视屏终端综合征的研究进展

视屏终端(visual display terminal,VDT)综合征,是由于长时间使用VDT操作而影响眼睛和身心健康所产生的一组疾病,又称技术紧张性眼病或电脑视力综合征。VDT综合征的病因主要包括屈光与调节机制(调节痉挛)、眼表机制(泪膜功能异常)和眼外机制(显示器视觉效应)。基于VDT综合征多种病因的研究,治疗具有多向性,不仅对视疲劳进行对症治疗,也要对不良的工作环境和生活习惯行对因治疗。我们就VDT综合征的病因及治疗的研究进展做一综述。     

视屏终端综合征与干眼症关系的研究

目的:研究视屏终端综合征(visual display terminal,VDT)与干眼症的关系,并分析视屏操作时间对它的影响。方法:对符合干眼诊断标准的60例VDT患者进行问卷调查和眼科常规检查,作为可疑干眼的观察组,取年龄与之匹配的正常患者60例作为对照组,分别做基础泪液分泌试验(schimerⅠtest,SⅠt)、泪膜破裂时间检查(break uptime,BUT)、角膜荧光素染色(fluorescent,FL)、结膜细胞印迹学检查(impression cytology,IC),分析观察组的症状、病因进行分析。结果:观察组比对照组SⅠt试验,BUT,IC均显著降低,观察组症状的严重程度与每日VDT操作时间有显著性差异。结论:VDT是干眼的相关危险因素,且VDT的症状严重程度与VDT使用电脑时间相关。     

视屏终端工作者泪液中基质金属蛋白酶-9、组织金属蛋白酶抑制剂-1浓度与眼表检查相关性研究

目的 探讨视屏终端(VDT)工作者泪液当中基质金属蛋白酶-9(MMP-9)、组织金属蛋白酶抑制剂-1(TIMP-1)与眼表检查间潜在相关性.方法 前瞻性横断面研究VDT工作者45例(45只眼),进行眼表疾病指数问卷(OSDI)对眼部症状进行登记.依次行泪膜破裂时间(TBUT)、角膜荧光染色、基础泪液分泌试验(SchirmerI).采集受试者右眼泪液标本,应用双抗体夹心酶联免疫吸附法(ELISA)检测泪液眼中MMP-9、TIMP-1的浓度(ng/ml).结果 视屏终端工作者中干眼患病构成比为13.3％,VDT工作者泪液中MM-9浓度与VDT使用时间、角膜荧光染色分级正相关,与泪膜破裂时间负相关.TIMP-1与VDT使用时间、角膜荧光染色分级正相关.结论 测量泪液中MMP-9、TIMP-1浓度具有辅助诊断干眼和量化干眼程度的临床意义.     

视屏终端作业对视疲劳影响的调查

目的 探讨视屏终端(VDT)作业者视疲劳的个人防护。方法 对VDT作业人员328例进行职业史，既往史，工作情况，工作环境，特别是眼部自觉症状等问卷调查并统计分析。结果 发现89．63％的人有不同程度的视疲劳症状，其中患者慢性结膜炎者症状较严重，近视者眼疲劳症状较明显，多数近视程度不断发展，还有新出现近视者。近视者作业时均戴原配戴的远用矫正眼镜，大多连续作业3～4小时。结论 建议工作30分钟到1小时后应稍作休息，望远处；建议配用中距离眼镜，工作距离以50～70cm为佳。     

青年视屏终端工作者干眼症的患病因素分析及治疗

目的：分析青年视屏终端工作者干眼症的患病因素,探讨人工泪液治疗干眼症的疗效。方法：对136例长期视屏终端接触的青年干眼症患者进行临床调查,包括常见症状（眼干、视疲劳、异物感等）,泪膜破裂时间（BUT）、SⅠt试验。共发放136份问卷,有效问卷130份,有效率95.6%。将130例随机分组,治疗组65例应用人工泪液（泪然）,3次/d,1滴/次。对照组65例口服四环素,2次/d,250mg/次,连续服用3mo。结果：常见症状依次是：眼干燥异物感（治疗组89.2%、对照组80.0%）、灼热感（治疗组33.9%、对照组30.8%）、视疲劳（治疗组72.3%、对照组67.7%）、视物模糊（治疗组30.8%、对照组35.4%）、眼痛（治疗组24.6%、对照组21.5%）;两组无显著性差异。治疗前后两组BUT、SⅠt试验存在明显统计学差异。结论：视屏终端综合征（video display terminals,VDT）是引起青年干眼症的主要原因,局部使用人工泪液组明显优于口服四环素组。     

