Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia

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Understanding the link between myopia and screen media use is crucial for promoting children’s long-term eye health and mitigating the burden of myopia. Methods The study was a retrospective study design that investigated 94 complete medical records of myopic patients who had attended pediatric ophthalmology clinic at King Fahad University Hospital (KFUH) in Saudi Arabia between November 2021 and November 2023. Data was cleaned, coded and analyzed using SPSS version 20 to obtain important insights. Results The results revealed a statistically significant difference in total screen time between age groups (4–6 years, 7–9 years, and 10–12 years), with a p-value of 0.021. The most commonly used screen media devices among myopic children were smartphones (98.9%) and laptops (87.2%). Regression analysis indicated that the differences in screen time based on the children’s age at first use of screen media devices (smartphones, tablets, and laptops) were not statistically significant (p =0.196). Additionally, the study found a statistically significant association between patients’ age, the age at which they were first diagnosed with myopia, and their myopia category (p = 0.030 and p = 0.005, respectively). Conclusion The study established a significant association between myopia and screen use in pediatric patients, with total screen time increasing significantly with age. Smartphones and laptops were the most commonly used devices among myopic children. These findings highlight the need to understand the relationship between myopia and screen time in order to develop evidence-based guidelines for managing screen time, protecting children from the adverse effects of screen media exposure, and promoting their eye health and overall well-being. 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F1000Research 2025, 14 :148 ( https://doi.org/10.12688/f1000research.160914.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia [version 1; peer review: 3 approved with reservations] Noura AL Mulhim 1 , Maiadah AlFares 1 , Shahd AlMehrij https://orcid.org/0009-0002-4649-6630 2 , [...] Farah Al Haidar https://orcid.org/0009-0009-4044-1111 2 , Manar AlOmair 2 , Reem AlMutairi https://orcid.org/0009-0001-1469-8863 2 , Rafeef Abalkhail https://orcid.org/0009-0004-8433-8400 2 , Nazish Rafique 1 , Rabia Latif 1 , Lubna Al-Asoom 1 Noura AL Mulhim 1 , Maiadah AlFares 1 , [...] Shahd AlMehrij https://orcid.org/0009-0002-4649-6630 2 , Farah Al Haidar https://orcid.org/0009-0009-4044-1111 2 , Manar AlOmair 2 , Reem AlMutairi https://orcid.org/0009-0001-1469-8863 2 , Rafeef Abalkhail https://orcid.org/0009-0004-8433-8400 2 , Nazish Rafique 1 , Rabia Latif 1 , Lubna Al-Asoom 1 PUBLISHED 30 Jan 2025 Author details Author details 1 Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 31541, Saudi Arabia 2 College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 31541, Saudi Arabia Noura AL Mulhim Roles: Investigation, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing Maiadah AlFares Roles: Investigation, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing Shahd AlMehrij Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Farah Al Haidar Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Manar AlOmair Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Reem AlMutairi Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Rafeef Abalkhail Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Nazish Rafique Roles: Investigation, Methodology, Project Administration, Validation, Writing – Review & Editing Rabia Latif Roles: Investigation, Methodology, Project Administration, Validation, Writing – Review & Editing Lubna Al-Asoom Roles: Investigation, Methodology, Project Administration, Validation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Eye Health gateway. Abstract Background Pediatric myopia is a growing global public health concern, exacerbated by the increasing screen time among children, who spend more time on devices for both entertainment and education. Understanding the link between myopia and screen media use is crucial for promoting children’s long-term eye health and mitigating the burden of myopia. Methods The study was a retrospective study design that investigated 94 complete medical records of myopic patients who had attended pediatric ophthalmology clinic at King Fahad University Hospital (KFUH) in Saudi Arabia between November 2021 and November 2023. Data was cleaned, coded and analyzed using SPSS version 20 to obtain important insights. Results The results revealed a statistically significant difference in total screen time between age groups (4–6 years, 7–9 years, and 10–12 years), with a p-value of 0.021. The most commonly used screen media devices among myopic children were smartphones (98.9%) and laptops (87.2%). Regression analysis indicated that the differences in screen time based on the children’s age at first use of screen media devices (smartphones, tablets, and laptops) were not statistically significant (p =0.196). Additionally, the study found a statistically significant association between patients’ age, the age at which they were first diagnosed with myopia, and their myopia category (p = 0.030 and p = 0.005, respectively). Conclusion The study established a significant association between myopia and screen use in pediatric patients, with total screen time increasing significantly with age. Smartphones and laptops were the most commonly used devices among myopic children. These findings highlight the need to understand the relationship between myopia and screen time in order to develop evidence-based guidelines for managing screen time, protecting children from the adverse effects of screen media exposure, and promoting their eye health and overall well-being. READ ALL READ LESS Keywords Pediatrics, myopia, smartphone, public health, ophthalmology, screen time, Saudi Arabia, King Fahd University Hospital Corresponding Author(s) Shahd AlMehrij ( [email protected] ) Close Corresponding author: Shahd AlMehrij Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 AL Mulhim N et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: AL Mulhim N, AlFares M, AlMehrij S et al. Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia [version 1; peer review: 3 approved with reservations] . F1000Research 2025, 14 :148 ( https://doi.org/10.12688/f1000research.160914.1 ) First published: 30 Jan 2025, 14 :148 ( https://doi.org/10.12688/f1000research.160914.1 ) Latest published: 30 Jan 2025, 14 :148 ( https://doi.org/10.12688/f1000research.160914.1 ) Introduction and Literature review Myopia, commonly known as nearsightedness, is a major cause of visual disability. 1 The prevalence of myopia is increasing worldwide, especially in urbanized countries, where children are less likely to spend time outdoors. 2 By 2050, it is predicted that myopia would affect half of the population. 3 The estimated prevalence of refractive error in Saudi children was around 17.5%, out of which myopia prevalence was 40.8%. 4 In addition to the disease burden of myopia it also hinders academic performance of children, in two large scale studies in China, 5 , 6 it was concluded that the correction of myopia was linked with significant improvements in the academic performance of children. Myopia is caused by an increase in axial length of the eyeball, resulting in refractive error. In normal eyes, the image of distant objects is focused on photoreceptors in the retina, and the image of near objects is focused behind the photoreceptors, but it is corrected by the lens accommodation. While in myopic eyes the image of a distant object is focused in front of the photoreceptors and cannot be corrected even with the accommodation of the lens. 1 Myopia in childhood is the result of complex processes, one of them is emmetropisation, where refractive components of the eye balance each other to reach normal vision. As children are born hyperopic, correction occurs with growth when the eyeball elongates until it reaches normal vision. 7 Myopia develops when the elongation continues instead of stabilizing. The lens power also changes in childhood, to prevent the possible myopic shift caused by emmetropisation, but the decrease in lens power can continue, therefore causing myopia. 7 Several genetic and environmental risk factors have been strongly associated with the development of myopia, including outdoor activities, near work and family history. 8 Numerous studies have reported that children who spend more time outdoors and read at a proper distance of more than thirty centimeters for a period of less than thirty minutes, have a lower risk of developing myopia in comparison to those who do not. 9 , 10 Moreover, children of myopic parents are at a greater risk of being myopic as a study by Pan et al. 2012, has shown that the risk of myopia development increases two times if a child has one myopic parent. 8 The rise in digital use and concurrent eye complaints, such as eye strain and dry eye syndrome, have provoked investigations for the underlying pathogenesis and possible correlation. 11 Although there is insufficient evidence on the correlation of artificial light exposure with different eye conditions, several studies conducted on animals have explored the impact of light on the eyes. 12 – 14 The studies have concluded that light can damage the retina via three different mechanisms, photochemical, photo-thermal and photomechanical. Photochemical damage is associated with an oxidative process that results from exposure to light while photomechanical damage is dependent on the amount of energy. Photo-thermal damage occurs with high intensity light that raises the temperature of the tissues, subsequently causing damage. In addition, exposure to light is not only associated with physiological changes in the ocular surfaces but also found to have an effect on the circadian rhythm. 