{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T23:56:37Z","timestamp":1788825397193,"version":"build-2803163510"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p><jats:bold>Objectives:<\/jats:bold> During the coronavirus disease 2019 (COVID-19) self-quarantine period, the transition to online-course has profoundly changed the learning modes of millions of school-aged children and put them at an increased risk of asthenopia. Therefore, we aimed to determine associations of the total screen\/online-course time with asthenopia prevalence among that children during the COVID-19 pandemic, and whether the associations were mediated by psychological stress.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Asthenopia was defined according to a validated computer vision syndrome questionnaire (CVS-Q). We used CVS-Q to collect the frequency and intensity of 16 asthenopia-related eye symptoms of 25,781 children. Demographic features, eye care habits, visual disorders, lifestyle, psychological and environmental factors, were also collected.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> The overall asthenopia prevalence was 12.1%, varying from 5.4 to 18.2% across grade\/gender-classified subgroups. A 100-h increment of total screen\/online-course time were associated with an increased risk of asthenopia by 9% [odds ratio (OR) = 1.09] and 11% (OR = 1.11), respectively. Mediation analysis showed that the proportions of total effects mediated by psychological stress were 23.5 and 38.1%, respectively. Age, female gender, having myopia or astigmatism, bad habits when watching screens were also risk factors. Conversely, keeping 34\u201365 cm between eyes and screen, increased rest time between classes, and increased eye exercise were all associated with a decreased risk.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Our study indicated that the influence of long total screen or online-course time on psychological stress increases asthenopia risk. The findings of this study have provided a new avenue for intervening screen-related asthenopia in addition to incorporating a reasonable schedule of online courses into educational policy.<\/jats:p>","DOI":"10.3389\/fpubh.2021.736617","type":"journal-article","created":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T21:38:12Z","timestamp":1638394692000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":26,"title":["Contribution of Total Screen\/Online-Course Time to Asthenopia in Children During COVID-19 Pandemic via Influencing Psychological Stress"],"prefix":"10.3389","volume":"9","author":[{"given":"Lin","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moxin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiao","family":"Chu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Run","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weizhong","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengcheng","family":"Xun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jibo","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,12,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1056\/NEJMoa2001017","article-title":"A novel coronavirus from patients with pneumonia in China, 2019","volume":"382","author":"Zhu","year":"2020","journal-title":"N Engl J Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1016\/S0140-6736(20)30154-9","article-title":"A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster","volume":"395","author":"Chan","year":"2020","journal-title":"Lancet."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1612","DOI":"10.1001\/jama.2020.4326","article-title":"Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State","volume":"323","author":"Arentz","year":"2020","journal-title":"JAMA."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1863","DOI":"10.1007\/s00134-020-06211-2","article-title":"Clinical characteristics and outcomes of critically ill patients with novel coronavirus infectious disease (COVID-19) in China: a retrospective multicenter study","volume":"46","author":"Xie","year":"2020","journal-title":"Intensive Care Med."},{"key":"B5","unstructured":"Coronavirus Disease (COVID-2019) Weekly Epidemiological Update2021"},{"key":"B6","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1016\/S0140-6736(20)30547-X","article-title":"Mitigate the effects of home confinement on children during the COVID-19 outbreak","volume":"395","author":"Wang","year":"2020","journal-title":"Lancet."},{"key":"B7","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1111\/j.1475-1313.2012.00925.x","article-title":"Computer-related visual symptoms in office workers","volume":"32","author":"Portello","year":"2012","journal-title":"Ophthalmic Physiol Opt."