渐进多焦点眼镜对缓解视屏终端操作者视疲劳症状临床观察

目的:了解渐进多焦点眼镜缓解视屏终端(visual display terminal,VDT)操作者视疲劳的效果。方法:有视疲劳症状且屈光不正的VDT操作者98例,按自愿原则分为2组,其中一组配戴普通单光眼镜,共52例;另一组配戴渐进多焦点眼镜,共46例,经1a随访,分析两组屈光状态及其缓解视疲劳的效果。结果:所有98例患者中,44例存在未矫正、屈光矫正不足和过矫正;视物不能持久、眼部酸胀2种症状在两组中的差异有极显著性统计学意义(P<0.01),眼痛、眼干和眼睑沉重3项在两组中无统计学意义。结论:渐进多焦点眼镜对缓解轻中度近视VDT操作者视疲劳有效。     

视屏终端的使用对人泪膜及眼表的影响及非侵入性眼表综合分析仪的应用价值

背景 目前,视屏终端已广泛用于人们的工作和生活中,其对眼表健康的影响受到关注,而临床上对眼表的健康评估和干眼的早期诊断尚有一定的困难.以往对眼表的检查以侵入性方法为主,影响检查结果的客观性.近年来,非侵入性眼表综合分析仪已用于临床,其在对视屏终端使用者眼表健康状况的评估方面的研究尚少. 目的 使用Keratograph 5M非侵入性眼表综合分析仪观察青年人长时间注视视屏终端对泪膜及眼表的影响.方法 采用前瞻性干预性研究方法,于2015年3月1日至11月10日在南昌大学附属眼科医院纳入健康志愿者81人,其中男39人,女42人;年龄18～ 30岁,均取右眼为受试眼.受试者在自然光线和屈光矫正状态下观看和操作计算机上的同一个视频,距离计算机显示屏约30 cm,使用Keratograph 5M非侵入性眼表综合分析仪分别测定受试者计算机操作前后右眼非侵入性泪膜破裂时间(NITBUT)、泪河高度、结膜充血评分、角膜缘充血评分、睑板腺和泪膜脂质层等,比较计算机操作前后各项检查指标的差异和出现眼表异常的眼数.结果 受试者持续操作计算机3h后出现视物疲劳、干涩感、眼胀痛、视物模糊和结膜充血的眼数明显多于试验前,差异均有统计学意义(均P＜0.01).受试眼计算机操作后首次NITBUT、平均NITBUT分别为(6.086±3.701)s和(9.103±4.680)s,明显低于试验前的(11.445±4.964)s和(14.626±4.467)s;操作后受试眼泪河高度为(0.190±0.032) mm,明显低于受试前的(0.212±0.040) mm;操作后结膜充血评分和角膜缘充血评分分别为0.869±0.311和0.572±0.276,均分别高于受试前的0.780±0.306和0.509±0.266,差异均有统计学意义(均P＜0.01),而试验前后眼压变化及不同级别角膜荧光素染色眼数分布、不同形态睑板腺眼数分布及不同形态的脂质层眼数分布均无改变.结论 长时间注视视屏终端影响泪膜及眼表健康,Keratograph 5M非侵入性眼表综合分析仪是临床上客观评估泪膜及眼表情况的有用手段.     

