Awareness Level of Ocular Symptoms Caused by Smart Phone Use

Objective To evaluate awareness about ocular symptoms due to smart phone use, awareness about smart phone causing vision problems.
Methodology: A cross sectional study was done in Pakistan Institute of Community Ophthalmology (PICO) from September 2018 till February 2019. An informed consent was taken from all the smart phone users eligible for the study. Questionnaires were circulated among the subjects evaluating awareness about ocular symptoms due to smart phone use. The data was recorded for awareness about smart phone causing vision problems. Subjects who were aware about 3 or more ocular symptoms were labeled as aware’ness. If subjects were aware of 3-4 symptoms they were included in the criteria of low level awareness. Subjects aware of 5-6 symptoms were categorized in moderate level of awareness and subjects who were aware about 7 or more ocular symptoms were categorized in high level awareness.
Results: Data was collected from 104 subjects. 82 (78%) subjects were aware about ocular symptoms due to smart phone use and 22 (21%) were unaware. 34 out of 38 (89%) staff members and (48 out of 66) 72% students were aware about it. High level awareness was 50% (17 out of 34) among staff members and 50% (24 out of 48) students were highly aware about ocular symptoms due to smart phone use. 80% subjects were aware about the eye strain/fatigue, 76% subjects were aware about irritation/burning, 51% subjects were aware about the ocular pain, 46% subjects were aware about the redness of the eyes, 45% were aware about the watering of the eyes, 42% were aware about the eyesight deterioration, 31% were aware about the double vision, 8% were aware about the macular degeneration and 6% were aware about the cataract due to smart phone usage.
Conclusion: There is a shortage of literature survey to find out the awareness in developing the ocular symptoms due to smart phone use. From this study it is concluded that most of the subjects i.e. staff members and students were aware about ocular symptoms due to smart phone use. Unlike students, staff members were more aware of it. Numerous staff members and students were highly aware while very few were unaware about some of the ocular symptoms caused due to smart phone use.
Key words: Smart phone, Awareness, Blue light.

INTRODUCTION

A smart phone is a very useful device which includes sending and receiving emails and photographs, browsing the internet, playing games, video chat, creating high quality photographs, determining user’s exact location utilizing GPS (global positioning system) satellites and many more.1 Two of the most popular smart phone operating systems are Android and IOS According to World  Population Clock the current world population is 7 billion and currently 2.71 billion world population uses smart phone which is expected to pass 5 billion mark by the end of 2019. 2 A study “Smartphone addiction among university students in the light of some variables” the frequency and indices of smart phone addiction in a group of King Saud University students investigated smart phone addiction based on different variables. Results revealed that the addiction percentage among participants was 48%. Bachelor degree students were found to have the highest degree of addiction. 3


1.Optometrist,2 Pakistan Institute of Community Ophthalmology,
HMC, Peshawar. Lecturer Optometry Pakistan Institute of
Community Ophthalmology, HMC, Peshawar 3. Low Vision Specialist,
Ophthalmology Unit.HMC Peshawar.


Correspondence: Unsa Habib 0 332 9139292
Email:unsa72@hotmail.com House # 41, Sector D/3, Street 10,
Phase-1, Hayatabad Peshawar


Received May 2018 Accepted June’2019


Most of the subjects i.e. staff members and students were aware about ocular symptoms due to smart phone use. Unlike students, staff members were more aware of it.


