Ophthalmic & Physiological Optics ISSN 0275-5408

REVIEW

A multidisciplinary approach to solving computer related

vision problems
Jennifer Long1 and Magne Helland2
1
School of Optometry and Vision Science, University of New South Wales, Sydney, Australia, and 2Department of Optometry and Visual Science,
Buskerud University College, Kongsberg, Norway

Citation information: Long J & Helland M. A multidisciplinary approach to solving computer related vision problems. Ophthalmic Physiol Opt
2012, 32, 429435. doi: 10.1111/j.1475-1313.2012.00911.x

Keywords: control rooms, ergonomics, Abstract

multidisciplinary teams, optometry, visual
displays
Correspondence: Jennifer Long
E-mail address: j.long@unsw.edu.au
Received: 4 January 2012; Accepted: 16
March 2012
Purpose: This paper proposes a multidisciplinary approach to solving computer
related vision issues by including optometry as a part of the problem-solving
team.
Recent findings: Computer workstation design is increasing in complexity.
There are at least ten different professions who contribute to workstation
design or who provide advice to improve worker comfort, safety and efficiency.
Optometrists have a role identifying and solving computer-related vision issues
and in prescribing appropriate optical devices. However, it is possible that
advice given by optometrists to improve visual comfort may conflict with other
requirements and demands within the workplace. A multidisciplinary approach
has been advocated for solving computer related vision issues. There are
opportunities for optometrists to collaborate with ergonomists, who coordinate
information from physical, cognitive and organisational disciplines to enact
holistic solutions to problems. This paper proposes a model of collaboration
and examples of successful partnerships at a number of professional levels
including individual relationships between optometrists and ergonomists when
they have mutual clients/patients, in undergraduate and postgraduate education
and in research. There is also scope for dialogue between optometry and
ergonomics professional associations.
Summary: A multidisciplinary approach offers the opportunity to solve vision
related computer issues in a cohesive, rather than fragmented way. Further
exploration is required to understand the barriers to these professional
relationships.

Information and communication technology (ICT) is a
part of modern life for people of all ages. Although white
collar work dominates in developed countries (e.g. 59%
Australian workers in 2006,1 60% American workers in
20022) electronic displays are not confined to these
industries, e.g. computers and visual displays are used in
vehicles, hand held devices (including phones) and in
industrial control rooms. Workers may also use multiple
devices mounted at different working distances and
displaying various computer applications. Figure 1 shows a
typical industrial control room with nine desk mounted
monitors, two of which are stacked vertically and five mon-
itors suspended from the ceiling above head height.
Such complexity poses a challenge for the clinical
optometrist who needs to be able to identify and solve
visual issues associated with computer use3 and prescribe
spectacle lenses according to the task requirements.4,5 An
ageing population worldwide6 also means that optome-
trists need to consider the impact of presbyopia and
vision complications of ocular and systemic disease on
the ability of individuals to see and use ICT comfortably.
For many presbyopic workers, ordinary general purpose
spectacles are insufficient for comfortable ICT use.79
Ideally, optical appliances should be prescribed after
the working environment has been configured8, and
patients may ask optometrists for advice on this matter

Ophthalmic & Physiological Optics 32 (2012) 429435 2012 The College of Optometrists 429
A multidisciplinary approach to solving vision ICT problems J Long and M Helland

information may be displayed on the screen page at any

Figure 1. A typical industrial control room.
during clinical consultations.10,11 Unfortunately, it is not
always a simple matter for an optometrist to advise their
patient to alter their working distance (since the display
may be fixed to the workstation), change the display mag-
nification, colour or font size (if the application does not
have this facility) or take more frequent rest breaks (if
this does not fit in with shift arrangements or work
demands). Recommendations to improve visual comfort
can also have other ramifications in the workplace. For
example, if the font size is increased on a display then less
one time; this in turn could reduce productivity and
increase the risk of musculoskeletal discomfort from
mouse scrolling.12
Many different professions are involved in the design,
manufacture and installation of computer workstations
and ensuring that workers can perform their work com-
fortably, safely and efficiently (see Table 1). With such
diverse input into the problem solving process, there is
the risk that solutions to vision problems will become
fragmented as each profession manages the issue accord-
ing to their understanding of the problem.13
Cohesive and well-rounded solutions to vision related
issues associated with computer use can be achieved by
adopting a multidisciplinary approach.1315 A multidisci-
plinary team is a group of individuals with various back-
grounds and expertise who work together under one
organisational umbrella or as a unique team to solve a
problem.16
Ergonomics (also known as human factors) is a disci-
pline which can achieve this aim since it has a broad scope
which includes physical (e.g. workstation arrangement),
cognitive (e.g. visual perception) and organisational
factors (e.g. work design).17 Table 1 maps potential vision
issues associated with visual comfort in the control room
depicted in Figure 1 against these three domains.

