Pseudo-Myopia and Screen Time: A Pre and Post Cycloplegic Refractive Evaluation of Children age 4–16 years

Purpose: to examine the magnitude of pseudo-myopia in relation to preand post-cycloplegic refractive status among individuals aged 4 to 16 years and to investigate the relationship of pseudo myopia and screen time in said population.

Material and methods. Study included 66 subject’s right eyes of 48 % males, 52 % females aged 4–16 with mean and standard deviation of 10.0 ± 3.40. This comparative crosssectional study was conducted at the department of ophthalmology Tertiary Care Hospital, Islamabad. Consecutive non-randomized sampling techniques was adopted. Screen time duration in hours was measured using self-report or screen time tracking applications in smartphones. Visual acuity (VA) was measured with a standard Log MAR chart. Pre and post cycloplegic refraction with retinoscopy and Auto-refractometer were performed using Tropicamide 1 %. Paired t test was applied for pre and post cycloplegic refraction change, while Pearson correlational analysis was also calculated. Descriptive statistics were calculated using SPSS Version 21.

Results. Average screen time was 5.6 ± 1.5 hours, outdoor activity was 50.6 ± 27.3 minutes. Pre-dilation VA improved from 0.3 ± 0.3 to 0.05 ± 0.14 log MAR post-dilation. The mean spherical equivalent refractive error in pre-dilation state was –4.1 ± 2.2 D, while in post-dilation it was 0.76 ± 0.8 D. The differences were significant (p<0.01). A statistically significant relationship found between screen exposure time and pseudo-myopia (r=0.41, p<0.001).

Conclusion. Increasing screen time is associated with pseudo-myopia. Prolonged screen exposure led to increased pseudo-myopia in low myopes and hyperopes.

1. García-Montero M, Felipe-Márquez G, Arriola-Villalobos P, Garzón N. Pseudo-myopia: a review. Vision. 2022 Mar 4; 6 (1): 17. https://doi.org/10.3390/vision6010017

2. Flitcroft DI, He M, Jonas JB, et al. IMI-Defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies. Invest Ophthalmol Vis Sci. 2019 Feb 28; 60 (3): M20–30. https://doi.org/10.1167/iovs.18-25957

3. Kaštelan S, Gverović-Antunica A, Pelčić G, et al. Refractive changes associated with diabetes mellitus. Seminars in Ophthalmology. 2018 Nov 17; 33 (7–8): 838–45. doi: 10.1080/08820538.2018.1519582

4. Riedl P, Škiljić D, Arnell P, et al. Myopic shift and lens turbidity following hyperbaric oxygen therapy–a prospective, longitudinal, observational cohort study. Acta Ophthalmologica. 2019 Sep; 97 (6): 596–602. https://doi.org/10.1111/aos.14010

5. de Jong PT. Myopia: its historical contexts. Br J Ophthalmol. 2018 Aug 1; 102 (8): 1021–7. https://doi.org/10.1136/bjophthalmol-2017-311625

6. Khalid K, Padda J, Pokhriyal S, et al. Pseudo-myopia and its association with anxiety. Cureus. 2021 Aug 24; 13 (8). https://doi.org/10.7759/cureus.17411

7. Peinado GA, Sanz PM, Del Cerro Pérez I, de Liaño Sánchez PG. Unilateral accommodation spasm: Case report and literature review. Archives de la Sociedad Española de Ophtalmología (English Edition). 2019 Jun 1; 94 (6): 285–7. https://doi.org/10.1016/j.oftale.2019.01.008

8. Sun W, Yu M, Wu J, et al. Pseudo-myopia as an independent risk factor for myopia onset: a prospective cohort study among school-aged children. Br J Ophthalmol. 2024 May 21; 108 (6): 873–8. doi: 10.1136/bjo-2022-322330

