Computer vision syndrome: A review.

BACKGROUND: Computer vision syndrome (CVS) is a collection of symptoms related to prolonged work at a computer display. OBJECTIVE: This article reviews the current knowledge about the symptoms, related factors and treatment modalities for CVS. METHODS: Relevant literature on CVS published during the past 65 years was analyzed. RESULTS: Symptoms reported by computer users are classified into internal ocular symptoms (strain and ache), external ocular symptoms (dryness, irritation, burning), visual symptoms (blur, double vision) and musculoskeletal symptoms (neck and shoulder pain). The major factors associated with CVS are either environmental (improper lighting, display position and viewing distance) and/or dependent on the user's visual abilities (uncorrected refractive error, oculomotor disorders and tear film abnormalities). CONCLUSION: Although the factors associated with CVS have been identified the physiological mechanisms that underlie CVS are not completely understood. Additionally, advances in technology have led to the increased use of hand-held devices, which might impose somewhat different visual challenges compared to desktop displays. Further research is required to better understand the physiological mechanisms underlying CVS and symptoms associated with the use of hand-held and stereoscopic displays.

Effect of font size and glare on computer tasks in young and older adults.

PURPOSE: At a fixed viewing distance (VD), reading speed increases with print size. It is not known if this holds for computer tasks when postures are not constrained. Reflective glare on a monitor may reduce productivity. The effects of both may be modified by age. We evaluated effects of age, font size, and glare on performance for visually demanding text-based tasks on a computer. METHODS: Nineteen young (18 to 35 years old) and eight older (55 to 65 years old wearing progressive lenses that correct for presbyopia) subjects participated in a study with two trial factors: font size (1.78, 2.23, and 3.56 mm) and glare (produced by bright light-emitting diode task light reflective off a matte liquid crystal display monitor). The monitor location was fixed but subjects were allowed to change their posture and move the chair. Subjects performed visual tasks that required similar visual skills to common tasks such as Internet use, data entry, or word processing. RESULTS: Productivity, accuracy, and VD increased as font size increased. For each 1-mm increase in font size, there was a mean productivity gain of 3 correct clicks/min and an improvement in accuracy of 2%. Font size increase also led to lowered perceived task difficulty. Adding reflective glare on the monitor surface led to a reduced VD but had no effect on productivity or accuracy. With visual corrections for presbyopia, age had no effect on these relationships. CONCLUSIONS: Productivity is improved when the font is increased from 1.78 or 2.23 to 3.56 mm for text-based computer tasks. The largest font size corresponds to a visual angle of font of 23.4 arcmin. This visual angle of font is above the high end of ISO recommendations (International Organization for Standardization, 1992, 2011). The findings may be useful for setting the font sizes for computers and for training office workers.

Comparison of three techniques in measuring progressive addition lenses.

PURPOSE: To measure progressive addition lenses (PALs) by three techniques and to compare the differences across techniques. METHODS: Five contemporary PALs (Varilux Comfort Enhanced, Varilux Physio Enhanced, Hoya Lifestyle, Shamir Autograph, and Zeiss individual) with plano distance power and a +2.00 diopters (D) add were evaluated under the condition of lateral displacement of the lens (no rotation and no tilt) using three methods. A Hartmann-Shack wavefront sensor (HSWFS) on a custom-built optical bench was used to capture and measure wavefront aberrations. A Rotlex Class Plus lens analyzer operating as a moiré interferometer was used to measure spherical and cylindrical powers. A coordinate measuring machine (CMM) was used to measure front and back surfaces of PALs and converted to desired optical properties. The data were analyzed with MATLAB programs. Contour plots of spherical equivalent power, cylindrical power, and higher-order aberrations (HOAs) in all PALs were generated to compare their differences. RESULTS: The differences in spherical equivalent and cylinder at distance, near, and progressive corridor areas among the HSWFS, Rotlex, and CMM methods were close to zero in all five PALs. The maximum differences are approximately 0.50 D and located below the near power zone and the edge areas of the lens when comparing the HSWFS and CMM with the Rotlex. HOAs measured both by the HSWFS and CMM were highest in the corridor area and the area surrounding the near zone in all PALs. The HOAs measured by the CMM were lower than those from the HSWFS by 0.02 to 0.04 µm. CONCLUSIONS: The three measurement methods are comparable for measuring spherical and cylindrical power across PALs. The non-optical method, CMM, can be used to evaluate the optical properties of a PAL by measuring front and back surface height measurements, although its estimates of HOAs are lower than those from the HSWFS.