Table 1. Visual issues associated with control rooms and complex multi-screen environments and the professions who may provide advice on this
issue

Domain of
ergonomics/
human factors Visual issue within control room Professions

Physical Individual workers have adequate visual skills Optometry

Visual corrections are appropriate for the task
Display characteristics e.g. font size, display colours
Ambient temperature and humidity and its effect on
ocular comfort
Location of computer monitors e.g. height, distance,
arrangement at workstation
Lighting (artificial and natural) and the ability of workers
to adapt to illumination and luminance levels
Air quality, chemical and microbial hazards and the effect
on ocular surface health
Cognitive Amount of information displayed on each computer monitor
Colour coding within displays
Workload and issues of divided attention
Noise, alarms and other auditory distractions which compete
with visual attention
Organisational Workload and issues of divided attention
Rest breaks and fatigue
Shift length
Optometry
Engineering, interface design, optometry
Occupational hygiene, occupational medicine, optometry
Architecture, ergonomics/human factors, engineering,
optometry
Architecture, engineering, lighting design, optometry
Occupational hygiene, occupational medicine, optometry
Engineering, ergonomics/human factors, interface design,
psychology
Engineering, ergonomics/human factors, interface design,
optometry, psychology
Ergonomics/human factors, management, psychology
Ergonomics/human factors, psychology
Ergonomics/human factors, management, psychology
Ergonomics/human factors, management, occupational
medicine, optometry, psychology
Ergonomics/human factors, management, psychology

430 Ophthalmic & Physiological Optics 32 (2012) 429435 2012 The College of Optometrists
J Long and M Helland A multidisciplinary approach to solving vision ICT problems

Table 2. An example of the process for designing and installing new visual displays in a workplace and the professions who may provide advice
on this issue

Stage Description Profession

Initiator The need for a new visual displays is identified Management, workers
1 Task/job is analysed and workers are consulted to determine specifications Ergonomics/human factors, engineering,
which are required management, workers
2 Computer software and hardware is sourced or designed based on the Management, interface design, engineering,
requirements identified in stage 1. ergonomics/human factors, optometry
Software options include custom designed software, off the shelf software which
is used unmodified and off-the-shelf software which is customised for the workplace
3 Work environment is designed taking into consideration industry standards, work Architecture, engineering, ergonomics/human
and computer system requirements identified in stages 1 and 2 and commercial factors, lighting design, optometry
availability of products (hardware, infrastructure, furniture). Design aspects include:
Number and location of displays
Lighting, thermal and acoustic environment
4 Post-occupancy modifications may be implemented. For example, relatively minor Architecture, engineering, ergonomics/human
modifications to the location of displays, furniture and lighting. factors, lighting design, optometry
5 The requirements of individual workers are addressed, if indicated. For example: Ergonomics/human factors, optometry
Task specific spectacles are prescribed
Ancillary equipment is provided e.g., footrests