15 A systematic review and meta-analysis study by Foreman et al. 2021, was done to review the literature on the relationship between digital screen time and myopia through the appraisal of thirty-three existent literature. The study results concluded that smartphones alone, or with computer screen time, can be linked to a greater risk of developing myopia. 16 Moreover, another study was conducted in Spain by Alvarez et al. to assess the connection between screen and outdoor time and myopia rates among children. A thorough examination of the vision of 7,497 children between the ages of five and seven was done during the “Annual School Campaign for Children’s Visual Health” which was associated with children’s lifestyle, considering hours per day spent on digital devices and daily outdoor time. The results concluded that children with myopia reported more screen time and less outdoor time. 17 In another meta-analysis study from 2020, which included 14 studies, the total of participants was 27,110 ranging in age from 9.5 to 26.0 years. The aim was to evaluate whether using smartphones excessively causes visual impairments, the cross-sectional studies yielded a pooled odds ratio (OR) of 1.05, which indicates that excessive smartphone use is not extensively linked to myopia or blurred vision, but these ophthalmologic problems were more evident in children (OR 1.06) than in young adults (OR 0.91). 18 In addition, a different meta-analysis study from the same year was done to determine the association between screen time and the risk of developing myopia in children. The results were mixed, but notably the more recent included studies showed an association trend. 19 There are two recent Saudi studies published in 2023, one done in the city of Bisha reported the prevalence of myopia to be around 32.7% among schoolchildren, 20 while another one done in Jeddah found it to be 40.7% in children below the age of 14 years old. 21 In that study, the use of electronic devices was not a statistically significant risk factor, while the presence of family history in a first degree relative was associated with increased risk of myopia. Studies on myopia risk factors have been conducted, however in the last decade, myopia cases have increased steadily, along with the widespread use of electronic devices which led us to investigate if there is a link between them. The lack of solid and conclusive data regarding the correlation between children’s continuous usage of digital devices and the development of myopia in Saudi Arabia led us to build this project. The purpose of our study is to study the connection between the prolonged use of screen time and development of myopia in children between the ages of 4 and 12 in Saudi Arabia. Purpose To study the connection between the prolonged use of screen time and development of myopia in children between the ages of 4 and 12 in Saudi Arabia. Methods Subjects This is a retrospective case-control survey-based study, the duration of which was six months starting from November 2023 and ending in April 2024. A validated questionnaire from previous literature was used, the questionnaire was developed and validated by members of the center for Research in Childhood Health and Research unit for Exercise Epidemiology at the University of Southern Denmark, and media experts. It was tested on different samples and evaluated for validity and reliability. 22 The questionnaire measures the screen time which children spent in front of electronic screens, the number and type of electronic devices in the household, frequency of use by the child, type and purpose of device usually used, if smart screens are used at school, and the age at which the device was first introduced. The questionnaire is originally in the English language and was translated into Arabic by the research team following translation guidelines. 23 The Arabic questionnaire was validated using test-retest technique. Sample size was calculated to be 228, using the online epidemiological calculator Epitools, 24 with the expected proportion in controls being 0.05, and the assumed odds ratio 3.7, based on a study that found prolonged near work in school children to be significantly associated with myopia, 25 considering that screen use is near work. Confidence level was set at 95% and the desired power was 0.8. The total number of cases was 94 and the number of controls was 146. Data collection Data for the pediatric patients with myopia was collected from the patients’ medical records in King Fahad Hospital of the university (KFHU) in Khobar, Saudi Arabia, and then the patients’ guardians were contacted to administer the questionnaire over the phone. Myopia diagnosis was established following a comprehensive eye assessment including, visual acuity test using Snellen chart, measuring the refractive error in Diopter with an autorefractor and performing a fundoscopic examination to assess the ocular structures. 26 The patients’ degree of myopia was taken from the electronic medical records. And for the control subjects the questionnaire was sent along with informed consent using a QuestionpPro link. 27 The duration of the study was six months. Sampling technique: non-probability sampling. This study was approved by the Imam Abdulrahman bin Faisal University Institutional Review Board (IRB) committee, IRB number (IRB-UGS-2023-01-486). Inclusion criteria Patients eligible for inclusion are those aged above 4 years old, and below 12 years old, of both genders, who followed up in the pediatric ophthalmology clinic in KFUH, between November 2021 and November 2023. Only children diagnosed with myopia, with spherical equivalent refraction (SER) ≤ –0.50 D, within specified age range are included. Exclusion criteria Patients are excluded if they are below 4 years old or above 12 years old, have guardians who are unreachable or unable to answer the questionnaire, or have incomplete medical records. Additionally, children with eye conditions other than myopia, such as pathological myopia, strabismus, hyperopia, glaucoma, or systemics disorders with ophthalmologic manifestations (e.g., diabetes mellitus, trisomy 21, any genetic disorders), are excluded. However, patients with astigmatism are not excluded. Variables The independent variables in this study include screen time, types of electronic devices used, age at device introduction, the number and presence of devices in the household, the frequency of device usage, and the use of smart devices for educational purposes. The dependent variable is the degree of myopia, measured as the spherical equivalent refraction (SER). Controlled variables include age, with patients below 4 years or above 12 years excluded, as well as the exclusion of cases with pathological myopia and strabismus to minimize confounding factors. Materials The study included patients aged above 4 years and below 12 years who were followed up in the pediatric ophthalmology clinic at KFUH between November 2021 and November 2023, along with a control group of children in the same age range who were free of myopia. Data was collected using a Microsoft Excel sheet, with questionnaires completed through the QuestionPro tool. 27 Analysis was performed using the Statistical Package for Social Sciences (SPSS) for Windows, Version 26. 28 Written informed consent was obtained from all guardians after they were briefed on the study’s goals and assured of the confidentiality of their personal information. The study received Institutional Review Board (IRB) approval from Imam Abdulrahman bin Faisal University’s IRB committee on November 12, 2023, under the number IRB-UGS-2023-01-486. Procedures 1. Select Questionnaire (SCREENS-Q) • Choose SCREENS-Q 22 validated questionnaire for screen use habits of children (answered by parent/guardian). ↓ 2. Modify & Translate Questionnaire • Modify and translate SCREENS-Q into Arabic. ↓ 3. Review Translation Accuracy • Pilot-test on 10 individuals from the study field to review translation accuracy and reliability. ↓ 4. Extract Medical Records • Retrieve medical record numbers of pediatric patients (ages 4-12) who visited the KFHU outpatient ophthalmology clinic between Nov 2021 – Nov 2023. ↓ 5. Review Medical Records for Myopia Diagnosis • Check for diagnosis of myopia with spherical equivalent refraction (SER) ≤ -0.50 D. ↓ 6. Exclude Specific Cases • Exclude patients with other ophthalmologic conditions or systemic diseases (e.g., diabetes, trisomy 21, nystagmus, strabismus, pathological myopia), except for astigmatism. ↓ 7. Retrieve Relevant Data • Retrieve data from medical records (demographic data, presence of astigmatism, family history of myopia, refractive error values). ↓ 8. Group Patients Based on Myopia Degree • Categorize patients into 3 groups based on myopia degree: • Low (−0.50 D to −3.00 D) • Moderate (−3.00 D to −6.00 D) • High (>−6.00 D) ↓ 9. Retrieve Contact Info for Guardians • Gather contact details for the patients’ parent/guardian. ↓ 10. Contact Parents/Guardians • Call guardian, explain study purpose and importance related to screen time and myopia. ↓ 11. Obtain Consent • Obtain informed consent from the guardian for participation. ↓ 12. Administer Questionnaire • Administer the translated SCREENS-Q questionnaire to the parent/guardian. ↓ 13. Exclusion If Consent Refused • If the guardian refuses participation, exclude patient from the study. ↓ 14. Enter Data into QuestionPro • Fill in patient information and questionnaire responses in QuestionPro form. ↓ 15. Find Control Group • Identify and recruit a control group. • Obtain consent from control group guardians and administer the questionnaire. ↓ 16. Data Analysis • Analyze the collected data statistically to investigate relationships between screen time and myopia. Data analysis The data was organized through a data collection sheet in Microsoft Excel, and the questionnaire was filled through the free essentials license from the survey tool QuestionPro. 