VDU work with downward gaze: the emperor's new clothes or scientifically sound?

Lower monitor placements, with gaze angles to the centre of the screen 30–45° below the horizontal line are proposed as an alternative to higher monitor placements advocated by prevailing guidelines. A scientific basis for this proposition has been established within a comprehensive theoretical framework, founded on an ecological systemic approach to vision. A review of the literature shows reduced visual strain and a strong tendency towards reduced symptomatology in subjects working with downward gaze. Increased musculoskeletal load is not evident in m. trapezius, while a clinically insignificant increase might be present in some other neck and shoulder muscles. Research studying subjective preferences is inconclusive at present. The evidence indicates that lower monitor placements result in less strain on the total network of muscles involved in visual display unit (VDU) work. VDUs are widely used in industry. Monitor placement is a critical factor in the discussion about negative health effects associated with VDUs. A review of the present knowledge represents a basis for the development of future guidelines.