Digital eye strain (DES) is an entity encompassing visual and ocular symptoms arising due to the prolonged use of digital electronic devices. It is characterized by dry eyes, itching, foreign body sensation, watering, blurring of vision, and headache. Non-ocular symptoms associated with eye strain include stiff neck, general fatigue, headache, and backache. A variable prevalence ranging from 5 to 65% has been reported in the pre-COVID-19 era. With lockdown restrictions during the pandemic, outdoor activities were restricted for all age groups, and digital learning became the norm for almost 2 years. While the DES prevalence amongst children alone rose to 50-60%, the symptoms expanded to include recent onset esotropia and vergence abnormalities as part of the DES spectrum. New-onset myopia and increased progression of existing myopia became one of the most significant ocular health complications. Management options for DES include following correct ergonomics like reducing average daily screen time, frequent blinking, improving lighting, minimizing glare, taking regular breaks from the screen, changing focus to distance object intermittently, and following the 20-20-20 rule to reduce eye strain. Innovations in this field include high-resolution screens, inbuilt antireflective coating, matte-finished glass, edge-to-edge displays, and image smoothening graphic effects. Further explorations should focus on recommendations for digital screen optimization, novel spectacle lens technologies, and inbuilt filters to optimize visual comfort. A paradigm shift is required in our understanding of looking at DES from an etiological perspective, so that customized solutions can be explored accordingly. The aim of this review article is to understand the pathophysiology of varied manifestations, predisposing risk factors, varied management options, along with changing patterns of DES prevalence post COVID-19. 

https://link.springer.com/content/pdf/10.1007/s40123-022-00540-9.pdf

Digital Eye Strain- A Comprehensive Review

Background In Alpine regions, which are very similar due to their topographical location and their wide-ranging sports offerings, the restrictions on sports activities during the COVID-19 pandemic differed in type and level: while in some regions (Tyrol, South Tyrol, Trentino), all sports activities were forbidden except for walking near the home, in other regions (Upper Bavaria, Vorarlberg), people were allowed to go hiking and running during the first lockdown. Objective The aim of this study was to investigate the change in physical activity (PA) behavior in different Alpine regions (Upper Bavaria, Vorarlberg, Tyrol, South Tyrol, Trentino) over four periods in 2020, to examine the effects of COVID-19 measures of varying severity on PA behavior and to identify factors associated with a change in PA over time. Methods A retrospective online survey was conducted (N = 2975) from December 2020, to January 2021. Using the questionnaire of the Eurobarometer 472 study, PA behavior was measured over four periods: before COVID-19 (March), during the first lockdown (March and April), during the relaxed period (May-October) and during the second lockdown (November and December) in 2020. Results During the first (M = 5.0h, SD = 4.5) and the second lockdowns (M = 4.9h, SD = 4.3), the participants (age: 42 years, overly active in sports) engaged less in sports than before (M = 5.9h, SD = 4.8) and during the relaxed period in summer (M = 6.4h, SD = 5.0) (average number of hours per week being physically active). A larger percentage of participants from Alpine regions with severe restrictions (Tyrol, South Tyrol, Trentino) decreased their PA during the first lockdown as compared to participants from Upper Bavaria and Vorarlberg with a less strict first lockdown. Those with psychological distress, male participants, and individuals with decreased physical health and less free time during COVID-19 were more likely to reduce their PA. Conclusions Despite a short-term negative effect of COVID-19 restrictions on exercise participation during lockdowns, the majority of respondents returned to their original levels of PA during the relaxed COVID-19 phases. As a comparison of Alpine regions shows, particularly severe COVID-19 measures seem to have reduced PA with potential negative health effects. For the future, policy makers and sports organizations should collaborate to support the population in their PA behavior during pandemics to outweigh restrictions.

