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Introduction

COVID -19 pandemic and lockdown condition in past 2-3 years affected educational systems and most of the businesses    worldwide leading to the total closure of school colleges and companies. But the pandemic also gives a new trend of online learning processes and work from home that accelerated the digitalisation of world speedily. Mandatory E-learning trend has emerged as new online method of education during pandemic 1. Digitalisation helps to connect people during lock-down periods, and the shift to remote working and e-learning will likely extend beyond the COVID-19 pandemic. These new educational online techniques and work from home trend gives more and more exposure to digital screens .without any specific guidelines and rules, it is now routine of all age groups to spend most of the time to attend classes, for work or doing time pass in front of the computers, laptops and on more digital screens with an accompanying rise in the prevalence of ocular complaints. Many individuals experience eye discomfort and vision problems when viewing digital screens for extended periods. The level of discomfort appears to increase with the amount of digital screen use.CVS, or digital eye strain, refers to a spectrum of clinical vision-related and muscular symptoms perceivably resulting from prolonged and continuous use of visual display terminals (VDTs), such as computers, smartphones, televisions, and tablets.2 it is the increasing eye problem as shadow of digitalisation after the pandemic. For the majority of CVS cases, treatments focus on alleviating symptoms rather than addressing the causes of CVS3. Regular use of artificial tears, anti-inflammatory drops, or punctal plugs provides only transient release and can often induce ocular side effects.  As Ayurveda is recognized as foremost life science and describes ways to prevent disorders, the world is being attracted towards its potential. Dincharya (daily routine practices for wellbeing) ,  Netra Kriyakalpa( ophthalmic therapeutic procedures) and Netra Hitakara Ahara( eye beneficial food )are the important features of Ayurveda that can help to reduce digital eye strain . Preventive measures described in Ayurveda, eye exercises and some basic rules to use digital screen can collectively help to deal with this eye problems.Main focus of this review article is to compile information about the Ayurvedic approach of preventive measures for digital eye strain and CVS.

Aim: current review is discussing at computer vision syndrome, bad effects of exposure of screens leading to Digital eye strain as effect of pandemic digitalisation of world. Main focus of this review article is to compile information about the Ayurvedic approach of preventive measures for digital eye strain and CVS.

Methodology: a literature search was done using PubMed, Google Scholar and literature of Ayurveda for relevant articles. Articles identified, included and compiled for the narrative review.

Digital Eye Strain (DES) and Computer Vision Syndrome (CVS)

In the modern digitalised world persons of all age groups are quiet dependable on digital screens. The use of computer and various digital screens in every workplace has made life easier and increase output tremendously. Screens have become almost an indispensable piece of equipment both at office and at home. The extensive use of computers in the workplace has led to a rise in visual health concerns and suboptimal visual function, causing significant physical and occupational burden; an estimated 50% to 90% of all computer users experience symptoms of CVS.4

Computer vision syndrome also referred to as digital eye strain, ?describes a group of eye- and vision-related problems that result from prolonged computer, tablet, e-reader and cell phone use. The symptoms experienced in computer vision syndrome are caused by three potential mechanisms: (i) Extra ocular mechanism, (ii) accommodative mechanism, (iii) ocular surface mechanism5

        Mechanism                                            Symptoms

• Extraocular    (musculoskeletal symptoms due to improper placement of computer screen.)   
  • • • Neck stiffness These symptoms are well associated with
      • Neck pain
      • Shoulder pain
      • Headache
      • Backache

• Ocular surface

• Tearing
• Gritty
• Dryness
• Redness
• Gritty
• sensation Burning
• Contact lens related problem

• Accommodative mechanism              

• Blurring of vision
• Double vision
• Presbyopia
• Myopia
• Slowness of focus change

The main ocular symptoms reported by workers are eye strain, irritation, burning sensation, redness, blurred vision and double vision.6.These symptoms are usually temporary and disappear at the end of the working day even though a minority of worker may experience continuity of symptoms after work. If no intervention is initiated, a majority of these symptoms will recur and also worsen in the future.

Factors contributing to CVS:

A study showed that there is a relation between the symptoms and signs and the time used per day and duration per year of exposure to the computer 7

Not taking a break between activity is also one of the factors that predispose individuals to develop CVS .8 In general personal, environmental and device related factors lead to the development of CVS .9 Summary of risk factors are displayed below

1. Personal factor          

• Poor seating posture
• Reduced blinking
• Improper viewing distances
• Improper viewing angle
• Ocular diseases
• Medical diseases
• Ageing

1. Environmental factor            

• Poor lighting
• Imbalance of light between
• the computer screen and
• the surrounding

1. Computer factor       

• Poor resolution
• Poor contrast
• Glare of the display
• Slow refresh rate

Discussion

Prevention and management of Computer Vision Syndrome:

There is no single management option for the treatment of computer vision syndrome as the cause is multifactorial. The multidirectional approach is recommended to alleviate symptoms of computer vision syndrome.

