Ayman A. Ahmad et al, 2021;5(9):1647–1654.

International Journal of Medicine in Developing Countries

https://doi.org/10.24911/IJMDC.51-1627643005

ORIGINAL ARTICLE

Eyeing computer vision syndrome:

awareness, knowledge, and its impact
on sleep quality among health sciences
students during the COVID-19 pandemic in
Taif, Kingdom of Saudi Arabia
Ayman A. Ahmad1, Bushra F. Alshehri2*, Ameerah M. Almalki2, Abdulelah
M. Albaradi2, Manal S. Almalki2, Khadijah Y. Alattas3

ABSTRACT
Background: Prolonged use of computer devices during the COVID-19 pandemic can cause symptoms known
as computer vision syndrome (CVS). Proper identification of symptoms and risk factors is needed for effective
prevention and control of CVS. The present study was aimed to assess the awareness and knowledge of CVS
and its impact on sleep quality among health sciences students in Taif, Kingdom of Saudi Arabia (KSA).
Methods: A cross-sectional study was conducted on 564 health science students using electronic devices
in Taif city, KSA. An online questionnaire was distributed to collect students’ demographics, digital devices
using habits, frequency of eye symptoms, ergonomic practices, knowledge of computer CVS, and sleep quality
assessment by the Pittsburgh Sleep Quality Index.
Results: The tablet was the most used device by females, while smartphones were the most used device by
males. Medical students used tablets more commonly (68.1%) than other branch students, and 81.4% had poor
sleep quality. Eye strain/fatigue (77.7%) and neck, shoulder, and backache (73.6%) were the most common
reported CVS symptoms. Although (70.4%) took breaks, while working on their laptops, only a small percent-
age applied ergonomic practices. 89.4% reported that they had never heard of CVS, and 1.1% knew it very well.
About 73% (73.4%) had good, and 26.4% had poor knowledge related to CVS.
Conclusion: CVS has a high prevalence among students, which can affect their lifestyle and academic perfor-
mance. Preventive measures and raising awareness will help to decrease the effect of this syndrome.
Keywords: CVS, knowledge, sleep, quality, students, Taif.

Introduction

Computers and visual display devices have become an
integral part of everyone’s daily activities [1]. They have
become a vital tool in every aspect of life [2]; nowadays,
there is extensive use of computers as an instrument of
teaching and learning in universities and schools. Doctors
can now hold textbooks on their smartphones and use
resources such as medical calculators and drug formularies
[3]. We cannot deny that those devices are good task
performers and that they’ve made communication,
teaching and learning easier, especially during the
COVID-19 pandemic. Still, they also affect our health in
stress, postures, and productivity [2]. The prolonged and
continuous use of computers and digital screens causes a
vision problem called computer vision syndrome (CVS),
as defined by the American Optometric Association, it
is a complex of eye and vision troubles associated with
Correspondence to: Bushra F. Alshehri
*Medical student, Taif University, Taif, Saudi Arabia.
Email: Bushra_f_sh@outlook.com
Full list of author information is available at the end of
the article.
Received: 30 July 2021 | Accepted: 31 August 2021

