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

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 (I

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]; I

FUNDING

None.

Informations de copyright

Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of interests JF, ATS, and DF are employees of Plano. AP was an employee of Plano at the time of writing. JC is a shareholder in Plano. MD is the co-founder, a shareholder, and the current managing director of Plano. Plano is a health technology start-up that was created as part of the Singapore Eye Research Institute-Singapore National Eye Centre Ophthalmic Technologies Incubator Programme to develop evidence-based technological and educational solutions to address the global burden of myopia. In accordance with policies of the Singapore National Eye Centre, TYW has received grants, contracts, consulting fees, honoraria, and travel support from, and has participated on advisory boards for Allergan, Bayer, Boehringer Ingelheim, Eden Ophthalmic, Genentech, Iveric Bio, Merck, Novartis, Oxurion (ThromboGenics), Roche, Samsung, Shanghai Henlius, and Zhaoke Pharmaceutical. TYW is the co-founder of Plano and EyRiS. The commercial relationships have not influenced the methods used in this study. All evidence has been presented and appraised in a balanced manner, and all data have been collected and analysed rigorously and without bias. DSWT, MGH, and RRAB declare no competing interests.