{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T03:40:12Z","timestamp":1790826012520,"version":"4.1.0"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2023,10,20]],"date-time":"2023-10-20T00:00:00Z","timestamp":1697760000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>The purpose of this cohort study was to investigate the association between the prevalence of abnormal ocular examination results and the common visual symptoms of eye strain, blurred vision and photophobia.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Consecutive first-visit outpatients with best-corrected visual acuity better than 20\/30 in both eyes were enrolled and those with a history of intra-ocular lens implantation and glaucoma were excluded. Dry eye-related examinations and retinal thickness measurement were conducted. The odds ratio (OR) was calculated with logistic regression analyses of ocular data in relation to the presence of visual symptoms.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 6078 patients (3920 women, mean age 49.0 \u00b1 20.4 years) were analyzed. The prevalence of each symptom was 31.8% for eye strain, 22.5% for blurred vision and 16.0% for photophobia. A significant risk factor for eye strain was short tear break-up time (TBUT) (OR 1.88), superficial punctate keratitis (SPK) (OR 1.44), and thickness of ganglion cell complex (GCC) (OR 1.30). Risk factors for blurred vision were short TBUT (OR 1.85), SPK (OR 1.24) and GCC (OR 0.59). Risk factors for photophobia were short TBUT (OR 1.77) and SPK (OR 1.32). Schirmer test value, peripapillary nerve fiber layer thickness and full macular thickness were not associated with the tested symptoms.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The current study successfully identified female gender, short TBUT, and SPK as significant risk factors for eye strain, blurred vision, and photophobia with considerable ORs.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0293320","type":"journal-article","created":{"date-parts":[[2023,10,20]],"date-time":"2023-10-20T17:30:41Z","timestamp":1697823041000},"page":"e0293320","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Association of eye strain with dry eye and retinal thickness"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9481-0164","authenticated-orcid":true,"given":"Masahiko","family":"Ayaki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manami","family":"Kuze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuno","family":"Negishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,10,20]]},"reference":[{"issue":"12","key":"pone.0293320.ref001","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1167\/tvst.9.12.31","article-title":"Strip meniscometry correlates with ocular surface tests and symptoms.","volume":"9","author":"K Negishi","year":"2020","journal-title":"Trans Vis Sci Tech"},{"issue":"5","key":"pone.0293320.ref002","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1167\/tvst.11.5.3","article-title":"Tear strip meniscometry and its clinical application: Analysis of more than 2000 cases.","volume":"11","author":"K Miyasaka","year":"2022","journal-title":"Transl Vis Sci Technol."},{"issue":"11","key":"pone.0293320.ref003","doi-asserted-by":"crossref","first-page":"e0259142","DOI":"10.1371\/journal.pone.0259142","article-title":"Presbyopia developed earlier during the COVID-19 pandemic.","volume":"16","author":"K Negishi","year":"2021","journal-title":"PLoS One"},{"issue":"3","key":"pone.0293320.ref004","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1080\/10803548.2021.1936912","article-title":"High frequency of digital eye strain and dry eye disease in teleworkers during the coronavirus disease (2019) pandemic.","volume":"28","author":"D Salinas-Toro","year":"2022","journal-title":"Int J Occup Saf Ergon"},{"key":"pone.0293320.ref005","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.2147\/OPTH.S406032","article-title":"Prevalence of Digital Eye Strain Among University Students and Its Association with Virtual Learning During the COVID-19 Pandemic.","volume":"17","author":"AM AlQarni","year":"2023","journal-title":"Clin Ophthalmol."},{"issue":"2","key":"pone.0293320.ref006","doi-asserted-by":"crossref","first-page":"412","DOI":"10.3390\/medicina59020412","article-title":"Computer Vision Syndrome: An Ophthalmic Pathology of the Modern Era.","volume":"59","author":"IA Pavel","year":"2023","journal-title":"Medicina (Kaunas)."