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。     

长期VDT对视网膜视神经影响的观察

目的视屏显示终端(video display terminal,VDT)是一类与计算机使用有关的视觉综合征。眼部的症状包括视疲劳、调节与集合反应异常、眼干等。本研究通过评价VDT在视功能方面的影响从而提供可能的防治方法。方法选择45名(45眼)志愿者,年龄(27.27±2.23)岁。根据每日视频操作时间分为三组,Ⅰ组VDT每天作业时间≤2h;Ⅱ组VDT每天作业时间2～4h;Ⅲ组VDT每天作业时间>4h。并分析在三组从事VDT工作后0.5a、1.0a、2.0a、2.5a每位志愿者眼部情况、视疲劳、视觉诱发电位、视野、黄斑中央厚度的差异。结果在同一组内和不同组间,操作VDT时间越长,视疲劳等眼部不适症状的受试者相应增多,但是视觉诱发电位振幅、潜伏期和OCT检查黄斑中央厚度在不同时间点差异均未有统计学意义(均为P>0.05)。所有受试者不同时间点均未发现暗点等视野异常。结论 VDT作业对视功能有一定负作用,因此,我们应该预防VDT对眼部的影响。     

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。     

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。     

七叶洋地黄双苷滴眼液治疗VDT综合征的有效性和临床安全性研究

目的:探讨七叶洋地黄双苷滴眼液对视屏显示终端(visual display terminal,VDT)综合征的有效性和临床安全性。方法:采用自身对照。单独应用七叶洋地黄双苷滴眼液点眼,观察用药前后VDT综合征相关症状,包括:近距离工作不能持久、眼及眼睑周围疼痛、异物感、眼睑沉重、视物模糊复视、眼红、干涩流泪、头痛、恶心呕吐、眩晕共10项。结果:患者VDT综合征明显改善,观察期间未发现局部及全身不良反应。结论:七叶洋地黄双苷滴眼液可有效地缓解VDT综合征,临床应用安全。     

大学生视屏终端暴露时间与视屏终端相关眼病相关性分析

目的:探讨大学生视屏终端(visual display terminal,VDT)暴露时间与视屏终端相关眼病的相关性。方法:对珠海市3所高校1218名在校本科生进行问卷调查,了解视屏终端暴露时间、眼部症状评分,对不同年级学生视屏终端暴露时间及不同暴露强度人群眼部症状评分进行比较,并对视屏终端暴露时间与眼部症状评分进行相关性分析。结果:3所高校本科生视屏终端暴露时间平均为3.72±2.17h,随着年级的增长,视屏终端暴露时间延长,暴露时间越长,眼部症状越明显,视屏终端相关眼病与视屏终端暴露时间具有正相关性。结论:长时间视屏终端暴露不利于眼健康。应加强对大学生的眼保健教育,避免或减少视屏终端暴露带来的健康损失。     

Quantitative analysis of eye movement during VDT work]

The point of fixation during visual display terminal (VDT) work was analyzed by using Eye Mark Recorder-NAC with their corneal reflexes. The subjects were categorized into 2 groups, expert VDT worker and non-expert with VDT work. As for the VDT task, Japanese sentences were loaded. On the other hand, ordinary desk work copying was loaded using the same Japanese sentences. The following results were obtained. VDT work needed more complex eye movements in both vertical and horizontal directions compared with desk work. The point of fixation was mainly located on the surface of the oscilloscope in the expert subjects, whereas, it was mainly located on the keyboard in non-expert subjects. In analyzing the velocity of eye movements during VDT work, the expert moved the eyes more slowly than the non-expert. These results suggested that the VDT experts can move their eyes more effectively and slowly.     

视频终端相关性干眼的研究进展

目前视频终端(video display terminal,VDT)相关性干眼已成为眼科临床主要亚病种之一,严重影响眼部健康.VDT相关性干眼的发病机制复杂,包括机械机制和非机械机制.机械机制主要与瞬目运动有关,包括完全性瞬目减少,不完全瞬目增多及眼表暴露面积增大.非机械机制包括眼表炎症、黏蛋白浓度降低及泪腺功能减弱等.针对VDT相关性干眼的特异性检查尚属空白,临床建议采用问卷结合症状、常规干眼检查的综合检查方法进行诊断.     

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。     

视屏显示终端对操作者眼的影响

对118名视屏显示终端(VDT)工作人员的眼部调查,发现VDT作业可致近视力减退,休息后可恢复.发现VDT作业,可使角膜上皮受到损害,损害的程度与近视力减退的程度成正比.注视VDT的时间越长,对近视力及角膜上皮的影响越严重.VDT作业对调节功能和眼压无明显的影响.     

Symptoms in video display terminal operators and the presence of small refractive errors

Although the effects of using video display terminals (VDTs) have been examined from a number of perspectives, there has been relatively little study of the effect of small uncorrected refractive errors in the production of visual discomfort. The purpose of this study was to examine the level of six commonly assessed symptoms in a sample of 32 VDT operators via a questionnaire and to determine whether these were related to their habitual small refractive errors. The subjects reported substantial prevalence (55-81%) of each of the symptoms except double vision (16%). After a complete vision examination, the VDT operators were classified as relative myopes, hyperopes, astigmats or emmetropes. The criterion was a minimum of 0.50 D in the most ameotropic eye. Using this criterion, analysis showed that small refractive errors were significantly related to the reported level of symptoms of VDT operators. These results suggest the utility of proper refractive correction for the comfortable use of a VDT and the value of further research into this putative causal relationship.     

