C L I N I C A L A N D E X P E R I M E N T A L

OPTOMETRY
RESEARCH PAPER

Comparison of progressive addition lenses for general purpose and for

computer vision: an office field study

Clin Exp Optom 2015; 98: 234243 DOI:10.1111/cxo.12259

Wolfgang Jaschinski* Dr Ing
Mirjam Knig* Dipl Ing (FH)
Tiofil M Mekontso* Dipl Stat
Arne Ohlendorf Dr Sc Hum
Monique Welscher Dipl Ing (FH)
* Leibniz Research Center for Working Environment
and Human Factors, Dortmund, Germany
Background: Two types of progressive addition lenses (PALs) were compared in an office
field study: 1. General purpose PALs with continuous clear vision between infinity and near
reading distances and 2. Computer vision PALs with a wider zone of clear vision at the
monitor and in near vision but no clear distance vision.
Methods: Twenty-three presbyopic participants wore each type of lens for two weeks in a
double-masked four-week quasi-experimental procedure that included an adaptation phase
(Weeks 1 and 2) and a test phase (Weeks 3 and 4). Questionnaires on visual and muscu-

ZEISS Vision Science Lab, Carl Zeiss Vision

loskeletal conditions as well as preferences regarding the type of lenses were administered.
International GmbH, Tbingen, Germany

Technology & Innovation, Carl Zeiss Vision GmbH, After eight more weeks of free use of the spectacles, the preferences were assessed again. The
Aalen, Germany ergonomic conditions were analysed from photographs.
E-mail: jaschinski@ifado.de Results: Head inclination when looking at the monitor was significantly lower by 2.3 degrees
with the computer vision PALs than with the general purpose PALs. Vision at the monitor was
judged significantly better with computer PALs, while distance vision was judged better with
general purpose PALs; however, the reported advantage of computer vision PALs differed in
extent between participants. Accordingly, 61 per cent of the participants preferred the
computer vision PALs, when asked without information about lens design. After full
information about lens characteristics and additional eight weeks of free spectacle use, 44
per cent preferred the computer vision PALs.
Conclusion: On average, computer vision PALs were rated significantly better with respect
to vision at the monitor during the experimental part of the study. In the final forced-choice
Submitted: 6 June 2014 ratings, approximately half of the participants preferred either the computer vision PAL or
Revised: 20 October 2014 the general purpose PAL. Individual factors seem to play a role in this preference and in the
Accepted for publication: 23 October 2014 rated advantage of computer vision PALs.

Key words: computer work, presbyopia, progressive lenses, spectacle lenses

Computer vision syndrome comprises many
ocular causes,1 including the reduced
accommodation in presbyopic computer
users, who require spectacle lenses with a
near vision addition to clarify their vision for
computer work. Different types of lenses can
be used with specific advantages and disad-
vantages from an optometric point of view;
additionally, work-related and ergonomic
factors play a role. Thus, the type of lens that
is most appropriate in the workplace needs
to be determined. The present office field
study compares two types of progressive
addition lenses (PALs), the general purpose
PAL and the computer vision PAL.
The optical characteristic of progressive
addition lenses is the gradual change in
near-vision addition power:25 the conven-
tional, general purpose PAL is designed for
continuous clear vision between infinity
and near reading distances, while the
benefit of using the gradual addition power
is limited to the central vertical progressive
zone because astigmatic aberrations are
optically inevitable at some eccentricity.
The acceptance of progressive lenses in eve-
ryday vision can depend on the optical lens
characteristics6 and on individual eye move-
ment characteristics.711 The blurred and
distorted vision through the peripheral and
lower parts of the lens can affect the per-
ception of steps and may lead to more vari-
able foot positioning and an even higher
risk of falling.1214 Furthermore, eye move-
ments as well as gaze stabilisation take
longer, while the wearer needs to find the
area with the optimal focus for a given
viewing distance during near and interme-
diate tasks.15 A narrow progressive zone may
lead to larger horizontal head movements,
when reading a line of text at near or inter-
mediate distances; thus, the co-ordination
of eye and head movements is affected.1619
This effect can decrease performance in
visual tasks across larger horizontal visual
fields.20 Advances in optical lens design and
fabrication have led to free-form PALs that
provide a larger horizontal extent of clear
vision at reading distances; the study par-
ticipants also subjectively preferred these
lenses.21
The limited horizontal field of clear vision
during near vision has led to the develop-
ment of alternative PALs that are designed
for specific tasks, for example, the use in an
office or at a computer monitor. The upper
part of the progressive lenses for computer
vision does not include the distance refrac-
tion but does include refraction and addi-
tional power for intermediate distances at

