Hi Tommy
Thanks for your post – you ask some straightforward questions which are very interesting. Interesting not just because they affect many people (I think the vast majority of us do some sort of screen based work at least some of the time these days) but also because they bring up some conundrums with rare conditions like Keratoconus.
I work with statistical models and risk management so I get asked all the time things like “how likely is this- or that- scenario to happen”. In order to answer accurately you need two key things. One is a good set of data on the event you’re trying to model. That’s the easy part – so long as you can get the data and it’s reliable. The other is an awareness that there’s no hidden interactions between seemingly unrelated events which you might be tempted to overlook. People do, I find, have short attentions spans and wish to grasp simplistic – dare I say dumbed-down ? – rationales for complex and dynamic situations... alas... Move on Chris, otherwise you’ll start a rant...
You mention eye rubbing so let’s look at that first. Eye rubbing, as you might have been told be the clinician you saw, is clearly implicated in the development or progress of Keratoconus. It’s probably one of the best established correlations. However, even this fairly well demonstrated effect isn’t quite as simple as it seems. For example, I was, I’m sorry to say, a habitual eye-rubber until I was finally told of it’s possible ill effects on people with Keratoconus and also looked at the clinical evidence. So for a long time, I rubbed my eyes, sometimes quite hard. However, although I rubbed both eyes equally in terms of time, and equally firmly, the Keratoconus developed to a significantly more advanced degree in the left eye compared to the right one. So clearly, there’s a little more to it than simply rubbing your eyes. Because otherwise, I’d have been expected to exhibit the same degree of Keratoconus progression in both eyes if it was simply down to eye rubbing.
When you look for evidence in clinical studies about eye rubbing, what you find isn’t an established, repeatable causal factor. All you find is a strong correlation. Now, if anyone ever tries to sell you “correlation” as “proof” of something then please send them to me for a good beating with a hard-backed copy of “Statistics for Dummies”. In this instance, not rubbing your eyes is good advice because the correlation is as I say strong, and it’s a pretty easy thing to avoid (well, not that easy sometimes... but you can do it without too much hassle) so it’s a no-brainer.
Turning to your actual question about whether doing screen based activities with Keratoconus will exacerbate the condition. Or whether squinting will make things worse. I wish I could say “oh, well, look at this study here where it says that screen based work makes Keratoconus worse” or “here’s one that shows a control group of squinters had no material change in their Keratoconus compared to non-squinters”. Unfortunately such evidence doesn’t exist, as least not that I’ve seen.
What has been shown is that the cells in the corneas of people with Keratoconus have demonstrably less viability than normal corneas. So anything that stresses the eye is going to have a disproportionately greater impact on a Keratoconic cornea. Whether that impact would make any different to the progression of the disease process is an open question. I’ve a hunch (and here’s I’m descending into speculation) that what will eventually emerge is that Keratoconus is susceptible to trigger factors such as genetic predisposition, environmental elements, mechanical stresses, changes in body chemistry etc. etc. and that there’s a subtle interplay in these different factors at work in initially triggering Keratoconus and then influences the progression of it once triggered.
Until more research is done, we don’t therefore know the exact mechanism(s) at work. So for me, I have a simple principle that “if it’s hurting, it isn’t doing me any good” and “if it seems to help, then it might be a good thing to keep doing”. in other words, trust your instincts about what to do for the best.
And anyway, as you rightly said, there’s a good range of treatments out there and you can’t spend all your time worrying. So I do on occasions stare too long at my iphone, read when I’m tired or go out in the sun without my sunglasses on because just for a while I want to live “normally” and if that means having a good old squinting session, then so be it. Then again, I’ll also follow my own whack-job theories about what helps as well. For me, it’s all about trying to find the right balance.
If there’s any evidence from professionals that is pertinent to what Tommy’s asked, be interested to read it.
Best wishes, thanks again for the questions. Anything else you need to know, chuck us a post.
Cheers
Chris