9. Kang MT. Refractive characteristics of pseudo-myopia and its association with myopia progression: Anyang Childhood Eye Study. Invest Ophthalmol Vis Sci. 2019 Jul 22; 60 (9): 5849. https://iovs.arvojournals.org/article.aspx?articleid=2745015

10. Gifford KL, Richdale K, Kang P, et al. IMI–clinical management guidelines report. Invest Ophthalmol Vis Sci. 2019 Feb 28; 60 (3): M184–203. https://doi.org/10.1167/iovs.18-25977

11. Jin P, Zhu J, Zou H, et al. Screening for significant refractive error using a combination of distance visual acuity and near visual acuity. PLoS One. 2015 Feb 17; 10 (2): e0117399. https://doi.org/10.1371/journal.pone.0117399

12. Tarutta EP, Proskurina OV, Tarasova NA, Markosyan GA. Analysis of risk factors that cause myopia in pre-school children and primary school students. Health Risk Analysis. 2019; (3): 26–33. doi: 10.21668/health.risk/2019.3.03.eng

13. Lin Z, Vasudevan B, Liang YB, et al. The association between near workinduced transient myopia and progression of refractive error: a 3-year cohort report from Beijing myopia progression study. J Optom. 2021; 14: 44–9. https://doi.org/10.1016/j.optom.2020.05.004

14. Kaur K, Gurnani B, Kannusamy V. Myopia: Current concepts and review of literature. TNOA J Ophthalmic Sci Res. 2020 Oct 1; 58 (4): 280. doi: 10.4103/tjosr.tjosr_85_20

15. Sanfilippo PG, Chu BS, Bigault O, et al. What is the appropriate age cut-off for cycloplegia in refraction? Acta ophthalmologica. 2014 Sep; 92 (6): e458–62. https://doi.org/10.1111/aos.12388

16. Kang M-T, Jan C, Li S, et al. Prevalence and risk factors of pseudo-myopia in a Chinese children population: the anyang childhood eye study. Br J Ophthalmol. 2021; 105: 1216–21. https://doi.org/10.1136/bjophthalmol-2020-316341

17. Rupali SP, Ghosh S, Singh PK. Incidence of accommodative excess reported at binocular vision therapy clinic of a tertiary Eye Care Centre among school children during pandemic lockdown. J Opto Ophth. 2022; 3 (1): 1–1. https://doi.org/10.37191/Mapsci-JOO-3(1)-02

18. Li T, Zhou X, Zhu J, Tang X, Gu X. Effect of cycloplegia on the measurement of refractive error in Chinese children. Clinical and Experimental Optometry. 2019 Mar 1; 102 (2): 160. https://doi.org/10.1111/cxo.12829

19. Hu YY, Wu JF, Lu TL, et al. Effect of cycloplegia on the refractive status of children: the Shandong children eye study. PLoS One. 2015 Feb 6; 10 (2): e0117482. https://doi.org/10.1371/journal.pone.0117482

20. Hopkins S, Sampson GP, Hendicott P, Lacherez P, Wood JM. Refraction in children: a comparison of two methods of accommodation control. Optometry and Vision Science. 2012 Dec 1; 89 (12): 1734–9. doi: 10.1097/OPX.0b013e318277182c

21. Mimouni M, Zoller L, Horowitz J, et al. Cycloplegic autorefraction in young adults: is it mandatory? Graefes Arch Clin Exp Ophthalmol. 2016 Feb; 254 (2): 395–8. doi: 10.1007/s00417-015-3246-1

22. Ip JM, Saw SM, Rose KA, et al. Role of near work in myopia: Findings in a sample of Australian school children. Invest Ophthalmol Vis Sci. 2008 Jul; 49 (7): 2903–10. doi: 10.1167/iovs.07-0804

23. Gwiazda JE, Hyman L, Hussein M, et al. A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children. Invest Ophthalmol Vis Sci. 2003 Apr; 44 (4):1492–500. doi: 10.1167/iovs.02-0816