Clinical and Experimental Optometry 98.3 May 2015 2015 The Authors
234 Clinical and Experimental Optometry 2015 Optometry Australia
 General purpose versus computer PALs Jaschinski, Knig, Mekontso, Ohlendorf and Welscher

at longer viewing distances is preferred

(accepting a more narrow progressive zone)
or clear vision across a larger screen area is
preferred (accepting a smaller range of
viewing distances).
Work-related and ergonomic aspects play
a role because the refractive lens profile is
related to favourable viewing distances and
vertical gaze angles at the workplace. When
the monitor can be adjusted freely to the
individual preference, the gaze inclination
to the screen (Figure 2) was found to be 7.7
degrees lower in users of multifocal lenses
than in pre-presbyopic users;24 however, in a
Figure 1. Profile of astigmatic distortions within a general purpose progressive addition
more fixed high monitor position, general
lens (PAL) (distant refraction in the upper part of the lens) and with two items of
purpose PALs induce a higher muscular
computer vision PALs (office lens), which provide clear vision from near up to the load in the neck with an upward inclination
individually chosen maximum intermediate distance (MID), which were 400 cm and of the head,25 while this does not occur with
200 cm in these examples, respectively. When the maximum intermediate distance is computer vision PALs.26
closer, the range of near vision addition is smaller and the resulting width of the Laboratory studies6,1217,20,21 with con-
progressive zone increases. The general purpose PAL can be understood to have a MID trolled viewing conditions are useful
of infinity. to describe the optical and physiological
mechanisms involved in presbyopic correc-
tions. In addition, field studies are required
to investigate the effects of lenses over a full
working day in real office conditions to iden-
tify the possible implications on the subjec-
tive ratings of the viewing conditions, visual
or musculoskeletal strain and ergonomic
conditions. For example, a one-year field
study27 reported an improved overall satis-
faction, when participants changed from
single vision lenses to computer vision
PALs.
While the advantages and disadvantages
between general purpose PALs and com-
puter vision PALs are clear from a technical
optics point of view, the purpose of the
present study was to investigate the subjec-
tive questionnaire ratings of users with
Figure 2. Illustration of ergonomic parameters taken from pho- respect to the quality of vision and work-
tographs at the workplace. Geometric calculations provided the related complaints, as well as the ergonomic
viewing distance (from the canthus at the eye to the centre of the conditions in real office work. These find-
ings may be related to the acceptance rates
monitor), gaze inclination (line from the canthus at the eye to the
and the final individual preference for
centre of the screen, relative to horizontal) and head inclination
one of these lenses and could be a basis for
(line from the canthus at the eye to the tragus at the ear, relative to recommendations that optometrists give to
horizontal); on average, this eye-ear line was approximately 11 their patients.
degrees above the Frankfurt plane (from the orbitale to the Therefore, the present field study com-
porion). Negative signs of inclination angles indicate a downward pared general purpose PALs and computer
inclination. vision PALs in a quasi-experimental
approach with an intra-individual compari-
son. A group of 23 presbyopic users changed
the monitor or in the office.22 Thus, distance with clear vision for near and intermediate these lenses every week over a one-month
vision is blurred. According to Minkwitzs distances. Furthermore, the maximum period. The following questions were
law,23 the resulting smaller amount of intermediate distance (Figure 1) can be addressed.
change in the additional power within the adjusted by modifying the additional power 1. Do the participants notice the visual con-
lens provides reduced aberrations in the in the upper part of the computer vision ditions that result from the two different
periphery of the lens and a wider field of view PAL, depending on whether clear vision lens designs?

