RESEARCH ARTICLE


The Impact of Excessive Use of Digital Devices During the Pandemic of Corona Virus Disease (COVID-19) Among Saudi Arabia Population



Abdulrahman A. Almuhwwis1, *, Abdulelah A. Alshumaym2, Majid A. Moafa3, Mohammed Alluwimi3, Mansour A. Alghamdi4, Saif Hassan Alrasheed3
1 Hayat National Hospital, Riyadh, Saudi Arabia
2 Department of Optometry, Magrabi Hospital, Jeddah, Saudi Arabia
3 Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
4 Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia


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Creative Commons License
© 2022 Almuhwwis et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Hayat National Hospital, Riyadh, Saudi Arabia; Tel: 00966557191881, E-mail: Od.3bdulr7man@gmail.com


Abstract

Background:

A substantial increase in using digital devices was observed among the population due to staying at home as a result of the quarantine during the coronavirus pandemic. Consequently, ocular symptoms appeared due to spending several hours of screen time per day.

Objective:

The current study aimed to assess the impact of excessive use of digital devices during the pandemic of coronavirus among the Saudi population.

Methods:

A community-based cross-sectional study was carried out from November 2020 to January 2021 among the Saudi population. Data were collected by using Ocular Surface Disease Index (OSDI) questionnaires for the assessment of symptoms related to dry eye and their effect on vision. A logistic regression model was used to evaluate the association between the risk factors and the symptoms of dry eye. SPSS 22nd edition was used, any p-value <0.05 was considered significant.

Results:

Out of 1573 participants, 93.8% used mobile, 42.4% experienced uncomfortable sensitivity to the light. There were 49.15% of the participants who showed that none of the time they felt blurry vision, 54.8% did not report double vision, and 30.5% who felt a headache recently after quarantine. About 48% of the participants did not have any ocular symptoms, while 52% had dry eye symptoms (mild 22.3%, moderate 13.7%, and severe 15.9%). When the logistic regression model of risk factors associated with severe symptoms of dry eye was applied, wearing a contact lens was the most significant variable (p<0.0001).

Conclusion:

Dry eye symptoms increased during the quarantine, which indicated that the digital device users need to learn more about the preventive measures from practitioners in eye healthcare. More studies are warranted to assess the impact of digital device usage on all age groups starting from children up to the elderly population.

Keywords: Coronavirus lockdown, Dry eye symptoms, Digital devices, Quarantine, OSDI , Digital eye strain.



1. INTRODUCTION

The COVID-19 pandemic has had a tremendous impact on our everyday lives. Most people are quarantined at home, leading to an increase in near work and the use of smart devices, both of which create visual difficulties. Computer Vision Syndrome (CVS) has been identified in roughly 60 million people worldwide, according to a 2016 study [1]. CVS is a group of visual and extraocular symptoms linked to the continuous use of Visual Display Terminals (VDTs) [2]. Some of these common symptoms include visual and ocular symptoms, sensitivity to light, asthenopia, musculoskeletal symptoms, and other general symptoms [3]. Some of these visual symptoms are related to blurry vision, such as post-work distance blurred vision, constant and intermittent blurred vision, the most Ocular surface symptoms are itching, foreign body sensation, and burning sensation [2, 3].

People who spend more than 4 hours every day in front of a VDT are more likely to develop dry eye diseases [3]. This ocular symptom is often caused by dysfunctions of the meibomian gland [3]. Some of the patient's ocular complaints include excessive blinking and tearing [4]. According to a previous study, the prevalence of asthenopia is estimated to be approximately 55% and 81% among gadget users, the condition causes several binocular anomalies, including near point of convergence removal, phoria deviation in the near vision, and some accommodative responses can be inaccurate [2]. These responses are temporary and do not have any permanent effects on accommodation responses [5]. Musculoskeletal symptoms, such as neck, back, and shoulder pain, are associated with the prolonged use of computers [2]. VDT users in previous studies [6-8] showed that eye-related symptoms are the most common health problems [6-8]. All the previously described symptoms of CVS are included in the American Optometric Association clinical definition as “the combination of eye and vision problems associated with the use of computers[9, 10]. Asthenopia is considered the most common complaint in patients with CVS. Asthenopia symptoms include strained and tired eyes, ocular surface-related symptoms include dry eyes, watery eyes, irritation, redness, and foreign body sensation, also visual-related symptoms include blurred and double vision [8-10].