27 Statistical analysis The data was analyzed using Statistical Package for Social Sciences (SPSS) for Windows, version 26. 28 Descriptive statistics were used to determine the demographic data. All statistical methods used were two-tailed with an alpha level of 0.05 considering significance if P value less than or equal to 0.05. Descriptive analysis was done by prescribing frequency distribution and percentage for study variables including children demographic data, myopia, screen use and parents concern. All correlations were done based on Pearson’s Chi-square test and Fisher’s exact test for small frequency distributions. Association of excessive screen time with various grades of myopia would be done by using chi-square test. Graphs were initiated using Microsoft Excel software. Results The study included complete records of 94 myopic patients and 146 controls, shown in Table 1 , aged 4 to 12 years, of both genders. In the myopic group, the mean age was 8.21 ± 2.37 years, with a notable proportion (38 patients, 40.4%) aged 7–9 years. The majority of patients were female (55, 58.5%), and more than half were Saudi nationals (68, 72.3%). A significant proportion had a family history of myopia (81, 86.2%), and nearly half (45, 47.9%) spent more than one hour outdoors each day. Table 1. Demographic characteristics. Variables Myopic group Control group P-value Category n (%) Categories n (%) Gender Male 39 (41.5%) Male 78 (53.4%) 0.339 Female 55 (58.5%) Female 68 (46.6%) Age 4-6 years 26 (27.7%) 4-6 years 45 (30.8%) 0.161 7-9 years 38 (40.4%) 7-9 years 40 (27.4%) 10-12 years 30 (31.9%) 10-12 years 61 (41.8%) Age (Mean ± SD) ( Mean ± SD) 8.21 ± 2.373 ( Mean ± SD) 8.38 ± 2.827 0.135 Nationality Saudi 68 (72.3%) Saudi 143 (97.9%) 0.475 Non-Saudi 26 (27.7%) Non-Saudi 3 (2.1%) Family history of myopia Yes 81 (86.2%) Yes 92 (63.0%) 0.815 No 13 (13.8%) No 54 (37.0%) Time spent outside the house <30 minutes 26 (27.7%) <30 minutes 25 (17.1%) 0.075 <1 hour 23 (24.4%) 1 hour 45 (47.9%) >1 hour 79 (54.1%) * Significant at p<0.05 level. In the control group, the mean age was 8.38 ± 2.83 years, with a substantial proportion (61 controls, 41.8%) aged 10–12 years. Most controls were male (78, 53.4%), and the vast majority were Saudi nationals (143, 97.9%). A considerable proportion had a family history of myopia (92, 63.0%), and more than half (79, 54.1%) spent over one hour outdoors each day. Figure 1 illustrates the distribution of myopia categories among the patients. The results showed that the majority of patients had mild myopia (54 patients, 57.5%), followed by moderate myopia (33 patients, 35.1%), and the least number had high myopia (7 patients, 7.4%) Figure 1. The number of screen media devices present in the household where the child lived among the Myopic and Control groups. Figure 2 shows the age distribution of patients at the time of their first myopia diagnosis. The results revealed that most of the patients were first diagnosed with myopia aged 4–6 years (38 patients, 40.4%), followed by those aged 7–9 years (26 patients, 27.7%), 10–12 years (17 patients, 18.1%), and the smallest group was those aged under 4 years (13 patients, 13.8%). Figure 2. Child age when first diagnosed with myopia. The most commonly used screen media devices among myopic children were smartphones (98.9%) and laptops (87.2%), while in the control group, the most commonly used devices were television (95.9%) and smartphones (94.5%). The results revealed a statistically significant association between the ownership of screen media devices, bringing devices to school, and myopia, with p-values of <0.001. A considerable proportion of children in the myopic group owned a smartphone (54, 57.4%), a laptop (22, 23.4%) and an e-reader (9, 9.6%), compared to the control group. Additionally, more proportion of children in the myopic group brought a tablet/iPad to school on a daily or weekly basis (5.3%) than in the control group (3.4%). Other attributes were not statistically significant across the true groups. Figure 3 shows the types and numbers of screen media devices present in the households where the children lived. It reveals that a higher proportion of smartphones and laptops were found in the myopic group than in the control group Figure 3. The number of screen media devices present in the household where the child lived among the Myopic and Control groups. Figure 4 shows the frequency of screen media device usage by children in households over the past month. The results indicate a higher frequency of device use among children in the control group compared to those in the myopic group, with television and smartphones being the most commonly used devices. Figure 4. The frequency of use of screen media devices by the child in the household in the past month with respect to the Myopic and Control groups. Figure 5 shows children’s ownership of screen media devices. The findings revealed that most smartphones, laptops, and e-readers were owned by children in the myopic group (p<0.001), while most televisions, tablets/iPads and both handheld and non-handheld gaming consoles were owned by children in the control group. Figure 5. Children’s ownership of screen media devices among the myopic and control group. Table 3 shows the distribution of time spent on screen-based activities per day by children in the myopic and control groups over the past month. The study found no significant difference in the amount of time spent on screen-based activities during weekdays and weekends between the myopic and control groups Table 2. Frequency distribution of the type, number and use of screen media device across myopic and control groups. How many of the following screen media devices are present in the household where the child lives? P-value Type of devices Myopic Control /No 0 1 2 3 4 5 or more 0 1 2 3 4 5 or more Laptop 9 (9.6%) 34 (36.2%) 23 (24.5%) 11 (11.7%) 12 (12.8%) 5 (5.3%) 19 (13%) 41 (28.1%) 33 (22.6%) 20 (13.7%) 14 (9.6%) 19 (13.0%) 0.699 Desktop 67 (71.3%) 19 (20.2%) 4 (4.3%) 3 (3.2%) 1 (1.1%) - 82(56.2%) 47 (32.2%) 10 (6.8%) 5 (3.4%) 1 (0.7%) 1 (0.7%) Tablet/ipad 18 (19.1%) 37 (39.4%) 19 (20.2%) 9 (9.6%) 6 (6.4%) 5 (5.3%) 25(17.2%) 51 (34.9%) 37 (25.3%) 20 (13.7%) 10 (6.8%) 3 (2.1%) Smartphone 1 (1.1%) 1 (1.1%) 11 (11.7%) 24 (25.5%) 20 (21.3%) 37 (39.4%) 8 (5.5%) 17 (11.6%) 17 (11.6%) 18 (12.3%) 18 (12.3%) 68 (46.6%) Television 4 (4.3%) 33 (35.1%) 37 (39.4%) 12 (12.8%) 4 (4.3%) 4 (4.3%) 6 (4.1%) 54 (37.0%) 34 (23.3%) 33 (22.6%) 14 (9.6%) 5 (3.4%) Non-handheld gaming console 33 (35.1%) 53 (56.4%) 7 (7.4%) 1 (1.1%) - - 34(23.3%) 73 (50.0%) 26 (17.8%) 8 (5.5%) 3 (2.1%) 2 (1.4%) Handheld gaming console 83 (88.3%) 8 (8.5%) 3 (3.2%) - - - 95 (65.1%) 42 (28.8%) 7 (4.8%) - 1 (0.7%) 1 (0.7%) E-reader 85 (90.4%) 9 (9.6%) - - - - 132(90.4%) 11 (7.5%) 1 (0.7%) 1 (0.7%) 1 (0.7%) - Others 69 (73.4%) 25 (26.6%) - - - - 134(91.8%) 5 (3.4%) 3 (2.1%) 4 (2.7%) - - How often has the child used the following screen media devices in the household within the past month? P-value Type of devices Myopic Control /No Never <1 2-3 3-4 4-5 Every day Never <1 2-3 3-4 4-5 Every day Laptop 47 (50.0%) 7 (7.4%) 4 (4.3%) 7 (7.4%) 7 (7.4%) 22 (23.4%) 56(38.4%) 20 (13.7%) 12 (8.2%) 5 (3.4%) 13 (8.9%) 40 (27.4%) 0.568 Desktop 84 (89.4%) 3 (3.2%) 2 (2.1%) 5 (5.3%) - - 103(70.6%) 18 (12.3%) 3 (2.1%) 2 (1.4%) 5 (3.4%) 15 (10.3%) Tablet/ipad 27 (28.8%) 6 (6.4%) 6 (6.4%) 3 (3.2%) 4 (4.3%) 48 (51.1%) 36(24.7%) 15 (10.2%) 18 (12.3%) 12 (8.2%) 10 (6.9%) 55 (37.7%) Smartphone 21 (22.3%) 4 (4.3%) 5 (5.3%) 2 (2.1%) 4 (4.3%) 58 (61.7%) 26(17.8%) 18 (12.4%) 13 (8.9%) 8 (5.5%) 18 (12.3%) 63 (43.2%) Television 24 (25.5%) 7 (7.4%) 5 (5.3%) 6 (6.4%) 7 (7.4%) 45 (47.9%) 7(4.8%) 14 (9.6%) 12 (8.2%) 11 (7.5%) 16 (11.0%) 86 (58.9%) Non-handheld gaming console 54 (57.4%) 6 (6.4%) 6 (6.4%) 4 (4.3%) 6 (6.4%) 18 (19.1%) 66(45.2%) 14 (9.6%) 15 (10.3%) 8 (5.5%) 15 (10.3%) 28 (19.2%) Handheld gaming console 81 (86.2%) 1 (1.1%) 5 (5.3%) 3 (3.2%) 1 (1.1%) 3 (3.2%) 107(73.3%) 11 (7.5%) 9 (6.2%) 2 (1.4%) 4 (2.7%) 13 (8.9%) E-reader 93 (98.9%) - - - - 1 (1.1%) 137(93.8%) 2 (1.4%) 1 (0.7%) 3 (2.1%) 1 (0.7%) 2 (1.4%) Others 93 (98.9%) - - - - 1 (1.1%) 133(91.1%) 5 (3.4%) 2 (1.4%) 1 (0.7%) 1 (0.7%) 4 (2.7%) Does the child have their own of the following screen media devices? Type of devices Myopic Control P-value /No Yes No Yes No Laptop 22 (23.4%) 72 (76.6%) 22 (15.1%) 124 (84.9%) <0.001* Desktop 9 (9.6%) 85 (90.4%) 15 (10.3%) 131 (89.7%) Tablet/ipad 50 (53.2%) 44 (46.8%) 82 (56.2%) 64 (43.8%) Smartphone 54 (57.4%) 40 (42.6%) 62 (42.5%) 84 (57.5%) Television 3 (3.2%) 91 (96.8%) 86 (58.9%) 60 (41.1%) Non-handheld gaming console 19 (20.2%) 75 (79.8%) 68 (46.6%) 78 (53.4%) Handheld gaming console 1 (1.1%) 93 (98.9%) 29 (19.9%) 117 (80.1%) E-reader 9 (9.6%) 85 (90.4%) 6 (4.1%) 140 (95.9%) Others 20 (21.3%) 74 (78.7%) 5 (3.4%) 141 (96.6%) Does the child bring the following screen media devices to school? Type of devices Myopic Control P-value /No Yes, weekly No, never Yes, weekly No, never Laptop 2 (2.1%) 92 (97.9%) 6 (4.1%) 140 (95.9%) <0.001* Tablet/ipad 5 (5.3%) 89 (94.7%) 5 (3.4%) 141 (96.6%) Smartphone 3 (3.2%) 91 (96.8%) 11 (7.5%) 135 (92.5%) T Handheld gaming console 2 (2.1%) 92 (97.9%) 3 (2.1%) 143 (97.9%) Others 17 (18.1%) 77 (81.9%) 3 (2.1%) 143 (97.9%) Does the child use a tablet, smartphone, or computer in connection with school-related