},{"key":"B8","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1177\/0748233710386407","article-title":"Asthenopia (eyestrain) in working children of gem-polishing industries","volume":"27","author":"Tiwari","year":"2011","journal-title":"Toxicol Ind Health."},{"key":"B9","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1007\/s13312-013-0117-x","article-title":"Eyestrain in working children of footwear making units of Agra, India","volume":"50","author":"Tiwari","year":"2013","journal-title":"Indian Pediatr."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1595","DOI":"10.2147\/OPTH.S84976","article-title":"Asthenopia in schoolchildren","volume":"9","author":"Vilela","year":"2015","journal-title":"Clin Ophthalmol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"346","DOI":"10.3928\/01913913-20170510-01","article-title":"Video game vision syndrome: a new clinical picture in children?","volume":"54","author":"Rechichi","year":"2017","journal-title":"J Pediatr Ophthalmol Strabismus."},{"key":"B12","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1186\/s12886-019-1082-5","article-title":"Visual implications of digital device usage in school children: a cross-sectional study","volume":"19","author":"Ichhpujani","year":"2019","journal-title":"BMC Ophthalmol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1016\/j.ajo.2006.03.047","article-title":"Prevalence of eye disorders in young children with eyestrain complaints","volume":"142","author":"Ip","year":"2006","journal-title":"Am J Ophthalmol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1111\/j.1475-1313.2006.00364.x","article-title":"Accommodation and the relationship to subjective symptoms with near work for young school children","volume":"26","author":"Sterner","year":"2006","journal-title":"Ophthalmic Physiol Opt."},{"key":"B15","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1080\/09273970802020243","article-title":"Orthoptic findings and asthenopia in a population of Swedish schoolchildren aged 6 to 16 years","volume":"16","author":"Abdi","year":"2008","journal-title":"Strabismus."},{"key":"B16","doi-asserted-by":"publisher","first-page":"e442","DOI":"10.1111\/aos.13885","article-title":"Correlation between handheld digital device use and asthenopia in Chinese college students: a Shanghai study","volume":"97","author":"Xu","year":"2019","journal-title":"Acta Ophthalmol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"898","DOI":"10.1001\/jamapediatrics.2020.1619","article-title":"Mental health status among children in home confinement during the coronavirus disease 2019 outbreak in Hubei province, China","volume":"174","author":"Xie","year":"2020","journal-title":"JAMA Pediatr."},{"key":"B18","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1016\/j.jclinepi.2015.01.015","article-title":"A reliable and valid questionnaire was developed to measure computer vision syndrome at the workplace","volume":"68","author":"Segui Mdel","year":"2015","journal-title":"J Clin Epidemiol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"2483","DOI":"10.3390\/nu5072483","article-title":"Eye nutrition in context: mechanisms, implementation, and future directions","volume":"5","author":"Demmig-Adams","year":"2013","journal-title":"Nutrients."},{"key":"B20","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1001\/jamapediatrics.2018.5056","article-title":"Association between screen time and children's performance on a developmental screening test","volume":"173","author":"Madigan","year":"2019","journal-title":"JAMA Pediatr."},{"key":"B21","volume-title":"Stata Item Response Theory Reference Manual (Release 16). College Station","year":"2019"},{"key":"B22","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1016\/S0140-6736(98)06098-X","article-title":"Chronic stress in elderly carers of dementia patients and antibody response to influenza vaccination","volume":"353","author":"Vedhara","year":"1999","journal-title":"Lancet."},{"key":"B23","volume-title":"Stata Statistical Software (Release 16): College Station","year":"2019"},{"key":"B24","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1080\/01621459.1993.10594284","article-title":"Approximate inference in generalized linear mxed models","volume":"88","author":"Breslow","year":"1993","journal-title":"J Am Stat Assoc."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1080\/17470218.2015.1115884","article-title":"Explanation in causal inference: methods for mediation and interaction","volume":"69","author":"Bohnke","year":"2016","journal-title":"Q J Exp Psychol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1111\/j.1475-1313.2011.00834.x","article-title":"Computer vision syndrome: a review of ocular causes and potential treatments","volume":"31","author":"Rosenfield","year":"2011","journal-title":"Ophthalmic Physiol Opt."