1. Modification and following specific rules for use of digital screens :

• Environmental factor modification:

Among the most important modifiable external environmental factors is lighting. Bright lights, windows and overhead fluorescent lights often contribute to discomfort glare. These bright light sources need to be controlled with proper blinds, filters or adjustment of the room arrangement so that an acceptable level of lighting is obtained to minimize visual fatigue.

Use of screen filters can reduce glare and reflection of the computer screen, but it should be used as a supplement and not a replacement for poor lighting of the room.10

Reducing screen luminance is one of the methods to increase the blinking rate .11 The mean distance of viewing a computer is suggested to be in the range of 60-80cm. 12 Another important ergonomics practice is the usage of ‘1, 2, 10’ rule that shows proper distance for cell phones and e-books to be at one feet (30 cm), for computers to be at 2 feet (60 cm) and for televisions to be at ten feet (3m) 13. The other important solution is to design forearm support and vertical mouse design 14

• Proper Eye Care

Using 20-20-20 rule is a most and simple method to prevent CVS, which means after 20 minutes of computer usage, look at distance of 20 feet for 20 seconds 15.

Taking a short break, stretching the muscles, change of scenery and a quick walk around the office have been shown to improve productivity and reduce ocular symptoms of stress. Working nonstop for more than 4 hours has been associated with eye strain. Frequent short break can restore and relax the accommodative system of the eyes and preventing ocular strain and visual fatigue.

Dry eyes secondary to decreased blink rate can be easily managed by applying lubricating eye drops or artificial tears. Patients are advised to consult their doctor first if they have any ocular symptoms before applying this eye lubricating solution although they are available over the counter in pharmacy. Workers who are using contact lens must be more careful with any ocular symptom which started acutely such as pain and redness. Complications following prolonged contact lens usage such as cornea ulcer must be excluded by proper ophthalmological assessment and examination before one can say that the symptoms are due to computer vision syndrome.16

Use of proper corrective glasses for refractive errors such as myopia, astigmatism and presbyopia are important to prevent further deteriorating of the ocular symptoms which can lead to poor work performance and the poor quality of life.

1. Preventive measures in Ayurveda:

Different modalities specially mentioned in Dincharya are very helpful for keeping eyes healthy.

Washing the eyes with medicated decoctions like Trifala, Lodhra or Amalaki Swarasa or decoction after getting up from bed in the morning is a very good therapy for eyes.17

Anjana (collyrium) – applying anjana because of Theekshna property, eliminate the vitiated Doshas from the Siras pertaining to Varthma (eye lids) and eye .18

Abhyanga (massage) suppress the Vatadosha confined to eye. Local Abhyanga over the eyes gives cooling effect &also relaxes the eye from strain and also strengthens the muscles of the eyes. ShiroAbhyanga helps the oil to reach up to the brain. The optic nerve which ends in the Drishtipatalam (retina) is the direct extension of brain stem. So daily application of oil, selected according to the Prakriti of the person helps in preventing eye diseases and also nourishes all sense organs and also helps in Drishtiprasadana19. Padabhyanga is also beneficial for eye health.

 Netra Tarpana20: It is a specialized Ayurvedic treatment for eyes, that helps relieve tiredness and improves eyesight. Netra Tarpana acts as both preventive & curative therapy for maintaining normal healthy condition of eyes. Netra Tarpana is a procedure where the lukewarm medicated oil or ghee is made to stay stagnant in the eyes for a speculated time in a specific formed frame. The lipophilic action of Ghrita facilitates the transportation of the drug to the target organ and finally reaches the cell because the cell membrane also contains lipids. Moreover, the preparations used in Netra Tarpana is in the form of suspension containing different particles of the drug and the particles do not leave the eye as quick as a solution. Tissue contact time and bioavailability is more and hence therapeutic concentration is achieved by Netra Tarpana.

Netra Hitkar Ahar (food beneficial to eyes): daily intake of food and herbs like amalaki, trifala, carrot, yashtimadhu, Goghrita, Shatavari is also beneficial to keep eyes healthy.

Eye Exercises and Yoga: 21

Yogic practices help to reduce eyestrain and also build up the stamina of eye muscles. Mainly Trataka & NetiKriya helps in improving the vision & maintain the eye health. Distant Tratak and Nasagra Tratak are very beneficial to reduce eye strain.

Blinking- To minimize your chances of developing dry eye when using a computer, make an effort to blink frequently. Blinking keeps the front surface of your eye moist. Regular eye examinations and proper viewing habits can help to prevent or reduce the development of the symptoms associated with Computer Vision Syndrome.

Conclusion

the development of CVS we have to manage multifactorial treatment and preventive measures for it. Ayurveda is science for prevention of diseases mainly. Thus,   we can use various preventive measures included in Dincharya, Ahar and procedures useful for eyes to prevent CVS. We can also follow the rules for digital screen usage. Eye exercises and yoga may help to reduce the digital eye strain.