Astenopia digital em controladores de tráfego aéreo: diagnóstico e avaliação na Força Aérea Portuguesa / Digital-related eye strain in air traffic control specialists: diagnosis and evaluation in the Portuguese Air Force staff

RESUMO A função de controlador aéreo exige várias horas de visualização de ecrãs, o que torna esses profissionais um grupo particularmente exposto à astenopia digital. Procuramos, com este artigo de revisão, compreender quais os métodos quantitativos e qualitativos usados atualmente para diagnosticar e avaliar a fadiga ocular em controladores de tráfego aéreo. Trata-se de pesquisa bibliográfica utilizando as bases de dados PubMed® e ClinicalKey®, usando palavras-chave, tendo sido selecionados artigos de revisão e estudos observacionais com publicação posterior ao ano 2000, de modo que os termos buscados estivessem no título e/ou resumo do trabalho. Excluímos artigos em línguas que não inglesa. Existem vários métodos para melhor caracterizar a astenopia digital, destacando-se os subjetivos, como questionários, e os objetivos, que procuram, por um lado, diagnosticar o olho seco, bem como alterações da acomodação e da convergência. Da análise efetuada, ressaltou-se uma escassez de estudos prospectivos com Níveis de Evidência moderados e altos relacionados com a aplicação dos vários métodos de diagnóstico. A Computer-Vision Symptom Scale parece ser um questionário confiável e que pode ser aplicado aos controladores de tráfego aéreo, para diagnóstico de astenopia digital. Vários métodos objetivos podem também ser utilizados para essa avaliação, sendo importante, numa fase posterior, aplicar esses dois tipos de métodos de diagnóstico para avaliar a prevalência dessa patologia em controladores de tráfego aéreo.

ABSTRACT The work of air traffic control specialists require several hours looking at screens, and they comprise a group particularly exposed to digital-related eye strain. In this review we aim to understand the quantitative and qualitative methods currently used to diagnose and evaluate asthenopia in air traffic control specialists. A bibliographic search was carried out at the databases PubMed® and ClinicalKey®, using keywords, and selecting review articles and observational studies, dated after 2000, containing the keywords in the title and/o abstract. Articles not published in English were excluded. There are several subjective and objective methods to better describe digital-related eye strain, including questionnaires, aiming to make diagnosis of dry eye disease or changes in accommodation and convergence. From our analysis, there are few prospective studies with moderate and high levels of evidence regarding these diagnostic methods. The Computer-Vision Symptom Scale seems to be a reliable questionnaire to be applied to air traffic control specialists, for diagnosis of digital-related eye strain. Several objective methods can also be employed in this evaluation, and, in a later stage, it will be important to apply both diagnostic methods to evaluate the prevalence of this condition in air traffic control specialists.

Prevalence of asthenopia in children: a systematic review with meta-analysis / Prevalência de astenopia em crianças: análise sistemática com metanálise

OBJECTIVE: To estimate the prevalence of asthenopia in 0-18 year-old children through a systematic review and meta-analysis of prevalence studies.SOURCES: Inclusion criteria were population-based studies from 1960 to May of 2014 reporting the prevalence of asthenopia in children. The search was performed independently by two reviewers in the PubMed, EMBASE, and LILACS databases, with no language restriction. This systematic review was performed in accordance with the Cochrane Collaboration guidelines and the PRISMA Statement. Downs and Black score was used for quality assessment.SUMMARY OF FINDINGS: Out of 1692 potentially relevant citations retrieved from electronic databases and searches of reference lists, 26 were identified as potentially eligible. Five of these studies met the inclusion criteria, comprising a total of 2465 subjects. Pooled prevalence of asthenopia was 19.7% (12.4-26.4%). The majority of children with asthenopia did not present visual acuity or refraction abnormalities. The largest study evaluated 1448 children aged 6 years and estimated a prevalence of 12.6%. Associated risk factors were not clearly established.CONCLUSION: Although asthenopia is a frequent and relevant clinical problem in childhood, with potential consequences for learning, the scarcity of studies about the prevalence and clinical impact of asthenopia hinders the effective planning of public health measures.

OBJETIVO: Estimar a prevalência de astenopia em crianças até 18 anos por meio de uma análise sistemática e uma metanálise dos estudos de prevalência.FONTES DOS DADOS: Os critérios de inclusão foram estudos de base populacional de 1960 a maio de 2014 que relataram prevalência de astenopia em crianças. A busca foi feita de maneira independente por dois analisadores nas bases de dados PubMed, Embase e Lilacs, sem restrição de idioma. Essa análise sistemática foi feita de acordo com as diretrizes da Colaboração Cochrane e com a Declaração dos Itens de Relatório Preferidos para Análises Sistemáticas e Metanálise (Prisma). A escala Downs & Black foi usada para avaliação da qualidade.SÍNTESE DOS DADOS: De 1.692 citações possivelmente relevantes recuperadas de bases de dados eletrônicas e buscas de listas de referência, 26 foram identificadas como possivelmente elegíveis. Cinco desses estudos atenderam aos critérios de inclusão e incluíram 2.465 indivíduos. A prevalência total de astenopia foi de 19,7% (12,4-26,4%). A maioria das crianças com astenopia não apresentava anomalias de acuidade visual ou refração. O maior estudo avaliou 1.448 crianças de seis anos, com prevalência estimada de 12,6%. Os fatores de risco associados não foram claramente estabelecidos.CONCLUSÃO: Embora a astenopia seja um problema clínico frequente e relevante na infância, com possíveis consequências para o aprendizado, a escassez de estudos sobre a prevalência e o impacto clínico da astenopia prejudica o planejamento efetivo das medidas de saúde pública.

