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New Indicator of Children's Excessive Electronic Screen Use and Factors in Meibomian Gland Atrophy

Published:April 12, 2021DOI:https://doi.org/10.1016/j.ajo.2021.03.035

      Purpose

      To evaluate the association of children's daily electronic screen use with severe meibomian gland atrophy (MGA).

      Design

      Retrospective cross-sectional study.

      Methods

      Children (aged 6-17years) presenting at clinical practice December 2016 – October 2017 were evaluated for ≥grade 2 MGA vs age-matched controls with insignificant atrophy (<grade 1 atrophy). Questionnaires assessed dry eye symptoms, daily electronic screen use hours, diet, and outdoor time. Meibography imaging assessed for severe meibomian gland atrophy (≥grade 2 atrophy; ≥1 eyelid on validated, 4-point, ImageJ scale: 0 [normal] - 3 [severe]). Autoimmune disease biomarker positivity was assessed in 16 severe meibomian gland atrophy cases after being found relevant in firstcase.

      Results

      A total of 172 children were evaluated. Patients with known meibomian gland atrophy causes or poor-quality meibographies were excluded. Forty-one met inclusion criteria (mean age, 11 years; 49% female): 17 cases had severe meibomian gland atrophy; 24 controls had insignificant gland atrophy. All severe meibomian gland atrophy cases had ocular symptoms/signs of dry eye disease including corneal neovascularization (29%), best-corrected visual acuity loss (41%), and central corneal neovascularization (14%). No controls had significant dry eye symptoms/signs. Controls had lower/“better” meibogrades vs cases (P < .01). In severe meibomian gland atrophy cases, 86% reported ≥4 hours of daily electronic screen use; 50% reported ≥8 hours. No controls exceeded 2 hours. Increased electronic screen use was positively associated with increased/“worse” meibogrades (odds ratio: 2.74; 95% confidence interval, 1.39-5.41). In 16 severe meibomian gland atrophy cases, 62.5% tested positive for autoimmune biomarker(s), though none had systemic symptoms: 18.8% rheumatoid factor; 6.25% SS-A/SS-B; 31.3% early Sjögren syndrome biomarkers; 6.25% ANA-positive/RF-negative. Autoimmune disease biomarker positivity was not significantly associated with severe meibomian gland atrophy vs controls (P = .34, right-eye; P = .71, left-eye).

      Conclusions

      Children's excessive electronic screen use is associated with severe meibomian gland atrophy. Further research is needed to establish formal electronic screen use limits based on meibography grade and evaluate correlation of autoimmune disease biomarker positivity in children with severe meibomian gland-atrophy.
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      References

        • Wong C
        • Tsai A
        • Jonas J
        • et al.
        Digital screen time during the COVID-19 pandemic: risk for a further myopia boom?.
        Am J Ophthalmol. 2021; 223: 333-337
      1. Price, C. How to Create Screen-Life Balance When Life Has Shifted to Screens. Available at https://www.nytimes.com/2020/04/24/well/mind/screen-life-balance-computers-phones-quarantine-shelter-social-distancing-virus.html. Accessed April 27, 2020.

      2. Stephens-Davidowitz, S. Google Searches Can Help Us Find Emerging Covid-19 Outbreaks. Available at https://www.nytimes.com/2020/04/05/opinion/coronavirus-google-searches.html. Accessed April 27, 2020.

      3. Centers for Disease Control and Prevention. Symptoms of Coronavirus. Available at https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html. Accessed April 27, 2020.

