Screen Exposure during Early Life and the Increased Risk of Astigmatism among Preschool Children: Findings from Longhua Child Cohort Study

Association of excessive screen time exposure with ocular changes leading to astigmatism in children

PURPOSE

The purpose of this study was to find the relationship between excessive screen time exposure and the development of astigmatism in children.

METHODS

A cross-sectional correlational study was conducted at tertiary care hospital, Islamabad between June 2023 to May 2024. In total, 431 patients were included in this study after informed written consent. Screen time exposure was assessed through smartphone usage history or parental reports of daily use of smart gadget(s). Tear break-up time was measured using a fluorescein strip, cobalt blue filter on a slit-lamp biomicroscope and a stopwatch. Data was analyzed using univariate and multivariate statistical tests including Spearman's correlation and regression analyses.

RESULTS

The study included 431 children (mean age: 6.70 ±  1.80 years; 55% male, 45% female). Mean screen time was 4.54 ±  1.52 hours/day. A positive correlation between screen time and the magnitude of astigmatism was observed (r = 0.33, p < 0.001). Regression analysis showed a significant relationship among screen time and astigmatism (B = 0.177, CI: 0.80-0.25). Tear break- up time (TBUT) showed a significant negative correlation with screen time (r = -0.167, p < 0.001), and reduced TBUT was linked to a higher risk of inflammatory conjunctivitis and lid thickening (B = -0.431, CI: -0.12 to -0.49, p < 0.001). The results highlighted that inflammatory conjunctivitis/lid thickness have three times greater risk of developing high astigmatism (OR =  3.31, p-value <  0.001, CI =  1.91 to 5.73) while the risk of moderate astigmatism in such cases was two times higher (2.12, p-value =  0.004, CI = 1.26-3.56). However, the effect of lid thickness on astigmatism when combining with screen time has a little effect that is not significant (p-value = 0.053). Thus, excessive screen time is an independent risk factor of causing astigmatism in children (p < 0.001). The Wilcoxon Signed Ranks Test demonstrated significant improvement in visual acuity after correction (p < 0.001).

CONCLUSION

Excessive screen time in children is significantly associated with astigmatism, tear film instability, inflammatory ocular conditions, including conjunctivitis and lid thickening. These findings suggest the need for preventive strategies, such as reducing screen time and encouraging regular eye examinations, to protect children's ocular health.

Problematic Digital Technology Use Measures in Children Aged 0 to 6 Years: Scoping Review

BACKGROUND

In the interest of accurately assessing the effects of digital technology use in early childhood, researchers and experts have emphasized the need to conceptualize and measure children's digital technology use beyond screen time. Researchers have argued that many patterns of early digital technology use could be problematic, resulting in the emerging need to list and examine their measures.

OBJECTIVE

We aimed to review existing empirical literature that is using measures for problematic digital technology use in preschool children with the end goal of identifying a set of reliable and valid measures, predicting negative outcomes for children's health, development, or well-being.

METHODS

We conducted a scoping review across the Web of Science, PubMed, and Google Scholar databases to identify peer-reviewed publications that were published from January 2012 to December 2023, were written in the English language, described an empirical study, and included a measure of problematic digital technology use beyond exposure (ie, screen time) in children aged 0 to 6 years.

RESULTS

The search yielded 95 empirical studies, in which 18 composite measures of problematic use and 23 measures of specific problematic use aspects were found. Existing composite measures conceptualize problematic use as either a group of risky behaviors or as a group of symptoms of a presumed underlying disorder, with the latter being more common. Looking at their conceptual background and psychometric properties, existing composite measures fall short of reliably assessing all the crucial aspects of problematic digital technology use in early childhood. Therefore, the benefits and shortcomings of single-aspect problematic digital technology use measures are evaluated and discussed.

CONCLUSIONS

On the basis of current research, early exposure to digital technologies, device use before sleep, and solitary device use represent measures that have been consistently associated with negative outcomes for children. In addition, potential measures of problematic use include device use during meals, device use for emotional regulation, device multitasking, and technoference, warranting further research. Public health benefits of defining problematic digital technology use as a group of risky behaviors rather than a group of addiction symptoms are discussed.