视屏终端工作者泪液中基质金属蛋白酶-9、组织金属蛋白酶抑制剂-1活性研究

目的 观察视屏终端工作者泪液中基质金属蛋白酶-9（matrix metalloproteinase-9,MMP-9）、组织金属蛋白酶抑制剂-1（tissue inhibitors of matrix metalloproteinase-1,TIMP-1）活性变化。设计 横断面研究。研究对象 视屏终端工作者45例（45眼）。方法 按照视频终端工作日平均时间将受试者分为三组：分别为<4小时者17例（17眼）、4~8小时者13例（13眼）、>8小时者15例（15眼）。采用眼表疾病指数问卷（OSDI）对眼部症状问卷调查。泪膜破裂时间（BUT）、基础泪液分泌试验（Schirmer I）、角膜荧光素染色检查。使用双抗体夹心酶联免疫吸附法（ELISA）检测受试者泪液细胞因子MMP-9、TIMP-1的浓度。主要指标 干眼症状评分、BUT、Schirmer I、角膜染色、泪液中MMP-9、TIMP-1的浓度。结果 45例视屏终端工作者中干眼患病率为13.3%,日平均使用时间<4小时组、4~8小时组、>8小时组OSDI得分分别为（16.47±3.28）、（18.77±4.38）、（21.16±3.76）（F=6.11,P=0.005）,>8小时组OSDI得分较<4小时组高（P=0.003）,而4~8小时组与>8小时组和<4小时组OSDI得分无显著差异（P=0.311,0.319）; BUT、Schirmer I、角膜荧光染色得分三组均无显著性差异（P=0.687、0.122、0.714）。泪液中MMP-9、TIMP-1浓度在>8小时组中分别为（9.579±0.48） ng/ml和（3.174±0.29） ng/ml,明显较<4小时组[分别为（2.111±0.17） ng/ml和（0.391±0.06） ng/ml]和4~8小时组高[分别为（7.403±0.06） ng/ml和（2.286±0.28） ng/ml]（P值均=0.000）。<4小时组和4~8小时组泪液中MMP-9（P=0.72、0.13）、TIMP-1（P=0.21、0.37）工作前后浓度无显著差异。>8小时组中,工作后MMP-9、TIMP-1浓度均高于工作前水平（P=0.04、0.01）。结论 视屏终端工作者中干眼发生普遍。视屏终端工作日平均使用时间越长,泪液中MMP-9、TIMP-1浓度越高,提示泪液中MMP-9、TIMP-1浓度升高与干眼发病有关。     

七叶洋地黄双苷滴眼液治疗视屏终端综合征50例

目的:观察七叶洋地黄双苷滴眼液治疗视屏显示终端综合征的临床疗效。方法:对视屏显示终端综合征50例100眼采用七叶洋地黄双苷滴眼液治疗30d,观察治疗前后视觉疲劳9项症状记分。结果:本组50例100眼,治疗前的症状总积分均数为12.64±6.56,治疗后的症状总积分为3.56±4.80分,治疗前后比较,差异有统计学意义(t=8.7409,P<0.01);观察期间,无治疗引起的不良反应。结论:七叶洋地黄双苷滴眼液治疗视屏显示终端综合征近期缓解视觉疲劳症状是安全有效的。     

视屏终端对视功能影响的观察

目的　探讨视屏终端(VDT)作业对青年学生视功能的影响,以揭示VDT作业的累积作用与眼保健的关系,为防治提供可能依据。方法　对5 0例长期接触VDT的青年学生,在1年内进行3次视功能系列检查,并与对照组进行比较分析。结果　观察组在观察期间出现视疲劳者逐步增加,各阶段均明显高于对照组,1年间增加例数与对照组比较差异有显著意义(P <0 . 0 5 )。视力下降和泪膜破裂时间异常等都明显高与对照组(P <0 .0 5 ) ,屈光改变例数比对照组多,但差异无显著意义(P>0 . 0 5 )。结论　VDT作业累积对视功能有一定的影响。     

Meibomian gland dysfunction and ocular discomfort in video display terminal workers

PURPOSE: Meibomian gland dysfunction (MGD) is one of the most common ocular disorders encountered in clinical practice. The clinical manifestations of MGD are related to the changes in the tear film and ocular surface with symptoms of ocular discomfort. In recent years, many surveys have evaluated symptoms associated with the use of Video Display Terminals (VDT), and VDT use is recognized as a risk factor for eye discomfort.The aim of the present study was to determine if the presence of MGD contributes to the signs and symptoms of ocular discomfort during the use of VDT. METHODS: In course of a routine health surveillance programme, a group of 70 subjects fulfilled the inclusion criteria and responded to a questionnaire about symptoms of ocular discomfort. The following ocular tests were performed: tear break-up time, fluorescein corneal stain, and basal tear secretion test. RESULTS: A total of 52 subjects out of 70 (74.3%) had MGD. A statistically significant correlation between the symptoms of ocular discomfort and hours spent on VDT work was observed in the total population (r=0.358; P=0.002; 95% CI 0.13-0.54) and in the group of subjects with MGD (r=0.365; P=0.009; 95% CI 0.103-0.58). Such correlation was not shown in subjects without MGD. CONCLUSIONS: The high prevalence of MGD among the subjects with symptoms of ocular discomfort suggests that this diagnosis should be considered when occupational health practitioners encounter ocular complaints among VDT operators. It appears that MGD can contribute to the development of ocular discomfort in VDT operators.     

