Background: Digital Eye Strain (DES), also known as Computer Vision Syndrome (CVS), is increasingly common due to rising screen exposure in professional and educational settings. Characterized by eye fatigue, dryness, headaches and visual discomfort, DES often goes unnoticed due to limited public awareness of its symptoms and preventive strategies. This study aimed to assess DES awareness, knowledge and preventive practices among residents of Himachal Pradesh, India, while identifying demographic patterns influencing awareness levels. Materials and Methods: A descriptive cross-sectional study was conducted among 400 adults in Himachal Pradesh using a structured online questionnaire. The survey collected socio-demographic data, assessed DES knowledge and evaluated awareness of preventive practices. Participants' knowledge was categorized as Very Good (>80%), Good (60%-79%), Fair (41%-59%) and Poor (<40%). Data analysis was conducted using SPSS (v26.0) with significance set at p<0.05. Results: Findings revealed that while most participants had a sound understanding of DES causes (81.8%) and preventive strategies like the 20-20-20 rule (73%), gaps remained in recognizing symptoms such as headaches (64.5%) and visual fatigue (67%). Awareness of environmental triggers (66%) and nutritional support (61.8%) was also limited. Approximately 38% scored "Very Good," 39.5% scored "Good," while 15.8% and 6.8% achieved "Fair" and "Poor" scores, respectively. Knowledge gaps were more pronounced among rural populations and those with lower educational attainment. Conclusion: Although awareness regarding DES is encouraging in some areas, gaps persist in recognizing key symptoms, environmental triggers and effective preventive practices. Focused educational campaigns and workplace wellness programs are crucial to improving public understanding and promoting healthier screen-use behaviors. Future initiatives should prioritize vulnerable populations in rural and underserved regions.
The increasing reliance on digital devices has become an integral part of modern life, fundamentally altering work habits, education and leisure activities. While technological advancements have enhanced productivity and connectivity, they have also given rise to a significant yet often overlooked health concern-Digital Eye Strain (DES), also known as Computer Vision Syndrome (CVS). DES is characterized by ocular discomfort and visual disturbances resulting from prolonged screen exposure. Common symptoms include eye fatigue, dryness, redness, blurred vision, headaches and neck or shoulder pain, collectively impacting productivity, focus and overall well-being [1-4].
With the rapid expansion of remote work, online education and digital entertainment, DES is increasingly prevalent, particularly among working professionals, students and individuals engaged in prolonged screen-based activities. Factors such as inadequate blinking, poor posture, excessive screen brightness and insufficient breaks exacerbate symptoms. Despite its growing incidence, awareness regarding DES prevention, symptom recognition and management strategies remains limited. Misconceptions about digital screen exposure, alongside a lack of proactive eye care practices, often lead individuals to ignore early signs of DES, increasing the risk of chronic discomfort and long-term visual impairment [5-8].
In India, where digital penetration has surged significantly, especially post-pandemic, addressing DES awareness is particularly crucial. Regions such as Himachal Pradesh, with diverse demographic profiles and varying levels of digital access, face unique challenges in promoting eye health education. Rural communities, often with less access to ophthalmic care, may experience delayed diagnosis and ineffective management of screen-related visual discomfort. Additionally, younger populations heavily engaged in digital learning environments may underestimate the long-term impact of excessive screen exposure on their ocular health [7-9].
Given the rising screen dependency across professional and personal domains, there is a pressing need to evaluate public awareness of DES, common misconceptions and preventive practices. This study aims to assess knowledge, attitudes and behaviors related to digital eye strain among residents of Himachal Pradesh, with a focus on identifying demographic patterns linked to awareness levels. Findings will help inform targeted educational strategies and public health interventions to mitigate the growing burden of DES and promote healthy screen-use practices.
Research Design: A descriptive cross-sectional study was conducted to assess public awareness, knowledge and preventive practices related to Digital Eye Strain (DES) among the general population of Himachal Pradesh, India. The study utilized a structured online questionnaire to collect data, ensuring broad socio-demographic representation across urban and rural regions.
