Ophthalmic & Physiological Optics ISSN 0275-5408

Effect of contact lens use on Computer Vision Syndrome

Molina6 and Mar Segu
2,7
Ana Tauste1,2, Elena Ronda2,3,4,5, Mar
a-Jose
1
Doctorate Program on Health Science, University of Alicante, Alicante, 2Public Health Research Group, University of Alicante, Alicante, 3Preventive
Medicine and Public Health Area, Faculty of Health Sciences, University of Alicante, Alicante, 4CISAL (Centre for Research in Occupational Health),
Barcelona, 5CIBERESP (Biomedical Research Networking Centre, Epidemiology and Public Health), Madrid, 6Valencian Institute of Occupational Safety
and Health (INVASSAT), Alicante, and 7Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain

Citation information: Tauste A, Ronda E, Molina M-J & Segu
M. Effect of contact lens use on Computer Vision Syndrome. Ophthalmic Physiol Opt
2016; 36: 112119. doi: 10.1111/opo.12275

Keywords: computer terminals, Computer Abstract

Vision Syndrome, contact lenses, occupational
exposure, occupational health
Correspondence: Mar Segu
Crespo
E-mail address: mm.segui@ua.es
Received: 26 August 2015; Accepted: 11
December 2015; Published Online: 6 January
2016
Purpose: To analyse the relationship between Computer Vision Syndrome (CVS)
in computer workers and contact lens use, according to lens materials.
Methods: Cross-sectional study. The study included 426 civil-service office work-
ers, of whom 22% were contact lens wearers. Workers completed the Computer
Vision Syndrome Questionnaire (CVS-Q) and provided information on their
contact lenses and exposure to video display terminals (VDT) at work. CVS was
defined as a CVS-Q score of 6 or more. The covariates were age and sex. Logistic
regression was used to calculate the association (crude and adjusted for age and
sex) between CVS and individual and work-related factors, and between CVS and
contact lens type.
Results: Contact lens wearers are more likely to suffer CVS than non-lens wearers,
with a prevalence of 65% vs 50%. Workers who wear contact lenses and are
exposed to the computer for more than 6 h day 1 are more likely to suffer CVS
than non-lens wearers working at the computer for the same amount of time
(aOR = 4.85; 95% CI, 1.2518.80; p = 0.02).
Conclusions: Regular contact lens use increases CVS after 6 h of computer work.

and convergence when doing some specific tasks which

Introduction
The increasing role of information technology in the
workplace has led to the computer becoming an indis-
pensable tool in most professions and trades. The V
European Survey on Working Conditions has reported
that computer usage at work has risen steadily over the
last two decades, with the proportion of workers saying
they use the computer almost all the time or most of
their time more than doubling, from 14% in 1991 to
31% in 2010.1 Use of the computer in the workplace is
related to the development of a set of ocular and visual
symptoms known as Computer Vision Syndrome (CVS),
which include burning, itching, dryness, photophobia,
double vision and blurred vision, among other symp-
toms.24 CVS involves several mechanisms not only
related to the damage of the ocular surface and the tear
film, but also to the possible overload of accommodation
normally hold high visual and cognitive demands.5,6 The
probability of developing CVS increases with length of
exposure,7,8 with not taking rest periods8,9 and with years
of use.10
Contact lens use has also increased in recent years as the
usual way to compensate refractive errors. In Spain, 55% of
contact lenses fitted in 2013 were new fits; soft conventional
hydrogel lenses accounted for 40% of all contact lens fits,
and silicone hydrogel accounted for 47%.11 Wearing con-
tact lenses sometimes leads to tear film and ocular surface
alterations.1214 Characteristics like the permeability and
water content of the material, type of lens use, as well as
frequency of replacement with a new lens, affect comfort
and establish the pattern of possible complications due to
the fit.1517
While CVS has been widely studied in the last decade,5, 18
a recent review suggests that few empirical studies have