Prevalence of astigmatism among 99,515 children in different areas of Xi'an City, China

PURPOSE

To investigate the prevalence of astigmatism among children in different areas of Xi'an.

METHODS

A cross-sectional study was conducted in Xi'an, China, involving children from 139 primary schools, 28 junior high schools, and 10 senior high schools. Data on uncorrected visual acuity (UCVA) and non-cycloplegic spherical equivalent (SE) were collected from March 2023 to June 2023 based on a new screening model by the Department of Ophthalmology of Xi'an Central Hospital. Data from the right eye were included in the statistical analysis. Trend changes in astigmatism prevalence across different areas, educational stages, ages, and genders were analyzed using the X² test and trend test.

RESULTS

A total of 99,515 children were included in the analysis. The overall prevalence of astigmatism was 59.3% [95% CI: 59.0% to 59.6%]. The prevalence of astigmatism was higher in urban areas compared to the urban-rural fringe (61.1% [95% CI: 60.6% to 61.6%] vs. 58.3% [95% CI: 57.9% to 58.7%]) (X²trend = 73.174, P < 0.05). Boys had a higher prevalence of astigmatism than girls (59.8% [95% CI: 59.4% to 60.2%] vs. 58.8% [95% CI: 58.6% to 59.0%]) (X²trend = 11.613, P < 0.05). Compared to the primary and senior school, the overall prevalence of astigmatism is most significant during the junior school stage (X²trend = 1710.133, P < 0.05), with rates of 54.6% in primary school, 71.3% in junior high school, and 68.7% in senior high school (X²trend = 10.694-868.913, P < 0.05), among which grade 9 has the highest prevalence (X²trend = 2766.194, P < 0.05). Myopia severity increased with the degree of astigmatism (X²trend = 2547.677, P < 0.05), and boys were more likely to experience worsening myopia with increasing astigmatism compared to girls (X²trend = 36.878, P < 0.05).

CONCLUSIONS

Astigmatism was most prevalent among children in Xi'an during junior school, peaking in grade 9. Urban areas showed higher incidence rates than urban-rural ones, and boys had a consistently higher prevalence than girls, with WTR being the most common type.

The Impact of Excessive Digital Screen use on Refractive Error Progression Over 1 Year Among Schoolchildren in Northwest Algeria

Objectives

The shift from outdoor play to prolonged use of electronic devices among children, exacerbated by the COVID-19 pandemic, has raised concerns about its impact on visual health. This study explores the relationship between the excessive use of digital devices and the development of various refractive errors in children. This study aims to investigate the association between excessive screen time (including smartphones, tablets, computers, and televisions) with different types of refractive errors and axial length (AL) elongation in a cohort of school-aged children in North-West Algeria. It is a cross-sectional analysis focused on a representative sample from this region.

Methods

Over a 1-year period, 208 schoolchildren (416 eyes), aged 6-18 years (mean age: 6.21±3 years), underwent comprehensive eye examinations at the ophthalmic service of the pediatric hospital EHS Canastel, Oran. Cycloplegic measurements assessed the refractive errors, while A-scan ultrasonography measured the ocular biometry. The study also evaluated children's technology usage patterns, including daily screen time, types of devices used, and time spent outdoors.

Results

The study revealed a significant decrease in mean spherical equivalence (SE) in both eyes over the 1-year period. In the right eye (RE), SE dropped from -0.96 D to -1.48 D, and in the left eye (LE) from -0.70 D to -1.39 D. Myopic astigmatism was the most prevalent condition, affecting 51% of children, especially younger screen users (p<0.001). Axial length (AL) increased in both eyes, with an average elongation of 0.54 mm in the RE and 0.57 mm in the LE. There was a strong correlation between excessive screen use and the progression of myopic astigmatism, along with changes in spherical equivalence. Factors such as device type, screen time, and reduced outdoor activity were significantly associated with the progression of refractive errors and AL elongation (p<0.005).