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 Eyeing computer vision syndrome
the activities that stress the near vision and which are
experienced during or in relation to the use of computers
[4]. Different studies have reported a long list of symptoms,
including blurred vision, eye strain, burning of the eyes,
red eyes, photophobia, tearing, headache, and neck and
shoulder pain [1,5]. CVS also known as digital eye strain,
since the public may not consider portable devices as
tablets and smartphones to be computers, the latter term is
preferable [5,6]. Approximately 75% to 90% of computer
users experience CVS symptoms [7]. A study conducted
on health science students at King Saud Bin Abdulaziz
University Hospital for Health Sciences. (KSAUHS) in
Jeddah showed that mobile phones’ most used device. The
most common reason was entertainment, with headaches
being the most common reported CVS symptom [8].
A recent study was done showed that in individuals with
CVS, half of the students had moderate symptoms, and
just 34.1% of medical students were conscious of the
CVS; most of the components of the Pittsburgh Sleep
Quality Index (PSQI) score are statistically significantly
higher than in individuals without CVS, compared to
females, males reported a higher CVS prevalence [3].
Another study in Riyadh revealed that company learners
were 1.6 times as likely to complain from CVS as
medical students with the use of electronic devices
for more than 5 hours associated with a higher risk of
experiencing CVS symptoms [9]. A study conducted in
Ethiopia, 2018 showed that the prevalence of CVS was
approximately 70%, with blurred vision, eyestrain, and
eye irritation being the most common reported symptoms
[4]. While another study in Pakistan that was published
in 2017-pointed to headache as the commonest symptom,
with the prevalence of CVS by 75% [2]. In contrast, a
study conducted in Iran in 2016 showed the prevalence
of poor sleep quality was 61.7%, with a significant direct
association between the total score of sleep quality and
cell phone addiction [10]. Also, research done in India
in 2016 reported that about 66.3% of subjects were
suffering from asthenopia symptoms during or after work
on a computer [11].
Awareness, preventive methods, and knowledge are all
important aspects of healing the problem. However, the
studies about CVS are still limited in Saudi Arabia, and
no recent study about this issue was done in Taif city
on health sciences students. So, we aimed to assess the
awareness, knowledge of CVS and its impact on sleep
quality among health sciences students in Taif, Kingdom
of Saudi Arabia (KSA).
Subjects and Methods
This was a descriptive cross-sectional study conducted in
Taif, Saudi Arabia. The study duration was from January
2021 to June 2021. Data were collected by an electronic
survey containing several questions distributed through
social media and targeting all health science students in
Taif city. Study participants: the minimum recommended
sample size of our survey was 300 participants. The
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inclusion criteria were participants of both genders
(males and females), from health science specialities
at Taif University, learning through online educational
platforms during the COVID-19 pandemic, and who has
completed the questionnaire after giving consent, and
the exclusion criteria were participants from specialities
other than health sciences, not studying at Taif University,
anyone who denies using electronic devices, and those
who did not understand or complete the questionnaire.
Study instrument: the questionnaire included questions
on sociodemographic information, digital devices using
habits, frequency of eye symptoms, ergonomic practices,
assessment of awareness and knowledge of CVS, and
sleep quality assessment by the PSQI.
The Statistical Package for the Social Sciences (SPSS)
program version 23.0 was used to evaluate the data
(SPSS, Inc, Chicago, IL); data were expressed as
mean ± SD and mean (range) for continuous variables.
Frequency (percentage) was defined as categorical
variables. Parametric and non-parametric tests were
used according to distribution normality to assesses the
relation between numeric variables. The chi-square test
was used for categorical variables to be compared. The
level of significance was set at or less than 0.5.
Results
This study found that all the 564 health science students
used an electronic device such as a computer, tablet, or
smartphone for their academic or personal purposes.
When we inquire the students about the most commonly
used electronic device, it was reported that it was a tablet
(56.2%) followed by a smartphone (29.1%), laptop
(11.3%), and a desktop (3.4%) (Table 1). When compared
this usage with the gender of the students, it was found
that tablets were used comparatively more by female
students (58.7%) compared to male students (41.3%). In
contrast, smartphones were more used by male students
(67.1%) compared to females (32.9%) and both showed a
statistically significant association (p < 0.001). Students
in the medical programs used tablets more commonly
(68.1%) than other branches, and smartphone use was
more reported in pharmacy (18.3%) students, whereas
applied medical sciences students more commonly used
laptops (35.6%) more often than any other branches (p <
0.001) (Table 1).
A significant association was observed with the year
of study and the type of electronic device used. Tablet
usage was more commonly reported by first- and fifth-
year students, whereas smartphone usage was more
commonly used by the sixth year and interns (p < 0.001)
(Table 1). According to the total sleep quality according
to PSQI, our study population’s mean total sleep quality
score was 8.89 ± 3.57. The comparison between these
sleep quality scores between different electronic devices
showed that students who used tablets and laptops
had higher scores compared to others, which showed
statistically significant differences [F (3,569) = 4.474, p
< 0.004] (Table 2).
 Eyeing computer vision syndrome

Table 1. Commonly used electronic devices based on demographic details.