112 2016 The Authors Ophthalmic & Physiological Optics 2016 The College of Optometrists
Ophthalmic & Physiological Optics 36 (2016) 112119
A Tauste et al.
analysed the syndrome in contact lens wearers,19 and only
three of them have observed a statistically significant associ-
ation.2022 Furthermore, the results of this review19 provide
weak evidence due to the heterogeneity of the populations
studied in relation to the characteristics of the groups com-
pared (contact lens wearers vs non-wearers,2023 contact
lens wearers vs persons who had undergone laser-in-situ-
keratomileusis LASIK surgery,24 hydrogel soft contact
lens wearers vs silicone hydrogel contact lens wearers25)
and to the different categories of computer exposure anal-
ysed (use: Yes vs No,24,25 <4 vs 4 h day 1,23 among other
classifications), even to the use of unstructured and not val-
idated questionnaires to measure CVS. This lack of consen-
sus on the methodological approach and the small number
of articles makes it very difficult to compare the results and
rigor of the conclusions. Studies are needed that establish
control groups of non-contact lens wearers, in which all
available materials are compared, and which analyse com-
puter use and lens-wearing habits that favour reduced
symptoms.
Accordingly, the objective of this study was to analyse
the relationship between CVS in computer workers and
contact lens use, according to lens materials, and to observe
the effect of increasing number of hours of computer use in
the workplace.
Methods
Study population
This was an observational cross-sectional epidemiological
study of civil service office workers in the province of Ali-
cante, Spain. The study was conducted during the annual
review to monitor workers health carried out by the
Prevention Service of the Valencian Institute of Occupa-
tional Safety and Health. The participants were the 496
office workers who attended the review during the study
period (November 2013February 2014). During this rou-
tine review, a questionnaire was included on ocular and
visual symptoms when using the computer at work, as well
as a series of questions about computer usage at work and
habits of contact lens wearers.
All participants signed an informed consent form autho-
rising their participation, in which data confidentiality was
guaranteed during the entire process. Of the 496 workers
who participated in the study, 38 were excluded for the fol-
lowing reasons: 14 because they had undergone cataract,
refractive or strabismus surgery, 10 for amblyopia and/or
strabismus, three for glaucoma, and the remaining 11 for
active corneal or retinal disease and/or treatment at the
time of examination. Also excluded were 21 part-time spo-
radic wearers (those who used contact lenses while playing
sports or in other recreational situations, but not during
the workday) and 11 workers due to lack of information
2016 The Authors Ophthalmic & Physiological Optics 2016 The College of Optometrists
Ophthalmic & Physiological Optics 36 (2016) 112119
Computer Vision Syndrome in contact lens users
regarding their contact lenses. The final sample was com-
posed of 426 workers. This study was approved by the
Ethics Committee of the University of Alicante (Spain),
and adhered to the tenets of the Declaration of Helsinki.
Data collection
An optometrist was responsible for collecting the following
information:
Information on exposure to video display terminals (VDT) at
work
We studied computer work habits based on the following
variables: number of hours used per day (2, 36, >6),
years as a VDT worker (10, 1120, >20), maximum con-
tinuous work time at the VDT (<1, 12, >2 h), scheduled
breaks during VDT work (yes or no) and length of these
breaks (5, 10, 15 or 20 min).
Information on contact lenses
Participants were asked if they wore contact lenses (yes
or no); if they did, information was collected on the lens
material used: type (conventional hydrogel, silicone
hydrogel or rigid gas permeable contact lenses), water
content (low: 50% or high: >50%) and oxygen perme-
ability (low: Dk 60 or high: Dk > 60 barrer). Informa-
tion was also obtained on replacement (daily, monthly or
annually) and number of years as a contact lens wearer
(10, 1120, >20).
Computer Vision Syndrome Questionnaire (CVS-Q)
The CVS-Q, designed and validated by Segu
et al.26 was
used to measure perceived ocular and visual symptoms
during or immediately following computer work. This is a
self-administered questionnaire that evaluates the fre-
quency (never, occasionally or often/always) and the inten-
sity (moderate or intense) of 16 symptoms: burning,
itching, feeling of a foreign body, tearing, excessive blink-
ing, eye redness, eye pain, heavy eyelids, dryness, blurred
vision, double vision, difficulty focusing for near vision,
increased sensitivity to light, colored halos around objects,
feeling that sight is worsening, and headache. Subjects with
a score of 6 or more on the questionnaire are classified as
symptomatic (suffering CVS). Information was also
obtained on age (35, 3645 and >45 years) and sex.
Statistical analysis
To detect statistically significant differences between con-
tact lens wearers and non-wearers according to individual
and work characteristics the chi-squared test of indepen-
dence was used. A p value of less than 0.05 was considered
statistically significant.
113
Computer Vision Syndrome in contact lens users A Tauste et al.