In 2008, study results of over 400 computer operators in India reported asthenopic symptoms almost in 46.3% of participants [11]. A study of 35 Mexican computer terminal workers found an even higher prevalence of symptoms, with 68% of the subjects experiencing symptoms due to prolonged VDT [12]. In addition, a study in Australia of more than 1000 computer workers showed that 63% of the subject's reported symptoms of uncontrolled conditions; this number decreased to 25.2% after some adjustments that include the introduction of an optimized ergonomic desk and more frequent work breaks [13]. It is not clear yet if asthenopia symptoms caused by extended computer usage are related to age [11, 13, 14]. Females appear to have a higher prevalence as compared to males [15, 16].

While the electronic screen represents one visual target, a hard paper copy can also behave as a visual target. However, the evidence shows that the two forms of the target presented are not equivalent to each other. For instance, [17] the performance of subjects on an editing task with the material presented either as a VDT or in hard copy form. the evidence shows that with the hard copy presented, subjects make fewer errors and perform the task faster as compared with the VDT subjects. Other studies have reported matching results with fewer errors made by participants when viewing printed materials [18-20]. According to the Sixth European Working Conditions Survey, almost more than 50% of European workers use VDTs at work, with 37% using VDTs no less than three-quarters of the workday [8, 21, 22]. Therefore, the impact of VDTs on ocular health is a relevant area of study. However, the studies published so far have a huge limitation in evaluating CVS through invalidated or unstructured questionnaires, which include different symptoms according to the author and imprecise definitions of when the subjects should be characterized as symptomatic, tremendously compromising the findings of the studies [23-25]. Therefore, the current study aimed to assess the impact of excessive use of digital devices during the pandemic of coronavirus among the Saudi population.

2. MATERIALS AND METHODS

2.1. Design and Setting

A community-based cross-sectional study was administered between November 2020 and January 2021 to the Saudi Arabian population. Informed consent was obtained from each participant.

2.2. Participants

The study was conducted among the Saudi Arabian population both gender (males and females) was considered.

2.3. Inclusion Criteria

The inclusion criteria included subjects living in Saudi Arabia during the pandemic, aged between 10 to 70 years. Those who excessively use electronic digital devices for more than 4 hours per day. Both males and females were included. The exclusion criteria were any subjects suffering from the following:

  • Rheumatology disease.
  • Any ocular surgery.
  • Age younger than 10 and above 70 years.
  • Any refractive surgery.

2.4. Data Collection Procedures

Data were collected using a validated questionnaire in Arabic consisting of 35 questions administered. It included questions pertaining to the signs and symptoms related to eye dryness, digital eye strain, and some general symptoms related to musculoskeletal symptoms and the participant’s medical history [26-28]. The questionnaire was checked and evaluated by eye care professionals (optometrists and ophthalmologists) and tested with a pilot study of 50 subjects to reduce the bias during the process of data collection.

2.5. Ethical Clearance

Ethical clearance for the study was obtained from the Biomedical Ethics Committee at qassim health cluster ministry of health. The study was conducted according to the Declaration of Helsinki guidelines. Informed consent was taken from the participants before completing the questioners. All collected data were kept confidential and used only for research purposes. In addition, the questionnaires did not include participants’ names, file numbers, and mobile phone numbers. All participants had the right to stay or withdraw from the study.