Efficacy of a novel moist cool air device in office workers with dry eye disease

Purpose: To evaluate the efficacy and safety of new moist cool air device (MCAD) for ocular symptoms, tear film stability and ocular surface status in office workers with dry eye disease (DED). Methods: In this prospective single‐centre clinical trial, 40 eyes of 20 patients with DED were recruited and randomly divided into two groups (group with MCAD exposure and group without MCAD). All subjects are visual display terminals (VDTs) workers spending at least 4 h/day in front of VDTs. Patients using MCAD underwent moist air applications for 4 h/day for a total of five working weekdays during VDT works at their offices. The other group of patients performed their VDT work without moist cool air device exposure. The change in symptoms of ocular surface (OS) dryness, fatigue and discomfort was evaluated using visual analogue scale (VAS) scores. Changes in visual function, tear functions and ocular surface status were evaluated using best‐corrected visual acuity (BCVA), the functional visual acuity (FVA) test, blink rate, BUT measurements, strip meniscometry (SM), tear evaporation rate, fluorescein staining and rose bengal staining scores. Tear film lipid layer interferometry was also performed to assess the status of the lipid layer over the tear film. In addition, adverse events were recorded. Results: In group with MCAD, symptoms of OS dryness during VDTs work, and FVA and BUT were significantly improved. SM and tear evaporation rate were significantly improved. There were no statistically significant differences on lipid layer stability and corneal staining scores in both groups. Blink rate was significantly increased in group without MCAD. No adverse events were reported during this trial. Conclusion: Moist cool air device use provided symptomatic relief of ocular dryness and improvement on tear stability in office workers with DED. This new device seems to be a safe and promising alternative in the treatment of DED.     

应该重视视频终端综合征的研究

本文介绍了视频终端（VDT）的特性及VDT综合征患者的眼部表现,VDT对眼部的影响研究涉及对视觉功能、视觉发育和眼表性状等各方面。此类研究目前尚处初步阶段,重视和深入研究才能为临床提供积极有效的防治方法。     

眼局部联合全身综合治疗视频终端综合征的临床疗效

目的：观察眼局部联合全身综合治疗视频终端(VDT)综合征的临床效果。

方法：选取2017-08/2018-05在我院眼科就诊的VDT综合征患者62例124眼,随机分为试验组和对照组,各31例62眼。对照组患者给予人工泪液点眼,试验组患者在对照组的基础上进行耳穴压豆及眼周穴位联合全身中医推拿治疗,治疗期间对两组患者均进行健康宣教。两组患者均以治疗2wk为一疗程。所有患者分别于治疗前和治疗后2wk行症状评分及屈光矫正基础下的调节幅度、调节灵敏度、调节反应、集合近点和调节性集合与调节的比值(AC/A)检查,比较治疗前后各参数变化并评价治疗效果。

结果：治疗后,两组患者症状评分、调节灵敏度均较治疗前改善,差异均有统计学意义(P<0.05),试验组患者调节幅度、集合近点也较治疗前改善,差异均有统计学意义(P<0.05)。

结论：眼局部联合全身综合治疗能有效改善VDT综合征患者的调节和集合功能,缓解VDT综合征患者的眼部及全身疲劳症状。     

儿童视频终端综合征研究进展

随着信息时代的高速发展,视频显示终端(visual display terminal,VDT)广泛进入人们的生活,视频显示终端对操作者健康的影响已被公认,现代医学称之为视频显示终端综合征。同时,儿童接触视频终端的频率越来越高。儿童时期,眼球发育处于关键期,资料显示,过度使用视频显示终端会引起儿童眼疲劳、近视、干眼、异常瞬目症、头痛等症状。我们对儿童视频终端综合征的相关症状,发生机制以及预防和治疗进行概述。     

七叶洋地黄双苷滴眼液与眼部按摩治疗视频终端视疲劳的效果

目的：评价七叶洋地黄双苷滴眼液与眼局部穴位按摩单用及联用治疗视频终端( video display terminal, VDT)视疲劳的效果。
　　方法：随机数字表法将224例VDT视疲劳患者分为滴眼液组、按摩组、合用组及对照组各56例,分别用七叶洋地黄双苷滴眼液治疗、眼局部穴位按摩治疗、七叶洋地黄双苷滴眼液与按摩联合治疗及常规用眼卫生指导,疗程4 wk。以症状疗效指数、泪膜破裂时间( BUT )、泪液分泌试验( SIt)和角膜荧光素染色积分作为评价指标。
　　结果：(1)合用组症状疗效指数(78.96±5.29)%高于滴眼液组(69.55±6.23)%和按摩组(71.15±6.41)%,而滴眼液组和按摩组又高于对照组(33.01±4.26)%(P<0.01);七叶洋地黄双苷滴眼液、按摩的主效应及二者的交互作用对疗效指数的影响均有统计学意义(P<0.01)。(2)滴眼液组、按摩组、合用组干预后的BUT值和SIt值较干预前提高( P<0.05);干预后合用组BUT值大于滴眼液组、按摩组和对照组;对照 SIt 值低于滴眼液组、按摩组及合用组。
　　结论：七叶洋地黄双苷滴眼液滴眼和眼局部穴位按摩均可显著改善VDT视疲劳患者的症状和眼生理状况,二者合用具有协同增效作用。     

