Association of Problematic Smartphone Use With Digital Eye Strain, Dry Eye Symptoms, and Sleep Quality Among High School Students
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Abstract
Background: Problematic smartphone use is increasingly common among adolescents and may contribute to digital eye strain, dry eye symptoms, reduced blink rate, and impaired sleep quality because of prolonged near-work demand, sustained screen fixation, and bedtime screen exposure. Objective: To determine the association of problematic smartphone use with digital eye strain, dry eye symptoms, blink-rate status, and sleep quality among high school students. Methods: This school-based cross-sectional observational study included 108 high school students aged 13–18 years from American Lycetuff Model Town, Lahore, Pakistan. Participants were selected using convenience sampling. Data were collected using a structured proforma, Smartphone Addiction Scale–Short Version, digital eye strain symptom checklist, Ocular Surface Disease Index, Pittsburgh Sleep Quality Index, Snellen visual acuity assessment, and blink-rate evaluation during smartphone viewing. Associations were analyzed using chi-square tests and Pearson correlation in SPSS version 26, with statistical significance set at p < 0.05. Results: Mean daily smartphone use was 5.42 ± 1.86 hours and mean total daily screen time was 7.73 ± 2.34 hours. Problematic smartphone use was present in 62 students (57.4%). Moderate/severe digital eye strain was more frequent among problematic users than normal users (77.4% vs 34.8%; OR 6.43, 95% CI 2.75–15.04; p = 0.001). Moderate/severe dry eye symptoms were also higher among problematic users (71.0% vs 28.3%; OR 6.21, 95% CI 2.67–14.43; p = 0.001). SAS-SV score was positively correlated with PSQI score (r = 0.462; p = 0.001). Conclusion: Problematic smartphone use was significantly associated with greater digital eye strain, more severe dry eye symptoms, and poorer sleep quality among high school students. School-based visual hygiene education, screen-break practices, and reduced bedtime smartphone exposure may help reduce ocular and sleep-related symptom burden.
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