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            new TextRun({ text: 'Eye Strain and Screen Exposure — A Clinical Overview', italics: true, size: 18, color: '888888', font: 'Calibri' }),
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            new TextRun({ text: 'Sabiya | 6th Semester BSc Optometry | April 2026      Page ', size: 18, color: '888888', font: 'Calibri' }),
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      // ── Title block ─────────────────────────────────────────────────────────
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        children: [new TextRun({ text: 'EYE STRAIN AND SCREEN EXPOSURE', bold: true, size: 52, color: '1F3864', font: 'Calibri' })],
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        children: [new TextRun({ text: 'Date: April 28, 2026', size: 22, font: 'Calibri' })],
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      // ── Abstract ─────────────────────────────────────────────────────────────
      heading1('ABSTRACT'),
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          new TextRun({ text: 'The widespread adoption of digital devices has led to a global surge in eye strain, now formally recognised as Digital Eye Strain (DES) or Computer Vision Syndrome (CVS). DES affects an estimated 50–69% of regular screen users, spanning all age groups.', size: 22, font: 'Calibri' }),
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          new TextRun({ text: 'This article reviews the definition, epidemiology, pathophysiology, symptoms, risk factors, clinical evaluation, management strategies, and preventive measures related to eye strain induced by prolonged screen exposure.', size: 22, font: 'Calibri' }),
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          new TextRun({ text: 'DES is a multifactorial condition with ocular and systemic manifestations. A combination of ergonomic modifications, optical correction, lubricating therapy, and behavioural interventions can significantly reduce its burden.', size: 22, font: 'Calibri' }),
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          new TextRun({ text: 'Digital Eye Strain, Computer Vision Syndrome, Asthenopia, Screen Time, Blue Light, Visual Fatigue, Dry Eye, Optometry.', size: 22, italics: true, font: 'Calibri' }),
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      // ── 1. Introduction ───────────────────────────────────────────────────────
      heading1('1. INTRODUCTION'),
      body('In the 21st century, digital screens have become inseparable from daily life. Smartphones, tablets, laptops, and desktop computers are used for education, employment, communication, and entertainment — often for more than 8–10 hours per day. The COVID-19 pandemic further accelerated this dependence, shifting education and work entirely online for prolonged periods.'),
      body('This extraordinary increase in screen exposure has given rise to a significant public health concern: Digital Eye Strain (DES), also referred to as Computer Vision Syndrome (CVS). The American Optometric Association defines CVS as a complex of eye and vision problems related to activities which stress the near vision and are experienced in relation, or during, the use of a computer or other digital screen device.'),
      body('The term "asthenopia" — derived from the Greek words "asthenos" (weak) and "ops" (eye) — has long described eye fatigue due to sustained near-vision tasks. With the digital revolution, asthenopia has become epidemic, making it one of the most frequently encountered conditions in modern optometric practice. As future optometrists, understanding the science behind DES is crucial to providing evidence-based patient care.'),
      spacer(),

      // ── 2. Definition and Terminology ────────────────────────────────────────
      heading1('2. DEFINITION AND TERMINOLOGY'),
      body('Digital Eye Strain (DES) is an umbrella term for a constellation of visual and ocular symptoms arising from prolonged use of digital electronic devices such as computers, smartphones, tablets, and e-readers. It encompasses:'),
      bullet('Asthenopia: Eye strain or eye fatigue secondary to sustained near work or uncorrected refractive errors.'),
      bullet('Computer Vision Syndrome (CVS): An older, more restricted term focusing specifically on personal computer use.'),
      bullet('Visual Fatigue: The subjective sensation of tired, sore, or strained eyes following sustained visual activity.'),
      bullet('Screen-induced Dry Eye: Reduced blink rate and altered tear film dynamics secondary to digital screen use.'),
      body('While CVS and DES are often used interchangeably in contemporary literature, DES is the preferred modern term as it encompasses all screen-based devices, not just desktop computers (Mylona et al., 2023).'),
      spacer(),