The prevalence of CVS was calculated based on the num- Table 1. Distribution of contact lens wearers and non-wearers accord-
ber of persons who obtained a score of 6 or more on the ing to individual and work characteristics
questionnaire, by individual (age, sex and contact lens use) No. of CL Non CL
and work characteristics (use of VDT at work, time as VDT subjects wearers wearers
worker, maximum continuous work time at the VDT, Variables n = 426 n = 92 n = 334 p-Value*
scheduled breaks during VDT work, and length of breaks).
Age (years)
For contact lens wearers, we also calculated the prevalence 35 45 (10) 5 (5) 40 (12) 0.001
of CVS according to contact lens type. The explanatory 3645 143 (34) 46 (50) 97 (29)
independent variables that were associated with the depen- >45 238 (56) 41 (45) 197 (59)
dent variable in the univariate analysis (p < 0.1) were Sex
selected to be included in the multivariate analysis. Age was Male 204 (48) 22 (24) 182 (54) <0.001
always included in the model because it was considered Female 222 (52) 70 (76) 152 (46)
Use of VDT at work (hours per day)
clinically important. Logistic regression was used to calcu-
2 28 (6) 4 (4) 24 (7) 0.62
late the crude (cOR) and age- and sex-adjusted (aOR) odds 36 306 (72) 68 (74) 238 (71)
ratios to measure the association between CVS and individ- >6 92 (22) 20 (22) 72 (22)
ual and work-related factors, and between CVS and contact Time as VDT worker (years)
lens use and type. Finally, these results were stratified by 10 81 (19) 15 (16) 66 (20) 0.23
number of hours per day of VDT use at work (6 and >6) 1120 240 (56) 59 (64) 181 (54)
to assess the effect modification. The SPSS statistical >20 105 (25) 18 (20) 87 (26)
Maximum continuous work time at the VDT (hours)
program for Windows (http://www-01.ibm.com/software/
<1 115 (27) 27 (29) 88 (26) 0.28
analytics/spss/), version 16.0, was used for all calculations 12 123 (29) 31 (34) 92 (28)
and statistical analyses. >2 188 (44) 34 (37) 154 (46)
Scheduled breaks during VDT work
No 277 (65) 47 (51) 230 (69) 0.002
Results Yes 149 (35) 45 (49) 104 (31)
Table 1 shows the characteristics of the 426 workers Length of breaks (minutes)
5 59 (40) 22 (49) 37 (36) 0.13
included in the study (mean age 47.3  8.9 years, 52%
10 48 (32) 16 (36) 32 (31)
women, and 22% contact lens wearers). Some 72% of the 15 24 (16) 5 (11) 19 (18)
sample used the VDT 36 h day 1, and 81% had used 20 18 (12) 2 (4) 16 (15)
VDTs for more than 10 years, with 44% looking at the
screen continuously for more than 2 h day 1. CL, contact lenses; VDT, video display terminal.
*The p-values shown are for the comparison between CL and non CL
The comparison of contact lens wearers and non-wearers
wearers.
(Table 1) showed significant differences by age and sex.
Women were more often contact lens wearers than men
(p < 0.001), and most contact lens wearers were 36 ity, while the latter had low water content in 96% of cases,
45 years of age, while non-wearers were generally over 45 just the opposite of the conventional hydrogel lenses, which
(p = 0.001). It was also seen that non-wearers were less had low oxygen permeability (100%) and high water con-
likely to take breaks during VDT use at work (p = 0.002). tent (77%).
No significant differences were seen in the rest of the indi- Table 3 shows the prevalence of and associations between
vidual or work-related characteristics. CVS and individual and work factors. The prevalence of
In the group of contact lens wearers (Table 2), the most CVS in all workers was 53%. Women had a higher preva-
frequently worn lenses were those made of silicone hydro- lence than men in the crude analysis (cOR = 2.00; 95% CI,
gel (51%). Conversely, rigid gas permeable lenses were used 1.362.95; p < 0.001). The same occurred with the use of the
very infrequently (11%). About 60% of participants had VDT at work, with a clear trend: the more hours working on
been using contact lenses for more than 20 years. The vari- the computer, the greater the probability of suffering CVS.
ables replacement, oxygen permeability and water content The syndrome was not found to be associated with number
are closely related to each type of contact lens. The rigid gas of years as a VDT worker, with time of continuous VDT use,
permeable lenses were replaced annually in all cases, while or with number or duration of breaks during VDT use.
the soft lenses (silicone hydrogels and conventional hydro- As can be seen in Table 4, in the comparison of contact
gels) were replaced monthly in most cases (98% and 83%, lens wearers vs non-wearers, the former are the most
respectively). With regard to the characteristics of each affected by CVS, with a prevalence of 65% vs 50% in non-
material, 100% of the rigid gas permeable lenses and 91% wearers. The probability of CVS is higher in contact lens
of the silicone hydrogel lenses had high oxygen permeabil- wearers than in non-wearers in the crude analysis

