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SIGNIFICANCE Digital display use has been accepted as a contributing factor to dry eye disease. Nowadays, plenty of new models of digital displays have been developed, and the differences in their nature and the ways in which they are set and used may contribute to differences in the eye-related problems they cause. PURPOSE This study aimed to analyze the differences in ocular surface, tear film, and visual fatigue parameters after reading on different digital displays, with and without initial instillation of artificial tears. METHODS Thirty-one healthy individuals ranging in age from 20 to 26 years (mean ± standard deviation, 21.26 ± 1.73 years) were included in this prospective clinical study. Subjects' ocular surface, tear film, and visual fatigue parameters were assessed after reading for 15 minutes on a laptop computer, tablet, e-reader, and smartphone with matching characteristics and a baseline measurement. Measurements were taken with and without the instillation of artificial tears before the reading tasks and included the Ocular Surface Disease Index questionnaire, the Computer Vision Syndrome Questionnaire, tear meniscus height, the Schirmer I test, noninvasive keratograph break-up time, osmolarity, bulbar redness, and pupil size. RESULTS Statistically significant differences in the Ocular Surface Disease Index, Computer Vision the Syndrome Questionnaire, tear meniscus height, the Schirmer I test, noninvasive keratograph break-up time, osmolarity, and bulbar redness were obtained when comparing the displays (P < .05). Best results were obtained with the smartphone and the e-reader. Conversely, the computer produced the highest disturbance on the ocular surface and tear film. Finally, the instillation of artificial tears revealed no statistical improvement of ocular surface or tear film parameters for the same device (P > .05). CONCLUSIONS Taking into account the clinical tests for dry eye diagnosis, the smartphone may be considered as the least disturbing display, producing lower dry eye signs and symptoms in comparison with other devices.

Computer vision syndrome (CVS) describes 'a group of eye and vision-related problems that result from prolonged computer, tablet, e-reader and cell phone use'. 1 Complaints of ocular dryness represent one of the main groups of CVS symptoms 2 and are often encountered in otherwise healthy patients. 3 Research conducted over the last decade reported significantly higher dry eye signs and symptoms in digital display users compared with nonusers. [4][5][6][7] Consequently, digital display use has been listed by the Tear Film and Ocular Surface (TFOS) Dry Eye

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Every part of the human body is subject to aging, including the eye. An increased 3 prevalence of dry eye disease with age is widely acknowledged. Aging threatens 4 ocular surface homeostasis, altering the normal functioning of the lacrimal 5 functional unit and potentially leading to signs and symptoms of dry eye. 6 Additional age-related processes take place within the crystalline lens, leading to 7 presbyopia and cataractogenesis. Correction strategies for presbyopia and 8 cataracts may directly or indirectly challenge the ocular surface. Contact lenses 9 disturb the normal structure of the tear film and can interact negatively with the ocular surface, further deteriorating an already unbalanced tear film in presbyopes, however, newer contact lens designs can overcome some of these issues. Moreover, cataract and corneal refractive surgeries sever corneal nerves and disrupt the corneal epithelium and ocular surface, which can influence surgical outcomes and aggravate dryness symptoms in older age groups. This review summarises the current understanding of how the invasive nature of contact lens wear and cataract and refractive surgery influence signs and symptoms of ocular dryness in an aging population.