{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:40:59Z","timestamp":1792035659634,"version":"4.4.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T00:00:00Z","timestamp":1682899200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>The present work style and lifestyle have increased the digital device use. Therefore, an increase in digital eyestrain is to be expected. We undertook a survey during coronavirus disease 2019 (COVID-19) pandemic to investigate the practice of 20\/20\/20 rule and its association with digital device use and asthenopic symptoms. While this rule is commonly advised, little is known about its validity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>An online survey form was disseminated through social media and emails. The questions for eye-related symptoms were similar to the convergence insufficiency symptom survey (CISS). Participants with age \u22655 years were included, with parents completing the survey for children (\u226416 years).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 432 participants (mean \u00b1 standard deviation [SD]: 26.06 \u00b1 13.92 years) were enrolled, of which 125 responses were for children. The 20\/20\/20 rule was practiced only by 34% of the participants either regularly (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 38) or occasionally (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 109). Those who had complaints of burning sensation and headache tended to practice this rule. Among adult participants, more females (47%) practiced this rule when compared to males (23%). Also, adult females significantly (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.04) had more symptoms score when compared to males. In children, no such gender difference was found.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Only one-third of participants practice the 20\/20\/20 rule at least occasionally. More number of adult females being symptomatic and practicing in greater number could be due to higher prevalence of dry eye condition in females. While the symptom of burning sensation could be related to dry eye, that of headache could be related to refractive error or binocular vision dysfunctions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijo.ijo_2056_22","type":"journal-article","created":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T03:24:48Z","timestamp":1684293888000},"page":"2071-2075","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":19,"title":["The 20\/20\/20 rule: Practicing pattern and associations with asthenopic symptoms"],"prefix":"10.4103","volume":"71","author":[{"given":"Sourav","family":"Datta","sequence":"first","affiliation":[{"name":"Brien Holden Institute of Optometry and Vision Sciences, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivalika","family":"Sehgal","sequence":"additional","affiliation":[{"name":"Brien Holden Institute of Optometry and Vision Sciences, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bidisha","family":"Bhattacharya","sequence":"additional","affiliation":[{"name":"Brien Holden Institute of Optometry and Vision Sciences, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prem Nandhini","family":"Satgunam","sequence":"additional","affiliation":[{"name":"L V Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,5,17]]},"reference":[{"key":"R1-20251006","first-page":"102171","article-title":"Impact of digital surge during Covid-19 pandemic: A viewpoint on research and practice","volume":"55","author":"Pandey","year":"2020","journal-title":"Int J Inf Manage"},{"key":"R2-20251006","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1038\/d41586-020-00896-7","article-title":"Five tips for moving teaching online as COVID-19 takes 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