114 2016 The Authors Ophthalmic & Physiological Optics 2016 The College of Optometrists
Ophthalmic & Physiological Optics 36 (2016) 112119
A Tauste et al. Computer Vision Syndrome in contact lens users

Table 2. Distribution of contact lens wearers by type according to con- 6 h day 1 are more likely to suffer CVS than non-lens
tact lens characteristics and conditions of use wearers working at the computer for the same amount of
Type of CL time. Lens type seems to be a key factor in the presence of
the syndrome. Although not statistically significant, there is
SiHy CH a trend suggesting that wearing conventional hydrogel
CL wearers RGP wearers wearers wearers
lenses and even more so in the case of silicone hydrogel
n = 92 n = 10 n = 47 n = 35
lenses increases the likelihood of CVS, and that the risk of
Variables No. of subjects (%) CVS increases with the number of hours of computer use.
Nevertheless, these results should be interpreted with
Replacement
Daily 2 (2) 0 (0) 1 (2) 1 (3)
caution given the limitations of our study. One limitation
Monthly 75 (82) 0 (0) 46 (98) 29 (83) that should be noted is the sample size in the group of con-
Annually 15 (16) 10 (100) 0 (0) 5 (14) tact lens wearers. Although the trend suggests that hydrogel
Time as a CL wearer (years) lenses may cause a greater problem, this cannot be inferred
10 15 (16) 0 (0) 9 (19) 6 (17) conclusively because the relatively small number of these
1120 22 (24) 1 (10) 10 (21) 11 (32)
types of lenses did not make it possible to obtain significant
>20 55 (60) 9 (90) 28 (60) 18 (51)
results. Also, in the case of rigid gas permeable lenses
Oxygen permeability (barrer)
High (Dk > 60) 53 (58) 10 (100) 43 (91) 0 (0) (n = 10) it should be taken into account that a minority of
Low (Dk 60) 39 (42) 0 (0) 4 (9) 35 (100) persons used these types of lenses (about 10% of the refits
Water content (%) in Spain11). Nonetheless, our results make it possible to
Low (50) 63 (68) 10 (100) 45 (96) 8 (23) observe certain associations, although they are not always
High (>50) 29 (32) 0 (0) 2 (4) 27 (77) significant; these can be considered a good starting point
CH, conventional hydrogel; CL, contact lenses; RGP, rigid gas perme-
for future investigations with larger sample sizes, which
able; SiHy, silicone hydrogel. may arrive at more conclusive results. Another limitation is
1 barrer = 1011 [cm2 s 1][mL O2 mL 1 mmHg 1]. one that is characteristic of a cross-sectional design: we can-
not be sure that the cause (use of contact lenses) precedes
(cOR = 1.90; 95% CI 1.183.07; p = 0.009), but this rela- the effect (presence of CVS). There are even several risk fac-
tionship is not significant in the analysis adjusted for age tors studied that are related to the effect, such as computer
and sex (aOR = 1.58; 95% CI, 0.952.62; p = 0.08). Wear- exposure, which may generate interaction phenomena. For
ing silicone hydrogel contact lenses almost doubles the prob- this reason, we performed a stratified analysis by hours per
ability of suffering CVS compared to non-wearers of contact day of VDT use, which showed the increased effect in
lenses (cOR = 1.96; 95% CI, 1.033.72; p = 0.04), although workers who use the computer more than 6 h day 1. On
after adjusting for age and sex these results lose significance. the other hand, the same contact lens wearer may have a
Table 4 also shows the results by moderate (6 h day 1) varied history in terms of type and use of lenses, and fre-
and high (>6 h day 1) VDT exposure. The probability of quency of replacement, which would influence the effect,
suffering CVS in the group with moderate exposure was or a non-wearer may have worn contact lenses previously
lower in all cases; moreover, this association loses strength and then abandoned their use due to certain complications.
after adjusting for age and sex. Conversely, in the group of However, we were able to collect this information in the
workers exposed to the computer for more than 6 h day 1, latter group, and found that only 18 of the 334 current
the OR values are very high in the crude analysis non-wearers of contact lenses had worn them at some time
(cOR = 4.29; 95% CI, 1.1515.93; p = 0.03), and are even in their lives; this is a very small percentage (5%), which we
higher after adjustment (cOR = 4.85; 95% CI, 1.2518.80; do not believe is affecting the results. In any case, new
p = 0.02). This indicates that the probability of suffering experimental studies should be planned with follow-up
CVS in this group is almost five times higher in contact lens over time; these would allow us to determine whether the
wearers than in non-wearers. People who wear conventional different materials and conditions of use of contact lenses
hydrogel lenses show an aOR of 4.59 (95% CI, 0.50, 42.39; affect the incidence of CVS in workers with equal computer
p = 0.18), and the aOR in those who wear silicone hydrogel exposure who have not previously used contact lenses.
lenses is 7.94 (95% CI, 0.9367.61; p = 0.06); although it Given that women constitute 76% of the contact lens
does not reach statistical significance in either case. wearers and that they were twice as likely as men to suffer
CVS (p < 0.001), adjustment for sex was considered essen-
tial for correct interpretation of the results.
Discussion
Despite the aforementioned limitations, ours is the first
The main result of this study is that workers who wear con- study of these characteristics to analyse the relation between
tact lenses and are exposed to the computer for more than CVS and contact lens use in computer workers, as well as

