Background Excessive use of digital smart devices, including smartphones and tablet computers, could be a risk factor for myopia. We aimed to review the literature on the association between digital smart device use and myopia.Methods In this systematic review and meta-analysis we searched MEDLINE and Embase, and manually searched reference lists for primary research articles investigating smart device (ie, smartphones and tablets) exposure and myopia in children and young adults (aged 3 months to 33 years) from database inception to June 2 (MEDLINE) and June 3 (Embase), 2020. We included studies that investigated myopia-related outcomes of prevalent or incident myopia, myopia progression rate, axial length, or spherical equivalent. Studies were excluded if they were reviews or case reports, did not investigate myopia-related outcomes, or did not investigate risk factors for myopia. Bias was assessed with the Joanna Briggs Institute Critical Appraisal Checklists for analytical cross-sectional and cohort studies. We categorised studies as follows: category one studies investigated smart device use independently; category two studies investigated smart device use in combination with computer use; and category three studies investigated smart device use with other near-vision tasks that were not screen-based. We extracted unadjusted and adjusted odds ratios (ORs), β coefficients, prevalence ratios, Spearman's correlation coefficients, and p values for associations between screen time and incident or prevalent myopia. We did a meta-analysis of the association between screen time and prevalent or incident myopia for category one articles alone and for category one and two articles combined. Random-effects models were used when study heterogeneity was high (I²>50%) and fixed-effects models were used when heterogeneity was low (I²≤50%).Findings 3325 articles were identified, of which 33 were included in the systematic review and 11 were included in the meta-analysis. Four (40%) of ten category one articles, eight (80%) of ten category two articles, and all 13 category three articles used objective measures to identify myopia (refraction), whereas the remaining studies used questionnaires to identify myopia. Screen exposure was measured by use of questionnaires in all studies, with one also measuring device-recorded network data consumption. Associations between screen exposure and prevalent or incident myopia, an increased myopic spherical equivalent, and longer axial length were reported in five (50%) category one and six (60%) category two articles. Smart device screen time alone (OR 1•26 [95% CI 1•00-1•60]; I²=77%) or in combination with computer use (1•77 [1•28-2•45]; I²=87%) was significantly associated with myopia. The most common sources of risk of bias were that all 33 studies did not include reliable measures of screen time, seven (21%) did not objectively measure myopia, and nine (27%) did not identify or adjust for confounders in the analysis. The high heterogeneity between studies included in the meta-analys...

Background: Given the rising public health burden of myopia, population-based data on the level of awareness about myopia amongst parents in Singapore are required for planning future awareness campaigns and public health interventions. This study aimed to evaluate the level of awareness of myopia amongst a group of parents residing in Singapore. Methods: This study was a cross-sectional survey. A sample of 326 participants aged 19 to 69 years with at least 1 child were recruited at The Kidz Academy (TKA) 2018 exhibition in Singapore. Socio-demographic characteristics, smart device use and awareness of myopia (prevalence and mitigation strategies) were collected via an interviewer-administered online questionnaire. Results: 56.7% (185/326) of survey respondents were aware of the high prevalence of myopia amongst secondary school-going Singaporean children. 18.1% (59/326) of the respondents reported that an eye-to-screen distance of less than 30 cm was acceptable and 27.0% (88/326) were unaware of the importance of regular eye examinations among children. Less than half of the respondents [46.6% (152/326)] correctly identified that Singaporean children spend at least 6.5 hours a day on digital screens. 87.7% (286/326) were aware of the importance of outdoor activity as an intervention to slow the progression of myopia, with female respondents significantly more likely to be aware of its importance [odds ratio (OR) = 2.12, 95% confidence interval = 1.09 – 4.13, χ2 = 4.86, P = .03]. Conclusion: Survey respondents demonstrated a good level of awareness of the high prevalence of myopia in Singapore and the protective role of outdoor activity in its development and progression. Awareness campaigns may be beneficial for promoting regular eye examinations amongst children and educating the public on the risk of excessive time spent on smart devices.

Background: Given the rising public health burden of myopia, population-based data on the level of awareness about myopia amongst parents in Singapore are required for planning future awareness campaigns and public health interventions. This study aimed to evaluate the level of awareness of myopia amongst a group of parents residing in Singapore. Methods: This study was a cross-sectional survey. A sample of 326 participants aged 19 to 69 years with at least 1 child were recruited at The Kidz Academy (TKA) 2018 exhibition in Singapore. Socio-demographic characteristics, smart device use and awareness of myopia (prevalence and mitigation strategies) were collected via an interviewer-administered online questionnaire. Results: 56.7% (185/326) of survey respondents were aware of the high prevalence of myopia amongst secondary school-going Singaporean children. 18.1% (59/326) of the respondents reported that an eye-to-screen distance of less than 30 cm was acceptable and 27.0% (88/326) were unaware of the importance of regular eye examinations among children. Less than half of the respondents [46.6% (152/326)] correctly identified that Singaporean children spend at least 6.5 hours a day on digital screens. 87.7% (286/326) were aware of the importance of outdoor activity as an intervention to slow the progression of myopia, with female respondents significantly more likely to be aware of its importance [odds ratio (OR) = 2.12, 95% confidence interval = 1.09 – 4.13, χ2 = 4.86, P = .03]. Conclusion: Survey respondents demonstrated a good level of awareness of the high prevalence of myopia in Singapore and the protective role of outdoor activity in its development and progression. Awareness campaigns may be beneficial for promoting regular eye examinations amongst children and educating the public on the risk of excessive time spent on smart devices.

Background: Given the rising public health burden of myopia, population-based data on the level of awareness about myopia amongst parents in Singapore are required for planning future awareness campaigns and public health interventions. This study aimed to evaluate the level of awareness of myopia amongst a group of parents residing in Singapore. Methods: This study was a cross-sectional survey. A sample of 326 participants aged 19 to 69 years with at least 1 child were recruited at The Kidz Academy (TKA) 2018 exhibition in Singapore. Socio-demographic characteristics, smart device use and awareness of myopia (prevalence and mitigation strategies) were collected via an interviewer-administered online questionnaire. Results: 56.7% (185/326) of survey respondents were aware of the high prevalence of myopia amongst secondary school-going Singaporean children. 18.1% (59/326) of the respondents reported that an eye-to-screen distance of less than 30 cm was acceptable and 27.0% (88/326) were unaware of the importance of regular eye examinations among children. Less than half of the respondents [46.6% (152/326)] correctly identified that Singaporean children spend at least 6.5 hours a day on digital screens. 87.7% (286/326) were aware of the importance of outdoor activity as an intervention to slow the progression of myopia, with female respondents significantly more likely to be aware of its importance [odds ratio (OR) = 2.12, 95% confidence interval = 1.09 – 4.13, χ2 = 4.86, P = .03]. Conclusion: Survey respondents demonstrated a good level of awareness of the high prevalence of myopia in Singapore and the protective role of outdoor activity in its development and progression. Awareness campaigns may be beneficial for promoting regular eye examinations amongst children and educating the public on the risk of excessive time spent on smart devices.