Abstract
BACKGROUND:
Prolonged screen time and abnormal postures can cause backache, neck pain, headache, and finger pain. Studies have shown that excessive usage of gadgets has increased during the coronavirus disease 2019 (COVID-19) pandemic, causing health and ocular hazards. This study used qualitative research methods to understand the health and ocular effects of gadget usage following the COVID-19 postlockdown in optometry students.
MATERIALS AND METHODS:
A qualitative study using a semi-structured face-to-face interview was conducted for undergraduate and postgraduate students in different optometry institutes who underwent at least 3 months of online teaching learning during the pandemic after obtaining informed consent. The interviews were conducted online; the sessions were audio-recorded, transcribed, and analyzed. Thematic analyses were conducted to understand the challenges faced.
RESULTS:
Twenty participants were interviewed, of which 70% (n = 14) were females. Thematic analysis identified seven major themes: gadget usage (frequency of usage, type of device, and time spent), challenges during online classes (comprehension, distraction, and network issues), ocular effects (asthenopic symptoms and ocular symptoms), health effects (musculoskeletal disorders), ways to relieve symptoms, recreational activities (breaks and entertainment), and environment and ergonomics (posture and study area and preferred lighting). All the participants reported ocular/health-related symptoms, including eye strain, burning sensation, headache, back pain, finger pain, and neck pain post the lockdown period due to prolonged gadget usage and poor ergonomic postures.
CONCLUSIONS:
Given the significant increase in digital usage following the pandemic, the study’s findings are currently relevant. The prolonged usage of gadgets and poor ergonomic postures have led to ocular and musculoskeletal problems among optometry students. To improve gadget usage without any health-related consequences, students should have access to information regarding ergonomics, increasing the blink rate, and taking regular digital breaks.
Keywords: Coronavirus disease 2019, gadget usage, health hazards, ocular hazards, optometry students, qualitative study
Introduction
Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization in March 2020 due to its rapid spread.[1,2] Social restrictions increased online communication[3,4] and technology use[5] to combat pandemic-induced depression, anxiety, and education disruptions.[4,6] Digital eye strain, neck pain, and sleep disorders were associated with long-term device usage.[7,8] Digital eye strain and ocular surface diseases are associated with excessive device usage among students.[9,10] Lockdown-induced lifestyle changes, including decreased physical activity, increased smartphone use, and reduced sleeping time, may intensify mental health problems in students.[11,12] Gadget use reduces blink rates, leading to dry eyes and blurred vision, and increased light exposure may cause headaches, drowsiness, and other sleep problems.[13] Electronic device usage increased among health-care students during the pandemic. Understanding the impact of extended device use can lead to recommendations for students to reduce their risk of health and ocular problems by improving their posture, environment, and device usage. This study explored the health and ocular hazards of gadget usage following the COVID-19 lockdown among optometry students using qualitative research methods in South India.
Materials and Methods
A cross-sectional, qualitative study was conducted using semi-structured interviews with optometry students in South India between August and October 2022. The institutional ethics committee approved the study. Face-to-face interviews were conducted based on a thematic descriptive approach. The semi-structured interview guide was developed after reviewing the literature and was peer-reviewed, refined, and approved by optometry educators and ophthalmologists [Supplementary File 1]. Heads of optometry institutes in Tamil Nadu, Kerala, and Karnataka approached undergraduate and postgraduate optometry students from various institutes who had undergone online learning for at least 3 months. Other allied health students without online classes were excluded.
Participants were purposively identified to represent a diversity of age, gender, duration of online classes, health, and ocular impacts of gadget usage. Oral and written informed consent was obtained before commencing the interviews. Face-to-face interviews were conducted with participants online in their convenient language. Twenty interviews (ten undergraduates and ten postgraduates) were conducted. Interviews were 20–30 min long and audio-video recorded. All the interviews were transcribed, and data saturation was reached after the eighth interview for both participants. Additional interviews confirmed data saturation.[14,15]
Thematic analysis was performed in the following steps: familiarizing with the data, coding or highlighting, theme generation, and defining and renaming the themes according to the key aspects of the questions.[15] All themes and subthemes were discussed with co-investigators before confirming the final categorization of themes, leading to internal validity and investigation triangulation.[14]
Results
Twenty participants were interviewed, of which 70% (n = 14) were females. Thematic analysis identified seven major themes: gadget usage (frequency or period of usage, hours of usage, average time spent per day, and devices used for online classes), challenges during online classes (comprehension, distraction, and network issues), ocular effects (asthenopic symptoms and ocular symptoms), health effects (musculoskeletal disorders [MSDs]), ways to relieve ocular and health-related symptoms (ocular and health preventive measures), recreational activities (break hours during online classes and entertainment), and environment and ergonomics during online class (positions during online classes, study area during online class, and preferred lighting during online classes). Table 1 shows the demographic details of the participants. All the participants reported ocular and health-related symptoms, including eye strain, burning sensation, headache, back pain, finger pain, and neck pain following the lockdown period due to prolonged gadget usage and poor ergonomic postures.