Comparative effect of lens care solutions on blink rate, ocular discomfort and visual performance.

PURPOSE: To help maintain clear vision and ocular surface health, eye blinks occur to distribute natural tears over the ocular surface, especially the corneal surface. Contact lens wearers may suffer from poor vision and dry eye symptoms due to difficulty in lens surface wetting and reduced tear production. Sustained viewing of a computer screen reduces eye blinks and exacerbates such difficulties. The present study evaluated the wetting effect of lens care solutions (LCSs) on blink rate, dry eye symptoms, and vision performance. METHODS: Sixty-five adult habitual soft contact lens wearers were recruited to adapt to different LCSs (Opti-free, ReNu, and ClearCare) in a cross-over design. Blink rate in pictorial viewing and reading (measured with an eyetracker), dry eye symptoms (measured with the Ocular Surface Disease Index questionnaire), and visual discrimination (identifying tumbling E) immediately before and after eye blinks were measured after 2 weeks of adaption to LCS. Repeated measures anova and mixed model ancova were conducted to evaluate effects of LCS on blink rate, symptom score, and discrimination accuracy. RESULTS: Opti-Free resulted in lower dry eye symptoms (p = 0.018) than ClearCare, and lower spontaneous blink rate (measured in picture viewing) than ClearCare (p = 0.014) and ReNu (p = 0.041). In reading, blink rate was higher for ClearCare compared to ReNu (p = 0.026) and control (p = 0.024). Visual discrimination time was longer for the control (daily disposable lens) than for Opti-Free (p = 0.007), ReNu (p = 0.009), and ClearCare (0.013) immediately before the blink. CONCLUSIONS: LCSs differently affected blink rate, subjective dry eye symptoms, and visual discrimination speed. Those with wetting agents led to significantly fewer eye blinks while affording better ocular comfort for contact lens wearers, compared to that without. LCSs with wetting agents also resulted in better visual performance compared to wearing daily disposable contact lenses. These presumably are because of improved tear film quality.

Stereoscopic viewing and reported perceived immersion and symptoms.

PURPOSE: Stereoscopic 3D displays heighten perceived immersion but elevate viewing symptoms for some viewers. The present study measured prevalence and magnitude of perceived immersion and viewing symptoms in stereoscopic viewing, and related them to viewer's characteristics and viewing position. METHODS: Two hundred three teens and adults viewed a movie in 2D or 3D while sitting at different angles and distances. Their prior viewing symptoms, as well as visual and physical discomfort immediately before and after viewing, were measured with questionnaires. They were also asked to report their perceived immersion after the viewing. RESULTS: Twelve percent and twenty-one percent of 2D and stereoscopic 3D participants reported increases of measured symptoms during and/or after viewing. Stereoscopic 3D viewing incurred greater and more frequent perception of blurred vision, double vision, dizziness, disorientation, and nausea than 2D viewing. Reported ocular and physical symptoms were negatively correlated to perceived immersion in 3D viewing. Older viewers (age 46 years or older) reported greater ocular, visual, and motion sickness symptoms in 2D viewing, and younger viewers (age 24-34 years) reported greater visual and motion sickness symptoms in 3D viewing. Sitting in an oblique position attenuated perceived immersion but also reduced motion symptoms in 3D viewing. Prior viewing symptoms in 2D tasks also predicted ocular and physical symptoms in 2D but less so in 3D viewing. CONCLUSIONS: Stereoscopic 3D viewing provides greater immersion, but it can also lead to heightened visual and motion sickness symptoms. Viewers with prior symptoms in viewing TV and computer screen are not more likely to have increased ocular and physical symptoms in 3D viewing. Young viewers incurred higher immersion but also greater visual and motion sickness symptoms in 3D viewing; both will be reduced if a farther distance and a wider viewing angle are adopted.