activities? Myopic Control P-value Yes, Daily and weekly Never Yes, Daily and weekly Never 87 (92.6%) 7 (7.4%) 109 (74.7%) 37 (25.3%) 0.058 Does the child use a tablet, smartphone, or other screen media device in break time, for example to play a screen-based game? Myopic Control P-value Yes, Daily and weekly Never Yes, Daily and weekly Never 92 (97.9%) 2 (2.1%) 132 (90.4%) 14 (9.6%) 0.466 Table 3. Frequency distribution of the time spent per day on the screen-based activities across the myopic and control groups. Screen-based activities Myopic Control P-value /Time spent per day Low 0-2 hrs/day Moderate 2-3 hrs/day High >3 hrs/day Low 0-2 hrs/day Moderate 2-3 hrs/day High >3 hrs/day Within the past month, how much time has the child typically spent per day on the following screen-based activities during leisure time? (in a weekday) Movies, TV shows, YouTube video clips/movies, entertainment programs 45 (47.9%) 18 (19.1%) 31 (33.0%) 67 (45.9%) 34 (23.3%) 45 (30.8%) 0.726 Games (on smartphone, tablet, game console, PC) 45 (47.9%) 18 (19.1%) 31 (33.0%) 67 (45.9%) 34 (23.3%) 45 (30.8%) School-related tasks using screen media devices 45 (47.9%) 18 (19.1%) 31 (33.0%) 67 (45.9%) 34 (23.3%) 45 (30.8%) Video calls (e.g., Face time, Skype) 45 (47.9%) 18 (19.1%) 31 (33.0%) 67 (45.9%) 34 (23.3%) 45 (0.8%) Social media or other types of communication 45 (47.9%) 18 (19.1%) 31 (33.0%) 67 (45.9%) 34 (23.3%) 45 (0.8%) Other 45 (47.9%) 18 (19.1%) 31 (33.0%) 67 (45.9%) 34 (23.3%) 45 (0.8%) Within the past month, how much time has the child typically spent per day on the following screen-based activities during leisure time? (in a weekend day) Movies, TV shows, YouTube video clips/movies, entertainment program 36 (38.3%) 14 (14.9%) 44 (46.8%) 76 (52.1%) 26 (17.8%) 44 (30.1%) 0.629 Games (on smartphone, tablet, game console, PC 36 (38.3%) 14 (14.9%) 44 (46.8%) 76 (52.1%) 26 (17.8%) 44 (30.1%) School-related tasks using screen media devices 36 (38.3%) 14 (14.9%) 44 (46.8%) 76 (52.1%) 26 (17.8%) 44 (30.1%) Video calls (e.g., Face time, Skype) 36 (38.3%) 14 (14.9%) 44 (46.8%) 76 (52.1%) 26 (17.8%) 44 (30.1%) Social media or other types of communication 36 (38.3%) 14 (14.9%) 44 (46.8%) 76 (52.1%) 26 (17.8%) 44 (30.1%) Other 36 (38.3%) 14 (14.9%) 44 (46.8%) 76 (52.1%) 26 (17.8%) 44 (30.1%) Table 4 presents the distribution of screen-based activity use in the myopic and control groups. The results showed that more than half of the children in both groups used screen media within half an hour after waking up in the morning for 0–2 days per week: 54 children (57.5%) in the myopic group and 96 children (65.8%) in the control group (p = 0.004). Additionally, a notable proportion of children in both groups used screen media within half an hour before going to sleep for 0–2 days per week: 35 children (37.2%) in the myopic group and 82 children (57.5%) in the control group (p = 0.043). The study also found that a significant proportion of children in both groups (myopic: 17 children, 34.0%; control: 30 children, 36.6%) were aged 7–9 years when they first got their own tablet (p = 0.012). Table 4. Distribution of the use of the screen-based activities across the myopic and control groups. Statements Myopic Control P-value Category n (%) Category n (%) Any rules for the child’s use of screen media Yes 63 (67.0%) Yes 101 (69.2%) 0.528 No 31 (33.0%) No 45 (30.8%) Number of days in a typical week the child use screen media in these time periods: Within half an hour after they wake up in the morning? 0-2 days 54 (57.5%) 0-2 days 96 (65.8%) 0.004* 3-5 days 13 (13.8%) 3-5 days 28 (19.2%) >5 days 27 (28.7%) >5 days 22 (15.0%) Within half an hour before they go to sleep in the evening? 0-2 days 35 (37.2%) 0-2 days 82 (57.5%) 0.043* 3-5 days 18 (19.1%) 3-5 days 6 (24.7%) >5 days 41 (43.7%) >5 days 26 (17.8%) When the child uses screen media, how often does he/she use more than one screen media device at a time? Never 67 (71.3%) Never 48 (32.9%) 0.479 Sometimes 14 (14.9%) Sometimes 46 (31.5%) Rarely 4 (4.3%) Rarely 41 (28.1%) Always 9 (9.6%) Always 11 (7.5%) When the child uses screen media, they are usually Alone 45 (47.9%) Alone 35 (24.0%) 0.815 With a sibling 15 (16.0%) With a sibling 50 (34.2%) With an adult 34 (6.2%) With an adult 61 (41.8%) I am concerned about the child's screen media use in relation to his/her health and development Agree 78 (83.0%) Agree 110 (75.3%) 0.974 Disagree 7 (7.4%) Disagree 1 (0.7%) Partially agree 9 (9.6%) Partially agree 35 (24.0%) I am concerned about the child's screen media use for the sake of his/her social life Agree 67 (71.3%) Agree 110 (75.3%) 0.400 Disagree 9 (9.6%) Disagree 1 (0.7%) Partially agree 13 (13.8%) Partially agree 34 (23.3%) Partially disagree 5 (5.3%) Partially disagree 1 (0.7%) How old was the child when he/she got his/her own smart phone? <4 years 3 (5.6%) <4 years 4 (6.5%) 0.919 4-6 years 6 (11.1%) 4-6 years 23 (37.1%) 7-9 years 21 (8.9%) 7-9 years 24 (38.7%) 10-12 years 24 (44.4%) 10-12 years 11 (17.7%) How old was the child when he/she got his/her own tablet? <4 years 6 (12.0%) <4 years 12 (14.6%) 0.012* 4-6 years 15 (30.0%) 4-6 years 29 (35.4%) 7-9 years 17 (34.0%) 7-9 years 30 (36.6%) 10-12 years 12 (24.0%) 10-12 years 11 (13.4%) How old was the child when he/she got his/her own laptop? <4 years 0 (0.0%) <4 years 2 (9.1%) 0.982 4-6 years 4 (18.2%) 4-6 years 4 (18.2%) 7-9 years 12 (54.5%) 7-9 years 12 (54.5%) 10-12 years 6 (27.3%) 10-12 years 4 (18.2%) Table 5 (below) presents the attributes of patients by myopia category. The results indicate a significant association between patients’ age, their age at which they were first diagnosed with myopia and their myopia category (p = 0.030 and p = 0.005, respectively). However, no other patient attributes were significantly associated with myopia category. Table 5. Patients’ attributes by Myopia category. Variable Category High Mild Moderate P-value Gender Male 5 (12.8%) 21 (53.9%) 13 (33.3%) 0.247 Female 2 (3.6%) 33 (60.0%) 20 (36.4%) Age 4-6 years 5 (19.2%) 14 (53.9%) 7 (26.9%) 0.030 * 7-9 years 1 (2.6%) 19 (50.0%) 18 (47.4%) 10-12 years 1 (3.3%) 21 (70.0%) 8 (26.7%) Nationality Saudi 6 (8.8%) 35 (51.5%) 27 (39.7%) 0.162 Non-Saudi 1 (3.8%) 19 (73.1%) 6 (23.1%) Family history of myopia Yes 5 (6.2%) 46 (56.8%) 30 (37.0%) 0.379 No 2 (15.4%) 8 (61.5%) 3 (23.1%) Child age when first diagnosed with myopia <4 years 3 (23.0%) 4 (30.8%) 6 (46.2%) 0.005 * 4-6 years 3 (7.9%) 17 (44.7%) 18 (47.4%) 7-9 years 0 (0.0%) 18 (69.2%) 8 (30.8%) 10-12 years 1 (5.9%) 15 (88.2%) 1 (5.9%) Time spent outside the house <30 minutes 1 (3.8%) 14 (53.9%) 11 (42.3%) 0.616 1 hour 5 (11.1%) 27 (60.0%) 13 (28.9%) * Significant at p<0.05 level. Table 6 presents the Analysis of Variance (ANOVA) results of total screen time in children, based on their age at first use of screen media devices (smartphone, tablet, and laptop). The results indicate that the differences between these groups were not statistically significant (p = 0.196). This suggests that the age at which children first used screen media devices does not explain the variation in their total screen time. Table 6. Analysis of Variance (ANOVA). Model Sum of squares df Mean square F Sig Regression 12.904 3 4.301 1.595 0.196 Residual 242.713 90 2.697 Total 255.617 93 a Dependent variable: Total spend time. b Predictors: (Costant), Age_laptop, Age_tablet, Age_smartphone. Table 7 presents the results of a one-way ANOVA examining the mean difference in total screen time between groups categorized by the age of the children (4–6 years, 7–9 years, and 10–12 years). The results revealed a statistically significant difference across the groups (p= 0.021). This suggests that total screen time differs substantially across the age groups children. Table 7. Analysis of Variance (ANOVA). Model Sum of squares df Mean square F Sig Between groups 20.689 2 10.344 4.007 0.021* Within groups 234.928 91 2.582 Total 255.617 93 a Dependent variable: Total screen time. b Independent variable Age (4-6 year, 7-9 years and 10-12 years). Discussion The increasing use of screen media devices among children has raised concerns about its potential link to the growing prevalence of myopia. 29 While factors such as physical activity, genetics, screen time, and time outdoors contribute to myopia, the relationship between screen time and myopia is not fully understood. 30 This study aimed to explore the association between screen time and myopia in pediatric patients at King Fahad University Hospital, providing insights into the impact of screen use on children’s eye health. The study revealed considerable exposure of children to screen media, including smartphones, laptops, and tablets. It found a higher proportion of smartphones (98.9%) and laptops (87.2%) in households with children in the myopic group, compared to the control group, which had lower proportions of smartphones (94.5%) and laptops (87.0%). These findings are consistent with those of Rideout and Robb, who observed a significant increase in average daily screen time up to 5 hours and 7 minutes in children, aged 8 to 12 in 2019. This poses a high risk of myopia and could also affect academic performance with television and smartphones being the most commonly used devices in both groups 31 ( Table 2 ). The study found that a substantial proportion of children, particularly in the myopic group, owned smartphones (57.4%) and laptops (23.4%), compared to the control group, where the proportions were lower: smartphones (42.5%) and laptops (15.1%). This highlights the increasing screen time over the years, an observation that aligns with a 2018 report which found that about 5% of children aged 5 to 7 globally already owned a mobile phone, and 42% had their own tablet; an observation which can be linked to the rising number of myopic children globally. 