Investigation of asthenopia prevalence and related factors in university students with ordered logistic regression

ABSTRACT

Background:

Asthenopia, eye strain, occurs with prolonged use of digital devices and causes symptoms such as blurred vision and headaches. Its prevalence is increasing among university students and office workers; studies report a prevalence of 50–90%, with screen use and ergonomic factors in particular appearing to increase the risk.

Aims:

This study investigated the prevalence of asthenopia and associated risk factors among university students in Turkey.

Methods:

A web-based survey was administered to 547 students, and 234 met the inclusion criteria. Statistical analyses were performed with the SPSS 29.0 package program. Frequency and percentage distributions of variables were analyzed in descriptive statistics. First, the prevalence of asthenopia was investigated. Participants who showed any of the symptoms of blurred vision, dry eyes, redness in the eyes, pain in the eyes, itching in the eyes, and eye fatigue were defined as patients with asthenopia, and participants who did not show them were described as “patients without asthenopia.” Multiple logistic regression analysis was applied to identify variables that most contributed to asthenopia. The study evaluated the significance level based on a P value of 0.05 and a 95% confidence interval.

Results:

Results showed that 75.6% of participants experienced asthenopia; the most common symptom was eyestrain (37.6%). Logistic regression analysis revealed that women were 3.385 times more likely to develop asthenopia than men. Wearing glasses increased the risk by 4,645 times compared to not wearing corrective lenses. Interestingly, while using digital devices for studying had a protective effect, recreational use for more than 2 hours significantly increased the risk.

Conclusion:

The high prevalence of asthenopia among digital device users highlights the need for targeted interventions. The protective effect of work-related device use and the increased risk from recreational use provide fundamental information for developing strategies to reduce eye strain.

Introduction and Background

With the advent of digital technology, digital devices such as desktops, laptops, tablets and phones have been widely used by students for academic, entertainment, and social purposes. The use of digital devices has become a part of modern life and health problems related to the use of these devices have inevitably increased. Especially during the COVID-19 pandemic, applications such as remote working and online education have significantly increased screen time.[1] This has led to eye strain and related symptoms becoming more common. This increased use of digital devices has led to a wide range of physical and psychological problems in students. One of these problems is asthenopia, which refers to visual discomfort accompanied by other symptoms such as dizziness, headaches, redness or itching of the eyes, and inability to concentrate.[2]

Asthenopia is a condition of pain and fatigue in the eyes, usually due to overuse of the eye for a certain period. Symptoms include blurred vision, double vision, photophobia, dryness when falling, foreign body sensation, eye pain, headache, burning, and itching in the eyes. Asthenopia is caused by a combination of factors. Prolonged screen use can cause dry eyes by reducing the rate of blinking. In addition, the constant bright light and high contrast on screens require the eyes to constantly adjust, which causes eye muscles to fatigue.[3] The use of cell phones, especially with small screens, requires the eyes to focus on smaller details, leading to more eye strain. This can affect children’s attention, learning process, and academic performance at school.[4]

The relationship between digital device use and asthenopia is well documented. Prolonged use of screens requires constant focus and adaptation, leading to ocular discomfort and visual disturbances.[5] This phenomenon, often referred to as Digital Eye Strain (DES) or Computer Vision Syndrome (CVS), is exacerbated by factors such as poor lighting, inappropriate viewing distances, screen glare, and uncorrected vision problems.[6] For example, frequent focus shifts between the screen and surrounding objects can strain the ciliary muscles and contribute to asthenopia symptoms.[2]

The manifestations of asthenopia vary depending on the duration of use, the posture adopted during use, and the type of device used. Recent research has highlighted a significant increase in asthenopia cases among children and adolescents, associated with increased screen time for online learning and entertainment activities.[7,8] Children and adolescents are groups at high risk of developing asthenopia due to digital device use. This age group tends to spend more time on digital devices and use them extensively for both educational and entertainment purposes.[9] Their evolving visual systems and prolonged screen use increase the likelihood of this group experiencing eye strain. College students are particularly vulnerable due to evolving visual systems and high time spent on digital devices. In addition, blue light emitted from screens is suspected to increase eye strain by affecting contrast sensitivity and contributing to glare.[10] Several strategies have been proposed to prevent and manage asthenopia. Adopting the 20–20–20 rule, i.e., looking at an object 20 feet (about 6 meters) away for 20 seconds every 20 minutes, can help reduce eye strain.[11] It may also be helpful to optimize screen settings, adjust brightness and contrast, and use anti-glare screens or blue light filters. Regular eye examinations and the use of appropriate corrective lenses are also important in managing symptoms.[12] In conclusion, the widespread use of digital devices has led to a significant increase in cases of asthenopia, affecting individuals across various age groups. Understanding the factors contributing to digital eye strain and implementing effective preventive measures are important to maintain eye health and mitigate the effects of this condition.