Conclusion

Prolonged use of digital screens is significantly correlated with increased risks of myopic astigmatism, AL elongation, and changes in spherical equivalent values. These findings emphasize the urgent need for further research and public health measures to address the impact of prolonged digital device use on children's vision.

Meridional Amblyopia and Spectacle Correction: A Prospective Interventional Study of Children Aged 4-11 Years

Background Amblyopia, often linked to high astigmatism in children, presents challenges in understanding the contributing factors and visual outcomes. Methods A total of 132 samples were included in this prospective pre- and post-interventional study using the purposive sampling technique. Descriptive statistics were applied for age, gender, uncorrected visual acuity, corrected visual acuity, type, and magnitude of astigmatism. A repeated measure ANOVA was used, and a paired t-test was also done for groups with corrected visual acuity in meridional amblyopia at two follow-ups spaced six months apart. Logistic regression was used to identify the association between astigmatism types and patients' recovery from amblyopia after intervention. Results The age of participants was 4-11 years with meridional amblyopia. Initial findings showed a mean uncorrected visual acuity of 0.73 LogMAR in the right eye (RE) and 0.71 LogMAR in the left eye (LE), improving significantly to 0.35 LogMAR post-intervention in both eyes. The calculated mean difference between the first correction and the first follow-up was 0.12 and 0.13 LogMAR, while it was 0.20 and 0.21 LogMAR in the RE and LE, respectively, at the second follow-up. Spherical refractive errors averaged +0.93 DS, with mean cylindrical refraction indicating predominant with-the-rule corneal astigmatism (-3.46 DS). We observed a significant improvement in visual acuity (p-value < 0.001) and an increase in the magnitude of cylindrical prescription (p-value < 0.001). However, astigmatism types are not associated with response to therapy. Conclusion The study concluded that early detection of meridional amblyopia and early intervention with spectacles significantly improve visual acuity.

Prevalence and risk factors for astigmatism in 7 to 19-year-old students in Xinjiang, China: a cross-sectional study

BACKGROUND

To investigate the prevalence and risk factors for astigmatism in 7-19-year-old students in Xinjiang, China.

METHODS

A school-based, cross-sectional study was conducted on students who underwent refraction examination in Xinjiang, China, between May and December 2019. The prevalence of astigmatism was determined. Astigmatism was defined as cylinder power (C) ≤-0.75 D, undefined astigmatism as ≤-1.50 D, and high astigmatism as C ≤-3.00 D. Astigmatism types were: against-the-rule astigmatism (maximum refraction of the main meridian in 180° ± 30°), with-the-rule astigmatism (maximum refraction of the main meridian at 90°±30°), and oblique astigmatism (all other cases).

RESULTS

Of the 71,838 students examined (51.0% boys, 7 - 19 years old), 25,945 (36.1%, 95%CI: 35.52-36.68%) had astigmatism and 1267 (1.8%, 95%CI: 1.07-2.53%) had high astigmatism. The prevalence of astigmatism was greater in Han individuals (39.6%) compared with the Hui (34.0%), Kazakh (34.0%), Kyrgyz (32.1%), and Uyghur (26.4%) populations. Among the 25,945 students with astigmatism, 19,947 had with-the-rule astigmatism (76.9%), 3405 had against-the-rule astigmatism (13.1%), and 2593 had oblique astigmatism (10.0%). Multivariable logistic regression analysis showed that ethnicity (Han individuals more susceptible), male gender, age, and refractive errors (myopia and hyperopia) were independently associated with astigmatism, high astigmatism, and with-the-rule astigmatism (all P < 0.05).

CONCLUSIONS

The prevalence of astigmatism among children and adolescents in Xinjiang was 36.1%, including 1.8% of high astigmatism. In this population, astigmatism was mainly of the with-the-rule astigmatism type (76.9%). Han ethnicity, male gender, and myopia or hyperopia were independently associated with a high risk of astigmatism.

