Increase in ocular problems during COVID-19 pandemic in school going children- a survey based study

Dear Editor,

The Covid related pandemic has led to a sharp increase in our screen time, owing to virtual education, work from home, video conferences, online entertainment, gaming, shopping and video chatting with friends and family. “Screen time” refers to the duration of time spent by an individual in activities that involve peering at a digital screen. This pandemic has given rise to another pandemic of eye related issues.

This was a cross-sectional observational study, where-in an online questionnaire was circulated to parents of school going children via various social media platforms. The online portal was open till four weeks and responses till 1^stAugust, 2020 were taken into consideration. Children with history of contact lens use, ocular surgery or Covid-infection were excluded. Our study was approved by the ethical committee of our college.

A total of 872 responses were received out of which 840 responses were included in this study. Average age of the students whose parents participated in our survey was 12.53 years. Headache (n = 328) and rubbing of eyes (n = 320) were the most common ocular symptoms reported in children due to digital device use [Fig. 1]. As high as 55.23% (n = 464) parents denied presence of ocular symptoms before COVD19 related lockdown.

Figure 1.

Ocular symptoms experienced by school going due to digital device use

We found that mobile was the most preferred device [96%] used by children and also contributed to maximum screen time [P < 0.05] [Table 1] Online classroom education was the most common activity performed for prolonged hours on digital device followed by online surfing and web series and movies. [P = 2.34] [Table 2 An additional increase of more than two hours per day in screen time was reported by parents of up to 59.04% students (n = 496) with 4.76% (n = 40) reporting the increase to be as high as more than six hours per day. Parents of 34% children reported their kids indulging in wrong postures while working on their respective digital devices [Figure 2]. Around 13.8% (n = 120) students had their glass prescription changed and almost 3.8% (n = 32) started wearing glasses for the first time during this lockdown.

Table 1.

Division of screen time per digital device used per day as reported by parents of school going children

Digital devices	<1 h	1-2 h	2-4 h	4-6 h	>6 h	N/A
Mobile	160	240	192	128	88	32
Ipad/Tablet	336	72	64	80		288
Laptop/Computer	312	40	152	80	24	232
TV	184	376	176	64		40

Table 2.

Division of screen time per activity per day as reported by parents of school going children

Activity	<1 h	1-2 h	2-4 h	>4 h	N/A
Classroom webinar/online classes	88	176	328	248
Online surfing for education	456	160	48	56	120
Game	544	120	64	16	96
News Reading	640	24	8		168
Movies/series	376	200	80	8	176
Video chat with friends and family	592	80	8		160
Social media	528	144	8	8	152

Figure 2.

Postures preferred by students while using digital devices

Only a marginal percentage of 17.3% parents consulted ophthalmologist with regard to ocular problems in their kid. Regarding computer vision syndrome, 59.04% (n = 496) were completely unaware of ocular morbidities associated with increase in screen time. As high as 67.26% (n = 565) parents denied any guidance about the screen time use from either the institute or the teacher's side.

Human population has been largely confined indoors to maintain social distancing. Digital gadgets have become an indispensable part of our daily lives. Online entertainment services have reported 82% increase screen time spent daily.[1] Few studies[2] have suggested up to a 100% increase in screen time for children who attend classes online. The complex eye problems experienced during or after prolonged digital device use is known as “computer vision syndrome (CVS)”. Eye strain due to long screen use can result in disturbed ocular health and physical discomfort leading to tearing, tired eye, burning sensation, headache, blurred vision, redness, squinting, double vision, dryness or foreign body sensation in eyes. Secondary problems can be stiff neck, backache, vertigo and overall fatigue.

The most important thing required to treat or avoid digital eye strain is to establish a “good screen schedule”. As suggested by the parents in our survey, maintaining proper posture, distance and avoiding unnecessary indulgence in online content will help in reducing digital eye strain to much extent. Also, following 20-20-20 rule i.e., after every 20 minutes of screen time, taking a twenty second break and focussing eyes on something 20 feet away will not only reduce stress on eyes but also will keep individual active. Many parents 40% (n = 336) gave affirmation to disturbed sleep pattern in children. There are reports about the blue and violet light being emitted from the digital devices which may interrupt our circadian rhythm possibly causing sleep disturbances. So, it is better to take a break of at least two hours from digital devices before going to sleep and to activate the blue filter in the screen settings or wear anti-reflective blue blocker glasses. Also, screens should be cleaned regularly as dirt and dust may hamper the clarity of vision, thus increasing eye-strain.[3]

As high as 26.6% (n = 224) parents gave affirmation of some ocular problems suffered by their children but only 5.7% (n = 48) of parents sorted to ophthalmic visit or tele-consult. This reflects the lack of awareness and seriousness of parents towards ocular health related problems of their children. Impaired ocular health due to increased screen time can not only lead to dryness in the eyes but also myopia progression which may get accelerated due to rubbing of eyes as well. We found that 59.04% parents were unaware of any guidelines given to children regarding proper screen use and eye health. It is good that schools, teaching institutions and teachers a taking new initiatives so as children do not suffer academically during this pandemic, but it is also important for them to consider the children's vision needs, educate them about proper screen use and incorporate eye health strategies that will also protect the children while they gain from online education.

Though current generation is fortunate enough to have these connecting devices and technologies at hand, but one should also be smart enough to use them judiciously and not be their slaves. It is for the parents to give clear instructions regarding duration of screen time and abide by them, use parental controls and utilise this lockdown to encourage communication and build a healthy relationship between them and their children.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.