# Clinical manifestations, prevalence, and risk factors of asthenopia: a systematic review and meta-analysis

## TL;DR

This study finds that asthenopia, or eye strain, is common, especially among digital device users, and is linked to factors like screen time and sleep.

## Contribution

The paper provides a comprehensive meta-analysis of asthenopia's prevalence, symptoms, and risk factors across diverse populations.

## Key findings

- The pooled prevalence of asthenopia is 51% across populations, with higher rates among digital device users and computer workers.
- Common symptoms include eye tiredness, eye strain, and musculoskeletal discomfort like neck and shoulder pain.
- Risk factors include prolonged screen time, short sleep, and air conditioning use, while protective measures include anti-glare filters and regular breaks.

## Abstract

This meta-analysis aims to determine the clinical manifestations, prevalence, and risk factors of asthenopia across diverse populations.

We systematically searched PubMed up to April 2024 for studies published within the last five years on asthenopia, without language or design restrictions. Reference lists were also reviewed. The study quality was evaluated using the Newcastle-Ottawa Scale. A random-effects meta-analysis was conducted to calculate proportions, prevalence rates, odds ratios (ORs) and their 95% confidence intervals (CIs).

Overall, 63 studies were included. The pooled prevalence of asthenopia detected via questionnaires or symptom report was 51% (95% CI = 50%, 52%). Subgroup analyses showed high prevalence among digital device users (90%) and computer workers (77%). During the COVID-19 pandemic, prevalence rose among adults (39%–45%), university students (36%–57%), and school-aged children (45%–64%). The most frequent ocular symptoms were eye tiredness (65%, 95% CI = 46%, 84%), eye strain (47%, 95% CI = 37%, 58%), and burning/irritation (43%, 95% CI = 35%, 51%). Musculoskeletal symptoms, including neck pain (45%, 95% CI = 28%, 62%) and shoulder pain (30%, 95% CI = 12%, 48%) were also prevalent. Neuropsychological symptoms included headache (50%, 95% CI = 41%, 59%) and difficulty concentrating (44%, 95% CI = 32%, 56%). Risk factors included short sleep duration (OR = 1.28; 95% CI = 1.04, 1.57), prior eye disease (OR = 2.59; 95% CI = 1.43, 4.69), prolonged screen time (OR = 1.15; 95% CI = 1.09, 1.21), and ambient conditions like air conditioning use (OR = 23.02; 95% CI = 4.94, 107.18). Protective measures included anti-glare filters (OR = 0.34; 95% CI = 0.19, 0.64), regular breaks (OR = 0.21; 95% CI = 0.09, 0.51), and computer use knowledge (OR = 0.20; 95% CI = 0.13, 0.30).

Asthenopia is prevalent across diverse populations, characterised by a wide range of symptoms and influenced by modifiable risk factors. Our findings support a unified definition to improve clinical recognition and offer preliminary evidence to help shape future research on preventive strategies.

PROSPERO: CRD42024536841.