Ergonomists strive to improve comfort, safety and pro-
ductivity by ensuring a balance between the capabilities of
individuals and the elements of the environment in which
they interact. They achieve this by coordinating informa-
tion gained from a variety of sources with the aim of
enacting holistic solutions to problems.12 Optometry can
contribute to this process by establishing professional
partnerships with ergonomists. This is similar to shared
care arrangements which optometrists may have with
other healthcare professionals for patients with complex
medical needs.18,19
There are many different levels at which optometrists
and ergonomists can interact in the design and installa-
tion of ICT environments (see Table 2). Optometrists
commonly participate in the last stage of this process
(prescribing task appropriate eyewear) but may have
involvement in stage 2 (e.g. providing advice on font col-
our or size), stage 3 (e.g. predicting vision issues within a
work environment so these issues can be designed out)
or stage 4 (e.g. suggesting modifications to a lighting
installation to solve glare related issues). This paper pro-
poses a model of collaboration and examples of successful
partnerships between optometry and ergonomics at a
number of professional levels.
In the workplace
In an ideal world, optometrists participating with ergono-
mists in multidisciplinary teams would visit workplaces to
observe the environment firsthand. This would help
optometrists understand the work context and any com-
peting issues (e.g. if displays are fixed to the workstation)
and assist them in providing solutions which can actually
be implemented. There are optometrists who work in this
way, but there are very few reports in the scientific litera-
ture documenting these relationships.
One example which has been extensively reported is a
Scandinavian project conducted over more than 15 years
which has included optometrists, occupational physicians,
lighting designers, workstation designers and occupational
health personnel.2022 The investigation has included eval-
uation of visual discomfort with lighting conditions, mus-
culoskeletal discomfort and the effect of spectacle
corrections on visual comfort.20 It was later expanded to
evaluate musculoskeletal, visual and psychosocial stress in
office workers associated with moving from single occu-
pancy to open plan offices.21,22
Initial optometric involvement was to provide eye exam-
inations, prescribe spectacles and gather ocular-specific
data (e.g. measurements of eye-blink rate). However, dur-
ing the open-plan office stage of the project the optome-
trists on the team identified glare issues with the lighting
and were able to negotiate with the lighting designers for
an alternative installation to avoid glare problems.21 Modi-
fications to the lighting included replacing the reflectors
within the luminaires from shiny to semi-diffuse (to
reduce the luminance from the reflector-louvre system),
lowering the height of the fittings from 2.8 m to 2.15 m
(to minimise the direct view of the fluorescent lamps
within the luminaires) and installing Venetian blinds on
the windows (to provide better control of natural light).
This process was facilitated by the workplace medical doc-
tor who had training in occupational medicine and coordi-
nated the project.

Ophthalmic & Physiological Optics 32 (2012) 429435 2012 The College of Optometrists 431
A multidisciplinary approach to solving vision ICT problems J Long and M Helland

This was essentially a research project. One of the
optometrist participants had worked with the company
health care team for many years while the other was
invited to participate through his academic institution.
This should not preclude optometrists in clinical practice
from participating in similar arrangements. When
relationships are built with industry in other capacities
(e.g. through the provision of prescription eyewear for
computer users) opportunities for further collaboration
will arise as relationships develop.
In the consultation room
Building relationships with industry sounds easy but
is it? One way to build associations between ergonom-
ics and optometry is to acknowledge that optometrists
and ergonomists may already have mutual clients/
patients. Rather than relying on the patient, formal
communication between the two professions can help
optometrists provide more targeted solutions and
improve vision related outcomes associated with ICT
use. For example:
(1) Ergonomists can provide information about the task
requirements to optometrists e.g. by photographs of the
work environment and measurements of working dis-
tances and viewing positions2325. This will assist optome-
trists in understanding the work environment before they
make prescribing decisions. Table 3 provides an example
of the type of information which could be provided by an
ergonomist prior to spectacles being prescribed for a
worker who works in the control room shown in Figure 1.
(2) Optometrists can communicate their findings and
prescribing decisions to ergonomists. It would be difficult
to prescribe spectacles for a presbyope who works at the
control room shown in Figure 1: single vision and
extended focus lenses (i.e., specially designed spectacle
lenses for computer work primarily focussed for interme-
diate and near distances) would be suitable for viewing
the vertically stacked monitors but would not allow clear
distance viewing, whereas progressive lenses would allow
clear viewing both at distance as well as the monitors sus-
pended from the ceiling but would require neck flexion
when viewing the vertically stacked monitors.
A model for this type of collaboration is described by
the Norwegian Labour Inspection Authority and has three
stages: (1) an ergonomics assessment is conducted within
the workplace and the workstation environment is opti-
mised. (2) The lighting conditions are evaluated and opti-
mised. (3) Visual parameters are measured e.g. viewing
distance, viewing angles and gaze direction.26 This process
has been successfully used by the first author (JL) in a
control room environment. In this case, the first two
stages were conducted by ergonomists and engineers
hired by the employer. The third stage consisted of the
first author making physical measurements of the work
environment and evaluating commercially available spec-
tacle lens options to determine which lens designs would
be most appropriate. Information about the work envi-
ronment and potentially suitable (and unsuitable) specta-
cle lens designs were included in a letter provided to the
optometrist by the control room operators. This assisted
the prescribing of appropriate eyewear and initiated dia-
logue between the ergonomists and optometrists.
Ergonomists in Australia have indicated that they
would like to have working relationships with clinical
optometrists but report difficulty identifying optometrists
interested in these collaborations. Communication could
be initiated by shared professional development events