2015 The Authors Clinical and Experimental Optometry 98.3 May 2015
Clinical and Experimental Optometry 2015 Optometry Australia 235
General purpose versus computer PALs Jaschinski, Knig, Mekontso, Ohlendorf and Welscher
2. Do the two types of PALs lead to different
levels of complaints at work?
3. Is the head inclination different for the
two types of lenses?
The potential individual differences were
analysed because optometric praxis reveals
that subjects differ in their acceptance of
PAL spectacles.
METHODS
Participants and their refraction
The participants were 23 PAL-wearers (13
women, mean and standard deviation of age
was 55 4, range: 46 to 61 years). These
participants were recruited from the sample
in a previous field study28 of 175 computer
users aged 35 to 63 years, where the mean
questionnaire ratings were 1.49 0.56 for
ocular strain and 2.19 1.29 for muscu-
loskeletal strain. From these subjects,
we recruited 23 participants based on two
criteria.
1. They habitually used general purpose
PALs for their office work; three of these
23 participants had additional habitual
computer vision PALs and some had
reading glasses.
2. They had indicated higher ocular (1.74
0.48) and musculoskeletal strain (2.84
1.13) ratings in a questionnaire; this cri-
terion was used because the effects of
the lens type might be larger in these
subjects.
Approximately one year after the previous
study and before the start of the present
study, these 23 participants were tested again
with their previous habitual lenses, which
yielded mean ocular and musculoskeletal
strain ratings of 1.51 0.60 and 2.00 0.74,
respectively. Thus, the level of complaints
declined from one study to the next and
approached the general population mean,
so that the previously higher complaints
appear to be a random effect. Retrospec-
tively, the evidence does not support that the
present sample differed in complaints from
the average in the previous sample.
Participants were employed at the local
tax office in Dortmund and performed
administrative work. They had no particular
knowledge of ergonomics or optometry.
They were recruited from departments in
which employees worked primarily at the
computer in their offices and had no regular
conversations with customers or colleagues.
The mean daily duration of work was 7.9
1.6 hours (range from four to 10 hours).
Clinical and Experimental Optometry 98.3 May 2015
236
Most participants worked five days per week,
three participants worked four days and one
participant worked three days.
The refractive error (spherical compo-
nent) was -0.90 2.66 D averaged across the
two eyes (range -6.25 D to +4.00 D) and the
cylindrical refraction was -0.90 0.69 D
(range from zero to -2.75 D). The additional
power for near vision was 2.06 0.41 D
(range from 1.00 D to 2.50 D). The indi-
vidual refractions and additional powers are
reported in a parallel study on the vertical
zones of clear vision with these lenses.29 The
procedures of this study were approved
by the Ethics Committee of the Leibniz
Research Centre of Working Environment
and Human Factors and participants signed
an informed consent. The study followed the
tenets of the Declaration of Helsinki.
Lenses
Two types of lenses were compared: Zeiss
Officelens Individual (computer vision
PAL) and Zeiss Progressive Individual 2
(general purpose PAL). For Zeiss Officelens
Individual, the participants could choose
the maximum intermediate distance
(MID) between one and four metres
depending on whether they preferred clear
vision at longer viewing distances (but with a
narrower progressive zone) or clear vision
across a larger screen area (but with a
smaller range of viewing distances). The
mean MID-value was 313 76 cm, ranging
from 200 to 400 cm and participants
selected MID values of 400 (seven partici-
pants), 350 (three), 300 (five), 250 (one)
and 200 (five participants). The power in the
upper part of the lens was calculated accord-
ing to the MID. Figure 1 illustrates the astig-
matic aberrations for some examples of
these lenses. Participants could keep these
glasses without cost after the study.
Design of the study
All subjects received a subjective refraction
of both eyes by a certified optometrist (co-
author MK), using a letter chart at six metres
and trial lenses. Visual acuity was logMAR
0.00 or better in each eye, with optical
correction if necessary. The lenses were
fit with the procedures of the system RV
Terminal (Zeiss). The data on refraction
were transmitted to Carl Zeiss Vision, where
two spectacles were produced and labelled
with either one or two dots on the spectacle
frame and referred to as Spectacle 1 and
Spectacle 2 during the complete field study
Clinical and Experimental Optometry 2015 Optometry Australia
and data analysis. Spectacle 1 was assigned to
the computer vision PAL (Officelens Indi-
vidual) of half of the participants and the
general purpose PAL (Individual 2) of the
other half (Spectacle 2). Neither the experi-
menters nor the participants were aware of
this assignment to ensure a double-masked
condition as much as possible. We intended
for the participants to evaluate the two types
of lenses purely based on their perception
and experience without being influenced by
information about the features and pur-
poses of these lenses. The experimenters
were neutral, as they were not informed
about the type of lenses and did not commu-
nicate with the participants about the lenses;
however, it was almost inevitable that partici-
pants noticed the blurred distance vision
with the computer vision PALs, which can
occur when looking outside the window.
These conditions cannot be avoided, if real-
istic office conditions are to be investigated.
The purpose of the study was to evaluate
the lenses with respect to computer work
and therefore, the participants were
informed that they were testing two types of
lenses for use during computer work and
that they should use these lenses during the
working day at their workplaces and in the
office building. They were instructed not to
take the spectacles home to prevent the use
of computer vision lenses when driving a car.
To avoid confusion between the experimen-
tal spectacles, participants had only one type
of spectacle available at their workplace.
When they went home, they changed to their
own habitual spectacles.
The schedule of the 12 weeks of the
experimental part of the study is illustrated
in Figure 3 and comprises two main
parts. Part 1 (Weeks 1 to 4) was a quasi-
experimental procedure, during which the
lenses were worn following a strictly con-
trolled schedule and extended question-
naires were frequently administered. In
Weeks 1 and 2, participants were instructed
to adapt to the new lenses by wearing each
type of lens for one week. In Week 1, all
participants started with Spectacle 1, which
consisted of a computer vision PAL for one
half of the sample and a general purpose
PAL for the other half of the sample. The
spectacles were changed in Week 2 to
balance the order across the group. Week 3
and Week 4 were considered the main test
phase, with each spectacle worn for one
week in balanced order. After all test proce-
dures were completed on the last day of
Week 4, the participants were asked which
2015 The Authors