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Physical Activity Behavior During and After COVID-19 Stay-at-Home Orders—A Longitudinal Study in the Austrian, German, and Italian Alps

https://doi.org/10.1016/j.jad.2022.01.034

Brief, parent-led, transdiagnostic cognitive-behavioral teletherapy for youth with emotional problems related to the COVID-19 pandemic

Eye strain when performing tasks reliant on a digital environment can cause discomfort, affecting productivity and quality of life. Digital eye strain (the preferred terminology) was defined as "the development or exacerbation of recurrent ocular symptoms and/or signs related specifically to digital device screen viewing". Digital eye strain prevalence of up to 97% has been reported, due to no previously agreed definition/diagnostic criteria and limitations of current questionnaires which fail to differentiate such symptoms from those arising from non-digital tasks. Objective signs such as blink rate or critical flicker frequency changes are not 'diagnostic' of digital eye strain nor validated as sensitive. The mechanisms attributed to ocular surface disease exacerbation are mainly reduced blink rate and completeness, partial/uncorrected refractive error and/or underlying binocular vision anomalies, together with the cognitive demand of the task and differences in position, size, brightness and glare compared to an equivalent non-digital task. In general, interventions are not well established; patients experiencing digital eye strain should be provided with a full refractive correction for the appropriate working distances. Improving blinking, optimizing the work environment and encouraging regular breaks may help. Based on current, best evidence, blue-light blocking interventions do not appear to be an effective management strategy. More and larger clinical trials are needed to assess artificial tear effectiveness for relieving digital eye strain, particularly comparing different constituents; a systematic review within the report identified use of secretagogues and warm compress/humidity goggles/ambient humidifiers as promising strategies, along with nutritional supplementation (such as omega-3 fatty acid supplementation and berry extracts). 

TFOS lifestyle: Impact of the digital environment on the ocular surface.

Background Mass outbreaks such as pandemics are associated with mental health problems requiring effective psychological interventions. Although several forms of psychological interventions may be advocated or used, some may lack strong evidence of efficacy and some may not have been evaluated in mass infectious disease outbreaks. This paper reports a systematic review of published studies (PROSPERO CRD:42020182094. Registered: 24.04.2020) examining the types and effectiveness of psychological support interventions for the general population and healthcare workers exposed to mass infectious disease outbreaks. Methods A systematic review was conducted. Randomised Controlled Trials (RCT) were identified through searches of electronic databases: Medline (Ovid), Embase (Ovid), PsycINFO (EBSCO) and the Cochrane Library Database from inception to 06.05.2021 using an agreed search strategy. Studies were included if they assessed the effectiveness of interventions providing psychological support to the general population and / or healthcare workers exposed to mass infectious disease outbreaks. Studies were excluded if they focused on man-made or natural disasters or if they included armed forces, police, fire-fighters or coastguards. Results Twenty-two RCTs were included after screening. Various psychological interventions have been used: therapist-guided therapy (n = 1); online counselling (n = 1); 'Emotional Freedom Techniques' (n = 1); mobile phone apps (n = 2); brief crisis intervention (n = 1); psychological-behavioural intervention (n = 1); Cognitive Behavioural Therapy (n = 3); progressive muscle relaxation (n = 2); emotional-based directed drawing (n = 1); psycho-educational debriefing (n = 1); guided imagery (n = 1); Eye Movement Desensitization and Reprocessing (EMDR) (n = 1); expressive writing (n = 2); tailored intervention for patients with a chronic medical conditions (n = 1); community health workers (n = 1); self-guided psychological intervention (n = 1), and a digital behaviour change intervention (n = 1). Meta-analyses showed that psychological interventions had a statistically significant benefit in managing depression (Standardised Mean Difference [SMD]: -0.40; 95% Confidence Interval [CI]: - 0.76 to - 0.03), and anxiety (SMD: -0.72; 95% CI: - 1.03 to - 0.40). The effect on stress was equivocal (SMD: 0.16; 95% CI: - 0.19 to 0.51). The heterogeneity of studies, studies' high risk of bias, and the lack of available evidence means uncertainty remains. Conclusions Further RCTs and intervention studies involving representative study populations are needed to inform the development of targeted and tailored psychological interventions for those exposed to mass infectious disease outbreaks.

