Authors:
K. Réz Department of Clinical Ophthalmology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary

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Z. Z. Nagy Department of Clinical Ophthalmology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
Department of Ophthalmology, Faculty of General Medicine, Semmelweis University, Budapest, Hungary

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Abstract

Purpose

The aim of the study was to analyse the use of digital devices among children.

Materials/Methods

A specially designed questionnaire was distributed to 249 schoolchildren to assess their use of digital devices both in school and outside school. The questionnaire was used before the start of the COVID-19 pandemic. The children were asked about the extent of their use of digital devices, as well as about ophthalmic and general health complaints. Their responses were assessed statistically.

Results

Regarding age distribution, 145 children were between seven and 10 years old when they started to use digital devices. Most of the children used a digital device for between one and two hours a day. The majority preferred using smartphones. The second most popular devices were laptops and tablets, and the third most popular was the desktop computer. Fifty-six children wore glasses, 14 to correct hyperopia and 42 to correct myopia. 97 children spent between one and two hours a day outdoors; 99 children spent more than two hours outdoors; and 51 spent less than one hour outdoors. 71 children reported eye problems; 48 reported other general health problems (back and neck pain); and 43 mentioned blurred vision while using a digital device.

Conclusions

The use of digital devices can be regarded as general among schoolchildren, and most children use a digital device for longer than the recommended time. Excessive use of digital devices may contribute to an increase in the prevalence of myopia and other general eye and back problems.

Abstract

Purpose

The aim of the study was to analyse the use of digital devices among children.

Materials/Methods

A specially designed questionnaire was distributed to 249 schoolchildren to assess their use of digital devices both in school and outside school. The questionnaire was used before the start of the COVID-19 pandemic. The children were asked about the extent of their use of digital devices, as well as about ophthalmic and general health complaints. Their responses were assessed statistically.

Results

Regarding age distribution, 145 children were between seven and 10 years old when they started to use digital devices. Most of the children used a digital device for between one and two hours a day. The majority preferred using smartphones. The second most popular devices were laptops and tablets, and the third most popular was the desktop computer. Fifty-six children wore glasses, 14 to correct hyperopia and 42 to correct myopia. 97 children spent between one and two hours a day outdoors; 99 children spent more than two hours outdoors; and 51 spent less than one hour outdoors. 71 children reported eye problems; 48 reported other general health problems (back and neck pain); and 43 mentioned blurred vision while using a digital device.

Conclusions

The use of digital devices can be regarded as general among schoolchildren, and most children use a digital device for longer than the recommended time. Excessive use of digital devices may contribute to an increase in the prevalence of myopia and other general eye and back problems.

Introduction

For practical purposes, names have been assigned to generations born within a specified timespan and sharing a similar lifestyle. A generation typically ranges from 15 to 25 years, depending on how quickly changes in the environment, social customs and regulations occur. Members of the generation born before 1945 are usually referred to as “Veterans”, while those born between 1946 and 1964 are known as “Baby Boomers”. The name “Generation X” is given to those born between 1965 and 1979; “Generation Y” refers to those born between 1980 and 1994; while “Generation Z” is the cohort born between 1995 and 2009. People born after 2010 are known as “Generation Alpha”.

“Generation Z” can be characterised as “influencers”. Access to computer and mobile phone technology makes this the first global generation. Members of this cohort can easily connect with one another digitally, and travelling is no longer necessary to find out about the world. Digital knowledge is in their genes; they started using computers and mobile phones at a very young age and are very comfortable with social media, the internet, and mobile networks. They may form virtual communities, and one person may be a member of several such communities at the same time.

Between 50% and 70% of members of “Generation Alpha”, who are sometimes referred to as “Digital Babies”, started using digital devices while still at kindergarten and are proficient at surfing the internet [1]. As many as 30% of them were already using a tablet by two years of age and in 10% of cases, their first word was “tablet”. They are adept at playing video games, although this has major drawbacks, such as aggression and behavioural problems. One of the positive results of playing video games is improved spatial orientation. However, frequent use of digital devices can reduce the development of auditory and visual organisation in children.

