Screen Time and Visual Outcomes in School-Aged Children: A Cross-Sectional Analysis of Visual Acuity and Refractive Errors
Screen Time Patterns and Pediatric Visual Health
DOI:
https://doi.org/10.5281/zenodo.21261402Keywords:
Screen Time, Myopia, Visual Acuity, Asthenopia, Refractive ErrorsAbstract
Objective: To examine associations between temporal screen time patterns, outdoor activity duration, and visual health outcomes in school-aged children.
Methods: Cross-sectional study of 160 children aged 6–12 years attending ophthalmological assessments. Screen time data were collected via validated questionnaires assessing weekday and weekend usage patterns. Visual assessments included cycloplegic refraction and Snellen visual acuity testing. The examining ophthalmologist remained masked to screen time data during clinical assessments. Statistical analyses employed t-tests, chi-square tests, and Pearson correlation analyses with Bonferroni correction.
Results: Among 160 children (mean age 9.31±1.16 years), mean screen time was 3.95±0.76 hours daily with 22.5% myopia prevalence. Myopic children showed significantly higher weekday screen time (3.81±1.02 vs. 3.45±0.89 hours, p=0.039, Cohen’s d=0.37) but no difference in overall daily screen time (p=0.374). Screen time showed no correlation with visual acuity (r=−0.08, p=0.334). Outdoor activity >2 hours daily was associated with the absence of eye strain symptoms (0% vs. 60.0% in <30 minutes group, χ²=21.43, p<0.001, Cramér’s V=0.34).
Conclusions: Weekday screen time, rather than overall duration, was associated with myopia status. Outdoor activity >2 hours daily was associated with the absence of eye strain symptoms. Cross-sectional design and pronounced female predominance in the myopic group (80.6% vs. 37.9%, OR=6.89) limit causal inference. Longitudinal studies with objective monitoring are needed
References
Rideout V, Foehr UG, Roberts DF. Generation M2: Media in the Lives of 8- to 18-Year-Olds. Henry J Kaiser Family Foundation; 2010.
Anderson DR, Subrahmanyam K. Digital screen media and cognitive development. Pediatrics. 2017;140(Suppl 2):S57-S61.
Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036-1042.
Enthoven CA, Tideman JWL, Polling JR, Yang-Huang J, Raat H, Klaver CCW. The impact of computer use on myopia development in childhood: the Generation R study. Prev Med. 2020;132:105988. doi:10.1016/j.ypmed.2020.105988
Saw SM, Chua WH, Hong CY, et al. Nearwork in early-onset myopia. Invest Ophthalmol Vis Sci. 2002;43(2):332-339.
Gwiazda J, Thorn F, Bauer J, Held R. Myopic children show insufficient accommodative response to blur. Invest Ophthalmol Vis Sci. 1993;34(3):690-694.
Ha A, Lee YJ, Lee M, Shim SR, Kim YK. Digital screen time and myopia: a systematic review and dose-response meta-analysis. JAMA Netw Open. 2025;8(2):e2460026. doi:10.1001/jamanetworkopen.2024.60026
Huang HM, Chang DS, Wu PC. The association between near work activities and myopia in children—a systematic review and meta-analysis. PLoS One. 2015;10(10):e0140419.
Yang GY, Huang LH, Schmid KL, et al. Associations between screen exposure in early life and myopia amongst Chinese preschoolers. Int J Environ Res Public Health. 2020;17(3):1056.
McCrann S, Flitcroft I, Strang NC, et al. Smartphone use as a possible risk factor for myopia. Clin Exp Optom. 2021;104(1):35-41.
Ip JM, Saw SM, Rose KA, et al. Role of near work in myopia: findings in a sample of Australian school children. Invest Ophthalmol Vis Sci. 2008;49(7):2903-2910.
Rose KA, Morgan IG, Ip J, et al. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology. 2008;115(8):1279-1285.