},{"issue":"3","key":"pone.0293320.ref007","doi-asserted-by":"crossref","first-page":"119","DOI":"10.51329\/mehdiophthal1455","article-title":"Risk factor assessment of digital eye strain during the COVID-19 pandemic: a cross-sectional survey.","volume":"11","author":"NM Lotfy","year":"2022","journal-title":"Med Hypothesis Discov Innov Ophthalmol"},{"issue":"1","key":"pone.0293320.ref008","doi-asserted-by":"crossref","first-page":"140","DOI":"10.4103\/ijo.IJO_2535_20","article-title":"Prevalence and risk factor assessment of digital eye strain among children using online e-learning during the COVID-19 pandemic: Digital eye strain among kids (DESK study-1).","volume":"69","author":"A Mohan","year":"2021","journal-title":"Indian J Ophthalmol."},{"key":"pone.0293320.ref009","doi-asserted-by":"crossref","first-page":"e001122","DOI":"10.1136\/bmjophth-2022-001122","article-title":"New insights in presbyopia: impact of correction strategies","volume":"8","author":"JS Wolffsohn","year":"2023","journal-title":"BMJ Open Ophthalmol"},{"key":"pone.0293320.ref010","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1111\/j.1755-3768.1993.tb07146.x","article-title":"Ocular fatigue is the major symptom of dry eye.","volume":"71","author":"I Toda","year":"1993","journal-title":"Acta Ophthalmol (Copenh)."},{"key":"pone.0293320.ref011","doi-asserted-by":"crossref","first-page":"3014567","DOI":"10.1155\/2019\/3014567","article-title":"Association between Retinal Nerve Fiber Layer Thickness and Eye Fatigue","volume":"2019","author":"M Ayaki","year":"2019","journal-title":"BioMed Res Int"},{"key":"pone.0293320.ref012","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.exer.2015.05.025","article-title":"Light aversion and corneal mechanical sensitivity are altered by intrinscally photosensitive retinal ganglion cells in a mouse model of corneal surface damage","volume":"137","author":"A Matynia","year":"2015","journal-title":"Exp Eye Res"},{"key":"pone.0293320.ref013","doi-asserted-by":"crossref","first-page":"497","DOI":"10.3389\/fnins.2019.00497","article-title":"Implication of Melanopsin and Trigeminal Neural Pathways in Blue Light Photosensitivity in vivo.","volume":"13","author":"V Marek","year":"2019","journal-title":"Front Neurosci"},{"key":"pone.0293320.ref014","doi-asserted-by":"crossref","first-page":"16094","DOI":"10.1523\/JNEUROSCI.4132-11.2011","article-title":"Melanopsin-positive intrinsically photosensitive retinal ganglion cells: From form to function","volume":"31","author":"TM Schmidt","year":"2011","journal-title":"J Neurosci"},{"issue":"11","key":"pone.0293320.ref015","doi-asserted-by":"crossref","first-page":"e15009","DOI":"10.1371\/journal.pone.0015009","article-title":"Dissecting a role for melanopsin in behavioural light aversion reveals a response independent of conventional photoreception.","volume":"5","author":"M Semo","year":"2010","journal-title":"PLoS One."},{"key":"pone.0293320.ref016","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.exer.2013.11.013","article-title":"A role for the ciliary marginal zone in the melanopsin-dependent intrinsic pupillary light reflex","volume":"119","author":"M Semo","year":"2014","journal-title":"Exp Eye Res"},{"issue":"7371","key":"pone.0293320.ref017","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1038\/nature10567","article-title":"Melanopsin signalling in mammalian iris and retina","volume":"479","author":"T Xue","year":"2011","journal-title":"Nature"},{"key":"pone.0293320.ref018","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.optom.2016.07.004","article-title":"Electrophysiological responses from intrinsically photosensitive retinal ganglion cells are diminished in glaucoma patients.","volume":"10","author":"M Kuze","year":"2017","journal-title":"J Optom"},{"key":"pone.0293320.ref019","doi-asserted-by":"crossref","first-page":"7997","DOI":"10.1167\/iovs.14-15146","article-title":"A positive association between intrinsically photosensitive retinal ganglion cells and retinal nerve fiber layer thinning in glaucoma","volume":"18","author":"CP Gracitelli","year":"2014","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"pone.0293320.ref020","doi-asserted-by":"crossref","first-page":"992747","DOI":"10.3389\/fncel.2022.992747","article-title":"Intrinsically photosensitive retinal ganglion cells in glaucoma","volume":"16","author":"J Gao","year":"2022","journal-title":"Front Cell Neurosci"},{"key":"pone.0293320.ref021","article-title":"Association of macular OCT and OCTA parameters with visual acuity in glaucoma","author":"JH Wu","year":"2022","journal-title":"Br J Ophthalmol"},{"key":"pone.0293320.ref022","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/08164622.2022.2124848","article-title":"Higher susceptibility to central crowding in glaucoma.","volume":"2","author":"E Blanckaert","year":"2022","journal-title":"Clin Exp Optom."