Translation and validation of Convergence Insufficiency Symptom Survey (CISS) to Portuguese - psychometric results / Tradução e validação do CISS para a língua portuguesa - resultados psicométricos

Purpose: Translate and adapt the Convergence Insuficiency Symptom Survey (CISS) questionnaire to the Portuguese language and culture and assess the psychometric properties of the translated questionnaire (CISSvp). Methods: The CISS questionnaire was adapted according to the methodology recommended by some authors. The process involved two translations and back-translations performed by independent evaluators, evaluation of these versions, preparation of a synthesis version and its pre-test. The final version (CISSvp) was applied in 70 patients (21.79 ± 2.42 years) students in higher education, and at two different times, by two observers, to assess its reliability. Results: The results showed good internal consistency of the CISSvp (Cronbach's alpha - α=0.893). The test re-test revealed an average of the differences between the first and second evaluation of 0.75 points (SD ± 3.53), which indicates a minimum bias between the two administrations. The interrater reliability assessed by intraclass correlation coefficient ranged from 0.880 to 0.952, revealing that the CISSvp represents an appropriate tool for measuring the visual discomfort associated with near vision tasks with a high level of reproducibility. Conclusions: The CISS Portuguese version, showed good psychometric properties and has been sown to be applicable to the Portuguese population, to quantify the visual discomfort associated with near vision, in higher education students. .

Objetivo: Traduzir e adaptar transculturalmente o questionário Convergence Insuficiency Symptom Survey (CISS) para a língua portuguesa e avaliar as propriedades psicométricas do questionário traduzido (CISSvp). Métodos: O questionário CISS foi adaptado segundo metodologia recomendada por alguns autores. O processo envolveu duas traduções e retrotraduções realizadas por avaliadores independentes, avaliação das versões seguida da elaboração de uma versão síntese e pré-teste comentado. A versão final (CISSvp) foi aplicada em 70 indivíduos (21,79 ± 2,42 anos) estudantes do ensino superior, em dois momentos distintos e por dois observadores, para avaliar a confiabilidade do mesmo. Resultados: Os resultados evidenciaram boa consistência interna do CISSvp (alfa de Cronbach - α=0,893). O teste re-teste revelou uma media das diferenças entre a primeira e a segunda avaliação de 0,75 pontos (SD=±3,53) o que indica um viés mínimo entre as duas administrações. A confiabilidade inter-examinadores avaliada pelo coeficiente de correlação intraclasse variou de 0,880 e 0,952, revelando que o CISSvp representa uma ferramenta de medida do desconforto visual associado a tarefas em visão próxima com um nível de reprodutibilidade elevado. Conclusões: O CISS versão portuguesa apresentou boas propriedades psicométricas e demonstrou ser aplicável na população portuguesa, para quantificar a o desconforto visual associado à visão de perto, em estudantes do ensino superior. .

Prevalence of Asthenopia among Computer Users in Enugu; Southeast Nigeria

A cross-sectional survey of 560 computer users in Enugu urban; Enugu State was conducted between August and December 2002.The prevalence of asthenopic symptoms and risk factors to the occurrence of asthenopia were determined. Method: Interview was done using structured; pre-tested; interviewer- administered questionnaire. Subjects were examined with Snellen's chart to measure distance visual acuity; jaegers reading chart for near acuity; pen torch for anterior segment examination; direct ophthalmoscope for fundoscopy; streak retinoscope for refraction and metre tape for distance between the screen and the subject. Result: Out of 560 subjects interviewed and examined 401 (71.6) had asthenopic symptoms. Headache was the most common symptom occurring in 35of the subjects. Tearing was seen in 27.1; ocular discomfort or pains accounted for 26.6. Some subjects had more than one symptom. Presence of ametropia was found to be significantly related to the occurrence of asthenopia (P=0.0); as also the female gender compared to the males; P=0.0000007. Distance of operators to their monitors; age of operators and the use of screen filters did not seem to significantly influence occurrence of asthenopia (P= 0.71; P=0.55 and P=0.39 respectively). Majority of the subjects (96) had good vision (VA of 6/6- 6/18). Conclusion: Presence of ametropia is related to occurrence of asthenopia. Correction of existing ametropia would contribute to visual comfort of computer (vdt) users. Pre- employment and regular ocular examination should be made accessible to those who make regular and long use of computers

Estudio de la función visual en el trabajo con computadoras / [Visual function study in work with computer]

This investigation searched for the relationship between amount of nearwork, asthenopic symptoms and visual function, in a group of office workers engaged in telemarketing. Phoria, monocular accommodative facility with +/- 2 lens flippers and near point of convergence were measured in 100 office workers (mean age 21 +/- 2.6 years) whose uncorrected visual acuity was 20/30 or better. Daily hours of reading hard-copy and of computer use, and the level of asthenopic symptoms, were measured using a questionnaire. In this sample, telemarketers were involved 5.84 +/- 2.02 daily hours in computer use, and 2.87 +/- 2.13 daily hours in reading. The following asthenopic symptoms were present twice or more times in a week: headaches 16

, pain in the eyes 17

. An association was found between the amount of hours using computers and red eyes (chi 2 = 4.4, p = 0.0359) or blurred vision (chi 2 = 8.35, p = 0.0038). And also between deficit of convergence and headaches (chi 2 = 4.3313, p = 0.0374) or red eyes (chi 2 = 3.6416, p = 0.0564). No other associations could be found between the accommodative facility test results, the near point phoria, and the amount of nearwork or the asthenopic symptoms. In conclusion, computer use in telemarketing is associated with few asthenopic symptoms. Near point of convergence should be routinely measured, as it is associated with some asthenopic symptoms.