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The influence of dry eye and office environment on visual functioning

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Environmental factors, such as high airflow and low relative humidity, are known to promote dry eye symptoms during reading tasks in office workers. These symptoms are associated with an adverse impact on daily activities at work. This study reports on the relationship between eye symptoms and environmental factors in 294 employees at one office location.
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The influence of dry eye and office
environment on visual functioning
Mirjam VAN TILBORG a 1 ,Prof. Helianthe KORT a
Prof. Paul MURPHY b, Dr.Katharine EVANS c
a
University of Applied Sciences HU, research group Demand driven care
b University of Waterloo Optometry and Visual Sciences
cSchool of Optometry & Vision Sciences, Cardiff University
a
Abstract. Environmental factors, such as high airflow and low relative humidity,
are known to promote dry eye symptoms during reading tasks in office workers.
These symptoms are associated with an adverse impact on daily activities at work.
This study reports on the relationship between eye symptoms and environmental
factors in 294 employees at one office location.
Keywords. Humidity, indoor temperature, digital environment
Introduction
Dry eye, a disease of the tears and ocular surface, is characterised by tear film
hyperosmolarity and ocular surface inflammation. The prevalence of Dry Eye Disease
(DED) in the general population varies between 3.5 to 33.7%, depending on age and
diagnostic criteria [1]. The two main aetiologies of DED are insufficient tear
production or excessive tear evaporation. For the office worker, changes in their
environment that promote tear evaporation are therefore problematic Both causes are
typically treated with artificial tears, and although other treatment modalities are
equally or more effective, preventing the development of symptoms is preferable.
Typically referred to as an age-related disease, recent studies show that younger
persons also frequently suffer from DED [2]-[6].
As noted, the environment has an influence on the DED cascade. Environmental
factors, such as high airflow and low relative humidity, can exacerbate the condition,
promoting symptoms such as burning or tearing of the eyes. Symptoms of DED are
associated with an adverse impact on vision-related quality of life, the performance of
daily activities, the ability to work, and emotional well-being [7], [8], even for
mild/moderate dry eye [9].
1 Corresponding Author.
In the published literature, work-related dry eye symptoms often fall under the
diagnosis of Sick Building Syndrome (SBS), which includes a group of symptoms of
unclear aetiology. The group is divided into mucous membrane symptoms related to
the eyes, nose and throat, and dry skin and general symptoms of headache and lethargy
[10]. The term Sick Building Syndrome is only used when the symptoms relate to the
building site and which disappear after leaving the building [10]-[12].
For the eye, work-related dry eye symptoms that develop are similar to those of
age-related dry eye: burning, dryness, gritty, itchy and stinging sensation, soreness,
blurry vision, strain and eye irritation or asthenopia. These all affect the quality of
visual functioning, with the most common complaint being blurred vision. For the
symptoms to be diagnosed as being work-related, they need to be associated with a
work-related indoor environment [13]. For example, significant complaints can occur
even after only two hours of computer work [14]. The figure below shows the main
factors thought to influence dry eye symptoms in a work environment.
Modern offices often incorporate flexible working spaces and high visual demands
from computer screen presenting digital information. The environmental management
for these workspaces modifies air humidity, temperature and air flow, all of which are
known to exacerbate dry eye symptoms and visual functioning during computer tasks
[15] [16], [17].
Dry eye symptoms are a disorder that reduces visual functioning. Visual
functioning is related to the ability of an individual to perform visual dependent tasks,
such as reading and computer work, driving or watching television or using the more
intense video games [18], [19]. Significantly increased symptoms of blurred vision
during reading occur when reading from a computer screen vs reading from a hard
copy [20].
1. Objectives
1.1 Goal
By monitoring subject symptomatology and environmental variables, investigate
their relationship in a cohort of digital information workers within an indoor working
environment.
1.2 Project plan
Recruit subjects from employees working in a modern office building located in
the Netherlands, in which there was a high incidence of dry eye related complaints
reported over several years. Assess subject symptomatology using two comfort
measurements, in combination with environmental metrics for room temperature, air
quality and lighting.
2. Methods
A digital online survey was sent to all employees (n=600) who work in the test
building by email. The survey contained 16 forced-choice Likert scale questions
covering patient demographics, dry eye symptoms, and incidence of DED diagnosis.