Part 1
Double-masked administration
of lens 1 and lens 2
Adaptation Test phase
phase
Week 1 2 3 4
Lens 1 Lens 2 Lens 1 Lens 2
Workplace photographs
Daily questions
Weekly questions
Figure 3. Time scheme and measures in the present study (see text).
spectacles, either 1 or 2, they preferred
without being informed about the character-
istics of these two lenses.
In a meeting in Week 5, participants were
informed that they had used a computer
PAL and a general purpose PAL and that the
latter is also suitable for distance vision and
driving a car. They were provided with a
detailed description how and where to use
the two spectacles, their advantages and dis-
advantages. In the following eight weeks
(Part 2 of the study), the participants were
free to use the two lenses at their conveni-
ence without any participation by the experi-
menters. This design was selected to assess
the final preference of participants related
to both their vision at the screen and other
factors at the end of Week 12 (such as dis-
tance vision, the need to change between the
two types of spectacles for near and distance
vision). The preference for one of the lenses
was assessed to obtain a general global judg-
ment, while considering any possible advan-
tage or disadvantage of each lens. The
present study examined whether the results
of the questionnaire or optometric param-
eters may be related to participants selec-
tions of lenses. From a practical point of
view, computer vision PALs are not an alter-
native to general purpose PALs, rather, they
represent an additional pair of distance
vision lenses.
Ergonomic conditions
To control the ergonomic conditions, a
side-view photograph was taken once at the
2015 The Authors
Clinical and Experimental Optometry 2015 Optometry Australia
General purpose versus computer PALs Jaschinski, Knig, Mekontso, Ohlendorf and Welscher
Part 2
Free use of either lens 1 or lens 2
officially or privately
Lens info
5 6 7 8 9 10 11 12
Forced choice
preference of
lens 1 or lens 2
beginning and again at the end of Weeks
3 and 4 (Figure 2). The employees were
instructed to sit in a normal working posture
and look at the centre of the monitor. As
described in a previous study,30 print-outs of
these photographs were used to extract
three ergonomic measures:
1. the viewing distance from the eyes to the
centre of the screen
2. the vertical angle of this visual axis rela-
tive to the horizontal, that is, the gaze
inclination and
3. the head inclination, that is, the direction
of the eye-ear line relative to the horizon-
tal (Figure 3).31
The width of the screen was 39.8 6.1 cm
(range 33.4 to 56.5 cm) and the height
was 30.5 2.7 cm (range 20.9 to 35.3 cm).
The experimenters did not change the
ergonomic settings, which were intended
to remain constant between the two lens
conditions.
Questionnaire
The set of 25 questions is shown in Table 1.
The rating categories were 1, 2, 3, 4, 5 and 6
with high numbers indicating more unfa-
vourable conditions. This set includes 23
items that had been used in a previous
study,28 where a factor analysis identified five
separate aspects of complaints (factors). The
item Headache was not highly correlated
with other items and thus remained a single
item. Two additional items were added for
the present study to address the particular
conditions of computer vision PALs: Vision
in premises, up to the maximum intermedi-
ate distance and Distance vision. As such,
the present study included eight dependent
variables. The questions were administered
at the end of the working day to assess the
moment of maximum fatigue. Generally,
participants responded to the questions
once at the end of each week, while a subset
of presumably the most relevant questions
was administered daily during Weeks 3 and
4. As participants had already experienced
both lenses in this phase during the weeks
before, this is labelled as daily in Table 2.
Statistical analyses
The rating differences between the lens
types were described by the non-parametric
effect size, which is referred to as the prob-
ability of superiority,32 that is, the probabil-
ity that rating1 in a random matched pair is
greater than rating2 (when rating1 has most
frequently the higher score); this probability
is estimated as n+/N, where n+ is the number
of positive differences and N is the sample
size. This measure of the size of the effect is
easily interpreted as the percentage of par-
ticipants that respond according to the
hypothesis. The Wilcoxon test was used for
the ordinal scaled questionnaire data and
the t-test was used for the interval-scaled
ergonomic data. The Bonferroni-Holms cor-
rections of p-values were indicated as pcor for
the eight dependent variables that were
found to be correlated. Generally, two-tailed
p-values are given, while one-tailed p-values
were applied when clear directional hypoth-
eses existed, such as for test-retest correla-
tions and correlations between dependent
variables. Logistic multiple regression analy-
ses were applied to calculate the area under
the ROC curve (receiver operating charac-
teristic), which describes the accuracy of the
discrimination between the preferences of
one of the two lens types based on underly-
ing individual parameters.33 These logistic
regressions were limited to a single predic-
tor, as the present sample size of 23 is too
small to include more predictors.34
RESULTS
Group mean effects
Table 1 describes the eight dependent vari-
ables for the general purpose PALs (lens 1)
and the computer vision PALs (lens 2). Most
dependent variables took on more favour-
able values with the computer vision
PALs, except Distance vision. Table 1 also
Clinical and Experimental Optometry 98.3 May 2015
237
General purpose versus computer PALs Jaschinski, Knig, Mekontso, Ohlendorf and Welscher

Dependent variables Type of phase General Computer Correlation of lens effect

Legend: Item (daily application in test phase) purpose PAL vision PAL between adaptation
M1 SD1 M2 SD2 and test phase