2.6. Sampling

The study samples were calculated by the following formula: n=(Z^(2 ) P(1-P))/d^2 where n = sample size, Z = at the 95% confidence level = 1.96., P= expected prevalence or proportion, d=maximum acceptable sampling error. The final sample for this study was estimated to be 1825 participants. However, about 1573 approved to fill our online self-administered questionnaire that assesses the prevalence and risk factors for dry eye, giving a response rate of 86.2%.

2.7. Data Analysis

Statistical analyses were conducted using SPSS 22nd edition. Quantitative variables are presented as mean ± SD and compared using the Mann-Whitney U test and Kruskal-Wallis test. The chi-square test was used to compare qualitative variables expressed as frequency and percentage. A logistic regression model was used to assess risk factors for developing dry eye, while the Spearman correlation test was used to correlate age with the ocular surface disease index (OSDI) score. Statistical significance was set at p <0.05.

3. RESULTS

3.1. Demographic Characteristics of the Participants (N=1573)

A total of 1573 participants were approved to fill out our online self-administered questionnaire that assesses the prevalence and risk factors for dry eye. The sample comprised 869(56%) females and 668(44%) males with a mean age of 29.39± 9.86 (range, 10 to 70 years as shown in Tables 1, 2 and Fig. (1). Most of the participants (93.8%) used mobile, while 79.4% did not use the computer. On the other hand, approximately 93.1% did not practice hand worker drawing, 87.5% did not utilize reading or writing, and most did not play electronic games (86.2%).

Fig. (1). Histogram showing age distribution among participants.

Table 1. The ranges of all data of the participants.
Variable N Range Minimum Maximum Sum Mean Std. Deviation
Age 1537 54 10 70 45180 29.39 9.868
SUM A 1537 20 0 20 5585 3.63 3.920
SUM B 1537 16 0 16 3726 2.42 3.268
SUM C 1537 12 0 12 3514 2.29 2.796
SUM D 1537 28 0 28 16824 10.95 6.518
OSDI 1537 92 0 92 26718 17.3 17.278
Mobile 1537 1 0 1 1441 .94 .242
Computer 1537 1 0 1 316 .21 .404
Hand work draw 1537 1 0 1 106 .07 .253
Reading or writing 1537 1 0 1 192 .12 .331
Electronic games 1537 1 0 1 212 .14 .345
Table 2. Demographics and usage of electronic devices.
Characteristics N %
Age 10-20 523 33.2
21-50 757 48.1
51-70 293 18.7
Gender Female 869 56.5%
Male 668 43.5%
Mobile No 96 6.2%
Yes 1441 93.8%
Computer No 1221 79.4%
Yes 316 20.6%
Hand worker draw No 1431 93.1%
Yes 106 6.9%
Reading or writing No 1345 87.5%
Yes 192 12.5%
Electronic games No 1325 86.2%
Yes 212 13.8%

Table 3 shows component A of the OSDI score, 42.4% some of the times have experienced about eyes are sensitive to light. Most of the participants during quarantine had no experience (none of the time) regarding eyes that feel gritty, painful, or sore eyes, blurred vision, or poor vision (65.8%, 69.2%, 52.1%, and 56.2%, respectively). Component A score at Mean ±SD (4±4).

Table 4 shows component B of the OSDI score, most of the participants showed that none of the time their eyes limited them in performing reading, driving a night, working on a computer or ATM, or watching TV during the quarantine (65.9%, 70.2%, 64.4%, or 58.4%, respectively). Component B score at Mean ±SD (2±3).