32 The study reported a higher frequency of screen media use among the myopic group compared to the control group. Children in the myopic group used tablets, smartphones, and computers more frequently for school-related activities (92.6%) and more children in the myopic group (5.3%) regularly brought a tablet/iPad to school compared to the control group (3.4%), highlighting the increasing prevalence of myopia associated with higher screen time ( Table 2 ). The results showed that more than half of the children in both groups used screen media within half an hour after waking up in the morning for 0–2 days per week: 54 children (57.5%) in the myopic group and 96 children (65.8%) in the control group (p = 0.004). Similarly, a notable proportion of children in both groups used screen media within half an hour before going to sleep for 0–2 days per week: 35 children (37.2%) in the myopic group and 82 children (57.5%) in the control group (p = 0.043). The study also found that early and frequent exposure to screen media was associated with a higher risk of myopia in children. A significant proportion of both groups (myopic: 17 children, 34.0%) received their first tablet at ages 7–9 years (p = 0.012). These findings highlight the importance of regulating children’s screen media use to reduce the risk of myopia ( Table 4 ). The study found a significant association between patients’ age, the age at which they were first diagnosed with myopia, and their myopia category (p = 0.030 and p = 0.005, respectively). Children aged 4-6 years were more likely to have high myopia, consistent with findings by Smith and Walline who observed a high prevalence of myopia among children aged 4 to 7 years. 33 This association may be attributed to increased indoor activities and reduced time spent outdoors in this age group, which increases their risk of myopia due to prolonged exposure to screen media devices 34 ( Table 5 ). The current study also found that a younger age at diagnosis was associated with a higher likelihood of developing high myopia, with children under 4 years old being more likely to develop high myopia. This is consistent with Rose et al.’s observation that the association is due to the longer duration of myopia progression. Early onset of myopia gives the eye more time to grow and elongate, increasing the potential for worsening myopia and raising the likelihood of high myopia. 9 The analysis of variance results indicates that differences in screen time based on children’s age at first use of screen media devices (smartphone, tablet, and laptop) were not statistically significant (p = 0.196). This suggests that the age at which children first use screen media devices does not account for the variation in their total screen time ( Table 6 ). The result revealed statistically significant difference in total screen time between age groups (4–6 years, 7–9 years, and 10–12 years), with a (p-value=0.021) suggesting that total screen time increases with age ( Table 7 ). This finding is consistent with a study conducted in Spain by Alvarez-Peregrina et al., which found that the number of hours spent using electronic devices increased significantly with age, with children aged 7 years and older spending more time on these devices. 17 The increasing frequency of screen media use among children, both at home and school, highlights the growing dependence on technology in their daily activities. There are a few limitations to this study, which needs to be considered. This research was confined in the data collection aspect as the research population was limited to pediatric ophthalmology patients of KFHU only, while it could cover wider population of patients from other hospitals for a stronger association. Further research in a larger population is needed to support the findings of this study. The lack of detailed and accurate information on the timing and severity of myopia poses significant constraints on achieving the study’s objectives. Conclusion The study established a significant association between patients’ age, the age at first diagnosis and myopia levels in pediatric patients attending King Fahad University Hospital (KFUH) in Saudi Arabia from November 2021 to November 2023. The patients’ screen time varied substantially across the age groups (4–6 years, 7–9 years, and 10–12 years); with smartphones being the most commonly used devices among both myopic children and control group. These findings highlight the need to better understand the relationship between myopia and screen time in pediatric patients, in order to develop evidence-based guidelines for managing screen time, protecting children from the adverse effects of screen media exposure, and promoting their eye health and overall well-being. This study can guide future research on the subject of screen time and children’s development and health, specifically for myopia and its prevention, this study also contributes to the literature and research at the local level in the Eastern Province of Saudi Arabia. Ethics and consent Ethical approval was obtained from the Institutional Review Board (IRB) at Imam Abdulrahman bin Faisal University. The approval was granted on November 12, 2023, under the number IRB-UGS-2023-01-486. Written informed consent was obtained from all guardians after they were fully briefed on the study’s goals. They were also assured of the confidentiality and privacy of their personal information. Additionally, participants were informed that their participation was voluntary and that they could withdraw at any time without consequence. Data availability statement Data repository 4TU.ReasearchData: Questionnaire Data -Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia DOI: 10.4121/336f4172-3fec-4002-85c1-c9b6e90831fb . 35 This project contains the following underlying data: 1. Questionnaire Data Set.xlsx Dataset titled Questionnaire Data, contains all raw data including questionnaire’s answers, and degree of myopia for patients. Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Bibliography 1. Morgan IG, Ohno-Matsui K, Saw S: Ophthalmology 2: Myopia. Lancet. 2012 May; 379 (9827): 1739–1748. Publisher Full Text 2. Pan CW, Ramamurthy D, Saw SM: Worldwide prevalence and risk factors for myopia. Ophthalmic Physiol. Opt. 2012 Jan; 32 (1): 3–16. Publisher Full Text 3. Holden BA, Fricke TR, Wilson DA, et al. : Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. 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Rose KA, Morgan IG, Ip J, et al. : Outdoor activity reduces the prevalence of myopia in children. Ophthalmology. 2008 Aug 1; 115 (8): 1279–1285. Publisher Full Text 10. Dirani M, Tong L, Gazzard G, et al. : Outdoor activity and myopia in Singapore teenage children. Br. J. Ophthalmol. 2009 Aug 1; 93 (8): 997–1000. PubMed Abstract | Publisher Full Text 11. Hipólito V, Coelho JM: Blue Light and Eye Damage: A Review on the Impact of Digital Device Emissions. Photonics. MDPI; 2023 May 11; Vol. 10 (5): p. 560. 12. Behar-Cohen F, Martinsons C, Viénot F, et al. : Light-emitting diodes (LED) for domestic lighting: any risks for the eye? Prog. Retin. Eye Res. 2011 Jul 1; 30 (4): 239–257. PubMed Abstract | Publisher Full Text 13. Xia H, Hu Q, Li L, et al. : Protective effects of autophagy against blue light-induced retinal degeneration in aged mice. Sci. China Life Sci. 2019 Feb; 62 : 244–256. PubMed Abstract | Publisher Full Text 14. Jaadane I, Boulenguez P, Chahory S, et al. : Retinal damage induced by commercial light emitting diodes (LEDs). Free Radic. Biol. Med. 2015 Jul 1; 84 : 373–384. PubMed Abstract | Publisher Full Text 15. Tosini G, Ferguson I, Tsubota K: Effects of blue light on the circadian system and eye physiology. Mol. Vis. 2016; 22 : 61–72. PubMed Abstract 16. Foreman J, Salim AT, Praveen A, et al. : Association between Digital Smart Device Use and myopia: A systematic review and meta-analysis. Lancet Digit. Health. 2021 Oct 5; 3 (12): e806–e818. PubMed Abstract | Publisher Full Text 17. Alvarez-Peregrina C, Sánchez-Tena MÁ, Martinez-Perez C, et al. : The relationship between screen and outdoor time with rates of myopia in Spanish children. Frontiers. Public Health. 2020; 8 : 8. PubMed Abstract | Publisher Full Text | Free Full Text 18. Wang J, Li M, Zhu D, et al. : Smartphone overuse and visual impairment in children and young adults: systematic review and meta-analysis. J. Med. 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Tsang S, Royse CF, Terkawi AS: Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi J. Anaesth. 2017 May 1; 11 (Suppl 1): S80–S89. PubMed Abstract | Publisher Full Text 24. Epidemiological calculators. Ausvet. 2018. Reference Source 25. Philipp D, Vogel M, Brandt M, et al. : The relationship between myopia and near work, time outdoors and socioeconomic status in children and adolescents. BMC Public Health. 2022 Nov 10; 22 (1): 2058. PubMed Abstract | Publisher Full Text | Free Full Text 26. Baird PN, Saw SM, Lanca C, et al. : Myopia. Nat. Rev. Dis. Primers. 2020 Dec 17; 6 (1): 99. Publisher Full Text 27. Free Online Survey Software and Tools|QuestionPro®.2020. Reference Source Reference Source 28. IBM: SPSS statistics for Windows. Version 26.0. Armonk, NY: IBM; 2012. 29. Ramamurthy D, Lin Chua SY, Saw SM: A review of environmental risk factors for myopia during early life, childhood and adolescence. Clin. Exp. Optom. 2015 Nov 1; 98 (6): 497–506. PubMed Abstract | Publisher Full Text 30. Lissak G: Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study. Environ. Res. 2018 Jul 1; 164 : 149–157. PubMed Abstract | Publisher Full Text 31. Rideout VJ, Robb MB: The Common Sense census: Media use by tweens and teens in America, A Common Sense media research study, United States.2019. 