1. Variable (factor): Vision at the monitor

How well can you see on your entire screen without head movements? (daily) Adaptation phase 1.78 0.80 1.14 0.38 r = 0.69
How annoying are the head movements required to view the entire screen? (daily) Test phase 1.61 0.65 1.22 0.41 pcor = 0.0009
How well can you see small objects on your screen? (daily)
How do you judge vision at the monitor?
How do you judge near vision?
2. Variable (factor): Ocular strain
I have difficulties in seeing. (daily) Adaptation phase 1.65 0.76 1.38 0.55 r = 0.47
My eyelids are heavy. (daily) Test phase 1.37 0.65 1.13 0.38 pcor = 0.059
I feel eye strain. (daily)
My eyes are watering. (daily)
I have burning eyes. (daily)
I have an uncomfortable feeling at the eyes. (daily)
I have itching eyes. (daily)
3. Variable (factor): Musculoskeletal strain
I have pain in my arms. (daily) Adaptation phase 1.94 0.89 1.56 0.70 r = 0.22
I have pain in my neck. (daily) Test phase 1.64 0.68 1.48 0.56 Not significant
I have pain in my back. (daily)
I have pain in my shoulders. (daily)
Do you feel tension in posture of head or body? (daily)
4. Variable (factor): Dizziness
I feel dizzy. (daily) Adaptation phase 1.34 0.94 0.96 0.46 r = 0.42
I feel numb. (daily) Test phase 1.08 0.63 0.87 0.32 pcor = 0.092
5. Variable (factor): Dynamic vision
If you look up from your screen to space, how fast are you able to see clearly? (daily) Adaptation phase 1.68 0.78 1.60 0.72 r = 0.60
How do you judge vision when moving in premises and on stairs? Test phase 1.63 0.57 1.51 0.54 pcor = 0.007
How do you judge vision during head movements?
6. Variable (single item): Headache
I have headaches (daily) Adaptation phase 1.87 1.29 1.65 1.19 r = 0.12
Test phase 1.80 1.13 1.53 0.65 not significant
7. Variable (single item): Vision in premises, up to MID
How do you judge vision in these premises, up to MID? Adaptation phase 2.17 1.23 2.26 0.81 r = 0.34
Test phase 2.17 0.94 2.17 0.98 not significant
8. Variable (single item): Distance vision
25. How do you judge distance vision, looking through the window? (daily) Adaptation phase 2.00 1.04 2.91 1.56 r = 0.70
Test phase 1.91 0.88 2.80 1.21 pcor = 0.0008

PAL: progressive addition lens, MID: maximum intermediate distance

Table 1. The questionnaire (translated into English) and comparison of lens types with means and standard deviations. Generally, the
items were applied weekly; in the test phase, some items were applied daily as indicated. Correlation of the lens effect between
adaptation and test phase were tested with one-tailed pcor-values with a Bonferroni-Holm correction across the eight dependent
variables.

suggests that the mean difference was similar
in the adaptation phase and in the test
phase. Moreover, the lens effect (rating1 -
rating2) was correlated between these two
phases for most dependent variables. These
inter-phase correlations of the lens effects
ranged from 0.12 to 0.70 (median 0.45) and
were significant for Vision at the monitor
(pcor = 0.0009), Dynamic vision (pcor =
0.007) and Distance vision (pcor = 0.0008).
A possible trend appeared for Ocular strain
(pcor = 0.059) and Dizziness (pcor = 0.092).
Because of these inter-correlations, tests of
statistical significance would be inflated;
thus, they were not performed in this first

Clinical and Experimental Optometry 98.3 May 2015 2015 The Authors
238 Clinical and Experimental Optometry 2015 Optometry Australia
 General purpose versus computer PALs Jaschinski, Knig, Mekontso, Ohlendorf and Welscher

(a) General purpose PAL (b) Paired Wilcoxon-test (c) Number (d) Effect size: probability
versus computer vision PAL two-tailed p-values of cases of superiority
mean difference SE n+ / n0 / n- PS = n+ / 23

1. Vision at the monitor 0.51 0.13 W = 35.0

pcor = 0.008 17 / 0 / 6 0.74
2. Ocular strain 0.26 0.09 W = 49.5
pcor = 0.065 18 / 0 / 5 0.78
3. Musculoskeletal strain 0.27 0.08 W = 43.0
pcor = 0.044 17 / 1 / 4 0.74
4. Dizziness 0.29 0.11 W = 19.5
pcor = 0.052 13 / 7 / 3 0.57
5. Dynamic vision 0.10 0.14 Not significant
11 / 1 / 11 0.48
6. Headache 0.24 0.16 Not significant
7 / 14 / 2 0.30
7. Vision in remises, up to MID -0.04 0.23 Not significant
6 / 7 / 10 0.43
8. Distance vision -0.90 0.26 W = 169 PS = n-/23
pcor = 0.021 3 / 4 / 16 0.70

PAL: progressive addition lens

Table 2. Statistics of the difference between the lens types. Positive differences indicate an advantage for computer vision lenses. The
non-parametric effect size, the probability of superiority (PS) is based on the number of cases with positive differences (n+), zero
differences (n0) and negative differences (n-) between the lenses. PS = n+ / 23 indicates the percentage of participants reporting an
advantage of computer vision lenses; only for Distance vision, probability of superiority reflects the percentage of participants
reporting a disadvantage of computer vision lenses.