      // ── 3. Epidemiology ───────────────────────────────────────────────────────
      heading1('3. EPIDEMIOLOGY AND PREVALENCE'),
      body('DES is one of the most prevalent occupational disorders of the modern era. Key epidemiological findings include:'),
      makeTable(
        ['Parameter', 'Key Data'],
        [
          ['Global prevalence', '50–69% of regular screen users (Kahal et al., 2025)'],
          ['Pre-COVID prevalence range', '5–65% across studied populations (Kaur et al., 2022)'],
          ['Post-COVID (children)', '50–60% among school-age children'],
          ['Highest-risk group', 'University students (prolonged screen use, poor ergonomics)'],
          ['Gender predisposition', 'Higher prevalence in females'],
          ['Regional variation', 'Higher in Africa and Asia (2023 meta-analysis)'],
          ['Occupational risk', 'IT professionals, students, office workers'],
        ]
      ),
      spacer(),
      body('The COVID-19 pandemic marked a watershed moment, converting face-to-face learning into digital learning globally. This led to unprecedented increases in daily screen time among children and adults alike, with DES prevalence rising sharply and new-onset esotropia and myopia progression emerging as significant complications (Kaur et al., 2022).'),
      spacer(),

      // ── 4. Aetiology and Risk Factors ─────────────────────────────────────────
      heading1('4. AETIOLOGY AND RISK FACTORS'),
      heading2('4.1 Screen-Related Factors'),
      bullet('Prolonged screen time (>2 hours continuously)'),
      bullet('Poor screen resolution or refresh rate'),
      bullet('Excessive screen glare and reflections'),
      bullet('Inappropriate screen brightness and contrast'),
      bullet('Blue light emission from LED-backlit screens'),
      bullet('Viewing distance: screens held closer than the recommended 50–70 cm'),
      bullet('Viewing angle: screens positioned above eye level (increased incomplete blink rate)'),

      heading2('4.2 User-Related Factors'),
      bullet('Uncorrected or under-corrected refractive errors (myopia, hyperopia, astigmatism)'),
      bullet('Presbyopia — reduced amplitude of accommodation in older users'),
      bullet('Vergence disorders — convergence insufficiency, exophoria at near'),
      bullet('Accommodative dysfunction — accommodative spasm, reduced facility'),
      bullet('Pre-existing dry eye disease'),
      bullet('Contact lens wear — reduces tear stability'),
      bullet('Reduced blink rate (normal: 15–20 blinks/min; screen use: 5–7 blinks/min)'),

      heading2('4.3 Environmental Factors'),
      bullet('Poor ambient lighting (too dim or too bright relative to screen luminance)'),
      bullet('Low humidity environments (air conditioning/heating)'),
      bullet('Air draught directed toward the face'),
      bullet('Inadequate workstation ergonomics — inappropriate desk/chair height'),
      spacer(),

      // ── 5. Pathophysiology ────────────────────────────────────────────────────
      heading1('5. PATHOPHYSIOLOGY'),
      body('DES is multifactorial in origin. Three principal mechanisms underlie its symptoms:'),

      heading2('5.1 Accommodative-Convergence Imbalance'),
      body('Digital screens require sustained and precise accommodation at a near, fixed distance. Unlike reading print, digital text is composed of pixelated characters with imprecise letter edges and reduced contrast, forcing the ciliary muscle to repeatedly attempt re-focussing. This continuous ciliary muscle contraction leads to accommodative spasm and fatigue.'),
      body('Prolonged near fixation also demands sustained convergence. An imbalance between accommodation and convergence — particularly in individuals with latent hyperopia, convergence insufficiency, or phoria — produces visual discomfort and asthenopia. Symptoms include blurred distance vision after screen use, fluctuating vision when shifting gaze from near to far, and headache (Wills Eye Manual).'),
      body('Accommodative spasm, defined as the inability to relax the ciliary muscles, is characterised by bilateral blurred distance vision, fluctuating vision, headache, and eye strain during reading. It is frequently seen in teenagers under stress or after prolonged near work, and manifest myopia may be as high as 10 dioptres on manifest refraction compared to cycloplegic refraction (Wills Eye Manual, Chapter 13.6).'),

      heading2('5.2 Ocular Surface and Tear Film Disruption'),
      body('The normal blink rate is 15–20 blinks per minute. During screen use, this falls dramatically to 5–7 blinks per minute. Blinks are also incomplete — the lower lid does not fully close to the upper lid. These factors result in:'),
      bullet('Increased tear evaporation from the exposed corneal surface'),
      bullet('Destabilisation of the tear film lipid layer'),
      bullet('Reduced tear distribution across the corneal surface'),
      bullet('Desiccation of the conjunctival and corneal epithelium (desiccating stress)'),
      body('When the screen is positioned above eye level, the palpebral aperture widens further, increasing the exposed corneal surface area and accelerating evaporation. Conversely, looking downward at a screen slightly below eye level narrows the aperture, which is why a slightly downward gaze angle is recommended ergonomically.'),
      body('The resultant tear film instability manifests as dry eye symptoms: foreign body sensation, burning, itching, watering (reflex tearing), and blurred vision that fluctuates with blinking.'),