In October 2014, Gen Xers, and Millennials a report from the Vision Council discussed digital device usage by adults 90% spend 4 hours per day, 60% spend more than 5 hours per day and 30% spend more than 9 hours per day. More than 60% report symptoms of digital eyestrain including redness, burning, itchiness, blurred vision, fatigue and headaches.4While staring at screens, we blink less increasing the risk of dry-eye disease. 5 In discussion more than 10 million people suffer from dry eyes in this age of smart phones. 6 Eye strain occurs when the eyes get tired from intense use of cell phone.7 Excessive use of the smart phone at near leads to excessive stimulation of ciliary muscle. It was the first case series to report an association of smart phones and accommodative spasm.8 Use of smart phones may be an emerging cause of unilateral ocular pain and headache.9 A study revealed that children using mobile phones for over 4 hours a day develop squint and double vision.10 The premature development of cataract is closely linked to the increase in cases of eye fatigue or presbyopia, which appears more and more to be the result of longer usage of smartphones.11 Scientists have found the chemical reason that blue lights are bad for the eyes. The blue light from smart phones could also contribute to age-related macular degeneration. The cell death caused by blue light excited-retinal doesn’t usually happen until a person is about 50 or 60 years old, which is when age-related macular degeneration usually sets in.12 Mobile phones have been linked to a rare form of eye cancer. The regular use of cell phones could lead to an increased risk of contracting uveal melanoma, in which tumors form in the layer that makes up the iris and base of the retina.13 Most of the subjects, unlike students are aware of ocular symptoms.

METHODOLOGY

A device used for phone calls and having a highly advanced features, high-resolution touch screen display, Wi-Fi connectivity, and Web browsing capabilities. Subjects who knew about 3 or more ocular symptoms were labeled as aware and below that were labeled as unaware. Low level awareness: If subjects were aware of 3-4 ocular symptoms they were included in the criteria of low level awareness. Moderate level awareness: Subjects aware of 5-6 ocular symptoms were categorized in moderate level awareness. High level awareness: Subjects who were aware about 7 or more ocular symptoms were categorized in high level awareness It is a cross- sectional study, at the Pakistan Institute of Community Ophthalmology (PICO) Hayatabad Peshawar for 6 months and non-probability convenient sampling. After ethical approval, an informed written consent was taken from all the subjects meeting eligibility criteria of the study. Data was collected using a questionnaire for awareness about ocular symptoms caused due to smart phone use. The data was entered and analysed through SPSS software version 17. Inclusion Criteria: All the literate subjects of the Pakistan Institute of Community Ophthalmology present at the time of data collection were included in my study.
Exclusion Criteria: Those who were not willing to participate.

RESULTS



Graph 1: Students Awareness Level The above graph shows that 50% (24 out of 48) students were highly aware, 33% (16 out of 48) were low level aware and 16% (8 out of 48) were moderate level aware about ocular symptoms due to smart phone use.



Graph 2: Symptoms Awareness The above graph shows that 80% subjectswere aware about the eyestrain/fatigue of the eyes due to smart phone usage.

76% subjects were aware about the irritation/burning of the eyes
51% subjects were aware about the ocular pain
46%subjects were aware about the redness of the eyes
45%were aware about the watering of the eyes
42%were aware about the eyesight deterioration
31%were aware about the double vision
8%were aware about the macular degeneration
6%were aware about the cataract

