How digital device usage is affecting youth
If you aren't screening your younger patients, you should
The time we are spending on digital devices is on the rise, and it’s unlikely to slow down any time soon. With more and more apps, games, and social media options, we have all become more dependent on smartphones, tablets, and other electronic devices.
This increased time is trickling down to children and teens as well. American teens use nine hours of media per day, in addition to time spent on homework and schoolwork.1 A 2014 study (n=288) showed that increased time on smartphones was significant for dry eye disease; however, interestingly, time spent watching television and using computers were not factors.2
Meibomian gland dysfunction (MGD) and dry eye disease (DED) are thought to primarily affect the older population. However, data shows that digital device use is an important dry eye disease risk factor in children.2
Previously from Dr. Schachter: Demodex update: 4 things you need to know
Devices and blink rate
Blink quality and quantity suffer when focused on near tasks. When blink rates decline, problems ensue.
The tear film will likely begin to break up prior to the blink response. This lack of protection from the tear film leaves the surface of the eye vulnerable, resulting in damage to cells of the cornea and conjunctiva and impaired functional visual acuity of dry eye patients.3 This damage leads to inflammation, causing goblet cell death, lacrimal gland inflammation, and MGD, which results in decreased tear quantity and poor quality.
With digital device usage increasing, long-term effects on the lacrimal unit of the eye need to be considered. MGD has been defined as “a chronic, diffuse abnormality of the meibomian glands, commonly characterized by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion.”4 In addition, MGD “may result in alteration of the tear film, symptoms of eye irritation, clinically apparent inflammation, and ocular surface disease.”4
While the exact mechanism of MGD and dry eye is not known, there are some prevailing theories. Meibum from the meibomian glands is drawn out by the full force of a blink. With less blinking and partial blinking, the meibum stagnates.
Think of it like an open tube of toothpaste that is not squeezed. The meibum begins to thicken, which causes obstruction. Blocked glands then atrophy and ultimately disappear completely.
In addition, the increased demand placed on the glands by evaporative stress (created by reduced blink rates while staring at devices) causes meibocyte proliferation, increased production of meibum, duct dilation, and then obstruction. Suhalim et al suggested that “continued exposure to desiccating stress may therefore potentially deplete meibocyte stem cells and lead to early aging changes and gland atrophy.”5
The classic MGD patient is a post-menopausal female; therefore, dry eye screenings in eyecare practices may to be skewed toward older women.