Digital Screen Use and Dry Eye: A Review

Body mass index, diet, and outdoor activity linked with meibomian gland abnormalities in children

SIGNIFICANCE

Dry eye disease is frequently underdiagnosed in pediatric patients. Meibomian gland morphology abnormalities (atrophy and tortuosity) may be associated with dry eye. This study examined risk factors for gland morphology abnormalities in children.

PURPOSE

This study aimed to characterize meibomian gland morphological abnormalities (atrophy and tortuosity) and identify risk factors for the same in children.

METHODS

A total of 160 children, primarily African American and Hispanic, aged 5 to <18 years underwent a comprehensive eye exam including slit-lamp examination to evaluate the meibomian glands, conjunctival papillae, and tear film. Infrared photography was performed including assessment of noninvasive tear film breakup time and tear meniscus height. Meibomian gland atrophy and tortuosity were assessed. A modified Ocular Surface Disease Index survey was administered along with surveys on screen time, diet, and outdoor activity. Linear multiple regression was performed to determine risk factors for meibomian gland abnormalities.

RESULTS

The average age of participants (76 male, 84 female) was 10.9 ± 3.0 years. Severe meibomian gland atrophy (score ≥2) was found in 31.0% of participants in at least one eyelid. Severe meibomian gland tortuosity (score ≥2) was found in 84.0% of participants in at least one eyelid. The median symptom score was 9.8 (range, 0 to 71), with 16.9, 8.8, and 12.5% of the children having mild, moderate, and severe dry eye symptoms, respectively. Elevated body mass index (p<0.001), reduced outdoor activity (p=0.02), and unhealthy diet (p=0.01) were found to be risk factors for meibomian gland abnormalities. Screen time, symptom score, age, gender, and race/ethnicity were not associated with gland abnormalities (all p values >0.05).

CONCLUSIONS

This study determined that meibomian gland morphological abnormalities were commonly found in children aged 5 to <18 years. Risk factors for these abnormalities include elevated body mass index, an unhealthy diet, and reduced outdoor activity.

The severity of dry eye symptoms and risk factors among university students in Saudi Arabia: a cross-sectional study

Dry eye syndrome (DES) is a tear film disorder caused by increased tear evaporation or decreased production. The heavy workload on the eye and the increased usage of digital screens may decrease blink frequency, leading to an increased evaporation rate and an upsurge in the incidence and severity of DES. This study aims to assess the severity of DES symptoms and the risk factors among university students. A cross-sectional study was conducted at Umm AlQura University to evaluate the severity of DES among students and explore its potential association with digital screen use. Validated questionnaires were used to assess the severity of DES and digital screen usage. The study included 457 participants, of which 13% had symptoms suggestive of severe DES. Furthermore, multiple risk factors had a significant association with the severity of DES, including gender, use of monitor filters, monitor and room brightness, and smoking habits. DES symptoms were prevalent among university students, particularly female students. Although there was no significant association with the duration of screen usage and collage distribution. Other factors however, such as the usage of screen monitors and the brightness of both the monitor and the room, were significantly associated with the severity of DES symptoms.

Effects of brightness variations on a smartphone-based version of Radner reading charts

OBJECTIVE

The purpose of this study was to evaluate the equivalence of smartphone-based measurements of near visual acuity under different screen brightness conditions with a standard near visual acuity test.

METHODS

On a sample of 85 participants, we have evaluated near visual acuity with a smartphone-based version of the Radner reading chart at three distinct screen brightness levels. Results have been compared with those obtained with classical Radner paper charts.

RESULTS

We have found that, when a sufficient screen brightness is employed, the smartphone-based version of the Radner reading chart produces results that are in line with the paper Radner charts while low brightness levels lead to a significant underestimation of reading acuities. This result was consistent across different refractive conditions.

CONCLUSIONS

In conclusion, we have shown that handheld devices, such as smartphones, can be potentially exploited for remote measurements of near visual acuity provided a correct control of brightness screen is employed.

The Efficacy and Safety of Chinese Eye Exercise of Acupoints in Dry Eye Patients: A Randomized Controlled Trial

INTRODUCTION

Dry eye disorder (DED) is a growing global issue linked to excessive digital screen time. Chinese eye exercise of acupoint (CEA), a set of self-massages on shared Chinese acupuncture (CA), has been used to reduce visual-related ocular symptoms and possibly as an alternative treatment for DED. This study aimed to assess the efficacy and safety of CEA.

METHODS

A single-blind randomized controlled trial was conducted at Thammasat University Hospital in Thailand, recruiting 56 participants aged 20-60 years, equally divided into two groups: the treatment group with CEA and the control group with standard lid hygiene treatment (STD). The intervention program lasted 12 weeks.

MAIN OUTCOME MEASURES

Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), Schirmer-I test (SIT), corneal surface staining (CSS), and self-recorded forms for safety and adverse effects were measured at baseline, week 4, and week 12. An independent sample t test, paired t test, and repeated measures (ANOVA) were used to compare results between both groups, study visits, and primary and secondary outcome measurements, respectively. The p values <0.05 were considered statistically significant.

RESULTS

The characteristics were not statistically different between both groups at the baseline. The mean OSDI scores were significantly reduced in both groups at week 4 and week 12 compared to baseline (p value <0.05). Additionally, both CEA and STD showed significant improvement in TBUT and SIT (p value <0.05). CSS was significantly improved only in the CEA groups (p value <0.05). No significant differences were observed between the study groups, except for SIT at week 12 (p value <0.05). For the safety, there were no adverse side effects in either group.

CONCLUSION

CEA seemed to be as effective as STD in improving the OSDI, TBUT, and SIT of DED without causing any side effects.

Einleitung

Das Trockene Auge (Dry eye disorder, DED) ist weltweit ein zunehmendes Problem, das mit übermässiger Bildschirmarbeit zusammenhängt. Die chinesische Augenübung der Akupunkturpunkte (Chinese eye exercise of acupoint, CEA), eine Reihe von Selbstmassagen an gemeinsamen CA-Akupunkturpunkten, wird zur Linderung visusbezogener Augensymptome und als mögliche alternative Behandlung für DED eingesetzt. Mit dieser Studie sollte die Wirksamkeit und Sicherheit von CEA bewertet werden.

Methoden

Am Thammasat-Universitätsklinikum in Thailand wurde eine einfach verblindete, randomisierte, kontrollierte Studie mit 56 Teilnehmern im Alter von 20 bis 60 Jahren durchgeführt, die zu gleichen Teilen zwei Gruppen zugewiesen wurden: die Behandlungsgruppe mit CEA und die Kontrollgruppe, die die Standard-Lidhygienebehandlung erhielt (STD). Das Interventionsprogramm dauerte 12 Wochen. Die Haupt-Zielkriterien, der Ocular Surface Disease Index (OSDI), die Tränenfilmaufreisszeit (tear break-up time, TBUT), der Schirmer-I-Test (SIT), das Corneal Surface Staining (CSS) und Selbstauskunftsformulare zur Sicherheit und zu unerwünschten Wirkungen wurden zu Beginn der Behandlung, in Woche 4 und in Woche 12 ermittelt. Für den Vergleich der Ergebnisse zwischen den beiden Gruppen, den Studienvisiten bzw. den primären und sekundären Zielkriterien wurden ein t Test für unabhängige Stichproben, ein t Test für paarige Stichproben und eine ANOVA mit Messwiederholungen verwendet. p-Werte <0,05 galten als statistisch signifikant.