Commonly used electronic devices
Total
Desktop Laptop Smartphone Tablet
4 33 54 186 277
Female
Gender

21.1% 51.6% 32.9% 58.7% 49.1%

<0.001
15 31 110 131 287
Male
78.9% 48.4% 67.1% 41.3% 50.9%
8 27 87 216 338
Medicine
42.1% 42.2% 53.0% 68.1% 59.9%
0 0 3 4 7
Dentistry
0.0% 0.0% 1.8% 1.3% 1.2%
College

5 14 30 46 95
Pharmacy <0.001
26.3% 21.9% 18.3% 14.5% 16.8%
Applied medical 6 23 40 51 120
sciences 31.6% 35.9% 24.4% 16.1% 21.3%
0 0 4 0 4
Other
0.0% 0.0% 2.4% 0.0% 0.7%
2 17 18 71 108
First
10.5% 26.6% 11.0% 22.4% 19.1%
8 11 25 46 90
Second
42.1% 17.2% 15.2% 14.5% 16.0%
2 6 19 34 61
Third
Academic year

10.5% 9.4% 11.6% 10.7% 10.8%

6 13 36 75 130
Fourth <0.001
31.6% 20.3% 22.0% 23.7% 23.0%
0 4 6 41 51
Fifth
0.0% 6.3% 3.7% 12.9% 9.0%
0 6 31 35 72
Sixth
0.0% 9.4% 18.9% 11.0% 12.8%
1 7 29 15 52
Intern
5.3% 10.9% 17.7% 4.7% 9.2%

Table 2. Comparison of sleep quality scores.

N Mean Std. deviation p value
Desktop 19 7.05 3.92
Laptop 64 9.16 3.61
Smartphone 164 8.29 3.70 0.004
Tablet 317 9.25 3.42
Total 564 8.89 3.57

Regarding the sleep quality based on the PSQI total score
obtained, it was found that 81.4% (N = 459) had poor sleep
quality, and the sleep quality was comparatively poorer
in female students (52.5%) than male students (47.5%),
which showed statistically significant difference (p <
0.001). There were no statistically significant differences
in sleep quality observed between different branches
(p = 0.556) and between different academic years (p =
0.082) (Table 3). The assessment of ergonomic practices
related to electronic devices’ usage showed that 70.4%
of students took a break in between while working on
their device, and only 33.9% used glasses or contact
lenses when using a computer (laptop or desktop). It was
reported by only 9.8% of students that they used an anti-
glare glass when using a computer, and 17.6% reported
that they kept their head level properly when using an
electronic device (Table 4).

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 Eyeing computer vision syndrome

Table 3. Sleep quality based on demographics of students.

Sleep quality
Total
Normal/Good Poor
N 36 241 277
Female
Gender

% 34.3 52.5 49.1

N 69 218 287
Male
% 65.7 47.5 50.9
N 60 278 338
Medicine
% 57.1 60.6 59.9
N 1 6 7
Dentistry
% 1.0 1.3 1.2
College

N 18 77 95
Pharmacy
% 17.1 16.8 16.8
N 24 96 120
Applied medical sciences
% 22.9 20.9 21.3
N 2 2 4
Other
% 1.9 0.4 0.7
N 11 97 108
First
% 10.5 21.1 19.1
N 17 73 90
Second
% 16.2 15.9 16.0
N 12 49 61
Third
Academic year

% 11.4 10.7 10.8

N 32 98 130
Fourth
% 30.5 21.4 23.0
N 6 45 51
Fifth
% 5.7 9.8 9.0
N 14 58 72
Sixth
% 13.3 12.6 12.8
N 13 39 52
Intern
% 12.4 8.5 9.2

Table 4. Ergonomic practices related to electronic device usage.

Took a break in between while working on your No 167 29.6
device
Yes 397 70.4
Use of glasses or contact lenses while using your No 373 66.1
computer
Yes 191 33.9
Use of an antiglare glasses while using your No 509 90.2
computer
Yes 55 9.8
Position your body when using the device Other 465 82.4
Head is level, forward facing and balanced 99 17.6

This study found that on assessing the prevalence of
symptoms related to CVS, it was found that 4.4% of the
students did not have any symptoms, and 3.4% had at
least one symptom related to the same, whereas 92.2%
had two or more symptoms. The most commonly reported
CVS symptom was eye strain/fatigue (77.7%) and neck,
shoulder, and backache (73.6%), and the least commonly
reported was changes in color perception (Figure 1).
Results of the present work revealed that on evaluating the
students’ awareness regarding the term “Computer vision
syndrome, it was reported by 89.4% that they had never
heard of it, and only 1.1% know it very well” (Figure 2).
Assessment of knowledge related to CVS showed that
73.4% had good and 26.4% had poor knowledge related
to symptoms of CVS. But this knowledge didn’t show
any statistically significant relationship with gender, the
branch of study, and academic year (Table 5).

