OSLI Retina

May 2018

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346 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ I N S T R U M E N T S / D E V I C E S / T E C H N O L O G Y ■ Ocular Tolerance of Contemporary Electronic Display Devices Andrew J. Clark, PhD; Paul Yang, BS; Khizer R. Khaderi, MD, MPH; Andrew A. Moshfeghi, MD, MBA ABSTRACT: Electronic displays have become an in- tegral part of life in the developed world since the revolution of mobile computing a decade ago. With the release of multiple consumer-grade virtual re- ality (VR) and augmented reality (AR) products in the past 2 years utilizing head-mounted displays (HMDs), as well as the development of low-cost, smartphone-based HMDs, the ability to intimately interact with electronic screens is greater than ever. VR/AR HMDs also place the display at much closer ocular proximity than traditional electronic devices while also isolating the user from the ambient en- vironment to create a "closed" system between the user's eyes and the display. Whether the increased interaction with these devices places the user's ret- ina at higher risk of damage is currently unclear. Herein, the authors review the discovery of photo- chemical damage of the retina from visible light as well as summarize relevant clinical and preclinical data regarding the influence of modern display de- vices on retinal health. Multiple preclinical studies have been performed with modern light-emitting diode technology demonstrating damage to the retina at modest exposure levels, particularly from blue-light wavelengths. Unfortunately, high-quali- ty in-human studies are lacking, and the small clin- ical investigations performed to date have failed to keep pace with the rapid evolutions in display technology. Clinical investigations assessing the ef- fect of HMDs on human retinal function are also yet to be performed. From the available data, mod- ern consumer electronic displays do not appear to pose any acute risk to vision with average use; however, future studies with well-defined clinical outcomes and illuminance metrics are needed to better understand the long-term risks of cumulative exposure to electronic displays in general and with "closed" VR/AR HMDs in particular. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:346-354.] INTRODUCTION Consumers of contemporary electronic devices have increased interactive exposure to electronic computer displays today more than ever before in the form of smartphones, handheld computer tablets, laptop and desktop computers, and televisions (Table 1). These devices are ubiquitous in practically ev- ery aspect of our daily lives in the developed world. Computer display technology has undergone a revo- lution in recent years with the advent and adoption of new display modalities, such as light-emitting diode (LED) and active-matrix light-emitting diode (AMO- LED) type displays that are often integrated into the aforementioned devices. These new display technol- ogies have provided for miniaturization and portabil- ity of computing displays. Although most of these innovations have resulted in the computer display terminal remaining still at essentially "arm's-length" from the user's eyes, new advances in virtual real- ity (VR) systems have brought those displays much closer — within the range of 3 mm to 12 mm. 1-3 In- deed, VR head-mounted displays (HMDs) represent the cutting edge of such technologies, made possible by significant progress in electronic miniaturization, computer graphics, and said display technology. VR HMDs are goggle-like devices that position display(s) directly in front of the user's eyes to simulate a three- From Keck School of Medicine of the University of Southern California, Los Angeles (AJC, PY, AAM); University of Utah Moran Eye Center, Department of Ophthalmology, University of Utah School of Medicine, Salt Lake City (KRK); and USC Roski Eye Institute, Department of Ophthalmology, Univer- sity of Southern California Keck School of Medicine, Los Angeles (AAM). Originally submitted June 21, 2017. Revision received June 21, 2017. Accepted for publication September 21, 2017. Funding for this study was provided by an unrestricted institutional grant to the University of Southern California Roski Eye Institute at Keck School of Medicine from Research to Prevent Blindness (New York, NY). Dr. Khaderi is a founder, equity owner, and employee of Vizzario; holds U.S. patents related to Vizzario technology; and is an advisor to and equity owner of Magic Leap. The remaining authors report no relevant financial disclosures. Address correspondence to Andrew A. Moshfeghi, MD, MBA, USC Roski Eye Institute, Department of Ophthalmology, University of Southern California Keck School of Medicine — Los Angeles, 1450 San Pablo St, Los Angeles, CA 90033; email: amoshfeghi@gmail.com. doi: 10.3928/23258160-20180501-08

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