Wang Chunyang, Yuan Kelan, Mou Yujie, Wu Yaying, Wang Xin, Hu Renjian, Min Jinjin, Huang Xiaodan, Jin Xiuming
Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Front Med (Lausanne). 2022 Apr 26;9:829271. doi: 10.3389/fmed.2022.829271. eCollection 2022.
To investigate the effects of high-intensity use of smartphones on ocular surface homeostasis and to explore whether high-intensity use of handheld digital devices can cause false increase of dry eye diagnostic rate.
In this prospective self-control study, 60 subjects (120 eyes) were recruited and asked to read on smartphones provided by the same manufacturer for two consecutive hours. This study was conducted during 8:00 - 10:00 AM to eliminate the influence of digital equipment used the previous day. Ophthalmological examinations [non-invasive tear breakup time (NIBUT), fluorescein breakup time (FBUT), Schirmer I test, corneal fluorescein staining (CFS), bulbar conjunctival redness and meibomian gland (MG) assessment] and a questionnaire survey were conducted before and after the reading test. Based on the collected data, the changes in ocular surface damage and subjective symptoms of the subjects were evaluated, and the differences in the diagnostic rate of dry eye before and after high-intensity use of smartphones were compared.
The diagnostic rate of dry eye was sharply increased (61.7% vs. 74.2%). The severity of dry eye also changed significantly, and the moderate and severe degree increased after reading (10% vs. 15%; 5% vs. 10.8%). The aggravated severity subjects had lower MG expressibility and more evident bulbar conjunctival redness compared to the non-aggravated severity subjects. After 2 h of continuous reading, NIBUT-First, NIBUT-Average and FBUT-Average were significantly decreased, while the proportion of BUT ≤ 5 s increased significantly. Non-invasive keratograph tear meniscus height(NIKTMH) decreased significantly compared to the baseline level, while the proportion of NIKTMH<0.20 mm increased significantly. No significant difference was observed in the Schirmer I test and CFS score between the two groups. Compared to the baseline, evident aggravation was observed in bulbar conjunctival redness. The Ocular Surface Disease Index (OSDI) was significantly higher than the baseline after the reading test.
Diagnostic indicators related to dry eye are rapidly deteriorating after high-intensity smartphone use, especially those with lower MG expressibility and ocular redness. High-intensity smartphone use can increase the false positive rate of dry eye diagnosis by disturbing ocular surface homeostasis.
研究高强度使用智能手机对眼表稳态的影响，并探讨高强度使用手持数字设备是否会导致干眼诊断率的假性升高。
在这项前瞻性自身对照研究中，招募了60名受试者（120只眼），要求他们连续两小时阅读同一制造商提供的智能手机上的内容。本研究在上午8:00至10:00进行，以消除前一天使用数字设备的影响。在阅读测试前后进行眼科检查[非侵入性泪膜破裂时间（NIBUT）、荧光素破裂时间（FBUT）、Schirmer I试验、角膜荧光素染色（CFS）、球结膜充血和睑板腺（MG）评估]以及问卷调查。根据收集的数据，评估受试者眼表损伤和主观症状的变化，并比较高强度使用智能手机前后干眼诊断率的差异。
干眼诊断率急剧上升（61.7%对74.2%）。干眼严重程度也有显著变化，阅读后中度和重度程度增加（10%对15%；5%对10.8%）。与严重程度未加重的受试者相比，严重程度加重的受试者MG表达能力较低，球结膜充血更明显。连续阅读2小时后，首次NIBUT、平均NIBUT和平均FBUT显著降低，而BUT≤5秒的比例显著增加。与基线水平相比，非侵入性角膜地形图泪膜弯月面高度（NIKTMH）显著降低，而NIKTMH<0.20mm的比例显著增加。两组之间Schirmer I试验和CFS评分未观察到显著差异。与基线相比，球结膜充血明显加重。阅读测试后眼表疾病指数（OSDI）显著高于基线。
高强度使用智能手机后，与干眼相关的诊断指标迅速恶化，尤其是MG表达能力较低和眼发红的指标。高强度使用智能手机会干扰眼表稳态，从而增加干眼诊断的假阳性率。
