Dry Eye-Related Risk Factors for Digital Eye Strain

A prospective self-controlled study on the alterations of the ocular surface and conjunctival transcriptomic profile associated with prolonged exposure to video display terminals

PURPOSE

To assess the impact of prolonged and intense exposure to video display terminals (VDTs) on ocular surface homeostasis.

METHODS

30 subjects limited daily VDT usage to less than 3 h for one week, then extended usage to more than 8 h/day for the next three weeks. Ocular symptoms and signs were evaluated weekly using the Ocular Surface Disease Index (OSDI) questionnaire and clinical examinations. Eyelid margins and meibomian glands were examined, and ocular surface samples were collected for transcriptomic analysis.

RESULTS

Average daily VDT time increased from 2.55 ± 0.46 h initially to 11.17 ± 2.45, 11.75 ± 2.63, and 10.89 ± 2.41 h over three weeks. The dry eye diagnosis rate rose from 6.67 % to 51.67 %. Total OSDI score (P = 0.008), symptoms score (P = 0.014), and visual function score (P = 0.002) significantly increased. Mean fluorescein break-up time (FBUT) decreased from 6.46s to 3.08s. Corneal fluorescein staining (CFS) score (P < 0.001) and lissamine green conjunctival staining (LCjs) score (P = 0.036) worsened. Ocular redness index (RI) increased at 1 week and 3 weeks (P = 0.007, P = 0.001). Telangiectasia scores of both upper and lower eyelid margins increased at 3 weeks (P = 0.002, P < 0.001). Meibomian gland orifice blockage worsened (P = 0.014, P = 0.002). Transcriptomic analysis revealed dynamic alterations in ocular surface gene expression, including inflammatory and hormonal responses. MUC5AC and TFF1 genes showed negative correlations with OSDI and conjunctival staining score, respectively.

CONCLUSION

Prolonged VDT exposure deteriorates ocular surface symptoms and signs, with significant inflammatory responses and hormonal activity indicating an imbalance in ocular surface homeostasis.

Association between potential factors and dry eye disease: A systematic review and meta-analysis

BACKGROUND

The 2017 TFOS DEWS II report provided an overview of the epidemiology of dry eye disease (DED) and identified several potential risk factors. This study aimed to conduct a meta-analysis on these potential risk factors.

METHODS

A comprehensive systematic search was conducted in PubMed, Embase, Web of Science, and Cochrane Library databases to include observational studies. Two researchers independently extracted adjusted odds ratios (AORs) and their 95% confidence intervals (CIs), and a random-effects model was used to combine the data. Results were reported using odds ratios (ORs) and their 95% CIs.

RESULTS

The meta-analysis results showed that the risk factors for DED were smoking (OR 1.18, 95% CI 1.07-1.29), alcohol consumption (OR 1.18, 95% CI 1.03-1.35), rosacea or acne (OR 1.96, 95% CI 1.56-2.45), allergic conjunctivitis (OR 4.59, 95% CI 3.38-6.23), refractive surgery (OR 1.78, 95% CI 1.05-3.00), diabetes (OR 1.14, 95% CI 1.06-1.22), thyroid disease (OR 1.57, 95% CI 1.36-1.82), viral infections (OR 1.54, 95% CI 1.33-1.78), anxiety (OR 2.39, 95% CI 1.30-4.39), depression (OR 1.59, 95% CI 1.39-1.82), post-traumatic stress disorder (OR 1.43, 95% CI 1.42-1.45), and stress (OR 1.59, 95% CI 1.24-2.05). However, there was no significant association between Hispanic ethnicity, menopause, past smoking, current smoking, multivitamin use, and DED.

CONCLUSION

These findings provide valuable insights for further research on the prevention and treatment of dry eye disease.

Digital eye strain and clinical correlates in older adults

PURPOSE

To evaluate the screen time habits, associated symptoms and clinical characteristics of an older population (60 years and older) drawn from primary care optometry.

