“Screen time won the great screen time war.” – Craig Garthwaite
You can’t wait to get back to the business end of a slit lamp. Admit it. You’re so done with the whole “shelter in place” thing, so ready to be back at work, you’ve been bingeing Netflix through a pair of binoculars. It’s so bad that you are actually looking forward to seeing dry eye disease patients. Am I right? Of course I am. If you had to choose between that miserable DED patient I’ve named Linda Blair (after her most famous role) and one more press conference discussing the up-to-the-minute COVID-19 stats, you’re choosing Linda.
Plus, you just know that your DED patients have been totally following all of your instructions. Perfect compliance with their immunomodulator, no matter which one it is. Heck, your “prior auth” person has been the only person in the office you couldn’t furlough, they’ve been so busy with DED refill stuff. With all of that “save mankind/stay at home” time, each and every one of them has discovered the joys of cooking from scratch. No processed, packaged food for your DED patients. Uh-uh. They’ve gone all paleo and primal, cooking up nothing but fresh produce and free-range, prairie-raised protein sources literally oozing omega-3 fatty acids.
Can we talk about screen time? It’s like someone turned the calendar back to, oh, 1985 or something. Screen time means a television screen! Seriously. And the bigger the better. Size matters. It’s not a quality binge unless you can count the pores on Nicole Kidman’s face in Eyes Wide Shut. There are whole generations who have discovered the joys of reading books in — wait for it — books. Paper. Ink. You are fully aware of this because your millennial boomerang is reading poetry, for heaven’s sake. You hated Dickinson the first time around. Being back in the office has got to be better than listening to your WFH child read e.e. cummings out loud. At least you know that all of your DED patients have set aside their various screens, too. It’s gonna be so awesome to see how everybody looks; they’ve had all kinds of time to keep up with their Bruder mask, non-preserved tears and blinking exercises.
Meh. Who are we kidding? It’s gonna be just as terrible as you think it is.
Every single DED patient has spent every waking moment staring at their smartphones. When the BreakFree app chimes, they take a rest from their phone by staring at a tablet. ZenScreen buzzing at them? Time for a Zoom cocktail party on the laptop. “DinnerMode” just means they use one hand for their phone and the other to shovel Cheez-Its into their mouths. You’ll soon have “RealizD” that their “AppDetox” has launched a “Social Fever” without a “Moment” of “Freedom” from the glow of the screens, torching their meibomian glands and desiccating their corneas. Their lid margins glow and spark like lava on telemedicine visits.
The return to the active practice of DED care is going to be a train wreck. Prediction: lots of backsliding due in large part to the uptick in screen use while we’ve been homebound. It’s also quite likely that any of them already suffering from depression have had an even tougher time of it. When you have depression, taking care of yourself is rough to begin with. All of the loneliness and isolation has likely made that worse, leading to even worse adherence to regular treatment regimens.
For some of our patients, it will be almost as if they never started treatment at all. We will need to be ready to crank out the LipiFlow (Johnson & Johnson Vision) and fire up the intense pulsed light. Brush off all of those coupons for steroid drops; folks are gonna need more aggressive treatment when we get back. The best we can hope for? It’s so hard to get Cheez-It dust off the screen, some of them really did put down their phone and picked up a book.
Alas, “The Road Not Taken,” I fear.
Disclosure: White reports he is a consultant to Allergan, Shire, Sun, Kala, Ocular Science, Rendia, TearLab, Eyevance and Omeros; is a speaker for Shire, Allergan, Omeros and Sun; and has an ownership interest in Ocular Science and Eyevance.