},{"key":"B27","doi-asserted-by":"publisher","first-page":"2501","DOI":"10.3390\/ijerph16142501","article-title":"Video display operator complaints: a 10-year follow-up of visual fatigue and refractive disorders","volume":"16","author":"Larese Filon","year":"2019","journal-title":"Int J Environ Res Public Health."},{"key":"B28","doi-asserted-by":"publisher","first-page":"718","DOI":"10.3980\/j.issn.2222-3959.2013.05.31","article-title":"Prevalence of asthenopia and its risk factors in Chinese college students","volume":"6","author":"Han","year":"2013","journal-title":"Int J Ophthalmol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1111\/cxo.12851","article-title":"Ocular and visual discomfort associated with smartphones, tablets and computers: what we do and do not know","volume":"102","author":"Jaiswal","year":"2019","journal-title":"Clin Exp Optom."},{"key":"B30","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1136\/oem.58.4.267","article-title":"Psychological factors and visual fatigue in working with video display terminals","volume":"58","author":"Mocci","year":"2001","journal-title":"Occup Environ Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"e000146","DOI":"10.1136\/bmjophth-2018-000146","article-title":"Digital eye strain: prevalence, measurement and amelioration","volume":"3","author":"Sheppard","year":"2018","journal-title":"BMJ Open Ophthalmol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1111\/cxo.12798","article-title":"Management of digital eye strain","volume":"102","author":"Coles-Brennan","year":"2019","journal-title":"Clin Exp Optom."},{"key":"B33","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1038\/s41562-020-0884-z","article-title":"Using social and behavioural science to support COVID-19 pandemic response","volume":"4","author":"Bavel","year":"2020","journal-title":"Nat Hum Behav."},{"key":"B34","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1001\/jamainternmed.2020.1562","article-title":"The mental health consequences of COVID-19 and physical distancing: the need for prevention and early intervention","volume":"180","author":"Galea","year":"2020","journal-title":"JAMA Intern Med."},{"key":"B35","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1001\/jamapediatrics.2020.1456","article-title":"Coronavirus disease 2019 (COVID-19) and mental health for children and adolescents","volume":"174","author":"Golberstein","year":"2020","journal-title":"JAMA Pediatr."},{"key":"B36","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1080\/00140139.2012.681808","article-title":"Effects of job-related stress and burnout on asthenopia among high-tech workers","volume":"55","author":"Ostrovsky","year":"2012","journal-title":"Ergonomics."},{"key":"B37","doi-asserted-by":"publisher","first-page":"474","DOI":"10.18502\/jovr.v14i4.5455","article-title":"High prevalence of asthenopia among a population of university students","volume":"14","author":"Hashemi","year":"2019","journal-title":"J Ophthalmic Vis Res."},{"key":"B38","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1007\/s10384-018-00648-1","article-title":"Tear film change and ocular symptoms after reading printed journal and electronic journal: a crossover study","volume":"63","author":"Prabhasawat","year":"2019","journal-title":"Jpn J Ophthalmol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.jtos.2018.09.006","article-title":"The ocular surface in children: a review of current knowledge and meta-analysis of tear film stability and tear secretion in children","volume":"17","author":"Chidi-Egboka","year":"2019","journal-title":"Ocul Surf."},{"key":"B40","doi-asserted-by":"publisher","first-page":"3783","DOI":"10.1038\/s41598-019-40539-0","article-title":"Association between dry eye disease and psychological stress among paramedical workers in Korea","volume":"9","author":"Hyon","year":"2019","journal-title":"Sci Rep."},{"key":"B41","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.jtos.2021.05.001","article-title":"Demographic and lifestyle risk factors of dry eye disease subtypes: a cross-sectional study","volume":"21","author":"Wolffsohn","year":"2021","journal-title":"Ocul Surf."},{"key":"B42","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1016\/j.jped.2014.10.008","article-title":"Prevalence of asthenopia in children: a systematic review with meta-analysis","volume":"91","author":"Vilela","year":"2015","journal-title":"J Pediatr."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.736617\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T21:38:21Z","timestamp":1638394701000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.736617\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,1]]},"references-count":42,"alternative-id":["10.3389\/fpubh.2021.736617"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2021.736617","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,1]]},"article-number":"736617"}}