Asthenopia and blink rate under visual and cognitive loads.

PURPOSE: Asthenopia has been associated with reading under visually stressful conditions. However, it is not known whether increased cognitive load contributes to asthenopic symptoms. The purpose of this study was to evaluate the contribution of increased cognitive load (with or without visual stress inducing conditions) to asthenopic symptoms associated with prolonged near work. METHODS: Thirty-three visually normal subjects, aged 18 to 30 years, participated in the study. Subjects read texts or watched videos under different visual stress and cognitive loads. Visual stress conditions were good visual quality, low contrast, and induced refractive error. The cognitive load levels were watching video, reading fairy tales, and reading technical articles. As an additional task, subjects also listened to technical articles. At the end of each condition, subjects rated the magnitude of any asthenopic symptoms, visual discomfort, and cognitive discomfort they experienced during the task. Electromyography potentials recorded from the lower orbicularis oculi muscle were used to obtain blink rate. RESULTS: Subjects reported greater internal symptoms for the refractive error condition coupled with higher cognitive load compared to good visual and low contrast conditions (p < 0.01). For the low contrast condition coupled with higher cognitive load, greater external symptoms were reported compared to good visual and refractive error conditions (p < 0.05). However, asthenopic symptoms were not reported for cognitively demanding tasks when the visual condition was good. Blink rates were not significantly different between the good visual and low contrast conditions within each cognitive load level. For the cognitively difficult reading conditions, blink rate was significantly decreased for the low contrast and good visual conditions compared to the refractive error condition. CONCLUSIONS: An interaction between cognitive and visual demands was observed. Greater cognitive loads accentuate the same differentiated symptoms normally caused by visual stressors.

Interactions of visual and cognitive stress.

BACKGROUND: The objective of this research is to assess the ocular and muscular response to long-duration reading under different visual and cognitive difficulty levels. METHODS: Thirty-five subjects, with 20/20 vision and without history of ocular pathology or cognitive deficits, participated in the study. Subjects read under different visual and cognitive difficulty levels for 6 (30-minute) conditions. Upper and lower orbicularis oculi, frontalis, and trapezius muscle activities were recorded using surface electromyography (EMG). Aperture size, pupil diameter, and pulse rate of the subjects were recorded with a video camera, pulse meter, and ISCAN eye tracker (ISCAN Inc.), respectively. RESULTS: The results show that the texts read with a refractive error caused increased orbicularis oculi EMG power and reduced aperture size (P < 0.001). There was no statistically significant difference between the conditions for pulse rate, pupil diameter, or EMG activity of the frontalis and trapezius muscles with either visual or cognitive stress presented in this experiment. CONCLUSION: Visual stress experienced due to reading under an induced refractive error is potentially mediated by a local mechanism, different from the mechanism underlying reading under low contrast or high cognitive demand.

Effects of ocular transverse chromatic aberration on peripheral word identification.

Transverse chromatic aberration (TCA) smears the retinal image of peripheral stimuli. We previously found that TCA significantly reduces the ability to recognize letters presented in the near fovea by degrading image quality and exacerbating crowding effect from adjacent letters. The present study examined whether TCA has a significant effect on near foveal and peripheral word identification, and whether within-word orthographic facilitation interacts with TCA effect to affect word identification. Subjects were briefly presented a 6- to 7-letter word of high or low frequency in each trial. Target words were generated with weak or strong horizontal color fringe to attenuate the TCA in the right periphery and exacerbate it in the left. The center of the target word was 1°, 2°, 4°, and 6° to the left or right of a fixation point. Subject's eye position was monitored with an eye-tracker to ensure proper fixation before target presentation. They were required to report the identity of the target word as soon and accurately as possible. Results show significant effect of color fringe on the latency and accuracy of word recognition, indicating existing TCA effect. Observed TCA effect was more salient in the right periphery, and was affected by word frequency more there. Individuals' subjective preference of color-fringed text was correlated to the TCA effect in the near periphery. Our results suggest that TCA significantly affects peripheral word identification, especially when it is located in the right periphery. Contextual facilitation such as word frequency interacts with TCA to influence the accuracy and latency of word recognition.