Ergebnisse

Hinsichtlich der Merkmale bestand zwischen den beiden Gruppen kein statistischer Unterschied bei Studienbeginn. In beiden Gruppen fielen die mittleren OSDI-Scores in Woche 4 und Woche 12 im Vergleich zum Ausgangswert signifikant geringer aus (p-Wert <0,05). Darüber hinaus zeigten sowohl die CEA- als auch die STD-Gruppe eine signifikante Verbesserung der TBUT- und SIT-Werte (p-Wert <0,05). Das CSS verbesserte sich nur in der CEA-Gruppe signifikant (p-Wert <0,05). Zwischen den Studiengruppen waren keine signifikanten Unterschiede zu beobachten, ausser beim SIT in Woche 12 (p-Wert <0,05). Was die Sicherheit betrifft, so traten in beiden Gruppen keine unerwünschten Nebenwirkungen auf.

Schlussfolgerung

Die CEA schien die OSDI-, TBUT- und SIT-Werte bei DED ebenso wirksam zu verbessern wie die Standardbehandlung, ohne Nebenwirkungen zu verursachen.

Study of Face Mask-associated Dry Eye among Medical Students

Purpose

The purpose of this study was to evaluate face mask-associated factors causing dry eye among medical students.

Methodology

This was a cross-sectional study conducted on undergraduate medical and dental students, of all phases, while they were attending offline classes and were required to wear face masks in accordance with the government regulations. Sociodemographic data, ocular and medical history, face mask-wearing practices, screen usage, and quantification of symptoms using the modified Ocular Surface Disease Index (OSDI) questionnaire were collected. Objective tests were conducted in students having dry eye. The association of quantitative variables was done using ANOVA, Mann-Whitney, and Kruskal-Wallis test, whereas the Chi-square test was done for qualitative variables. Multivariate logistic regression was used to identify the risk factors for varying severity of dry eye.

Results

The mean age of the 410 students was 21 ± 1.6 years. According to the OSDI, 39.51% (162/410) of students had dry eyes, 23.41% (96/410) had mild dry eye, 8.78% (36/410) had moderate dry eye, and 7.32% (30/410) had severe dry eye. Face mask-associated factors which were significantly linked to dry eye were N95 masks, loose-fit masks, and 6-8 h of continuous mask use. The Schirmer's test and tear film break-up time were performed on 29 and 20 students, respectively, mean values being 19.25 ± 5.29 mm and 10.15 ± 1.41 s for nonsevere and 6.53 ± 1.55 mm and 5.3 ± 0.98 s for severe dry eye, respectively.

Conclusion

It is important to educate medical students and create awareness regarding "face mask-appropriate behavior" to reduce the chances of dry eye secondary to face masks use.

Dry Eyes among Visual Display Terminal Users Visiting the Outpatient Department of Ophthalmology of a Tertiary Care Centre

Introduction

Visual display terminal usage has increased substantially in recent years across all age groups and is considered one of the major risk factors for dry eye disease. Early assesment of dry eyes and prevention is important. The aim of this study is to find the prevalence of dry eyes among visual display terminal users visiting the Outpatient Department of Ophthalmology of a tertiary care centre.

Methods

A descriptive cross-sectional study was conducted among patients visiting the Department of Ophthalmology in a tertiary care centre after receiving ethical approval from the Institutional Review Committee. Data was collected from 1 October 2021 to 31 March 2022. Convenience sampling method was used. The point estimate was calculated at a 90% Confidence Interval.

Results

Among 94 visual display terminal users, the prevalence of dry eyes was 55 (58.51%) (50.18-66.84, 90% Confidence Interval).

Conclusions

The prevalence of dry eyes among visual display terminal users visiting the Outpatient Department of Ophthalmology was similar to other studies done in similar settings.

Keywords

dry eyes; health; prevalence.

International Olympic Committee (IOC) consensus paper on sports-related ophthalmology issues in elite sports

Vision plays an important role in an athletes' success. In sports, nearly 80% of perceptual input is visual, and eye health and sports medicine are closely intertwined fields of utmost importance to athletes. The physical nature of sports activities renders individuals more prone to various eye injuries than the general population. Ocular trauma can lead to lifelong sequelae, and impaired vision requires careful follow-up and management. Apart from injuries, athletes may also experience vision problems that can hamper their performance, including blurred vision, double vision, and light sensitivity. The interdisciplinary nature of sports medicine necessitates collaboration between sports medicine professionals and ophthalmologists. Through such collaborations, athletes can receive appropriate eye care, education on proper eye protection and guidance on adopting good eye health practices. If any inconspicuous symptoms are not detected and treated promptly, athletes may acquire systemic injuries because of defective vision, preventing them from achieving high level athletic performance in competitions. The protection of the elite athlete is the responsibility of all of us in sports medicine. To advance a more unified, evidence-informed approach to ophthalmic health assessment and management in athletes and as relevant for sports medicine physicians, the International Olympic Committee Consensus Group aims for a critical evaluation of the current state of the science and practice of ophthalmologic issues and illness in high-level sports, and present recommendations for a unified approach to this important issue.

TFOS Lifestyle: Impact of contact lenses on the ocular surface

Several lifestyle choices made by contact lens wearers can have adverse consequences on ocular health. These include being non-adherent to contact lens care, sleeping in lenses, ill-advised purchasing options, not seeing an eyecare professional for regular aftercare visits, wearing lenses when feeling unwell, wearing lenses too soon after various forms of ophthalmic surgery, and wearing lenses when engaged in risky behaviors (e.g., when using tobacco, alcohol or recreational drugs). Those with a pre-existing compromised ocular surface may find that contact lens wear exacerbates ocular disease morbidity. Conversely, contact lenses may have various therapeutic benefits. The coronavirus disease-2019 (COVID-19) pandemic impinged upon the lifestyle of contact lens wearers, introducing challenges such as mask-associated dry eye, contact lens discomfort with increased use of digital devices, inadvertent exposure to hand sanitizers, and reduced use of lenses. Wearing contact lenses in challenging environments, such as in the presence of dust and noxious chemicals, or where there is the possibility of ocular trauma (e.g., sport or working with tools) can be problematic, although in some instances lenses can be protective. Contact lenses can be worn for sport, theatre, at high altitude, driving at night, in the military and in space, and special considerations are required when prescribing in such situations to ensure successful outcomes. A systematic review and meta-analysis, incorporated within the review, identified that the influence of lifestyle factors on soft contact lens dropout remains poorly understood, and is an area in need of further research. Overall, this report investigated lifestyle-related choices made by clinicians and contact lens wearers and discovered that when appropriate lifestyle choices are made, contact lens wear can enhance the quality of life of wearers.