海军舰员远航条件下视疲劳状况调查分析

目的：调查分析海军某部连续远航舰员视疲劳状况,探究与视疲劳发生相关的危险因素并构建视疲劳预测决策树模型。

方法：采用分层随机抽取方式选取2016-07/10海军某舰队参加远航任务舰员373名。通过询问受试者病史、个人基本情况,检查裸眼视力、最佳矫正视力、 裂隙灯检查包括：眼睑、睑缘、睑板腺改变、角膜及结膜是否存在眼表损害体征,并行角膜荧光素染色,确定泪膜破裂时间(BUT)。填写眼表疾病分析量表(OSDI)和视疲劳调查表,统计受试者眼部疲劳发生率及严重程度,分析视疲劳发生危险因素。

结果：纳入受试者373名中 63.0%(235名)舰员存在不同程度的视疲劳状况。其中视疲劳发生与性别、年龄及既往角膜屈光手术史无相关性(P>0.05); 存在干眼主观症状及电子屏幕暴露时长是其发生的危险因素(P<0.01)。相关危险因素构建CHAID决策树模型,总体预测准确率为76.9%。

结论：连续航行舰员中存在干眼主观症状,电子屏幕暴露时长是舰员发生视疲劳的危险因素。     

Vision screening and symptoms among VDT users

We conducted eye examinations on 79 subjects who used visual display terminals (VDTs) for a significant portion of their normal working day. The examination included the detection of ocular pathology, near and intermediate visual acuity, accommodative facility, fusional vergences, near point of convergence, fixation disparity, near horizontal heterophoria and colour vision. Each subject maintained a diary over five working days in which they recorded the frequency and intensity of symptoms experienced. Symptoms were classed as either ocular (discomfort) or visual (blur) symptoms. Multiple regression analysis techniques were used to investigate the relationship between symptoms and eye examination results and demographic characteristics of subject gender, age and experience with VDTs. None of the eye examination findings was significantly associated with symptoms and of the demographic variables, only VDT experience was significantly associated with symptom rates. Statistical associations were limited in a number of measures by the relatively small population of VDT users sampled.     

Influence of accommodative response and visual symptoms on visual display terminal adult operators with asthenopia through adequately corrected refractive errors

PURPOSE: Application of adequate correction of refractory errors for the treatment of asthenopia of young visual display terminal (VDT) workers was evaluated from subjective complaints and the effect on accommodation dynamics (step response) before and after 6 months. METHODS: Young VDT workers who visited the clinic because of eye strain were consecutively selected. Fifteen workers who were under-corrected for myopia and three workers who were over-corrected for myopia were treated by "adequate correction of refractory errors" with spectacles or soft contact lenses. The adequate correction was defined as minimum convex lenses which could obtain visual acuity of 1.2 or better, similar to daily life conditions, without cyclopegia or fogging. The workers were in their 20's. Accommodative responses to step stimuli were recorded by infrared optometer, and questionnaires were filled out by the VDT workers concerning the severity (a severity rating in percent in five steps) of subjective symptoms (headache, dry eye, eye strain, and eye irritation). Spectacles or disposable contact lenses were prescribed for the workers for "adequate correction". Six months later, accommodative responses and subjective symptoms were evaluated and compared with under-or over-corrected conditions and adequate correction. RESULTS: In under-corrected workers, the adequate correction significantly improved complains i.e. headache, eye strain, eye tiredness (p < 0.005). Accommodative responses also improved in gain (%), maximum velocity (D/sec), and time of accommodation and relaxation (p < 0.05). Three over-corrected workers showed improvement of complains and also accommodative response in gain, maximum velocity, and time of accommodation and relaxation. CONCLUSIONS: Application of "adequate correction" to young VDT workers with asthenopia by using adequately corrected spectacles or soft contact lenses improved the asthenopia and accommodative dynamics.