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Computer Vision Syndrome Smart Questionnaire and Score (CVS-Smart)

Article · July 2024

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Mohammed Iqbal
Sohag University Hospital, Sohag University, Egypt.
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 Computer Vision Syndrome Smart (CVS-Smart)
Questionnaire and Score
CVS-Smart questionnaire1, 2
The Computer Vision Syndrome–Smart (CVS-Smart) questionnaire is a novel reliable
and valid ultra-short self-assessment questionnaire that can definitely diagnose CVS
cases without the need of ophthalmic examination.1 The CVS-Smart is linked to an
additional score (CVS-Smart score) that provides the suitable diagnosis and
recommendation.1, 2 CVS-Smart is supported by Iqbal’s anti-CVS protective measures
(Iqbal’s instructions) to re-schedule the screen time and style to guard against the
potential CVS sequelae.1, 2 The CVS-Smart included only five questions that were
developed from the reliable and valid CVS-F4 questionnaire1, 3 (Kuder Richardson 20
Formula .81 and Content Validity Index 0.92)1 and the experts’ recommendations.1, 3, 4
CVS-Smart questionnaire is ideal for University students and young adults.1 Both CVS-
Smart questionnaire and score are available as online tool at SurveyMonkey web site. 2
However, it could be printed in a paper format as desired for personal use or research
work.

CVS-Smart online link2

https://www.surveymonkey.com/r/YHXVNWC

Informed/Electronic consent1, 2
Please note that your response to the online CVS-Smart is considered as an informed
or electronic consent that we could use the resultant data in the scientific research and
analysis to improve the CVS-Smart and score. Be sure that there is no personal data
required in this questionnaire and your response is anonymous (no names required for
online CVS-Smart).

Alternatively, you can simply print the CVS-Smart questionnaire and score for personal
use to self-assess your CVS-status. Individual/Personal use of CVS-Smart requires no
permissions. Permissions are only required when CVS-Smart is used for research work.
Reliability and validity of CVS-Smart questionnaire1, 2

Variables CVS-Smart
Number of questionnaire items 5
Responses 3 responses/answers/choices for each questionnaire item
Reliability indices:
Cronbach's Alpha Coefficient .860 (high reliability)
Guttman Split-Half Coefficient .805 (high reliability)
Interrater Reliability
(Spearman's rho correlation coefficient):
-Significance at a 0.01 significance level significant for all questionnaire items
-Correlation Interpretation Moderate to strong correlation for all questionnaire items
(range .511-.691)
Validity indices:
I.Content validity (by 5 experts)
-Content Validity Ratio (CVR) 1 for each of 5 questionnaire items
-Content Validity Index (CVI) 1 (perfect content validity)
II.Face validity (by non-experts)
Face validity was evaluated by some Strong, clear, relevant, appropriate, concise, simple, easy
medical students (participants) to understand, comprehensive and all 5 items are of
same importance
III.Construct validity
A.Confirmatory Factor Analysis (CFA)
-Comparative Fit Index (CFI) .986 (good fit)
-Tucker Lewis Index (TLI) .971 (good fit)
-Root Mean Square Error of .078 (mediocre fit)
Approximation (RMSEA)
B.Spearman's rho correlation coefficient
-Significance at a 0.01 significance level significant for all questionnaire items
-Correlation Interpretation strong correlation for all questionnaire items (range .771-
.830)

How to self-assess yourself

Please, read and respond carefully to the following 5 questions, then refer to the CVS-
Smart score to diagnose your CVS-status by yourself and discover a friendly-guide tool
to manage your case. Both CVS-Smart score and Iqbal’s instructions are linked at the
end of this CVS-Smart questionnaire. CVS-Smart score of 7-10 score points signifies a
positive CVS-case.1, 2
 Computer vision syndrome-Smart questionnaire (CVS-Smart) 1, 2
Name (optional): Age: Sex: Occupation:
5 Questions Content CVS diagnostic criteria Score
1. Visual 9 visual complaints: Question 1:
Blurred vision
Eye strain/fatigue Out of these 9 visual complaints; how
Double vision/diplopia many complaints you suffer from?
Difficulty in refocusing the eyes No visual complaints 0
Near vision discomfort/difficulty
Unclear objects post-screen use One visual complaint 1
Glare/seeing halos of light
Feeling diminution of vision Two or more visual complaints 2
Increased sensitivity to light
2. Ocular 9 ocular surface complaints: Question 2:
surface Dry eyes
Eye redness Out of these 9 ocular surface complaints;
Eye irritation/discomfort how many complaints you suffer from?
Foreign body sensation No ocular surface complaints 0
Burning sensation/stinging sensation
Itching/eye rubbing One ocular surface complaint 1
Lacrimation/watery eye
Eyelids feel heavy Two or more ocular surface complaints 2
Frequent blinking
3. Extraocular 9 extraocular complaints: Question 3:
Headache
Neck pain Out of these 9 extraocular complaints;
Shoulder pain how many complaints you suffer from?
Back pain No extraocular complaints 0
Joint pain in fingers and wrists
Inability to hold objects well One extraocular complaint 1
Difficulty to write using a pen
Sleep disturbances/ insomnia Two or more extraocular complaints 2
Inattention/depression
4. Frequency Frequency of the complaints Question 4:
How do you describe the frequency of
your complaints?

Rare 0
Infrequent 1
Frequent 2
5. Screen- The complaints should be related to Question 5:
associated and associated with the time of
screen use Are your complaints associated with the
time of the screen use? (i.e. are your
complaints exist during the time of screen
use?)