Study Area and Population: The study was conducted in various districts of Himachal Pradesh, a northern Indian state characterized by diverse socio-economic backgrounds and varying levels of digital exposure. The target population included adults aged 18 years and above from both urban and rural settings. Special emphasis was placed on populations engaged in screen-intensive activities such as students, working professionals and homemakers.
Sample Size and Sampling Technique: A sample size of 400 participants was calculated based on a 95% confidence interval, 50% estimated prevalence of DES awareness and a 5% margin of error. To account for incomplete or erroneous responses, an additional 10% buffer was included. The study employed convenience sampling and purposive sampling techniques, leveraging social media platforms such as WhatsApp, Facebook and local online community groups to reach a wide demographic.
Inclusion and Exclusion Criteria: Inclusion criteria included adults aged 18 years and above, permanent residents of Himachal Pradesh, individuals who use digital screens for at least two hours daily for work, study, or entertainment and those with the ability to comprehend and respond to the questionnaire in Hindi or English.
Exclusion criteria included individuals with severe ocular conditions unrelated to DES, participants unwilling or unable to provide informed consent and responses that were incomplete or ambiguous.
Data Collection Instrument: A structured, validated questionnaire was developed with inputs from ophthalmologists, optometrists and public health experts. The questionnaire was designed to assess socio-demographic information, including age, gender, education level, occupation and residential setting (urban or rural). It also included knowledge and awareness of DES, such as understanding of DES symptoms, risk factors, preventive practices and misconceptions.
In addition, the questionnaire evaluated screen use behavior and eye care practices, including screen exposure patterns, frequency of breaks, use of protective measures such as anti-glare screens or blue light filters and healthcare-seeking behavior. The questionnaire comprised 20 multiple-choice questions (MCQs) and was made available in both Hindi and English to maximize accessibility. A pilot study was conducted among 20 individuals to ensure clarity, reliability and validity of the tool before full-scale data collection.
Scoring and Knowledge Classification: Responses in the DES knowledge section were scored and categorized as follows:
This scoring system facilitated targeted identification of participants with significant knowledge gaps requiring intervention.
Data Collection Procedure: Data collection occurred over three months (October to December 2024) through an online Google Forms platform. The questionnaire link was widely disseminated through social media platforms, local educational groups and community forums to ensure participation across diverse socio-economic and occupational groups. Clear instructions regarding the study’s purpose, voluntary participation, anonymity and data confidentiality were provided before participants could proceed. Explicit informed consent was obtained from all respondents before participation.
Data Analysis: All collected data were thoroughly reviewed, cleaned and organized using Microsoft Excel. Descriptive statistics were generated using SPSS (version 26.0) to summarize socio-demographic characteristics, DES knowledge scores and preventive practices.
Ethical Considerations: Ethical approval for the study was secured from the relevant institutional ethics committee. Participants were informed about the study’s objectives and voluntary participation was emphasized. Data confidentiality was maintained throughout the study, ensuring that responses remained anonymous and were used strictly for research purposes. Participants retained the right to withdraw from the study at any point without repercussions.
The socio-demographic profile of the 400 participants revealed a near-equal gender distribution, with males comprising 50.3% and females 49.8%. Most respondents were between the ages of 26-35 years (36%) and 36-45 years (28%), representing a substantial proportion of the working-age population actively exposed to digital devices. Educational backgrounds varied, with the majority holding undergraduate (35.3%) or secondary school qualifications (33%), while only a small portion had no formal education (4%). In terms of occupation, homemakers (25.8%) and office workers (24%) formed the largest groups, followed by teachers (16.8%), healthcare professionals (10.8%) and students (13.5%). Rural residents constituted a significant majority (58.5%) compared to urban participants (41.5%), emphasizing the need to address digital eye strain awareness in less urbanized regions (Table 1).