METHODS

Consecutive patients aged 60 years and older, who used a digital device for at least 1 hour per day, attending for an eye examination at a primary care optometric practice in Dublin, Ireland, were invited to participate. The study gathered information regarding the participant's use of digital devices, the types of devices used and duration of use. Best corrected distance acuity and near vision adequacy for reading and device use was recorded.

RESULTS

401 responses were included in the analysis. Based on a Computer Vision Syndrome Questionnaire (CVS-Q) score ≥6, the occurrence of DES in this population was high at 51.6 % with females having a higher median score than males. The mean number of hours devices were used for was 4 hours. 71 % of participants reported symptoms of digital eye strain (DES) when using digital devices. Smart phones were the device type used most by participants but tablets were the device type used for the longest duration. Single vision spectacles were the most commonly used method of visual correction when using digital devices. Participants with better levels of acuity used devices for longer periods than those with poorer acuity.

CONCLUSION

This study provides a valuable insight into the screen habits and likelihood of symptoms of DES in an older population and, is to date, the first of its kind. It shows that the prevalence of DES in older age adult device users is high, at 51.6 %, with a clear link between dry eye and symptoms of DES. Its results will enable optometrists to provide specific advice to this age group on how best to reduce symptoms of DES.

Prevalence of Computer Vision Syndrome and Its Risk Factors in a Spanish University Population

OBJECTIVES

To determine the prevalence of digital eye strain or computer vision syndrome (CVS) and its risk factors in a university population (University of Valladolid, Spain).

METHODS

An anonymous cross-sectional online survey was conducted in a university population [staff (lecturers and administrative employees) and students (undergraduate, master's, and PhD)], including two validated questionnaires (Ocular Surface Disease Index [OSDI] and the 17-item Computer-Vision Symptom Scale questionnaire [CVSS17]) and questions about sociodemographic data and visual display terminal use. The prevalence and risk factors for CVS (CVSS17≥29) (multivariate logistic regression model) were calculated.

RESULTS

One thousand nine participants responded to the survey (35.2±15.2 years; 64.1% women). The mean OSDI and CVSS17 questionnaire scores were 18.9±15.6 and 31.5±6.4, respectively, and 35.4% of the respondents had dry eye symptoms (OSDI>22). The total prevalence of CVS was 65.4% (95% CI 62.1-68.3). Undergraduate students showed the highest CVS prevalence (72.6%; P <0.01), which was significant. In addition, women, participants younger than 36 years old, contact lens wearers, and subjects with dry eye symptoms reported a statistically higher CVSS17 score ( P ≤0.01). In the multivariate model, significant factors associated with the presence of CVS ( P ≤0.03) were female sex (OR=2.10; 95% CI 1.54-2.88), dry eye symptoms (OSDI>22) (OR=16.98; 95% CI 10.36-27.84), VTD use ≥6 hr daily (OR=1.96; 95% CI 1.09-3.52), and being an undergraduate student (OR=2.23; 95% CI 1.54-3.24).

CONCLUSION

A high prevalence (65.4%) of CVS was found among the Spanish university population, with the undergraduate student group having the highest prevalence (72.6%). Female sex, more than 6 hr/day of visual display terminal use, being an undergraduate student, and dry eye symptoms significantly increased the risk of CVS in the university population.

Digital Challenges: Investigating Computer Vision Syndrome in Thai Esports Through a Case-Control Approach

Purpose

To determine the factors associated with eyestrain in esports athletes in Bangkok compared with controls.

Patients and Methods

A cross-sectional descriptive study was conducted between April and June 2023, involving 160 male participants (aged 20-35 years) who used digital devices, consisting of esports athletes and a control group. Data were collected using a general information questionnaire, Computer Vision Syndrome Questionnaire (CVS-Q), and Depression anxiety stress scale-21 (DASS-21). Ophthalmic instruments were used for the eye examinations by an optometrist.