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 Eyeing computer vision syndrome

Figure 1. Prevalence of symptoms related to computer vison syndrome.

Figure 2. Awareness regarding computer vison syndrome.

Discussion used different devices was higher in males than females

This study aimed to assess the awareness, knowledge,
and impact of CVS on the sleep quality of health science
students in Taif, Saudi Arabia, during the COVID-19
pandemic. CVS is a constellation of eye symptoms that
are mainly associated with computer use [4]. The present
study revealed that the most used electronic device in
medical students were tablets, and most of the users
were females (58.7%). But generally, the total number of
(50.9%). A possible explanation for this is that the use of
tablets for accessibility to the information is easier than
other devices in recent years.
In contrast, a previous study in Jeddah, KSA, found that
the most used electronic device in medical students were
smartphones (78%) [8]. Both applied medical sciences
(35.9%) and pharmacy students (21.9%) used laptops
as their primary electronic computers. Medical students
were also found to be the most vulnerable to CVS in our

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 Eyeing computer vision syndrome

Table 5. Knowledge regarding CVS based on baseline characteristics.

Knowledge
Total p value
Good Fair Poor
N 213 64 0 277
Female
Gender

% 51.4 43.2 0.0 49.1

0.087
N 201 84 2 287
Male
% 48.6 56.8 100.0 50.9
Applied medical N 94 24 2 120
sciences % 22.7 16.2 100.0 21.3
N 5 2 0 7
Dentistry
% 1.2 1.4 0.0 1.2
College

N 240 98 0 338.0
Medicine 0.130
% 58.0 66.2 0.0 59.9
N 2 2 0 4
Other
% 0.5 1.4 0.0 0.7
N 73 22 0 95
Pharmacy
% 17.6 14.9 0.0 16.8
N 86 22 0 108
First
% 20.8 14.9 0.0 19.1
N 63 26 1 90
Second
% 15.2 17.6 50.0 16.0
N 46 15 0 61
Third
Academic year

% 11.1 10.1 0.0 10.8

N 97 33 0 130
Fourth 0.388
% 23.4 22.3 0.0 23.0
N 34 17 0 51
Fifth
% 8.2 11.5 0.0 9.0
N 55 17 0 72
Sixth
% 13.3 11.5 0.0 12.8
N 33 18 1 52
Intern
% 8.0 12.2 50.0 9.2

research due to their higher use of electronic devices
(59.9%) as opposed to other specialities. Another study
in Riyadh city, KSA, showed that CVS was found to be
1.6 times more prevalent in business students than in
medical students. These differences can be explained
because the business students were not involved in our
research [9]. In general, dentistry students were the least
likely to use electronic devices, attributed to the small
number of participants from this speciality.
This work found that almost all participants had a
poor sleep quality, with the poorest being significantly
associated with tablet use. Fourth-year students had the
worst quality of sleep, followed by first-year students.
Even so, the fifth-year students exhibited the best quality
of sleep. It seems possible that these findings are because
the fact that fourth-year students were the most likely
to use electronic devices (23%), followed by first-year
students (19.1%), and fifth-year students were the least
likely to use electronic devices (9%). Many theories
discussed the effect and the relation between the use
of electronic devices and sleep quality. These studies
found that the device screen’s light emission suppresses
the pineal gland’s melatonin secretion (environmental
light\dark cycle) [12,13]. It may also delay sleep when
one engages with the media and spends time with a
sleep delay or when being psychosocially active with
interference with sleep [14].
Previous studies reported the association between poor
PSQI scores and the increased use of electronic devices.
A recent study conducted in Maharashtra, India, reported
a significant positive relation between poor sleep quality
and individuals suffering from CVS, and this result agrees
with our findings [3]. We found a significant difference
between sleep quality and gender, with a higher number
of females with poor sleep quality (52.5%) than males
who have more normal\good sleep quality (65.7%).
This result was observed although both genders reported
nearly equal use of electronic devices. This can be

