Top


CVS has been a persistent problem, but it is highly under diagnosed. The CVS cases, which are present in our society is only the tip of the iceberg, major submerged portion is yet to be detected. During the lockdown phase due to ongoing COVID pandemic, CVS symptoms have reached at their peak. In this lockdown phase, everyone is dependent on their digital devices for their work, education, news, and entertainment. However, these increased digital devices use has made them vulnerable for the CVS symptoms and RSI symptoms for small muscles of the hand.

In the present study, it was found that most common digital device being used by the study participants were mobile phones followed by laptops/computers. Most of the study participants from all occupations agreed for the increased usage of digital devices during this lockdown. Study participants of productive year age group (26–45 years) were the maximal users of different types of digital devices. This finding was in concordance with the results of a similar study in which nearly 79% participants were of 25–29 years' age group.[5]

It was reflected from this study that only a meager percentage of 13% were using digital devices for < 2 h. In a similar study at United Arab Ajman, it was found that 94.4% university students used computers for > 2 h/day.[8]

The most common CVS symptoms presented in the current analysis were in the form of backache (36.5%) and pain/soreness in eyes (32.9%) among the study population. Another similar study conducted by Akinbinu and Mashalla also found eyestrain (30.9%) and headache (30.9%) as the most disturbing complaint.[9]

It was reflected from the present study that more than half (57%) of the study population never heard about CVS. In this modern and digitalized world, it is surprising to know that such a large proportion of population were still ignorant about the disease (CVS) which was associated with their increased use of digital devices. Moreover, among study subjects who had heard about CVS, half (51%) of them presented with the symptoms of CVS. It shows their knowledge about CVS is incomplete and inaccurate. They were probably not aware of preventive measures for CVS. Mowatt et al. reported a lower awareness of CVS (26.4%) among medical university students as compared to our study.[10] Hence, the awareness among future technical experts was also low. In another study on Indian ophthalmologists, awareness of CVS was 100%, but the confusion regarding treatment modalities persisted.[11]

In the present study, the prevalence of CVS was found to be 69%. Our finding was lower as compared to the prevalence rate of 81.9% in engineering students[12] and 89.9% among university students.[13] Ranasinghe et al.[14] reported a comparable prevalence rate of 67.4%. It could be due to the fact that most of the studies dealt with the prevalence of CVS and RSI among engineering/medical students/computer professionals. None was conducted among the general population.

The current analysis documented that the presence of CVS was directly proportional to the duration of uses, and it was statistically significant also. Similar finding was also found in another study from Karnataka.[5] Moreover, 18.4% of population had chronic eye disease of which 80% incurred symptoms of CVS. CVS probably flares up the previous morbidities of the eye.

From several literatures and consultation from various ophthalmologists, some preventive measures have been suggested for the control of CVS. Some major preventive measures are the use of ergonomic chair, using natural light, use of anti-glare spectacles, and taking regular breaks. The practice of preventive measures was enquired in the current study also. It was found that ergonomic chairs were used by nearly 33% subjects and usage of these chairs significant probability of prevention of occurrence of CVS. Majority (77%) were using digital devices under bulb/LED/tubelights which had no effect on the development of CVS symptoms. This could be due to multiple devices being used in different light conditions and causality is difficult to establish in this analysis.

In the present study, it was good to know that nearly 65% participants were taking regular breaks during digital devices usage. However, probability of CVS was higher among these only. It reflects that they were not following the interval of breaks during digital use as recommended or probably started it after the development of symptoms. Various research studies and books have documented that taking a smaller break for 5–10 min more frequently is better than taking a longer break every 2 or 3 h.[15] A 10–15 min break from the computer is recommended for every continuous 1–2 h of computer use.[16],[17] Majority (83%) were not using antiglare glasses/spectacles. The findings were in concurrence to that reported by Talwar et al., where 85.2% having symptoms did not use antiglare filters.[18]

The symptoms of RSI of muscles of the hand and wrist were reported to low (around 20%) among the study population. However, this is another emerging condition of the double-edged sword called technology. Smart phones, Tab phone, and laptops have made our lives easier, at the cost of increasing number of people have complaining of finger, hand and elbow pain as well as CVS symptoms as a result of using their device.[19]

Limitations

The self-administered online survey could have resulted in reporting bias. Establishing the causality was difficult due to the cross-sectional nature of the study.


