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Appendix ~ Dissent Lawrence W. Stark ~ am dissenting from our panel report because of my concern that the report does not provide adequate guidance to a VDT user or his or her physician regarding complaints of ocular discomfort and visual fatigue. I do not, however, disagree with the body of the report or with the "Executive Summary" in any of the detailed findings; in particular, I do not believe that radiation damage or serious diseases such as cataracts result from VDT use. My own review of the literature substantiated the opinion that visual fatigue is not a well-defined physiological or clinical entity, but this scientifically accurate statement cannot negate the fact that all of us feel fatigue at various times. Indeed, many of us, finding ourselves at a given moment without sufficient motivation to go on, have halted tasks as a result of fatigue. I believe that many highly motivated VDT users suffer from ocular discomfort and visual fatigue beyond that appropriate to a normal workplace. Implicit in the appearance of video display terminals on the marketplace for office and clerical work is the manufacturers' claim that adequate legibility can be obtained from these ter- minals. I believe this not to be true. I have never seen a video display terminal that was nearly as legible as the ordinary pieces of typewritten paper or copied reports that circulate in our paper world. We all prefer to look down, with easy convergence on reading matter--a book, a sheet of typewritten material, or handwritten correspondence. No VDTs provide robust enough contrast to enable this "natural" position for the tube face. Most commercially available VDTs have been simply adapted from television entertainment video monitors. Those monitors were originally designed for pictures with fairly large images and especially for images in motion, a quite different spatial reso- lution task than reading static alphanumeric characters. Also, consideration must be given to the length of time spent at a task and the possible inflexibility of a job requiring reading from the face of a VDT for an 8-hour day. Our panel report does not 235
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236 condemn the poor quality and legibility of current VDTs, but rather states that scientific evaluation is difficult. These deficiencies in the report may be the result of the pro- cess by which the report was assembled. The charges to the panel (listed in the preface) are narrowly directed. The panel, excellent scientists from the academic community, all thoroughly reviewed the scientific literature. We met face to face as a panel on four occasions and also had opportunities to attend several related pro- fessional meetings in Washington, D.C. Thus, adequate time and effort was spent sharing each others' partitioned reviews forming the narrow responses to the charges; I learned about ergonomics, display technology, job design, survey methodology, radiation standards, and clinical epidemiology. In contrast, adequate time was not spent on consideration of policy questions by the group as a whole (time and funding constraints, not conspiracy, determined this). As I learned more about these issues and realized how cen- tral they were to the panel's overall tasks, I missed the luxury of panel face-to-face discussions on them. Rather a complex proce- dure, all by correspondence, of multiple review and responsive modifications ensued. Thus the panel, to my frustration, was unable to deal as a group with interpretation and policy, but remained limited to our focused scientific reviews in response to the narrow charges. My dissent rests on possible misinterpreta- tion of the report with its detailed, balanced "scientific" outlook and style, as supporting the status quo of no standards or guide- lines for VDT workplaces and no clear concern with unacceptable levels of ocular discomfort and visual fatigue.