Article

DRY EYE DX AND TX

DRY EYE DISEASE: A NEW GENERATION?

This year marks the 10th anniversary of Apple’s first iPhone release. Its touchscreen technology and connectivity to the internet changed the way we communicate, access information, listen to music, and play games. Subsequent to the iPhone’s introduction, many other “smart” devices have been introduced over the years, providing millions of people with access to communication, knowledge, media, and entertainment.

The Bad with the Good

Notwithstanding these benefits, devices also have the potential to cause negative, long-lasting effects. This is perhaps most evident in the influences that these devices may have on children and young adults. Domingues-Montanari (2017) performed a literature review study on the impact of device viewing, especially television, on young children. She found that increased screen time in the hour prior to sleep is associated with delayed language skills as well as decreased vocabulary and number knowledge scores.

Dube et al (2017) reported that children who used electronic entertainment and communication devices one hour prior to sleep had impaired sleep quality, and their risk for obesity doubled. In very young children, increased television exposure has been associated with emotional issues and aggression. Video gaming has been associated with severe depressive symptoms and anxiety.

The words “dry eye patient” may conjure up an image of an elderly patient shuffling down the hall to an examination room, but recent studies show that dry eye is increasingly common in the young. Meibomian gland dysfunction is a common underlying factor in dry eye disease (DED). Mizoguchi et al (2017) evaluated the ocular surface and meibomian glands in 15-year-old male and female Japanese students. They found substantial alterations in meibomian gland anatomy and function (meiboscore and meibum grade), which were more severe in males. Their findings seemed to be worse than those described in previous studies.

In addition, Moon et al (2016) assessed smartphone use as a risk factor for pediatric dry eye in urban and rural areas. Their findings suggest that risk factors for dry eye in children include living in urban areas; higher rates of smartphone use (associated with older age); and shorter duration of time spent out of doors. After one month of cessation of smartphone use in the dry eye group, signs and symptoms improved. They concluded that use of devices, especially smartphones, should be monitored.

Why Is This Happening?

The causes are probably multifactorial, but the answer may lie, in part, with the issue of blinking. Chu et al (2014) compared blink rates of individuals reading identical text from a book and from a computer screen. The blink rates for both media were similar; however, they found a significantly higher percentage of incomplete blinks in subjects reading from a computer. Previously, McMonnies (2011) described the importance of blinking efficiency to the health of the ocular surface.

Extended reading may lead to incomplete blinking, which in turn reduces tear film integrity. Korb et al (1994) determined that “forceful” blinking enhances lipid layer thickness. This may explain why children who view screens, sometimes for hours, have altered tear films and reduced vision.

The implications of this information are impactful. Parent education regarding the potential complications of overuse of devices in pediatric and young populations is vital. And, when evaluating our young patients, we should ask the parents about how much time their children spend on devices, evaluate children for signs and symptoms of DED, and educate parents about the long-term consequences of overuse of devices in their children. CLS

For references, please visit www.clspectrum.com/references and click on document #263.