【NEJM】“手机辐射致癌”风波未了,“手机导致失明”风云又起
2016/06/26
手机的癌症风波还在结束,手机导致失明的案例又掀起了一场风云。6月23日,《新英格兰医学杂志》报道了两例在黑暗中长期使用智能手机导致失明的案例,这两名患者均为女性,年龄分别为22岁和40岁。


当今,手机不离身已经成为普遍的现象,然而这也许是某些疾病的祸根。

手机辐射和癌症

手机辐射与癌症是长期以来一直存在争议的问题。今年5月份,由美国FDA资助的国家毒理学计划(National Toxicology Program,NTP)研究团队发现,暴露在手机辐射下的雄性小鼠患罕见脑癌和心脏癌症的风险增加。这项研究成果以预印本文献的形式发表在冷泉港实验室(CSHL)主办的BioRxiv上,再次把手机辐射与癌症相关推到了风口。

不过大家还不用恐慌,因为手机辐射致癌,还没有足够的证据来定论,因为该研究还存在很多令人不解的地方。首先该试验的受试对象为老鼠,人类是否也会出现同样的效应尚未确定;其次该研究还出现了很奇怪的现象,在所有的受试老鼠中,只有雄性老鼠的癌症发生率提高,雌性老鼠并没有;此外更令人不解的是,与为接受手机辐射的老鼠相比,接受手机辐射的老鼠平均寿命竟然更长。

【NEJM案例】在黑暗中玩手机,导致失明


手机的癌症风波还在结束,手机导致失明的案例又掀起了一场风云。6月23日,《新英格兰医学杂志》报道了两例在黑暗中长期使用智能手机导致失明的案例,这两名患者均为女性,年龄分别为22岁和40岁。

因此眼科医生对广大民众提出警示:晚上躺床上看手机会对视力造成严重的破坏,若一定要在黑暗中翻阅手机,一定要用两只眼睛看。这究竟是怎么回事?医生为何建议用两只眼睛?

在本案例中,两名女性经受着长达15分钟暂时性失明反复发作的影响,但多种医学检查包括核磁共振成像扫描和心脏检查,均为未找到能解释该现象的原因。但伦敦Moorfield眼科医院的Gordon Plant博士解开了这个谜团。

“我只是简单地了解在发生这种情况时患者正在做的事情,就大概能判断导致该现象的原因。两位患者均表示当时在盯着智能手机,侧躺在黑暗的房间中,而且只用一只眼睛,另一只眼睛被枕头覆盖着”,Gordon Plant博士解释道,“这种情况下,一只眼睛适应了光,另一只眼睛适应了黑暗。当放下手机时,盯手机的那只眼睛暂时看不见,是因为它需要几分钟的时间去跟上那只适应黑暗的眼睛。暂时性失明最终是无害的,如果人们坚持用两只眼睛看手机的话,这种现象是可以避免的。”

在Gordon Plant博士诊断之后,其中一名患者对短暂失明放宽了心,因为没有信号表明更严重的问题会发生,而另外一名患者则持有怀疑的态度,并坚持以日记的形式记录短暂失明的发生,直到她相信医生的判断。

然而,美国眼科学会发言人Rahul Khurana博士称这是个吸引人的假设,两个案例不足以证明在黑暗中用单只眼睛看手机会导致失明。同时他还怀疑许多智能手机用户都会出现该现象。作为一个智能手机的狂热追求者,他表示自己和妻子近日多次在黑暗中重复以上两位患者的动作,但很难达到只用单只眼睛来看手机,他认为这非常的奇怪。

编者寄语

虽然手机辐射致癌尚未定论,黑暗中玩手机导致失明也还存在疑问,但编者认为,在生活中正确使用手机对个人的身心健康和人际关系均有益。曾经看到一则公益广告,女孩在和朋友聚餐或逛街时,由于太钟爱玩手机,结果再也没有朋友愿意和她一起玩......我想这则广告想告诉人们,要学会放下手机,多和身边的朋友交流,多看看大自然的风景。

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  • Transient Smartphone “Blindness”

    Transient monocular vision loss is a common clinical presentation, and the cause is not always thromboembolic.1 We present two cases in which careful history taking established a benign cause (for the case histories, see the Supplementary Appendix, available with the full text of this letter at NEJM.org). A 22-year-old woman presented with a several months’ history of recurrent impaired vision in the right eye that occurred at night. The results of ophthalmic and cardiovascular examinations were normal. Vitamin A levels and the results of magnetic resonance angiography, echocardiography, and a thrombophilia screening were also normal. The second case involved a 40-year-old woman who presented with a 6-month history of recurrent monocular visual impairment on waking, lasting up to 15 minutes. The results of investigations for a vascular cause were again normal. Aspirin therapy had been commenced. When the patients were seen in our neuro-ophthalmic clinic, detailed history taking revealed that symptoms occurred only after several minutes of viewing a smartphone screen, in the dark, while lying in bed (before going to sleep in the first case and after waking in the second). Both patients were asked to experiment and record their symptoms. They reported that the symptoms were always in the eye contralateral to the side on which the patient was lying. We hypothesized that the symptoms were due to differential bleaching of photopigment, with the viewing eye becoming light-adapted while the eye blocked by the pillow was becoming dark-adapted. Subsequently, with both eyes uncovered in the dark, the light-adapted eye was perceived to be “blind.” The discrepancy lasted several minutes, reflecting the time course of scotopic recovery after a bleach.2-4 In a study approved by a research ethics committee, two of the authors monocularly viewed a smartphone screen at arm’s length and quantified the time course of recovery of sensitivity in the dark both psychophysically and electrophysiologically (Figure 1FIGURE 1 Diminished Retinal Sensitivity after Smartphone Viewing. ). Visual sensitivity was appreciably reduced after smartphone viewing, taking several minutes to recover, and this reduction in sensitivity was measurable at the level of the retina (Figure 1B). Although most people view screens binocularly, people frequently use smartphones while lying down, when one eye can be inadvertently covered. Smartphones are now used nearly around the clock, and manufacturers are producing screens with increased brightness to offset background ambient luminance and thereby allow easy reading. Hence, presentations such as we describe are likely to become more frequent. Our cases show that detailed history taking and an understanding of retinal physiology can reassure both patient and doctor and can avoid unnecessary anxiety and costly investigations.

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