Consensus on Diagnostic Criteria, Clinical Symptoms, and Risk Factors for Visual Fatigue: A Modified Delphi Study
11 affiliations
- 1School of Optometry, The Hong Kong Polytechnic University
- 2Xiamen University Affiliated Xiamen Eye Center, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Fujian Engineering and Research Center of Eye Regenerative Medicine, School of Medicine, Eye Institute of Xiamen University, Xiamen University
- 3Corneal and External Eye Disease Service, Singapore National Eye Centre
- 4Department of Optometry and Vision Sciences, The University of Melbourne
- 5State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-Sen University
- 6Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Sciences Key Lab, Capital Medical University
- 7Tsubota Laboratory, Inc.
- 8Department of Ophthalmology, Faculty of Medicine, Toho University
- 9Department of Ophthalmology, Yonsei University College of Medicine
- 10Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
- 11Centre for Public Health, School of Medicine, Dentistry, and Biomedical Sciences, Queen’s University Belfast
Abstract
Introduction Visual fatigue is becoming increasingly prevalent globally, while universally accepted definitions and standardized diagnostic criteria remain lacking. This study aims to develop consensus-based recommendations on the definition, diagnostic criteria, core symptoms, risk factors, and assessment of visual fatigue, using a modified Delphi process to support standardized clinical and epidemiologic practice. Methods A modified Delphi process was conducted with an international panel of experts in optometry, ophthalmology, and related disciplines. Two rounds of questionnaires were used to generate candidate definitions, diagnostic criteria, symptoms, risk factors, assessment methods and management principles. A subsequent hybrid meeting was held to discuss unresolved items and consolidate the final recommendations. Results Of 20 experts invited, 14 participated in the panel (response rate 70%); 13 (92.8%) completed the round-2 questionnaire and 12 (85.7%) took part in the hybrid discussion. The final consensus comprised three major recommendations with 13 constituent items. Recommendation 1 defines visual fatigue as a functional disease characterized by a core symptom set and functional impact and emphasizes identification of common associated conditions. Recommendation 2 specifies a structured assessment pathway including essential clinical examinations for confirming visual fatigue and ruling out comorbidities, and the use of questionnaires and objective assessments where available. Recommendation 3 focuses on prioritizing high-risk populations, targeting modifiable risk factors, and principles for management and outcomes to track in future work. Conclusions This consensus provides a foundational framework for addressing the growing global burden of visual fatigue by defining it as a distinct functional disease and providing a structured diagnostic framework and a stepwise management approach. It offers a foundation for the global standard of care for visual fatigue.
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BibTeX
@article{chen2026consensus,
title = {{Consensus on Diagnostic Criteria, Clinical Symptoms, and Risk Factors for Visual Fatigue: A Modified Delphi Study}},
author = {Yanxian Chen and Zuguo Liu and Fan Song and Louis Tong and Ching Yi Wu and Lingyi Liang and Ying Jie and Kazuo Tsubota and Yuichi Hori and Chea-su Kee and Lei Zhou and Kyoung Yul Seo and Alvin Young and Nathan Congdon and Xia Gong and Mingguang He},
journal = {Ophthalmology and Therapy},
year = {2026},
month = sep,
doi = {10.1007/s40123-026-01491-1},
url = {https://doi.org/10.1007/s40123-026-01491-1},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Consensus on Diagnostic Criteria, Clinical Symptoms, and Risk Factors for Visual Fatigue: A Modified Delphi Study
AU - Yanxian Chen
AU - Zuguo Liu
AU - Fan Song
AU - Louis Tong
AU - Ching Yi Wu
AU - Lingyi Liang
AU - Ying Jie
AU - Kazuo Tsubota
AU - Yuichi Hori
AU - Chea-su Kee
AU - Lei Zhou
AU - Kyoung Yul Seo
AU - Alvin Young
AU - Nathan Congdon
AU - Xia Gong
AU - Mingguang He
PY - 2026
DA - 2026/09/01
JO - Ophthalmology and Therapy
DO - 10.1007/s40123-026-01491-1
UR - https://doi.org/10.1007/s40123-026-01491-1
AB - Introduction Visual fatigue is becoming increasingly prevalent globally, while universally accepted definitions and standardized diagnostic criteria remain lacking. This study aims to develop consensus-based recommendations on the definition, diagnostic criteria, core symptoms, risk factors, and assessment of visual fatigue, using a modified Delphi process to support standardized clinical and epidemiologic practice. Methods A modified Delphi process was conducted with an international panel of experts in optometry, ophthalmology, and related disciplines. Two rounds of questionnaires were used to generate candidate definitions, diagnostic criteria, symptoms, risk factors, assessment methods and management principles. A subsequent hybrid meeting was held to discuss unresolved items and consolidate the final recommendations. Results Of 20 experts invited, 14 participated in the panel (response rate 70%); 13 (92.8%) completed the round-2 questionnaire and 12 (85.7%) took part in the hybrid discussion. The final consensus comprised three major recommendations with 13 constituent items. Recommendation 1 defines visual fatigue as a functional disease characterized by a core symptom set and functional impact and emphasizes identification of common associated conditions. Recommendation 2 specifies a structured assessment pathway including essential clinical examinations for confirming visual fatigue and ruling out comorbidities, and the use of questionnaires and objective assessments where available. Recommendation 3 focuses on prioritizing high-risk populations, targeting modifiable risk factors, and principles for management and outcomes to track in future work. Conclusions This consensus provides a foundational framework for addressing the growing global burden of visual fatigue by defining it as a distinct functional disease and providing a structured diagnostic framework and a stepwise management approach. It offers a foundation for the global standard of care for visual fatigue.
SN - 2193-8245
SN - 2193-6528
ER -