Table 3. component A of OSDI score.
Question N %
Have you experienced any of the following during Quarantine (Eyes that are sensitive to light?) All the time 61 4.0%
Half of the time 119 7.7%
Most of the time 138 9.0%
None of the time 568 37.0%
Some of the time 651 42.4%
Have you experienced any of the following during Quarantine (Eyes that feel gritty?) All the time 26 1.7%
Half of the time 67 4.4%
Most of the time 46 3.0%
None of the time 1011 65.8%
Some of the time 387 25.2%
Have you experienced any of the following during Quarantine (Painful or sore eyes?) All the time 29 1.9%
Half of the time 73 4.7%
Most of the time 59 3.8%
None of the time 1063 69.2%
Some of the time 313 20.4%
Have you experienced any of the following during Quarantine (Blurred vision?) All the time 164 10.7%
Half of the time 107 7.0%
Most of the time 0 0.0%
None of the time 801 52.1%
Some of the time 465 30.3%
Have you experienced any of the following during Quarantine (Poor vision?) All the time 89 5.8%
Half of the time 108 7.0%
Most of the time 70 4.6%
None of the time 864 56.2%
Some of the time 406 26.4%
Component A score 4 4

Table 4. component B of OSDI score.
Question N %
Have your eyes limited you in performing any of the following during the quarantine? (Reading) All the time 52 3.4%
Half of the time 89 5.8%
Most of the time 50 3.3%
None of the time 1013 65.9%
Some of the time 333 21.7%
Have your eyes limited you in performing any of the following during the quarantine? (Driving at night) All the time 53 3.4%
Half of the time 64 4.2%
Most of the time 65 4.2%
None of the time 1079 70.2%
Some of the time 276 18.0%
Have your eyes limited you in performing any of the following during the quarantine? (Working on a computer or ATM) All the time 40 2.6%
Half of the time 86 5.6%
Most of the time 91 5.9%
None of the time 990 64.4%
Some of the time 330 21.5%
Have your eyes limited you in performing any of the following during the quarantine? (Watching TV) All the time 63 4.1%
Half of the time 110 7.2%
Most of the time 86 5.6%
None of the time 897 58.4%
Some of the time 381 24.8%
Component B score 2 3

Table 5 represents component C of the OSDI score, most of the participants showed that none of the time their eyes felt uncomfortable during the quarantine in windy conditions, places with low humidity (very dry), or in areas that are air-conditioned (51.9%, 64.2%, or 59.5%, respectively). Component C score at Mean ±SD (2±3).

Table 6 represents component D of the OSDI score; most of the participants showed that none of the time they felt blurry vision recently (even with glasses if they have it), felt for a second’s double vision, felt increased in emotions and nervousness recently, or felt a headache recently after quarantine (49.1%, 54.8%, 25.6%, and 30.5%, respectively). Other participants showed that half of the time, they felt pain in the neck, shoulders, and back recently, felt tired and exhausted at the end of the day, or felt sleepy most of the day recently (30.1%, 26.9%, and 23%, respectively). Component D score at Mean ±SD (11±7).

Table 5. Component C of OSDI score.
Question N %
Have your eyes felt uncomfortable in any of the following situations during the quarantine? (Windy conditions) All the time 101 6.6%
Half of the time 120 7.8%
Most of the time 107 7.0%
None of the time 797 51.9%
Some of the time 412 26.8%
Have your eyes felt uncomfortable in any of the following situations during the quarantine? (Places with low humidity (very dry)) All the time 52 3.4%
Half of the time 110 7.2%
Most of the time 82 5.3%
None of the time 987 64.2%
Some of the time 306 19.9%
Have your eyes felt uncomfortable in any of the following situations during the quarantine? (Areas that are air-conditioned) All the time 83 5.4%
Half of the time 110 7.2%
Most of the time 88 5.7%
None of the time 915 59.5%
Some of the time 341 22.2%
Component C score 2 3
Table 6. Component D of OSDI score.
Question (Choose the answers that best suit your situation from the beginning until the end of the home quarantine) N %
Do you feel blurry vision recently? (even with glasses if you have it?) All the time 54 3.5%
Half of the time 296 19.3%
Most of the time 80 5.2%
None of the time 754 49.1%
Some of the time 353 23.0%
Do you feel for a second’s double vision? All the time 39 2.5%
Half of the time 228 14.8%
Most of the time 78 5.1%
None of the time 843 54.8%
Some of the time 349 22.7%
Do you feel pain in the neck, shoulders, and back recently? All the time 228 14.8%
Half of the time 463 30.1%
Most of the time 307 20.0%
None of the time 272 17.7%
Some of the time 267 17.4%
Do you feel tired and exhausted at the end of the day? All the time 270 17.6%
Half of the time 414 26.9%
Most of the time 296 19.3%
None of the time 287 18.7%
Some of the time 270 17.6%
Do you feel sleepy most of your day recently? All the time 261 17.0%
Half of the time 354 23.0%
Most of the time 330 21.5%
None of the time 296 19.3%
Some of the time 296 19.3%
Do you feel increased your emotions and nervousness recently? All the time 213 13.9%
Half of the time 323 21.0%
Most of the time 276 18.0%
None of the time 394 25.6%
Some of the time 331 21.5%
Do you feel a headache recently after quarantine? All the time 171 11.1%
Half of the time 332 21.6%
Most of the time 264 17.2%
None of the time 469 30.5%
Some of the time 301 19.6%
Component D score 11 7