        • Christakis D.
        The challenges of defining and studying "digital addiction" in children.
        JAMA. 2019; 321: 2277-2278
        • Ra CK
        • Cho J
        • Stone MD
        • et al.
        Association of digital media use with subsequent symptoms of attention-deficit/hyperactivity disorder among adolescents.
        JAMA. 2018; 320: 255-263
        • Moon JH
        • Kim KW
        • Moon NJ.
        Smartphone use is a risk factor for pediatric dry eye disease according to region and age: a case control study.
        BMC Ophthalmol. 2016; 16: 188
        • Robinson TN.
        Reducing children's television viewing to prevent obesity: a randomized controlled trial.
        JAMA. 1999; 282: 1561-1567
        • Alim-Marvasti A
        • Bi W
        • Mahroo OA
        • Barbur JL
        • Plant GT.
        Transient smartphone "blindness".
        N Engl J Med. 2016; 374: 2502-2504
        • Blehm C
        • Vishnu S
        • Khattak A
        • Mitra S
        • Yee RW.
        Computer vision syndrome: a review.
        Surv Ophthalmol. 2005; 50: 253-262
        • LeBourgeois MK
        • Hale L
        • Chang AM
        • Akacem LD
        • Montgomery-Downs HE
        • Buxton OM.
        Digital media and sleep in childhood and adolescence.
        Pediatrics. 2017; 140: S92-S96
        • Chhadva P
        • Goldhardt R
        • Galor A.
        Meibomian gland disease: the role of gland dysfunction in dry eye disease.
        Ophthalmology. 2017; 124: S20-S26
        • Schiffman RM
        • Walt JG
        • Jacobsen G
        • Doyle JJ
        • Lebovics G
        • Sumner W.
        Utility assessment among patients with dry eye disease.
        Ophthalmology. 2003; 110: 1412-1419
        • Um SB
        • Yeom H
        • Kim NH
        • Kim HC
        • Lee HK
        • Suh I.
        Association between dry eye symptoms and suicidal ideation in a Korean adult population.
        PLoS One. 2018; 13e0199131
      4. Hawley J. The Social Media Addiction Reduction Technology (SMART) Act. 2019. Available at https://www.hawley.senate.gov/sites/default/files/2019-07/Social-Media-Addiction-Reduction-Technology-Act.pdf. Accessed July 30, 2019.