32. Ofcom UK: Children and parents: Media use and attitudes report 2018. London, UK: Ofcom Website; 2019 Jan 29. 33. Smith MJ, Walline JJ: Controlling myopia progression in children and adolescents. Adolesc. Health Med. Ther. 2015; 6 : 133–140. PubMed Abstract | Publisher Full Text | Free Full Text 34. Sherwin JC, Reacher MH, Keogh RH, et al. : The association between time spent outdoors and myopia in children and adolescents: a systematic review and meta-analysis. Ophthalmology. 2012; 119 : 2141–2151. Publisher Full Text 35. Al Haidar F: Questionnaire Data - Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia. [Dataset]. Netherlands: 4TU.ResearchData; 2025. Reference Source Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 30 Jan 2025 ADD YOUR COMMENT Comment Author details Author details 1 Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 31541, Saudi Arabia 2 College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 31541, Saudi Arabia Noura AL Mulhim Roles: Investigation, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing Maiadah AlFares Roles: Investigation, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing Shahd AlMehrij Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Farah Al Haidar Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Manar AlOmair Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Reem AlMutairi Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Rafeef Abalkhail Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Nazish Rafique Roles: Investigation, Methodology, Project Administration, Validation, Writing – Review & Editing Rabia Latif Roles: Investigation, Methodology, Project Administration, Validation, Writing – Review & Editing Lubna Al-Asoom Roles: Investigation, Methodology, Project Administration, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 30 Jan 2025, 14:148 https://doi.org/10.12688/f1000research.160914.1 Copyright © 2025 AL Mulhim N et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article AL Mulhim N, AlFares M, AlMehrij S et al. Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia [version 1; peer review: 3 approved with reservations] . F1000Research 2025, 14 :148 ( https://doi.org/10.12688/f1000research.160914.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 30 Jan 2025 Views 0 Cite How to cite this report: Okenwa-Vincent EE. Reviewer Report For: Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia [version 1; peer review: 3 approved with reservations] . F1000Research 2025, 14 :148 ( https://doi.org/10.5256/f1000research.176875.r392236 ) The direct URL for this report is: https://f1000research.com/articles/14-148/v1#referee-response-392236 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 26 Jul 2025 Emmanuel E Okenwa-Vincent , Kaimosi Friends University, Kaimosi, Kenya Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.176875.r392236 Title: Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia Summary of the Article This article explores the association between screen time and myopia in children aged ... Continue reading READ ALL Title: Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia Summary of the Article This article explores the association between screen time and myopia in children aged 4–12 years attending a tertiary hospital in Saudi Arabia. Using medical records and a validated questionnaire administered to caregivers, the study compares screen device ownership and usage between 94 myopic children and 146 controls. The results suggest a significant association between screen media usage and the presence of myopia, especially with smartphones and laptops. Age was significantly associated with increased screen time and higher myopia categories. Specific Comments 1. The article presents a timely and relevant investigation into the association between screen time and myopia in pediatric populations. The introduction and background are generally well-written and supported by multiple relevant citations. However, several issues hinder clarity: There is some inconsistency in terminology, e.g., the use of “retrospective study” versus “case-control survey-based” needs to be clearly distinguished. The manuscript occasionally uses awkward phrasing and inconsistent formatting (e.g., “screenmedia” instead of “screen media”). Some references lack complete bibliographic information or are not formatted as per clear specific standards, e.g., Vancouver, NLM, etc. Improvement Required: Clarify study design terminology. Edit the text for clarity, grammar, and consistent formatting. Standardize reference formatting and include all necessary citation details. 2. The study addresses an important research question using a case-control design involving questionnaire-based data and retrospective medical record review. The use of a validated instrument (SCREENS-Q) strengthens the design. However, there are several methodological concerns: Control group recruitment differed from the myopia cases, potentially introducing selection bias. The combination of retrospective chart review with prospective survey methods introduces methodological ambiguity. The sampling method (non-probability) was not well-justified for the population size and limits generalizability. Improvement Required: Clearly define and justify the study design. Acknowledge and discuss potential biases introduced by different recruitment strategies for cases and controls. Consider the implications of non-probability sampling on the findings. 3. While the article describes the data collection process in a stepwise manner, several areas lack sufficient detail: The translation validation process for the Arabic version of the questionnaire is briefly described, but no reliability metrics (e.g., Cronbach’s alpha) are reported. The statistical analysis section outlines tools used (SPSS, Chi-square, ANOVA), but effect sizes, confidence intervals, and assumptions for tests are not reported. Improvement Required: Provide full statistical output (e.g., regression coefficients, confidence intervals). Report translation validation metrics. 4. The authors use appropriate statistical tests (Chi-square, ANOVA); however: Effect sizes are missing, making it hard to gauge clinical relevance. Regression analysis is mentioned in the abstract but not thoroughly described or justified in the results. No checks for statistical assumptions (e.g., normality for ANOVA) are described. Improvement Required: Provide a comprehensive output and interpretation of the regression analysis. Report effect sizes and assumptions of statistical tests. Ensure statistical claims are supported by appropriate metrics and plots, if applicable. 5. Even though the study questionnaire is deposited in a public repository, “4TU.ReasearchData”, the article, however, does not provide access to raw or anonymized source data or even summary data files, which is a requirement under open science and F1000Research’s policies, Improvement Required: Provide anonymized source datasets as supplementary files or deposit them in an open-access repository. 6. The conclusions reflect the study findings reasonably well, especially regarding: Higher ownership and use of smartphones/laptops among myopic children. Age-related differences in screen time. However, some conclusions overstate the strength of the findings: The non-significant association between age at first device use and screen time is downplayed. The lack of difference in screen-based activity time between groups is not addressed in the conclusion. Improvement Required: Temper conclusions to align with mixed findings. Acknowledge non-significant findings and limitations more explicitly. Overall Recommendation The article investigates a pertinent public health issue and presents valuable findings for pediatric eye health. However, major revisions are needed in the following areas to improve scientific rigor and transparency: Clarification of study design and sampling strategy. Enhanced detail and transparency in methodology and statistical reporting. Provision of source data for reproducibility. Balanced and cautious interpretation of results. Specific areas for Improvement Area: Recommendation Study Design: Clarify retrospective vs. prospective elements Sampling: Acknowledge and discuss selection bias in control group Statistical Reporting: Report effect sizes and confidence intervals Questionnaire: Provide metrics for translation validation Discussion: Deepen interpretation of findings and acknowledge inconsistencies Figures & Tables: Improve captions and integration with narrative Language: Proofread for clarity, grammar, and formatting Once these issues are addressed, the article will offer a meaningful contribution to the literature on pediatric myopia and digital device exposure. Final Evaluation Scientific merit: Moderate to strong. Originality: Moderate. Clarity of writing: Fair, but can be improved. Suitability for F1000Research: Yes, with major revisions. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? No Are the conclusions drawn adequately supported by the results? Partly References 1. AL Mulhim N, AlFares M, AlMehrij S, Al Haidar F, et al.: Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia. F1000Research . 2025; 14 . Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Public Health Optometrist—Pediatric, Low Vision, and Rehabilitative Care I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Okenwa-Vincent EE. Reviewer Report For: Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia [version 1; peer review: 3 approved with reservations] . F1000Research 2025, 14 :148 ( https://doi.org/10.5256/f1000research.176875.r392236 ) The direct URL for this report is: https://f1000research.com/articles/14-148/v1#referee-response-392236 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Marković L. Reviewer Report For: Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia [version 1; peer review: 3 approved with reservations] . F1000Research 2025, 14 :148 ( https://doi.org/10.5256/f1000research.176875.r392232 ) The direct URL for this report is: https://f1000research.com/articles/14-148/v1#referee-response-392232 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 26 Jul 2025 Leon Marković , University Hospital “Sveti Duh”, University Josip Juraj Strossmayer, Zagreb, Croatia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.176875.r392232 This study investigates the association between screen time and myopia among pediatric patients at King Fahad University Hospital in Saudi Arabia. It uses a retrospective case-control design with data from 94 children with myopia and 146 controls. Screen time habits ... Continue reading READ ALL This study investigates the association between screen time and myopia among pediatric patients at King Fahad University Hospital in Saudi Arabia. It uses a retrospective case-control design with data from 94 children with myopia and 146 controls. Screen time habits were collected via a validated questionnaire and compared with demographic and clinical data. The authors found that screen time increased with age and that myopic children were more likely to own and use smartphones and laptops. A significant association was observed between screen time, age at myopia diagnosis, and myopia category. However, the age at which screen devices were first used was not significantly associated with total screen time. Despite being observational and relying on parental reports, the study provides valuable insight into pediatric screen habits and myopia. The conclusions are well-supported, and the literature is appropriately cited. Some methodological limitations—non-probability sampling, reliance on subjective reports, and the absence of raw data sharing—should be addressed. Recommendations for Improvement: Statistical Analysis Enhancements: 1. Include confidence intervals and effect sizes to strengthen interpretation. 2. Consider multivariate regression models adjusting for outdoor time, gender, and family history. Design Improvement: 1. Future studies should use prospective or longitudinal designs with objective screen tracking. Clarify Limitations: 1. Expand on selection bias, recall bias, and generalizability in the discussion section. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: ophthalmology, genetics, molecular biology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Marković L. Reviewer Report For: Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia [version 1; peer review: 3 approved with reservations] . F1000Research 2025, 14 :148 ( https://doi.org/10.5256/f1000research.176875.r392232 ) The direct URL for this report is: https://f1000research.com/articles/14-148/v1#referee-response-392232 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Kam KW. Reviewer Report For: Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia [version 1; peer review: 3 approved with reservations] . F1000Research 2025, 14 :148 ( https://doi.org/10.5256/f1000research.176875.r392247 ) The direct URL for this report is: https://f1000research.com/articles/14-148/v1#referee-response-392247 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 22 Jul 2025 Ka Wai Kam , Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Hong Kong, Hong Kong Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.176875.r392247 The authors conducted a retrospective case-control study, and identified several risk factors associated with myopia in childhood through a validated questionnaire. The methodology was well described including the statistical methods and sample size calculation which was fulfilled. ... Continue reading READ ALL The authors conducted a retrospective case-control study, and identified several risk factors associated with myopia in childhood through a validated questionnaire. The methodology was well described including the statistical methods and sample size calculation which was fulfilled. Several comments regarding the manuscript (1) Figure 1, the caption underneath the pie chart is inaccurate, please replace with "distribution of myopia severity among myopic children" (2) the proportion of children owing a smartphone was only marginally higher in the myopia group than controls. Yet the ownership of a device does not always mean a greater frequency or duration of use of such device. Looking at Figures 3 and 4, you may see that in Figure 4, the control group had a greater frequency of using ALL the devices compared to the myopic children group. (3) Table 2 illustrates the no of devices present within each household, and whether a child own their screen media device. There was however only one p value presented in the third and fourth rows. It may be worthwhile to compare individual device. Base on the actual data presented, I was not very convinced that there was a significant difference between the ownership/frequency of use of electronic devices between myopic and non myopic children. (4) Table 4 illustrates an interesting phenomenon which could be further elaborated. The quesitonnaire explored the use of screen media during the first and last half an hour of the day. And the result showed a higher frequency of such phenomenon in the myopic group. Rather than reporting the actual frequency or duration of use, the timing of use or habit of using such screen media may be associated with the development of myopia in children. (5) Table 4, last three rows - regarding the age at which the child acquired his/her own device. It seemed that myopic children tended to get their own tablet at a later age (p=0.012), whereas no difference was detected for smart phone nor laptop. My general impression was that the difference was not clinically significant. (6) Table 5, I was quite surprised that there was NO association between the family history of myopia and the severity of child myopia. As parental myopia has already been shown as a strong risk factor for child myopia. See: Am J Ophthalmol. 2020 Oct:218:199-207. This led me to doubt about the accuracy and measurement of parental myopia in the cohort. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: epidemiology, astigmatism I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Kam KW. Reviewer Report For: Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia [version 1; peer review: 3 approved with reservations] . F1000Research 2025, 14 :148 ( https://doi.org/10.5256/f1000research.176875.r392247 ) The direct URL for this report is: https://f1000research.com/articles/14-148/v1#referee-response-392247 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 30 Jan 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 1 30 Jan 25 read read read Ka Wai Kam , Prince of Wales Hospital, Hong Kong, Hong Kong Leon Marković , University Hospital “Sveti Duh”, University Josip Juraj Strossmayer, Zagreb, Croatia Emmanuel E Okenwa-Vincent , Kaimosi Friends University, Kaimosi, Kenya Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Okenwa-Vincent E. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 26 Jul 2025 | for Version 1 Emmanuel E Okenwa-Vincent , Kaimosi Friends University, Kaimosi, Kenya 0 Views copyright © 2025 Okenwa-Vincent E. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Title: Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia Summary of the Article This article explores the association between screen time and myopia in children aged 4–12 years attending a tertiary hospital in Saudi Arabia. Using medical records and a validated questionnaire administered to caregivers, the study compares screen device ownership and usage between 94 myopic children and 146 controls. The results suggest a significant association between screen media usage and the presence of myopia, especially with smartphones and laptops. Age was significantly associated with increased screen time and higher myopia categories. Specific Comments 1. The article presents a timely and relevant investigation into the association between screen time and myopia in pediatric populations. The introduction and background are generally well-written and supported by multiple relevant citations. However, several issues hinder clarity: There is some inconsistency in terminology, e.g., the use of “retrospective study” versus “case-control survey-based” needs to be clearly distinguished. The manuscript occasionally uses awkward phrasing and inconsistent formatting (e.g., “screenmedia” instead of “screen media”). Some references lack complete bibliographic information or are not formatted as per clear specific standards, e.g., Vancouver, NLM, etc. Improvement Required: Clarify study design terminology. Edit the text for clarity, grammar, and consistent formatting. Standardize reference formatting and include all necessary citation details. 2. The study addresses an important research question using a case-control design involving questionnaire-based data and retrospective medical record review. The use of a validated instrument (SCREENS-Q) strengthens the design. However, there are several methodological concerns: Control group recruitment differed from the myopia cases, potentially introducing selection bias. The combination of retrospective chart review with prospective survey methods introduces methodological ambiguity. The sampling method (non-probability) was not well-justified for the population size and limits generalizability. Improvement Required: Clearly define and justify the study design. Acknowledge and discuss potential biases introduced by different recruitment strategies for cases and controls. Consider the implications of non-probability sampling on the findings. 