Table 1.
Participant’s demographics
| Demographics | Undergraduates, n (%) | Postgraduates, n (%) | ||
|---|---|---|---|---|
| Number of participants | 10 (50) | 10 (50) | ||
| Age (years), mean (SD) | 21.4 (0.9) | 23.2 (0.9) | ||
| Gender | ||||
| Male | 3 (15) | 3 (15) | ||
| Female | 7 (35) | 7 (35) | ||
| Year of study | ||||
| 1st year | 3 (15) | |||
| 2nd year | 2 (10) | 7 (35) | ||
| 3rd year | 6 (30) | |||
| 4th year | 2 (10) |
SD: Standard deviation
Theme 1: Gadget usage
Before the lockdown, most students (n = 18; 90%) reported using their devices for no more than 2 to 3 h each day for assignments, notes, and other leisure activities:
“I used to work on gadgets for fewer hours every day before the lockdown since I was doing other things with them…”
Most students (n = 18; 90%) reported that before the lockdown, they used technology primarily for leisure activities (e.g., watching movies, using WhatsApp, playing video games, and using other social media). However, due to the pandemic, most students now rely on technology primarily for academic purposes:
“I use my smartphone for around 8 h daily for online classes…”
After the lockdown, students used electronic gadgets for more than 5 h daily. The average reported time spent on gadgets was 6–7 h per day:
“Normally, I use gadgets for 6-7 hours…”
Students also reported that most of them prefer smartphones for online classes, and laptops are not as common:
“Ah, smartphones are commonly used. I prefer a laptop for online classes rather than recreational activities or social media, and a smartphone for other activities…”
Theme 2: Challenges during online classes
All participants (n = 20; 100%) reported not listening to online classes properly. Some students said that they switched off classes due to distractions from other students, poor network connection, or health-related issues:
“During online classes, it is hard to concentrate due to distractions from other students, less interaction with teachers, and inability to understand what the teachers are saying. There are also network issues; if there is a power outage, it is difficult to charge the device, and we cannot get a proper class. Using laptops and smartphones can also cause charging issues. Continuous use of a mobile phone can cause headache, burning sensation, back pain, neck pain, and hand pain from taking notes....”
Most students (n = 16; 80%) reported experiencing sleepiness, headache, burning sensation, back pain, neck pain, and finger pain after using their mobile phones:
“For academic purposes, offline classes were better than online classes because offline classes were more interactive. Online classes are difficult because of network issues, and it is difficult to sit in one place….”
“It is also very different from a classroom setting. In offline classes, we can at least go out somewhere, but in online classes, I used to lie in bed and get headaches and eyestrain from using gadgets....”
Most students (n = 17; 85%) reported that virtual classes are isolating and distracting. They need to sit in a quiet place to focus, but they are easily distracted by other social media apps and have difficulty understanding the topic:
“It is difficult to understand the topic. I need to sit alone in a closed room because of outside distractions. Distractions from other apps lead to poor concentration…”
Some students (n = 10; 50%) reported that prolonged use of gadgets causes sleep delay at night due to eye pain and headache.
