Smartphone use as a possible risk factor for myopia

McCrann, Saoirse; Loughman, James; Butler, John S.; Paudel, Nabin; Flitcroft, Daniel Ian

doi:10.1111/cxo.13092

Cited by 83 publications

(105 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, the heterogeneity was high in the meta-analysis of included cross-sectional studies. First, a large number of studies have identified potential risk factors that may result in visual impairment, which included both genetic and environmental factors [ 20 , 26 , 56 , 58 ] such as age [ 26 ], education and occupation [ 58 ], outdoor activity [ 20 , 58 ], and parental myopia [ 20 ]. However, some studies did not include these variables in the multivariate analysis, which might contribute to the inconsistent findings, and might further affect the individual effect estimates and the pooled OR.…”

Section: Discussionmentioning

confidence: 99%

“…For example, a cross-sectional study (N=1153 participants) using stratified random cluster samples did not find a statistically significant association between smartphone use time and myopia [ 25 ]. Similarly, a study conducted in Ireland (N=418 participants) indicated that smartphone use time was not a risk factor for myopia [ 26 ]. Toh et al [ 27 ] found that smartphone use time was associated with an increased risk of visual symptoms (ie, blurring of vision, dry eye), but a decreased odds of myopia.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Smartphone Overuse and Visual Impairment in Children and Young Adults: Systematic Review and Meta-Analysis

Wang¹,

Li²,

Zhu³

et al. 2020

J Med Internet Res

View full text Add to dashboard Cite

Background Smartphone overuse has been cited as a potentially modifiable risk factor that can result in visual impairment. However, reported associations between smartphone overuse and visual impairment have been inconsistent. Objective The aim of this systematic review was to determine the association between smartphone overuse and visual impairment, including myopia, blurred vision, and poor vision, in children and young adults. Methods We conducted a systematic search in the Cochrane Library, PubMed, EMBASE, Web of Science Core Collection, and ScienceDirect databases since the beginning of the databases up to June 2020. Fourteen eligible studies (10 cross-sectional studies and 4 controlled trials) were identified, which included a total of 27,110 subjects with a mean age ranging from 9.5 to 26.0 years. We used a random-effects model for meta-analysis of the 10 cross-sectional studies (26,962 subjects) and a fixed-effects model for meta-analysis of the 4 controlled trials (148 subjects) to combine odds ratios (ORs) and effect sizes (ES). The I2 statistic was used to assess heterogeneity. Results A pooled OR of 1.05 (95% CI 0.98-1.13, P=.16) was obtained from the cross-sectional studies, suggesting that smartphone overuse is not significantly associated with myopia, poor vision, or blurred vision; however, these visual impairments together were more apparent in children (OR 1.06, 95% CI 0.99-1.14, P=.09) than in young adults (OR 0.91, 95% CI 0.57-1.46,P=.71). For the 4 controlled trials, the smartphone overuse groups showed worse visual function scores compared with the reduced-use groups. The pooled ES was 0.76 (95% CI 0.53-0.99), which was statistically significant (P<.001). Conclusions Longer smartphone use may increase the likelihood of ocular symptoms, including myopia, asthenopia, and ocular surface disease, especially in children. Thus, regulating use time and restricting the prolonged use of smartphones may prevent ocular and visual symptoms. Further research on the patterns of use, with longer follow up on the longitudinal associations, will help to inform detailed guidelines and recommendations for smartphone use in children and young adults.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Smartphone Overuse and Visual Impairment in Children and Young Adults: Systematic Review and Meta-Analysis

Wang¹,

Li²,

Zhu³

et al. 2020

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“… 17 A study of 418 students found that device recorded smartphone data usage, an objective surrogate for time spent using the smartphone, was independently associated with myopia in a study of 418 students (OR1.08, 95% CI 1.03-1.14). 18 …”

Section: Global Tightening Of Infection Control Measuresmentioning

confidence: 99%

Digital Screen Time During the COVID-19 Pandemic: Risk for a Further Myopia Boom?

Wong

Tsai

Jonas

et al. 2021

American Journal of Ophthalmology

294

228

View full text Add to dashboard Cite

Purpose To review the impact of increased digital device usage arising from lockdown measures instituted during the COVID-19 pandemic on myopia, and make recommendations for mitigating potential detrimental effects on myopia control. Design Perspective Methods Review of studies focused on digital device usage, near work, and outdoor time in relation to myopia onset and progression. Public health policies on myopia control, recommendations on screen time and information pertaining to the impact of COVID-19 on increased digital device use were presented. Recommendations to minimize the impact of the pandemic on myopia onset and progression in children were made. Results Increased digital screen time, near work and limited outdoor activities were found to be associated with the onset and progression of myopia, and could potentially be aggravated during and beyond the COVID-19 pandemic outbreak period. While school closures may be short-lived, increased access, adoption and dependence on digital devices could have a long term negative impact on childhood development. Raising awareness among parents, children and government agencies is key to mitigating myopigenic behaviours that may become entrenched during this period. Conclusions While it is important to adopt critical measures to slow or halt the spread of COVID-19, close collaboration between parents, schools and ministries is necessary to assess and mitigate the long term collateral impact of COVID-19 on myopia control policies.

show abstract

“…While some studies reported a significant association between increased computer and smart phone use time and myopia development 23,24 , a meta-analysis reported s no association of screen time with the prevalence or incidence of myopia 25 . Recent studies have shown that children who increased time spent outdoors (but not indoors) have a lower possibility of incident myopia 26,27 .…”

