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Clinical & Experimental Optometry Sep 2019Smartphone and tablet use in Australia and worldwide is reaching saturation levels and associated visual and ocular discomfort such as headaches, eyestrain, dry eyes and... (Review)
Review
Smartphone and tablet use in Australia and worldwide is reaching saturation levels and associated visual and ocular discomfort such as headaches, eyestrain, dry eyes and sore eyes are widespread. This review synthesises the available literature and considers these symptoms in the context of a binocular vision and/or ocular surface aetiology. Eye discomfort with smartphones and tablets is discussed alongside similar symptoms reported with desktop computer use. Handheld devices differ from computers in viewing position and distance, screen size and luminance, and patterns of use. Accommodation is altered with handheld device use, with increased lag and decreased amplitude. Smartphone and tablet use results in reduced fusional convergence and possibly a receded near point of convergence. This is similar to what happens with computer use. Findings related to blink rate with smartphone and tablet use are contradictory, perhaps due to the influence of task difficulty, and there is limited evidence related to blink amplitude. Reduced blink rate and amplitude are consistently reported with computer use. Use of handheld digital devices, like computers, may adversely impact tear stability. There is insufficient evidence to support the impact of handheld devices on tear volume, although this is reduced with computer use. The available literature does not conclusively link eye and visual discomfort symptoms reported with handheld digital devices, with changes in binocular vision, blinking or ocular surface. However, there is a gap in our understanding of symptoms which occur with smartphone and tablet use in the context of how these devices are used. In addition, studies are required in high users such as teenagers, and in patients with dry eye or accommodative/binocular vision anomalies, all of whom may have a higher risk of symptoms. A better understanding of symptom aetiology can guide clinical advice to minimise adverse impacts on visual and ocular surface health and discomfort.
Topics: Asthenopia; Computers; Computers, Handheld; Dry Eye Syndromes; Humans; Smartphone; Vision Disorders; Vision, Binocular
PubMed: 30663136
DOI: 10.1111/cxo.12851 -
Clinical & Experimental Optometry Jan 2019Digital eye strain, an emerging public health issue, is a condition characterised by visual disturbance and/or ocular discomfort related to the use of digital devices... (Review)
Review
Digital eye strain, an emerging public health issue, is a condition characterised by visual disturbance and/or ocular discomfort related to the use of digital devices and resulting from a range of stresses on the ocular environment. This review aims to provide an overview of the extensive literature on digital eye strain research with particular reference to the clinical management of symptoms. As many as 90 per cent of digital device users experience symptoms of digital eye strain. Many studies suggest that the following factors are associated with digital eye strain: uncorrected refractive error (including presbyopia), accommodative and vergence anomalies, altered blinking pattern (reduced rate and incomplete blinking), excessive exposure to intense light, closer working distance, and smaller font size. Since a symptom may be caused by one or more factors, a holistic approach should be adopted. The following management strategies have been suggested: (i) appropriate correction of refractive error, including astigmatism and presbyopia; (ii) management of vergence anomalies, with the aim of inducing or leaving a small amount of heterophoria (~1.5 Exo); (iii) blinking exercise/training to maintain normal blinking pattern; (iv) use of lubricating eye drops (artificial tears) to help alleviate dry eye-related symptoms; (v) contact lenses with enhanced comfort, particularly at end-of-day and in challenging environments; (vi) prescription of colour filters in all vision correction options, especially blue light-absorbing filters; and (vii) management of accommodative anomalies. Prevention is the main strategy for management of digital eye strain, which involves: (i) ensuring an ergonomic work environment and practice (through patient education and the implementation of ergonomic workplace policies); and (ii) visual examination and eye care to treat visual disorders. Special consideration is needed for people at a high risk of digital eye strain, such as computer workers and contact lens wearers.