Participants could complete the survey within a four-week period: from 16 October
2014 to 14 November 2014. Two environment measurement stands were placed at the
south corner of the building on the second floor from 26 November 2014 to 15
December 2014. The instruments at these locations measured temperature (supplied air,
air temperature, radiation temperature), air quality (CO2, relative humidity (RH),
airflow speed, particle counter), and light (radiation) every hour.
3.Results
(i) Symptomatology
The survey was completed by 294 subjects (49% response rate), with 30%
reporting complaints of dry eye symptoms. Of these, 5% were already diagnosed with
DED. The average age was 42.5 years. Blurry vision, transient vision and irritation of
the eyes were the highest ranked symptoms. The question “Are the symptoms that you
experience inhibiting you in your daily activities at work?” was positively answer by
75% of the employees.
(ii) Environmental
During the recording period, the overall indoor air quality was acceptable,
conforming to the Dutch Build Code Guidelines, the Working Conditions Act (ARBO
wet), and the Ministry of Infrastructure and Environment Guidelines. The RH
measurements were low, but within acceptable limits, and fluctuation during the day
was related to indoor temperature. Greater fluctuation in temperature, humidity and
airflow were seen with outdoor sunshine. A rise in temperature from 5°C to 25°C
produced a drop in humidity from 40% to 22%.
4. Discussion
A considerable proportion of employees were diagnosed with having DED
symptoms. The average age of the employees did not reflect the typical age at which
dry eye symptoms can occur. The test building was found to have low relative humidity
and an air flow effect, which, in combination with high levels of visually-demanding
tasks, such as computer, laptop and smart phone use, stimulated the development of dry
eye sensation in a large proportion of workers. The environmental effects were
accentuated by the south facing aspect of the building promoting an increase in
building temperature from solar heat, with a subsequent increase in airflow rate to
maintain building temperature. This increased airflow further stimulated tear film
changes and worker dry eye discomfort in the office.
5. Conclusions
The study location building air environment had a high impact on eye symptoms,
leading to inhibition in daily work activities. Sunshine further stressed the indoor air
quality and the indoor comfort. Adjustments are needed to create a comfortable indoor
environment for all weather conditions outside, to minimise the development of dry eye
symptoms in workers and good visual functioning.
Acknowledgements
Special thanks to Giel Craenmehr and dr.ir. Marcel Loomans, Technical University
of Eindhoven, for their expertise and measurements.
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[21]
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... [5] This may be attributed to occupational risk factors such as visually demanding tasks (visual display terminal [VDT]) and dry working environments with low humidity, increased airflow, and higher temperatures. [1,5] The impact of DES could be classified into three categories: direct costs (e.g., medical fees); indirect costs such as unemployment, inability to work, or low productivity; and an overall reduction in the quality of life due to substantial impairment in daily activities and a subsequent negative impact on mental health. [6][7][8] In the literature, many studies have discussed various risk factors associated with the development of DES. ...
... Among those, 75% admitted that their symptoms interfered with their work activities. [5] Many studies described various risk factors mentioned above; however, not many compared the risk of developing the disease in relation to occupational categories. One remarkable population-based study was done in Korea by Lee et al. regarding various occupational characteristics and their relationships to symptoms of DES. ...
... p = 0.000) was observed. Findings suggests non-significant differences in work limitations (SMD = Corresponding to the above findings, studies investigating the non-SS (n = 4) and SS (n = 1) patient population reported subjective difficulties in the workplace due to dry eye, ranging from 22 to 75% [21,[43][44][45][46]. Figure 3b illustrates the results of four studies [21,43,44,46] investigating subjective difficulties at work in the non-SS DED population. While there was significant heterogeneity between studies (I 2 = 96.0%; ...
... p = 0.000) was observed. Findings suggests non-significant differences in work limitations (SMD = Corresponding to the above findings, studies investigating the non-SS (n = 4) and SS (n = 1) patient population reported subjective difficulties in the workplace due to dry eye, ranging from 22 to 75% [21,[43][44][45][46]. Figure 3b illustrates the results of four studies [21,43,44,46] investigating subjective difficulties at work in the non-SS DED population. While there was significant heterogeneity between studies (I 2 = 96.0%; ...