Section: Introductionmentioning

confidence: 99%

COVID-19 Quarantine Reveals Grade-specific Behavioral Modification of Myopia: One-Million Chinese Schoolchildren Study

Yuan

et al. 2020

Preprint

View full text Add to dashboard Cite

SummaryBackgroundHigh prevalence of myopia of adolescent has been a global public health concern. Their risk factors and effective prevention methods for myopia across schoolchildren developmental stages are critically needed but remain uncertain due to the difficulty in implementing intervention measurements under normal life situation. We aimed to study the impact of the COVID-19 quarantine on myopia development among over one-million schoolchildren.MethodsWe designed the ongoing longitudinal project of Myopic Epidemiology and Intervention Study (MEIS) to biannually examine myopia among millions of schoolchildren for ten years in Wenzhou City, Zhejiang Province, China. In the present study, we performed three examinations of myopia in 1,305 elementary and high schools for schoolchildren in June 2019, December 2019 and June 2020. We used the normal period (June-December 2019) and COVID-19 quarantine period (January-June 2020) for comparisons. Myopia was defined as an uncorrected visual acuity of 20/25 or less and a spherical equivalent refraction (SER) of -0.5 diopters (D) or less. High myopia was defined as an SER of -6.0 D or less.FindingsIn June 2019, 1,001,749 students aged 7-18 were eligible for examinations. In the 6-month and 12-month follow-up studies, there were 813,755 eligible students (81.2%) and 768,492 eligible students (76.7%), respectively. Among all students, we found that half-year myopia progression increased approximate 1.5 times from -0.263 D (95% CI, -0.262 to -0.264) during normal period to -0.39 D (95% CI, -0.389 to -0.391) during COVID-19 quarantine (P < 0.001). Multivariate Cox regression analysis identified grade rather than age was significantly associated with myopia (Hazard ratio [HR]: 1.10, 95% CI, 1.08 to 1.13; P < 0.001) and high myopia (HR: 1.40, 95% CI, 1.35 to 1.46; P < 0.001) after adjustment for other factors. The prevalence, progression, and incidence of myopia and high myopia could be categorized into two grade groups: I (grades 1-6) and II (grades 7-12). Specifically, COVID-19 quarantine for 6 months sufficiently increased risk of developing myopia (OR: 1.36, 95% CI, 1.33 to 1.40) or high myopia (OR: 1.30, 95% CI, 1.22 to 1.39) in Grade Group I, but decreased risk of developing myopia (OR: 0.45, 95% CI, 0.43 to 0.48) or high myopia (OR: 0.57, 95% CI, 0.54 to 0.59) in Grade Group II.InterpretationThe finding that behavioral modifications for six months during COVID-19 quarantine sufficiently and grade-specifically modify myopia development offers the largest human behavioral intervention data at the one million scale to identify the grade-specific causal factors and effective prevention methods for guiding the formulation of myopia prevention and control policies.FundingKey Program of National Natural Science Foundation of China; the National Natural Science Foundation of China; Scientific Research Foundation for Talents of Wenzhou Medical University; Key Research and Development Program of Zhejiang Province.Research in contextEvidence before this studyMyopia is the most-common refractive error worldwide. Myopia with younger onset may result in developing high myopia, which is associated with sight-threatening ocular diseases such as maculopathy, retinal detachment, opticneuropathy, glaucoma, retinal atrophy, choroidal neovascularization. In light of the increasing prevalence of myopia and high myopia has been a global public health concern, the impact of COVID-19 lockdown on myopia development has gained substantial attention. We searched PubMed, Google Scholar, and MEDLINE databases for original articles reported between database inception and November 10, 2020, using the following search terms: (coronavirus OR COVID* OR SARS-COV-2 OR lockdown OR quarantine) AND (myopia OR short-sightedness OR refractive error). To date, there was no original study reported to uncover the influence of COVID-19 quarantine on myopia progression.Added value of this studyThis study provides the largest longitudinal intervention data on myopia progression in Chinese schoolchildren covering all grades of schoolchildren at one-million scale. COVID-19 quarantine model uncovers that behavioral modifications for six months may lead to significant increase of overall prevalence of myopia associated with their increased screen times and decreased outdoor activity times. Importantly, their effects on developing myopia or high myopia of students are grade-dependent, which were risk factors for elementary schools period but protective factors for high schools period partly due to reduced school education burden.Implications of all the available evidenceThis one-million schoolchildren myopia survey offers evidence that six months behavioral modifications sufficiently and grade-specifically change the progression of myopia and high myopia. In view of the increased use of electronic devices is an unavoidable trend, effective myopia prevention strategy according to grade among students is urgently needed. Since COVID-19 outbreak is still ongoing and spreading, international collaborate efforts are warranted to uncover the influence of COVID-19 on myopia progression to further substantiate these findings.

show abstract

Smartphone use as a possible risk factor for myopia

Cited by 83 publications

References 42 publications

Smartphone Overuse and Visual Impairment in Children and Young Adults: Systematic Review and Meta-Analysis

Smartphone Overuse and Visual Impairment in Children and Young Adults: Systematic Review and Meta-Analysis

Digital Screen Time During the COVID-19 Pandemic: Risk for a Further Myopia Boom?

COVID-19 Quarantine Reveals Grade-specific Behavioral Modification of Myopia: One-Million Chinese Schoolchildren Study

Contact Info

Product

Resources

About