DISCUSSION

The study “Awareness about ocular symptoms due to smart phone use” aimed to evaluate the awareness about ocular symptoms due to smart phone use. There were many contradictory results reported regarding ocular symptoms due to smart phone use and its awareness. It was found that 82 out of 104 (78%) subjects were aware about ocular symptoms due to smart phone use while 22 (21%) subjects were unaware about it. A survey was conducted named “Influence of smart phone on dry eye syndrome in adolescents” in which they analyzed the relevance association between smart phone usage time and dry eyes in high school students. They conducted question investigation survey of 200 (men 140, women 60) high school students. 182 students who met the appropriate criteria were included in this study. 94 students were diagnosed with dry eye syndrome by Ocular Surface Disease Index (OSDI). In this study, they revealed and observed a meaningful significant correlation between smart phone usage and dry eye syndrome. Therefore, it is important to emphasize control of smart phone usage in adolescents.14 Awareness among professions showed that 89% (34 out of 38) staff members and 72% (48 out of 66) students were aware about ocular symptoms due to smart phone use. In 2014 Jun Hyung Moon carried out a case control study and stated that children using mobile phone was high associated with pediatric Dry Eye Disease.15 The awareness and unawareness among staff members about ocular symptoms due to smart phone use in which 89% (34 out of 38) were aware and 10% (4 out of 38)were unaware about ocular symptoms dueto smart phone. A survey was done in Hong Kong in which anonymous 40 years old was diagnosed with eye cancer and the reason was known to be the usage of his smart phone pattern. There are still doubts about smart phone causing a threatening ocular disease i.e. eye cancer. 16Awareness level among staff members shown in graph 4 showed 50% (17 out of 34) staff members were highly aware, 26% (11 out of 34) were low level aware and 11% (6 out of 34) were moderate level aware aboutocular symptoms due to smart phone use. The awareness among students in which 72% (48 out of 66) students were aware and 27% (18 out of 66) were unaware about ocular symptoms due to smart phone use. Andrew Griffin performed a study on people who were addicted to their smart phones. He found out that it is causing chemical variation of the brain that could lead to severe tiredness and anxiety.1750% (24 out of 48) students were highly aware, 33% (16 out of 48) were low level aware and 16% (8 out of 48) were moderate level aware about ocular symptoms due to smart phone use. A medical director named Jeff Taylor claimed that at least 1 out of every 4 eye patients comes with complain of eyestrain and the commonest reason is using small screen smart phone for reading purpose.18 This study also showed awareness about different ocular symptoms caused due to smart phone use. It showed that most 80% staff members and students were aware about eyestrain/fatigue caused due to smart phone while very few 8% and 6% were aware about smart phone use causing cataract and macular degeneration respectively. A study conducted by Aswitha Priya Sadagopan in 2017 revealed that 43% of the students having symptoms complained of any one of the symptoms of vision syndrome while working on smartphone.19 We also found that 76% of subjects were aware about the irritation/burning of the eyes, 51% subjects were aware about the ocular pain, 46% subjects were aware about the redness of the eyes, 45% were aware about the watering of the eyes, 42% were aware about the eyesight deterioration and 31% were aware about the double vision due to smart phone use. A study in Kocaeli, Turkey concluded that subjects who possessed smart phone for more than 2 years had a significant increase in blurring of vision compared to users having mobile phone for less than 2 years in which female had been reported to have more inflammation in the eyes as compared to men.20

CONCLUSION

There is a shortage of literature survey to find out the awareness in developing the ocular symptoms due to smart phone use. From this study it is concluded that most of the subjects i.e. staff members and students were aware about ocular symptoms due to smartphone use. Unlike students, staff members were more aware about it. Numerous staff members and students were highly aware while very few were unaware about some of the ocular symptoms caused due to smart phone use.

