Smartphone work, low light associated with increase in IOP
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Working on a smartphone in low-light conditions can induce elevated IOP in patients with normal tension glaucoma, according to findings published in the British Journal of Ophthalmology.
In patients who had undergone trabeculectomy, changes in IOP were lower under similar conditions.
Ahnul Ha, MD, and colleagues investigated the effect of reading or writing on a smartphone in terms of IOP change in eyes with glaucoma as well as determining whether previous glaucoma filtering surgery can affect IOP fluctuation during the work.
“While viewing smartphones, sustained effort accommodation and ocular surface changes such as dry eye have been known to occur,” Ha, of the Department of Ophthalmology at Seoul National University in South Korea, and colleagues wrote. “Ocular changes related to near vision are believed to cause temporary, but meaningful, fluctuations in intraocular pressure as well.”
The researchers examined 40 eyes of 40 medically well IOP-controlled normal tension glaucoma (NTG) patients and 38 eyes of 38 NTG patients who had successful trabeculectomy.
Participants in the study were required to read sample text and then type the text on a smartphone under low-light conditions, Ha and colleagues wrote. IOP measurements were gathered – baseline, during smartphone work (5 to 25 minutes) and post work (5 to 15 minutes).
The researchers identified that baseline IOP did not differ between the trabeculectomy and medication groups (13.6 mm Hg vs. 13.9 mm Hg).
The medication group showed a significant elevated mean IOP after 5 minutes of smartphone work (15.5 mm Hg + 11.5%; P < .001) with additional increases over the course of 25 minutes (17.5 mm Hg +25.9%, P < .001). Five minutes after the end of work, IOP decreased below the baseline (13.1 mm Hg).
Ha and colleagues wrote that the trabeculectomy group saw an elevated IOP after 5 minutes of work (14.9 mm Hg + 9.4%; P < .001), but there was no further increase over the course of 25 minutes of work (15 mm Hg; +10.3%). Five minutes after cessation, IOP returned to pre-work levels (14 mm Hg + 2.8%; P = .053).
“Further studies determining whether smartphone-associated IOP fluctuation can affect glaucoma progression, and whether there are any additional benefits of the surgical approach for daily IOP changes, are warranted,” the researchers wrote. – by Earl Holland Jr.
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Mark Eltis, OD, FAAO
Is smartphone use risky for our glaucoma patients? The possibility of smartphones increasing IOP under dim lighting should be taken very seriously as even brief fluctuations in IOP have previously been associated with disease progression.
Ha and colleagues found that cell phone use results in a mild but significant increase in IOP. Interestingly, they concluded that patients who had undergone filtration surgery did not have the same pressure increases as glaucoma patients being treated with pharmaceutical agents.
The study had numerous limitations including small sample size, homogenous populations, uncontrolled variables and lack of a definitive proposed mechanism for the IOP elevations. It was speculated that accommodation/convergence, dry eye, extraocular muscle contraction and neck posture (among other variables) could be at play.
It is safe to say that there is not a definitive opinion in the literature at this time regarding potentially harmful effects of cell phone use or other activities. Science is constantly evolving, and we owe it to our patients to continually reevaluate our understanding of disease. Otherwise, we risk a breach of trust and loss of faith in health care providers.
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