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I congratulate Dr Tatemichi and his team on the interesting study on the possible association between heavy computer use and glaucomatous visual field abnormalities.1 I would like to take this opportunity to share some of my thoughts:
(1) The authors concluded that heavy computer users with refractive errors have an increased risk of FDT-VFA and that glaucoma might be involved. I do not totally agree to this. It has been established that heavy visual task is associated with myopic progression2 and significant myopia is associated with open angle glaucoma (OAG).3,4 But these arguments cannot lead to a sensible inference that heavy visual task is in any association with OAG. The authors have failed to find another underlying mechanism between heavy visual task and glaucoma other than myopia.
(2) Several limitations have been mentioned in this study, namely the limitations of a cross sectional study, possible bias towards male, myopia, normal tension glaucoma, and the significant data loss during investigation. The diagnosis of glaucoma requires confirmation of progression of visual field abnormality. Hence, of these limitations, this cross sectional study does not command full recognition.
(3) The stratification of hours of computer use into light/moderate/heavy sufferers formed the pitfall of oversimplification and coarse statistical analysis. The actual hours of visual demanding task should be computed instead.
(4) The study has only concentrated on Japanese people. In other words, the comparatively high rate of glaucoma may merely be a reflection of the underlying epidemiological properties of the population at interest.5 The association between visual task and glaucoma may be another of “bystander effect”.
Dr Tatemichi’s paper has certainly been an insightful manuscript. As our world is becoming more and more computer dependent, it is important to understand any health issues related to such development. The postulation on the correlation of glaucoma and computer use needs to be further investigated. Further proof may be established by carefully planned longitudinal studies on susceptible workers.