Table 1: Socio-Demographic Characteristics of Participants
Variable | Category | Frequency (n) | Percentage (%) |
Age Group (Years) | 18–25 | 88 | 22.0 |
26–35 | 144 | 36.0 | |
36–45 | 112 | 28.0 | |
46 and above | 56 | 14.0 | |
Gender | Male | 201 | 50.3 |
Female | 199 | 49.8 | |
Education Level | No formal education | 16 | 4.0 |
Primary school | 62 | 15.5 | |
Secondary school | 132 | 33.0 | |
Undergraduate degree | 141 | 35.3 | |
Postgraduate degree | 49 | 12.3 | |
Occupation | Homemaker | 103 | 25.8 |
Office Worker | 96 | 24.0 | |
Teacher | 67 | 16.8 | |
Healthcare Professional | 43 | 10.8 | |
Student | 54 | 13.5 | |
Other | 37 | 9.3 | |
Residential Setting | Urban | 166 | 41.5 |
Rural | 234 | 58.5 |
Regarding awareness and knowledge of digital eye strain, participants demonstrated a generally good understanding of the condition. A large majority (81.8%) correctly identified digital eye strain as eye discomfort caused by screen use and 70.8% recognized prolonged screen exposure as a primary cause. While 86.5% correctly understood that DES does not typically cause permanent vision damage, fewer respondents were aware of preventive strategies such as the role of vitamin A (61.8%) or environmental factors like dry air (66%). Positive awareness was noted in recognizing effective relief measures, with 79.5% correctly recommending breaks from screen use and 73% understanding the benefits of the 20-20-20 rule. However, gaps emerged in identifying subtle symptoms such as eye fatigue (67%) and the risks associated with long-term screen exposure, with only 64.5% acknowledging that DES could lead to headaches and discomfort. These findings indicate a strong foundation in DES awareness but underscore the need for targeted educational efforts to reinforce preventive strategies and symptom recognition (Table 2).
Table 2: Awareness and Knowledge of Digital Eye Strain Among the General Population
No. | Question | Options | Correct Responses (n) | Percentage (%) |
1 | What is digital eye strain? | a) Ear fatigue, b) Eye discomfort from screen use, c) Throat dryness, d) Skin irritation | 327 | 81.8 |
2 | What is a primary cause of digital eye strain? | a) Loud noise, b) Poor diet, c) Prolonged screen exposure, d) Cold air | 283 | 70.8 |
3 | What part of the eye is most affected by digital eye strain? | a) Lens, b) Cornea and tear film, c) Optic nerve, d) Retina | 273 | 68.3 |
4 | Can digital eye strain cause permanent vision damage? | a) Yes, b) No, c) Only in children, d) Only if chronic | 346 | 86.5 |
5 | Which nutrient may help reduce eye strain? | a) Vitamin B12, b) Vitamin A, c) Vitamin K, d) Iron | 247 | 61.8 |
6 | What should someone do if they feel eye strain after screen use? | a) Ignore it, b) Take a break and rest eyes, c) Rub eyes, d) Increase screen time | 318 | 79.5 |
7 | What is a common symptom of digital eye strain? | a) Hearing loss, b) Sore throat, c) Eye fatigue, d) Fever | 268 | 67.0 |
8 | Which symptom requires urgent medical attention? | a) Mild dryness, b) Severe eye pain with blurred vision, c) Occasional redness, d) Tiredness | 301 | 75.3 |
9 | Can blue light from screens contribute to eye strain? | a) Yes, b) No, c) Only at night, d) Only in the elderly | 277 | 69.3 |
10 | What is a common way to reduce digital eye strain? | a) Staring longer, b) Using the 20-20-20 rule, c) Brightening screens, d) Rubbing eyes | 292 | 73.0 |
11 | What is a risk of prolonged digital eye strain? | a) Headaches and discomfort, b) No risk, c) Hair loss, d) Joint pain | 258 | 64.5 |
12 | Can children experience digital eye strain? | a) Yes, b) No, c) Only after age 10, d) Only if outdoors | 311 | 77.8 |
13 | How does screen brightness affect eye strain? | a) No effect, b) Too bright or too dim increases strain, c) Improves vision, d) Causes ear pain | 276 | 69.0 |
14 | What environmental factor worsens digital eye strain? | a) High humidity, b) Dry air, c) Loud noise, d) Warm temperature | 264 | 66.0 |
15 | Can adjusting screen settings reduce eye strain? | a) Yes, b) No, c) Only for adults, d) Only temporarily | 271 | 67.8 |
16 | What habit helps prevent digital eye strain? | a) Rubbing eyes, b) Continuous screen use, c) Taking regular breaks, d) Dimming lights | 324 | 81.0 |
17 | What should you avoid to minimize digital eye strain? | a) Drinking water, b) Staring at screens without breaks, c) Blinking, d) Resting | 304 | 76.0 |