Theme 3: Ocular effects
Most students (n = 19; 95%) reported eye pain, burning sensation, and constant rubbing of eyes due to the constant use of gadgets. This ocular symptom distracted students from online classes and made them feel tired:
“Dry eyes, burning sensation, watery eyes, eye strain due to prolonged gadget usage…”
Some students (n = 6; 30%) reported delayed sleeping time and eyestrain. As a result, most students skipped classes and did not listen to them properly:
“I usually have difficulty sleeping at night and neck pain, as well as a burning sensation…”
Theme 4: Health effects
All participants (n = 20; 100%) reported that constant use of gadgets causes MSDs (e.g., back, neck, wrist, and shoulder pain), abnormal postures, reduced blinking, headaches, eyestrain, and burning sensations:
“We do not need to turn on our video for most classes. Therefore, I will not sit at my desk or chair; I will mostly be on my bed with a supportive cushion, so I do not feel any back pain. However, if there is a video class, I will sit at my desk and feel back pain and neck pain because sometimes I rest my wrist on the table and lean forward, which causes back pain and neck pain….”
“I mostly listen to online classes while lying on my bed, which causes wrist, hand, and neck pain due to continuously holding my smartphone.”
“I usually have difficulty sleeping at night and neck and hand pain.”
“I usually have back pain, headache, and neck pain when using gadgets for a prolonged period. If I have continuous back pain, I will not listen to the classes; I will take a break from focusing on the screen and lie on the bed for a while…”
Theme 5: Ways to relieve ocular and health-related symptoms
Upon experiencing ocular and health-related symptoms, most students (n = 19; 95%) avoid focusing on the screen and take short breaks to relieve the symptoms:
“There are no continuous classes in a day; there is a break in between every two hours. After each class, I wash my eyes and face frequently, lie on the bed, or take a short nap….”
Some students (n = 15; 75%) reported using cold water to wash their eyes and closing their eyes to relieve related symptoms such as eye pain, headache, burning sensation, and dryness:
“I used to wash my eyes with cold water, close my eyes, and relax for a while…”
Most students (n = 18; 90%) report headaches while focusing on the screen:
“Yes, sometimes I used to nap briefly to relieve the headache….”
Theme 6: Recreational activities
Most students (n = 15; 75%) reported feeling too tired to focus on the screen after prolonged use of gadgets, so they took 15-min breaks to relieve the strain:
“We have a 15-minute break during which I used to watch TV for a while….”
Most students (n = 18; 95%) reported using their break hours to go for walks, take short naps for relaxation, or watch movies on television to relieve depression and stress due to increased academic activities:
“We have a break after two hours of class; I mostly go for a walk…”
“Yes, we have a one-hour break after each class. I use my smartphone for 15 min, read or take notes, and then sleep in between….”
Theme 7: Environment and ergonomics during online class
Most students (n = 15; 75%) prefer improper postures during online classes, such as lying supine while holding their smartphones, sitting with a slightly bent back, or sitting on the floor with their wrists resting and their bodies bent forward. Most students prefer to take online classes in their study rooms, using a study table and chair, while a few students sit on the floor:
“I usually lie on my bed, but because of back pain, I prefer to sit in a chair, usually sitting straight and slightly leaning back to listen to online classes…”
“I usually prefer to sit in my study room in the evening. Mostly during the day, I used to sit on my terrace with a slightly bent posture; sometimes, I would change my posture due to neck and back pain.”
“I usually use a straight and slightly bent posture while using a smartphone, but sometimes I lie on the bed.”
“I prefer to use a study table only during online classes; the rest of the time, while doing assignments/seminars, I sit with my laptop on the bed. I prefer to sit inside my room.”
Discussion
This study explored the health and ocular hazards of gadget usage following the COVID-19 lockdown among optometry students using qualitative research methods in South India. Key findings were that gadget usage increased significantly after the lockdown, mainly for academic purposes. Smartphones were preferred for online classes, but students faced distractions, network problems, and health-related discomfort. Prolonged gadget usage led to physical symptoms such as eyestrain, headaches, pain, and MSDs. Students used adaptive strategies such as short breaks and eye washing to alleviate these symptoms, but these strategies were often reactive rather than proactive. During breaks, students engage in recreational activities to reduce strain and promote a better balance between academics and relaxation. The study also found that students had diverse preferences for study environments and postures, with some opting for proper furniture and others for less ergonomic options.
Yilmaz et al. reported that mobile phones are one of the most popular devices for virtual learning among students, followed by laptops and tablets.[16] This study’s findings are consistent with that. Mortazavi et al. and He et al. also found that using apps to control glare on the screen can significantly reduce the prevalence of burning sensations.[13,17] This suggests that even simple measures like adjusting the display brightness can help reduce dry eye symptoms. In addition, this study found that students experience ocular-related issues such as headaches, eyestrain, watering, and burning sensations when using gadgets for extended periods. To reduce these symptoms, students reported taking breaks, avoiding focusing on the screen, doing eye exercises, using lubricating drops, wearing protective glasses, and reducing the brightness of their smartphones.