      heading2('5.3 Blue Light and Circadian Disruption'),
      body('Digital device screens emit high-energy visible (HEV) light in the blue spectrum (approximately 380–500 nm). Blue light is known to:'),
      bullet('Stimulate intrinsically photosensitive retinal ganglion cells (ipRGCs) that contain melanopsin'),
      bullet('Suppress melatonin secretion, delaying sleep onset and disrupting circadian rhythm'),
      bullet('Potentially contribute to photoreceptor stress in in vitro models (though clinical evidence at screen-exposure levels remains controversial)'),
      body('The role of blue light in directly causing symptomatic DES remains debated. Current evidence does not clearly support blue light as the primary driver of ocular surface symptoms; however, its role in circadian disruption and sleep disturbance is well established. Blue-light-blocking spectacles have shown limited clinical efficacy in randomised controlled trials for reducing DES symptoms per se (Kahal et al., 2025).'),
      spacer(),

      // ── 6. Clinical Features ──────────────────────────────────────────────────
      heading1('6. CLINICAL FEATURES'),
      body('DES produces both ocular and extraocular (systemic) symptoms, often collectively termed "visual and musculoskeletal discomfort."'),

      heading2('6.1 Ocular Symptoms'),
      makeTable(
        ['Symptom', 'Mechanism'],
        [
          ['Eye strain / fatigue (asthenopia)', 'Sustained ciliary muscle contraction; accommodative overload'],
          ['Blurred vision (near or distance)', 'Accommodative spasm; tear film instability'],
          ['Dry, gritty, or burning eyes', 'Reduced blink rate; increased tear evaporation'],
          ['Watery eyes', 'Reflex tearing secondary to desiccation'],
          ['Foreign body sensation', 'Corneal epithelial desiccation'],
          ['Itching and redness', 'Ocular surface inflammation; meibomian gland dysfunction'],
          ['Diplopia or fluctuating vision', 'Vergence fatigue; decompensating phoria'],
          ['Photophobia', 'Glare sensitivity; increased light scatter from poor tear film'],
          ['Difficulty shifting focus near-to-far', 'Accommodative fatigue or spasm'],
        ]
      ),
      spacer(),

      heading2('6.2 Extraocular (Systemic) Symptoms'),
      bullet('Headache — typically frontal or temporal, related to sustained vergence/accommodative effort'),
      bullet('Neck, shoulder, and back pain — poor posture and workstation ergonomics'),
      bullet('General fatigue and reduced concentration'),
      bullet('Sleep disturbance — blue light-mediated melatonin suppression'),
      bullet('Musculoskeletal pain — repetitive strain from keyboard/mouse use'),
      spacer(),

      // ── 7. Classification ─────────────────────────────────────────────────────
      heading1('7. CLASSIFICATION OF DES SYMPTOMS'),
      body('DES symptoms are broadly grouped into four categories:'),
      bullet('Internal (accommodative/vergence): Blurring, diplopia, difficulty with near-to-far focus shift.', 0),
      bullet('External (ocular surface): Dryness, burning, redness, foreign body sensation, watering.', 0),
      bullet('Postural/musculoskeletal: Neck pain, back pain, shoulder stiffness.', 0),
      bullet('Visual performance: Reduced contrast sensitivity, glare intolerance, photophobia.', 0),
      spacer(),

      // ── 8. Diagnosis ──────────────────────────────────────────────────────────
      heading1('8. CLINICAL EVALUATION AND DIAGNOSIS'),
      body('DES is a clinical diagnosis based on characteristic history, symptom profiling, and optometric examination. There is no single diagnostic test; rather, a systematic assessment is required.'),

      heading2('8.1 History'),
      bullet('Daily screen time (hours) and type of devices'),
      bullet('Working/viewing distance and gaze angle'),
      bullet('Lighting conditions and presence of glare'),
      bullet('Use of spectacles or contact lenses'),
      bullet('Nature, onset, duration, and frequency of symptoms'),
      bullet('Relation of symptoms to screen tasks vs. non-screen near work'),
      bullet('Sleep quality and systemic health history'),