Table 7 shows the risk factors for developing dry eye, 85.3% of the participants did not smoke, all the participants were not diagnosed with arthritis. Moreover, 96.2% were not diabetics and 91.3% did not have high cholesterol in the blood. Most of the participants (97.7%) did not take aspirin, 98.4% did not take antidepressant medications, 71.5% did not take multivitamins. Higher percentages of the participants (61.1%) drink caffeine (coffee, tea, power drinks, soft drinks), 84.9% did not use contact lenses, and all the participants did not undergo LASIK surgery before.

Table 7. Risk factors for developing dry eye.
Question N %
Do you smoke? No 1311 85.3%
Yes 226 14.7%
Have you been diagnosed with arthritis? No 1537 100.0%
Yes 0 0.0%
Do you have diabetes mellitus? No 1479 96.2%
Yes 58 3.8%
Do you have any thyroid diseases? No 1462 95.1%
Yes 75 4.9%
Do have high cholesterol in the blood? No 1403 91.3%
Yes 134 8.7%
Do you take aspirin? No 1502 97.7%
Yes 35 2.3%
Do you take antidepressant medications? No 1512 98.4%
Yes 25 1.6%
Do you take multivitamins? No 1099 71.5%
Yes 438 28.5%
Do you drink caffeine (coffee, tea, power drinks, soft drinks)? No 598 38.9%
Yes 939 61.1%
Do you use contact lenses? No 1305 84.9%
Yes 232 15.1%
Did you have LASIK surgery before? No 1537 100.0%
Yes 0 0.0%

Table 8 shows a summary of OSDI score among respondents, 48% did not have any ocular symptoms and about 22.3% has mild ocular symptoms (Fig. 2).

Table 8. Summary of OSDI score among respondents.
Question Mean N %
OSDI score No symptoms 0 738 48.0%
Mild symptoms 1 343 22.3%
Moderate symptoms 2 211 13.7%
Severe symptoms 3 245 15.9%

Fig. (2). Bar chart showing the severity of dry eye among participants.

Table 9 represents the correlation between OSDI score and risk factors for developing dry eyes, a significant correlation was found between OSDI and age (Fig. 3), gender, having thyroid diseases, taking antidepressant medications, multivitamins, and use of contact lenses (p=0.02, p=0.003, p˂0.0001, p=0.01, p=0.02, and p˂0.0001, respectively) (Fig. 4).