The relationships between screen exposure, parent-child interactions and comprehension in 8-month-old infants: The mediating role of shared viewing and parent-child conversation

OBJECTIVE

To explore the relationships between screen exposure, parent-child interactions and comprehension in 8-month-old infants, and to examine whether shared viewing and parent-child conversation during screen exposure may play mediating role in that relationships.

METHODS

The sample included 437 infants aged 8 months from the Children's Health Department of Guiyang Maternal and Child Health Hospital during January 2022 to February 2023. The use of electronic screen devices was assessed using a screen exposure questionnaire. The Brigance Parent-child interactions Scale was used to assess parent-child interactions and the Putonghua Communicative Development Inventory (PCDI) scale was used to assess infants' word comprehension.

RESULTS

48.7% of infants were found to be using screens 1-2 days per week. There was a significant difference (p < 0.05) in the PCDI-comprehension scores of screen-exposed infants compared to non-screen-exposed infants. Shared viewing and parent-child conversation during screen exposure were positively associated with parent-child interactions (p < 0.05). Mediation analysis revealed that parent-child conversation fully mediated between screen exposure and PCDI-comprehension, but partially mediated between parent-child interactions and PCDI-comprehension.

CONCLUSIONS

Shared viewing and parent-child conversation during screen exposure may mediate between screen exposure and comprehension development. Shared viewing, parent-child conversation and parent-child interactions may be protective factors for screen exposure in comprehension development. Suggests that parents should accompany and communicate with their children when they use electronic screen devices to reduce the negative impact of screen exposure on children's comprehension.

Refractive Error Changes Due to COVID-19 Pandemic Confinement in Children from Puerto Rico: A Retrospective Study

SIGNIFICANCE

The progression of myopia increased in children after the pandemic confinement. A myopic shift in the refractive error of the Hispanic population was found regardless of the refractive status of the school-aged children studied.

PURPOSE

This study aimed to evaluate the refractive error in Puerto Rican children before and after the COVID-19 pandemic. We were interested in whether there was a significant change in refractive error attributed to online learning during the pandemic lockdown.

METHODS

A retrospective record review of children aged 7 to 18 years who underwent a comprehensive visual evaluation between 2018 and 2021 at the Inter American Eye Institute in Puerto Rico was performed. The spherical equivalent pre- and post-lockdown was compared. The study excluded the best-corrected visual acuities worse than 20/40, any corneal or retinal disease, and amblyopia.

RESULTS

In total, 801 records were included in this study. The mean age was 12.7 ± 3.2 years, with 50.3% male and 49.7% female children. The mean spherical equivalent for the right and left eyes was similar ( r = 0.93, P ≤ .001). A significant difference in the mean spherical equivalent was found pre- and post- lockdown (0.22 ± 0.59 D, t800 = 10.44, P ≤ .001). A myopic shift post-lockdown was significant for all ages except those in the 7- (0.13 ± 0.79 D, t28 = 0.84, P = .40) and 8-year-old range (0.12 ± 0.65 D, t40 = 1.22, P = .23), respectively. No significant change was found between sexes before (0.16 ± 0.12 D; t799 = 1.38, P = .16) and after (0.15 ± 0.13 D; t799 = 1.19, P = .23) confinement.

CONCLUSIONS

The current study revealed a significant myopic shift in Hispanic school-aged children as a result of the pandemic confinement.

Prevalence, determinants and consequences of problematic smartphone use among preschoolers (3-5 years) from Dhaka, Bangladesh: A cross-sectional investigation