},{"issue":"4","key":"pone.0293320.ref023","doi-asserted-by":"crossref","first-page":"e0152936","DOI":"10.1371\/journal.pone.0152936","article-title":"Reducing Short-Wavelength Blue Light in Dry Eye Patients with Unstable Tear Film Improves Performance on Tests of Visual Acuity.","volume":"11","author":"M Kaido","year":"2016","journal-title":"PLoS One."},{"key":"pone.0293320.ref024","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1097\/APO.0000000000000069","article-title":"Effect of blue light-reducing eye glasses on critical flicker frequency.","volume":"4","author":"T Ide","year":"2015","journal-title":"Asia-Pacific J Ophthalmol."},{"key":"pone.0293320.ref025","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1167\/iovs.16-20663","article-title":"Short-Wavelength Light-Blocking Eyeglasses Attenuate Symptoms of Eye Fatigue","volume":"58","author":"JB Lin","year":"2017","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"22","key":"pone.0293320.ref026","first-page":"00077","article-title":"Intercritical photophobia in the migrainous patient. Proposal for diagnostic criteria.","volume":"S2173-5808","author":"F Ly-Yang","year":"2022","journal-title":"Neurologia (Engl Ed)."},{"issue":"18","key":"pone.0293320.ref027","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1212\/WNL.0000000000010830","article-title":"Connections between intrinsically photosensitive retinal ganglion cells and TBI symptoms","volume":"95","author":"J Elenberger","year":"2020","journal-title":"Neurology"},{"key":"pone.0293320.ref028","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.exer.2012.09.012","article-title":"Intrinsically photosensitive retinal ganglion cells are the primary but not exclusive circuit for light aversion","volume":"105","author":"A Matynia","year":"2012","journal-title":"Exp Eye Res"},{"key":"pone.0293320.ref029","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.pain.2009.07.018","article-title":"An fMRI case report of photophobia: activation of the trigeminal nociceptive pathway","volume":"145","author":"EA Moulton","year":"2009","journal-title":"Pain"},{"key":"pone.0293320.ref030","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1038\/nn.2475","article-title":"A neural mechanism for exacerbation of headache by light","volume":"13","author":"R Noseda","year":"2010","journal-title":"Nat Neurosci"},{"key":"pone.0293320.ref031","doi-asserted-by":"crossref","first-page":"60","DOI":"10.3389\/fncir.2016.00060","article-title":"Peripheral Sensory Neurons Expressing Melanopsin Respond to Light.","volume":"10","author":"A Matynia","year":"2016","journal-title":"Front Neural Circuits."},{"issue":"3","key":"pone.0293320.ref032","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1136\/bjo.76.3.157","article-title":"The importance of the precorneal tear film for the quality of optical imaging","volume":"76","author":"G. Rieger","year":"1992","journal-title":"Br J Ophthalmol"},{"issue":"14","key":"pone.0293320.ref033","doi-asserted-by":"crossref","first-page":"DES36","DOI":"10.1167\/iovs.17-23500","article-title":"Irregular Astigmatism and Higher-Order Aberrations in Eyes With Dry Eye Disease","volume":"59","author":"S. Koh","year":"2018","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"pone.0293320.ref034","doi-asserted-by":"crossref","first-page":"S83","DOI":"10.1097\/ICO.0000000000000998","article-title":"Mechanisms of Visual Disturbance in Dry Eye","volume":"1","author":"S. Koh","year":"2016","journal-title":"Cornea"},{"issue":"14","key":"pone.0293320.ref035","doi-asserted-by":"crossref","first-page":"DES29","DOI":"10.1167\/iovs.17-23721","article-title":"Functional Visual Acuity","volume":"59","author":"M. Kaido","year":"2018","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"3","key":"pone.0293320.ref036","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.ajo.2013.11.010","article-title":"Rebamipide Ophthalmic Suspension Long-term Study Group. A multicenter, open-label, 52-week study of 2% rebamipide (OPC-12759) ophthalmic suspension in patients with dry eye","volume":"157","author":"S Kinoshita","year":"2014","journal-title":"Am J Ophthalmol"},{"issue":"2","key":"pone.0293320.ref037","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1007\/s12325-019-01188-x","article-title":"Long-Term Safety and Effectiveness of Diquafosol for the Treatment of Dry Eye in a Real-World Setting: A Prospective Observational Study.","volume":"37","author":"Y Ohashi","year":"2020","journal-title":"Adv Ther."