Association between digital smart device use and myopia: a systematic review and meta-analysis

Summary: 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 searc...

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Autores principales:	Joshua Foreman, PhD, Arief Tjitra Salim, BEng, Anitha Praveen, PhD, Dwight Fonseka, MEdu, Daniel Shu Wei Ting, MD, Ming Guang He, ProfMD, Rupert R A Bourne, ProfMD, Jonathan Crowston, ProfMD, Tien Y Wong, ProfMD, Mohamed Dirani, PhD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Computer applications to medicine. Medical informatics R858-859.7
Acceso en línea:	https://doaj.org/article/e91aae80d5ab48aab59c496d527b3d10
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id	oai:doaj.org-article:e91aae80d5ab48aab59c496d527b3d10
record_format	dspace
institution	DOAJ
collection	DOAJ
language	EN
topic	Computer applications to medicine. Medical informatics R858-859.7
spellingShingle	Computer applications to medicine. Medical informatics R858-859.7 Joshua Foreman, PhD Arief Tjitra Salim, BEng Anitha Praveen, PhD Dwight Fonseka, MEdu Daniel Shu Wei Ting, MD Ming Guang He, ProfMD Rupert R A Bourne, ProfMD Jonathan Crowston, ProfMD Tien Y Wong, ProfMD Mohamed Dirani, PhD Association between digital smart device use and myopia: a systematic review and meta-analysis
description	Summary: 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-analysis resulted from variability in sample size (range 155–19 934 participants), the mean age of participants (3–16 years), the standard error of the estimated odds of prevalent or incident myopia (0·02–2·21), and the use of continuous (six [55%] of 11) versus categorical (five [46%]) screen time variables Interpretation: Smart device exposure might be associated with an increased risk of myopia. Research with objective measures of screen time and myopia-related outcomes that investigates smart device exposure as an independent risk factor is required. Funding: None.
format	article
author	Joshua Foreman, PhD Arief Tjitra Salim, BEng Anitha Praveen, PhD Dwight Fonseka, MEdu Daniel Shu Wei Ting, MD Ming Guang He, ProfMD Rupert R A Bourne, ProfMD Jonathan Crowston, ProfMD Tien Y Wong, ProfMD Mohamed Dirani, PhD
author_facet	Joshua Foreman, PhD Arief Tjitra Salim, BEng Anitha Praveen, PhD Dwight Fonseka, MEdu Daniel Shu Wei Ting, MD Ming Guang He, ProfMD Rupert R A Bourne, ProfMD Jonathan Crowston, ProfMD Tien Y Wong, ProfMD Mohamed Dirani, PhD
author_sort	Joshua Foreman, PhD
title	Association between digital smart device use and myopia: a systematic review and meta-analysis
title_short	Association between digital smart device use and myopia: a systematic review and meta-analysis
title_full	Association between digital smart device use and myopia: a systematic review and meta-analysis
title_fullStr	Association between digital smart device use and myopia: a systematic review and meta-analysis
title_full_unstemmed	Association between digital smart device use and myopia: a systematic review and meta-analysis
title_sort	association between digital smart device use and myopia: a systematic review and meta-analysis
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/e91aae80d5ab48aab59c496d527b3d10
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spelling	oai:doaj.org-article:e91aae80d5ab48aab59c496d527b3d102021-11-24T04:33:20ZAssociation between digital smart device use and myopia: a systematic review and meta-analysis2589-750010.1016/S2589-7500(21)00135-7https://doaj.org/article/e91aae80d5ab48aab59c496d527b3d102021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2589750021001357https://doaj.org/toc/2589-7500Summary: 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-analysis resulted from variability in sample size (range 155–19 934 participants), the mean age of participants (3–16 years), the standard error of the estimated odds of prevalent or incident myopia (0·02–2·21), and the use of continuous (six [55%] of 11) versus categorical (five [46%]) screen time variables Interpretation: Smart device exposure might be associated with an increased risk of myopia. Research with objective measures of screen time and myopia-related outcomes that investigates smart device exposure as an independent risk factor is required. Funding: None.Joshua Foreman, PhDArief Tjitra Salim, BEngAnitha Praveen, PhDDwight Fonseka, MEduDaniel Shu Wei Ting, MDMing Guang He, ProfMDRupert R A Bourne, ProfMDJonathan Crowston, ProfMDTien Y Wong, ProfMDMohamed Dirani, PhDElsevierarticleComputer applications to medicine. Medical informaticsR858-859.7ENThe Lancet: Digital Health, Vol 3, Iss 12, Pp e806-e818 (2021)

Association between digital smart device use and myopia: a systematic review and meta-analysis

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