2016 The Authors Ophthalmic & Physiological Optics 2016 The College of Optometrists 115
Ophthalmic & Physiological Optics 36 (2016) 112119
Computer Vision Syndrome in contact lens users A Tauste et al.

Table 3. Prevalence and associations between Computer Vision Syn-

p-Value
drome and individual and work factors

0.02

0.18
0.06
0.63
Variables Prevalence n (%) Crude OR (95% CI) p-Value

4.85 (1.25, 18.80)

4.59 (0.50, 42.39)

7.94 (0.93, 67.61)
1.88 (0.15, 23.61)
No. of subjects 226 (53)

OR (95% CI)
Age (years)

adjusted
Age-sex
35 25 (56) 1.00

1.00

1.00
3645 79 (55) 0.99 (0.50, 1,94) 0.97
>45 122 (51) 0.84 (0.44, 1.60) 0.60
Sex

Value
of VDT use

0.03

0.17
0.08
0.74
Male 90 (44) 1.00

p-
Female 136 (61) 2.00 (1.36, 2.95) <0.001

4.29 (1.15, 15.93)

4.54 (0.52, 39.65)

6.81 (0.82, 56.58)
1.51 (0.13, 17.44)
Use of VDT at work (hours per day)
2 12 (43) 1.00

Crude OR
>6 h day
36 156 (51) 1.39 (0.64, 3.03) 0.41

(95% CI)
>6 58 (63) 2.28 (0.96, 5.37) 0.06

1.00

1.00
Time as VDT worker (years)
10 41 (51) 1.00

Value
1120 126 (53) 1.08 (0.65, 1.79) 0.87

0.49

0.54
0.60
1.00

CH, conventional hydrogel; CI, confidence interval; CL, contact lenses; OR, odds ratio; RGP, rigid gas permeable; SiHy, silicone hydrogel.
>20 59 (56) 1.25 (0.79, 2.24) 0.45

p-
Maximum continuous work time at the VDT (hours)

1.22 (0.69, 2.16)

1.30 (0.57, 2.97)

1.22 (0.59, 2.53)
1.00 (0.21, 4.74)
<1 62 (54) 1.00

adjusted OR
12 65 (53) 0.96 (0.58, 1.60) 0.87

(95% CI)
Age-sex
>2 99 (53) 0.95 (0.60, 1.51) 0.83
Scheduled breaks during VDT work

1.00

1.00
No 151 (55) 1.00
Yes 75 (50) 0.85 (0.57, 1.26) 0.41

Value
of VDT use

0.07

0.20
0.18
0.62
Length of breaks (minutes)

p-
Table 4. Prevalence and associations between Computer Vision Syndrome and contact lens use and type