1. Andrew Nusca. 20 August 2009. “Smartphone vs. feature phone arms race heats up; which did you buy?” [Accessed date: 12- 4-2019]
2. Christof Baron. Number of smartphone users worldwide from 2014 to 2020 (in billions). Available from: https://www.statista.com/statistics/330695/number-of-smartphone-usersworldwide/.[Accessed date: 11-4-2019].
3. Suliman S.AljomaaMohammad F.Al.QudahIsmael S.Albursan et al. August 2016. Smartphone addiction among university students in the light of some variables. [Accessed 17th April 2019].
4. Zunaira Riaz, Shaiza Hassan. June 2018. Vision Problems in Smart Phone Users amongstthe Students of Isra University. [Accessed date: 12-4-2019].
5. Sreemoyee Chatterjee. Suffering from dry eyes? Your smartphone may be to blame. 6 April, 2017. Available from: https:// www.gadgetsnow.com/tech-news/suffering-from-dry-eyes-yoursmartphone- may-be-the-reason/articleshow/58042579.cms [Accessed 24th December 2018]
6. Andrew a. Dahl. Eye Strain. 12th May, 2018. Available from: https://www.medicinenet.com/eye_strain/article.htm#eye_ strain_facts [Accessed 27th December 2018].
7. What is digital eye strain? 15 October. Available from: https:// gunnar.com/what-is-digital-eye-strain/ [Accessed 27th December 2018].
8. Sertaç Argun K?vanç, Berna Akova Budak, Mahmut O?uz Ulusoy. Relation between Smartphone Use and Unilateral Ocular Pain and Headache. 6 April, 2016. Available from: https://www. intechopen.com/books/current-perspectives-on-less-known aspects-of-headache/relation-between-smartphone-use-andunilateral- ocular-pain-and-headache [Accessed 31st December 2018].
9. Study Cell Phone Radiation Can Damage Eyes Cause Early Cataracts. Available from: https://www.rfsafe.com/study-cellphone- radiation-can-damage-eyes-cause-early-cataracts/ [Accessed 31st December 2018].
10. Rahul Gupta. Smartphone use can cause cataract. 16 August, 2018. Available from: https://www.themobileindian.com/news/ smartphone-use-can-cause-cataract-7427 [Accessed 31st December 2018].
11. Daniela Ongaro. 25 August, 2014. Your child’s phone and tablet could be harming their eyes, expert warns. Available from: https://www.dailytelegraph.com.au/entertainment/arts/yourchilds- phone-and-tablet-could-be-harming-their-eyes-expertwarns/ news-story/c91174a8dcd55d0e70f0836144a403c5 [Accessed 1st January 2019].
12. James Chapman. Mobiles linked to eye cancer. December 31st, 2018. Available from: https://www.dailymail.co.uk/health/ article-15446/Mobiles-linked-eye-cancer.html [Accessed 10th January 2019].
13. Sae-Yun Park, Min-Jeong Kim, Seok-Joong Kim, et al. Influence of Smart Phone on Dry Eye Syndrome in Adolescents. September 30, 2015. Available from: http://www.kjfp.or.kr/ journal/view.html?uid=291&vmd=Full [Accessed 10th January 2019].
14. Jun Hyung Moon, Kyoung Woo Kim and Nam Ju Moo. Smartphone use is a risk factor for pediatric dry eye disease according to region and age: a case control study. 28 October, 2016. Available from: https://bmcophthalmol.biomedcentral. com/articles/10.1186/s12886-016-0364-4 [Accessed 15th January 2019].
15. Marlene Greenfield. Global market share held by the leading smartphone operating systems in sales to end users from 1st quarter 2009 to 2nd quarter 2018. Available from: https://www. statista.com/statistics/266136/global-market-share-held-bysmartphone- operating-systems/ [Accessed 15th January 2019].
16. Annie Dee. Smartphone Use in Dark Can Allegedly Cause Eye Cancer. February 4, 2016. Available from: https://www. youthhealthmag.com/articles/36730/20160204/smartphoneuse- dark-allegedly-cause-eye-cancer.htm [Accessed 19th January 2019].
17. Andrew Griffin. 30 November 2017. Smartphone addiction causes an imbalance in the brain that makes people tired and anxious, study finds.
18. Patricia Wen. December 16, 2013. Tiny screens can be a big strain on eyes. Available from: https://www.bostonglobe.com/  lifestyle/health-wellness/2013/12/16/all-that-squinting-tinyscreens-causing-physical-problems-for-some-but-there-areways- lessen-harm/14Nmdk9Znjnppv3TMqqg9K/story.html. [Accessed 17th April, 2019].
19. Sertaç Argun K?vanç, Berna Akova Budak, Mahmut O?uz Ulusoy, et al. Relation between Smartphone Use and Unilateral Ocular Pain and Headache. April 12th 2017. Available from: https:// www.intechopen.com/books/current-perspectives-on-lessknown- aspects-of-headache/relation-between-smartphoneuse- and-unilateral-ocular-pain-and-headache [Accessed 15th January 2019].
20. Balik H. H., Turgut-Balik D., et al. Some ocular symptoms and sensations experienced by long term users of mobile phones. Pathol. Biol. 2005; 53: 88–91. [Accessed 17th April 2019].




Uveal melanoma 

An old woman presented to the emergency department with a 4-day history of inflammation and pain in the right eye. She had been blind in the eye for several years. MRI revealed a right orbital mass. Abdominal and thoracic imaging showed numerous hepatic masses, abdominal and thoracic lymphadenopathy, and vertebral sclerotic osseous disease. The right eye was enucleated for palliative relief and to obtain tissue for diagnosis.
Differential Diagnosis. Amaurosis fugax, T-cell lymphoma, Uveal melanoma, Vitreous hemorrhage, Disseminated aspergillosis.