Computer Vision Syndrome Among the General Population in the Eastern Region of Libya: Prevalence and Risk Factors

Aim To assess the prevalence and determine the risk factors of computer vision syndrome among the general population in the Eastern region of Libya. Methods This study used a descriptive cross-sectional design and comprised a random sample of 407 Libyan adults from Eastern Libya. Data were collected using an online-based questionnaire. Statistical analysis of all the datasets was performed using SPSS software, version 21.0 (IBM Corp., Armonk, NY). Results The mean age of the participants was 32.1 years (SD=12.8), and most participants 281 (69%) were female. As for employment status, 261 (64.1%) were students, 70 (17.2%) were non-healthcare workers, and 46 (11.3%) were healthcare workers. The majority of participants, 353 (86.7%), used a computer seven days a week, with 187 (45.9%) of those participants using a computer for over six hours daily. Over one-third of participants, 157 (38.6%), had computer vision syndrome. Being over 45 years of age, being a student, and using a computer for over six hours a day were the main factors associated with computer vision syndrome. Neck pain was the most commonly reported complaint in 235 (57.5%). Conclusion Increased use of electronic devices is leading to a higher prevalence of computer vision syndrome. Our study emphasizes the need to raise awareness regarding computer vision syndrome among the general public and medical professionals.


Introduction
Electronic devices have become widely used in the 21st century and are an integral part of most people's daily lives [1].People spend more than 75% of their waking hours on computers [2].People use many types of digital displays at home or the workplace.These include laptops, desktop computers, smartphones, and ereaders.If the time spent on these digital devices exceeds three hours per day or more than 30 hours per week, it increases their likelihood of developing computer vision syndrome (CVS) [3].CVS, also known as digital eye strain or visual fatigue, is a set of ocular and visual disorders caused by prolonged exposure to high-resolution digital display terminals, such as computers, tablets, and smartphones, as defined by the American Optometric Association [4].The reported number of CVS cases accounts for over 60 million individuals worldwide.In Ethiopia, Egypt, and Nigeria, the prevalence rate of CVS is 81.3%, 75%, and 54.2%, respectively [5].In addition to the amount of time spent using digital devices, strobe lights, poor lighting, eye problems, advancing age, and improper sitting postures are also risk factors for CVS [6][7][8][9][10][11].
CVS is divided into four categories based on the symptoms.These are asthenopic CVS, ocular surface CVS, visual CVS, and extraocular CVS [7].Although the discomfort associated with extensive computer use has not been proven to result in a long-term decline, it can reduce one's skillfulness by almost 40%.Therefore, an increase in CVS prevalence is anticipated to result not only in increased health problems associated with

Statistical analysis
The data were collected, reviewed, and then fed to Statistical Package for Social Sciences (SPSS) software, version 21 (IBM Corp., Armonk, NY).All statistical methods used were two-tailed with an alpha level of 0.05.P-values ≤ 0.05 were considered statistically significant.Descriptive analysis was conducted by prescribing frequency distribution and percentages for study variables, including participants' demographic data, computer use, associated CVS symptom frequency and intensity, and associated complaints.Ocular symptom frequency and associated complaints were graphed as well as the overall prevalence of CVS.Cross tabulation to assess factors associated with CVS among study participants was carried out with Pearson Chisquare test for significance and exact probability test if there were small frequency distributions.

Results
A total of 407 participants fulfilling the inclusion criteria completed the study questionnaire.Participants' ages ranged from 18 to over 45 years with a mean age of 32.Frequency: Never (the symptom does not occur at all); Occasionally (sporadic episodes or once a week); Always: Two or three times a week or almost every day.