Effects of postural and visual stressors on myofascial trigger point development and motor unit rotation during computer work.

Musculoskeletal complaint rates are high among those performing low-level static exertions (LLSEs), such as computer users. However, our understanding of the causal mechanisms is lacking. It was hypothesized that myofascial trigger point (MTrP) development might be one causal mechanism to help explain these complaints and that static postural and visual demands may be contributing factors. Therefore, the purpose of this experiment was to examine MTrP development and the behavior of multiple parts of the trapezius muscle under postural and mental stress (represented by visual stress) conditions during computer work. Twelve subjects (six male and six female) were monitored for MTrP development via expert opinion, subject self-report, and cyclic changes in EMG median frequency across fourteen spatial locations. Results showed that MTrPs developed after one hour of continuous typing, despite the stress condition. Interestingly, both the high postural and high visual stress conditions resulted in significantly fewer median frequency cycles (3.76 and 5.35 cycles, respectively), compared to the baseline low stress condition (6.26 cycles). Lastly, the MTrP location as well as locations more medial to the spine showed significantly fewer cycles than other locations. Findings suggest that MTrPs may be one causal pathway for pain during LLSEs and both postural and visual demands may play a role in muscle activation patterns, perhaps attributing to MTrP development and resultant discomfort.

Effects of ocular transverse chromatic aberration on near foveal letter recognition.

Transverse chromatic aberration (TCA) smears retinal images of peripheral stimuli. In reading, text information is extracted from both foveal and near fovea, where TCA magnitude is relatively small and variable. The present study investigated whether TCA significantly affects near foveal letter identification. Subjects were briefly presented a string of five letters centered one degree of visual angle to the left or right of fixation. They indicated whether the middle letter was the same as a comparison letter subsequently presented. Letter strings were rendered with a reddish fringe on the left edge of each letter and a bluish fringe on the right edge, consistent with expected left periphery TCA, or with the opposite fringe consistent with expected right periphery TCA. Effect of the color fringing on letter recognition was measured by comparing the response accuracy for fringed and non-fringed stimuli. Effects of lateral interference were examined by manipulating inter-letter spacing and similarity of neighboring letters. Results demonstrated significantly improved response accuracy with the color fringe opposite to the expected TCA, but decreased accuracy when consistent with it. Narrower letter spacing exacerbated the effect of the color fringe, whereas letter similarity did not. Our results suggest that TCA significantly reduces the ability to recognize letters in the near fovea by impeding recognition of individual letters and by enhancing lateral interference between letters.

The effects of visual display distance on eye accommodation, head posture, and vision and neck symptoms.

OBJECTIVE: Determine the effects of display viewing distance on both the visual and musculoskeletal systems while the text height is held constant across viewing distances. BACKGROUND: The distance from the eyes to a computer display may affect visual and neck comfort. If the angular size of the characters remains the same, it is recommended that the display be placed at a farther viewing distance (e.g., 70-100 cm). However, in common usage, the character sizes are not adjusted based on viewing distance. METHOD: Participants under the age of 35 years (N = 24) performed visually demanding tasks using a computer display for 2 hr each at three viewing distances (mean: 52.4, 73.0, and 85.3 cm) while torso and head posture were tracked. At the end of each task, eye accommodation was measured and symptoms were recorded. RESULTS: The near distance was associated with significantly less blurred vision, less dry or irritated eyes, less headache, and improved convergence recovery when compared with the middle and far distances. Participants moved their torsos and heads closer to the monitor at the far distance. CONCLUSION: If the computer screen character sizes are close to the limits of visual acuity, it is recommended that the computer monitor be positioned between the near (52 cm) and middle (73 cm) distance from the eyes. APPLICATION: The location of a computer display should take into account the size of the characters on the screen and the visual acuity of the user.

Computer use, symptoms, and quality of life.