},{"issue":"10","key":"pone.0293320.ref038","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1001\/jamaophthalmol.2013.4503","article-title":"Development and validation of the Dry Eye-Related Quality-of-Life Score questionnaire","volume":"131","author":"Y Sakane","year":"2013","journal-title":"JAMA Ophthalmol"},{"issue":"1","key":"pone.0293320.ref039","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1097\/WNO.0000000000000766","article-title":"Neurobiology of Photophobia.","volume":"39","author":"R Burstein","year":"2019","journal-title":"J Neuroophthalmol"},{"key":"pone.0293320.ref040","first-page":"90","article-title":"A controlled trial of regional sympatholysis in the treatment of photo-oculodynia syndrome.","volume":"15","author":"PG Fine","year":"1995","journal-title":"J Neuroophthalmol"},{"key":"pone.0293320.ref041","doi-asserted-by":"crossref","first-page":"E433","DOI":"10.1210\/jc.2011-2391","article-title":"Human melatonin and alerting response to blue-enriched light depend on a polymorphism in the clock gene PER3","volume":"97","author":"SL Chellappa","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"key":"pone.0293320.ref042","doi-asserted-by":"crossref","first-page":"e60310","DOI":"10.1371\/journal.pone.0060310","article-title":"Melanopsin gene polymorphism I394T is associated with pupillary light responses in a dose-dependent manner.","volume":"8","author":"S Higuchi","year":"2013","journal-title":"PLoS One."},{"issue":"6","key":"pone.0293320.ref043","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1001\/archophthalmol.2009.106","article-title":"Inner retinal layer thinning in Parkinson disease","volume":"127","author":"ME Hajee","year":"2009","journal-title":"Arch Ophthalmol"},{"issue":"7","key":"pone.0293320.ref044","doi-asserted-by":"crossref","first-page":"2461","DOI":"10.1167\/iovs.19-26891","article-title":"Difference in Topographic Pattern of Prelaminar and Neuroretinal Rim Thinning Between Nonarteritic Anterior Ischemic Optic Neuropathy and Glaucoma","volume":"60","author":"EJ Lee","year":"2019","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"1","key":"pone.0293320.ref045","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1186\/s12886-018-0902-3","article-title":"A prospective case-control study comparing optical coherence tomography characteristics in neuromyelitis optica spectrum disorder- optic neuritis and idiopathic optic neuritis.","volume":"18","author":"X Zhao","year":"2018","journal-title":"BMC Ophthalmol"},{"key":"pone.0293320.ref046","doi-asserted-by":"crossref","first-page":"e76121","DOI":"10.1371\/journal.pone.0076121","article-title":"Patient reported differences in dry eye disease between men and women: impact, management, and patient satisfaction.","volume":"8","author":"DA Schaumberg","year":"2013","journal-title":"PLoS One"},{"issue":"2","key":"pone.0293320.ref047","first-page":"301","article-title":"Gender differences in adolescent dry eye disease: a health problem in high school girls.","volume":"11","author":"M Ayaki","year":"2018","journal-title":"Int J Ophthalmol"},{"issue":"4","key":"pone.0293320.ref048","doi-asserted-by":"crossref","first-page":"193","DOI":"10.3390\/diagnostics10040193","article-title":"Age Is a Determining Factor of Dry Eye-Related Signs and Symptoms.","volume":"10","author":"M Ayaki","year":"2020","journal-title":"Diagnostics (Basel)."},{"issue":"12","key":"pone.0293320.ref049","doi-asserted-by":"crossref","first-page":"2361","DOI":"10.1016\/j.ophtha.2011.05.029","article-title":"Prevalence and risk factors of dry eye disease in Japan: Koumi study","volume":"118","author":"M Uchino","year":"2011","journal-title":"Ophthalmology"},{"issue":"4","key":"pone.0293320.ref050","doi-asserted-by":"crossref","first-page":"567","DOI":"10.18240\/ijo.2021.04.14","article-title":"Prevalence and risk factors of dry eye disease in young and middle-aged office employee: a Xi\u2019an Study.","volume":"14","author":"JW Hu","year":"2021","journal-title":"Int J Ophthalmol."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0293320","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,20]],"date-time":"2023-10-20T17:31:18Z","timestamp":1697823078000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0293320"}},"subtitle":[],"editor":[{"given":"Kofi","family":"Asiedu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,10,20]]},"references-count":50,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10,20]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0293320","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,20]]}}}