The effectiveness of psychological support interventions for those exposed to mass infectious disease outbreaks: a systematic review.

BACKGROUND: The COVID-19 pandemic has led to worldwide school closures, with millions of children confined to online learning at home. As a result, children may be susceptible to anxiety and digital eye strain, highlighting a need for population interventions. OBJECTIVE: The objective of our study was to investigate whether a digital behavior change intervention aimed at promoting physical activity could reduce children's anxiety and digital eye strain while undergoing prolonged homeschooling during the COVID-19 pandemic. METHODS: In this cluster randomized controlled trial, homeschooled grade 7 students at 12 middle schools in southern China were recruited through local schools and randomly assigned by the school to receive (1:1 allocation): (1) health education information promoting exercise and ocular relaxation, and access to a digital behavior change intervention, with live streaming and peer sharing of promoted activities (intervention), or (2) health education information only (control). The primary outcome was change in self-reported anxiety score. Secondary outcomes included change in self-reported eye strain and sleep quality. RESULTS: On March 16, 2020, 1009 children were evaluated, and 954 (94.5%) eligible children of consenting families were included in the intention-to-treat analysis. Children in the intervention (n=485, 6 schools) and control (n=469, 6 schools) groups were aged 13.5 (SD 0.5) years, and 52.3% (n=499) were male. The assigned interventions were completed by 896 children (intervention: n=467, 96.3%; control: n=429, 91.5%). The 2-week change in square-root-transformed self-reported anxiety scores was greater in the intervention (-0.23, 95% CI -0.27 to -0.20) vs control group (0.12, 95% CI 0.09-0.16; unadjusted difference -0.36, 95% CI -0.63 to -0.08; P=.02). There was a significant reduction in square-root-transformed eye strain in the intervention group (-0.08, 95% CI -0.10 to 0.06) compared to controls (0.07, 95% CI 0.05-0.09; difference -0.15, 95% CI -0.26 to -0.03; P=.02). Change in sleep quality was similar between the two groups. CONCLUSIONS: This digital behavior change intervention reduced children's anxiety and eye strain during COVID-19-associated online schooling. TRIAL REGISTRATION: ClinicalTrials.gov NCT04309097; http://clinicaltrials.gov/ct2/show/NCT04309097.

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A Peer-to-Peer Live-Streaming Intervention for Children During COVID-19 Homeschooling to Promote Physical Activity and Reduce Anxiety and Eye Strain: Cluster Randomized Controlled Trial.

To investigate the relationships among child psychological abuse and neglect (CPAN), children’s learning engagement, family socioeconomic status (family SES), and children’s academic achievement, 271 children (Mage = 9.41 ± 0.81 years old) and their parents participated in this study with a longitudinal design. Results revealed that learning engagement at T1 mediated the relationship between CPAN at T1 and academic achievement at T2 when gender, age, grade, and academic achievement at T1 were under control. Family SES at T1 moderated the relationship between children’s learning engagement at T1 and academic achievement at T2. The association between learning engagement and academic achievement was stronger among children from lower family SES. Our findings highlighted the negative impact of CPAN and the critical role of learning engagement in children’s academic achievement, especially for those from low SES families.

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Longitudinal Association Between Child Psychological Abuse and Neglect and Academic Achievement in Chinese Primary School Children: A Moderated Mediation Model

Haoning Liu

Papers

A Peer-to-Peer Live-Streaming Intervention for Children During COVID-19 Homeschooling to Promote Physical Activity and Reduce Anxiety and Eye Strain: Cluster Randomized Controlled Trial.

Longitudinal Association Between Child Psychological Abuse and Neglect and Academic Achievement in Chinese Primary School Children: A Moderated Mediation Model

Training and asymmetrical transfer effects of working memory and inhibitory control in primary school children.

More than visual-spatial skills: The important role of phonological awareness in mathematical abilities among Chinese primary school children