Smartphone Use Associated with Refractive Error in Teenagers: The Myopia App Study

  • The purpose of this study is to investigate the association between smartphone use and refractive error in teenagers using the Myopia app.

  • A cross-sectional population-based study was conducted with a total of 525 teenagers 12 to 16 years of age from 6 secondary schools and from the birth cohort study Generation R participated.

  • A smartphone application (Myopia app; Innovattic) was designed to measure smartphone use and face-to-screen distance objectively and to pose questions about outdoor exposure. 

  • Participants underwent cycloplegic refractive error and ocular biometry measurements. 

  • Mean daily smartphone use was calculated in hours per day and continuous use as the number of episodes of 20 minutes on screen without breaks. 

  • Linear mixed models were conducted with smartphone use, continuous use, and face-to-screen distance as determinants and spherical equivalent of refraction (SER) and axial length-to-corneal radius (AL:CR) ratio as outcome measures stratified by median outdoor exposure.

  • Dutch teenagers spent almost 4 hours per day on their smartphones. 

  • Episodes of 20 minutes of continuous use were associated with more myopic refractive errors, particularly in those with low outdoor exposure. 

  • This study suggested that frequent breaks should become a recommendation for smartphone use in teenagers. 

  • Future large longitudinal studies will allow more detailed information on safe screen use in youth.

Publication date

September 11, 2021




Enthoven CA, Polling JR, Verzijden T, Tideman JWL, Al-Jaffar N, Jansen PW, Raat H, Metz L, Verhoeven VJM, Klaver CCW
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