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 inves-tigate 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 spher-ical 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).
DISCUSSION AND 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.