Table 9. Correlation between OSDI score and risk factors for developing dry eyes.
Variables OSDI score P value
No symptoms Mild symptoms Moderate symptoms Severe symptoms
N % N % N % N %
Age (Mean ± SD) 30 10 29 10 29 11 10 30 0.02
Gender F 393 53.3 186 54.2 139 65.9 151 61.6 0.003
M 345 46.7 157 45.8 72 34.1 94 38.4
Do you smoke? No 628 85.1 295 86.0 182 86.3 206 84.1 0.89
Yes 110 14.9 48 14.0 29 13.7 39 15.9
Have you been diagnosed with arthritis? No 738 100 343 100 211 100 245 100 NA
Yes 0 0.0 0 0.0 0 0.0 0 0.0
Do you have diabetes mellitus? No 713 96.6 336 98.0 199 94.3 231 94.3 0.05
Yes 25 3.4 7 2.0 12 5.7 14 5.7
Do you have any thyroid diseases? No 706 95.7 338 98.5 191 90.5 227 92.7 <0.001
Yes 32 4.3 5 1.5 20 9.5 18 7.3
Do have high cholesterol in the blood? No 673 91.2 316 92.1 186 88.2 228 93.1 0.27
Yes 65 8.8 27 7.9 25 11.8 17 6.9
Do you take aspirin? No 718 97.3 341 99.4 203 96.2 240 98.0 0.06
Yes 20 2.7 2 0.6 8 3.8 5 2.0
Do you take antidepressant medications? No 728 98.6 342 99.7 206 97.6 236 96.3 0.01
Yes 10 1.4 1 0.3 5 2.4 9 3.7
Do you take multivitamins? No 529 71.7 260 75.8 153 72.5 157 64.1 0.02
Yes 209 28.3 83 24.2 58 27.5 88 35.9
Do you drink the caffeine (coffee, tea, power drinks, soft drinks)? No 283 38.3 133 38.8 81 38.4 101 41.2 0.87
Yes 455 61.7 210 61.2 130 61.6 144 58.8
Do you use contact lenses? No 655 88.8 296 86.3 165 78.2 189 77.1 <0.001
Yes 83 11.2 47 13.7 46 21.8 56 22.9
Did you have LASIK surgery before? No 738 100 343 100 211 100 245 100 NA
Yes 0 0.0 0 0.0 0 0.0 0 0.0
Fig. (3). Box plot showing age distribution based on the severity of symptoms of dry eye.

Fig. (4). Bar chart showing the percentage of patients with risk factors of developing dry eye based on the severity of their symptom.

Table 10 shows a comparison of mean OSDI score based on risk factors, gender, having thyroid diseases, taking multivitamins, and use of contact lens showed a significant difference (p<0.0001, p=0.009, p=0.028, and p<0.0001, respectively) (Figs. 5, 7).

Table 10. Comparison of mean OSDI score based on risk factors.
- OSDI P-Value
Mean Standard Deviation
Gender Female 18.6 17.4 <0.0001
Male 15.8 17.0
Do you smoke? No 17.4 17.2 0.58
Yes 17.2 17.7
Have you been diagnosed with arthritis? No 17.4 17.3 NA
Yes . .
Do you have diabetes mellitus? No 17.3 17.2 0.30
Yes 20.3 19.3
Do you have any thyroid diseases? No 17.1 17.0 0.009
Yes 23.3 21.2
Do have high cholesterol in the blood? No 17.4 17.4 0.35
Yes 17.4 15.6
Do you take aspirin? No 17.4 17.3 0.96
Yes 17.8 18.2
Do you take antidepressant medications? No 17.2 17.1 0.13
Yes 25.7 23.4
Do you take multivitamins? No 16.9 17.1 0.028
Yes 18.7 17.6
Do you drink caffeine (coffee, tea, power drinks, soft drinks)? No 18.2 19.0 0.94
Yes 16.9 16.1
Do you use contact lenses? No 16.4 16.7 <0.0001
Yes 23.0 19.3
Did you have LASIK surgery before? No 17.4 17.3 NA
Yes . .
Fig. (5). Histogram OSDI score among respondents.

Fig. (6). Box plot showing OSDI score distribution based on wearing contact lenses.


Table 11. Spearman correlation test between age and OSDI score.
Variables Spearman correlation coefficient P-value
Age and OSDI score r= -0.059 0.02


A significant correlation was found between age and the OSDI score (p=0.02) (Fig. 8 and Table 11).

