Ha Ahnul, Lee Yun Jeong, Lee Marvin, Shim Sung Ryul, Kim Young Kook
Department of Ophthalmology, Jeju National University Hospital, Jeju-si, Korea.
Department of Ophthalmology, Jeju National University School of Medicine, Jeju-si, Korea.
JAMA Netw Open. 2025 Feb 3;8(2):e2460026. doi: 10.1001/jamanetworkopen.2024.60026.
IMPORTANCE: The association of digital screen time with myopia has been documented, but the dose-response association and safe exposure threshold remain unclear. OBJECTIVE: To evaluate the dose-response association of time spent on digital screens with myopia risk. DATA SOURCES: PubMed, EMBASE, Cochrane Library databases, CINAHL, and ClinicalTrials.gov were searched for full-length articles from peer-reviewed journals without restrictions on study design, publication date, or language from inception to November 25, 2024. STUDY SELECTION: Primary research articles investigating the association of exposure to digital screen devices (ie, smartphones, tablets, game consoles, computers, or television) with myopia-related outcomes (ie, prevalent or incident myopia and the rate of myopia progression) were identified by reviewers. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data using a standardized procedure in accordance with the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. A random-effects, dose-response meta-analysis (DRMA) was utilized to examine the pattern of the association of screen time with myopia. MAIN OUTCOME AND MEASURES: Increased odds of myopia per hour of daily screen time. RESULTS: In the linear DRMA of 45 studies with 335 524 participants (mean [SD] age, 9.3 [4.3] years), an additional hour of daily screen time was associated with higher odds of myopia (odds ratio [OR], 1.21; 95% CI, 1.13-1.30). The nonlinear DRMA of 34 studies with 314 910 participants also indicated higher odds of myopia with increasing screen time, ranging from 1 hour of daily exposure (OR, 1.05; 95% CI, 1.01-1.09) to 4 hours (OR, 1.97; 95% CI, 1.56-2.40). The dose-response curve showed myopia risk increasing significantly between 1 to 4 hours of daily screen time, and then rising more gradually after 4 hours. CONCLUSIONS AND RELEVANCE: In this systematic review and DRMA, a daily 1-hour increment in digital screen time was associated with 21% higher odds of myopia and the dose-response pattern exhibited a sigmoidal shape, indicating a potential safety threshold of less than 1 hour per day of exposure, with an increase in odds up to 4 hours. These findings can offer guidance to clinicians and researchers regarding myopia risk.
重要性：数字屏幕使用时间与近视之间的关联已有文献记载，但剂量反应关联和安全暴露阈值仍不明确。 目的：评估数字屏幕使用时间与近视风险之间的剂量反应关联。 数据来源：检索了PubMed、EMBASE、Cochrane图书馆数据库、CINAHL和ClinicalTrials.gov，以获取同行评审期刊上的全文文章，对研究设计、出版日期或语言均无限制，检索时间从数据库建立至2024年11月25日。 研究选择：评审人员确定了主要研究文章，这些文章调查了接触数字屏幕设备（即智能手机、平板电脑、游戏机、电脑或电视）与近视相关结果（即近视患病率或发病率以及近视进展率）之间的关联。 数据提取与合成：两名独立评审人员按照流行病学观察性研究的Meta分析（MOOSE）和系统评价与Meta分析的首选报告项目（PRISMA）报告指南，使用标准化程序提取数据。采用随机效应剂量反应Meta分析（DRMA）来研究屏幕使用时间与近视之间的关联模式。 主要结局与测量指标：每日屏幕使用时间每增加一小时，近视几率增加。 结果：在对45项研究、335524名参与者（平均[标准差]年龄为9.3[4.3]岁）进行的线性DRMA中，每日屏幕使用时间每增加一小时，近视几率更高（优势比[OR]为1.21；95%置信区间为1.13 - 1.30）。对34项研究、314910名参与者进行的非线性DRMA也表明，随着屏幕使用时间增加，近视几率更高，范围从每日暴露1小时（OR为1.05；95%置信区间为1.01 - 1.09）到4小时（OR为1.97；95%置信区间为1.56 - 2.40）。剂量反应曲线显示，在每日屏幕使用时间1至4小时之间，近视风险显著增加，4小时后上升更为平缓。 结论与意义：在这项系统评价和DRMA中，数字屏幕使用时间每日增加1小时与近视几率高21%相关，且剂量反应模式呈S形，表明潜在安全阈值为每日暴露少于1小时，4小时内几率增加。这些发现可为临床医生和研究人员提供有关近视风险的指导。
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