stage of analysis. Therefore, data for the
adaptation and test phases were averaged for
further analyses. Table 2 describes the differ-
ences between the two lenses; positive differ-
ences indicate an advantage with the
computer vision PALs. Statistical signifi-
cance (Table 2b) was found for Vision at the
monitor (pcor = 0.008), Distance vision (pcor
= 0.021) and Musculoskeletal strain (pcor =
0.044), while a possible trend was found for
Dizziness (pcor = 0.052) and Ocular strain
(pcor = 0.065). Table 2 (c-d) shows that the
non-parametric effect size (the probability
that a subject reports an advantage with the
computer vision PAL) ranged from 0.57
to 0.78 (median 0.74) for these dependent
variables, which is approximately halfway
between the 50 per cent chance level and
100 per cent probability.
Individual differences
Further analyses examined whether partici-
pants rated differently the advantage of the
computer vision PAL. Therefore, these
analyses include the four dependent vari- this indicator of the combined advantage of
ables that at least showed a possible ten- computer PALs is plotted in Figure 4 (G)
dency toward a significant difference in the and shows that the majority of participants
mean (pcor < 0.1): Vision at the monitor, had positive values that reflected the signifi-
Ocular strain, Musculoskeletal strain and cant group mean advantage of computer
Dizziness. Figure 4 (A-F) shows the corre- PALs reported above; however, some par-
sponding six inter-correlations of the ticipants showed no advantage to the com-
lens effect (rating1 - rating2) that ranged puter vision PALs because their indicator
between 0.57 and 0.86 and were all signifi- was near zero.
cant (pcor < 0.01, one-tailed). Approxi- The benefit of computer vision PALs
mately half of the sample showed small may depend on two optometric param-
differences near zero, that is, in the range eters. First, participants with higher levels
of -0.5 to 0.5; however, approximately the of refractive errors may be accustomed to
other half of the sample showed larger dif- aberrations and thus more tolerant to
ferences in the positive direction, suggest- smaller progressive zones in the general
ing an advantage for the computer vision purpose PALs. In fact, the score of the
PAL. This finding indicates that the indi- combined advantage of computer vision
vidual advantage of the computer vision PALs tended to be negatively correlated
PAL is reflected in several aspects of com- with the absolute amount of the spherical
plaints or visual conditions. Therefore, we equivalent but this correlation was non-
calculated the average lens effect over these significant (r = -0.18, not significant).
four variables, in order to obtain a single Second, the advantage of computer vision
individual indicator of the advantage of the PALs may be larger for larger amounts of
computer vision PAL. The distribution of near additions because the progressive

2015 The Authors Clinical and Experimental Optometry 98.3 May 2015
Clinical and Experimental Optometry 2015 Optometry Australia 239
General purpose versus computer PALs Jaschinski, Knig, Mekontso, Ohlendorf and Welscher

A r = 0.78 B r = 0.57 C r = 0.62 ring the computer vision PAL, the indicator
Vision at the monitor

Vision at the monitor

Vision at the monitor

2 2 2 of the combined advantage of computer
Advantage in

Advantage in

Advantage in
vision PALs was significantly larger than in
1 1 1 the subgroup preferring the general
purpose PAL. This difference was true for
the first statement of preference directly
-1 1 2 -1 1 2 -1 1 2 after the double-masked quasi-experimental
Advantage in Advantage in Advantage in phase (Part 1) as well as the second state-
-1 Ocular strain -1 Musculoskeletal strain -1 Dizziness ment of preference after eight weeks of free
D E
r = 0.67 r = 0.86 use of the spectacles (Part 2). These statistics
2 2
are described in Table 3.
Advantage in

Advantage in
Ocular strain

Ocular strain
A further approach is a logistic regression
1 1 to explain the statements of lens preference
(that is, a binary choice variable) from
potential predictor variables. The experi-
-1 1 2 -1 1 2 ences with these lenses at work, that is, the
G
Advantage in Advantage in reported complaints, were expected to
-1 Musculoskeletal strain -1 Dizziness
predict the preference when testing the
Number of subjects

F r = 0.73 internal consistency within this study. In fact,

Musculoskeletal strain
4
2
the score of the combined advantage could
Advantage in

discriminate between the two preferences

2 1 with a high accuracy of 89 and 84 per cent in
the first and second choices, respectively
0
(indicated by the area under the ROC curve,
0 1 -1 1 2 which can lie between 100 per cent accuracy
Combined advantage for computer vision PAL Advantage in and the chance level of 50 per cent). An
-1 Dizziness
optometric parameter that might predict
the forced-choice preference is the near
Figure 4. For the four dependent variables Vision at the monitor, Ocular strain, vision addition, as suggested above. The
amount of the near vision addition revealed
Musculoskeletal strain and Dizziness the six inter-correlations of the individual advan-
accuracies of 70 and 72 per cent in the first
tage of the computer vision progressive addition lens (PAL) are plotted in (A to F); the last
and second choice, respectively; this can be
is the rating with the general purpose PAL minus the rating with the computer vision PAL considered as a fair prediction.
(positive differences mean an advantage of the computer vision PAL). The distribution of
the combined advantage score is plotted in (G): it refers to the average across the four
variables mentioned above. Ergonomic conditions
Table 4 shows the ergonomic parameters for
the two lenses when participants viewed the
zone in general purpose PALs is rather also be used for general purposes, for centre of the monitor. While the viewing
narrow in these cases. This correlation example, for driving a car. The participants distance and gaze inclination were very
nearly reached significance (r = 0.34, p = were fully informed about the lens proper- similar for the two spectacles, the head
0.058, one-tailed). ties in Week 5. After having used the two inclination was significantly higher by 2.3
The Distance vision of the computer lenses in Part 2 of the study for a further degrees for general purpose PALs compared
vision PAL was judged significantly worse eight weeks, without any intervention by to computer PALs.
than that of the general purpose PAL (pcor < the experimenter, 10 of 23 (44 per cent)
0.021). This effect was reliable between the preferred the computer vision PALs and 13
DISCUSSION
adaptation and test phases (r = 0.70) but not of 23 (56 per cent) preferred the general
significantly correlated with the lens effect in purpose PALs. Specifically, five participants A comparison of general purpose and
Ocular strain (-0.19), Musculoskeletal changed their choice and finally preferred computer vision PALs in the workplace
strain (-0.26), Vision at the monitor (-0.02) general purpose PALs, while one partici- should consider the ergonomic conditions,
or Dizziness (-0.08). pant changed in the other direction. particularly the monitor position. The mean
On the last day of Week 4, the 23 par- Thus, participants did not display a viewing distance to the screen centre
ticipants were asked to indicate the pre- general preference for one of the types (79 cm) and the mean gaze inclination from
ferred lens in a forced-choice judgment. of lens. As such, we sought to determine the eye to the centre of the screen (-17
Fourteen (61 per cent) preferred the com- whether the individual choice might be degrees) were similar for the two types of
puter vision PAL, while nine (39 per cent) related to particular individual parameters. lenses and within the range that is typically
preferred the general purpose PALs. When In a first approach, the forced-choice ratings described as ergonomically favourable.3539 A
giving this judgment, the participants did were related to the questionnaire ratings in parallel study29 described measurements of
not yet know which of the two lenses could Part 1 of the study. In the subgroup prefer- vertical zones of clear vision with the same