      heading2('8.2 Optometric Examination'),
      makeTable(
        ['Test', 'Purpose'],
        [
          ['Visual acuity (distance and near)', 'Baseline visual function; detect under-correction'],
          ['Manifest and cycloplegic refraction', 'Identify latent hyperopia, accommodative spasm (myopic shift on manifest vs cycloplegic)'],
          ['Cover test / prism cover test', 'Detect heterophoria or tropia; convergence insufficiency'],
          ['Near point of convergence (NPC)', 'Assess convergence adequacy; NPC receded in CVS patients'],
          ['Accommodative amplitude', 'Reduced in fatigue; compare to Hofstetter\'s norms'],
          ['Accommodative facility (±2.00 D flipper)', 'Reduced facility indicates accommodative dysfunction'],
          ['Binocular vision assessment (AC/A ratio)', 'Evaluate vergence-accommodation relationship'],
          ['Slit-lamp biomicroscopy', 'Corneal staining; meibomian gland evaluation; tear meniscus'],
          ['Tear breakup time (TBUT)', 'Reduced TBUT (<10 sec) indicates instability; non-invasive NIBUT preferred'],
          ['Schirmer\'s test / phenol red thread test', 'Aqueous tear production measurement'],
          ['Ocular surface staining (fluorescein/rose bengal)', 'Punctate epithelial erosions indicate desiccating stress'],
          ['Meibography', 'Meibomian gland dropout in chronic dry eye associated with DES'],
        ]
      ),
      spacer(),

      // ── 9. Management ─────────────────────────────────────────────────────────
      heading1('9. MANAGEMENT'),
      body('Management of DES is multimodal, addressing optical, ocular surface, ergonomic, and behavioural factors simultaneously.'),

      heading2('9.1 Optical and Refractive Management'),
      bullet('Full optical correction of refractive errors — even small amounts of uncorrected hyperopia or astigmatism exacerbate asthenopia'),
      bullet('Computer glasses: single vision lenses optimised for intermediate/near working distance (typically 60 cm); reduces accommodative demand'),
      bullet('Progressive addition lenses (PALs) in presbyopes: wider intermediate zone preferred for screen use'),
      bullet('Anti-reflective (AR) coating: reduces glare and reflections from screen surfaces; standard recommendation for all screen users'),
      bullet('Blue-light-filtering lenses: marketed widely; clinical evidence for reducing DES symptoms is limited (current reviews show minimal benefit); however, may benefit sleep quality when used in the evening'),
      bullet('Prismatic correction: for significant heterophoria with asthenopia; base-in prism for exophoria, base-out for esophoria'),
      bullet('Accommodative support lenses: low-plus adds (e.g., +0.75 to +1.25 D) in younger patients with accommodative dysfunction or early presbyopia'),

      heading2('9.2 Ocular Surface and Dry Eye Management'),
      bullet('Lubricating eye drops (artificial tears): sodium hyaluronate, carboxymethylcellulose, or polyethylene glycol-based formulations; preservative-free preferred for frequent use'),
      bullet('Warm compresses and lid massage: meibomian gland expression to improve lipid layer quality'),
      bullet('Lid hygiene: lid scrubs to reduce blepharitis and meibomian gland dysfunction (MGD)'),
      bullet('Omega-3 fatty acid supplementation: anti-inflammatory effect on meibomian glands; emerging evidence for reducing evaporative dry eye in screen users'),
      bullet('Topical cyclosporine 0.05% or lifitegrast 5%: for moderate-to-severe dry eye with screen use'),
      bullet('Punctal plugs: to conserve tears in refractory dry eye'),
      bullet('Contact lens modifications: switching to daily disposable lenses with high Dk/t; silicone-hydrogel materials; consideration of orthokeratology'),

      heading2('9.3 Ergonomic Interventions'),
      makeTable(
        ['Ergonomic Parameter', 'Recommendation'],
        [
          ['Screen distance', '50–70 cm (arm\'s length) from the eyes'],
          ['Screen height/gaze angle', 'Screen centre 10–20° below horizontal eye level (slight downward gaze)'],
          ['Screen tilt', '10–15° backward tilt to reduce glare'],
          ['Font size', 'Minimum 12 pt; increase to 14–16 pt for comfort'],
          ['Screen brightness', 'Match to ambient room lighting; avoid high contrast against dark room'],
          ['Ambient lighting', 'Indirect, diffuse lighting; avoid glare sources behind/in front of screen'],
          ['Room humidity', 'Maintain 40–60% relative humidity; use humidifier if needed'],
          ['Chair and desk height', 'Forearms parallel to desk; feet flat on floor; back supported'],
          ['Screen surface', 'Matte-finish screens; anti-glare screen filters if needed'],
        ]
      ),
      spacer(),