Topics: Asthenopia; Computer Systems; Disease Management; Humans; Vision Disorders
PubMed: 29797453
DOI: 10.1111/cxo.12798 -
La Revue de Medecine Interne Jul 2019Primary open-angle glaucoma is a progressive chronic optic neuropathy, typically bilateral, that occurs after the age of 40 years. It is the second leading cause of... (Review)
Review
Primary open-angle glaucoma is a progressive chronic optic neuropathy, typically bilateral, that occurs after the age of 40 years. It is the second leading cause of irreversible blindness in the world. Primary open-angle glaucoma corresponds to a progressive loss of retinal ganglion cell characterized by an excavation of the optic disc associated with typical visual field defects. Elevated intraocular pressure is the main risk factor of primary open-angle glaucoma. Diagnosis and monitoring of primary open-angle glaucoma arebased on both analysis of structural alteration, by clinical examination of optic disc completed by imaging tests (Ocular Coherence Tomography), and functional alterations, by visual field tests. The only effective treatment to slow primary open-angle glaucoma progression is the reduction of the intraocular pressure with anti-glaucomatous eye drops, laser or surgical treatments.
Topics: Adult; Aged; Aged, 80 and over; Antihypertensive Agents; Diagnosis, Differential; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Middle Aged; Monitoring, Physiologic; Ophthalmic Solutions; Tomography, Optical Coherence; Vision Disorders; Visual Field Tests
PubMed: 30594326
DOI: 10.1016/j.revmed.2018.12.001 -
Seminars in Neurology Dec 2019The presentation of idiopathic intracranial hypertension (IIH) in pediatric populations has several important distinctions from that in adults, especially among... (Review)
Review
The presentation of idiopathic intracranial hypertension (IIH) in pediatric populations has several important distinctions from that in adults, especially among prepubertal patients, in which there is no apparent association with gender or obesity. Pediatric patients are more likely to be asymptomatic or present with atypical symptoms than their adult counterparts, posing a diagnostic challenge in some cases. It is important to be aware of the ways in which diagnostic criteria for IIH are modified from that of adults. Ideal treatment practices and the natural history of pediatric IIH remain unclear. Acetazolamide is the mainstay of medical treatment, but some patients with significant visual loss may require surgical intervention. Multicenter studies to accrue a large number of cases and future prospective studies will help to better define pediatric IIH and to formulate consensus guidelines for treatment and management of these patients.
Topics: Child; Humans; Papilledema; Pseudotumor Cerebri; Vision Disorders
PubMed: 31847041
DOI: 10.1055/s-0039-1698743 -
Current Opinion in Neurology Feb 2020Visual snow is considered a disorder of central visual processing resulting in a perturbed perception of constant bilateral whole-visual field flickering or pixelation.... (Review)
Review
PURPOSE OF REVIEW
Visual snow is considered a disorder of central visual processing resulting in a perturbed perception of constant bilateral whole-visual field flickering or pixelation. When associated with additional visual symptoms, it is referred to as visual snow syndrome. Its pathophysiology remains elusive. This review highlights the visual snow literature focusing on recent clinical studies that add to our understanding of its clinical picture, pathophysiology, and treatment.
RECENT FINDINGS
Clinical characterization of visual snow syndrome is evolving, including a suggested modification of diagnostic criteria. Regarding pathophysiology, two recent studies tested the hypothesis of dysfunctional visual processing and occipital cortex hyperexcitability using electrophysiology. Likewise, advanced functional imaging shows promise to allow further insights into disease mechanisms. A retrospective study now provides Class IV evidence for a possible benefit of lamotrigine in a minority of patients.
SUMMARY
Scientific understanding of visual snow syndrome is growing. Major challenges remain the subjective nature of the disease, its overlap with migraine, and the lack of quantifiable outcome measures, which are necessary for clinical trials. In that context, refined perceptual assessment, objective electrophysiological parameters, as well as advanced functional brain imaging studies, are promising tools in the pipeline.