5 29 (49) 1.00

1.63 (0.96, 2.76)

1.69 (0.76, 3.76)

1.61 (0.80, 3.24)
1.46 (0.32, 6.66)
10 25 (52) 1.12 (0.53, 2.41) 0.76
15 11 (46) 0.88 (0.34, 2.27) 0.78
1

Crude OR
6 h day

20 10 (56) 1.29 (0.45, 3.73) 0.60 (95% CI)

1.00

1.00
CI, confidence interval; CL, contact lenses; OR, odds ratio; VDT, video
display terminal.
Value

0.08

0.22
0.13
0.80
p-

the effect of different lens materials. A notable strength of

1.58 (0.95, 2.62)

1.60 (0.75, 3.39)

1.67 (0.86, 3.23)
1.18 (0.32, 4.35)
the study is the use of a recently validated questionnaire to
OR (95% CI)

measure CVS,26 which lends greater rigour to our findings

adjusted
Age-sex

as compared to previous studies of this subject. In those

studies, failure to control the workplace temperature and
1.00

1.00

humidity was a limitation, since it could not be known if

Value

these were outside the recommended ranges and could be

0.009

0.08
0.04
0.52
p-

affecting tear stability and, consequently, provoking

increased symptoms. In Spain, Royal Decree 486/1997, of
1.90 (1.18, 3.07)

1.94 (0.94, 4.03)

1.96 (1.03, 3.72)
1.52 (0.42, 5.48)

14 April, which establishes minimum safety and health reg-

Crude OR

ulations in the workplace, stipulates that in sedentary jobs

(95% CI)

typical of offices or similar types of work, the temperature

1.00

1.00
All

should be maintained between 17 and 27C, and relative

humidity between 30% and 70%.27 According to reports of
Prevalence

the Prevention Service, all workplaces of the persons who

166 (50)
60 (65)

166 (50)
23 (66)
31 (66)
6 (60)
n (%)

participated in our study complied with the existing

regulations.
The approach of most studies of the effect of contact
Non-wearers
Variables

