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The Effect of Different Digital Displays on the Ocular Surface
TAKE-HOME MESSAGE
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In a cohort of young adults aged 20 to 26 years, the authors investigated the effects of different digital displays on visual fatigue and the ocular surface by clinical measures and the Ocular Surface Disease Index responses. Results indicate that reading on a computer resulted in significantly greater dryness and visual symptoms than did reading on an e-reader or smartphone. In addition, the use of artificial tears did not significantly improve ocular surface parameters.
- The smartphone may be the least disturbing display in comparison with other electronic devices.
abstract
This abstract is available on the publisher's site.
Access this abstract nowSIGNIFICANCE
Digital display use has been accepted as a contributing factor to dry eye disease. Nowadays, plenty of new models of digital displays have been developed, and the differences in their nature and the ways in which they are set and used may contribute to differences in the eye-related problems they cause.
PURPOSE
This study aimed to analyze the differences in ocular surface, tear film, and visual fatigue parameters after reading on different digital displays, with and without initial instillation of artificial tears.
METHODS
Thirty-one healthy individuals ranging in age from 20 to 26 years (mean ± standard deviation, 21.26 ± 1.73 years) were included in this prospective clinical study. Subjects' ocular surface, tear film, and visual fatigue parameters were assessed after reading for 15 minutes on a laptop computer, tablet, e-reader, and smartphone with matching characteristics and a baseline measurement. Measurements were taken with and without the instillation of artificial tears before the reading tasks and included the Ocular Surface Disease Index questionnaire, the Computer Vision Syndrome Questionnaire, tear meniscus height, the Schirmer I test, noninvasive keratograph break-up time, osmolarity, bulbar redness, and pupil size.
RESULTS
Statistically significant differences in the Ocular Surface Disease Index, Computer Vision the Syndrome Questionnaire, tear meniscus height, the Schirmer I test, noninvasive keratograph break-up time, osmolarity, and bulbar redness were obtained when comparing the displays (P < .05). Best results were obtained with the smartphone and the e-reader. Conversely, the computer produced the highest disturbance on the ocular surface and tear film. Finally, the instillation of artificial tears revealed no statistical improvement of ocular surface or tear film parameters for the same device (P > .05).
CONCLUSIONS
Taking into account the clinical tests for dry eye diagnosis, the smartphone may be considered as the least disturbing display, producing lower dry eye signs and symptoms in comparison with other devices.
Additional Info
Disclosure statements are available on the authors' profiles:
How Do Different Digital Displays Affect the Ocular Surface?
Optom Vis Sci 2020 Dec 01;97(12)1070-1079, C Talens-Estarelles, V Sanchis-Jurado, JJ Esteve-Taboada, ÁM Pons, S García-LázaroFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Today many people across the globe use digital displays. Over half the world uses the internet, particularly young people. Yet digital displays have been identified as a contributing factor to dry eye disease by the Tear Film and Ocular Surface Society.
The effect of using laptop computers, tablets, e-readers and smartphones on dry eye clinical parameters was assessed in 31 healthy people in this study. Those included had good ocular health, no dry eye, did not wear contact lens and were otherwise well. A similar reading task was given to all subjects under similar conditions. Effects were assessed after 15 minutes of use and after sodium hyaluronate artificial tears.
Computer use was found to have the worst impact on dry eye clinical findings and was attributed to a wider gaze angle exposing more of the ocular surface (palpebral fissure opening). Artificial tears led to some improvements particularly with handheld devices. E readers were noted to emit light rather than reflect it, with the later possibly causing squinting that may reduce the blink rate. In their discussion the authors cite other research in the area the findings of which were not always consistent with theirs. This may be as there are many factors that can impact whether a patient gets dry eye from digital display use including the viewing task, time and angle; type of light emissions; font type and size; the environment; and the methods of dry eye assessment.
What do we then tell our patients about digital display use and their eyes? It is not practical to advise patients not to use digital displays. From this study, we can learn that the type of display used may have an impact. Clinicians should ask about the type of device used and how it is being used. Strategies that could avoid dry eye include reviewing workstation design such as by lowering the viewing angle, changing between devices, and trialling artificial tears. Digital device use is here to stay but we all need to get smarter in its use for our eye health!