Digital eye strain and its associated factors in children during the COVID-19 pandemic

Abstract

Purpose: This study was undertaken to identify the prevalence of symptoms related to the use of display devices and contributing factors in children engaged in distance learning during the COVID-19 pandemic. Methods: An online electronic survey form was prepared using Google Forms (Alphabet Co., Mountain View, CA) and sent to parents of children under the age of 18 years engaged in distance learning during the COVID-19 pandemic. The types of display devices children use, how often such devices are used, the symptoms of digital eye strain, and the severity and frequency of the symptoms were recorded, and the associations between the factors were analyzed. Results: A total of 692 participants were included. The mean age of the children was 9.72 ± 3.02 years. The most common display devices used were personal computers ( n = 435, 61.7%) for online classes and smartphones ( n = 400, 57.8%) for nonacademic purposes. The mean duration of display device use was 71.1 ± 36.02 min without a break and 7.02 ± 4.55 h per day. The most common reported symptom was headache ( n = 361, 52.2%). Of the participants, 48.2% ( n = 332) reported experiencing 3 or more symptoms. The multivariate analysis detected that being male ( P = 0.005) and older age ( P = 0.001) were independent risk factors for experiencing 3 or more symptoms. Conclusion: The increasing use of digital devices by children is exacerbating the problem of digital eye strain in children as a side effect of online learning. Public awareness should be improved.

Digital Eye Strain- A Comprehensive Review

“…Hence, digital device usage increased throughout the world, exacerbating DES symptoms. DES prevalence amongst children alone rose to 50-60% in the COVID-19 era [44][45][46]. In children, the symptoms expanded to include recent onset esotropia and vergence abnormalities as part of the DES spectrum [47,48].…”

“…2022 Apr; 19(7): 3996 [ 53 ] Thailand 527 students, 70.40% females, mean age 20.04 ± 2.17 years Female gender, atopic eye disease, dry eyes, itching, red eye, eye pain, astigmatism, previous refractive surgery, tear substitute use, contact lens use, mobile and tablet use Eye pain-96.5%, burning sensation-92.5%, headache 90.08%, defective vision-15.95 CVS-Questionnaire (CVS-Q), CVS was diagnosed with a score of CVS-Q ≥ 6 Prevalence of CVS was 81%, distance less than 20 cm (52.7 vs. 40%), less brightness less 14.8 vs. 7.0%) and glare or reflection on display (47.8 vs. 29.0%) were associated with CVS Social distancing is mandatory, online classes are unavoidable, increased screen was associated with increases prevalence of CVS. Laptop/desktop should be preferred over mobile phone 2 Cai et al Front Med (Lausanne), 2022 Mar 21;9:853293 [ 54 ] China 115 children with myopia Strict home confinement, hereditary, closed indoor work time, excess exposure to electronic gadgets Protective factors- age, rest time, sleep time, and distance from the device while usage Asthenopic symptoms Axial length assessment (IOL Master 700) and refractive errors (without cycloplegia), visual function, convergence insufficiency symptom survey (CISS) and eye care habits questionnaire Axial length elongation was 35% higher than normal, positively correlated with severe asthenopia ( r = 0.711), negative with age ( r = − 0.442), distance from eyes (− 0.238) Decreased outdoor activities and increased screen time accelerated myopia progression by 1/3 3 Demirayak et al Indian J Ophthalmol 2022 Mar;70(3):988–992 [ 45 ] Turkey 692 children under the age of 18 years, mean age 9.72 ± 3.02 years, 360 (52%) were girls, 62.57% were students in primary school Computer use (61.7%), smartphones (57.8%), mean duration of display device use 71.1 ± 36.02 min Headache (52.2%), eye fatigue (49.3%), and eye redness (49.3%) and double vision-8.8% Online electronic survey using Google Forms 48.2% experienced 3 or more symptom, male gender and age were independent risk factors for 3 or more symptoms Digital device use during the pandemic exacerbated the DES among children 4 Basnet et al JNMA J Nepal Med Assoc, 2022 Jan 15;60(245):22–25 [ 55 ] Nepal 318 subjects Digital device use, tablet use, computer, and smartph...…”

“…Parents and caregivers need to pick up on early signs that a child may be straining the eyes. Children often do not express ocular discomfort but may manifest certain mannerisms such as forced blinking or avoidance of screens or complain of transient episodic eye pain, rubbing, or epiphora, which may indicate eye strain [ 45 ]. Pediatricians and visual health specialists need to brief parents and teachers to recognize these signs and take remedial measures such as reducing screen time, using larger high-resolution displays, adjusting the lighting, and increasing outdoor activity.…”

Ocular and musculoskeletal changes in the pediatric population using gadgets

“…A recent study found that a screen distance less than 40 cm is significantly associated with eye fatigue [ 12 ]. In our study, the average screen distance was 36.29 cm ± 5.19, suggesting a much shorter distance from current recommendations (50-100 cm), which is another important risk factor for CVS.…”

“…The use of artificial light has also been shown to be significantly correlated with eye strain, redness, and tearing [ 12 ]. In the present study, the preferred type of lighting was artificial light (52.9%), which highlighted the association between ambient lighting and eye symptoms.…”