The question therefore arises as to whether the use of digital devices by children is in fact an issue that needs to be addressed. The answer is definitely yes, considering that our skeletal motor and oculomotor systems were not anatomically developed to use such devices. In developed countries, almost all children are now growing up in front of a television, computer, or smartphone screen. The amount of screen time is very important. Between the ages of six and 10, the recommended maximum time for the use of digital devices is 45–60 min per day [1–3].

The uncontrolled use of digital devices may lead to the development of computer vision syndrome (CVS) in children, where the healthy development of the central nervous system and visual system is disrupted. Psychiatric disturbances may also arise [2, 3].

The very early and long-term use of digital devices may cause a significant increase in myopia among children globally [4, 5]. It may lead to functional impairments in the visual system, such as abnormal binocular vision, which may cause amblyopia in one eye [3]. It is estimated that by 2050, the number of people with myopia will have risen to five billion [6, 7].

Regarding the anatomical functioning of the human vertebral column, in a person standing straight, a weight of 5 kg (10–12 lbs) is supported by the vertebrae. If the head tilts anteriorly by 15°, this weight increases to 12 kg (27 lbs). If the head tilts by 30°, the load will be 18 kg (40 lbs); if the tilt is 45° the load will be 22 kg (49 lbs); and if the tilt is 60°, the load will be as much as 27 kg (60 lbs). This amount of weight on the neck will lead to pain, headaches, and muscle tension, and may induce other degenerative processes as well (Fig. 1) [8].

Fig. 1.
Fig. 1.

Load on the vertebral column with different degrees of head tilt

Source: Surgical Technology International.

Citation: Developments in Health Sciences 2024; 10.1556/2066.2023.00051

Participants and methods

The aim of this study was to assess the following factors among schoolchildren:

  • The age at which they start using digital devices

  • The most popular digital devices

  • How many of them are spending more than one to two hours in front of a computer/mobile phone screen

  • How many of them need glasses to correct myopia, hyperopia, or astigmatism

  • How much time they are spending outside in the fresh air

  • How many of them have eye problems, such as burning, itching, or a feeling of grit or sand in the eye

  • How many of them experience blurred vision while looking at a screen

  • How many of them have back or neck pain

Children between the ages of six and 15 attending a primary school in Budapest were examined in the study. The sample comprised 120 girls and 129 boys. All of them had filled out a valid questionnaire. The questionnaires were distributed in printed form between January and February 2020. In the second part of the study, the authors will focus on the effects of COVID-19 on teaching methods, online education, self-learning, and the use of Zoom and Teams software. The data were submitted to the Department of Information Technology and assessed using Excel.

Results

Figure 2 shows the age distribution of the schoolchildren in terms of digital device use: 86 were between three and six years of age when they started using digital devices; 145 were between seven and 10 years of age; and 14 were between 11 and 12 years of age.

Fig. 2.
Fig. 2.

Distribution according to age at which digital devices were first used (years)

Notes. N/A refers to the response “I don't know”.

Citation: Developments in Health Sciences 2024; 10.1556/2066.2023.00051

Figure 3 shows the amount of time spent per day using digital devices. Most of the children used a digital device for between one and two hours each day. There were some extremes, but prior to the COVID-19 pandemic, most of the children used a digital device for between one and four hours daily.

Fig. 3.
Fig. 3.

Frequency of number of hours spent using digital devices per day

Notes. N/A refers to the response: “I don't know”.

Citation: Developments in Health Sciences 2024; 10.1556/2066.2023.00051

Figure 4 shows children's preferences in terms of digital devices. Most preferred smartphones (they are handy, have a camera, and are easily connected to the internet and Wi-Fi). The second most popular devices were laptops and tablets, and the third most popular was the desktop computer.