Results

Seventy-six esports athletes showed significantly lower visual performance than controls in logMAR visual acuity (p < 0.020), phoria (p < 0.001), negative fusional vergence (blur, break, and recovery) (p < 0.012, p < 0.004 and p < 0.039), positive fusional vergence (blur, break, and recovery) (p < 0.005, p < 0.001 and p < 0.005), monocular estimation method (p < 0.001), monocular and binocular accommodative facility (p < 0.001), and vergence facility (p < 0.001). A study on risk factors for CVS found that esports athletes were significantly more likely to have CVS (p < 0.001). Work environments with high-intensity lighting significantly increase the risk of CVS compared to low-intensity lighting (p < 0.001). The use of a digital device for >4 h/day, having a history of alcohol consumption, and stress significantly increased the risk of CVS (p < 0.001, p < 0.023, p < 0.048).

Conclusion

This study found that esports athletes experienced vision health problems, indicating the need to prevent eyestrain caused by the use of digital devices.

Dry eye in primary care: the relationship between digital display device usage and dry eye syndrome (DES) in medical students

OBJECTIVE

As digital display devices become more and more indispensable, associated health problems have started to increase. We aimed to investigate the frequency and relationship of digital display device usage behaviours and dry eye syndrome (DES) in medical students.

METHODS

An observational, cross-sectional study was conducted on medical school students who voluntarily participated in our study online, about the duration and variety of their digital screen use, usage patterns, and protective measures, together with the Ocular Surface Disease Index (OSDI) questionnaire. Where necessary, the Schirmer-I, tear break-up time, and fluorescein staining tests were carried out.

RESULTS

Of the 255 participants, 75.3% (n = 192) were female, 63.1% (n = 161) had no refractive vision defects, and 45.9% used smartphones for more than 5 h a day. According to the OSDI scores for DES screening, only 36.1% of the participants were normal, 17.3% had mild DES, 20.4% had moderate DES, and 26.3% had severe DES. A positive correlation was found between digital display usage time in hours per day and a high OSDI score. As the distance between the eye and the screen decreased, the DES score increased, which is significant for computer, e-book, and tablet use (P < 0.005). The DES rate of the 25 participants who underwent further evaluation was 40% for the tear break-up time test and 52% for the fluorescein staining test.

CONCLUSION

The high prevalence of DES due to digital screen use among medical school students highlights the importance of DES screening as a preventive measure in family medicine.

Ocular surface changes following computer use in post-LASIK patients

PURPOSE

To assess the impact of computer use on the ocular surface of individuals after laser in situ keratomileusis (LASIK).

METHODS

The dry eye symptoms and ocular surface of 18 post-LASIK young individuals and 18 controls were evaluated before and after performing a 30-min task on a computer without (Visit 1) and with (Visit 2) initial instillation of artificial tears. Symptoms were assessed using the Ocular Surface Disease Index (OSDI), Symptom Assessment in Dry Eye questionnaire version two (SANDE II) and Computer Vision Syndrome Questionnaire (CVS-Q). The ocular surface was assessed by measuring corneal higher order aberrations, tear meniscus height (TMH), conjunctival redness, blink rate and incomplete blinking, lipid layer thickness (LLT) and non-invasive keratograph break-up time (NIKBUT).

RESULTS

SANDE II scores were >0 after the computer task in both groups (p ≤ 0.01). SANDE II and CVS-Q scores did not differ between LASIK and controls (p ≥ 0.43). Greater bulbar-temporal conjunctival redness, TMH and LLT and shorter NIKBUT were found after computer use in the LASIK group (p ≤ 0.04), whereas no changes were observed in the controls (p ≥ 0.20). Lower SANDE II and CVS-Q scores were reported at Visit 2 compared with Visit 1 in both groups (p ≤ 0.01). Likewise, no worsening of dry eye signs was observed at Visit 2 (p ≥ 0.11).