        • Uchino M
        • Yokoi N
        • Uchino Y
        • et al.
        Prevalence of dry eye disease and its risk factors in visual display terminal users: the Osaka study.
        Am J Ophthalmol. 2013; 156: 759-766
        • Gutgesell VJ
        • Stern GA
        • Hood CI.
        Histopathology of meibomian gland dysfunction.
        Am J Ophthalmol. 1982; 94: 383-387
        • Pflugfelder SC.
        Tear dysfunction and the cornea: LXVIII Edward Jackson Memorial Lecture.
        Am J Ophthalmol. 2011; 152: 900-909
        • Argilés M
        • Cardona G
        • Pérez-Cabré E
        • Rodríguez M.
        Blink rate and incomplete blinks in six different controlled hard-copy and electronic reading conditions.
        Invest Ophthalmol Vis Sci. 2015; 56: 6679-6685
        • Tomlinson A
        • Bron AJ
        • Korb DR
        • et al.
        The international workshop on Meibomian gland dysfunction: report of the diagnosis subcommittee.
        Invest Ophthalmol Vis Sci. 2011; 52: 2006-2049
        • Craig JP
        • Nelson JD
        • Azar DT
        • et al.
        TFOS DEWS II Report Executive Summary.
        Ocul Surf. 2017; 15: 802-812
        • Menzies KL
        • Srinivasan S
        • Prokopich CL
        • Jones L.
        Infrared imaging of meibomian glands and evaluation of the lipid layer in Sjögren's syndrome patients and nondry eye controls.
        Invest Ophthalmol Vis Sci. 2015; 56: 836-841
        • Machalińska A
        • Zakrzewska A
        • Markowska A
        • et al.
        Morphological and functional evaluation of meibomian gland dysfunction in rosacea patients.
        Curr Eye Res. 2016; 41: 1029-1034
        • Yeh TN
        • Lin MC.
        Risk factors for severe Meibomian gland atrophy in a young adult population: a cross-sectional study.
        PLoS One. 2017; 12e0185603
        • Karp LA
        • Streeten BW
        • Cogan DG.
        Radiation-induced atrophy of the Meibomian gland.
        Arch Ophthalmol. 1979; 97: 303-305
        • Eom Y
        • Baek S
        • Kim HM
        • Song JS.
        Meibomian gland dysfunction in patients with chemotherapy-induced lacrimal drainage obstruction.
        Cornea. 2017; 36: 572-577
        • Liang L
        • Liu Y
        • Ding X
        • Ke H
        • Chen C
        • Tseng SCG.
        Significant correlation between meibomian gland dysfunction and keratitis in young patients with Demodex brevis infestation.
        Br J Ophthalmol. 2018; 102: 1098-1102
        • El-Shazly AA
        • Mohamed AA.
        Relation of dry eye to disease activity in juvenile rheumatoid arthritis.
        Eur J Ophthalmol. 2012; 22: 330-334
        • Wu Y
        • Li H
        • Tang Y
        • Yan X.
        Morphological evaluation of meibomian glands in children and adolescents using noncontact infrared meibography.
        J Pediatr Ophthalmol Strabismus. 2017; 54: 78-83
        • Arita R
        • Itoh K
        • Inoue K
        • Amano S.
        Noncontact infrared meibography to document age-related changes of the meibomian glands in a normal population.
        Ophthalmology. 2008; 115: 911-915
        • Schiffman RM
        • Christianson MD
        • Jacobsen G
        • Hirsch JD
        • Reis BL.
        Reliability and validity of the Ocular Surface Disease Index.
        Arch Ophthalmol. 2000; 118: 615-621
        • Shen L
        • Suresh L
        • Lindemann M
        • et al.
        Novel autoantibodies in Sjogren's syndrome.
        Clin Immunol. 2012; 145: 251-255
        • Ma WT
        • Chang C
        • Gershwin ME
        • Lian ZX.
        Development of autoantibodies precedes clinical manifestations of autoimmune diseases: a comprehensive review.
        J Autoimmun. 2017; 83: 95-112
        • Gallo A
        • Martellucci S
        • Fusconi M
        • et al.
        Sialendoscopic management of autoimmune sialadenitis: a review of literature [Trattamento scialendoscopico delle scialoadeniti autoimmuni: revisione della letteratura].
        Acta Otorhinolaryngol Ital. 2017; 37: 148-154
        • Reyes NJ
        • Yu C
        • Mathew R
        • et al.
        Neutrophils cause obstruction of eyelid sebaceous glands in inflammatory eye disease in mice.
        Sci Transl Med. 2018; 10: eaas9164
        • Stern ME
        • Beuerman RW
        • Fox RI
        • Gao J
        • Mircheff AK
        • Pflugfelder SC.
        The pathology of dry eye: the interaction between the ocular surface and lacrimal glands.
        Cornea. 1998; 17: 584-589
        • Deinema LA
        • Vingrys AJ
        • Wong CY
        • Jackson DC
        • Chinnery HR
        • Downie LE.
        A randomized, double-masked, placebo-controlled clinical trial of two forms of omega-3 supplements for treating dry eye disease.
        Ophthalmology. 2017; 124: 43-52
        • Schallhorn CS
        • Schallhorn JM
        • Hannan S
        • Schallhorn SC.
        Effectiveness of an eyelid thermal pulsation procedure to treat recalcitrant dry eye symptoms after laser vision correction.
        J Refract Surg. 2017; 33: 30-36
        • Craig JP
        • Chen YH
        • Turnbull PR.
        Prospective trial of intense pulsed light for the treatment of meibomian gland dysfunction.
        Invest Ophthalmol Vis Sci. 2015; 56: 1965-1970
        • Maskin SL
        • Alluri S.
        Intraductal meibomian gland probing: background, patient selection, procedure, and perspectives.
        Clin Ophthalmol. 2019; 13: 1203-1223
        • Adil MY
        • Xiao J
        • Olafsson J
        • et al.
        Meibomian gland morphology is a sensitive early indicator of meibomian gland dysfunction.
        Am J Ophthalmol. 2019; 200: 16-25
        • Zhao Y
        • Chen S
        • Wang S
        • et al.
        The significance of meibomian gland changes in asymptomatic children.
        Ocul Surf. 2018; 16: 301-305
        • Gupta PK
        • Stevens MN
        • Kashyap N
        • Priestley Y.
        Prevalence of meibomian gland atrophy in a pediatric population.
        Cornea. 2018; 37: 426-430
        • Yeotikar NS
        • Zhu H
        • Markoulli M
        • Nichols KK
        • Naduvilath T
        • Papas EB.
        Functional and morphologic changes of meibomian glands in an asymptomatic adult population.
        Invest Ophthalmol Vis Sci. 2016; 57: 3996-4007
      5. American Academy of Pediatrics. American Academy of Pediatrics Announces New-Recommendations for Children's Media-Use. Available at https://services.aap.org/en/news-room/news-releases/aap/2016/aap-announces-new-recommendations-for-media-use/. Accessed January 12, 2021.