Smartphone Use Associated with Refractive Error in Teenagers: The Myopia App Study

Clair A. Enthoven, Jan Roelof Polling, Timo Verzijden, J. Willem L. Tideman, Nora Al-Jaffar, Pauline W. Jansen, Hein Raat, Lauwerens Metz, Virginie J.M. Verhoeven, Caroline C.W. Klaver*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Purpose: To investigate the association between smartphone use and refractive error in teenagers using the Myopia app. Design: Cross-sectional population-based study. Participants: A total of 525 teenagers 12 to 16 years of age from 6 secondary schools and from the birth cohort study Generation R participated. Methods: A smartphone application (Myopia app; Innovattic) was designed to measure smartphone use and face-to-screen distance objectively and to pose questions about outdoor exposure. Participants underwent cycloplegic refractive error and ocular biometry measurements. Mean daily smartphone use was calculated in hours per day and continuous use as the number of episodes of 20 minutes on screen without breaks. Linear mixed models were conducted with smartphone use, continuous use, and face-to-screen distance as determinants and spherical equivalent of refraction (SER) and axial length-to-corneal radius (AL:CR) ratio as outcome measures stratified by median outdoor exposure. Main Outcome Measures: Spherical equivalent of refraction in diopters and AL:CR ratio. Results: The teenagers on average were 13.7 ± 0.85 years of age, and myopia prevalence was 18.9%. During school days, total smartphone use on average was 3.71 ± 1.70 hours/day and was associated only borderline significantly with AL:CR ratio (β = 0.008; 95% confidence interval [CI], –0.001 to 0.017) and not with SER. Continuous use on average was 6.42 ± 4.36 episodes of 20-minute use without breaks per day and was associated significantly with SER and AL:CR ratio (β = –0.07 [95% CI, –0.13 to –0.01] and β = 0.004 [95% CI, 0.001–0.008], respectively). When stratifying for outdoor exposure, continuous use remained significant only for teenagers with low exposure (β = –0.10 [95% CI, –0.20 to –0.01] and β = 0.007 [95% CI, 0.001–0.013] for SER and AL:CR ratio, respectively). Smartphone use during weekends was not associated significantly with SER and AL:CR ratio, nor was face-to-screen distance. Conclusions: Dutch teenagers spent almost 4 hours per day on their smartphones. Episodes of 20 minutes of continuous use were associated with more myopic refractive errors, particularly in those with low outdoor exposure. This study suggested that frequent breaks should become a recommendation for smartphone use in teenagers. Future large longitudinal studies will allow more detailed information on safe screen use in youth.

Original languageEnglish
Pages (from-to)1681-1688
Number of pages8
JournalOphthalmology
Volume128
Issue number12
Early online date7 Jul 2021
DOIs
Publication statusPublished - 1 Dec 2021

Bibliographical note

Funding Information:
Supported by Oogfonds , ODAS, Uitzicht 2017-28 ( LSBS , MaculaFonds , Oogfonds); Netherlands Organization for Scientific Research (grant nos.: 91815655 [C.C.W.K.], 91617076 [V.J.M.V.], and 636320005 [P.W.J.]); and the European Research Council under the European Union’s Horizon 2020 research and innovation programme (grant no.: 648268 [C.C.W.K.]). The funding organizations had no role in the design or conduct of this research. They provided unrestricted grants.

Funding Information:
Supported by Oogfonds, ODAS, Uitzicht 2017-28 (LSBS, MaculaFonds, Oogfonds); Netherlands Organization for Scientific Research (grant nos.: 91815655 [C.C.W.K.], 91617076 [V.J.M.V.], and 636320005 [P.W.J.]); and the European Research Council under the European Union's Horizon 2020 research and innovation programme (grant no.: 648268 [C.C.W.K.]). The funding organizations had no role in the design or conduct of this research. They provided unrestricted grants. The author(s) have made the following disclosure(s): P.W.J.: Financial support ? ZonMW Obtained funding: Verhoeven, Klaver

Publisher Copyright:
© 2021 American Academy of Ophthalmology

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