Asthenopia can also significantly affect attention and academic performance and limit study capacity.[13] This may make asthenopia a public health problem.[14,15]

As in many countries, university students in Turkey spend most of their time on digital devices. This study aimed to investigate the relationship between the use of digital devices and the prevalence of asthenopia among students at a foundation university in Istanbul and to assess the risk factors. To the best of our knowledge, there is no published study on the prevalence of asthenopia and associated factors among university students in Turkey. The results of this study will provide an important basis for future awareness-raising campaigns and help evaluate the need for targeted screening for asthenopia among university students.

Materials and Methods

The population of the study will consist of university students studying in Türkiye. According to the Council of Higher Education Higher Education Statistics for the academic year 2023–2024, a total of 6,950,142 students are studying in 208 higher education institutions in Türkiye. Adequate sample size was calculated using the formula.[16] n_o = [(t × S)/d]2 n = [n₀/(1+ (n₀/N].

Sample selection for the study will be done through simple random sampling.

The inclusion criteria for our study included students older than 18 years of age, while the exclusion criteria applied to all students with amblyopia, conjunctivitis, eye inflammation/infection, pre-existing medical conditions (arthritis, osteoporosis, thyroid disease, diabetes, hypertension, chronic migraine and chronic headache), strabismus, high myopia (more than − 6.0 diopters), glaucoma or cataract, retinal nerve damage, any history of eye disease or eye surgery. As the study aimed to examine headaches as a pure consequence of asthenopia, chronic migraine, and chronic headaches were listed as exclusion criteria for participants.

The necessary data were obtained through a web-based questionnaire form. The “Informed Consent Form” about the study was presented to the participants before they started the questionnaire questions and the questionnaire was completed after they gave their consent.

Study design

In the questionnaire we applied to the sample group: (1) demographic information; (2) current department and faculty; (3) digital device use, device type, and duration of use; (4) reason for digital device use; (5) spectacle or contact lens use; (6) asthenopia symptoms; and (7) preventive measures were questioned.

This study adheres to the guidelines of the Declaration of Helsinki. Ethics was obtained from the Istanbul Sabahattin Zaim University ethics board. Within the scope of this study, informed consent was obtained electronically from the participants through the explanations at the beginning of the questionnaire. After the participants were informed about the purpose of the study, voluntary participation, and confidentiality, they were deemed to have given consent by completing the questionnaire.

Statistical analysis

Statistical analyses were performed with the SPSS 29.0 package program. Frequency and percentage distributions of variables were analyzed in descriptive statistics. Firstly, the prevalence of asthenopia was examined and participants who showed any of the symptoms of blurred vision, dry eyes, redness in the eyes, pain in the eyes, itchy eyes, or eye fatigue were defined as “having asthenopia” and participants who did not show any of the symptoms were defined as “not having asthenopia”. Multiple logistic regression analysis was applied to determine the variables that contributed most to asthenopia. The significance level in the analyses was evaluated according to a 0.05 P value and 95% confidence interval.

Results

Within the scope of the study, 547 participants were reached. Of the participants who completed the questionnaire, 172 had amblyopia, 70 had conjunctivitis or any inflammation/infection in their eyes within the last 6 years, 77 had arthritis, osteoporosis, thyroid disease, diabetes, hypertension, 34 had strabismus, 19 had high myopia, 11 had glaucoma/cataract, 146 had any other eye disease and 31 had any eye surgery. The 313 participants who answered “yes” to at least one of these questions, which were determined as confounding factors, were excluded from the study, and the analyses were performed with the remaining 234 participants [Figure 1].

Figure 1.