Time on task and task load in visual inspection: A four-month field study with X-ray baggage screeners

Previous studies suggest that performance in visual inspection and typical vigilance tasks depend on time on task and task load. European regulation mandates that security officers (screeners) take a break or change tasks after 20 min of X-ray baggage screening. However, longer screening durations could reduce staffing challenges. We investigated the effects of time on task and task load on visual inspection performance in a four-month field study with screeners. At an international airport, 22 screeners inspected X-ray images of cabin baggage for up to 60 min, while a control group (N = 19) screened for 20 min. Hit rate remained stable for low and average task loads. However, when the task load was high, the screeners compensated by speeding up X-ray image inspection at the expense of the hit rate over time on task. Our results support the dynamic-allocation resource theory. Moreover, extending the permitted screening duration to 30 or 40 min should be considered.

Comparison of mucin levels at the ocular surface of visual display terminal users with and without dry eye disease

BACKGROUND

The long-term use of visual display terminals (VDT) is linked to an increased risk of dry eye disease (DED). Numerous studies have indicated that ocular mucins play a vital role in the pathogenesis of DED. Therefore, we aimed to evaluate (1) whether mRNA levels of membrane-associated mucins (MAMs), including MUC1, MUC4, MUC16, and MUC20, as well as MUC5AC are altered in conjunctival cells of VDT users with and without DED and (2) the relationship between mucin levels and subjective and objective tests of DED in VDT users.

METHODS

Seventy-nine VDT users were enrolled and divided into DED (n = 53) and control (n = 26) groups. All participants were evaluated for parameters of DED using the Ocular Surface Disease Index (OSDI) questionnaire, tear breakup time (TBUT), corneal fluorescein staining (CFS), lissamine green (LG) staining, and tear meniscus height (TMH). Based on the conjunctival impression cytology (CIC) method, differences in MUC1, MUC4, MUC16, MUC20, and MUC5AC mRNA expression levels were observed between the DED and control groups, and between symptomatic and asymptomatic participants.

RESULTS

The DED group showed significantly decreased MUC1, MUC16, and MUC20 expressions (all P < 0.05) compared to the control group. In addition, these mucin levels were lower in subjects with frequent ocular symptoms (foreign body sensation, blurred vision and painful or sore eyes) than in asymptomatic participants (all P < 0.05). Correlation analysis revealed that MUC1, MUC16, and MUC20 levels in VDT users were positively correlated with TBUT or TMH, or both. However, no significant relationship was found between MUC4 and MUC5AC levels and the DED parameters.

CONCLUSION

VDT users with an increased frequency of ocular discomfort or a diagnosis of DED had a decreased MUC1, MUC16 and MUC20 mRNA expression in their conjunctival cells. MAMs deficiency in the conjunctival epithelium may be one of the mechanisms leading to tear film instability and DED in VDT users.

The Autoimmune Rheumatic Disease Related Dry Eye and Its Association with Retinopathy

Dry eye disease is a chronic disease of the ocular surface characterized by abnormal tear film composition, tear film instability, and ocular surface inflammation, affecting 5% to 50% of the population worldwide. Autoimmune rheumatic diseases (ARDs) are systemic disorders with multi-organ involvement, including the eye, and play a significant role in dry eye. To date, most studies have focused on Sjögren's syndrome (one of the ARDs) since it manifests as two of the most common symptoms-dry eyes and a dry mouth-and attracts physicians to explore the relationship between dry eye and ARDs. Many patients complained of dry eye related symptoms before they were diagnosed with ARDs, and ocular surface malaise is a sensitive indicator of the severity of ARDs. In addition, ARD related dry eye is also associated with some retinal diseases directly or indirectly, which are described in this review. This review also summarizes the incidence, epidemiological characteristics, pathogenesis, and accompanying ocular lesions of ARD's related dry eye, emphasizing the potential role of dry eye in recognition and monitoring among ARDs patients.

Lutein fortification of wheat bread with marigold powder: impact on rheology, water dynamics, and structure

BACKGROUND

Demands for foods conducive to eye health have been on the increase in the global healthcare sector. Marigold powder as a major source of lutein was utilized to produce lutein-fortified breads for ocular health. The physicochemical characteristics of the doughs and breads were investigated in terms of rheology, water mobility, and protein secondary structures.

RESULTS

The incorporation of marigold powder decreased the water absorption of doughs without significantly altering thermomechanical properties. With a range of fortification levels (1-3%), marigold powder led to decreased storage and loss modulus of doughs by weakening their gluten network, which was supported by their T₂ relaxation times. The resistance of the doughs weakened with increasing levels of marigold powder, while their extensibilities significantly incremented. Fourier transform infrared spectral deconvolution revealed the changes in wheat protein structures upon marigold powder incorporation, in which the proportion of β-turn increased at the expense of β-sheet ratio. The breads with marigold powder displayed increased specific volume from 4.034 to 4.368 mL g^-1 , accompanied by softer textures. The baking process led to heat-induced losses in lutein concentration of less than 10% within the crumb and approximately 30% in the crust.

CONCLUSION

The use of marigold powder induced changes in protein secondary structure and extensional features of doughs, contributing to increased loaf volume and softer texture. Overall, this study provides fundamental information on the rheological and structural effects of marigold powder in a wheat bread system, consequently encouraging the food industry to utilize marigold power as a functional food ingredient. © 2023 Society of Chemical Industry.

The relationship between sedentary behavior and dry eye disease

PURPOSE

Sedentary behavior (SB) has been linked with low-grade systemic inflammation, which could play a role in the development of dry eye disease (DED). This cross-sectional study aims to investigate the association between SB and DED.

METHODS

We assessed 48,418 participants from the population-based Lifelines cohort (58% female, 18-96 years). Women's Health Study (WHS)-defined DED was the primary outcome. SB was assessed using the Marshall Sitting Questionnaire. The relationship between DED and SB was analyzed using logistic regressions, corrected for age, sex, BMI, smoking status, demographics, and 48 comorbidities. Any potential modifying effect of physical activity (PA) was also assessed, and the analyses were repeated excluding the most computer-intensive domains, investigating SB independent from screen exposure.

RESULTS

WHS-defined DED was present in 9.1% of participants. Greater SB was associated with an increased risk of DED (odds ratio (OR) 1.015 per hour/day, 95%CI 1.005-1.024, P = 0.004). The association between SB and DED was only significant for those with less than WHO-recommended PA (OR 1.022, 95%CI 1.002-1.042, P = 0.027), and not in participants meeting WHO's recommendation (OR 1.011, 95%CI 0.999-1.023, P = 0.076). Lastly, when excluding computer-related sitting, the relationship between SB and DED was attenuated, and no longer significant (OR 1.009, 95%CI 0.996-1.023, P = 0.19).

CONCLUSIONS

Greater sedentary time was tied to an increased risk of DED, especially for those with lower PA levels than WHO recommendations. However, as there was no significant association when computer-intensive sitting time was excluded, screen use could explain the observed relationship and should be noted as a possible key confounder.

