Design and Trial of Computer Vision Syndrome Level Instruments
Irmayani
1
, Anggi Isnani
1
, Annisa Febriana Siregar
1
, Atika Sari Lubis
1
, Muchty Yudha Pratama
2
and
Fithri Handayani Lubis
3
1
Institut Kesehatan Medistra Lubuk Pakam, Sumatera Utara, Indonesia
2
Akademi Keperawatan Kesdam I/ BB Medan
3
Institut Kesehatan Deli Husada Deli Tua
Keywords: computer use, computer vision syndrome
Abstract: Computer use increases continuously over time. The average working time used for working with a computer
was 5.8 hours or 69% of the total 8 working hours. Computers that are now widely used as a tool turned out
to cause illness due to work or health problems. One of them was eye irritation due to the use of continuous
eye to stare at a computer monitor or visual display terminal (VDT). This study aimed at designing and testing
try the instrument computer vision syndrome on the user's computer. This research was a case study research.
Done in Grandmed Lubuk Pakam Hospital with a population that was all employees working in part the claims
BPJS, the registration section, parts of office and medical records of Grandmed Lubuk Pakam Hospital and
samplewas many as 30 people. Collecting data using primary and secondarydata. Primary data collection was
done through direct interviews with employees in the BPJS claims section using a questionnaire containing
30 questions and using a Likert scale. While collection of secondary data obtained from human resources of
Grandmed Hospital Lubuk Pakam. Data processing used validity and reliability tests. The results showed that
the instrument used to measure the level of computer vision syndrome in computer users showed a correlation
coefficient ranging from 0.542 to 0.973 and a reliability value of 0.986. It was recommended to further
research to use this computer vision syndrome level instrument when conducting research on the duration of
exposure to the occurrence of computer vision syndrome.
1 INTRODUCTION
The invention of the computer became a rapid
development in all fields of professions, architects, art
and design workers, journalists, flight controllers,
even today it was very necessary to have a computer
to work. This in addition to providing convenience for
the production process, of course, will cause side
effects that we can not avoid. The development of
information technology that must require humans to
have a direct relationship with computers both in
offices and parts of one's life.
The role of computers today was very broad,
generally 80% of office work can be completed using
a computer. The use of the internet which was now
also increasingly popular causes workers to spend
time in front of the computer at least 3 hours per day.
The benefits gained from the use of computers were
very numerous but not everyone was aware of the
problems caused when using a computer, especially
if working at the computer for too long and
continuously.
The rapid development of technology makes
computers as a tool that facilitates work quickly and
efficiently. Almost all fields of work today use
computers as a tool to facilitate their work, there were
around 100 million people use computers in their
daily work (Izquierdo, 2016). From the results of
research conducted by the National Institute of
Occupational Safety and Health (NIOSH) that the use
of computers for too long can cause higher stress than
other workers. NIOSH also shows that almost 88% of
all computer users experience Computer Vision
Syndrome (CVS), a condition that occurs because
they focus too long on the computer screen for more
than four 4 hours a day. The longer duration of daily
computer exposure wass directly proportional to the
number of symptoms experienced by computer user
respondents (Akinbinu and Mashalla, 2017). Various
128
Irmayani, ., Isnani, A., Siregar, A., Lubis, A., Pratama, M. and Lubis, F.
Design and Trial of Computer Vision Syndrome Level Instruments.
DOI: 10.5220/0009467201280134
In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 128-134
ISBN: 978-989-758-460-2
Copyright
c
 2020 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

symptoms that arise in computer workers who work
for a long time in addition to being caused by light
entering the eyeball, also due to the eyes of a worker
when staring at the computer, the blink of the eye was
reduced by 2/3 times less than normal. And other
complaints in the form of red eyes, burning sensation
in the eyes, and watery eyes .
The use of computers also has an effect on health,
one of which was eye disorders due to the continuous
use of eyes to stare at a computer monitor or Visual
Display Terminal (VDT). This will occur after using
the computer for more than 3 hours. Complaints will
appear 3 times more often on computer users who
have refractive abnormalities (Jonge, 2018).
Computer Vision Syndrome was also a term used
to describe various symptoms such as eye strain, eye
discomfort, headaches, dry eyes, blurred vision at
close range, and double vision in computer users.
