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Published on: April 1, 2019
New Indicator of Children's Excessive Electronic Screen Use and Factors in Meibomian Gland Atrophy
Sandra Lora Cremers1, Alicia R G Khan2, Jaeil Ahn3
1From the Department of Ophthalmology, Suburban Hospital, Johns Hopkins Hospital and Health System, Bethesda, Maryland, USA (S.L.C.); Visionary Eye Doctors, Rockville, Maryland, USA (S.L.C., C.P., A.M.).
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 (
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.