TFOS Lifestyle: Impact of the digital environment on the ocular surface

Eye strain when performing tasks reliant on a digital environment can cause discomfort, affecting productivity and quality of life. Digital eye strain (the preferred terminology) was defined as "the development or exacerbation of recurrent ocular symptoms and/or signs related specifically to digital device screen viewing". Digital eye strain prevalence of up to 97% has been reported, due to no previously agreed definition/diagnostic criteria and limitations of current questionnaires which fail to differentiate such symptoms from those arising from non-digital tasks. Objective signs such as blink rate or critical flicker frequency changes are not 'diagnostic' of digital eye strain nor validated as sensitive. The mechanisms attributed to ocular surface disease exacerbation are mainly reduced blink rate and completeness, partial/uncorrected refractive error and/or underlying binocular vision anomalies, together with the cognitive demand of the task and differences in position, size, brightness and glare compared to an equivalent non-digital task. In general, interventions are not well established; patients experiencing digital eye strain should be provided with a full refractive correction for the appropriate working distances. Improving blinking, optimizing the work environment and encouraging regular breaks may help. Based on current, best evidence, blue-light blocking interventions do not appear to be an effective management strategy. More and larger clinical trials are needed to assess artificial tear effectiveness for relieving digital eye strain, particularly comparing different constituents; a systematic review within the report identified use of secretagogues and warm compress/humidity goggles/ambient humidifiers as promising strategies, along with nutritional supplementation (such as omega-3 fatty acid supplementation and berry extracts).

Big data in corneal diseases and cataract: Current applications and future directions

The accelerated growth in electronic health records (EHR), Internet-of-Things, mHealth, telemedicine, and artificial intelligence (AI) in the recent years have significantly fuelled the interest and development in big data research. Big data refer to complex datasets that are characterized by the attributes of "5 Vs"-variety, volume, velocity, veracity, and value. Big data analytics research has so far benefitted many fields of medicine, including ophthalmology. The availability of these big data not only allow for comprehensive and timely examinations of the epidemiology, trends, characteristics, outcomes, and prognostic factors of many diseases, but also enable the development of highly accurate AI algorithms in diagnosing a wide range of medical diseases as well as discovering new patterns or associations of diseases that are previously unknown to clinicians and researchers. Within the field of ophthalmology, there is a rapidly expanding pool of large clinical registries, epidemiological studies, omics studies, and biobanks through which big data can be accessed. National corneal transplant registries, genome-wide association studies, national cataract databases, and large ophthalmology-related EHR-based registries (e.g., AAO IRIS Registry) are some of the key resources. In this review, we aim to provide a succinct overview of the availability and clinical applicability of big data in ophthalmology, particularly from the perspective of corneal diseases and cataract, the synergistic potential of big data, AI technologies, internet of things, mHealth, and wearable smart devices, and the potential barriers for realizing the clinical and research potential of big data in this field.

Improving Visual Comfort during Computer Gaming with Preservative-Free Hyaluronic Acid Artificial Tears Added to Ergophthalmological Measures

Digital asthenopia (DA) or Computer Vision Syndrome can occur after prolonged use of digital devices and is usually managed with ergophthalmological measures and the use of artificial tears. This prospective, controlled study evaluated the use of hyaluronic acid artificial tears on the signs and symptoms of DA in participants of a videogame convention. Subjects (n = 56) were randomized into a control group (CG, n = 26), which followed ergophthalmological measures, and a study group (SG, n = 30), which followed ergophthalmological measures and instilled 1 drop of artificial tears with hyaluronic acid 0.15% four times a day. Subjects were evaluated before and after playing for three consecutive days for eye dryness (SPEED questionnaire), conjunctival hyperemia, corneal fluorescein staining, conjunctival lissamine green staining, tear breakup time, Schirmer I test, near convergence and accommodation, and using questionnaires for DA symptoms. After 3 days of intense videogaming, the SPEED score of CG increased significantly (p = 0.0320), while for the SG it was unchanged. Similarly, the CG presented significant increases in ocular fatigue (p = 0.0173) and dryness (p = 0.0463), while these parameters decreased significantly in the SG (p = 0.0149 and p = 0.00427, respectively). This study confirms the protective effect of hyaluronic acid artificial tears against DA symptoms associated with prolonged visual display terminal use.

Eye discomfort at close work in Portuguese university students: A comparative analysis between the pre-COVID and confinement period

BACKGROUND

Many individuals experience visual symptoms associated with near work. The level of discomfort appears to increase with the amount of digital screen use.

OBJECTIVE

To study the eye discomfort with near tasks in university students in the pre-COVID period and in the period of confinement due to the pandemic.

METHODS

Two independent samples of students, aged between 18 and 35 years, were used to assess symptomatic behaviour with the Convergence Insufficiency Symptom Survey (CISS) questionnaire. In the pre-COVID period the sample had 342 participants, 64.6% females and in the COVID period 322 students participated, 71.4% females. The study of differences was carried out by the Mann-Whitney U test. The interpretation of the statistical inference was performed for a significance level≤0.05.

RESULTS

There was an increase in the number of symptomatic cases in the COVID period without statistical evidence of differences in the frequency of symptoms reported in the two periods. The dimensions "somatic sensations" and "cognitive performance" were the typology of symptoms that most contributed to visual complaints with near vision. There was a significantly different symptomatic behaviour between genders in the period of confinement (p = 0.001), worsening in females and improving in males.

CONCLUSION

These findings suggest that females and males exposed to digital environments, over time, may exhibit different symptomatic behaviour. Our results suggest that boys adapt more quickly than girls. Factors that predispose to these changes, aetiology and potential intervention actions still need further study.

20-20-20 Rule: Are These Numbers Justified?

SIGNIFICANCE

The use of digital devices has increased substantially in recent years across all age groups for both vocational and avocational purposes. There are a wide range of proposed therapeutic and management options for this condition, including optical, medical, and ergonomic interventions.

PURPOSE

Regular breaks are frequently recommended by clinicians to minimize digital eye strain. The so-called 20-20-20 rule, whereby individuals are advised to fixate on an object at least 20 feet (6 m) away for at least 20 seconds every 20 minutes is widely cited. Unfortunately, there is relatively little peer-reviewed evidence to support this rule. The aim of this investigation was to determine whether scheduled breaks are effective in reducing the adverse effects of digital device usage.

METHODS

The study was carried out on 30 young subjects who performed a 40-minute, cognitively demanding reading task from a tablet computer. The task required them to read random words and to identify which ones began with a specific letter chosen by the experimenter. The task was undertaken on four separate occasions, with 20-second breaks being allowed every 5, 10, 20, or 40 minutes (i.e., no break), respectively. Both before and after each trial, subjects completed a questionnaire regarding ocular and visual symptoms experienced during the session. In addition, both reading speed and task accuracy were quantified during each trial.

RESULTS

A significant increase in post-task symptoms (with respective to the pre-task value) was observed for all four trials ( P < .001). However, there was no significant effect of scheduled breaks on reported symptoms ( P = .70), reading speed ( P = .93), or task accuracy ( P = .55).

CONCLUSIONS

Although widely cited as a treatment option, these results do not support the proposal of using 20-second scheduled breaks as a therapeutic intervention for digital eye strain.