CONCLUSIONS

Ocular symptoms reported during computer use were comparable between the groups. However, a worsening of dry eye signs was mostly observed in post-LASIK individuals. The instillation of artificial tears was effective in preventing the effects of computer use on the ocular surface in post-LASIK patients.

Impact of Covid-19 on Pediatric Ophthalmology Care: Lessons Learned

The COVID-19 pandemic came with many new challenges that forced personal and professional lifestyle modifications. Medical facilities were in scarcity against this new unknown enemy and were challenged with the overloaded patient flow, scarcity of healthcare staff, and evolving treatment modalities with a better understanding of the virus each day. Ophthalmology as a "branch of medicine" suffered challenges initially because of a lack of guidelines for patient management, close working distance during routine examinations, and halt of major surgeries, including cataracts. Pediatric ophthalmology had major implications, as reduced outpatient visits would mean deeper amblyopia, and changed lifestyles, including online classes and home refinement, predisposing children to myopia, digital eye strain, and worsening of strabismus. COVID-19 also unveiled underlying accommodation and convergence anomalies that predisposed pediatric and adolescent patients to an increased prevalence of headache and acute onset esotropia. Teleophthalmology and other innovative solutions, including the use of prism glasses, safe slit-lamp shields, alternative ways of school screening with the use of photoscreeners, performing retinoscopy only when needed, and using autorefractors were among the few guidelines or modifications adopted which helped in the efficient and safe management of pediatric patients. Many pediatric ophthalmologists also suffered in terms of financial constraints due to loss of salary or even closure of private practices. School screening and retinopathy of prematurity screening suffered a great setback and costed a lot of vision years, data of which remains under-reported. Important implications and learnings from the pandemic to mitigate future similar situations include using teleophthalmology and virtual platforms for the triage of patients, managing non-emergency conditions without physical consultations, and utilizing home-based vision assessment techniques customized for different age groups. Though this pandemic had a lot of negative implications, the innovations, modifications, and other important learnings helped pediatric ophthalmologists in navigating safely.

Patient-reported outcomes of serum eye drops manufactured from Australian blood donations and packaged using Meise vials

Introduction

Serum eye drops (SED) are an effective treatment for dry eye syndrome. However, autologous serum collection can have challenges. Patient-tailored (allogeneic) SED (PT-SED) can be made from healthy blood donors. Australian Red Cross Lifeblood has manufactured both autologous SED (Auto-SED) and PT-SED and, in May 2021, introduced Meise vial packaging. This study aimed to explore SED patient-reported outcomes and vial packaging satisfaction.

Methods

A prospective cohort study was conducted with recruitment between 1 November 2021 and 30 June 2022. Participants completed the dry eye questionnaire (DEQ5), health-related quality-of-life (SF-8™), functional assessment of chronic illness therapy-treatment satisfaction-general (FACIT-TS-G), and general wellbeing surveys. Existing patients completed these once, and new patients were surveyed at baseline, 3 months post-treatment, and 6 months post-treatment.

Results

Participants who completed all study requirements were 24 existing and 40 new Auto-SED and 10 existing and 8 new PT-SED patients. Auto-SED patients were younger [56.2 (±14.7) years] than PT-SED patients [71.4 (±10.0) years]. Participants used a mean of 1.8 (±1.1) SED, 5.3 (±2.9) times per day. In new patients, DEQ5 scores improved within 6 months from 14.0 (±2.9) to 10.6 (±3.4) for Auto-SED and from 12.9 (±3.7) to 11.4 (±2.8) for PT-SED. General wellbeing measures improved in the new Auto-SED from 7.0 (±1.9) to 7.8 (±1.7) but were reduced for new PT-SED from 6.7 (±2.9) to 6.1 (±2.9).

Discussion

SED improved dry eye symptoms in most patients, regardless of the serum source. Patients using PT-SED showed decreases in some quality-of-life measures; however, recruitment was reduced due to operational constraints, and concurrent comorbidities were not assessed. General feedback for SED and vial packaging was positive, with some improvements identified.