  Conclusions and Recommendations Top


In this digitalized world, people of all age groups are dependent on digital devices for various needs of their day to day life, education, occupation, business, and entertainment purposes. Especially during the lockdown in COVID days, ocular and musculoskeletal problems increased exponentially. Therefore,it is the need of the hour that there should be extensive dissemination of information, education, and communication services regarding the symptoms of CVS and RSI and their preventive measures among the general population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Government of India. Ministry of Health and Family Welfare. Advisory on Social Distancing Measure in View of Spread of COVID-19 Disease. New Delhi, India: Ministry of Health and Family Welfare; 2020.  Back to cited text no. 1
    
2.
American Optometric Association. Guide to the Clinical Aspects of Computer Vision Syndrome. St. Louis: American Optometric Association; 1995.  Back to cited text no. 2
    
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Porcar E, Pons AM, Lorente A. Visual and ocular effects from the use of flat-panel displays. Int J Ophthalmol 2016;9:881-5.  Back to cited text no. 3
    
4.
Pulla A, Asma, Samyuktha N, Kasubagula S, Kataih A, Banoth D, et al. A cross sectional study to assess the prevalence and associated factors of computer vision syndrome among engineering students of Hyderabad, Telangana. Int J Community Med Public Health 2019;6:308-13.  Back to cited text no. 4
    
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Venkatesh SH, Girish AT, Shashikala, Kulkarni P, Mannava S, Rajarathnam R. A study of computer vision syndrome at the workplace-Prevalence and causative factors. Int J Contemp Med Res 2016;3:2375-7.  Back to cited text no. 5
    
6.
Hecht M. Everything You Should Know About Repetitive Strain Injury (RSI). Healthline. 9 March 2017. Available from: https://www.healthline.com/health/repetitive-strain-injury. [Last accessed on 2020 May 19].  Back to cited text no. 6
    
7.
Blehm C, Vishnu S, Khattak A, Mitra S, Yee RW. Computer vision syndrome: A review. Surv Ophthalmol 2005;50:253-62.  Back to cited text no. 7
    
8.
Shantakumari N, Eldeeb R, Sreedharan J, Gopal K. Computer use and vision-related problems among university students in Ajman, United Arab Emirate. Ann Med Health Sci Res 2014;4:258-63.  Back to cited text no. 8
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9.
Akinbinu TR, Mashalla YJ. Knowledge of computer vision syndrome among computer users in the workplace in Abuja, Nigeria. J Physiol Pathophysiol 2013;4:58-63.  Back to cited text no. 9
    
10.
Mowatt L, Gordon C, Santosh AB, Jones T. Computer vision syndrome and ergonomic practices among undergraduate university students. Int J Clin Pract 2018;72.  Back to cited text no. 10
    
11.
Bali J, Navin N, Thakur BR. Computer vision syndrome: A study of the knowledge, attitudes and practices in Indian ophthalmologists. Indian J Ophthalmol 2007;55:289-94.  Back to cited text no. 11
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Logaraj M, Madhupriya V, Hegde S. Computer vision syndrome and associated factors among medical and engineering students in Chennai. Ann Med Health Sci Res 2014;4:179-85.  Back to cited text no. 12
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Reddy SC, Low CK, Lim YP, Low LL, Mardina F, Nursaleha MP. Computer vision syndrome: A study of knowledge and practices in university students. Nepal J Ophthalmol 2013;5:161-8.  Back to cited text no. 13
    
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Ranasinghe P, Wathurapatha WS, Perera YS, Lamabadusuriya DA, Kulatunga S, Jayawardana N, et al. Computer vision syndrome among computer office workers in a developing country: An evaluation of prevalence and risk factors. BMC Res Notes 2016;9:150.  Back to cited text no. 14
    
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Thomson WD. Eye problems and visual display terminals – The facts and the fallacies. Ophthalmic Physiol Opt 1998;18:111-9.  Back to cited text no. 15
    
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Wang W, Li C, Zhan C, Long Y. Study on the psychological status of video display terminal operator. Wei Sheng Yan Jiu 1998;27:233-6.  Back to cited text no. 16
    
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Anshel J. Visual Ergonomics Handbook. New York: Taylor and Francis; 2005.  Back to cited text no. 17
    
18.
Talwar R, Kapoor R, Puri K, Bansal K, Singh S. A study of visual and musculoskeletal health disorders among computer professionals in NCR Delhi. Indian J Community Med 2009;34:326-8.  Back to cited text no. 18
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Powell R. Effects of Smartphones on our Fingers, Hands and Elbows. The Orthopedic Institute. Available from: https://www.toi-health.com/physician-articles/effects-smartphones-fingers-hands-elbows/. [Last accessed on 2020 May 19].  Back to cited text no. 19
    



 
 
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