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      Dynamic and Static Pupil Changes After Near Work: Comparison Between Reading a Book and Using a Smartphone

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          Abstract

          Objectives:

          Decreased static pupil size due to accommodation is a common clinical finding; however, changes in pupillary dynamic responses after near-work activities such as reading a book and using a smartphone are not well understood.

          Methods:

          The present study was performed on 76 right eyes of 76 volunteers (mean age: 20.95±2.34 years) who had ocular near activity more than 4 h per day. The participants were divided into two groups based on the dominant activity, reading a book (Group 1) or using a smartphone (Group 2). Evaluation of dynamic and static parameters of the pupil was performed before and after 1 h of continuous routine eye activity in both groups and compared.

          Results:

          Near work reduced pupil diameter (PD) in all static components (p<0.001) and the amount of change in the min PD (p=0.039) and mesopic PD (p=0.043) were different between two groups and were higher in Group 1 (both, p<0.05). Dynamic elements showed a decrease in initial diameter, amplitude and velocity of contraction and dilation, and an increase in other components so that the changes after using smartphone were significant in all dynamic parameters (all, p<0.05), but reading the book only made a significant difference in the initial diameter, amplitude, and velocity of contraction and duration of dilation (all, p<0.05); the changes were only different in the initial diameter between the two studied groups, which was higher in Group 1 (p=0.047).

          Conclusion:

          The present study showed that reading a book and using smartphone cause changes in the pupil components, which were decreasing in diameter components and velocity of changes and increasing in latency of changes; the type of ocular work may affect the changes.

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          Most cited references27

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          Digital eye strain: prevalence, measurement and amelioration

          Digital device usage has increased substantially in recent years across all age groups, so that extensive daily use for both social and professional purposes is now normal. Digital eye strain (DES), also known as computer vision syndrome, encompasses a range of ocular and visual symptoms, and estimates suggest its prevalence may be 50% or more among computer users. Symptoms fall into two main categories: those linked to accommodative or binocular vision stress, and external symptoms linked to dry eye. Although symptoms are typically transient, they may be frequent and persistent, and have an economic impact when vocational computer users are affected. DES may be identified and measured using one of several available questionnaires, or objective evaluations of parameters such as critical flicker–fusion frequency, blink rate and completeness, accommodative function and pupil characteristics may be used to provide indices of visual fatigue. Correlations between objective and subjective measures are not always apparent. A range of management approaches exist for DES including correction of refractive error and/or presbyopia, management of dry eye, incorporating regular screen breaks and consideration of vergence and accommodative problems. Recently, several authors have explored the putative role of blue light-filtering spectacle lenses on treating DES, with mixed results. Given the high prevalence of DES and near-universal use of digital devices, it is essential that eye care practitioners are able to provide advice and management options based on quality research evidence.
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            Normal values and standard deviations for pupil diameter and interpupillary distance in subjects aged 1 month to 19 years.

            Normal values of pupil diameters and interpupillary distances (PDs) were measured in a population of 1311 subjects (in 4294 visits) ranging from 1 month of age to slightly over 19 years of age. Subjects in this study were recruited from birth announcements in a local newspaper for a developmental vision project. Pupil sizes were measured photographically when the corneas were illuminated by 15.9 +/- 0.5 lux ambient illumination (i.e. under mesopic conditions). Interpupillary distance was measured with an interocular distance rule while the subject fixated an object at 0.66 m distance. These PD measurements were corrected for systematic measurement errors and to an infinite viewing distance using radii of ocular rotation based on age-dependent axial lengths. Means and S.D. were calculated for age, pupil diameter and PD for each 1-year group of male and female subjects. The second order regression equation for average pupil size as a function of age was determined: [males pupil diameter (in mm) = 5.83 +/- 0.181*age in years - 0053*age in years2, r2 = 0.897; female pupil diameter = 5.40 + 0.285*age in years - 0.0109*age in years2, r2 = 0.945]. The dierence between male and female pupil sizes (mean male - female = 0.13 mm) was marginally not significant (p < 0.054). The average corrected PDs as a function of age were found to approximate another second-order regression equation: (males PD = 43.36 + 1.663*age in years - 0.034*age in years2, r2 = 0.986; females PD = 41.76 + 1.891 *age in years - 0.052*age in years2, r2 = 0.986). Male PD was wider than female PD by an average of 1.58 mm (p < 0.0003). As expected, the results of this study were similar to a preliminary investigation conducted by Thunyalukul et al. [Invest. Ophthalmol. Vis. Sci. 37 (1996) S731] on a portion of the present data set, and also very similar to data from another study of comparable racial composition using a different measurement method [Pryor, Pediatrics 44 (1969) 973]. It was concluded that pupil diameter and PD increase more gradually than axial length of the eye in the first few years of life. The normal values and S.D. for both pupil size and PD determined in this study have important clinical implications as well as applications in the optical industry.
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              Functional Organization of the Sympathetic Pathways Controlling the Pupil: Light-Inhibited and Light-Stimulated Pathways