Users who complain of pain in the neck and back are
also included in the symptoms of CVS.
Various symptoms that arise in computer workers
who work for a long time in addition to being caused
by light entering the eyeball, also due to the eyes of a
worker when staring at the computer, the blink of the
eye was reduced by 2/3 times less than normal. And
other complaints in the form of red eyes, heartburn,
and watery eyes (Valentina, 2018).
With the existence of research instruments, we
will know the source of the data we will examine and
the type of data, data collection techniques, data
collection instruments, the steps of the preparation of
the research instruments as well as knowing the
validity, reliability, difficulty level, distinguishing
power, and deception / distractor of a data in research.
The instrument has a very important role. Because
with the presence of instruments, the quality of a
study can be known. If the instrument was made, has
good criteria, then the quality of the research was also
good, and vice versa.
Observations made at the BPJS Health Office
Lubuk Pakam, amounting to 36 employees, were
found that office employees work using computers as
a tool to complete their work. The time spent by
employees in working on computers averages 4-5
hours a day. The results of the employee's response
said that experiencing symptoms such as dry eyes
strained dry eyes and often complained of pain in the
neck. Based on the data and survey result, so the
authors are interested in conducting research on
"Design and Testing of Computer Vision Syndrome
Level Instruments".
2 RESEARCH METHOD
Grandmed Hospital was used as the location of this
study. This type of research used in this research was
quantitative research by case studies design. This
study aims to design and test instrument level
computer vision syndrome. Involved 30 office
employees who were placed in the BPJS claims
section, in-patient and outpatient registration, office
and medical records at Grandmed Lubuk Pakam
Hospital. The research sample was taken using total
sampling technique.
Data collection using primary data and
secondary data. Primary data were obtained by
conducting direct interviews with respondents with
the guideline questionnaire that has been prepared
in the form of questions. The number of questions
is 30 questions, using a likert scale with a choice of
answers always, sometimes and never. Validity of
the instrument was done by using validity and
reliability tests. The instrument validity test was
conducted on 30 people. Indicators of each
instrument are said to be valid when the correlation
value was calculated > correlation table (0.3) and
was said to be reliable when the Cronbach alpha
value > 0.6. Collecting secondary data obtained
from Human Resources at Grandmed Hospital
Lubuk Pakam. In carrying out the development of
research instruments, it can follow the Research
and Development or R&D procedures and the
instruments produced become products that result
from conducting R&D research. In the context of
this paper scientific research instruments are tools
used to assess the level of computer vision
syndrome. Data were analyzed using validity and
reliability tests to explain the suitability of the
measuring instrument.
The research process starts from identifying
problems at the research site, conducting literature
studies, formulating problems and research
objectives, determining research methods to be
used, identifying samples to be studied, preparing
research questionnaires, testing questionnaires and
distributing questionnaires, processing data,
determine the characteristics of the sample, describe
the results and discussion and make conclusions and
suggestions on the research obtained.
The flow of research activities was described in the
following of Figure 1:
Design and Trial of Computer Vision Syndrome Level Instruments
129

Figure 1: Research Activity Flow.
Computer vision syndrome or often also referred to
as visual fatigue and digital eye strain, is a term for a
collection of symptoms related to eye disorders due
to the use of computer-based electronic devices, such
as laptops, desktops, cellphones, and tablets.
Symptoms that usually accompany CVS are fatigue
or aching in the eyes, blurred or double vision, and
red, dry, or hot eyes. Even in some cases, headaches,
necks, shoulders and back can be accompanied. The
longer the duration of computer use, the longer the
symptoms will last, even continuing after computer
use is complete. Computer vision syndrome can arise
due to several reasons, namely: 1) when staring at the
screen, the eyes continue to move from one point to
another and focus for a long time. This activity
requires hard work of the eye muscles. 2) The letters
on a computer screen are generally not as sharp as in
the print media, so unconsciously it will force our
eyes to focus more on reading them. 3) Flickering and
glare coming from the screen adds to the workload on
the eyes. 4) The frequency of eyes to blink tends to
decrease when staring at the screen. This causes the
eyes to become drier.
The Figure 2 is the process of the occurrence of
computer vision syndrome was explained as follows:
Figure 2: The process of the occurrence of computer vision
syndrome.