Fig. 4.
Fig. 4.

Children's preferences in terms of digital devices

Citation: Developments in Health Sciences 2024; 10.1556/2066.2023.00051

With respect to sight correction, 56 children wore glasses, 14 of them to correct hyperopia and 42 to correct myopia.

Figure 5 shows the amount of time spent outdoors: 97 children spent one to two hours outside each day; 99 children spent more than two hours in the open air; and 51 spent less than one hour outside.

Fig. 5.
Fig. 5.

Frequency of amount of time spent outdoors

Notes. N/A refers to the response “I don't know”.

Citation: Developments in Health Sciences 2024; 10.1556/2066.2023.00051

Figure 6 presents the physical complaints mentioned by the children: 71 reported eye problems (burning eyes or “sand” in the eyes); 48 reported other problems (back and neck pain); and 43 mentioned vision problems, such as blurred vision while using a digital device.

Fig. 6.
Fig. 6.

Frequency of physical complaints

Citation: Developments in Health Sciences 2024; 10.1556/2066.2023.00051

Discussion

With advances in digital technology, the importance of vision is growing year by year. For members of the “Veterans” generation, mid-range distance vision and near vision were still adequate. Amblyopia was not usually detected and treated until adulthood. Regular assessment of vision was not a prerequisite for working, with the exception of drivers. Generation X could, or had to, access computer technology at a later age, while Generations Y and Z had to start using computer technology at kindergarten [1, 2]. Generation Alpha, or digital babies, started using digital technology even earlier. According to ophthalmic refractive studies, children are spending less and less time outdoors [9]. They are exposed mostly to artificial light rather than natural daylight outdoors. They obtain information through digital devices and typically communicate with each other through digital devices [5]. Personal communication is disappearing: children do not know how to speak to each other, or how to address an envelope in order to send a letter. Friendships, and sometimes even relationships, start on the internet.

As people are spending most of their time indoors, looking at near distances, the incidence and severity of myopia may increase globally [3, 6]. According to European and global studies, the incidence of myopia has already increased in Europe and North America, from around 25% in Europe to up to 50% today. Society must pay attention to such shocking data. Fortunately, while low myopia is increasing, at present there is no significant statistical increase in high myopia, which involves severe fundus changes (peripheral degeneration, vitreous degeneration, retinal holes, subsequent retinal detachment, macular changes, etc.).

In China, some schools have started to devote attention to preventing an increase in myopia, installing glass roofs in classrooms in order to expose children to more natural light. The incidence of myopia in China and the countries of the Far East was already far higher than in Europe decades ago, possibly for anatomical, genetic, and educational reasons. Nevertheless, societies in developed countries must intervene to reduce the incidence of myopia by restricting the use of digital devices in schools and at home. There are already some examples of this, such as special Waldorf Schools, where the use of digital devices is confined to the classroom including break times, and where reducing the use of digital devices at home is also recommended.

The results presented in this study are based on data collected before the COVID-19 pandemic, when children were using digital devices less and when teaching took place in person at school rather than online. The use of digital devices was mostly between one and four hours a day, which was still higher than the recommended one hour, although in practice two hours is usually sufficient for good school achievement.

The children usually preferred smartphones (which are handy, have a camera, and are easy to connect to the internet and Wi-Fi). The second most popular devices were laptops and tablets, and the third most popular was the desktop computer. Fifty-six children needed sight correction: 14 for hyperopia, and 42 for myopia. Interestingly, 97 children spent between one and two hours outside each day, 99 children spent more than two hours outdoors, and 51 spent less than one hour outside. Physical complaints are also very important when assessing the complications of the excessive use of digital devices: 71 children reported eye problems, 48 back and neck pain, and 43 blurred vision during the use of digital devices.

Conclusions

This paper has highlighted some important problems, indicating that society, the school system, and parents must focus on restricting the use of digital devices in order to avoid related eye problems such as myopia, as well as other physical problems caused by an irregular and demanding posture.