Ashby R, Ohlendorf A, Schaeffel F. The effect of ambient illuminance on the development of deprivation myopia in chicks. Invest Ophthalmol Vis Sci. 2009;50(11):5348-5354.
Touitou Y, Reinberg A, Touitou D. Association between light at night, melatonin secretion, sleep deprivation, and the internal clock: health impacts and mechanisms of circadian disruption. Life Sci. 2017;173:94-106.
Foreman J, Salim AT, Praveen A, et al. Association between digital smart device use and myopia: a systematic review and meta-analysis. Lancet Digit Health. 2021;3(12):e806-e818. doi:10.1016/S2589-7500(21)00135-7
Lanca C, Saw SM. The association between digital screen time and myopia: a systematic review. Ophthalmic Physiol Opt. 2020;40(2):216-229.
Zadnik K, Sinnott LT, Cotter SA, et al. Prediction of juvenile-onset myopia. JAMA Ophthalmol. 2015;133(6):683–689. doi:10.1001/jamaophthalmol.2015.0471.
Wu PC, Tsai CL, Wu HL, Yang YH, Kuo HK. Outdoor activity during class recess reduces myopia onset and progression in school children. Ophthalmology. 2013;120(5):1080-1085.
Mei Z, Zhang Y, Jiang W, Lam C, Luo S, Cai C, Luo S. Efficacy of outdoor interventions for myopia in children and adolescents: a systematic review and meta-analysis of randomized controlled trials. Front Public Health. 2024;12:1452567. doi:10.3389/fpubh.2024.1452567
Portello JK, Rosenfield M, Bababekova Y, Estrada JM, Leon A. Computer-related visual symptoms in office workers. Ophthalmic Physiol Opt. 2012;32(5):375-382.
Mohan A, Sen P, Shah C, Jain E, Jain S. Prevalence and risk factor assessment of digital eye strain among children using online e-learning during the COVID-19 pandemic: digital eye strain among kids (DESK study-1). Indian J Ophthalmol. 2021;69(1):140-144. doi:10.4103/ijo.IJO_2535_20
Ho M, Morjaria P. Cycloplegic refraction in children. Community Eye Health. 2024;37(122):14–15.
Flitcroft DI, He M, Jonas JB, et al. IMI—defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies. Invest Ophthalmol Vis Sci. 2019;60(3):M20-M30.
Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49(12):1373-1379.
Mutti DO, Mitchell GL, Moeschberger ML, Jones LA, Zadnik K. Parental myopia, near work, school achievement, and children’s refractive error. Invest Ophthalmol Vis Sci. 2002;43(12):3633-3640.
Logan NS, Shah P, Rudnicka AR, Gilmartin B, Owen CG. Childhood ethnic differences in ametropia and ocular biometry: the Aston Eye Study. Ophthalmic Physiol Opt. 2011;31(5):550-558.
Ashby RS, Schaeffel F. The effect of bright light on lens compensation in chicks. Invest Ophthalmol Vis Sci. 2010;51(10):5247-5253.
McCarthy CS, Megaw P, Devadas M, Morgan IG. Dopaminergic agents affect the ability of brief periods of normal vision to prevent form-deprivation myopia. Exp Eye Res. 2007;84(1):100-107.
Nickla DL, Totonelly K. Brief light exposure at night disrupts the circadian rhythms in eye growth of chicks. Exp Eye Res. 2016;146:189-195.
He M, Xiang F, Zeng Y, et al. Effect of time spent outdoors at school on the development of myopia among children in China: a randomized clinical trial. JAMA. 2015;314(11):1142-1148.
Jin JX, Hua WJ, Jiang X, et al. Effect of outdoor activity on myopia onset and progression in school-aged children in northeast China: the Sujiatun Eye Care Study. BMC Ophthalmol. 2015;15:73.
Downloads
Published
How to Cite
License
Copyright (c) 2026 İbrahim Edhem Yilmaz, Fatih Ali Ceylan, Yusuf Tüylü, Mehmet Göl
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The Avicenna Anatolian Journal of Medicine operates under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).
