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In a population of Korean children in grades 5 and 6 (ages 9–11), the authors compared symptoms and use of video display terminals in those with dry eye disease (9.7%, as determined by ophthalmic exam) with children without clinically determined dry eye. The risk factors for dry eyes in this population were related more to smartphone use (including mean duration of use, as reported by questionnaire) than to either computer or television viewing.

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The authors remind to keep the possibility of dry eye, which seems to be related to increased smartphone use, in mind in this population.

It is not uncommon for children between the ages of 9 and 11 — the population studied here — to exhibit potential signs of dry eye, which might include frequent blinking. Parents of children in this age range might also notice frequent or deep blinking behaviors that can be associated with tics or spasmodic blinking due to stress or anxiety.

The authors provide evidence that some of the signs and symptoms of ocular or visual discomfort can be associated with dry eyes. However, the jury is out on correlation or causation because the rate of dry eye signs was significantly greater in children with more smartphone use. The authors note that other visual factors have been reported as potentially associated with sustained smartphone use, such as accommodative issues and transient myopia. Because dry eye disease is not widely recognized as a potential problem in this age range, it adds to considerations in differential diagnosis of visual and ocular problems in childhood.

Two-hundred eighty-eight children were classified in either a dry eye disease group or control group according to the diagnostic criteria of dry eye disease. The results of ocular examinations, including best-corrected visual acuity, slit-lamp examination, and tear break-up time, were compared between groups. The results of questionnaires concerning video display terminal use and ocular symptoms were also compared.

Twenty-eight children were included in the dry eye disease group and 260 children were included in the control group. Gender and best-corrected visual acuity were not significantly different between the two groups. Smartphone use was more common in the dry eye disease group (71%) than the control group (50%) (P = .036). The daily duration of smartphone use and total daily duration of video display terminal use were associated with increased risk of dry eye disease (P = .027 and .001, respectively), but the daily duration of computer and television use did not increase the risk of dry eye disease (P = .677 and .052, respectively).

The results showed that smartphone use is an important dry eye disease risk factor in children. Close observation and caution regarding video display terminal use, especially smartphones, are needed for children.

Study source: JH Moon, MY  Lee, NJ Moon. Association Between Video Display Terminal Use and Dry Eye Disease in School Children. J Pediatr Ophthalmol Strabismus 2014 Mar 01;51(2)87-92.

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