Discussion
Our study aimed to assess the prevalence of CVS symptoms along with its risk factors among the Eastern Libyan population.The prevalence of CVS in our study group was 38.6%, which was 157 participants out of 407.The most frequently reported symptoms were non-ocular, with a high prevalence of headache (82%) and back pain (79%).This is in line with other previously published studies, which found headaches to be the most frequent symptom related to the use of computers [12][13][14][15].In contrast, body fatigue was more common in computer use among bank workers in Pakistan, where half of the participants used the computer for more than eight hours a day, which could be explained by prolonged sitting during working hours [16,17].The most commonly reported ocular symptoms in our study were eye burning and itching (68.3% and, 63.6%, respectively).The severity of eye itching severity was intense in 22.2% of the participants, and eye burning severity was intense in 19.2% of them.This finding is consistent with the above-mentioned study done in Pakistan, which found a 77.2% prevalence of eye burning [17].Excessive blinking and eye dryness are the least reported symptoms in our study.
Our findings show a statistically significant association between being over 45 years of age and the development of CVS.A study in Sri Lanka showed similar findings, where the prevalence of CVS was higher among participants over 40 years of age (72.7%) [14].This could be linked with decreased tear production as a normal process of aging [3].Gender is not strongly related to CVS in our study.On the contrary, significant female predominance in the one-year prevalence of CVS was found in the study done in Sri Lanka [14].
Another study done in the United Arab Emirates among university students demonstrated some differences in gender with certain symptoms of CVS, and headaches were more frequently reported in females [8].Moreover, a review done on CVS showed higher cases of dry eye in females [3].A study on university administrative staff in Ghana reported a higher prevalence of CVS in males, but the author pointed out that this could be due to the unequal distribution of gender in their study sample [8].
In addition, there is a strong association between the prolonged use of computers for more than six hours a day and CVS in our study, which is reported to be 46% of CVS cases.This association was also observed in a study done in Nigeria, which showed that 48.9% of their participants with CVS symptoms were using the computer for six to eight hours a day [12].Likewise, a study from Ethiopia reported a statistically significant association between prolonged daily exposure to the screen for more than 4.6 hours and the development of CVS [13].Similarly, another study done among undergraduates in Nigeria and the study done in Ghana reported similar findings [15,18].CVS symptoms in the present study were reported to be 41.7% of those who use the computer for five to six days a week, followed by 40% for using the computer one to four days a week.However, there is no significant association between the number of days of computer usage and CVS.
The study done among undergraduates in Nigeria reported that the number of years of using the computer was significantly related to CVS and in that study, participants who used the computer for more than 7 years were more likely to get CVS [15].
The present study demonstrated a high prevalence of CVS in students.In accordance, a study done in India on medical and engineering students reported a high prevalence of CVS (80.3%) [19].Another study done in Africa among undergraduates reported significant prevalence in students and clinicians [20].This could be explained by the frequent use of smart devices nowadays for studying purposes.Lower cases of CVS are noticed in non-healthcare workers and unemployed participants in this study.On the other hand, the type of computer used, whether a smartphone, tablet, desktop, or television by the participants is not significantly related to CVS in the current study.
This study shows that the lighting type used in the room (i.e., fluorescent, incandescent, or natural sunlight) has no relation to the development of CVS.On the other hand, the study done in the United Arab Emirates among students reported that the intensity of lighting in the room was related to CVS symptoms; eye fatigue was higher when the room was extremely bright or extremely dark during the use of the computer [8].
Another related factor demonstrated by the study done in Sri Lanka was that the screen contrast, compared to the surroundings, was significantly related to CVS [14].
There were several limitations to our study.Firstly, the sample size was small.Secondly, we did not consider other factors such as the distance from which the text was viewed or the size of the font used.Thirdly, the symptoms reported were based on self-reporting, which could have resulted in biased data.Fourthly, we did not test whether wearing glasses had any correlation with CVS.Lastly, we did not examine whether the participants' awareness played a role in the presence of CVS.To confirm our results, a large-scale, prospective, international study is required.

Conclusions
The widespread disease known as computer vision syndrome (CVS) has started to become more noticeable worldwide.People are utilizing digital devices more frequently for work and entertainment, which has resulted in increased CVS prevalence.CVS can be accompanied by a variety of painful symptoms and can impair visual function.This study has explored the prevalence of CVS and its risk factors, such as excessive screen usage, bad lighting, and type of device.The results highlight the necessity of raising CVS awareness among the general public and medical professionals.The risk of getting CVS can be mitigated by employing techniques such as taking regular breaks and maintaining good posture.Further research is needed on treating CVS to identify the long-term health impacts of chronic digital device usage and determine the most optimal prophylactic strategies.
Overall, this study highlights the necessity of continuing research and teaching in this field and emphasizes the significance of identifying CVS as a crucial public health concern.We can minimize the burden of CVS and enhance people's visual health and well-being in the digital age by cooperating to create efficient preventative and treatment techniques.

FIGURE 1 :FIGURE 2 :
FIGURE 1: Prevalence of computer vision syndrome among study participants, Eastern Region of Libya

TABLE 4 : Factors associated with computer vision syndrome among study participants
The most frequently reported complaints were neck pain (57.5%), tingling and numbness when holding a mobile phone (50.4%), having/performing trick movements to make the tingling and numbness go from one's hands (46.2%), and being woken by tingling and numbness in the hand during the night (35.1%).The associated complaints with CVS among study participants are shown in Table5.Items Percent of "yes"Has the pain in your wrist woken you at night? 66 (16.2%)Has tingling and numbness in your hand woken you during the night?143(35.1%)Are the tingling and numbness in your hand more pronounced first thing in the morning?123 (30.2%)

TABLE 8 : Frequency and intensity of symptoms associated with CVS (CVS-Q)
2023 Computer vision syndromeFrequency: Never (the symptom does not occur at all); Occasionally (sporadic episodes or once a week); Always (two or three times a week or almost every day).Intensity: Mild/Moderate/Severe/Intense.2023Alturaiki et al.Cureus 15(11): e48777.DOI 10.7759/cureus.48777