3. While the article describes the data collection process in a stepwise manner, several areas lack sufficient detail: The translation validation process for the Arabic version of the questionnaire is briefly described, but no reliability metrics (e.g., Cronbach’s alpha) are reported. The statistical analysis section outlines tools used (SPSS, Chi-square, ANOVA), but effect sizes, confidence intervals, and assumptions for tests are not reported. Improvement Required: Provide full statistical output (e.g., regression coefficients, confidence intervals). Report translation validation metrics. 4. The authors use appropriate statistical tests (Chi-square, ANOVA); however: Effect sizes are missing, making it hard to gauge clinical relevance. Regression analysis is mentioned in the abstract but not thoroughly described or justified in the results. No checks for statistical assumptions (e.g., normality for ANOVA) are described. Improvement Required: Provide a comprehensive output and interpretation of the regression analysis. Report effect sizes and assumptions of statistical tests. Ensure statistical claims are supported by appropriate metrics and plots, if applicable. 5. Even though the study questionnaire is deposited in a public repository, “4TU.ReasearchData”, the article, however, does not provide access to raw or anonymized source data or even summary data files, which is a requirement under open science and F1000Research’s policies, Improvement Required: Provide anonymized source datasets as supplementary files or deposit them in an open-access repository. 6. The conclusions reflect the study findings reasonably well, especially regarding: Higher ownership and use of smartphones/laptops among myopic children. Age-related differences in screen time. However, some conclusions overstate the strength of the findings: The non-significant association between age at first device use and screen time is downplayed. The lack of difference in screen-based activity time between groups is not addressed in the conclusion. Improvement Required: Temper conclusions to align with mixed findings. Acknowledge non-significant findings and limitations more explicitly. Overall Recommendation The article investigates a pertinent public health issue and presents valuable findings for pediatric eye health. However, major revisions are needed in the following areas to improve scientific rigor and transparency: Clarification of study design and sampling strategy. Enhanced detail and transparency in methodology and statistical reporting. Provision of source data for reproducibility. Balanced and cautious interpretation of results. Specific areas for Improvement Area: Recommendation Study Design: Clarify retrospective vs. prospective elements Sampling: Acknowledge and discuss selection bias in control group Statistical Reporting: Report effect sizes and confidence intervals Questionnaire: Provide metrics for translation validation Discussion: Deepen interpretation of findings and acknowledge inconsistencies Figures & Tables: Improve captions and integration with narrative Language: Proofread for clarity, grammar, and formatting Once these issues are addressed, the article will offer a meaningful contribution to the literature on pediatric myopia and digital device exposure. Final Evaluation Scientific merit: Moderate to strong. Originality: Moderate. Clarity of writing: Fair, but can be improved. Suitability for F1000Research: Yes, with major revisions. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? No Are the conclusions drawn adequately supported by the results? Partly References 1. AL Mulhim N, AlFares M, AlMehrij S, Al Haidar F, et al.: Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia. F1000Research . 2025; 14 . Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Public Health Optometrist—Pediatric, Low Vision, and Rehabilitative Care I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Okenwa-Vincent EE. Peer Review Report For: Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia [version 1; peer review: 3 approved with reservations] . F1000Research 2025, 14 :148 ( https://doi.org/10.5256/f1000research.176875.r392236) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-148/v1#referee-response-392236 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Marković L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 26 Jul 2025 | for Version 1 Leon Marković , University Hospital “Sveti Duh”, University Josip Juraj Strossmayer, Zagreb, Croatia 0 Views copyright © 2025 Marković L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This study investigates the association between screen time and myopia among pediatric patients at King Fahad University Hospital in Saudi Arabia. It uses a retrospective case-control design with data from 94 children with myopia and 146 controls. Screen time habits were collected via a validated questionnaire and compared with demographic and clinical data. The authors found that screen time increased with age and that myopic children were more likely to own and use smartphones and laptops. A significant association was observed between screen time, age at myopia diagnosis, and myopia category. However, the age at which screen devices were first used was not significantly associated with total screen time. Despite being observational and relying on parental reports, the study provides valuable insight into pediatric screen habits and myopia. The conclusions are well-supported, and the literature is appropriately cited. Some methodological limitations—non-probability sampling, reliance on subjective reports, and the absence of raw data sharing—should be addressed. Recommendations for Improvement: Statistical Analysis Enhancements: 1. Include confidence intervals and effect sizes to strengthen interpretation. 2. Consider multivariate regression models adjusting for outdoor time, gender, and family history. Design Improvement: 1. Future studies should use prospective or longitudinal designs with objective screen tracking. Clarify Limitations: 1. Expand on selection bias, recall bias, and generalizability in the discussion section. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise ophthalmology, genetics, molecular biology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Marković L. Peer Review Report For: Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia [version 1; peer review: 3 approved with reservations] . F1000Research 2025, 14 :148 ( https://doi.org/10.5256/f1000research.176875.r392232) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-148/v1#referee-response-392232 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Kam K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 22 Jul 2025 | for Version 1 Ka Wai Kam , Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Hong Kong, Hong Kong 0 Views copyright © 2025 Kam K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors conducted a retrospective case-control study, and identified several risk factors associated with myopia in childhood through a validated questionnaire. The methodology was well described including the statistical methods and sample size calculation which was fulfilled. Several comments regarding the manuscript (1) Figure 1, the caption underneath the pie chart is inaccurate, please replace with "distribution of myopia severity among myopic children" (2) the proportion of children owing a smartphone was only marginally higher in the myopia group than controls. Yet the ownership of a device does not always mean a greater frequency or duration of use of such device. Looking at Figures 3 and 4, you may see that in Figure 4, the control group had a greater frequency of using ALL the devices compared to the myopic children group. (3) Table 2 illustrates the no of devices present within each household, and whether a child own their screen media device. There was however only one p value presented in the third and fourth rows. It may be worthwhile to compare individual device. Base on the actual data presented, I was not very convinced that there was a significant difference between the ownership/frequency of use of electronic devices between myopic and non myopic children. (4) Table 4 illustrates an interesting phenomenon which could be further elaborated. The quesitonnaire explored the use of screen media during the first and last half an hour of the day. And the result showed a higher frequency of such phenomenon in the myopic group. Rather than reporting the actual frequency or duration of use, the timing of use or habit of using such screen media may be associated with the development of myopia in children. (5) Table 4, last three rows - regarding the age at which the child acquired his/her own device. It seemed that myopic children tended to get their own tablet at a later age (p=0.012), whereas no difference was detected for smart phone nor laptop. My general impression was that the difference was not clinically significant. (6) Table 5, I was quite surprised that there was NO association between the family history of myopia and the severity of child myopia. As parental myopia has already been shown as a strong risk factor for child myopia. See: Am J Ophthalmol. 2020 Oct:218:199-207. This led me to doubt about the accuracy and measurement of parental myopia in the cohort. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise epidemiology, astigmatism I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Kam KW. Peer Review Report For: Association of myopia with screen time use in pediatric patients in a tertiary hospital in Saudi Arabia [version 1; peer review: 3 approved with reservations] . F1000Research 2025, 14 :148 ( https://doi.org/10.5256/f1000research.176875.r392247) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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