School of Nursing, Shanghai Jiao Tong University, Shanghai, China.
School of Medical Sciences, Örebro University, Örebro, Sweden.
J Med Internet Res. 2020 Dec 8;22(12):e21923. doi: 10.2196/21923.
Smartphone overuse has been cited as a potentially modifiable risk factor that can result in visual impairment. However, reported associations between smartphone overuse and visual impairment have been inconsistent.
The aim of this systematic review was to determine the association between smartphone overuse and visual impairment, including myopia, blurred vision, and poor vision, in children and young adults.
We conducted a systematic search in the Cochrane Library, PubMed, EMBASE, Web of Science Core Collection, and ScienceDirect databases since the beginning of the databases up to June 2020. Fourteen eligible studies (10 cross-sectional studies and 4 controlled trials) were identified, which included a total of 27,110 subjects with a mean age ranging from 9.5 to 26.0 years. We used a random-effects model for meta-analysis of the 10 cross-sectional studies (26,962 subjects) and a fixed-effects model for meta-analysis of the 4 controlled trials (148 subjects) to combine odds ratios (ORs) and effect sizes (ES). The I statistic was used to assess heterogeneity.
A pooled OR of 1.05 (95% CI 0.98-1.13, P=.16) was obtained from the cross-sectional studies, suggesting that smartphone overuse is not significantly associated with myopia, poor vision, or blurred vision; however, these visual impairments together were more apparent in children (OR 1.06, 95% CI 0.99-1.14, P=.09) than in young adults (OR 0.91, 95% CI 0.57-1.46,P=.71). For the 4 controlled trials, the smartphone overuse groups showed worse visual function scores compared with the reduced-use groups. The pooled ES was 0.76 (95% CI 0.53-0.99), which was statistically significant (P<.001).
Longer smartphone use may increase the likelihood of ocular symptoms, including myopia, asthenopia, and ocular surface disease, 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 to inform detailed guidelines and recommendations for smartphone use in children and young adults.
智能手机过度使用已被认为是一种潜在的可改变的风险因素，可能导致视力障碍。然而，关于智能手机过度使用与视力障碍之间的关联的报道并不一致。
本系统评价的目的是确定智能手机过度使用与儿童和年轻人的视力障碍（包括近视、视力模糊和视力不佳）之间的关联。
我们在 Cochrane 图书馆、PubMed、EMBASE、Web of Science 核心合集和 ScienceDirect 数据库中进行了系统搜索，时间从数据库开始到 2020 年 6 月。确定了 14 项符合条件的研究（10 项横断面研究和 4 项对照试验），共纳入 27110 名受试者，平均年龄为 9.5 至 26.0 岁。我们使用随机效应模型对 10 项横断面研究（26962 名受试者）进行荟萃分析，使用固定效应模型对 4 项对照试验（148 名受试者）进行荟萃分析，以合并比值比（OR）和效应量（ES）。I 统计量用于评估异质性。
来自横断面研究的汇总 OR 为 1.05（95%CI 0.98-1.13，P=.16），表明智能手机过度使用与近视、视力不佳或视力模糊无显著关联；然而，这些视力障碍在儿童中更为明显（OR 1.06，95%CI 0.99-1.14，P=.09），而在年轻人中则不明显（OR 0.91，95%CI 0.57-1.46，P=.71）。对于 4 项对照试验，智能手机过度使用组的视觉功能评分较减少使用组差。汇总 ES 为 0.76（95%CI 0.53-0.99），差异有统计学意义（P<.001）。
较长时间使用智能手机可能会增加眼部症状（包括近视、视疲劳和眼表疾病）的可能性，尤其是在儿童中。因此，调节使用时间和限制长时间使用智能手机可能有助于预防眼部和视觉症状。进一步研究使用模式，并对纵向关联进行更长时间的随访，将有助于为儿童和年轻人制定有关智能手机使用的详细指南和建议。