Marked reduction and distinct patterns of eye blinking in patients with moderately dry eyes during video display terminal use

Purpose To analyze the spontaneous eye-blink rate (SEBR) and blinking pattern in patients with moderately dry eyes during video display terminal (VDT) use.Methods The SEBR of 30 patients with dry eye syndrome (median age 44.8 years, range 18 – 67 years) was measured using a computer-based video analysis system. Only complete eye blinks were recorded during 10 min of conversation, during initial VDT use and again after a preceding work period of 30 min.Results In comparison with SEBR during conversation (mean value 16.8 blinks/min, standard deviation 16.8 blinks/min) the SEBR significantly decreased during initial VDT use (6.6±4.8; P<0.001) and remained significantly decreased during re-measurement after 30 min (5.9±4.6; P<0.001). SEBR was not significantly different between initial VDT use and re-measurement after 30 min (P=0.65). The SEBR was characterized by marked interindividual variability during conversation and VDT use. No significant correlation was found between SEBR (either during conversation or during VDT use), and the quality (tear break-up time) or quantity (Schirmer I test, Jones test) of the tear film. Typical blinking patterns were found to be (1) a relatively time-independent, irregular pattern, (2) an initial phase of 2–4 min with shorter inter-eye-blink intervals, and (3) alternating periods of higher and lower inter-eye-blink intervals.Conclusions Reduction of the SEBR during VDT use is primarily determined by marked visual attention, resulting in an exacerbation of dry eye symptoms in predisposed humans. High interindividual variability and distinct patterns of eye blinking may be key factors in further clarification of VDT–eye interactions and develop individually designed solutions to prevent desiccation during VDT use.Presented at the annual meeting of the German Ophthalmological Society, Berlin, 2003     

青少年视频终端性视疲劳的分析与健康干预

目的观察青少年视频终端（VDT）视疲劳的临床特点，探讨其治疗原则及早期健康干预的措施。方法对137例青少年VDT视疲劳进行病史、眼科检查及治疗情况的分析。结果长时间操作VDT的青少年会出现视疲劳。屈光状态为近视89例（64．96％），远视17例（12．41％），正视31例（22．63％）。眼调节灵活性减弱11例（8．03％），平均泪液分泌量减少43例（31．39％），泪膜破裂时间缩短32例（23．36％）。结论青少年VDT视疲劳者逐渐增多，临床症状轻重不。屈光不正、眼干燥症、调节异常等临床症状更明显。其治疗原则为病因治疗，对症治疗和健康干预。制定健康干预的具体措施。从而有效的防治青少年VDT视疲劳。     

注视视频终端对眼健康的影响

目的:了解长时间注视视频终端(video display terminal,VDT)对眼健康的影响,并提出预防对策。方法:对长时间连续注视VDT者视功能、屈光状态及眼进行检查,测定调节幅度、集合近点,并与很少或不操作VDT者的同样检查或测定情况进行对比。结果:长时间连续注视VDT者,其眼的健康比非注视VDT者更容易出现眼痛、眼胀、视物模糊、视力下降等视疲劳现象,并且随注视时间的延长,视疲劳的倾向更明显,调节幅度降低,集合近点远离。两组比较差异有统计学意义(P<0.05)。结论:长时间连续注视视频终端较阅读书本等界面更易对眼产生负面影响,应加强预防VDT性眼健康损害。     

109例视频终端用户视觉障碍的原因对比分析

目的对比调查视频终端用户视疲劳产生原因的特点,探讨如何注意劳动保护。方法收集我院门诊就诊、有眼疲劳主观感受的患者185例,其中视频终端用户109例,其他行业工作者76例,详细询问病史和眼部检查,进行病因分析。定量资料组问比较采用t检验,定性资料组间比较采用检验,等级资料采用秩和检验。结果年龄、性别、主观症状、眼位功能、配镜情况两组差别无统计学意义,日作业时间、屈光检查、泪液分泌功能两组间差别有统计学意义。结论视频终端用户组日视作业时间高于其他行业组;屈光检查结果显示,视频终端用户组屈光不正高于其他行业组;视频终端用户组泪液分泌功能障碍更严重。     

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.     

Color of visual display terminals and the eye. Green VDTs provide the optimal stimulus to accommodation

The longitudinal chromatic aberration of the human eye is substantial and therefore the color of the phosphor chosen for a visual display terminal (VDT) will affect refractive state and accommodative demand. For most working distances, green stimuli (lambda max 520 nm) are optimal.     

视屏显示终端对操作人员眼影响的探讨

本文研究了视屏显示终端对操作人员眼的影响，结果发现观察组视疲劳症候群阳性率比对照组高（Ｐ〈０．０１），视觉运动反应时，阅字错误率班后比班前明显增加。脑力工作能力和明视持久度班后比班前减少（Ｐ〈０．０５），提示有明显的视疲劳与作业能力降低现象，未见晶体器质性改变。     

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.     

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。