      heading2('9.4 Behavioural Strategies'),
      new Paragraph({
        children: [
          boldRun('20-20-20 Rule: '),
          normalRun('Every 20 minutes of screen use, look at an object 20 feet (6 metres) away for at least 20 seconds. This relaxes ciliary muscle tension and allows the tear film to restabilise.'),
        ],
        spacing: { before: 80, after: 80 },
        alignment: AlignmentType.JUSTIFIED,
        bullet: { level: 0 },
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      bullet('Conscious blinking: train patients to blink fully and frequently, especially during screen tasks'),
      bullet('Screen breaks: minimum 5-minute break every 1 hour of continuous screen use'),
      bullet('Limit screen time before bedtime: avoid screens 1–2 hours before sleep to reduce blue-light-mediated circadian disruption'),
      bullet('Reduce multitasking across multiple screens simultaneously'),
      bullet('Adjust device settings: reduce blue light emission using "night mode" or warm colour temperature settings in the evening'),
      spacer(),

      // ── 10. Special Populations ────────────────────────────────────────────────
      heading1('10. SPECIAL POPULATIONS'),

      heading2('10.1 Children and Adolescents'),
      body('Children are particularly vulnerable to DES due to:'),
      bullet('Greater plasticity of the accommodative system — accommodative spasm is more common in teenagers under academic stress (Wills Eye Manual)'),
      bullet('Increased risk of new-onset or progressive myopia with excessive near screen work'),
      bullet('Post-COVID emergence of acute esotropia in children with prolonged near screen use'),
      bullet('Developing visual system susceptibility to circadian disruption'),
      body('Management priorities in children include limiting recreational screen time, ensuring adequate outdoor activity (minimum 2 hours/day), and annual optometric review.'),

      heading2('10.2 Presbyopes'),
      body('Patients over 40 years experience progressive reduction in accommodative amplitude. Even with distance correction, they may struggle to focus on near/intermediate screen distances, leading to uncomfortable postures (head tilting, neck strain). Computer-specific progressive lenses or dedicated intermediate-near bifocals are key management tools.'),

      heading2('10.3 Contact Lens Wearers'),
      body('Contact lens wear reduces tear film stability and is an independent risk factor for screen-related dry eye symptoms. Recommendations include:'),
      bullet('Increased lubrication with contact-lens-compatible drops'),
      bullet('Reduced wearing time on high screen-use days'),
      bullet('Consider glasses on days with intense screen use'),
      spacer(),

      // ── 11. Prevention ─────────────────────────────────────────────────────────
      heading1('11. PREVENTION'),
      body('Public health and workplace strategies for DES prevention include:'),
      bullet('Mandatory ergonomic workstation assessments in workplaces and academic institutions'),
      bullet('Educational campaigns on the 20-20-20 rule, proper screen ergonomics, and blink training'),
      bullet('Annual comprehensive optometric examinations for screen workers and students'),
      bullet('Employer-provided blue-light-filtering or AR-coated computer glasses for full-time screen workers'),
      bullet('Screen time guidelines for children from paediatric and optometric bodies'),
      bullet('Incorporation of DES awareness into school health curricula'),
      bullet('Technology design improvements: higher-resolution displays, edge-to-edge panels, built-in flicker-free backlighting, and adjustable blue-light filtering'),
      spacer(),

      // ── 12. Emerging Developments ──────────────────────────────────────────────
      heading1('12. EMERGING DEVELOPMENTS AND FUTURE PERSPECTIVES'),
      body('The management of DES is evolving rapidly. Notable emerging areas include:'),
      bullet('Artificial intelligence (AI)-based ergonomic monitoring: wearable devices and AI software providing real-time feedback on posture, gaze angle, and blink rate'),
      bullet('Smart glasses with eye-tracking: monitor blink frequency and remind users to blink or take breaks'),
      bullet('Novel spectacle lens technologies: adaptive tint lenses that modulate blue light transmission based on ambient light levels'),
      bullet('Telehealth optometry: remote refractive assessments reducing barriers to spectacle correction for screen workers in underserved areas'),
      bullet('Nutritional supplementation: macular carotenoids (lutein and zeaxanthin) are under investigation for their protective role against digital screen-related retinal exposure and contrast sensitivity improvement (Lem et al., 2022)'),
      body('Despite the widespread availability and marketing of blue-light-blocking spectacles, their clinical benefit remains controversial. Current evidence, including comprehensive systematic reviews (Kahal et al., 2025), indicates that ergonomic interventions and refractive correction have superior evidence bases for DES management compared to blue-light filtering alone.'),
      spacer(),