In the next phase, the authors would like to focus on analysing problems related to COVID-19 during the months when online teaching became the standard form of education to avoid spreading the virus within society and schools. The present preliminary study has demonstrated the negative consequences of excessive use of digital devices in the younger generation, and it can be supposed that the COVID-19 pandemic may have worsened this scenario [10].

Authors’ contributions

KR was responsible for data extraction, statistical analysis, and writing the paper; ZZN was responsible for planning, writing, and correcting, and for guidance on the paper.

Ethical approval

The survey was carried out with the approval of the school principal and all the parents of the surveyed pupils.

Conflicts of interests

The authors have no conflicts of interest to declare.

References

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    Bremond-Gignac D. Myopie de l’enfant [Myopia in children]. Med Sci (Paris) 2020;36:763768. https://doi.org/10.1051/medsci/2020131. [Article in French].

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    Wang J, Li Y, Musch DC, Wei N, Qi X, Ding G, et al. Progression of Myopia in School-aged children after COVID-19 home confinement. JAMA Ophthalmol. 2021;139:293300. https://doi.org/10.1001/jamaophthalmol.2020.6239.

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  • 1.

    Friedrich M. Digitale Medien und Myopiemanagement bei Kita-Kindern – Früh vorbeugen, Eltern beteiligen [Digital media and myopia management in day-care children - prevent early, involve parents]. DOZ 2020;12:S70S73.

    • Search Google Scholar
    • Export Citation
  • 2.

    Friedrich M. Digitale Medien und Myopiemanagement bei Schulkindern – Digitale Endgeräte sinnvoll einsetzen [Digital media and myopia management in school children - Using digital devices wisely]. DOZ 2021;02:S66S70.

    • Search Google Scholar
    • Export Citation
  • 3.

    Friedrich M. Digitale Medien und Myopiemanagement bei Kindern – Grenzen setzen und Kompetenz altersgerecht aufbauen. [Digital media and myopia management in children - setting limits and building competence in an age-appropriate way]. DOZ 2021;03:S90S93.

    • Search Google Scholar
    • Export Citation
  • 4.

    webbeteg.hu. Ezt okozhatja a túlzott mobilozás és tabletezés [This can be caused by excessive mobile and tablet use]. Available from: https://www.webbeteg.hu/cikkek/mozgasszervi_betegseg/17018/mobil_gerincbantalmak_szem.

    • Search Google Scholar
    • Export Citation
  • 5.

    Németh J, Tapasztó B, Aclimandos WA, Kestelyn P, Jonas JB, De Faber JHN, et al. Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute. Eur J Ophthalmol 2021;31:853883. https://doi.org/10.1177/1120672121998960.

    • Search Google Scholar
    • Export Citation
  • 6.

    Chassine T, Villain M, Hamel CP, Daien V. How can we prevent myopia progression? Eur J Ophthalmol 2015;25:280285. https://doi.org/10.5301/ejo.5000571.

    • Search Google Scholar
    • Export Citation
  • 7.

    Xiong S, Sankaridurg P, Naduvilath T, Zang J, Zou H, Zhu J, et al. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmol 2017;95:551566. https://doi.org/10.1111/aos.13403.

    • Search Google Scholar
    • Export Citation
  • 8.

    Radesky JS, Christakis DA. Increased Screen time: Implications for early childhood development and behavior. Pediatr Clin North Am 2016;63:827839. https://doi.org/10.1016/j.pcl.2016.06.006.

    • Search Google Scholar
    • Export Citation
  • 9.

    Bremond-Gignac D. Myopie de l’enfant [Myopia in children]. Med Sci (Paris) 2020;36:763768. https://doi.org/10.1051/medsci/2020131. [Article in French].

    • Search Google Scholar
    • Export Citation
  • 10.