Flowchart of the student recruitment process

Asthenopia definition and prevalence

Participants who experienced at least one of the symptoms of eye fatigue, itching in the eyes, blurred vision, dryness in the eyes, redness in the eyes, pain in the eyes, burning in the eyes, or headache and at least one of these symptoms within the last 6 months were considered to have asthenopia, so the presence of headache alone was not considered sufficient for asthenopia. According to this definition, 75.6% (n = 177) of the participants had asthenopia and the most frequently reported symptom after headache was eye fatigue with 37.6% (n = 88) and the least reported symptom was a dry eye with 16.2% (n = 38).

Association of demographic characteristics with asthenopia

Of the participants, 29.5% (n = 69) were male and 70.5% (n = 165) were female with a mean age of 23.63 years (SD = 6.640). The majority of the students were undergraduate students (171%, n = 73.1%) and 56.8% (n = 133) were studying in departments related to health sciences and services. The majority of the students (86.8%, n = 203) wore neither glasses nor contact lenses, 12.0% (n = 28) wore only glasses, and 1.3% (n = 3) wore both glasses and contact lenses [Table 1].

Table 1.

Descriptive characteristics of participating students

Characteristics	Frequency (%)
Gender
Male	69 (29.5%)
Female	165 (70.5%)
Age
18	2 (.9%)
19	35 (15.0%)
20	57 (24.4%)
21	27 (11.5%)
22	26 (11.1%)
23	26 (11.1%)
24	14 (6.0%)
25+	47 (20.0%)
Type of University
Private	118 (50.4%)
Public	116 (49.6%)
Education Level
Associate	55 (23.5%)
Undergraduate	171 (73.1%)
Master Degree-PhD	8 (3.4%)
Section
Health Sciences	133 (56.8%%)
Education and Social Sciences	50 (21.4%)
Engineering and Technology	18 (7.7%)
Business and Economics	33 (14.1%)
Eyewear
Wears only contacts	0 (.0%)
Wears only glasses	28 (12.0%)
Wears bothn contacnts and glasses	3 (1.3%)
Does not wear either	203 (86.8%)

Devices and their relation to asthenopia

When the device usage of the users was analyzed, it was seen that 36.3% (n = 85) of the participants who rated their usage status out of 5 rated their desktop or laptop computer as 4 or 5, and 80.3% rated their phone or tablet as 4 or 5. When the usage patterns were analyzed, 23.1% (n = 54) of the students spent 2–4 hours a day on their devices, 39.3% (n = 92) spent between 4-6 hours, 31.2% (n = 73) spent more than 6 hours, and only 6.4% (n = 15) of the participants reported spending less than 2 hours a day. 55.6% (n = 130) of the students reported spending less than 2 hours on their device in the dark. A total of 86.8% (n = 203) of the participants had been using their device for more than three years.

When the reasons for use are analyzed, 66.7% (n = 156) of the participants stated that they use their device for studying, 44.9% (n = 105) for work, 80.8% (n = 189) for entertainment, and 68.8% (n = 161) for entertainment. The majority of respondents (70.5%, n = 165) spend less than 4 hours on their device for studying. Similarly, the majority of the participants reported spending less than 4 hours on their device for studying (63.2%, n = 148), entertainment (66.2%, n = 155), and communication (78.2%, n = 183) [Table 2].

Table 2.