Clinical and Experimental Optometry 98.3 May 2015 2015 The Authors
240 Clinical and Experimental Optometry 2015 Optometry Australia
 General purpose versus computer PALs Jaschinski, Knig, Mekontso, Ohlendorf and Welscher

Indicator of the combined Wilcoxon-test of group

advantage of computer PALs difference (unpaired,
Mean SD two-tailed)

Subgroup preferring Subgroup preferring

computer vision PALs general purpose PALs

Preference 1: after 4 weeks of quasi-experimental use of spectacles 0.54 0.41 0.01 0.24 W = 112
(n = 14) (n = 9) p = 0.0022
Preference 2: after further eight weeks of free spectacle use 0.58 0.42 0.14 0.34 W = 109
(n = 10) (n = 13) p = 0.0070

PAL: progressive addition lens

Table 3. Mean values and statistical tests of the Combined advantage score of computer vision PALs in the subgroups of participants
preferring computer vision PALs or general purpose PALs. See text.

General purpose PAL Computer vision PAL t-test

Mean SD Mean SD (two-tailed)

Viewing distance (cm) from eye to screen centre 79.7 10.3 78.9 8.7 t (22) = 0.91
p = 0.3
Gaze inclination (degrees) -18.3 4.2 -16.0 9.2 t (22) = -0.71
Gaze direction (from eye to screen centre) relative to horizontal p = 0.3
Head inclination (degrees) 15.4 5.2 13.1 5.1 t (22) = 2.45
Eye-ear-line relative to horizontal p = 0.023

Table 4. Ergonomic parameters when viewing the screen centre

participants and lenses and for most partici-
pants, the full monitor was clearly visible
with computer vision PALs, while the upper
part of the monitor could not be seen clearly
with general purpose PALs. Participants may
have used a 2.3 degrees higher head inclina-
tion with general purpose PALs (15.4 5.2
degrees, eye-ear line relative to horizontal)
compared to computer vision PALs (13.1
5.1 degrees) to compensate for this differ-
ence (at least in part). Significantly higher
head inclinations with general purpose PALs
were also found in other studies in relation
to single near vision lenses that also do not
restrict head position: the effect was 4.6
degrees (16.3 6.9 versus 11.7 5.1 degrees)
(Weidling and Jaschinski, unpublished
data) and 6.8 degrees (17.4 9.2 versus 10.6
9.4 degrees),28 respectively. Ergonomic
studies4042 report a favourable head inclina-
tion in the range of eight to 15 degrees
(eye-ear line relative to the horizontal) to
avoid musculoskeletal strain. Relative to this
comfortable range, the typical mean head
inclination for general purpose PALs (15 to
17 degrees) is at the upper limit, which
is a risk for musculoskeletal strain.25 The
latter descriptions are inter-individual com-
parisons of independent groups. Intra-
individual intervention studies may be more
crucial. If users of general purpose PALs
used a lower head inclination by a few
degreeseither by changing to a computer
vision PAL as in the present study or by
lowering the monitor position (Weidling
and Jaschinski, unpublished data)they
reported lower musculoskeletal strain.
These findings support the notion of com-
bined optometric and ergonomic workplace
analyses and improvements.4346
Previous optometric field studies47,48 pro-
vided a more general survey of the computer
vision syndrome in all age groups, not focus-
ing specifically on particular presbyopic
corrections. The present study used a quasi-
experimental field study with an intra-
individual comparison of two important
presbyopic corrections, namely, the widely
used general purpose PALs and computer
vision PALs. The majority of observers
could notice the advantage of the computer
vision PALs expected from the optical
design of these lenses. The reduction in
several aspects of complaints was correlated
between the adaptation and the test phase
and thus, could be identified as reliable
and robust with the present methods,
although the schedule of administration of
the questionnaire differed slightly between
these phases. The quality of distance vision
was judged better with general purpose PALs
because computer vision PALs had a mean
addition in the upper part of the lens of
0.33 D.
The present sample comprised 23 users of
general purpose PALs who had reported a
relatively higher level of ocular and muscu-
loskeletal strain in a preceding study one
year earlier.28 At the start of the present
study, they showed an average level of com-
plaints, which can be explained by the
typical effect of regression to the mean.49