    Wang J, Li Y, Musch DC, Wei N, Qi X, Ding G, et al. Progression of Myopia in School-aged children after COVID-19 home confinement. JAMA Ophthalmol. 2021;139:293300. https://doi.org/10.1001/jamaophthalmol.2020.6239.

    • Search Google Scholar
    • Export Citation
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Senior Editors

Editor-in-Chief: Zoltán Zsolt NAGY
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Editorial Board

  • Zoltán BALOGH (Department of Nursing, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Klára GADÓ (Department of Clinical Studies, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • István VINGENDER (Department of Social Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Attila DOROS (Department of Imaging and Medical Instrumentation, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Judit Helga FEITH (Department of Social Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Mónika HORVÁTH (Department of Physiotherapy, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Illés KOVÁCS (Department of Clinical Ophthalmology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Ildikó NAGYNÉ BAJI (Department of Applied Psychology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Tamás PÁNDICS (Department for Epidemiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
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  • Lajos A. RÉTHY (Department of Family Care Methodology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • János RIGÓ (Department of Clinical Studies in Obstetrics and Gynaecology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Andrea SZÉKELY (Department of Oxyology and Emergency Care, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Márta VERESNÉ BÁLINT (Department of Dietetics and Nutritional Sicences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Gyula DOMJÁN (Department of Clinical Studies, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Péter KRAJCSI (Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • György LÉVAY (Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Csaba NYAKAS (Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Vera POLGÁR (Department of Morphology and Physiology, InFaculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • László SZABÓ (Department of Family Care Methodology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
  • Katalin TÁTRAI-NÉMETH (Department of Dietetics and Nutrition Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary)
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  • András FALUS (Department of Genetics, Cell- and Immunbiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary)
  • Zoltán UNGVÁRI (Department of Public Health, Faculty of medicine, Semmelweis University, Budapest, Hungary)
  • Romána ZELKÓ (Faculty of Pharmacy, Semmelweis University, Budapest, Hungary)
  • Mária BARNAI (Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary)
  • László Péter KANIZSAI (Department of Emergency Medicine, Medical School, University of Pécs, Pécs, Hungary)
  • Bettina FŰZNÉ PIKÓ (Department of Behavioral Sciences, Faculty of Medicine, University of Szeged, Szeged, Hungary)
  • Imre SEMSEI (Faculty of Health, University of Debrecen, Debrecen, Hungary)
  • Teija-Kaisa AHOLAAKKO (Laurea Universities of Applied Sciences, Vantaa, Finland)
  • Ornella CORAZZA (University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom)
  • Oliver FINDL (Department of Ophthalmology, Hanusch Hospital, Vienna, Austria)
  • Tamás HACKI (University Hospital Regensburg, Phoniatrics and Pediatric Audiology, Regensburg, Germany)
  • Xu JIANGUANG (Shanghai University of Traditional Chinese Medicine, Shanghai, China)
  • Paul GM LUITEN (Department of Molecular Neurobiology, University of Groningen, Groningen, Netherlands)
  • Marie O'TOOLE (Rutgers School of Nursing, Camden, United States)
  • Evridiki PAPASTAVROU (School of Health Sciences, Cyprus University of Technology, Lemesos, Cyprus)
  • Pedro PARREIRA (The Nursing School of Coimbra, Coimbra, Portugal)
  • Jennifer LEWIS SMITH (Collage of Health and Social Care, University of Derby, Cohehre President, United Kingdom)
  • Yao SUYUAN (Heilongjiang University of Traditional Chinese Medicine, Heilongjiang, China)
  • Valérie TÓTHOVÁ (Faculty of Health and Social Sciences, University of South Bohemia, České Budějovice, Czech Republic)
  • Tibor VALYI-NAGY (Department of Pathology, University of Illonois of Chicago, Chicago, IL, United States)
  • Chen ZHEN (Central European TCM Association, European Chamber of Commerce for Traditional Chinese Medicine)

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Developments in Health Sciences
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