Prevalence and risk factors of computer vision syndrome-assessed in office workers by a validated questionnaire

Background

Computer vision syndrome (CVS) is a common occupational health problem, but its clinical definition, prevalence and risk factors are not well defined. In general, non-validated diagnostic instruments have been used to assess its prevalence. For this reason, the aim of this study is to estimate the prevalence and potential risk factors for CVS using a validated questionnaire.

Methods

A cross-sectional study (n = 238) was carried out in Italian office workers using digital devices. All participants responded to an anamnesis, a digital exposure questionnaire, and the validated Italian version of the Computer Vision Syndrome Questionnaire. A battery of 3 ocular surface and tear ophthalmic tests (break-up time, BUT), Schirmer II and corneal staining) was performed.

Results

The mean age (±SD) was 45.55 (11.02) years, 64.3% were female. 71.4% wore glasses to work, whose design was monofocal (for distance) in 47.6%, monofocal (for near) in 26.5%, general progressive in 16.5% and occupational progressive in 8.8% of cases. 35.7% used digital devices >6 hours/day in the workplace. The prevalence of CVS was 67.2%. In the multivariate model, female sex (aOR: 3.17; 95% CI [1.75-5.73]), the use of digital devices >6 hours/day at workplace (aOR: 2.07; 95% CI [1.09-3.95]) and the use of optical correction at work (aOR: 2.69; 95% CI [1.43-5.08]) significantly increased the odds of CVS. Association was observed between presenting CVS and having abnormal BUT (χ2 = 0.017).

Conclusions

The prevalence of CVS in Italian office workers, especially among females, was high. Intensive use of digital devices at work (>6 hours/day) and the use of optical correction at work significantly increased the odds of CVS. There is an association between poor tear stability and CVS. Further research is needed on the influence of wearing optical correction on CVS. The use of a validated questionnaire in health surveillance of digital workers is strongly recommended.

The impact of the first United Kingdom COVID-19 lockdown on environmental air pollution, digital display device use and ocular surface disease symptomatology amongst shielding patients

Worldwide lockdown reduced air pollution during the first phase of the COVID-19 pandemic. The relationship between exposure to ambient air pollution, digital display device use and dry eye symptoms amongst patients with severe ocular surface disease (OSD) were considered. Symptoms and air pollutant concentrations for three different time periods (pre, during and post COVID-19 lockdown) were analysed in 35 OSD patients who achieved an immunosuppression risk-stratification score > 3 fulfilling the UK Government criteria for 12-week shielding. OSDI symptoms questionnaire, residential postcode air pollution data obtained from the Defra Automated Urban and Rural monitoring network for concentrations of nitrogen dioxide (NO₂), nitrogen oxides (NOx), particulate matter (PM) with diameters below 10 µm and 2.5 µm, and English Indices of Deprivation were analysed. Significant reductions in NO₂ and NOx concentrations were observed between pre- and during-lockdown periods, followed by a reversal in the post-lockdown period. Changes were linked to the Living Environment outdoor decile. A 12% increase (p = 0.381) in symptomatology during-lockdown was observed that reversed post-lockdown by 19% (p = 0.144). OSDI scores were significantly correlated with hours spent on digital devices (r² = 0.243) but not with air pollutant concentrations. Lockdown measures reduced ambient air pollutants whilst OSD symptomatology persisted. Environmental factors such as increased time indoors and use of bluescreen digital devices may have partly played a role.

Tweenager Computer Visual Syndrome Due to Tablets and Laptops during the Postlockdown COVID-19 Pandemic and the Influence on the Binocular and Accommodative System

The aim of our study was to compare computer visual syndrome (CVS) in a tweenager student population who use tablets and laptops only to play versus CVS in tweenagers who use these digital devices at school to study, in addition to playing. The tests performed were a validated survey for children for the detection of CVS and accommodative and vergence tests. The CVS item questionnaire was divided into four main groups based on questions concerning the following: (I) the digital device usage time, (II) musculoskeletal and ergonomic nature, (III) visual symptoms, and (IV) ocular surface symptoms. The high-demand digital device group showed worse punctuation in all item groups. From the optometric perspective, when the subjects were classified according to the CVS, high-demand participants presented a clear tendency to exophoria with statistically significant differences in distance vision (−1.94 ± 4.48 Δ) and near vision (−5.78 ± 8.62 Δ) (p < 0.01). Our results establish a relationship between the increased use of electronic devices and computer vision syndrome in the preadolescent population. In addition, this situation is related to the presence of visual, accommodative, and binocular dysfunctions that could affect the efficiency of the visual system.

Changes and correlates of screen time in adults and children during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

Screen time has increased as a result of the COVID-19 pandemic, and several correlates have been associated with these increases. These changes, however, have not been aggregated. It was the aim of this review to (a) aggregate changes in screen time in adults and children, and (b) report on variables in relation to screen time during the COVID-19 pandemic.

METHODS

A systematic review of major databases was undertaken for studies published from inception to 06/12/2021, using a pre-published protocol (PROSPERO ID: CRD42021261422). Studies reporting (a) screen time pre-versus-during the pandemic, (b) screen time percentage change, or (c) correlates of screen time during the pandemic were included. A random effects meta-analysis was undertaken with subgroup analysis by age group and type of screen time.

FINDINGS

After review, 89 studies (n = 204,734; median age=20·6; median female=53·3%) were included. The majority of studies were cross-sectional. With regards to total screen time, primary aged children (6-10 years) reported largest increases (1·4 hrs/day; 95%CI 1·1-1·7), followed by adults (>18 years; 1·0 hrs/day; 95%CI 0·7-1·2), adolescents (11-17 years; 0·9 hrs/day; 95%CI 0·3-1·5), and young children (0-5 years; 0·6 hrs/day 95%CI 0·3-0·9 hrs/day). For leisure screen time (non-work/non-academic), primary aged children reported largest increases (1·0 hrs/day 95%CI 0·8-1·3), followed by adults (0·7hr/day 95%CI 0·3-1·2), young children (0·6 hrs/day; 95%CI 0·4-0·8), with adolescents reporting the lowest increase (0·5 hrs/day 95%CI 0·3-0·7). Several correlates were associated with reported increases in screen time, including adverse dietary behaviours, sleep, mental health, parental health, and eye health.

INTERPRETATION

Pooled evidence suggest that primary aged children reported the highest increase in both total and leisure screen time during COVID-19. It is recommended that screen time should be reduced in favour of non-sedentary activities. This study has the potential to inform public health policy and future guidance regarding screen time, and to inform future research in this area.

FUNDING

No funding was received for this study.

The association between visual display terminal use and dry eye: a review

BACKGROUND

Dry eye disease (DED) is a multifactorial disease of the tear film and ocular surface. It causes ocular symptoms, reduced quality of life and a considerable economic burden on society. Prolonged use of visual display terminals (VDTs) has been suggested as an important risk factor for DED.

PURPOSE

This review aims to study the association between DED and VDT use with an emphasis on the prevalence of DED among VDT users and harmful daily duration of VDT use.

METHODS

A PubMed search was conducted and yielded 57 relevant articles based on a set of inclusion and exclusion criteria. The studies were subclassified according to study design.