Never 0
Sometimes 1
Always 2
Total score 0-10 points
 The CVS-Smart Score1, 2
CVS-Smart CVS-case Recommendations
total score probability status
7-10 points Positive CVS-case -Consult your ophthalmologist or optometrist to receive the
(CVS diagnosis is appropriate treatment
confirmed) -Reduce your screen-time
-Follow Iqbal’s instructions
-If you already have a chronic eye disease or pathology, or
previous eye surgery; this diagnosis might be inaccurate in your
condition
5-6 points High probability -Consult your ophthalmologist or optometrist to confirm or
exclude CVS diagnosis
-In case you are diagnosed as a positive CVS-case, please
receive the appropriate treatment
-If you are diagnosed as a negative CVS-case, please repeat
CVS-Smart every 6 months for check-up
-Reduce your screen-time
-Follow Iqbal’s instructions
3-4 points Low probability -Repeat CVS-Smart every 6 months for check-up
-Reduce your screen-time
-Follow Iqbal’s instructions
1-2 points Not CVS-case -Repeat CVS-Smart every 6 months for check-up
-Follow Iqbal’s instructions to improve your score to 0 points
0 points Normal subject -Follow Iqbal’s instructions as prophylactic measures
 Modified Iqbal’s instructions1, 2, 5

Iqbal’s anti-CVS protective measures

Screen-time Screen-style Eye-style and life-style
-Reduce your screen-time to minimum -Shift from hand-held to non-hand-held screens -Wear your spectacles during
-1 screen-hour daily is ideal -Shift from small-sized to large-sized screens watching screens
-Try not to exceed 2 screen-hours daily -Shift from old to new screen versions -Avoid/limit contact lens
-Focus your screen-hours to -Shift from screens to books for your studies wearing
accomplish your necessary -Print the necessary PDF or word files for your -Treat your eye disease as
assignments studies dry eye with necessary
-Specify one place only e.g. home or -Use speech language writing instead of medication
college to accomplish your keyboard
assignments
-Desktop computer or laptop is -Shift from other screens to TV screens to -Avoid taking your
preferred attend/watch necessary online courses, videos, smartphone to bed at night
-Avoid using smartphone to meetings, lectures and educational programs when you are going to sleep
accomplish your assignments -Connect TV screens to internet and watch i.e. keep your smartphone
-Day screen-hours are more preferred your desired movies, series and applications away from you when you are
than night screen-hours -The proper distance for watching TV is 4-6 sleeping
meters
-Avoid or limit video-calls -Avoid the following risk-factors that aggravate -Specify more time for sports
-Use regular audio-calls your subjective complaints: -Try to lose weight if you are
-Try to limit smartphone to audio-calls Poor screen-resolution or design overweight
and use other screens for video-calls if Screen-glare -Try to improve your social
necessary Screen edge at/above horizontal eye level life, family relationships and
-Uninstall the unnecessary applications Close eye-screen distance gain more friends
in your smartphone and other screens Poor lighting conditions -Get more interest with your
-Minimize your social-media Watch screen in the dark non-screen hobbies e.g.
applications’ time Uncomfortable seating postures diving
Small-font size -Join society organizations,
Texting with both thumbs public services or community
groups e.g. travelers’ groups
-Avoid continues screen watching, take -Adjust screen brightness to minimum possible -Adjust the indoor and
breaks and you could apply to the 20- -Try not to exceed 50% screen brightness outdoor light source to be
20-20 rule -Use smartphone holder instead of your hands above or behind your eyes

Permissions

To use CVS-Smart as a subjective instrument in research work, permissions should be

requested from Professor Mohammed Iqbal, MD, PhD

E-mail: dr_m_iqbal@yahoo.com

Institutional e-mail: mohamed_ahmed12@med.sohag.edu.eg

ORCID ID: https://orcid.org/0000-0002-7954-1277

 References

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Abdelhalim M, Shoughy S, Elgazzar A, Shamselden H, Hammour A, Eid M,

Elzembely H, Abdelaziz K. Visual, ocular surface, and extraocular diagnostic

criteria for determining the prevalence of computer vision syndrome: a cross-

sectional smart-survey-based study. Med Hypothesis Discov Innov Ophthalmol.

2024 Jul 1; 13(1): 1-15. https://doi.org/10.51329/mehdiophthal1489

2. CVS-Smart questionnaire (2021). ‘Computer Vision Syndrome Smart (CVS-

Smart) Questionnaire and Score’, SurveyMonkey website. Available at:

https://www.surveymonkey.com/r/YHXVNWC

3. CVS-F4 questionnaire (2021). ‘Computer Vision Syndrome Form 4 (CVS-F4)

Survey’, SurveyMonkey website. Available at:

https://www.surveymonkey.com/r/BTLGFDD

4. Iqbal M. Prevalence and Sequelae of Computer Vision Syndrome in Egyptian

Universities. 2021. [Accessed: May 30, 2024]. Available at:

https://clinicaltrials.gov/study/NCT05187221?term=NCT05187221&rank=1.

5. Iqbal M, Soliman A, Ibrahim O, Gad A. Analysis of the Outcomes of the Screen-

Time Reduction in Computer Vision Syndrome: A Cohort Comparative

Study. Clin Ophthalmol. 2023;17:123–134. doi: 10.2147/OPTH.S399044.

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