Original Research

Impact of an educational intervention using the 20/20/20 rule on Computer Vision Syndrome

Waleed M. Alghamdi, Saif H Alrasheed
African Vision and Eye Health | Vol 79, No 1 | a554 | DOI: https://doi.org/10.4102/aveh.v79i1.554 | © 2020 Waleed M. Alghamdi, Saif H. Alrasheed | This work is licensed under CC Attribution 4.0
Submitted: 06 February 2020 | Published: 23 September 2020

About the author(s)

Waleed M. Alghamdi, Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
Saif H Alrasheed, Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia; and, Department of Binocular Vision, Faculty of Optometry and Visual Sciences, Al-Neelain University, Khartoum, Sudan


Background: Global estimates suggest that nearly 60 million people suffer from Computer Vision Syndrome (CVS).

Aim: The goal of this research was to evaluate the effectiveness of an educational intervention using the 20/20/20 rule to reduce CVS symptoms.

Setting: The study was conducted in the Qassim University eye clinic.

Methods: An experiential intervention study was conducted amongst 40 patients with CVS, with their age ranging from 21 to 38 years. The sample was divided into two groups: (1) intervention patients (n = 20), who were given a structured advice booklet about how to reduce CVS symptoms using the 20/20/20 rule, and (2) control (n = 20) with CVS, who were given advice to simply drink more water. Both groups completed two questionnaires, namely, the CVS-Q and Dry Eye Questionnaire-5 (DEQ-5). Dry eye clinical tests were performed. The same procedures were repeated after 20 days to compare the outcomes before and after intervention.

Results: The study findings revealed that patients complaining from dry eye symptoms showed significant changes after the educational intervention (pre-intervention: 9.05 ± 4.32; post-intervention: 7.10 ± 3.61) (p = 0.04). The symptoms of CVS were slightly reduced after educational intervention, from 9.00 ± 3.03 to 8.35 ± 1.89 (p = 0.38). However, TBUT showed a significant increase after the educational intervention (pre-intervention: 6.20 ± 2.02 s; post-intervention: 8.55 ± 2.84 s) (p = 0.005).

Conclusion: The educational intervention of the 20/20/20 rule induces significant changes in dry eye symptoms and tear film and some limited changes for ocular surface integrity.


Computer Vision Syndrome; dry eye; ocular surface integrity; 20/20/20 rule; Dry Eye Questionnaire; tear film break-up time; digital eye strain; ocular discomfort.


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