PURPOSE: To model the effects of computer use on reported visual and physical symptoms and to measure the effects upon quality of life measures. METHODS: A survey of 1000 university employees (70.5% adjusted response rate) assessed visual and physical symptoms, job, physical and mental demands, ability to control/influence work, amount of work at a computer, computer work environment, relations with others at work, life and job satisfaction, and quality of life. Data were analyzed to determine whether self-reported eye symptoms are associated with perceived quality of life. The study also explored the factors that are associated with eye symptoms. Structural equation modeling and multiple regression analyses were used to assess the hypotheses. RESULTS: Seventy percent of the employees used some form of vision correction during computer use, 2.9% used glasses specifically prescribed for computer use, and 8% had had refractive surgery. Employees spent an average of 6 h per day at the computer. In a multiple regression framework, the latent variable eye symptoms was significantly associated with a composite quality of life variable (p = 0.02) after adjusting for job quality, job satisfaction, supervisor relations, co-worker relations, mental and physical load of the job, and job demand. Age and gender were not significantly associated with symptoms. After adjusting for age, gender, ergonomics, hours at the computer, and exercise, eye symptoms were significantly associated with physical symptoms (p < 0.001) accounting for 48% of the variance. CONCLUSIONS: Environmental variability at work was associated with eye symptoms and eye symptoms demonstrated a significant impact on quality of life and physical symptoms.

Eyelid squint response to asthenopia-inducing conditions.

PURPOSE: To study the orbicularis oculi muscle response to asthenopia-inducing conditions. METHODS: Twenty subjects (18-36 years) screened for 20/20 vision in each eye participated in the study. Subjects read passages under different asthenopia-inducing conditions. The inducing conditions were glare, low contrast, small font size, refractive error, up gaze, accommodative stress and convergence stress. Surface electromyography (EMG) was used to study the orbicularis oculi response from the right eye. Palpebral fissure height was measured from recorded video images of the right eye. At the end of each condition subjects were asked to rate the severity and type of visual discomfort experienced. RESULTS: Outcome measures for the asthenopia-inducing conditions were compared with their respective nonstress controls. Repeated measures analysis of variance was used to analyze the data. Refractive error (p = 0.0001), glare (p = 0.0001), low contrast (p = 0.007), small font (p = 0.034), and up gaze (p = 0.001) resulted in a significant increase in EMG power. Refractive error (p = 0.0001) and glare (p = 0.0001) also caused significant reduction in aperture size. Reading a low contrast text caused a reduction in blink rate (p = 0.035), whereas refractive error (p = 0.005) and glare (p = 0.01) caused an increase in blink rate. All conditions induced significant visual discomfort (p < 0.001). CONCLUSION: Refractive error and glare, which reduce image quality and benefit from eyelid squint, caused increased EMG power, eyelid squint response and increased blink rate. Low contrast and small font, which reduce image quality but do not benefit from eyelid squint, resulted in increased EMG power without changes in aperture size and reduced blink rate (for low contrast). Accommodative and convergence stress (in subjects with normal accommodative and vergence abilities) did not cause changes in EMG power, aperture size or blink rate. These results suggest that contraction of the orbicularis oculi is a part of the asthenopia mechanism related to compromised image quality.

Objective measurements of lower-level visual stress.

PURPOSE: To determine the sensitivity of the electromyography (EMG) response of the orbicularis oculi muscle to selected lower-level visually stressful conditions to establish the extent to which it can be used as a measure of visual discomfort. METHODS: Thirty-one subjects (18 years or older) with 20/20 vision, without history of ocular pathology, oculomotor limitation, or cognitive deficits participated in the study. Subjects read on a computer display for 27 trials of 5 min duration under different low-level asthenopic conditions. The conditions were graded levels of font size, font type, contrast, refractive error, and glare. Orbicularis oculi activity was recorded using surface EMG. Blink-free epochs of EMG data were analyzed for power for all the conditions. Blink rate for all the trials was also measured. At the end of each trial, subjects rated the severity of visual discomfort experienced while reading. RESULTS: Conditions that benefit from squint (refractive error and glare) showed increased EMG power (p < 0.001) from the orbicularis and increased blink rate (p = 0.002), whereas those that do not benefit from squint (small font and low contrast) showed no significant EMG response and a significant decrease in blink rate (p = 0.003 and p = 0.01). All conditions resulted in significant visual discomfort; the p value for font type was 0.039 and p < 0.001 for the other conditions. CONCLUSIONS: The results suggest that the squint-beneficial conditions are operated by a local mechanism involving contraction of the orbicularis and increase in reflex blinking, whereas those that do not benefit from squint do not engage the orbicularis and decrease blink, possibly through central inhibition of spontaneous blinking. The EMG response is a sensitive objective measure for the squint-beneficial conditions. However, for the non-squint-beneficial conditions, blink rate may be a more sensitive objective measure, although EMG with longer trial durations should be tested.

