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Editors Selection IGR 15-2

Miscellaneous: Do Smartphones affect IOP?

Comment by Tony Realini on:

112914 Intraocular Pressure Changes While Reading Smartphone Digital Text Versus Printed Text in Healthy Individuals and Those with Glaucoma, Srivastava RM; Agrawal S; Amrin N et al., Journal of Glaucoma, 2023; 0:

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Srivastava and colleagues have conducted a prospective evaluation of the effect of reading smartphone digital text versus printed text on intraocular pressure (IOP). Their study was conducted in 60 healthy volunteers and 22 patients with medically controlled primary open-angle glaucoma. Participants performed the same reading tasks first using written text and then using the same text on a smartphone screen. The order of the tasks was not randomized. Intraocular pressure was measured using rebound tonometry in the right eye of healthy participants and the worse eye in glaucoma patients at baseline and 10, 20, and 30 minutes while reading, and 10 and 20 minutes after the cessation of reading. The investigators found that IOP rose significantly after 20 and 30 minutes of reading in healthy volunteers and after 20 minutes of reading in glaucoma patients. The magnitude of the IOP rise was greatest during smartphone text reading and was on the order of 1.7 to 2.0 mmHg (versus mean IOP rises of 0.6-0.8 mmHg with printed text reading). In all cases, IOP had returned to baseline values within 20 minutes of the cessation of reading. The effect of accommodative convergence on IOP has occurs in reading has been well described in the past. With regard to the increased IOP rise with smartphone text reading versus printed text reading, the authors speculate that in addition to accommodative convergence effects, other factors such as sustained extraocular muscle contraction, neck-flexion posture, dry eyes, and elevated psychophysiological stress with smartphone use may also be contributory. The authors also noted anecdotally that the average reading distance while using the smartphone was smaller than with printed text, which may have exaggerated convergence effort. Because the investigators did not randomize the order of reading tasks, they cannot rule out a possible order effect by which the preceding printed reading task may have potentiated a larger IOP rise with continued reading of smartphone text. The practical impact of these findings on clinical practice is challenging to assess. Smartphones have become ubiquitous, even among our older glaucoma patients, and many people spend hours per day staring at their screens. Asking our glaucoma patients, or at least those at greatest risk of glaucoma progression, to decrease or eliminate their smartphone use is unlikely to be well received by most patients, and until these findings are confirmed in larger studies, may be premature. Also, future studies should include larger screen tablets that more closely match the size and reading distance of printed text and thus may partially mitigate the IOP rise seen with smartphone text reading.

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