Table 3. Task requirements information which could be provided by an ergonomist prior to an optometrist prescribing spectacles for a worker
who works in the control room shown in Figure 1.

Please provide a diagram or a photograph of the worker sitting/standing at their workstation.

Either indicate on the diagram or write below the following dimensions and measurements:
Number of displays
Location of displays
Size of displays
Other task requirements
How many displays does this worker use?
What proportion of time is spent using each display?
What is the height of each display relative to the workers eyes?
What is the viewing distance to each display?
What is the horizontal location of the display relative to the workers eyes? For example:
If using 2 monitors, is the worker seated midway between the two?
Do they swivel or move their chair to view each display?
What is the size of each visual display? (i.e. monitor size)
What is the total width of the display (i.e. all the monitors combined, physical size in centimetres)?
What size font does the worker typically view (physical size in millimetres)?
Are any other tasks performed e.g. reading, walking around or viewing out of the window?
Is it acceptable for the worker to have more than one pair of spectacles e.g. one for distance viewing and
one which is task-specific?
Are tinted lenses (e.g. photochromic lenses) required?
Do task-specific spectacles need to be constructed as prescription safety spectacles (e.g. provide impact resistance)?

432 Ophthalmic & Physiological Optics 32 (2012) 429435 2012 The College of Optometrists
J Long and M Helland
between the professions.23 This strategy is currently being
trialled with the Human Factors and Ergonomics Society
of Australia (HFESA) and the Optometrists Association
of Australia (OAA) so that individual optometrists and
ergonomists can meet each other, participate in a shared
professional development event, learn from each other
and strengthen communication when they have mutual
clients.
A more informal approach is to invite optometrists to
ergonomics conferences, and vice versa, when there is rele-
vant visual ergonomics content so that optometrists and
ergonomists can create their own networks. This is being
explored this year in Scandinavia by advertising the Nordic
Ergonomics Society conference (which has a strong visual
ergonomics component) in optometric publications.
Overcoming the barriers
One of the challenges for inter-professional partnerships
is that individual team members have different perspec-
tives of issues and problems13 and this can be perceived
as a hindrance to the problem solving process.27
It has been argued that multidisciplinary teams will
only be effective if the participants have education and
training in the environment in which they are working.27
While this may be a valid suggestion for an ergonomist
working full-time in an engineering or manufacturing
firm27 and for optometrists who participate in on-site
workplace interventions, it may not be feasible or practi-
cal for professionals who provide specific expertise in a
more limited capacity, e.g. clinical optometrists prescrib-
ing eyewear for computer users.
Irrespective of whether optometrists deal with vision
and ICT issues by visiting workplaces or remaining in
their consultation room, it is important that they have a
global understanding of the work environment, are aware
of the scope of work of the other team members and are
prepared to negotiate solutions to problems.28 An under-
standing of ergonomics and prescribing appropriate opti-
cal appliances for occupational use is a core competency
for optometrists in some countries.10,11,24 Expanding this
to include discussion about optometric involvement in
multidisciplinary teams can improve the success of these
relationships. This strategy has also been proposed for
occupational medicine.29
It is worth remembering that inter-disciplinary collabo-
rations develop over time and rely on an understanding
of the potential contribution which can be made by other
professions. For example, control room design has long
been the province of engineering and it has only been rel-
atively recently that ergonomics has participated in the
design process.30 Now it is accepted practice that archi-
tects, engineers, system designers, ergonomists and user
Ophthalmic & Physiological Optics 32 (2012) 429435 2012 The College of Optometrists
A multidisciplinary approach to solving vision ICT problems
representatives may be involved in the design and instal-
lation of full-scale simulations of control rooms before
final construction.31
Visual issues are acknowledged in control room envi-
ronments31,32 but optometrists are rarely included in