18 | Which of these is NOT a symptom of digital eye strain? | a) Dry eyes, b) Blurred vision, c) Neck pain, d) Sore throat | 249 | 62.3 |
19 | What is the first step if you notice eye strain from screens? | a) Increase screen time, b) Apply heat, c) Rest eyes and adjust screen, d) Ignore it | 269 | 67.3 |
20 | What type of doctor treats digital eye strain? | a) Cardiologist, b) Neurologist, c) Ophthalmologist, d) Dentist | 342 | 85.5 |
Knowledge score classification revealed that a considerable proportion of participants demonstrated commendable understanding. Approximately 38% achieved “Very Good” knowledge scores (>80%) and 39.5% attained “Good” scores (60%-79%). Nonetheless, a noteworthy segment exhibited only "Fair" (15.8%) or "Poor" (6.8%) knowledge levels, indicating persistent gaps in understanding key aspects of DES prevention, management and risks. Notably, individuals with lower educational attainment and those residing in rural settings were disproportionately represented in the lower knowledge categories, reinforcing the need for focused public health interventions tailored to these vulnerable groups (Figure 1).
Figure 1: Knowledge score classification
The present study comprehensively assessed public awareness, knowledge and preventive practices related to Digital Eye Strain (DES) among the general population of Himachal Pradesh, providing critical insights into the extent of awareness and identifying knowledge gaps requiring intervention. As digital screen usage continues to expand across educational, occupational and social domains, DES has emerged as a significant public health concern, particularly among individuals engaged in prolonged screen-based activities. The findings of this study reveal encouraging levels of awareness in some areas; however, substantial gaps persist, necessitating targeted educational interventions to mitigate the growing burden of DES.
The socio-demographic profile of the participants demonstrated an almost equal gender distribution, with males (50.3%) and females (49.8%) contributing comparably. The majority of respondents were within the economically active age groups of 26-35 years (36%) and 36-45 years (28%), underscoring the study’s focus on populations most vulnerable to screen-related visual fatigue due to occupational and academic screen exposure. Educational attainment varied, with a significant proportion possessing undergraduate (35.3%) or secondary school (33%) qualifications. Notably, rural participants (58.5%) outnumbered their urban counterparts, reinforcing the importance of extending DES awareness campaigns beyond urbanized areas and ensuring information reaches communities with limited access to ophthalmological care.
The assessment of DES knowledge yielded mixed findings, revealing both encouraging strengths and concerning gaps. On the positive side, a high proportion of respondents accurately identified DES as discomfort resulting from screen use (81.8%) and recognized prolonged screen exposure as a primary contributing factor (70.8%). Furthermore, 86.5% of participants correctly understood that DES does not usually cause permanent visual damage, reflecting a reasonable understanding of its short-term and reversible nature. Encouragingly, a majority of participants acknowledged essential preventive measures, such as taking screen breaks (79.5%) and employing the 20-20-20 rule (73%). This awareness aligns with research suggesting that simple preventive techniques, when practiced consistently, can significantly reduce DES symptoms and improve visual comfort.
However, significant knowledge gaps were evident in several crucial aspects. For instance, only 61.8% recognized vitamin A's role in promoting ocular health and reducing eye fatigue, indicating limited awareness of nutritional interventions for DES management. Similarly, only 66% correctly identified dry air as an environmental factor exacerbating DES, pointing to a gap in understanding how environmental conditions can influence screen-related discomfort. Furthermore, only 64.5% acknowledged that prolonged screen exposure could contribute to headaches and discomfort, reflecting a lack of awareness about common yet impactful symptoms of DES. These gaps may contribute to individuals failing to adopt timely preventive measures or underestimating the cumulative effects of screen exposure on visual well-being.