RESULTS

The far majority of the studies showed an association between VDT use and DED or DED-related signs and symptoms. The prevalence of definite or probable DED in VDT and office workers ranged from 26% to 70%, with as few as 1-2 hr of VDT exposure per day being associated with DED.

CONCLUSION

VDT use is strongly associated with DED. VDT-associated DED is prevalent, but the exact prevalence needs to be further elucidated using standardized DED diagnosis criteria. Furthermore, a safe lower limit of daily VDT use has yet to be established. More research is needed on the effect of digitalization and digital transformation, which are particularly high during the time of the COVID-19 pandemic.

Effects of digital devices and online learning on computer vision syndrome in students during the COVID-19 era: an online questionnaire study

PURPOSE

Computer vision syndrome (CVS) describes a group of eye and vision-related problems that result from prolonged digital device use. This study aims to assess the prevalence and associated factors of CVS among students during the lockdown resulting from the COVID-19 pandemic.

METHODS

A cross-sectional, online, questionnaire-based study performed among high school students in Thailand.

RESULTS

A total of 2476 students, with mean age of 15.52±1.66 years, were included in this study. The mean number of hours of digital device use per day (10.53±2.99) increased during the COVID-19 pandemic compared with before its advent (6.13±2.8). The mean number of hours of online learning was 7.03±2.06 hours per day during the pandemic. CVS was found in 70.1% of students, and its severity correlated with both the number of hours of online learning and the total number of hours of digital device usage (p<0.001). Multiple logistic regression analysis revealed that the factors associated with CVS included age ≤15 years (adjusted OR (AOR)=2.17), overall digital device usage >6 hours per day (AOR=1.91), online learning >5 hours per day (AOR=4.99), multiple digital device usage (AOR=2.15), refractive errors (AOR=2.89), presence of back pain (AOR=2.06) and presence of neck pain (AOR=2.36).

CONCLUSIONS

The number of hours of digital device usage increased during lockdown. Over 70% of children had CVS, whose associated factors, including hours of digital device usage, hours of online learning, ergonomics and refractive errors, should be adjusted to decrease the risk of acquiring this condition. Online learning will remain, along with CVS, after this pandemic, and we hope our research will be taken into account in remodelling our education system accordingly.

Immediate Ocular Changes After Light-Emitting Diode Displays Exposure-A Preliminary Study

Purpose

Computer vision syndrome (CVS) is one of the most frequently encountered problems among video display terminals (VDT) users, but little is known regarding the short-term effect after exposure to light-emitting diodes (LED). The purpose of this study was to determine if short-term exposure to LED leads to changes in corrected distance visual acuity (CDVA), lipid layer thickness (LLT), blink rates, partial blink ratio, and computer vision syndrome questionnaire (CVS-Q) score.

Design

Prospective, cross-sectional study.

Methods

In this study, participants were recruited at the National Cheng-Kung University Hospital, a tertiary referral center in southern Taiwan, for examination. Participants were asked to complete the CVS-Q and undergo a series of ocular examinations, including CDVA, LLT, blink rates and partial blink ratio before and after watching an LED display for 15 min. Main Outcome Measures were changes in CDVA, LLT, blink rates, partial blink ratio, and CVS-Q measurements.

Results

In total, 120 eyes from 60 participants (mean age: 35.7 ± 9.4 years) were included; 31 participants were men (51.7%), and 29 were women (48.3%). The CDVA, LLT, blink rates, and partial blink ratio did not change after watching the LED display. The CVS-Q score significantly improved after short-term LED exposure (P < 0.001). A subgroup analysis of subjects with a baseline LLT of <60 nm or ≥60 nm determined that LLT significantly decreased in individuals with a baseline LLT of ≥60 nm (P = 0.016).

Conclusion

Short-term use of LED displays reduced LLT in individuals with a baseline LLT of ≥60 nm, despite the visual symptoms of CVS improved subjectively. Therefore, digital device users should be aware of the potential negative effects of LED exposure on the eyes.

Is wearing a face mask associated with symptomatic dry eye disease among medical students during the COVID-19 era? An online survey

Background

Coronavirus disease 2019 has necessitate the routine use of masks worldwide. This study assessed the relationship between wearing a facemask and dry eye disease (DED) among a sample of medical students in Jordan.

Methods

This cross-sectional online survey enrolled medical students from all medical schools in Jordan. The questionnaire, which was shared via social media platforms, assessed sociodemographic information, ocular and medical history, facemask-wearing habits, the use of ocular devices, and the relationship with ocular discomfort. The ocular surface disease index (OSDI) questionnaire was also administered to quantify DED symptoms.

Results

A total of 1,219 students participated in this study. In total, 58.3% participants were females, and 52% were in the clinical science years. Symptomatic DED was found in 71.7% of participants. Female sex, basic science years, allergy reporting, and spending more than 6 h looking at screens were significantly associated with symptomatic DED.

Conclusion

Wearing a facemask was not significantly associated with symptomatic DED. Further studies are needed to investigate the effect of wearing a facemask on the ocular surface.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-022-02377-z.

Comparative antioxidant activity of various ophthalmic product types for artificial tears under different experimental conditions

Artificial tears or lubricants is a developing category in pharmaceutical research, due to the permanent increasing incidence of dry eye syndrome caused by the extensive use of personal computers and other gadget screens, associated with global warming and pollution. Considering the role of inflammation in dry eye syndrome, characterized by the production of free radicals, it is imperative to determine which elements are more significant in forming an artificial tear more effectively and more comfortably for the eye state and for the quality of life. Thus, the aim of the present study was to examine the evolution of the total antioxidant capacity of some frequently commercialized artificial tears via the photochemiluminescence method, using an antioxidant capacity of lipid soluble substances procedure, prior and subsequent to the exposure of these therapy agents to some physical agents. This is a preliminary research aiming to evaluate the impact of various environmental factors on these ophthalmic products, to be continued by evaluating whether the effectiveness of these products, in terms of objective examination and patient preference and adherence criteria, is impacted by the conditions of use and storage. Thus, the total antioxidant capacity of the evaluated artificial tear samples after UVC irradiation at 254 nm wavelength was studied, in order to investigate whether their status suffered any change in terms of antioxidant potential. In addition to the findings obtained in the study, some recommendations were also made.

Mean Tear-Film Lipid Layer Thickness and Video Display Terminal Time as Risk Factors for Abnormal Blinking in Children

Objective: To explore the risk factors for abnormal blinking in children and the role of the tear-film lipid layer thickness (LLT) as a function of duration of video display terminal (VDT) use in children. Methods: Children attending the Optometry Clinic of Xinhua Hospital affiliated with Shanghai Jiao Tong University were recruited for the study between June 2019 and June 2020. Time spent viewing a VDT (VDTt) over the previous 6 months was recorded. Incomplete blinking (IB) and blinking rate were measured over a 10 s period using the Lipiview^® interferometer (Tear Science, Morrisville, NC, USA), and participants were allocated into groups with normal blinking (NBG, blink rate < 20 blinks/min) and abnormal blinking (ABG, blink rate ≥ 20 blinks/min). T-test, chi-square test and Mann-Whitney U-test were used to compare the differences in tear film (TF) stability indexes and meibomian gland function indexes between the two groups. Binary logistic analysis was used to analyze the risk factors for abnormal blinking and protective factors related to children's use of VDT, and receiver operating characteristic (ROC) curve analysis was also conducted. Results: A total of 167 children were included, with no statistically significant differences in age or sex between the two groups. According to the t-test, VDTt was significantly higher in ABG than NBG, while TF stability indices including tear break up time, LLT and the height of the tear meniscus, were significantly higher in NBG than ABG (P < 0.001). The results also showed better meibomian gland function in NBG than ABG (P < 0.05). Binary logistic analysis showed that VDTt is an important risk factor for abnormal blinking, and the average of LLT (AVG) was found to be an important protective factor for children using a VDT for long periods, with a cut-off value of 1.5 h and 57.5 nm, respectively. ROC curve analysis showed that the area under the curve value of VDTt and AVG was 0.833 and 0.969, respectively (P < 0.001). Conclusion: In children, VDTt is an important risk factor for abnormal blinking, and the AVG is an important protective factor for children using VDT for long periods.