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 Eyeing computer vision syndrome
attributed to higher levels of anxiety reported in females
that can have a negative impact on sleep quality [15,16].
This study found that most students took a break in
between while working on their devices more than those
who did not (70.4%). A previous study in Northwest
Ethiopia showed that whoever took a break regularly, CVS
would decrease by 27% [4]. Another study recommended
looking far away from 20 feet for 20 seconds after using
the device for 20 minutes [2]. Or applying the American
Optometric Association recommendation, which is to
use the device for 2 hours and then take a break for 15
minutes, all will decrease the risk of developing CVS [2].
Most of the students of this work were not using glasses
or contact lenses while using the computer (66.1%) as
compared to a previous study was done in Egypt found
that most of the students were using glasses or contact
lenses (72%) [5]. Whereas using antiglare glasses was
the least ergonomic applied practice the best position
while using computers where the head is level, forward-
facing, and balanced was applied by only (17.6%) of
students, which is a small ratio, compared to a study that
was done in Jeddah showed that the position on face level
is the most common (59%) [8]. However, computer users
who are more aware of ergonomic practices have a 42%
less chance of developing CVS [4]. The most common
reported computer use symptoms were eye strain\fatigue,
neck and shoulder pain, and backache, respectively. Yet,
the reported symptoms among our participants and the
previous studies are generally the same [9].
Regarding the students’ awareness of the term (CVS),
it was reported by 89.4% that they had never heard of
it, and only 1.1% knew it very well. At the same time,
the assessment of knowledge related to CVS among the
participants showed that 73.4% had good and 26.4%
had poor knowledge related to symptoms of CVS. Such
results can be eventually related to the weak education of
the students regarding CVS and the effects of spending
hours in front of the electronic device without applying
the ergonomic practices. This was found to have a
significant negative impact on their daily performance in
general and the academic performance.
As for the academic year and its effect on CVS knowledge,
the fourth year students had good knowledge about CVS
by 23%, and the fifth year has poor knowledge by 9%.
This discrepancy could be attributed to the number of
participants where most of them were from fourth year,
while the fewest were from fifth year. This knowledge
did not show any statistically significant relationship
with gender, the branch of study, and academic year.
As we conducted our study during the COVID-19
pandemic with the increased use of electronic devices for
different daily tasks and goals, we believe it positively
affects our findings. Nevertheless, it made us face some
limitations as we could not distribute our survey in
person to make sure that our participants understood the
questions and the survey items fully. Another limitation
was that the students self-reported the symptoms with the
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lack of ophthalmologist examination to render it more
reliable.
Conclusion
This study found that almost all studied subjects have a
poor sleep quality, with the poorest being significantly
associated with tablet use. Fourth-year students had the
worst quality of sleep, followed by first-year students. A
significantly higher number of females had poor sleep
quality (52.5%) than males, and the most common
reported symptom of computer use was eye strain\
fatigue, neck and shoulder pain, and backache. Of
students, 89.4% had never heard of the term (CVS), and
only 1.1% knew it very well. About 73% (73.4%) had
good, and 26.4% had poor knowledge related to CVS.
More future studies are needed to assess the prevalence of
CVS and its impact on student’s academic performance,
sleep quality, and lifestyle. It is important to raise the
awareness of students and computer users about CVS
and encourage them to apply ergonomic practices while
using an electronic device.
Acknowledgement
The authors are highly grateful to the respondents for their
cooperation, and would like to thank the data collectors
Amjad Jawhari , Ahad Alnemari and Wareef Alhamidi for
their hard work and participation in this research.
Lis t of Abbreviations
CVS Computer vision syndrome
PSQI Pittsburgh Sleep Quality Index
SPSS Statistical Package for the Social Sciences
Conflicts of interest
No conflicts related to this work.
Funding
None.
Consent to participate
Informed consent was obtained from all the participants.
Ethical approval
The research was approved by the ethical committee at Taif
University. The collected data was confidential and used only
for scientific purposes.
Author details
Ayman A. Ahmad1, Bushra F. Alshehri2, Ameerah M. Almalki2,
Abdulelah M. Albaradi2, Manal S. Almalki2, Khadijah Y. Alattas3
1. Department of Family Medicine, Taif University, Taif, Saudi
Arabia
2. Medical Student, Taif University, Taif, Saudi Arabia
3. Department of Ophthalmology, King Abdulaziz University,
Jeddah, Saudi Arabia
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