Impact of Excessive Screen Use on Strabismic Anomalies of Binocular Vision in Children and Young Adults

Abstract

The pervasive use of digital devices for education and recreation is linked to a rising incidence of binocular vision anomalies, particularly heterophoria, in children and young adults. This retrospective cross-sectional study investigated the relationship between excessive screen use and heterophoria, specifically esophoria and exophoria, in 40 patients aged 5-30 years with best-corrected visual acuity of 6/9 or better. Participants were categorized into exophoria (n=30) and esophoria (n=10) groups and measurements included the magnitude of phoria (prism diopters, PD), near point of convergence (NPC), and near point of accommodation (NPA) along with daily screen time exposure data. The mean age was 18.2 ± 6.1 years, with a female predominance (62.5%) and average screen sreen time was 5.1 ± 2.3 hours/day. Females had higher odds of esophoria (OR=3.1, p=0.02), while screen time positively correlated with near phoria magnitude (r=0.32, p=0.04) and negatively with NPC (r= 0.41, p= 0.008).Esophoria was associated with shorter NPC (7.6 ± 1.1 cm vs. 9.8 ± 2.1 cm, p=0.003) and NPA (8.2 ± 1.3 cm vs. 10.3 ± 2.3 cm, p=0.02), and a higher prevalence of myopia (66.7% vs. 33.3%, p=0.04), while astigmatism was more prevalent in exophoria (66.7% vs. 33.3%, p=0.04). Regression analysis showed that each additional hour of screen time increased near phoria by 0.5 PD (p=0.01). these findings indicate that excessive screen exposure is significantly associated with heterophoria, reduced convergence, and specific refractive errors, particularly in females, underscoring the importance of early screening, visual hygiene education, and preventive measure to mitigate long term binocular vision complications.