No therapies for computer vision syndrome with high certainty evidence in meta-analysis

1. A systematic review and meta-analysis of 45 randomized controlled trials on the treatment of computer vision syndrome (CVS) found no benefit from optical aids, including multifocal and blue light-blocking lenses, though with low certainty of evidence.

2. Low certainty evidence was found for a reduction in CVS-related dry eye symptoms with oral omega-3 fatty acid supplements compared to placebo.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Prolonged, frequent use of computers is increasingly common, and often exacerbates dry eye symptoms, such as eye strain and blurred vision, as well as other symptoms, such as headache. This set of issues has been described as computer vision syndrome (CVS) and has inspired many prospective treatments, including widely marketed products like blue light-blocking lenses and oral supplements. This systematic review and meta-analysis aimed to assess evidence from randomized controlled trials (RCTs) of CVS therapies. The review included 45 RCTs representing about 4,500 patients. Among 10 trials of optical aids such as multifocal contact lenses and blue light-blocking glasses, meta-analysis revealed no effect on visual fatigue symptoms with low certainty of evidence. Low certainty evidence was also found for no difference with use of oral berry extract and polyunsaturated fatty acid supplements. Based on two studies with high heterogeneity, there was low certainty evidence for a decrease in dry eye symptoms with omega-3 supplements compared to placebo. Fewer studies with comparable, quantitative outcomes were available for other types of interventions, such as ergonomic adjustment and measures like the “20-20-20 rule” for taking breaks from screens. This review shows that though CVS treatments are increasingly studied, the current quality of evidence leaves much to be desired. The meta-analysis indicates only oral omega-3 supplements as a potentially effective treatment for CVS. However, further study of this possible benefit of these supplements, as well as the mechanism of therapeutic action and frequency of adverse gastrointestinal effects, would certainly be needed before they would be recommended for the large proportion of the general population that experiences CVS symptoms.

Click to read the study in Ophthalmology

Relevant Reading: Computer vision syndrome: A review of ocular causes and potential treatments

In-Depth [meta-analysis]: RCTs comparing any intervention for CVS management to a control, placebo, or sham group were included. Interventions were defined as optical aids, oral berry extract supplements, polyunsaturated fatty acid supplements, antioxidant supplements, traditional medicines, combination supplements, artificial tears, environmental modification, ergonomic adjustment, visual hygiene such as the “20-20-20 rule”, binocular vision training, and other interventions. Data on primary outcomes, most commonly visual fatigue symptom scores and critical flicker fusion frequency (CFF), were extracted. Fixed-effect models were used for pooling of fewer than three RCTs, and random-effects models otherwise. Evidence from all studies was determined to be very low, low, or moderate certainty based on risk of bias, including 35% of studies which did not mask either participants or study staff, and/or small sample size. The I² statistic for the 2 pooled studies on oral omega-3 fatty acid supplementation was 89%, indicating high heterogeneity.

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