Fig. (7). Box plot showing OSDI score distribution based on presence of thyroid disease.

Fig. 8. Scatter plot showing correlation between the OSDI score and age.

Table 12. Logistic regression model of risk factors associated with severe symptoms of dry eye.
- Correlation Coefficient Standard error Wald df P value OR 95% CI
Male 0.19 0.12 2.55 1 0.11 1.21 0.96 - 1.53
Smoking -0.09 0.16 0.35 1 0.56 0.91 0.67 - 1.24
Diabetes mellitus -0.40 0.29 1.94 1 0.16 0.67 0.38 - 1.18
Thyroid disease -0.24 0.25 0.92 1 0.34 0.79 0.49 - 1.28
High Cholesterol level -0.02 0.19 0.01 1 0.93 0.98 0.67 – 1.43
Aspirin intake 0.44 0.36 1.50 1 0.22 1.56 0.77 - 3.16
Antidepressant intake -0.39 0.42 0.86 1 0.35 0.68 0.30 – 1.54
Multivitamin’s intake 0.09 0.12 0.59 1 0.44 1.10 0.87 - 1.39
High Caffeine consumption 0.11 0.11 1.06 1 0.30 1.12 0.90 - 1.38
Wearing contact lenses -0.56 0.16 12.56 1 <0.0001 0.57 0.42 – 0.78
Constant 0.99 0.64 2.39 1 0.12 2.70
Table 13. Ordinal logistic regression model of electronic devices associated with severe symptoms of dry eye.
- Correlation Coefficient Standard Error Wald df P value OR 95% CI
Mobile 0.07 0.22 0.10 1 0.76 1.07 0.70 – 1.65
Computer 0.22 0.13 2.91 1 0.09 1.25 0.97 – 1.61
Hand worker draw -0.25 0.21 1.44 1 0.23 0.78 0.51 – 1.17
Reading or writing -.015 0.16 0.88 1 0.35 0.86 0.63 – 1.17
Electronic games 0.08 0.15 0.25 1 0.62 1.08 0.80 – 1.45
Constant 0.00 0.22 0.00 1 0.98 1.00

Table 12 shows the logistic regression model of risk factors associated with severe symptoms of dry eye, wearing contact lens was the most significant variables (p<0.0001), OR 0.57 (95% CI, 0.42 – 0.78).

Table 13 shows the ordinal logistic regression model of electronic devices associated with severe dry eye symptoms; there was no significant association (p˃0.05) between using electronic devices and severe symptoms of dry eye.

4. DISCUSSION

During the coronavirus pandemic, many people were quarantined at home to maintain social distance and avoid spreading the disease [7-10]. Accordingly, smart devices were used increasingly for prolonged periods, causing a potential upswing in CVS, an umbrella term for several visual disorders that affect 60 million people worldwide [12-17]. People are more likely to experience the risk of dry eye disease and the disruptive symptoms that go along with it if they work in front of a VDT for more than 4 hours per day [1, 2, 3]. Therefore, the current study aimed to assess the impact of excessive use of digital devices on the eyes during the coronavirus pandemic in the Saudi population.

The results of these studies showed that approximately 94% of the participants used a mobile phone. Nearly half of the participants (48%) did not have any symptoms of eye dryness while 52% experienced eye dryness symptoms (22.3% had mild, 13.7% had moderate, and 15.9% had severe symptoms), according to the OSDI score. It was reported that most of the participants did not feel foreign body sensations, pain, strained eyes, blurred vision, or poor vision during quarantine. Their eyes did not limit them from doing their daily activities of reading, driving at night, working on a computer, or even watching TV. The majority did not recently experience blurry vision or momentary double vision. These findings agree with previous studies that reported that mobile phones were the most used digital devices among all age groups during coronavirus lockdown [26, 27]. A previous study reported that the prevalence of asthenopia symptoms was higher among women than men, which is in line with our study results; among those who had mild symptoms, 54.2% were females, and 45.8% were males [15, 16].