Frequency distribution of possible risk factors and protective factors

	Frequency (%)
Most frequently used device (mostly rated as 4 or 5)
PC	85 (36.3%)
Phone/Tablet	188 (80.3%)
Hours spent per day
<2 h	15 (6.4%)
2–4 h	54 (23.1%)
4–6 h	92 (39.3%)
>6 h	73 (31.2%)
<4 h	69 (29.5%)
≥4 h	165 (70.5%)
Hours spent in the dark
<2 h	130 (55.6%)
2–4 h	61 (26.1%)
4–6 h	35 (15.0%)
>6 h	8 (3.4%)
<4 h	191 (81.6%)
≥4 h	43 (18.4%)
Years spent
<3 years	31 (13.2%)
≥3 years	203 (86.8%)
Reason for use
Studying
Yes	78 (33.3%)
No	156 (66.7%)
Work
Yes	129 (55.1%)
No	105 (44.9%)
Entertainment
Yes	45 (19.2%)
No	189 (80.8%)
Communication
Yes	73 (31.2%)
No	161 (68.8%)
Time spent studying
0 h (device not used)	24 (10.3%)
<2 h	72 (30.8%)
2–4 h	93 (39.7%)
4–6 h 155 (34.2%)	38 (16.2%)
>6 h	7 (3.0%)
0 h	24 (10.3%)
<4 h	165 (70.5%)
≥4 h	45 (19.2%)
Time spent working
0 h (device not used)	40 (17.1%)
<2 h	101 (43.2%)
2–4 h	47 (20.1%)
4–6 h 155 (34.2%)	21 (9.0%)
>6 h	25 (10.7%)
0 h	40 (17.1%)
<4 h	148 (63.2%)
≥4 h	46 (19.7%)
Time spent on entertainment
0 h (device not used)	11 (4.7%)
<2 h	59 (25.2%)
2–4 h	96 (41.0%)
4–6 h 155 (34.2%)	48 (20.5%)
>6 h	20 (8.5%)
0 h	11 (4.7%)
<4 h	155 (66.2%)
≥4 h	68 (29.1%)
Time spent on communication
0 h (device not used)	13 (5.6%)
<2 h	105 (44.9%)
2–4 h	78 (33.3%)
4–6 h 155 (34.2%)	25 (10.7%)
>6 h	13 (5.6%)
0 h	13 (5.6%)
<4 h	183 (78.2%)
≥4 h	38 (16.2%)
Symptoms of asthenopia
Headache	174 (74.4%)
Blurred vision	44 (18.8)
Dry eyes	38 (16.2%)
Red eyes	54 (23.1%)
Aching eyes	56 (23.9%)
Itchy eyes	52 (22.2%)
Eye strain	88 (37.6%)
Eye burn	61 (26.1%)
Asthenopia prevalence
Yes	177 (75.6%)
No	57 (24.4%)
Preventive measures adopted
Adjustable screen	135 (57.7%)
Adjustable chair	47 (20.1%)
Regular breaks	100 (42.7%)
Eye drops (artificial tears)	13 (5.6%)
Antiglare glasses	40 (17.1%)
At least one protective measure	234 (100%)

The results of logistic regression analysis revealed that gender affected the development of asthenopia (OR = 3.385, P < 0.05). Accordingly, being female increases the risk of asthenopia by 3.385 times. Age, type of university, level of university education, and department of study did not have any effect on the risk of asthenopia. When the effect of eyeglass and lens use on asthenopia was analyzed, it was observed that wearing only eyeglasses increased the risk of asthenopia 4 times compared to not wearing glasses or lenses (OR = 4.645, P < 0.05) [Table 3].

Table 3.

