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Gowrisankaran, Sowjanya; Nahar, Niru K.; Hayes, John R.; Sheedy, James E.

Asthenopia and Blink Rate Under Visual and Cognitive Loads

publication date
August 17, 2011
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Asthenopia has been associated with reading under visually stressful conditions. However, it is not known whether increased cognitive load contributes to asthenopic symptoms. The purpose of this study was to evaluate the contribution of increased cognitive load (with or without visual stress inducing conditions) to asthenopic symptoms associated with prolonged near work.



Thirty-three visually normal subjects, aged 18 to 30 years, participated in the study. Subjects read texts or watched videos under different visual stress and cognitive loads. Visual stress conditions were good visual quality, low contrast, and induced refractive error. The cognitive load levels were watching video, reading fairy tales, and reading technical articles. As an additional task, subjects also listened to technical articles. At the end of each condition, subjects rated the magnitude of any asthenopic symptoms, visual discomfort, and cognitive discomfort they experienced during the task. Electromyography potentials recorded from the lower orbicularis oculi muscle were used to obtain blink rate.



Subjects reported greater internal symptoms for the refractive error condition coupled with higher cognitive load compared to good visual and low contrast conditions (p < 0.01). For the low contrast condition coupled with higher cognitive load, greater external symptoms were reported compared to good visual and refractive error conditions (p < 0.05). However, asthenopic symptoms were not reported for cognitively demanding tasks when the visual condition was good. Blink rates were not significantly different between the good visual and low contrast conditions within each cognitive load level. For the cognitively difficult reading conditions, blink rate was significantly decreased for the low contrast and good visual conditions compared to the refractive error condition.



An interaction between cognitive and visual demands was observed. Greater cognitive loads accentuate the same differentiated symptoms normally caused by visual stressors.


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Also, he was better at listening. As a parent, we wanted learning to be fun for our Son, and vision therapy made this possible.

Amanda T.

Vision Therapy is well worth the expense, time and effort. Our son had a hard time focusing handwriting neatly. After vision therapy Seth could complete a task in half the time it previously took his abilities to focus and improved greatly and so did his handwriting.

Also, he was better at listening. As a parent you wanted learning to be fun for our son and vision therapy made this possible.

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Vision Therapy has given or son the tools he needs to be able to scan and read the written word more effectively and efficiently.

He love working with John and these working sessions give him the motivation to gladly work on his homework assignments.

It amazed us to see the difference in the tracking of his eyes and along a line of it's from the beginning to the end of the treatment.

Dr. McBryar , Kristen and John  are all marvelous and we would recommend them to anyone I only wish that we would have found them sooner!

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Prior to coming to the institute for vision development my son complained of daily headaches. Therapy has eliminated his headaches completely. I love knowing my son is able to learn pain-free for the rest of his life because of the work that has been done over just a few weeks in this office. He he absolutely loved coming that didn't even feel like going to a doctor or therapy. We are grateful for the relief he was able to find by coming here.

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Seems much less frustrated with life

Reads non-stop and fast

Spelling abilities have been hugely improved

Seems much more confident

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When we first came to the practice, my son did not have huge issues, but lots of small ones- trouble with reading, sports (hitting the baseball consistently), coordination, etc- that were not easily detectable,but when put together presented issues. The staff here were all very professional and loving towards him. While I was concerned in the reading, my son was concerned with the athletic side. Seeing improvement night off the bat gave him confidence that i have nor seen in him and made him want to not only Come to therapy, but also made him want to work hard. He has surpassed his grade level and above in reading and hit his first home run this year! Thank you!!!

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