Our results showed a significant association between age and the development of eye dryness symptoms (p=0.02), which disagreed with other studies in which there was no association between asthenopia symptoms and the age of the subjects [11, 13, 14]. Additionally, the current study showed a significant correlation between eye dryness and sex, having thyroid diseases, taking antidepressant medications, taking multivitamins, and using contact lenses. However, a logistic regression model of risk factors associated with severe dry eye symptoms revealed that wearing contact lenses was the most significant variable (p<0.0001) among the participants. A previous study reported several symptoms of eye dryness among mobile device users during the coronavirus lockdowns [11-20]. These symptoms, such as watering eyes, dry eyes, shoulder pain, headache, and back pain, were significantly associated with hours of using digital devices per day (p<0.05). Pain behind the eyes and itching eyes are the major symptoms among participants engaged in digital activities for prolonged periods. Additionally, some subjects complained of excessive tears and a high blinking rate due to the long-time use of digital devices [4]. Previous studies reported that the prevalence of asthenopia ranged from 55% to 81% among gadget users [5].

The prolonged use of gadgets may result in several binocular anomalies, such as the deficiency of near point of convergence, phoria deviation in near vision, and inaccurate accommodative responses [2-7]. All these modifications are temporary but do not have any permanent effect on accommodation. Prolonged use of digital devices has been reported to increase the prevalence of dry eye symptoms. A study reported that approximately 91% of the participants experienced dryness symptoms associated with excessive digital device usage, but this percentage was much higher than another study conducted in 2014 hence, the prevalence of symptoms was 81.9% and 78.6% for engineering students and medical college students, respectively [28]. This significant shift occurred due to the increase in the duration of digital device usage of the participants during coronavirus lockdown, estimated to be an average of 8.9 ± 3.63 hours of usage per day [28].

Facial masks are commonly used during the pandemic of coronavirus and this may be associated with increased dry eye and ocular symptoms [29]. However, in the current study, the facial mask was not considered a factor for assessing the dry eye symptom may have been considered as a limitation of this study. The current study has some limitations. First, it was a community-based cross-sectional study and was conducted online; consequently, the collected data was sometimes incomplete. To decrease the bias of the questionnaire, incomplete questionnaires were excluded from the final report. Furthermore, the participant response rate was slightly low, which reflects that not all the invited participants participated in the study. Second, the current study did not consider the facial mask as a factor for assessing the dry eye symptom may have been considered a limitation of this study All the above-mentioned limitations notwithstanding, the current study provides information about the impact of excessive use of digital devices during the pandemic of coronavirus among the Saudi population.

CONCLUSION

This study highlighted the potential increase in the use of different digital devices during the coronavirus pandemic lockdown and its adverse impact on ocular health among different age groups. There was a significant association found between age and development of eye dryness symptoms, with eye dryness symptoms increasing during quarantine. The previous findings suggest that it is important for digital device users to learn preventive measures from practitioners in eye healthcare, in order to reducd the effect of eye dryness. More studies should be conducted to assess the impact of digital device usage on all age groups, starting from children up to the elderly population.

LIST OF ABBREVIATIONS

OSDI = Ocular Surface Disease Index

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

Ethical clearance for the study was obtained from the Biomedical Ethics Committee of qassim health cluster ministry of health.

HUMAN AND ANIMAL RIGHTS

No Animals were used that are the basis of this study. all the human procedures were conducted according to the Declaration of Helsinki guidelines.

CONSENT FOR PUBLICATION

Informed consent has been taken from the participants before completing the questionnaires. All collected data were kept confidential and used only for research purposes. In addition, the questionnaires did not include participants’ names, file numbers, and mobile phone numbers. All participants had the right to stay or withdraw from the study.

STANDARDS OF REPORTING

STROBE guidelines were followed for this study.

AVAILABILITY OF DATA AND MATERIALS

Not applicable.

FUNDING

None.

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Declared none.

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