2015 The Authors Clinical and Experimental Optometry 98.3 May 2015
Clinical and Experimental Optometry 2015 Optometry Australia 241
General purpose versus computer PALs Jaschinski, Knig, Mekontso, Ohlendorf and Welscher
This suggests that the present sample is not
specifically symptomatic and that the previ-
ously higher complaints were a random
effect.
The previous experience with different
types of lenses may potentially affect the
comparison of two types of new PALs. Before
this study, all 23 participants had prior expe-
rience with their previous habitual general
purpose PALs and three of these 23 partici-
pants had an additional habitual computer
vision PAL and some had reading glasses. All
participants had one week of adaptation
phase with each type of lens, which was made
to let the participants experience both
lenses before the subsequent test phase.
These two phases revealed similar mean
results and a correlation on the individual
level. This is evidence that the prior experi-
ence of the participants with their habitual
lenses is less important for the results.
Not all participants reported an advantage
of computer vision PALs for computer work.
Rather, consistent patterns of individual dif-
ferences appeared. The rated advantage of
computer vision PALs was correlated with
several aspects of complaints (Vision at the
monitor, Ocular strain, Musculoskeletal
strain and Dizziness), while some partici-
pants hardly reported differences between
the lens types, and others reported consider-
able advantages to computer vision PALs.
Accordingly, the non-parametric effects size
(probability of superiority) was approxi-
mately 0.75 for the reported complaints
during Part 1 (when vision at the monitor
was mostly relevant), suggesting that
approximately 75 per cent of the partici-
pants reported an advantage for the com-
puter vision PALs (Figure 4). Accordingly,
61 per cent of the participants preferred the
computer vision PALs when asked at the end
of Part 1 without information about lens
design (Preference 1). After full informa-
tion about lens characteristics and addi-
tional eight weeks of free spectacle use,
44 per cent preferred the computer vision
PALs at the end of Part 2 of the study (Pref-
erence 2).
The present study attempted to explain
individual ratings of complaints and prefer-
ences of the lens type based on optometric
parameters. As classical optometric param-
eters, we considered the spherical equiva-
lent and the near vision addition; the latter
showed a possible tendency of an effect. The
larger the near vision addition, the higher
was the combined advantage score of com-
puter vision PALs (correlation r = 0.34) and
Clinical and Experimental Optometry 98.3 May 2015
242
the more frequently the computer vision
PALs were preferred in the final forced-
choice judgements (accuracy of about 70
per cent). This provides preliminary evi-
dence that the optometrists recommenda-
tion to a patient may rely on the near vision
addition. The statistical evidence in this
sample of 23 participants is limited as other
factors, such as the amount of refraction or
the monitor position relative to the eyes,29
may additionally play a role. Such a multi-
factor approach requires larger studies, also
including different types of lens design and
occupational tasks to arrive at more general
recommendations.
More practically, the experience with
these lenses in the present trial led 44 per
cent of the present sample to prefer the
computer PALs in the final forced-choice
preference. This percentage is much higher
than the general prevalence of computer
vision PALs, which is typically approximately
seven per cent according to a recent survey.28
For practical optometric consultations, one
may provide the customer with at least some
limited visual experience using trial lenses
with computer vision PALs to allow them to
observe directly the particular viewing con- 4. Sheedy JE. Correlation analysis of the optics of
ditions. This practice may help the optom-
etrist and patient to determine whether a
general purpose PAL or computer vision
PAL is more likely to meet visual needs. The
following further aspects may play a role in
other tasks and ergonomic conditions. The
size of the screen used may also play a role.
For example, if larger screens or several
screens are used, a computer vision PAL or a
single vision lens with a wider zone of clear
vision may be favoured as it may facilitate
task performance.20 The frequency with
which computer work is alternated with
other occupational activities, such as meet-
ings and customer consultation or phases of
distance vision, may also affect whether the
user wishes to wear a computer vision PAL,
which necessitates changing lenses for dis-
tance viewing and they may prefer a more
general purpose PAL instead.
In conclusion, the outcomes of this
study suggest that the preference of lens type
between general purpose and computer
vision PALs for presbyopic correction
depends on the individual optometric
parameters, the requirements of the occupa-
tional task and user preferences. To mini-
mise musculoskeletal strain and to maximise
visual function, the monitor position should
be placed within the vertical zone of clear
vision that depends on the optical lens
Clinical and Experimental Optometry 2015 Optometry Australia
characteristic when a favourable head
posture is maintained.29
ACKNOWLEDGEMENTS
The authors thank the Dortmund financial
administration where the field study was
conducted, the team, including C Reiffen, U
Lobisch, J Keller and P Weidling for data
collection and the anonymous reviewers for
constructive comments.
This study was conducted by the Leibniz
Research Center for Working Environment
and Human Factors in Dortmund
(Germany) and supported in part by Carl
Zeiss Vision GmbH in Aalen (Germany). M.
Welscher is an employee of Carl Zeiss Vision
GmbH and A Ohlendorf is an employee of
Carl Zeiss Vision International GmbH.
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