Hupert et al. found that 42% of college students had musculoskeletal symptoms in their upper extremities related to computer use.[18] Students also reported a high prevalence of neck, back, and wrist pain or stiffness after using electronic devices. These symptoms were most severe in those who used devices in prone positions or upright positions with a bent back. This study’s findings are consistent with previous studies that have reported that students who use digital devices experience upper extremity musculoskeletal symptoms such as back pain, neck pain, hand pain, headache, and ear and shoulder pain. Most students (80%) in this study reported that these symptoms were due to their abnormal postures during class hours, such as sitting on the floor with their backs bent forward, lying on their backs, resting their wrists on the floor, and experiencing hand pain due to prolonged class hours.
Kumar et al. found prolonged smartphone use associated with vision difficulties, hearing problems, reduced physical activity, and MSD-related and ocular-related asthenopic symptoms.[19] This study found that students who use gadgets for prolonged periods experience. MSD-related and ocular-related asthenopic symptoms include back pain, neck pain, shoulder pain, headache, eyestrain, burning sensation, and watering. Kim et al. (2024) suggest that increased use of digital devices for online learning during the pandemic may negatively affect university students’ eye and musculoskeletal health,[20] consistent with this study’s results.
This study had some limitations. It was a qualitative study with only 20 participants. However, saturation was reached at the eighth interview (undergraduate–postgraduate participants), and the study continued until the tenth interview to confirm saturation. Only students who were proactive and enthusiastic responded to the invitation to participate. Other student perspectives could have been missed. However, since students from multiple optometry institutes were included, this could balance the responses received. The students could not fully articulate their complaints during the interview due to their lack of recollection of the difficulties they experienced during the online classes. However, the study included many probes to help elicit maximum participant responses. Future studies should consider participants’ distance from the device and their use of lubricant, as these can impact visual comfort, user experience, and burning sensation.
Conclusions
COVID-19 pandemic has significantly affected the health and well-being of optometry students. The social restrictions significantly disrupted students’ social and academic activities, increasing their screen time and gadget usage and leading to several health and ocular issues, such as eyestrain, headaches, and musculoskeletal pain. This study remains essential postlockdown, as students’ digital usage will likely remain high. Students should be taught ergonomics, blinking, and digital breaks to reduce health risks from prolonged gadget use.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgments
We would like to thank Dr. Jameel Rizwana Hussaindeen, optometry educator and clinical researcher, for her inputs.
Supplementary File 1
Interview Guide:
Can you describe the average time spent on gadget or laptop usage?
What purpose you spend maximum time on gadgets?
Can you tell which type of digital device you use the most?
Can you describe the experience of online study on post-COVID-19?
Can you describe the time spent on gadget usage before and post lockdown period?
How long do you spend on digital devices other than online classes?
Can you describe the difficulties faced on the usage of gadgets for a prolonged period? Probe: Backache, neck pain, and finger pain
How and which is your place to study during online classes in your home? Probe: Study table and chair, proper illumination, screen of electronic device is below the horizontal level, and posture while using electronic device
For each day how many hours you will be having online classes?
Can you explain about the eye-related symptoms following the usage of gadgets? Probe: Headache, dry eyes, burning sensation, blurred vision, and watery eyes
What you will do when you have eye-related symptoms? Probe: Wash eyes and use some drops
Can you explain the health-related problems following gadget usage?
Describe whether you take a break after using your gadgets for a while? If so, how many hours you will have a break time after prolonged gadget usage?
What will you do during break hours? Probe: Go for a walk, play outside, and watch TV
Are you wearing any spectacles/protective eyewear while using gadgets and for how long you are using?
Explain at what working distance do you usually use your smartphone? Probe: Less than arm length and about an arm length
Which type of gadgets is more comfortable to listen online classes and why?
Explain about the most commonly used posture while using your smartphone? Probe: Upright with bend back, upright with straight back, lying down in supine position, and prone position
Describe what type of illumination you will use while listening online classes?
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