Jaiswal Sukanya, Asper Lisa, Long Jennifer, Lee Abigail, Harrison Kirsten, Golebiowski Blanka
School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia.
Clin Exp Optom. 2019 Sep;102(5):463-477. doi: 10.1111/cxo.12851. Epub 2019 Jan 21.
Smartphone and tablet use in Australia and worldwide is reaching saturation levels and associated visual and ocular discomfort such as headaches, eyestrain, dry eyes and sore eyes are widespread. This review synthesises the available literature and considers these symptoms in the context of a binocular vision and/or ocular surface aetiology. Eye discomfort with smartphones and tablets is discussed alongside similar symptoms reported with desktop computer use. Handheld devices differ from computers in viewing position and distance, screen size and luminance, and patterns of use. Accommodation is altered with handheld device use, with increased lag and decreased amplitude. Smartphone and tablet use results in reduced fusional convergence and possibly a receded near point of convergence. This is similar to what happens with computer use. Findings related to blink rate with smartphone and tablet use are contradictory, perhaps due to the influence of task difficulty, and there is limited evidence related to blink amplitude. Reduced blink rate and amplitude are consistently reported with computer use. Use of handheld digital devices, like computers, may adversely impact tear stability. There is insufficient evidence to support the impact of handheld devices on tear volume, although this is reduced with computer use. The available literature does not conclusively link eye and visual discomfort symptoms reported with handheld digital devices, with changes in binocular vision, blinking or ocular surface. However, there is a gap in our understanding of symptoms which occur with smartphone and tablet use in the context of how these devices are used. In addition, studies are required in high users such as teenagers, and in patients with dry eye or accommodative/binocular vision anomalies, all of whom may have a higher risk of symptoms. A better understanding of symptom aetiology can guide clinical advice to minimise adverse impacts on visual and ocular surface health and discomfort.
在澳大利亚及全球范围内，智能手机和平板电脑的使用已达到饱和水平，与之相关的视觉和眼部不适，如头痛、眼疲劳、干眼和眼痛等十分普遍。本综述综合了现有文献，并从双眼视觉和/或眼表病因学的角度对这些症状进行了考量。文中讨论了使用智能手机和平板电脑时的眼部不适，以及使用台式电脑时报告的类似症状。手持设备在观看位置和距离、屏幕尺寸和亮度以及使用模式方面与电脑有所不同。使用手持设备时，调节功能会发生改变，滞后增加而幅度减小。使用智能手机和平板电脑会导致融合性集合减少，近点集合可能后移。这与使用电脑时的情况类似。关于使用智能手机和平板电脑时眨眼率的研究结果相互矛盾，可能是由于任务难度的影响，而且与眨眼幅度相关的证据有限。使用电脑时一致报告眨眼率和幅度降低。与电脑一样，使用手持数字设备可能会对泪液稳定性产生不利影响。虽然使用电脑会使泪液量减少，但没有足够的证据支持手持设备对泪液量的影响。现有文献并未确凿地将手持数字设备报告的眼部和视觉不适症状与双眼视觉、眨眼或眼表变化联系起来。然而，在这些设备的使用背景下，我们对使用智能手机和平板电脑时出现的症状的理解存在差距。此外，还需要对青少年等高频用户以及干眼症或调节/双眼视觉异常患者进行研究，因为他们可能出现症状的风险更高。更好地理解症状病因可以指导临床建议，以尽量减少对视觉和眼表健康及不适的不利影响。
