Clinical features of phototoxic maculopathy due to screen use in the dark: A case series

This study aimed to investigate the clinical manifestations of phototoxic maculopathy due to screen use in the dark. A retrospective case series was conducted, including individuals with phototoxic maculopathy due to screen use in the dark between January 2023 and March 2024 at the Eye Center, Renmin Hospital of Wuhan University. Data on best-corrected visual acuity, optical coherence tomography (OCT), OCT angiography, visual field testing, and multifocal electroretinography (mfERG) were collected and analyzed during follow-up. The study included 10 cases (mean age 41.1 ± 17.48 years) involving 13 eyes, comprising 6 males (8 eyes) and 4 females (5 eyes). Bilateral involvement was observed in 3 cases, unilateral right eye involvement in 5, and unilateral left eye involvement in 2. Individuals with unilateral or more severe involvement reported a habit of preferentially using the affected eye for mobile phone viewing. Among the involved eyes, 3 eyes from 3 cases developed choroidal neovascularization (CNV); 6 eyes from 5 cases exhibited disruption of the myoid, ellipsoid, and interdigitation zones; and 4 eyes from 3 cases presented with largely intact macular structure but impaired P1 wave response density on mfERG. Prolonged screen use in the dark may lead to phototoxic maculopathy, characterized by impaired macular function, structural disruption or loss of the photoreceptor layer, and in some cases, formation of CNV.