The problematic smartphone use (PSU) has been becoming a challenging health issue for preschoolers aged 3-5 years as it has severe adverse effect on their psychological, physical, and cognitive development. The scarcity of scientific research on this issue in the context of Bangladesh motivated the authors for conducting this cross-sectional study to explore the prevalence of PSU with its influential factors and adverse effects on preschooler's psychological and physical development based on primary data collected from 400 mothers. The multivariable ordinal logistic regression (OLR) was used to compute the adjusted likelihoods. The estimated prevalence of PSU was approximately 86 %, where about 29 % were severely problematic user. The likelihood of preschoolers' PSU was observed to increase with >1 h/day usage of smartphone by children (Adjusted Odds Ratio (AOR): 3.92). Other important factors were parental smartphone use, education, profession, family income, and mother's age. Both of moderate and severe PSU had adverse effect on preschoolers' health- severe PSU was found to increase the likelihood of psychological and physical problems by 6.03 and 3.29 times, respectively. The preschoolers with PSU reported to suffer from many physical and mental health problems such as attention deficit and hyperactivity disorder (ADHD), emotional instability, aggressiveness, depression, lack of control, impaired vision and hearing, obesity, body imbalance, and lack of brain development. It is now prime time to undertake strategic policies considering the findings for limiting the preschoolers' usage of smartphone, which will make Bangladesh susceptible to protect its future generation from harmful effects of PSU.

Prevalence of and factors associated with astigmatism in preschool children in Wuxi City, China

PURPOSE

To investigate the status of astigmatism in preschool children in Wuxi City, and explore the risk factors related to astigmatism. The risk factors related to astigmatism development as predictors can help us identify preschool children who need vision screening at an early stage to ensure good visual quality.

METHODS

The cross-sectional study was conducted in 10 kindergartens randomly selected in five districts of Wuxi City in November 2018. All preschool children were measured by objective refractometry under non-cycloplegic refraction. The basic information of preschool children was collected. The relevant factors of astigmatism in the questionnaire were completed by parents. Spss 26. 0 software was used for univariate and multivariate correlation analysis.

RESULTS

A total of 889 preschool children participated in the study, 864 were finally included in the study. The prevalence of astigmatism was 36.0%. The risk of astigmatism in premature children was higher than that in non-premature children (adjusted odds ratio = 1.841). The prevalence of astigmatism with parents' astigmatism history was higher, compared with preschool children without parents' astigmatism history (adjusted odds ratio = 2.037). When maternal age at childbirth was older (≥ 35 years old), the risk of astigmatism increased in preschool children (adjusted odds ratio = 2.181). Compared with bottle feeding, the risk of astigmatism for mixed feeding and breastfeeding reduced in preschool children. Compared with preschool children exposed to electronic screen for less than 2 h every day, preschool children exposed to electronic screen for more than 2 h had an increased risk of astigmatism (P = 0.004).

CONCLUSION

The prevalence of astigmatism among preschool children in Wuxi City was high. Some risk factors such as premature birth, parents' astigmatism history, maternal age at childbirth, feeding pattern, and electronic screen exposure time were closely related to the occurrence of astigmatism among preschool children. For preschool children with significant risk factors, their eyesight should be checked regularly to ensure their visual quality.

Refractive errors and risk factors for myopia in infants aged 1-18 months in Tianjin, China

BACKGROUND

Infancy is the of a child's visual development. Refractive errors, especially myopia, are a common vision disorder. Thus, the purpose of this study was to explore refractive errors and risk factors for myopia among infants aged 1-18 months in Tianjin, China.

METHODS

A total of 583 infants aged 1-18 months participated in this cross-sectional study at Tianjin Women's and Children's Health Center in China from February 2019 to November 2020. Each infant received a complete ophthalmologic examination, and myopia-related risk factors were investigated using a questionnaire.

RESULTS

A total of 583 eligible infants participated in this study, including 312 (53.5%) boys and 271 (46.5%) girls. There were 164 (28.1%) premature born infants. The mean age was 6.59 ± 4.84 months (range, 1-18 months). The mean spherical equivalent (MSE) for the right eye was 1.81 D ± 1.56 D, with no difference related to sex (P = 0.104). Refractive state showed an average hyperopia of +2.74 ± 1.74 D at early ages, followed by a trend toward less hyperopia, finally reaching +1.35 ± 1.44 D at the age of 18 months (P ≤0.001). The overall prevalence rates of myopia (MSE ≤ -0.50 D), emmetropia (-0.50 D<MSE<+0.50 D), hyperopia (MSE ≥ +2.00 D), and astigmatism (≥ 1.50 D) were 5.1%, 10.8%, 42.7%, and 49.9%, respectively. The chi-square tests showed that gender, gestational age ≥37 weeks, winter birth, prenatal exposure to environmental tobacco smoke, and parental history of high myopia were associated with children's myopia (P = 0.022, P = 0.023, P = 0.038, P = 0.015, P<0.001, respectively).