A particularly concerning finding was the under-recognition of DES symptoms. While 67% of participants identified eye fatigue as a common indicator, a sizable proportion failed to connect digital eye strain with other symptoms such as blurred vision, dry eyes, or neck discomfort. This knowledge gap highlights the need to expand educational efforts emphasizing comprehensive symptom identification to facilitate early diagnosis and prompt intervention.
Preventive practices also showed room for improvement. While participants demonstrated awareness of breaks during screen use, fewer participants reported understanding other protective strategies such as adjusting screen brightness (69%), modifying environmental conditions (66%), or incorporating anti-glare screens and blue light filters. Inadequate knowledge of these preventive measures could result in individuals failing to create conducive screen-use environments that minimize DES risks. Moreover, misconceptions about screen exposure being harmless for children were notable, as only 77.8% acknowledged that children are equally susceptible to DES. Given the rising prevalence of online learning and gaming habits among youth, this gap demands urgent attention to raise parental awareness and promote protective measures among children.
The knowledge classification findings provided further evidence of these gaps. While 38% of respondents demonstrated "Very Good" awareness levels and 39.5% showed "Good" knowledge, a significant 15.8% and 6.8% exhibited only "Fair" and "Poor" knowledge levels, respectively. These lower awareness scores were disproportionately observed among rural participants and individuals with lower educational attainment, emphasizing the role of socio-demographic factors in shaping DES awareness. These findings align with prior research indicating that marginalized populations often face greater barriers in accessing reliable health information and preventive care. Consequently, targeted educational initiatives focusing on these vulnerable groups are critical.
Given these findings, several public health strategies are recommended to enhance DES awareness and preventive behaviors. First, comprehensive public awareness campaigns should prioritize emphasizing DES symptoms, risk factors and effective preventive measures. Such campaigns should utilize accessible language, visual aids and digital media platforms to effectively engage diverse audiences, particularly in rural and underserved areas. Second, educational institutions should integrate DES awareness into school curriculums to educate students, parents and educators about safe screen use practices, ensuring early adoption of protective strategies. Third, workplace wellness programs should incorporate routine digital eye strain assessments and educate employees about ergonomic screen setups, optimal lighting conditions and the importance of scheduled screen breaks [7,8].
Healthcare providers, particularly optometrists and ophthalmologists, also play a crucial role in improving DES awareness. Integrating DES screening into routine eye check-ups can improve early detection, while counseling patients on protective practices can enhance preventive behaviors. Collaboration between healthcare providers, employers and educational institutions will strengthen the reach and effectiveness of awareness initiatives [9-11].
This study highlights encouraging levels of DES awareness in some areas, yet identifies notable gaps in symptom recognition, preventive strategies and risk factor understanding, particularly among rural and less-educated populations. Addressing these gaps through targeted, culturally sensitive educational initiatives is essential to minimize the burden of DES, reduce visual discomfort and improve overall ocular health outcomes in screen-exposed populations. Future research should assess the long-term impact of educational interventions, monitor behavioral changes and evaluate healthcare-seeking patterns to ensure sustained improvements in DES awareness and prevention.
This study reveals a commendable level of awareness regarding Digital Eye Strain (DES) among residents of Himachal Pradesh, particularly regarding its causes, preventive practices and non-permanent nature. However, critical gaps persist in recognizing subtle symptoms, environmental triggers and protective strategies, especially among rural populations and individuals with lower educational attainment. These findings underscore the urgent need for targeted public health interventions, including educational campaigns, school-based awareness programs and workplace wellness initiatives to promote healthy screen-use habits. Strengthening awareness about preventive strategies such as the 20-20-20 rule, screen adjustments and nutritional support is vital to reducing the growing burden of DES. Future research should focus on evaluating the long-term impact of these interventions to ensure sustained improvements in public knowledge, behavior and overall ocular health.
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