Type of CL

lens use on VDT workers has been to compare self-

reported symptoms.19 In the study of Gonzalez-Meijome
CL use

SiHy
RGP
Yes

CH
No

et al.20 the most common symptoms in contact lens

116 2016 The Authors Ophthalmic & Physiological Optics 2016 The College of Optometrists
Ophthalmic & Physiological Optics 36 (2016) 112119
A Tauste et al.
wearers as compared to non-wearers were red eye (47.9%
vs 29.6%, p < 0.01) and scratchiness (31.0% vs 9.9%,
p < 0.01). Likewise, the studies of Uchino et al.21, 22
report a higher prevalence of dry eye in contact lens wear-
ers, with statistically significant differences (p < 0.01).
Even though our results are the first to show CVS as a
syndrome, an individual analysis of the symptoms is also
consistent with these studies, given that we found a higher
prevalence of dryness (73% vs 36%, p < 0.001), burning
(30% vs 20%, p = 0.04), feeling of a foreign body (42% vs
30%, p = 0.02) as well as excessive blinking (40% vs 28%,
p = 0.02) in the contact lens group compared to non-
wearers (data not shown).
Many authors defend the high permeability of silicone
hydrogels as the great advantage of these lenses compared
to conventional hydrogels since, by allowing greater passage
of oxygen to the cornea, they reduce hypoxia, corneal
oedema, and limbal and conjunctival redness, making these
types of lenses especially indicated for prolonged use.16,28,29
However, in our study, the worst results with respect to
non wearers were found in those who wore silicone hydro-
gel contact lenses and were exposed to the computer for
more than 6 h day 1 (cOR = 1.96; 95% CI, 1.033.72;
p = 0.04), although the OR in the adjusted analysis did not
quite reach statistical significance (aOR = 7.94; 95% CI,
0.9367.61; p = 0.06). Due to their high elastic modulus,
highly hydrophobic surfaces, and the tendency to accumu-
late lipid deposits, silicone hydrogel lenses in some cases
may not completely satisfy criteria of biocompatibility with
the ocular surface, leading to various kinds of complica-
tions and reduced comfort.3035 Moreover, the risk of infec-
tion increases if these lenses (most for biweekly or monthly
use) are not adequately cleaned or disinfected.3639
Although newer generations of silicone hydrogel lenses
have reduced the frequency and severity of some of these
complications,33, 40 others have remained at previously
reported levels.41, 42 We identified only one study analyzing
comfort with contact lenses during computer use, which
found increased comfort in persons who were refit with sil-
icone hydrogel lenses after previously using conventional
hydrogels.25 However, only one of the three silicone hydro-
gels refitted (Senofilcon A) yielded significant results,
whereas the other two (Galyfilcon A and Lotrafilcon B) did
not improve comfort. Furthermore, the authors empha-
sised as a study limitation that the measure of comfort was
obtained 2 weeks after refitting, which is considered an
insufficient follow-up period. Also, a recent literature
review by Guillon43 concludes that, although some studies
have reported that refitting contact lens wearers with sili-
cone hydrogel materials improves comfort, a more thor-
ough literature review shows that the most robust studies
(with concurrent controls and masking) have not demon-
strated that such differences really exist; in fact, some have
2016 The Authors Ophthalmic & Physiological Optics 2016 The College of Optometrists
Ophthalmic & Physiological Optics 36 (2016) 112119
Computer Vision Syndrome in contact lens users
even concluded that silicone hydrogel lenses are less com-
fortable.
As expected, water content 50% or Dk > 60 are proper-
ties characteristic of materials like Balafilcon A, Lotrafilcon
B, Senofilcon A, Comfilcon A, Enfilcon A and Narafilcon
A, the materials used by 92% of the workers in our sample
who wore silicone hydrogel lenses. Only two workers used
silicone hydrogel lenses with low permeability and high
water content (Filcon II 3: 58% and Dk = 60), and another
two used lenses with low permeability and low water con-
tent (Galyfincon A: 47% and Dk = 60). Moreover, 77% of
the workers who used conventional hydrogels wore lenses
with high water content (>50%) and low permeability (Dk
60): Etafilcon A, Methafilcon A, Nelfilcon A, Ocufilcon D,
Omafilcon A, among others. The exceptions in this case
were five workers who used Polymacon (38.6% and
DK = 8.5) and three who used pHEMA (38% and
Dk = 10), lenses with low water content and low perme-
ability.
With regard to contact lens maintenance, it is notable
that when asked about the system used to clean their lenses,
100% of those who wore lenses replaced monthly (conven-
tional hydrogel and silicone hydrogel contact lens wearers)
used only a multi-purpose lens care solution, which may
not be enough to eliminate superficial deposits and could
provoke increased symptoms.4446
People who replace their lenses daily wear them a mean
of 6.50  0.71 days a week, while those who replace them
monthly and annually wear them 6.51  0.84 and
6.27  1.33 days per week, respectively. This indicates
that, regardless of the frequency of replacement, workers
wear their lenses regularly during their workday. In our
study, no differences in CVS were seen in workers who
spent less time continuously viewing the computer screen,
or in those who took breaks, whatever their duration. These
results are consistent with the systematic review of Brewer
et al.,47 who state that there is insufficient evidence to con-
clude that taking breaks in computer work has a positive
effect on visual symptoms; as confirmed 2 years later by
Bhanderi et al.10
It can be concluded that regular use of contact lenses
when performing 6 h or more of computer work increases
CVS. In these conditions, there is a trend towards a greater
problem in wearers of conventional hydrogel and silicone
hydrogel contact lenses, especially those who wear the latter
type. However, given the small sample size (n = 35 CH and
n = 47 SiHy) in these two groups, the power of the study
to detect statistical significance is limited. In general, these
are lenses with monthly replacement. Ineffective cleaning
with multi-purpose solutions probably influences the
results obtained. Contact lens wearers should also be
advised to clean these lenses more thoroughly. The poorer
results with silicone hydrogels may be due to the
117
Computer Vision Syndrome in contact lens users
mechanical interaction of these materials with the ocular
surface. Future development of silicone hydrogels with a
lower elasticity modulus will be instrumental in reducing
these symptoms. For all these reasons, workers who use
contact lenses that put them at particular risk of developing
CVS should be monitored carefully.
Acknowledgements
This work was supported by a grant to carry out Projects in
Emerging Fields of Research of the University of Alicante
(GRE11-22). The sponsor or funding organization had no
role in the design or conduct of this research.
Disclosure
The authors report no conflicts of interest and have no pro-
prietary interest in any of the materials mentioned in this
article.
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