Table 1 is an overview of the respondents'
characteristics at the Grandmed Lubuk Pakam
Hospital:
Table 1. Characteristics of Respondents at Grandmed
Lubuk Pakam Hospital.
No Characteristics f (%)
1 Length of working
8 hours 30 100,0
Total 30 100,0
2 Working period
1-4 years
5-8 years
9-12 years
30
-
-
100,0
-
-
Total 30 100,0
3 RESULT AND DISCUSSION
3.1 Instrument Development
The preparation of the research instrument follows
the stages of development research. According to
Soenarto in Basic Concepts and Development
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Eligibility Methods in the field of education, research
development aims to produce products that can be
used to improve and improve quality. The concept of
developing a computer vision syndrome level
instrument was explained in Figure 3:
Figure 3: Instrument development.
The steps in developing a research instrument were
explained as follows:
a. Research and information collecting , was
carried out through preliminary studies by
gathering information on contextual conditions
where research will be conducted, reviewing
literature, research field observations , classes or
laboratories.
b. Planning, determining goals, identifying skills,
determining performance to be assessed.
c. Develop preliminary form of product , develop
initial instruments, prepare instrument lines, data
collection methods , and assessments.
d. Preliminary testing, validating the initial
instruments (products) produced in step 3.
e. Main product revision , product revision based
on input from the initial test. Conduct interviews,
observations and questionnaires on research
subjects.
f. Main field testing, field testing of 30 or more
respondents as product user respondents. Me
accumulate quantitative data.
g. Operational product revision , revising the
product based on input in field trials.
h. Operational testing testing, field trials involved
30 respondents of product users, collecting
quantitative data.
i. Final product revision, revising the instrument
based on input from operational field trials to
produce the final product.
j. Dissemination and implementation, making a
final product report and presented through a
seminar on research results.
Table 2 explains the content of the developed
questionnaire. The total questionnaire developed was
30 questions using a likert scale with a choice of
answers always, sometimes and never. The
questionnaire contains questions related to
complaints when using the computer in the eye area
such as eye pain, dry eyes, watery eyes, sandy eyes,
sore eyes, sore eyes, moving eyes when reading,
blurred vision, double vision, difficulty in vision,
eyes dazzled. The contents of the questionnaire also
explained the complaints felt by respondents in the
head, shoulders and neck. The following describes the
content of the developed questionnaire. The
developed questionnaire will be distributed to 30
respondents. Each respondent will be given 1
questionnaire and are required to fill in every question
contained in the questionnaire.
Table 2: Research Instruments.
No Questions
1. Do you have vision complaints such as tired
eyes?
2. Do you used eydrops when use a computer ?
3. Do you have complaints about using your
computer, such as aching eyes ?
4. Doyou chave visual complaints such as pain
when used computer in the eye area?
5. Do you have vision complaints when used
computer like dry eyes?
6. Do you feel like watery eyes when used
computer?
7. Do you feel have sand when used computer?
8. Do you have a headache when used your
computer?
9. Do you feel that your eyes feel sore when you
used computer?
10. Do the words in the text move when you read
on the computer for a long time?
11. Do you feel blurred when you used
computer?
12. Do you feel that you have double vision when
used computer ?
13. Do you have difficulty in focusing your eyes
on used computer?
14. Do you feel glare when used computer?
Design and Trial of Computer Vision Syndrome Level Instruments
131

15. Do you feel that in using your computer it is
not clear to see objects at close range or at far
distances?
16. Do you feel pain around the shoulder when
used computer?
17. Do you feel pain around the neck when used
computer?
18. When used computer do you feel changes in
vision or perception of color?
19. Do your vision go dark after used the
computer for a long time?
20. Do you really like holding your eyes
(rubbing) when used a computer?
21. Do you feel your eyelids twitching when used
a computer?
22. Do you easily feel sleepy when used a
computer?
23. Do you feel difficult to concentrate when
worked with a computer?
24. When used computer you narrowedyour eye?
25. Did you got a lot of errors in worked with a
computer?
26. Do you feel headaches when used the
computer for a long time?
27. Do you feel shoulder stiffness after a long
used computer?
28. Do you feel unbalanced whenyou stand up
after used an old computer?
29. Do you feel your thinking power has
decreased after used an old computer?
