New personal technology creating new ailments
■ Physicians are seeing an increasing number of tech-related problems, such as BlackBerry thumb and cell phone elbow, as dependence on electronic devices reaches unprecedented levels.
When Mike Sevilla, MD, sees young patients at his Salem, Ohio, family practice, he often finds them text messaging or listening to music on portable media players.
These tech-savvy patients may not realize it, but they could be on the way to developing health problems related to overuse of personal technology. That's why Dr. Sevilla uses such exam room encounters as a springboard to talk about the potential health impact of today's tech devices.
"I talk about listening to loud music and being distracted while driving. ... I bring up those examples of people who were hurt or killed because they could not disconnect themselves from their cell phone," he said.
Dr. Sevilla and other physicians across the nation are adding questions about cell phone use and computer habits to the office visit at a time when dependence on electronic devices has reached unprecedented levels.
Some doctors are noticing an uptick in patient complaints about physical problems related to new technology. Among the most common are vision trouble and elbow, thumb and wrist pain -- ailments sometimes traced to prolonged use of cell phones, computers and handheld electronic devices.
The conditions have names such as BlackBerry thumb, cell phone elbow and computer vision syndrome.
"Think back to 1993. There were no cell phones [except for] some boxy portable phones. That's just 17 years ago," said John McIntyre, MD, a clinical professor of psychiatry at the University of Rochester Medical Center in New York. "To a very large degree, we don't know the [health] effects yet of the tremendous explosion [in technology]. It's too recent."
As of November 2009, 57.7% of U.S. adults had two or more computers and 63.3% of people actively used the Internet, according to research firm The Nielsen Co. The number of Americans using cell phones more than doubled from 109.5 million in 2000 to 285.6 million in 2009, according to CTIA-The Wireless Assn., which represents the wireless communications industry.
The increasing amount of time people spend looking at computer screens and handheld devices is affecting their vision, said New York ophthalmologist Roy Chuck, MD, PhD. He pointed to a 2009 Archives of Ophthalmology study that found the prevalence of myopia among people 12 to 54 was 25% in 1971-72 compared with 41.6% from a 1999-2004 study period.
"The thought is that ... the more close work you do may result in an increasing amount of nearsightedness," said Dr. Chuck, chair of ophthalmology and visual sciences at Montefiore Medical Center and Albert Einstein College of Medicine in New York.
Just as concerning is the rising number of patients with dry eye syndrome and computer vision syndrome, Dr. Chuck said. When people stare at a computer screen, they tend not to blink. That leads tears to evaporate from the eyes, leaving them dry and irritated.
"Before the heavy use of computers, we saw a lot of dry eye. But we're now seeing it even more," he said.
In computer vision syndrome, people experience dry and burning eyes; blurred vision; and headache, neck aches and backaches, Dr. Chuck said. It often occurs after focusing one's eyes on a computer screen for protracted, uninterrupted periods.
He recommends that physicians consider these two conditions when examining patients who are tired, rubbing their eyes and complaining about vision problems. He suggests that doctors ask them how many hours a day they spend using a computer or handheld device.
One recent study noted a possible link between personal-listening devices and a rise in hearing loss among adolescents. The study, published online Sept. 1 in the Journal of Adolescent Health, found that high-frequency hearing loss nearly doubled among 8,710 female adolescents from 1985 to 2008.
Most of the hearing loss occurred between 2001 and 2008, when regular use of personal-listening gadgets rose from 18.3% to 76.4% among the study population.
Lead study author Abbey L. Berg, PhD, said the findings show that physicians, particularly pediatricians, should discuss with patients how to safely use iPods and similar media players.
"I wouldn't tell a child not to use an iPod, but I would say [keep the volume level] at the halfway point. And I would tell them not to listen [to any device] for more than one hour a day," said Berg, a professor of biology and health sciences at Pace University in New York.
Hand therapist Kristen Crowe has treated thumb pain and numbness at Beaumont Health Center in Royal Oak, Mich., that she believes are linked to personal technology. While typing on a regular keyboard involves all fingers, the thumbs do the fine motor work on handheld gadgets, she said.
"Thumbs are not meant to do that," she said. "If you do that over and over again, it can lead to strain."
Crowe also has seen an increasing number of people with nerve problems in their elbow due, in part, to holding a cell phone for extended periods. The condition is known as cubital tunnel syndrome, or cell phone elbow.
Some states are tackling public health concerns about texting and talking on cell phones while driving. Eight states and Washington, D.C., prohibit drivers from using handheld cell phones while behind the wheel, according to the Governors Highway Safety Assn. Text messaging while driving is banned in 30 states and Washington, D.C. In 2009, the American Medical Association's House of Delegates adopted a policy stating that any use of handheld devices while driving should be against the law.
Diagnosing technology-related health problems is challenging because the source of the patient's problem is not often clear, said Gwenn Schurgin O'Keeffe, MD.
"A child might come in with thumb pain, but the last thing the pediatrician will think of is that it's related to their cell phone use," said Dr. O'Keeffe, an executive committee member of the American Academy of Pediatrics' Council on Communications and Media. "That needs to change."
The Hudson, Mass., pediatrician recommends that physicians ask all patients what types of technology they use and how often they use them. She suggests that doctors schedule a follow-up visit to discuss technology habits if health problems are suspected.
But Dr. O'Keeffe admits that differentiating between technology use that is healthy and problematic can be difficult.
For example, she said Facebook helps adolescents improve social development and communication skills. But when people replace face-to-face interaction with online friends, they can get what she calls "Facebook depression."
"We can all quickly cross that line where normal [technology] use becomes abnormal. I talk to people about needing unplug time," when they turn off their computers and handheld devices, Dr. O'Keefe said.
"If we don't teach people how to interact face-to-face, we're going to have huge social and emotional problems. I can't even imagine how [those people] will be as parents and spouses."