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ABSTRACT
Purpose: To evaluate the risk factors of dry eye disease in
school children associated with video display terminal use.
Methods: 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.
Results: 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
INTRODUCTION
Dry eye disease is defined by the Report of the
Definition and Classification Subcommittee of the
International Dry Eye WorkShop as a multifactorial
disease of the tears and ocular surface, which results
in symptoms of discomfort, visual disturbance, and
tear film instability, with potential damage to the
ocular surface.1 The prevalence of dry eye disease is
estimated to be 7.4% to 33.7%, depending on the
diagnostic criteria used and population surveyed.2
Dry eye disease is known to increase with old age,
From the Department of Ophthalmology, College of Medicine, Chung-Ang University, Seoul, Korea.
Submitted: April 23, 2013; Accepted: December 10, 2013; Posted online: February 4, 2014
The authors have no financial or proprietary interest in the materials presented herein.
Correspondence: Nam Ju Moon, MD, PhD, Department of Ophthalmology, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, #224-1, Heukseok-Dong, Dongjak-Gu, Seoul 156-755, Korea. E-mail: njmoon@chol.com
doi: 10.3928/01913913-20140128-01
87
matched children with no evidence of dry eye disease were included in the control group. This study
was approved by the Institutional Review Board of
the Chung-Ang University Hospital of Korea.
Ophthalmologic Examinations
TABLE 1
Moderate episodic or
chronic, stress or no
stress
Severe frequent or
constant without
stress
Severe and/or
disabling and
constant
None or episodic
mild fatigue
Annoying and/or
activity-limiting
episodic
Annoying, chronic
and/or constant,
limiting activity
Conjunctival staining
None to mild
Variable
Moderate to marked
Marked
Corneal staining
None to mild
Variable
Marked central
Severe punctuate
erosions
Variable
10
Immediate
Data from International Dry Eye WorkShop. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop. Ocul Surf. 2007;5:75-92.
Of 302 children who performed all examinations and returned the questionnaires, 14 children
who were diagnosed as having nocturnal lagophthalmos, trichiasis, or epiblepharon were excluded.
Twenty-eight children were included in the dry eye
disease group and 260 children were included in the
control group. The mean age was 11.00 0.61 years
(range: 10 to 12 years) in the dry eye disease group
and 10.87 0.66 years (range: 10 to 12 years) in
the control group. Eighteen of 28 children (64.3%)
in the dry eye disease group and 128 of 260 children (49.2%) in the control group were female.
The age and gender distributions did not significantly differ between the two groups (P = .31 and
.13, respectively). The mean daily sleeping time was
7.79 0.69 hours (range: 6 to 10 hours) in the dry
eye disease group and 7.80 0.90 hours (range: 5
to 10 hours) in the control group, and also did not
show significant differences between the two groups
(Table 2).
Mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity was
0.053 (range: 0 to 0.301) in the dry eye disease group
and 0.063 (range: 0 to 0.698) in the control group,
which was not significant (P = .66). Mean TBUT
was 7.36 1.28 (range: 5 to 10 seconds) and 9.17
1.43 seconds (range: 8 to 15 seconds) in the dry
eye disease eye group and control group, respectively.
Punctate epithelial erosion was noted in 100% of
eyes in the dry eye disease group and 36.6% of eyes
in the control group. Mean TBUT and the accompanying rate of punctate epithelial erosion showed
significant differences between the two groups (P <
.001 and < .001, respectively). In addition, allergic
89
TABLE 2
Subjects
Normal Control
28
260
11.00 0.61
10.87 0.66
.31a
64.3
49.2
.13b
0.05 0.11
0.06 0.08
.66a
7.79 0.69
7.80 0.90
.92a
32.1
4.6
< .001b
logMAR = logarithm of the minimum angle of resolution; BCVA = best-corrected visual acuity; SD = standard deviation
a
By independent t test.
b
By Pearsons chi-square test.
TABLE 3
Visual Display Terminal Use in the Dry Eye Disease and Control Groups
Dry Eye Disease
(n = 28)
Normal Control
(n = 260)
Odds Ratioc
(95% CI)
20 (71.4)
130 (50.0)
2.500 (1.0635.880)
.036a
0.71 0.74
0.40 0.55
1.863 (1.0723.236)
.027b
0.68 0.31
0.64 0.32
1.281 (0.3994.110)
.677b
0.99 0.66
0.75 0.43
1.982 (0.9943.950)
.052b
2.38 0.96
1.80 0.84
1.821 (1.2602.631)
.001a
Variable
and television use did not increase the risk of dry eye
disease (P = .677 and .052, respectively) (Table 3).
DISCUSSION
Dry eye disease has shown a marked increase
due to video display terminal use and has become
a significant health issue affecting the quality of life
in industrialized countries.14 Dry eye disease associated with the use of video display terminals can be
multifactorial and is still not well understood.15 Decreased blinking and increased interpalpebral ocular
surface area during use of video display terminals
may increase tear evaporation due to destabilization
of the tear film.16
A smartphone is a portable information terminal that is used not only for telephone calls but also
as a small handheld computer. In Korea, 50.41%
of the adult population uses smartphones and the
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for children. Smartphones are used not only for telephone calls, but also for gaming, Internet searches,
and entertainment, and use time per day may increase as children become older. Increased use of
smartphones could result in other ocular problems
due to near visual tasking. Long-term use of near
visual tasking may affect accommodation and lead
to progression of myopia.21,22 Transient myopia induced by near work may contribute to the development and progression of permanent myopia.21,23,24
Thus, children with high levels of video display terminal use should undergo routine examinations and
treatment to preserve ocular health. Dry eye disease
in children must be detected early, and should be
treated with appropriate medical and environmental
manipulations and education.
REFERENCES
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Surf. 2007;5:75-92.
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2006;25:900-907.
3. Alves M, Dias AC, Rocha EM. Dry eye in childhood: epidemiological and clinical aspects. Ocul Surf. 2008;6:44-51.
4. Moss SE, Klein R, Klein BE. Prevalence of and risk factors for dry
eye syndrome. Arch Ophthalmol. 2000;118:1264-1268.
5. Schein OD, Muoz B, Tielsch JM, Bandeen-Roche K, West
S. Prevalence of dry eye among the elderly. Am J Ophthalmol.
1997;124:723-728.
6. Toda I, Shimazaki J, Tsubota K. Dry eye with only decreased tear
break-up time is sometimes associated with allergic conjunctivitis.
Ophthalmology. 1995;102:302-309.
7. Fujishima H, Toda I, Shimazaki J, Tsubota K. Allergic conjunctivitis and dry eye. Br J Ophthalmol. 1996;80:994-997.
8. Houlden H, Smith S, De Carvalho M, et al. Clinical and genetic
characterization of families with triple A (Allgrove) syndrome.
Brain. 2002;125:2681-2690.
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