Topics: Brain; Functional Neuroimaging; Humans; Perceptual Disorders; Retrospective Studies; Vision Disorders; Visual Perception
PubMed: 31714263
DOI: 10.1097/WCO.0000000000000768 -
Stroke and Vascular Neurology Dec 2017A large portion of the central nervous system is dedicated to vision and therefore strokes have a high likelihood of involving vision in some way. Vision loss can be the... (Review)
Review
A large portion of the central nervous system is dedicated to vision and therefore strokes have a high likelihood of involving vision in some way. Vision loss can be the most disabling residual effect after a cerebral infarction. Transient vision problems can likewise be a harbinger of stroke and prompt evaluation after recognition of visual symptoms can prevent future vascular injury. In this review, we discuss the visual aspects of stroke. First, anatomy and the vascular supply of the visual system are considered. Then, the different stroke syndromes which involve vision are discussed. Finally, topics involving the assessment, prognosis, treatment and therapeutic intervention of vision-specific stroke topics are reviewed.
Topics: Animals; Eye; Humans; Prognosis; Regional Blood Flow; Stroke; Vision Disorders; Vision, Ocular; Visual Pathways
PubMed: 29507782
DOI: 10.1136/svn-2017-000079 -
Neurologic Clinics May 2021Neuro-ophthalmic emergencies include optic nerve, central visual pathway, and ocular motility disorders that, if not identified and treated promptly, may lead to... (Review)
Review
Neuro-ophthalmic emergencies include optic nerve, central visual pathway, and ocular motility disorders that, if not identified and treated promptly, may lead to permanent vision loss, other significant morbidity, or mortality. This article provides a framework for approaching patients with neuro-ophthalmic symptoms and reviews the presentation, evaluation, and treatment of select emergent conditions that can cause them. Emergent causes of blurry vision, transient vision loss, papilledema, and diplopia, including giant cell arteritis, cardioembolic disease, and aggressive infection, are discussed.
Topics: Emergencies; Humans; Vision Disorders
PubMed: 33896536
DOI: 10.1016/j.ncl.2021.01.004 -
Journal of Neuro-ophthalmology : the... Jun 2018
Topics: Humans; Vision Disorders; Visual Acuity; Visual Fields
PubMed: 29750733
DOI: 10.1097/WNO.0000000000000655 -
Practical Neurology Oct 2022Palinopsia is an uncommon but important neuro-ophthalmic condition. It can present with a range of visual phenomena and may be misdiagnosed as migraine or a functional...
Palinopsia is an uncommon but important neuro-ophthalmic condition. It can present with a range of visual phenomena and may be misdiagnosed as migraine or a functional disorder. The list of possible causes is long and includes structural cerebral lesions. We present a clinical case to illustrate the condition before reviewing different palinoptic subtypes and discussing how these may help clinicians to narrow the differential diagnosis.
Topics: Diagnosis, Differential; Humans; Migraine Disorders; Nervous System Diseases; Neurology; Vision Disorders
PubMed: 35512929
DOI: 10.1136/practneurol-2022-003347 -
Practical Neurology Oct 2020'Photopsia' describes the symptom of visual disturbances that are typically flash-like, sudden in onset and brief, and occurring without light entering the eye. Patients...
'Photopsia' describes the symptom of visual disturbances that are typically flash-like, sudden in onset and brief, and occurring without light entering the eye. Patients reporting photopsia often pose a diagnostic challenge, given the wide range of possible neurological and ophthalmological causes. We review the common causes of photopsia, discuss the assessment and workup of this symptom, and stress the importance of close interdisciplinary liaison to help with its diagnosis and management. We discuss a patient with acute zonal occult outer retinopathy to illustrate these points.
Topics: Diagnosis, Differential; Female; Fluorescein Angiography; Fundus Oculi; Humans; Middle Aged; Retinal Diseases; Scotoma; Vision Disorders; Visual Fields; White Dot Syndromes
PubMed: 32536606
DOI: 10.1136/practneurol-2019-002460