Written by Joyce Smith, BS. This study suggests that smartphone use could not only aggravate subjective symptom indices such as the OSDI, VAS, and CVS but also induce tear film instability and oxidative stress indices in the tears and at the ocular surface.
The widespread use of mobile devices and smart phones has made visual display terminal use a common feature in many homes today 1. Smartphones with their many appealing functions such as web browsing, video watching, and social networking have become a popular household item. In fact, a 2013 study reported that the average time spent using a smartphone nearly doubled from 98 minutes per day in 2011 to 195 minutes in 2013 2. Health problems such as sleep disorders and headaches correlate with the excessive use of smart phones 3. Monocular vision loss 4, esotropia (a form of strabismus in which one or both eyes turn inward giving a “cross-eyed appearance”) 5, dry eye disease (DED) 6 and tear film and ocular surface damage have also been attributed to excessive smartphone use.
A recent 2016 study revealed that over exposure of blue light from smart phones caused tear film damage and demonstrated an increase in inflammatory markers and reactive oxygen species production at the ocular surface of mice 7, prompting Choi et al 8 to evaluate the influences of smartphone and computer display use on eighty healthy volunteers who had subjective symptoms and asthenopia (eye strain).Choi conducted a 2018 prospective, non-randomized, comparative clinical study included a smartphone group (n=50) and a computer display (n=30) control group. The smart phone had a 5.1 in light emitting diode (LED) screen from Galaxy S6, Samsung: the control group used the same computer display with a 19.0 inch Samsung screen. All subjects played a puzzle game. Subjective ocular symptoms and asthenopia were evaluated using the ocular surface disease index (OSDI), visual analogue scale (VAS), and computer vision syndrome (CVS) score before and after smartphone and computer use for 1 hour and again after 4 hours of use. All investigations were done by the same investigator and under identical conditions of humidity.
At 4 hours, the OSDI total, symptom, visual function, and trigger scores were higher in the smartphone group than in the control group. Total OSDI score increased significantly from baseline to 4 hours (P < 0.01) in the smartphone group but did not reach significance in the control group (P < 0.52 ). VAS increased significantly in both the smartphone and control groups but showed no significant difference between the two groups. CVS scores for fatigue, burning, and dryness were higher in the smartphone groups than in the control group at 4 hours (P < 0.05 for all). However, blurred vision and dullness scores showed no significant changes for either group. Both groups showed an increase in cellular reactive oxygen species (ROS) with higher value in the smartphone group versus the control group at 4 h (P < 0.01).
In a previous study, the authors demonstrated that overexposure to blue light led to oxidative damage, apoptosis, and inflammation of the ocular surface resulting in dry eye 7. This study revealed that smartphone use could not only aggravate subjective ocular symptoms and dry eye, but also compromise tear film stability and increase ROS production at the tear film and ocular surface. Smartphone users can also deteriorate the tear film by not blinking enough, by not closing the eyes completely and by exposing the ocular surface of the eye. Furthermore, smartphone use can induce oxidative stress at the surface of the eye, thus aggravating ocular symptoms. The authors suggest that increased awareness of the tear film and ocular surface changes resulting from smartphone use may contribute to better understanding and management of ocular discomfort and the problems that are associated with excessive smartphone use.
Source: Choi, Jung Han, Ying Li, Seon Ho Kim, Rujun Jin, Yung Hui Kim, Won Choi, In Cheon You, and Kyung Chul Yoon. “The influences of smartphone use on the status of the tear film and ocular surface.” PloS one 13, no. 10 (2018): e0206541.
© 2018 Choi et al. An open access article distributed under Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Posted July 22, 2019.
Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.
References:
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- Choi JH, Li Y, Kim SH, et al. The influences of smartphone use on the status of the tear film and ocular surface. PloS one. 2018;13(10):e0206541.