      // ── 13. Role of Optometrist ─────────────────────────────────────────────────
      heading1('13. ROLE OF THE OPTOMETRIST IN MANAGING DES'),
      body('The optometrist is uniquely positioned as the primary eye care professional for DES management. Key responsibilities include:'),
      bullet('Comprehensive binocular vision and refractive assessment tailored to digital device working distances'),
      bullet('Accurate diagnosis and management of accommodative and vergence disorders contributing to DES'),
      bullet('Ocular surface evaluation and management of screen-associated dry eye'),
      bullet('Prescribing appropriate optical solutions (computer glasses, AR coatings, contact lens modifications)'),
      bullet('Patient education on ergonomic practices, screen habits, and preventive measures'),
      bullet('Coordination with occupational health services for workplace DES management programs'),
      bullet('Monitoring for myopia progression in children with high screen use'),
      bullet('Referral to ophthalmology when structural pathology or refractory dry eye is identified'),
      body('As this is a growing area of optometric care, practitioners should remain updated with evolving evidence, particularly regarding blue light, myopia control, and digital-device-related binocular vision disorders.'),
      spacer(),

      // ── 14. Conclusion ─────────────────────────────────────────────────────────
      heading1('14. CONCLUSION'),
      body('Digital Eye Strain represents one of the defining occupational and lifestyle health challenges of the digital age. With global screen time continuing to rise — accelerated by remote work, e-learning, and digital entertainment — DES will remain a central concern for optometrists worldwide.'),
      body('Its pathophysiology is multifactorial, involving accommodative-convergence dysfunction, ocular surface destabilisation, and circadian disruption. Clinical management must address each contributing factor through a combination of optical correction, ocular surface therapy, ergonomic optimisation, and behavioural modification.'),
      body('The 20-20-20 rule, appropriate workstation ergonomics, full refractive correction, and preservative-free lubricating drops remain the cornerstones of management with the strongest evidence base. Blue-light-blocking lenses, while popular, have limited evidence for symptomatic DES relief but may benefit circadian health.'),
      body('As optometrists, developing clinical expertise in DES assessment and management — including binocular vision testing, tear film analysis, and occupational history — is essential to providing high-quality care to the modern digital patient.'),
      spacer(),
      hrLine(),

      // ── References ──────────────────────────────────────────────────────────────
      heading1('REFERENCES'),
      body('1. Kahal F, Al Darra A, Torbey A. Computer vision syndrome: a comprehensive literature review. Future Sci OA. 2025. PMID: 40055942.'),
      body('2. Kaur K, Gurnani B, Nayak S, et al. Digital Eye Strain — A Comprehensive Review. Ophthalmol Ther. 2022;11:1655–1680. PMID: 35809192.'),
      body('3. Mylona I, Glynatsis MN, Floros GD, Kandarakis S. Spotlight on Digital Eye Strain. Clin Optom (Auckl). 2023;15:1–13. PMID: 36875935.'),
      body('4. Auffret É, Gomart G, Bourcier T, et al. Digital eye strain: symptoms, prevalence, pathophysiology, and management. J Fr Ophtalmol. 2021;44(9):1406–1420. PMID: 34657757.'),
      body('5. Lem DW, Gierhart DL, Davey PG. Can Nutrition Play a Role in Ameliorating Digital Eye Strain? Nutrients. 2022;14(19):4058. PMID: 36235656.'),
      body('6. Kamøy B, Magno M, Nøland ST, et al. Video display terminal use and dry eye: preventive measures and future perspectives. Acta Ophthalmol. 2022;100(8):851–864. PMID: 35122403.'),
      body('7. Ehlers JP, Shah CP (eds). The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. 7th ed. Philadelphia: Wolters Kluwer; 2017.'),
      body('8. Adams and Victor\'s Principles of Neurology. 12th ed. McGraw-Hill; 2023.'),
      body('9. American Optometric Association. Computer Vision Syndrome. Available at: www.aoa.org.'),
      spacer(),
    ],
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