these teams. One reason for this could be lack of aware-
ness of their potential contribution. The first author (JL)
was recently invited by the ergonomics team at an indus-
trial site to give a presentation to engineers about visual
issues and control rooms. This presentation was part of a
larger education program within the organisation to
introduce engineers to different aspects of ergonomics
and design. In the ensuing discussion, one engineer com-
mented that he was aware of the various rules for inter-
face design and monitor placement but did not
understand the rationale for these rules. He believed that
if he was provided with specific information about visual
capabilities and the limitations of spectacle lens for pres-
byopia then it would be relatively easy to incorporate
these considerations into future designs, e.g. by designing
the work environment for a lesser number of viewing dis-
tances33 or limiting the use of vertically stacked monitors.
Ergonomists are often responsible for disseminating
information about vision and work within workplaces
and promoting the use of task-specific eyewear. There are
many existing health and safety publications34,35 which
assist these professionals with this process. However, there
is a need for optometric involvement in undergraduate
and postgraduate health and safety programs as this will
raise the profile and increase general understanding of
vision issues within workplaces. For several years the first
author (JL) has participated in this type of teaching.
Anecdotal reports from course participants indicate that
this is beneficial for their work and improves confidence
when dealing with eye care practitioners.
Future directions
The control room in Figure 1 is typical of a modern con-
trol room. As technological capabilities improve it is
likely that these work environments will increase in com-
plexity through the installation of more monitors, the use
of virtual displays and the invention of other types of
ICT interfaces. Existing spectacle lens designs for presbyo-
pia are often unsuitable for modern computer worksta-
tions. This can be a frustrating issue for optometrists who
try to prescribe appropriate eyewear, for users who find
the eyewear uncomfortable and for health and safety per-
sonnel who manage problems arising from poor posture
or the inability of workers to see clearly.
The advent of new forms of technology opens up pos-
sibilities for partnerships between interface designers and
vision scientists to devise alternative display options (as
433
A multidisciplinary approach to solving vision ICT problems
opposed to the current trend of providing more and lar-
ger monitors at individual workstations). There is also
the potential for partnerships between workstation
designers and spectacle lens manufacturers to design alter-
native spectacle lenses for presbyopia which meet the
visual requirements of these modern work environments.
Research is required into the acceptance of task specific
lenses for modern computer environments by optome-
trists, industry and patients while addressing any barriers
to their use. This will supplement earlier research pub-
lished when task specific lenses were first introduced into
the ophthalmic market.36,37
The optometric profession has a history of contributing
to knowledge and understanding about vision and com-
puters in the development of guidelines, standards and
recommendations.38,39 This needs to continue, particularly
for the use of new technology, complex multi-screen work-
stations and mobile (flexible) workstation arrangements.
There is also scope for dialogue between optometry
and ergonomics at a professional level, both nationally
(e.g. with ergonomics associations in individual countries)
and internationally (e.g. with the International Ergonom-
ics Association Technical Committee for Visual Ergonom-
ics). Further exploration is required to understand the
barriers to these collaborative relationships (including
funding arrangements for optometric participation), how
best to evaluate and document the short- and long-term
effectiveness of these partnerships and how to encourage
publication of case examples which illustrate successful
working partnerships.
Conclusion
There are many opportunities for developing partnerships
between optometry and ergonomics. A multidisciplinary
approach which includes optometrists offers the opportu-
nity to solve vision related computer issues in a cohesive
manner. This has the potential to improve visual comfort
whether in complex visual environments (as illustrated in
this paper), at standard office computers or when using
technology for personal and leisure activities.
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