Logistic regression analysis of variables contributing to asthenopia

Variable	Level	Unadjusted OR	Adjusted OR	P	95% CI
					Lower	Upper
Gender	Male	1
	Female	1.219	3.385	0.020	1.209	9.476
Age		-0.067	0.936	0.104	0.863	1.014
Type of University	Private	1
	Public	0.864	2.372	0.068	0.939	5.993
Education Level	Associate	1
	Undergraduate	0.259	1.296	0.676	0.385	4.367
	Master Degree-PhD	0.951	2.587	0.190	0.625	10.709
Fields of Study	Health Sciences and Services	0.259	1.296	0.676	0.385	4.367
	Education and Social Sciences	0.951	2.587	0.190	0.625	10.709
	Engineering and Technology	1.256	3.510	0.224	0.464	26.525
	Business and Economics	1
PC and Laptop Rating	<4	1
	≥4	0.062	1.063	0.893	0.435	2.602
Mobile phones and tablets rating	<4	1
	≥4	0.233	1.263	0.667	0.436	3.660
Reason: Studying	No	1
	Yes	0.134	1.143	0.826	0.348	3.760
Reason: Work	No	1
	Yes	0.392	1.480	0.471	0.510	4.292
Reason: Entertainment	No	1
	Yes	-0.947	0.388	0.137	0.111	1.352
Reason: Communication	No	1
	Yes	0.398	1.488	0.422	0.564	3.927
Frequency: Studying	0 h	1
	<2 h	-2.206	0.110	0.037	0.014	0.871
	2-4 h	-2.322	0.098	0.029	0.012	0.794
	4-6 h	-2.636	0.072	0.028	0.007	0.750
	≥6 h	-2.202	0.111	0.250	0.003	4.723
Frequency: Work	0 h	1
	<2 h	-0.488	0.614	0.435	0.180	2.090
	2-4 h	-0.451	0.637	0.580	0.129	3.148
	4-6 h	0.138	1.148	0.890	0.161	8.190
	≥6 h	1.728	5.629	0.128	0.609	52.018
Frequency: Entertainment	0 h	1
	<2 h	2.524	12.477	0.081	0.730	213.119
	2-4 h	3.374	29.207	0.019	1.738	490.862
	4-6 h	3.666	39.086	0.014	2.099	727.705
	≥6 h	3.083	21.815	0.047	1.049	453.815
Frequency: Communication	0 h	1
	<2 h	1.555	4.736	0.174	0.504	44.522
	2-4 h	1.177	3.245	0.303	0.346	30.421
	4-6 h	1.218	3.381	0.319	0.308	37.069
	≥6 h	0.967	2.631	0.521	0.137	50.515
Hours of Use per Day	<2 h	1
	2-4 h	0.019	1.019	0.983	0.175	5.919
	4-6 h	-0.641	0.527	0.479	0.089	3.109
	≥6 h	-0.904	0.405	0.367	0.057	2.884
Hours of Use in the Dark	<2 h	1
	2-4 h	0.536	1.709	0.339	0.570	5.128
	4-6 h	1.403	4.069	0.075	0.866	19.118
	≥6 h	0.986	2.680	0.447	0.211	33.976
Device use per year	1 year	1
	2 years	-0.441	0.643	0.689	0.074	5.584
	3 years	-0.645	0.525	0.510	0.077	3.575
	4 years	0.779	2.178	0.443	0.298	15.923
	≥5 years	-0.766	0.465	0.381	0.084	2.574
Eyewear	Do not use	1
	Wears glasses	1.536	4.645	0.048	1.013	21.307
	Wears both glasses and contacts	21.282	17.49	0.999	0.000	-
Adjustable Screen	Use	1
	Do not use	-0.391	0.677	0.478	0.230	1.990
Adjustable chair	Use	1
	Do not use	-0.794	0.452	0.166	0.147	1.389
Regular breaks	Use	1
	Do not use	-0.375	0.687	0.468	0.249	1.894
Eye drops	Use	1
	Do not use	-19.484	0.000	0.998	0.000	-
Antiglare glasses	Use	1
	Do not use	0.147	1.159	0.807	0.354	3.789

When the effect of digital device use on asthenopia was analyzed, it was observed that neither phone and tablet use nor desktop and laptop use posed a risk of asthenopia. Similarly, daily digital device use, device use in the dark, and year of digital device use did not have a significant relationship with asthenopia. None of the purposes of device use was found to have a significant relationship with asthenopia. However, the time spent on the digital device for studying was found to be a protective factor on asthenopia. It was observed that those who used their digital devices for less than 2 hours, between 2–4 hours and 4–6 hours for studying were significantly less likely to have asthenopia than those who never used them (OR = 0.110, P < 0.05; OR = 0.098, P < 0.05, OR = 0.028, P < 0.05, respectively). Accordingly, using the device for less than 2 hours for study purposes decreases the likelihood of asthenopia by 89%, using the device for 2–4 hours decreases the likelihood of asthenopia by 90%, and using the device for 4–6 hours decreases the likelihood of asthenopia by 97% compared to not using the device for study purposes at all. The duration of using the device for work and communication purposes did not affect asthenopia. In terms of using the device for recreational purposes, using the device for 2–4 hours, using the device for 4–6 hours, and using the device for more than 6 hours constituted a significant risk factor for asthenopia compared to never using the device for recreational purposes (OR = 29.207, P < 0.05; OR = 39.086, P < 0.05; OR = 21.815, P < 0.05, respectively). Accordingly, using the device between 2 and 4 hours increases the risk of asthenopia 29 times, using the device between 4 and 6 hours increases the risk of asthenopia 39 times, and using the device for more than 6 hours increases the risk of asthenopia 21 times compared to never using the device for recreational purposes [Table 3].

Preventive measures and their relationship with asthenopia

All of the participants in the study stated that they took at least one preventive measure. The most used preventive measures were adjustable screens with 57.7% (n = 135) and regular breaks with 42.7% (n = 100), while the least used preventive measure was eye drops with 5.6% (n = 13). None of the preventive measures had a significant effect on asthenopia [Table 3].