30. Do you wear anti-radiation glasses?
3.2 Test Research Instruments
This research used primary data. Data collected by
questionnaire technique, namely by giving written
questions to respondents. Furthermore the respondent
gave a response to the question given. Considering
that the data collection was carried out using a
questionnaire, the seriousness of the respondents in
answering the questions was very important in the
study. The questionnaire administered was designed
using a three -point Likert scale. The validity or
validity of the results of social research was largely
determined by the measuring instrument used. To
overcome this, two types of tests were needed,
namely the test of validity (test of validity or validity)
and the test of reliability (reliability test).
3.3 Test Validity of Research
Instruments
Validity test was used to measure the validity or
validity of a questionnaire. A questionnaire was said
to be valid if the questions on the questionnaire were
able to reveal something that will be measured by the
questionnaire. This study besides using content
validity test was a test related to the extent to which a
measurement scale / instrument represents the overall
characteristics of the content being measured, also by
means of AIC ( Average Inter-Item Correlation )
testing with a benchmark that gets an excess
coefficient value of 0.30 is declared valid.
Based on Table 3 of the validity testing results
, it was known that thirty questions used in the
research instrument have correlation coefficients
ranging from 0.542 to 0.973 . This could be
interpreted that each of the questions was valid. In
other words, these questions can represent or form the
construct of the computer vision syndrome incident
variable.
3.4 Reliability Test
Reliability test is a term used to indicate the extent to
which measurement results are relatively consistent if
measurements are repeated twice or more. Data
reliability in this study was tested using Inter-item
Consistency Reliability which saw Cronbach's
coefficient alpha as the coefficient of reliability.
Cronbach's alpha is a reliability coefficient that
shows how the parts of a set are positively correlated
with each other. An instrument is considered reliable
if it has an alpha coefficient (α) of 0.6 or more.
The basis for decision making for a reliable
instrument was:
1. If the alpha coefficient (α) test was greater than
(≥) 0.6 then the questions in the questionnaire are
worth using (reliable).
2. If the alpha coefficient (α) of the test was less
than (<) 0.6 then the questions in the
questionnaire are not reliable.
The cronbach's alpha coefficient for each construct is
meeting the recommended reliability criteria (greater
than 0.60). Thus, the respondents' answers to
questions that were used to measure each of these
constructs was consistent and construct trustworthy
(reliable).
The results of the analysis of the computer
vision syndrome instrument test on computer users
were presented in the in the Table 3:
Table 3 . Results of Analysis of Test Validity and
Reliability of Research Instruments.
No The question Validity Reliability
1 Question 1 0, 542 0.986
2 Question 2 0, 542
0.986
3 Question 3 0, 640
0.986
4 Question 4 0, 973
0.986
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132

5 Question 5 0, 846
0.986
6 Question 6 0, 928
0.986
7 Question 7 0, 944
0.986
8 Question 8 0, 897
0.986
9 Question 9 0, 567
0.986
10 Question 1 0 0, 936
0.986
11 Question 1 1 0, 623
0.986
12 Question 1 2 0, 872
0.986
13 Question 1 3 0, 910
0.986
14 Question 1 4 0, 892
0.986
15 Question 1 5 0, 973
0.986
16 Question 1 6 0, 846
0.986
17 Question 1 7 0, 928
0.986
18 Question 1 8 0, 944
0.986
19 Question 1 9 0, 897
0.986
20 Question 20 0, 567
0.986
21 Question 21 0, 936
0.986
22 Question 22 0, 872
0.986
23 Question 23 0, 910
0.986
24 Question 24 0, 892
0.986
25 Question 25 0, 973
0.986
26 Question 26 0, 846
0.986
27 Question 27 0, 928
0.986
28 Question 28 0, 944
0.986
29 Question 29 0, 897 0.986
30 Question 30 0, 567 0.986
3.5 Old Use of Computers
Table 4 shows that the majority of the old computer
use was in the medium category of 20 people
(66,6%). Increasing working hours at the computer
without interspersed with other activities can reduce
the ability of accommodation so that it will aggravate
the symptoms of CVS on computer user workers.
The use of computers that are too long without
interspersed with other activities can aggravate
symptoms and increase symptoms of Computer
Vision Syndrome (CVS) to workers. The longer
duration of daily computer exposure is directly
proportional to the number of symptoms experienced
by respondents of computer users (Raymond, 2017).