Blink rate decreases with eyelid squint.

PURPOSE: We hypothesize that eyelid squint inhibits blink rate. This is part of a larger hypothesis that, because eyelid squint improves vision under conditions of optical defocus and/or glare, and reduced blink rate is assumed to contribute to dry eye symptoms, eyelid squint is part of the mechanism resulting in asthenopia. This study investigates the effect of voluntary eyelid squint on blink activity and on electromyography (EMG) measures from the orbicularis oculi. METHODS: Ten subjects (18 to 38 years of age) performed 3 1-minute trials each (Latin Square order) of voluntary target squint levels of 5%, 20%, 35%, and 50% with respect to previously demonstrated 0% (relaxed) and 100% (maximum) squint levels. EMG recordings using surface electrodes were obtained from the orbicularis muscle. Vertical dimension of the palpebral fissure and eye lid blinks were measured with an ISCAN eye tracker and video recorder. RESULTS: Each target squint level produced significant changes (p<0.0001) in ocular aperture size, EMG power, and EMG amplitude. For target voluntary squint levels of 5%, 20%, 35%, and 50%, the mean squint responses were 24%, 35%, 42%, and 53%, respectively. Blink rate was inversely related to both target squint level and squint response (p<0.0001), decreasing from 15 blinks per minute at 0% squint to 7.5 blinks per minute at 5% target voluntary squint and to 4 blinks per minute at 50% target voluntary squint. CONCLUSIONS: Voluntary eyelid squint significantly reduces blink rate by an average of 50% or more dependent on attempted level. Further study is required to determine if involuntary squint causes the same. All tested levels of voluntary squint resulted in an EMG signal from the orbicularis muscle that is measurably different from resting state. This indicates that EMG can be used as a reliable indicator of eyelid squint.

Progressive powered lenses: the Minkwitz theorem.

PURPOSE: The Minkwitz theorem, which can be proven to apply to the immediate surface surrounding a line of umbilics, states that astigmatism perpendicular to the line changes twice as quickly as the rate of change of power along the line. Our objective is to test how the Minkwitz theorem applies to the design of progressive addition lenses (PALs). METHOD: Our primary investigation of the astigmatism/power rate relationship used Hoya Tact lenses because they have a relatively large central region with horizontal spherical equivalent power contours and vertical astigmatism power contours. Other PALs were used for subsequent analysis. Lenses were measured with a Rotlex Class Plus lens analyzer. RESULTS: Zone widths in the central region of the Tact lenses exceeded those predicted by the Minkwitz theorem. Above and below this region, zone widths were narrower than predicted. When averaged along the entire corridor, zone widths approximated the Minkwitz theorem. For other PALs, the measured zone widths exceed Minkwitz theorem in the top (distance) and middle (intermediate) corridor but fell short in the lower (near) corridor. Likewise, on average along the entire corridor, they approximate the Minkwitz theorem. CONCLUSIONS: Although the Minkwitz theorem must apply exactly to the immediate locale of an umbilic, deviations from Minkwitz can occur within 2 mm of the corridor. Several factors enable enough local deviation from the Minkwitz theorem to "steer" the astigmatism and affect its magnitude in the peripheral portions of a lens. Although the Minkwitz relationship may be altered in some regions of the corridor, there is a global component to the Minkwitz prediction that applies to PALs. On a global level, the gains and losses of astigmatism along the corridor with respect to the Minkwitz prediction have strong tendency to cancel one another. In the end, it appears the unwanted astigmatism associated with a given power change along a given distance can be redistributed but probably not reduced.