CONCLUSIONS

Among Chinese infants in Tianjin, hyperopia and astigmatism were the most frequent refractive errors, and the diopter was lower in individuals with higher age. In a small number of infants with myopia, genetic factors and the prenatal environment were associated with the early onset of myopia.

Measurement of screen time among young children aged 0-6 years: A systematic review

The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.

Combination Effect of Outdoor Activity and Screen Exposure on Risk of Preschool Myopia: Findings From Longhua Child Cohort Study

Evidence regarding screen use and outdoor activity during very early childhood (i. e., from aged 1 to 3 years) and their potential combined links to the later preschool myopia is limited. This information is needed to release effective public health messages and propose intervention strategies against preschool myopia. We collected information regarding very early childhood screen use, outdoor activity and the kindergartens vision screenings of 26,611 preschoolers from Longhua Child Cohort Study by questionnaires. Logistic regression models were used to examine the associations between reported outdoor activity, screen use from 1 to 3 years of age, and preschool myopia. Throughout very early childhood, from 1 to 3 years, the proportion of children exposed to screens increased (from 35.8 to 68.4%, p < 0.001), whereas the proportion of children who went outdoors ≥7 times/week (67.4–62.1%, p < 0.001) and who went outdoors for ≥60 min/time (53.3–38.0%, p < 0.001) declined. Exposure to fixed screen devices [adjusted odds ratio (AOR) = 2.66, 95% confidence interval (CI) = 2.09–3.44], mobile screen devices (AOR = 2.76, 95% CI = 2.15–3.58), and limited outdoor activity (AOR = 1.87, 95% CI = 1.42–2.51) during early childhood were associated with preschool myopia. Among children whose parents were myopic, the interactions between outdoor activity and fixed or mobile screen use on later preschool myopia were significant; the ORs and 95% CI were 3.34 (1.19–9.98) and 3.04 (1.06–9.21), respectively. Our findings suggest the possibility that the impact of screen exposure during early childhood on preschool myopia could be diminished by outdoor activity for children whose parents have myopia.

Early Electronic Screen Exposure and Autistic-Like Behaviors among Preschoolers: The Mediating Role of Caregiver-Child Interaction, Sleep Duration and Outdoor Activities

Research into early screen exposure has raised growing concerns about its impact upon children’s neuropsychological well-being. However, possible pathways remain unclear. This study therefore aimed not only to evaluate the association between screen exposure during the ages of 0–3 years and preschoolers’ autistic-like behaviors, but also the mediating roles of the frequency of caregiver-child interaction, sleep duration and level of participation in outdoor activities. Based on the 2017 survey of the Longhua Child Cohort Study, data of 29,595 child-caregiver dyads were obtained via a caregiver-reported questionnaire, with the data from 29,461 dyads included in the data analysis. Multiple linear and logistic regression models were employed to estimate the associations between screen exposure, caregiver-child interaction, sleep duration, outdoor activities, and children’s autistic-like behaviors. The results indicated that screen exposure during 0–3 years of age was associated with the presence of autistic-like behaviors at preschool age, and the strength of the association was enhanced with the increase of average daily screen time (Odds Ratios (ORs) ranging from 1.358 to 4.026). The frequency of caregiver-child interaction and sleep duration mediated 5.32% and 1.19% of the variance of the association respectively, but outdoor activities did not mediate the association. Our findings indicate that preschoolers who are exposed to screens at aged 0–3 years might have an increased risk of autistic-like behaviors, and that, the frequency of caregiver-child interaction and sleep duration might function as potential mediators of this association.