              Pupil dilation is mediated by a sympathetic output acting in opposition to parasympathetically mediated pupil constriction. While light stimulates the parasympathetic output, giving rise to the light reflex, it can both inhibit and stimulate the sympathetic output. Light-inhibited sympathetic pathways originate in retina-receptive neurones of the pretectum and the suprachiasmatic nucleus (SCN): by attenuating sympathetic activity, they allow unimpeded operation of the light reflex. Light stimulates the noradrenergic and serotonergic pathways. The hub of the noradrenergic pathway is the locus coeruleus (LC) containing both excitatory sympathetic premotor neurones (SympPN) projecting to preganglionic neurones in the spinal cord, and inhibitory parasympathetic premotor neurones (ParaPN) projecting to preganglionic neurones in the Edinger-Westphal nucleus (EWN). SympPN receive inputs from the SCN via the dorsomedial hypothalamus, orexinergic neurones of the latero-posterior hypothalamus, wake- and sleep-promoting neurones of the hypothalamus and brain stem, nociceptive collaterals of the spinothalamic tract, whereas ParaPN receive inputs from the amygdala, sleep/arousal network, nociceptive spinothalamic collaterals. The activity of LC neurones is regulated by inhibitory α2-adrenoceptors. There is a species difference in the function of the preautonomic LC. In diurnal animals, the α2-adrenoceptor agonist clonidine stimulates mainly autoreceptors on SymPN, causing miosis, whereas in nocturnal animals it stimulates postsynaptic α2-arenoceptors in the EWN, causing mydriasis. Noxious stimulation activates SympPN in diurnal animals and ParaPN in nocturnal animals, leading to pupil dilation via sympathoexcitation and parasympathetic inhibition, respectively. These differences may be attributed to increased activity of excitatory LC neurones due to stimulation by light in diurnal animals. This may also underlie the wake-promoting effect of light in diurnal animals, in contrast to its sleep-promoting effect in nocturnal species. The hub of the serotonergic pathway is the dorsal raphe nucleus that is light-sensitive, both directly and indirectly (via an orexinergic input). The light-stimulated pathways mediate a latent mydriatic effect of light on the pupil that can be unmasked by drugs that either inhibit or stimulate SympPN in these pathways. The noradrenergic pathway has widespread connections to neural networks controlling a variety of functions, such as sleep/arousal, pain, and fear/anxiety. Many physiological and psychological variables modulate pupil function via this pathway.
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                Author and article information

                Journal
                Beyoglu Eye J
                Beyoglu Eye J
                Beyoglu Eye Journal
                Kare Publishing (Turkey )
                2459-1777
                2587-0394
                2022
                15 November 2022
                : 7
                : 4
                : 253-260
                Affiliations
                [1 ]Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
                [2 ]Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
                [3 ]Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
                Author notes
                Address for correspondence: Alireza Jamali, MD. Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran Phone: +989122816388 E-mail: alirezajamali.1371@ 123456gmail.com
                Article
                BEJ-7-253
                10.14744/bej.2022.64325
                9794501
                36628079
                ab5f1355-e131-4840-9231-9411dea99a3e
                Copyright: © 2022 by Beyoglu Eye Training and Research Hospital

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

                History
                : 26 February 2022
                : 13 May 2022
                : 14 July 2022
                Categories
                Original Article

                static pupillometry,dynamic pupillometry,near work,metrovision monopack 1

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