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To evaluate the impact of ocular surface symptoms on quality of life in a veteran population receiving eye care services. Cross-sectional survey study. setting: Miami Veterans Affairs Medical Center (VAMC). patient population: Patients seen at the eye clinic between June and August 2010 were asked to fill out the Dry Eye Questionnaire 5 (DEQ5) and the Impact of Dry Eye on Everyday Life (IDEEL) questionnaire. main outcome measures: Correlation between ocular surface symptoms and functionality. Four hundred eighty-nine patients elected to fill out the DEQ5 questionnaire (36% response rate). The mean age of respondents was 66 years (standard deviation 12). Ninety-four percent were male; 62% were white and 37% were black. Using the DEQ5 as a surrogate measure of ocular surface symptoms, 65% of respondents reported at least mild ocular surface symptoms (DEQ5 ≥6) and 27% of them reported severe symptoms (DEQ5 ≥12). Black subjects had a 2-fold increased risk of severe symptoms compared to white subjects (odds ratio 2.06, 95% confidence interval 1.33-3.19). Several medications were associated with a significantly increased risk of severe symptoms, including glaucoma medications (1.7-fold increase), antidepressants (2.3-fold increase), and antihistamines (2.1-fold increase). There was an inverse correlation between DEQ5 and IDEEL scores with regard to ability to perform activities of daily living (n = 391, r = -0.54, P < .001), emotional well-being (n = 386, r = -0.63, P < .001), and the ability to work (n = 205, r = -0.57, P < .001). Fifty percent of patients with severe symptoms had documentation that their symptoms were addressed during the visit. Severe ocular surface symptoms reduce the quality of life of Miami VAMC veterans. Eye care professionals should be vigilant in eliciting ocular surface complaints from their patients.
Article
To estimate the prevalence and risk factors of dry eye disease (DED) in a rural setting in Japan. Cross-sectional study. We included 3294 subjects, aged ≥ 40 years who were in the residential registry for Koumi town. Subjects in a rural mountain area, Koumi town, completed questionnaires designed to detect dry eye diagnosis and risk factors. Clinically diagnosed DED was defined as the presence of a previous clinical diagnosis of DED by ophthalmologists or severe symptoms of DED (both dryness and irritation constantly or often). Current symptoms of DED and possible risk factors such as age, gender, educational history, smoking history, alcohol drinking history, height and weight, visual display terminal (VDT) use, and contact lens (CL) wear, and past/current history of certain common systemic diseases were the main outcome measures. We used logistic regression analysis to examine associations between DED and other demographic factors. Of the 3294 eligible residents, 2791 residents (85%) completed the questionnaire. The percentage of women with a composite outcome of clinically diagnosed DED or severe symptoms (21.6%; 95% confidence interval [CI], 19.5-23.9) was higher than that of men (12.5%; 95% CI, 10.7-14.5; P<0.001). A low body mass index (BMI; odds ratio [OR], 2.07; 95% CI, 0.98-4.39), CL use (OR, 3.84; 95% CI, 1.46-10.10), and hypertension (HT) (OR, 1.39; 95% CI, 0.94-2.06) were risk factors for DED in men. Use of a VDT (OR, 2.33; 95% CI, 1.12-4.85), CL use (OR, 3.61; 95% CI, 2.13-6.10), and myocardial infarction or angina were the risk factors (OR, 2.64; 95% CI, 1.51-4.62), whereas high BMI was a preventive factor (OR, 0.69; 95% CI, 0.48-1.01) for DED in women. Among a Japanese cohort, DED leading to a clinical diagnosis or severe symptoms is prevalent. Use of CLs was a common dry eye risk factor in both genders. The condition is more prevalent in men with low BMI, HT, and in women with myocardial infarction or angina and VDT use. Relevant measures directed against the modifiable risks may provide a positive impact on public health and quality of life of Japanese. The authors have no proprietary or commercial interest in any materials discussed in this article.
Article
Patients with dry eye disease (DED) often complain about poor vision, which is not easily quantifiable. This review assesses the current understanding of clinical evaluations of visual function in patients with DED. Several noninvasive techniques for the assessment of visual performance have been utilized in patients with DED, and these are critically reviewed in relation to the visual symptoms experienced by these patients. It is clear that none of the current techniques is ideal, and there is not one appropriate, simple, clinical test that can be used for assessing visual impairment in patients with DED. Evidence from a comprehensive literature search combined with clinical experience have been used to identify which tests are currently of most benefit and to highlight the future development of a more specific clinical test for visual impairment in the dry eye patient.