How common is digital eye strain in online learning?

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

Authors: Demirayak, Bengi (1), Yılmaz Tugan, Büşra (2), Toprak, Muge (3), Çinik, Ruken (4)

1. Department of Ophthalmology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
2. Department of Ophthalmology, Medical School, University of Kocaeli, Kocaeli, Turkey
3. Department of Ophthalmology, Gebze State Hospital, Kocaeli, Turkey
4. Department of Ophthalmology, Golcuk Necati Celik State Hospital, Kocaeli, Turkey

Date: March 2022

Reference: Demirayak B, Yılmaz Tugan B, Toprak M, Çinik R. Digital eye strain and its associated factors in children during the COVID-19 pandemic. Indian J Ophthalmol. 2022 Mar;70(3):988-99.

[Link to open access paper]

Visual problems relating to digital device use - known as Computer Vision Syndrome (CVS) or Digital Eye Strain (DES) - often include symptoms such as eyestrain and eye fatigue, blurred vision, eye redness and dryness and burning sensations.^1-3

Over periods of COVID-19 restrictions, children have been learning online instead of attending school, meaning they have spent more time indoors and using digital devices for longer periods.  Alongside restricted time to spend outdoors, there has been a concern that this has led to an increase in myopic prevalence.^4-6

This study investigated the prevalence of ocular symptoms arising from digital display device use in children over COVID-19 distance learning periods, through use of an online survey. The questionnaire investigated device usage, DES symptoms and background of eye health.

There were 692 complete responses to the survey.  The mean age of the children was nearly 10yrs old, 62.57% were of primary school age and all were completing schoolwork online.

The devices most used were personal computers (for schoolwork) and smartphones (recreational use).  An average time for using devices without a break was at least 30mins for 80% of children and 62% used a device for more than 4 hours per day.

Nearly half of the participants reported experiencing at least 3 ocular symptoms while using devices, the most common being headache (52%), eye fatigue (49%) and eye redness (49%).  The least commonly reported symptom was double vision (9% of participants).

The multivariate statistical analysis found that independent risk factors for experiencing 3 or more ocular symptoms were being male and being older.

Boys used devices for over 80mins without a break and for an average of 7hrs per day compared to girls who had a mean screen time of 64mins with no break and for 7hrs daily.  Boys were also more likely to report 3 or more ocular symptoms.

An increase of 1D or more of myopia was found for 36.8% of the participants.

Digital devices are commonplace for children to use, even if they don’t use them for study purposes.  This study found that smartphones, tablets, and personal computers were significantly associated with uncomfortable ocular symptoms:

• Headaches were the most reported problem when using devices and were a significant risk factor after 3hrs of use, although 35mins screen-time with no break was also a risk factor for headaches
• Eye pain, a foreign body feeling, and eye watering were associated with 4hrs of use
• More than 5hrs of use was associated with eye fatigue and redness 
• Smartphone screens (usually held closer) were significantly correlated with eye pain and foreign body sensation from bright screens
• Using devices in artificial light was also related to eye pain, eye fatigue, redness, and watering.  Using them in dark environments or after 8pm was associated with headaches, eye fatigue and redness.

Digital device use by children for online learning has increased during COVID-19 restriction periods and ocular discomfort symptoms are more common as usage increases.

Even after restrictions are lifted and classroom learning returns, practitioners and parents should be aware of the time children spend on devices and what the potential ocular symptoms can be.

The symptoms the children experienced were reported in this study via an online questionnaire.  This could give the following inaccuracies:

• Their symptoms were not confirmed by the researchers.
• The parents reported the symptoms on the children’s behalf and may have under- or over-reported the severity of the symptoms

More research into using digital devices would confirm a correlation between increased myopia and prolonged screen time.

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

Authors: Demirayak, Bengi; Yılmaz Tugan, Büşra; Toprak, Muge; Çinik, Ruken

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.

Conclusions: 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.

[Link to open access paper]