Potential Protective Role of TRPM7 and Involvement of PKC/ERK Pathway in Blue Light-Induced Apoptosis in Retinal Pigment Epithelium Cells in Vitro

PURPOSE

Blue light triggers apoptosis of retinal pigment epithelium (RPE) cells and causes retinal damage. The aim of this study was to elucidate the protective role of transient receptor potential melastatin 7 (TRPM7) in photodamaged RPE cells.

METHODS

RPE cells were isolated from Sprague-Dawley (SD) rats and exposed to varying intensities of blue light (500-5000 lux) in vitro. Cell proliferation and metabolic activity were respectively assessed by bromodeoxyuridine (BrdU) incorporation and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assays. Real-time polymerase chain reaction (RT-PCR) and western blotting were used to analyze the TRPM7, protein kinase C (PKC), extracellular signal-regulated kinase (ERK) and Bcl2-associated x/B-cell lymphoma 2 (Bax/Bcl-2) messenger RNA (mRNA) and protein expression levels. The cells were transfected with TRPM7 small interfering RNA (siRNA) or transduced with TRPM7-overexpressing lentiviruses and cultured with or without the pigment epithelium-derived factor (PEDF).

RESULTS

Blue light inhibited the proliferation and metabolic activity of RPE cells in an intensity-dependent manner when compared to nonirradiated controls (P < 0.05). Compared to the control, photodamaged RPE cells showed decreased levels of TRPM7, PKC, ERK, and Bax, and an increase in Bcl-2 levels (P < 0.01). Forced expression of TRPM7 partially rescued the proliferative capacity of RPE cells (P < 0.01) and restored the levels of TRPM7, PKC, ERK, and Bax (P < 0.01), whereas TRPM7 knockdown had the opposite effects (P < 0.01). TRPM7 and PEDF synergistically alleviated the damaging effects of blue light.

CONCLUSIONS

Blue light triggers apoptosis of RPE cells, and its deleterious effects can be partially attenuated by the synergistic action of TRPM7 and PEDF via the PKC/ERK signaling pathway.

Dynamics of a Gel-Based Artificial Tear Film with an Emphasis on Dry Disease Treatment Applications

This paper discusses the spreading of gel-based ophthalmic formulation on the cornea surface assumed to be flat. We show that gel-based formulations exhibit rheological behaviors that the Herschel–Bulkley model can describe. The continuity and momentum equations are solved numerically using the monofluid formulation and the volume-of-fluid (VOF) method. We investigated the influence of the rheological properties, namely the consistency, the yield stress, and the flow behavior index, on the spreading of a gel-based artificial tear over the cornea surface. We propose optimal values of these properties for efficient gel-based artificial tears.

Assessment and Management of Dry Eye Disease and Meibomian Gland Dysfunction: Providing a Singapore Framework

ABSTRACT

The purpose of this article is to provide a framework for general ophthalmologists in Singapore to manage dry eye. This framework considers the evidence in the literature as well as recommendations from expert panels such as the Tear Film & Ocular Surface Society Dry Eye Workshop II and the Asia Cornea Society Workgroup.This article covers the assessment of patient medical history and ask triage questions to identify local and systemic causes of dry eye disease (DED), excluding other possible causes, as well as the risk factors for DED and ocular surface inflammation. Evaluation of clinical signs to establish the diagnosis of DED and differentiation from other causes of irritable, red eyes are described. Tests for understanding the underlying disease processes and severity of DED are also presented.Management of dry eye should involve patient education and engagement. Information about the natural history and chronic nature of DED should be provided to improve long-term management of the disease and enhance compliance. Aggravating factors should be removed or lessened.We provide a guide to determine the most appropriate treatment (or combination of treatments) based on the severity and cause(s) of the disease, as well as the patient's needs and preferences. The aim of the management is to relieve ocular discomfort and prevent worsening of symptoms and signs, as well as to optimize visual function and minimize structural ocular damage. We also discuss the systematic follow-up and assessment of treatment response, as well as monitoring side effects of treatment, bearing in mind continuous support and reassurance to patients.

Problematic Internet Use Associated with Symptomatic Dry Eye Disease in Medical Students from Peru

PURPOSE

Dry eye is a multifactorial ocular surface disease (DED) characterized by a loss of tear film homeostasis, which is widely associated with alterations in mental health. Problematic internet use (PIU) is defined as the feeling of concern about using this tool irresistibly, for longer periods than usual, accompanied by anguish that results from not doing so without reaching mania or hypomania behaviors. Both PIU and DED present a theoretical link; however, there are no published studies that report its relationship with problematic internet use. Therefore, this study aims to determine the association between PIU and symptomatic DED in Peruvian medical students.

PATIENTS AND METHODS

Analytical cross-sectional study that included human medical students from Peru. For the measurement of main variables, the Ocular Surface Disease Index (OSDI) and the Internet Addiction Test (IAT) were used. To study their relationship, the Poisson regression analysis was used, we consider a p-value <0.05 as significant.

RESULTS

Data from 844 medical students were analyzed, 35.7% male and 64.3% female, with an average age of 21.8 ± 3.3 years. Likewise, the prevalence of symptomatic DED was 70.9%, and the internet's controlled use was 85.3%. In the analysis adjusted for symptomatic DED, the men showed significant differences in the controlled use of the internet (p <0.003), of which those who had PIU, 50% had severe symptomatic DED, as well as 80% of those addicted to the internet. The adjusted model showed that the PIU increases the prevalence of symptomatic DED in men (PR = 1.17, 95% CI: 1.06-1.29); however, in women, no association was found between both variables.

CONCLUSION

PIU and symptomatic DED showed a significant association in male medical students from Peru.

Factors influencing the 8-item contact lens dry eye questionnaire score and comparison of translations in Japanese soft contact lens wearers

PURPOSE

To determine (1) the factors associated with a high degree of self-reported symptoms with Japanese translations of the 8-Item Contact Lens Dry Eye Questionnaire (J-CLDEQ-8) in a cross-section of soft contact lens (SCL) wearers in Japan and (2) whether the difference in translation of the CLDEQ-8 affects the scores between validated and non-validated versions of the Japanese translation.