Visual effects of the luminance surrounding a computer display.

The luminance surrounding a computer display can potentially reduce visibility of the display (disability glare), result in sensations of discomfort (discomfort glare) and result in transient adaptation effects from fixating back and forth between the two luminance levels. The study objective was to measure the effects of surround luminance levels upon these functions in younger and older adults to determine recommended surround luminance levels. The younger age group comprised 20 subjects (mean age 27.9 years, range 23 - 39) and the older group 17 subjects (mean age 55.5 years, range 47 - 63). The central task was presented with luminance of 91 cd/M(2), tested surround luminance levels were 1.4, 2.4, 8.9, 25.5, 50, 91, 175, 317, and 600 cd/M(2). Disability glare was tested with low contrast (20%) visual acuity charts, transient adaptation was tested with a task that required regular fixation between the two luminance levels, discomfort was measured with a questionnaire after reading stories with different surround luminance levels, and preferred luminance was measured by method of adjustment. The surround luminance significantly affected transient adaptation (p < 0.0001), optimal performance occurred at 50 cd/M(2) and above for the young group and at 91 cd/M(2) and above for the older group. Neither low contrast acuity (disability glare) nor symptoms when reading were significantly affected by surround luminance. There was wide variation in preferred surround luminance; however, average preferred surround luminance was 86.9 cd/M(2) for the young group and 62.2 cd/M(2) for the older group, slightly below the central luminance of 91 cd/M(2). The effects of the surround luminance within the tested range are not large; however, the data show that the lowest surround luminance levels should be avoided and that surround luminance levels at or slightly below that of the central task are preferred.

The optics of occupational progressive lenses.

BACKGROUND: Occupational progressive lenses (OPLs) utilize progressive power optics and are designed primarily to meet near and intermediate viewing needs such as working at a computer workstation for presbyopic patients. OPLs are fabricated to have the prescribed near power in the lower part of the lens and the power in the upper portion of the lens is determined by the amount of power "degression" (decrease in plus power) relative to the near power. Independent measurements of the optical characteristics of these lenses have not been reported previously. METHODS: Manufacturers of 7 different OPL designs provided sample lenses for a patient with +2.50 D add that were measured with a Rotlex Class Plus lens analyzer (Rotlex Inc., Israel). Power measurements were normalized to the location specified by the manufacturer, and the vertical location of each lens was normalized to pupil center based on manufacturer fitting guidelines. RESULTS: Large optical differences exist among the OPL designs. The results show clear differences between the designs in terms of the add powers, their vertical location, and zone width. The size and location of the near, near-intermediate, far-intermediate, and far viewing zones were determined. CONCLUSIONS: The literature and clinical experience support that OPLs are successful at meeting the computer, general office, and other intermediate viewing distance needs of many patients. However, because of the large differences in the several OPL designs, patient success can likely be enhanced by selecting the design that best suits his or her viewing needs.

Text legibility and the letter superiority effect.

Effects of font design and electronic display parameters upon text legibility were determined using a threshold size method. Participants' visual acuity (inverse of the minimum detection size, representing the threshold legibility for each condition) was measured using upper- and lowercase letters and lowercase words in combinations of 6 fonts, 3 font-smoothing modes, 4 font sizes, 10 pixel heights, and 4 stroke widths. Individual lowercase letters were 10% to 20% more legible than lowercase words (i.e., lowercase words must be 10%-20% larger to have the same threshold legibility). This letter superiority effect suggests that individual letters play a large role and word shape plays a smaller role, if any, in word identification at threshold. Pixel height, font, stroke width, and font smoothing had significant main effects on threshold legibility. Optimal legibility was attained at 9 pixels (10 points). Verdana and Arial were the most legible fonts; Times New Roman and Franklin were least legible. Subpixel rendering (ClearType) improved threshold legibility for some fonts and, in combination with Verdana, was the most legible condition. Increased stroke width (bold) improved threshold legibility but only at the thinnest width tested. Potential applications of this research include optimization of font design for legibility and readability.