Discussion

Asthenopia, called eye strain, is common among people who frequently use digital devices. A recent study found that 75.6% of respondents experienced asthenopia, with the most commonly reported symptom being eye strain (37.6%) and the least reported symptom being dry eye (16.2%). This prevalence is essential because it highlights the shared nature of asthenopia among digital device users.[9,17]

The study also investigated demographic characteristics associated with asthenopia. In particular, gender was found to influence the development of asthenopia significantly; women were 3.385 times more likely to develop the condition than men. This finding aligns with previous research suggesting that women are more susceptible to visual fatigue due to various physiological and occupational factors.[12,18] Factors such as age, type of university, level of education, and field of study were not significantly associated with asthenopia, suggesting that these variables do not play a crucial role in the development of the condition.

Regarding the use of corrective eyewear, the study found that wearing eyeglasses alone increased the risk of asthenopia by 4.645 times compared to not wearing any corrective lenses. This finding is consistent with studies in the literature.[19,20,21] In addition, publications are showing that contact lens wear increases the severity of eye discomfort in patients with asthenopia; contact lenses irritate the ocular surface, create an unstable tear film, and alter the blink rate.[22,23]

Furthermore, inappropriate prescription or prolonged wear of spectacles without a break can increase eye strain, underscoring the need for appropriate eye care practices among spectacle wearers.[21]

Our study also examined the association between digital device use and asthenopia. Interestingly, the study found that neither phones and tablets nor desktops and laptops pose a significant risk for developing asthenopia.[6] Moreover, daily digital device use, device use in the dark, and years of digital device use were not significantly associated with asthenopia. This finding contradicts recent studies that have increasingly reported dry eye among young people and prolonged considerably screen use, regardless of content.[24] Several recent studies in children suggest that hours of daily screen use can predict symptoms of discomfort.[25,26,27] Emerging evidence suggests a link between the onset of extended screen use at an early age and structural changes in ocular surface health, some of which are irreversible.[28]

One of the most notable findings was the protective effect of using digital devices for studying. The study showed that using digital devices for the survey for less than 2 hours, between 2 and 4 hours, and between 4 and 6 hours significantly reduced the likelihood of developing asthenopia compared to not using the devices for studying at all. This finding contradicts the study’s results by Sawaya et al.[29] We can attribute this protective effect to more frequent breaks from recreational use and better ergonomic practices while studying.

In contrast, using digital devices for recreational purposes for more than 2 hours significantly increased the risk of asthenopia. Participants who used their devices for entertainment for 2-4 hours, 4-6 hours, and more than 6 hours were 29 times, 39 times, and 21 times more likely to develop asthenopia, respectively, compared to those who did not use their devices. This finding aligns with other studies suggesting that recreational screen time is a significant risk factor for digital eye strain due to prolonged screen exposure and less frequent breaks.[30,31]

Finally, the study investigated the effectiveness of various preventive measures for asthenopia. While most participants took preventive measures such as adjustable screens and regular breaks, none of these measures significantly reduced asthenopia. This result contradicts other studies showing that preventive measures are effective.[32,33] A recent meta-analysis said that taking preventive measures may not reduce eye strain and that using an adjustable chair and ergonomic training, blink animations, and omega-3 supplementation improved signs and symptoms. Taking frequent breaks was associated with fewer symptoms, but it is emphasized that no study has evaluated the widely recommended 20-20-20 rule.[34]

Conclusion and Recommendations

In conclusion, the findings of this study highlight the high prevalence of asthenopia among digital device users and identify important demographic and usage-related factors associated with this condition. The protective effect of using digital devices for studying and the increased risk associated with recreational use provide essential information for developing targeted interventions to reduce eye strain. Future research should continue exploring asthenopia’s multifaceted nature and develop preventive strategies to improve eye health in the digital age. Given the high prevalence of asthenopia among university students, it is essential to implement effective strategies to mitigate this condition. Based on our findings, we recommend the following measures:

• 1.Promote the 20–20–20 Rule
• 2.Optimize Study Environments
• 4.Use of Protective Eyewear
• 5.Educational Campaigns
• 6.Regular Eye Examinations
• 7.Further Research: Support further research on the long-term effects of digital device use on eye health and the development of more comprehensive prevention strategies.

By adopting these recommendations, universities can help reduce the incidence of asthenopia and promote better eye health among students, enhancing their academic performance and overall well-being.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.