Re:Differential visual perception following monocular exposure to bright screen
Dean M.Wingerchuk, Professor of Neurology, Mayo Clinic, Scottsdale, AZ[email protected]
Saraniya Sathiamoorthi, Rochester, MN
Submitted February 28, 2017
We thank Drs. Tripathy and Sengupta for the interest in our Clinical/Scientific Note. [1] Regarding their comments, we agree that our patient's clinical presentation was not consistent with demyelinating optic neuritis. This was one of several factors that led to misdiagnosis.
Although we agree that monocular viewing is generally uncommon in people with binocular vision, it is the specific physical environment in which an electronic device is viewed that may permit occurrence of the transient smartphone blindness (TSB) phenomenon (specifically, dim ambient light and a physical barrier in front of one eye that effectively results in monocular viewing). Monocular viewing of the device is required for the phenomenon, but may be inadvertent or unrecognized by the individual.
We also agree that this phenomenon could occur when viewing any bright object under the right circumstances. We suggest that the ubiquity of smartphone use and the likelihood of prolonged monocular viewing make smartphone use the most likely contemporary scenario. Furthermore, although many instances of dark or light adaptation are familiar and recognized as normal (e.g. transitioning from a very bright environment to a dark one), factors such as the unilateral nature of TSB, lack of recognition of monocular device viewing and/or of the specific predisposing environment, and relatively modest (but prolonged) inter-eye difference in light exposure may all contribute to an individual concluding that the transient visual event was not normal and to report it as a medical symptom.
The hypothesis that pre-existing hereditary, metabolic, or other disorders that might predispose certain individuals to TSB is interesting and could be specifically investigated, perhaps in individuals in which it is unusually prolonged or easily provoked.
1. Sathiamoorthi S, Wingerchuk DM. Transient smartphone blindness: Relevance to misdiagnosis in neurologic practice. Neurology Epub 2017 Jan 18.
For disclosures, please contact the editorial office at [email protected].
We thank Drs. Tripathy and Sengupta for the interest in our Clinical/Scientific Note. [1] Regarding their comments, we agree that our patient's clinical presentation was not consistent with demyelinating optic neuritis. This was one of several factors that led to misdiagnosis.
Although we agree that monocular viewing is generally uncommon in people with binocular vision, it is the specific physical environment in which an electronic device is viewed that may permit occurrence of the transient smartphone blindness (TSB) phenomenon (specifically, dim ambient light and a physical barrier in front of one eye that effectively results in monocular viewing). Monocular viewing of the device is required for the phenomenon, but may be inadvertent or unrecognized by the individual.
We also agree that this phenomenon could occur when viewing any bright object under the right circumstances. We suggest that the ubiquity of smartphone use and the likelihood of prolonged monocular viewing make smartphone use the most likely contemporary scenario. Furthermore, although many instances of dark or light adaptation are familiar and recognized as normal (e.g. transitioning from a very bright environment to a dark one), factors such as the unilateral nature of TSB, lack of recognition of monocular device viewing and/or of the specific predisposing environment, and relatively modest (but prolonged) inter-eye difference in light exposure may all contribute to an individual concluding that the transient visual event was not normal and to report it as a medical symptom.
The hypothesis that pre-existing hereditary, metabolic, or other disorders that might predispose certain individuals to TSB is interesting and could be specifically investigated, perhaps in individuals in which it is unusually prolonged or easily provoked.
1. Sathiamoorthi S, Wingerchuk DM. Transient smartphone blindness: Relevance to misdiagnosis in neurologic practice. Neurology Epub 2017 Jan 18.
For disclosures, please contact the editorial office at [email protected].