Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 29, 2020
Date Accepted: Oct 29, 2020
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Smartphone overuse and visual impairment in children and young adults: a systematic review and meta-analysis
ABSTRACT
Background:
Smartphone overuse has been cited as a potential modifiable risk factor that can result in visual impairment. However, associations between smartphone overuse and visual impairment have not been consistently reported.
Objective:
The aim of this systematic review is 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 since the beginning of the databases to June 2020. Fourteen eligible studies (ten cross-sectional studies and four controlled trials) were identified, which included a total of 27110 subjects with mean ages ranging from 9.5 to 26.0 years. We used a random-effects model in the ten cross-sectional studies (n = 26962) and a fixed-effects model in the four controlled trials (n = 148) to synthesize odds ratios (OR) and effect sizes (ES). The I2 statistics was used to assess heterogeneity.
Results:
A pooled OR of 1.05 (95% CI: 0.98, 1.13; p = 0.159) from cross-sectional studies suggests that smartphone overuse is not statistically significantly associated with visual impairment, however the adverse effect is more apparent in children (OR = 1.06, 95% CI: 0.99, 1.14; p = 0.087) compared to that in young adults (OR = 0.91, 95% CI: 0.57, 1.46; p = 0.707). In all the controlled trials, the smartphone overuse groups showed worse visual function scores compared with the less use groups. The pooled ES is 0.76 (95% CI: 0.53, 0.99) and statistically significant (p < 0.001).
Conclusions:
Our results indicate that longer smartphone use may increase the likelihood of multiple ocular symptoms, 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 inform detailed guidelines and recommendations for smartphone use in children and young adults.