The continuous used of computers for more than
4 hours has 26 times the risk of causing Computer
Vision Syndrome compared to the use of less than 4
hours (Azkadina , 2015). There was a significant
relationship between the length of computer use that
was carried out continuously with the incidence of
Computer Vision Syndrome (Bali, et al, 2015).
In
carrying out work in the BPJS office, employees work
together in carrying out many activities, such as
inputting data, data entry, and other work that uses
computers. This is the cause of CVS when doing
continuous work in front of the computer without a
break or ignoring things that will result from the long
use of the computer due to the work to be completed
first. For the employee's own knowledge about the
dangers of using the computer for too long it might be
good but just ignored because it is considered not too
important.
A rest period of less than 10 minutes after
computer use has a twenty old risk of suffering from
CVS compared to rest for more than or equal to 10
minutes after computer use.
Table 4: Distribution of Respondents Based on the Length
of Computer Usage at BPJS Office Employees.
Old Use of
Computers
Frequency
(people)
Percentage
(%)
Light
Medium
Weight
5
20
5
16.7
66.6
16.7
Total 30 100.0
3.6 Computer Vision Syndrome
Incidence
Table 5 shows that the majority of respondents
experienced CVS as many as 26 people (72.2%). The
American Optometric Association (AOA) defines
Computer Vision Syindrome (CVS) as a collection of
symptoms in the eyes and vision associated with the
use of computers, tablets, and cell phones with short
distances and lasts long (AOA, 2017). Computer
Vision Syndrome was also a term used to describe
various symptoms such as eye strain, eye discomfort,
headache, dry eyes, blurred vision at close range,
users who complain of pain in the neck and back were
also included in the symptoms CVS.
As many as 88.5% of respondents experienced
CVS complaints, this result was higher than the
prevalence of CVS in employees of a University in
Malaysia that is equal to 68.1%. The most common
complaints of CVS were eye strain / asthenopia and
neck / shoulder / back pain, each at 73.9%.
Meanwhile, CVS complaints that were least
experienced were dry / sandy eyes, which was 23.2%
(Jonge, 2018).
Quoting from the A Merican Optometrist
Association (AOA) to prevent eye fatigue, the
monitor should be placed in a position of 16-30
inches, depending on how big the screen is. Generally
a comfortable position for staring at a monitor was at
least 20 inches or 50 cm.
The occurrence of Computer Vision Syndromewa
was caused by prolonged use of computer signs
interspersed with adequate rest which causes CVS
symptoms. In addition, based on a questionnaire filled
out by BPJS office staff more answers to the answers
Design and Trial of Computer Vision Syndrome Level Instruments
133

"sometimes and always" on questions that lead to
questions experienced by employees every time they
use a computer, which means BPJS employees
experience CVS symptoms.
Table 5: Distribution of Respondents Based on Computer
Vision Syndrome Events.
Computer Vision
Syndrome Incidence
Frequency
(people)
Percentage
(%)
No CVS Occurred
CVS happened
10
20
33.4
66.6
Total 36 100.0
4 CONCLUSION
The validity of the instrument level of computer
vision syndrome tested had correlation coefficient
values ranging from 0.542 to 0.973 and was declared
valid. The computer vision syndrome instrument level
reliability tested had a Cronbach alpha of 0.986 and
was declared reliable.
The majority of computer
usage time in Grandmed Lubuk Pakam Hospital
office employees was in the medium category with 20
people (66.6 %)
. The majority of office employees at
Grandmed Lubuk Pakam Hospital experience
computer vision syndrome , as many as 20 people (
66.6 %).
5 SUGGESTION
Apply a computer vision syndrome level instrument
to determine the occurrence of computer vision
syndrome in office employees. For leader of the
company should issue a Standard Operating
Procedure health work for the computer and prepare
policies in accordance with Standard Operating
Procedures and It was expected to conduct further
research by adding other variables related to room
lighting when used a computer that can cause
Computer Vision Syndrome events in computer
users.
ACKNOWLEDGEMENTS
Researchers thank all those who have helped during
the research process and all the staff of the Institute
for Health Medistra Lubuk Pakam, Grandmed Lubuk
Pakam Hospital and Sembiring Deli Tua Hospital.
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