METHODS

Habitual SCL wearers completed the validated J-CLDEQ-8 and a previous non-validated version. Demographics and SCL history questions were queried when they presented for routine eye care in nine geographically distinct clinics across Japan. The following risk factors for high J-CLDEQ-8 scores (≥11) were tested: sex, age, SCL replacement (daily disposable vs. bi-weekly and monthly reusable), years of SCL wear, and self-reported use of rewetting drops. The scores of the validated and non-validated questionnaires were compared.

RESULTS

Significant patient-related risk factors for high J-CLDEQ-8 scores were female sex, use of reusable SCLs, longer years of SCL wear, and use of rewetting drops. Scores for six out of eight questions in the validated J-CLDEQ-8 were significantly higher than those of the non-validated version, resulting in a significant difference in the average total score between the two questionnaires (validated J-CLDEQ-8: 10.5 ± 5.9 vs non-validated J-CLDEQ-8: 9.5 ± 5.8, P < 0.001).

CONCLUSIONS

Female sex, use of reusable SCLs, longer years of SCL wear, and use of rewetting drops were significant risk factors for high J-CLDEQ-8 scores in a cross-sectional clinical population of Japanese SCL wearers. Symptoms with SCL are not predicted by age and must therefore be queried at follow-up visits for all SCL wearers. Differences in the two translations affected the ability of the questionnaire to identify individuals with high symptoms associated with SCL wear.

Prevalence and risk factors of dry eye disease among University Students in Bangkok, Thailand

Purpose

To investigate the prevalence of dry eye disease (DED) and its associated risk factors among Thai university students.

Methods

A cross-sectional study using an electronic survey was conducted in two Rajabhat universities in Bangkok, Thailand. The woman’s health study questionnaire was used to determine students with DED. The prevalence of DED along with 95% confidence interval (CI) were calculated. Logistic regression model was used to identify the associated risk factors.

Results

A total of 4,111 university students joined and completed the survey questionnaires. Mean age was 18.8 ± 1.1 years with female predominance (2874 students, 69.91%). Clinically diagnosed DED was reported in 136 students (3.31%), while severe symptoms of eye dryness and irritation were reported in 227 students (5.52%). The prevalence of DED among Thai university students was 8.15% (95% CI 7.33% to 9.02%). History of contact lens use and high screen time (> 8 hours per day) were reported in 868 students (21.11%) and 2101 students (51.11%), respectively. Male gender, contact lens use and high screen time were significantly associated with higher risk of DED with the adjusted ORs (95% CI) of 1.39 (1.09, 1.77), 2.49 (1.96, 3.17), and 1.43 (1.14, 1.80), respectively.

Conclusions

DED is not rare among Thai university students. Contact lens use and high screen time are two significant modifiable risk factors of DED in our students. These findings can raise awareness of DED in youth population and provide valuable information for public health promotion in university students.

Vision through Healthy Aging Eyes

As life expectancy grows, so too will the number of people adversely affected by age. Although it is acknowledged that many conditions and diseases are associated with age, this mini-review will present a current update of the various visual changes that generally occur in healthy individuals disregarding the possible effects of illness. These alterations influence how the world is perceived and in turn can affect efficiency or the ability to perform ordinary daily tasks such as driving or reading. The most common physical developments include a decreased pupil size and retinal luminance as well as changes both in intercellular and intracellular connections within the retina along the pathway to the visual cortex and within the visual cortex. The quantity and the physical location of retinal cells including photoreceptors, ganglion and bipolar retinal cells are modified. The clarity of intraocular organs, such as the intraocular lens, decreases. These all result in common visual manifestations that include reduced visual acuity, dry eyes, motility changes, a contraction of the visual field, presbyopia, reduced contrast sensitivity, slow dark adaptation, recovery from glare, variation in color vision and a decreased visual processing speed. Highlighting these prevalent issues as well as current and possible future innovations will assist providers to formulate treatments and thereby conserve maximum independence and mobility in the modern mature population.

Health Issues with Learning to Use Smart Devices in the Digital Age: Using a Grounded Theory Approach

The Korean government has announced a plan for a national policy to deliver smart education among all students. As a result, many people are worried about the possible health-related adverse effects. This qualitative study aimed at analyzing health issues related to middle school students who learn by using smart devices using the grounded theory approach. We conducted in-depth interviews with 30 students at four middle schools who used smart devices for more than a year. The analysis of this research data was based on the constant comparative method, using grounded theory as a theoretical framework. The data analysis revealed many concepts in 28 subcategories and 13 categories related to smart learning health issues, with the central phenomenon being experience with health problems. Students' health-related experiences were classified as physical or psychosocial symptoms. Adverse health effects related to smart learning were related to unsafe smart learning behavior and an inefficient smart learning environment. The consequences appeared to be the formation of diverse digital habits through the ambivalent use of smart devices and differences in ability to control health problems. Our findings suggest that students can form ideal habits for using smart devices if their health issues are well monitored and managed.

Correlation between the exposure time to mobile devices and the prevalence of evaporative dry eyes as one of the symptoms of computer vision syndrome among Senior High School students in East Java, Indonesia

OBJECTIVES

Computer vision syndrome (CVS) is a group of various eye and vision-related problems from prolonged use of mobile devices. Symptoms include dry eyes, blurred vision, eye strain, headache, and also neck and shoulder pain. This study was carried out to analyze the correlation between the exposure time of High Energy Visible (HEV) from mobile devices' use and the prevalence of evaporative dry eyes in young age.

METHODS

An observational cross-sectional study was done using quota sampling method for 100 High School students. Data collection was performed using questionnaire to identify daily use of mobile devices (hours) and duration for using mobile devices (years). A classification was determined as mild, moderate, and heavy HEV exposure. Evaporative dry eyes were diagnosed using tear break-up time test (TBUT) of less than 10 s for both eyes.

RESULTS

Ninety-four students participated in this study. A total of 82 students (87.2%) experienced evaporative dry eyes. There were 11 students (11.7%) who had dry eyes with mild exposure, 18 students (19.1%) had dry eyes with moderate exposure, and 53 students (56.4%) had dry eyes with heavy exposure. A chi square analysis showed all HEV exposures have similar risk to the prevalence of dry eyes among High School students (p<0.05).

CONCLUSIONS

The risk of developing evaporative dry eyes, as one of the symptoms of CVS in young age with normal tear production, could be induced even with minimal exposure to mobile devices.

COVID-19 and Dry Eye

ABSTRACT

The aim of this article is to review the literature on the impact of coronavirus disease 2019 (COVID-19) on dry eye disease (DED). A literature search on dry eye and COVID-19 was performed. Most current studies focus on DED in patients diagnosed with COVID-19 or dry eye symptoms in random populations of students and medical staff. Real-world dry eye practices revealed a variety of responses, possibly related to local environmental factors and lifestyle. Patients recovered from COVID-19 warrant ocular surface surveillance for DED. Pandemic mitigation strategies including remote work/school/leisure and mask wearing affect dry eye practices globally. Heightened reiteration of dry eye management for environmental and behavioral modifications, visual display terminals, and mask wearing with attention to its effects on the ocular surface is increasingly important as this pandemic continues.