Near-work activity duration and myopia in children: An updated systematic review and meta-analysis

The present systematic review and meta-analysis aimed to assess the association between near-work activity and myopia in children, as well as to examine the influence of potential moderators, such as age, region and study design. Multiple databases were systematically searched from inception through to June 2025 for observational studies exploring the connection between near work and myopia in children. Random-effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Analyses of heterogeneity, subgroup differences, meta-regressions and assessments of publication bias were conducted. A total of 33 studies (43 comparisons) were included. The pooled analysis revealed a significant association between increased near-work exposure and a higher risk of myopia in children (OR, 1.084; 95% CI, 1.060-1.108), although substantial heterogeneity was observed across studies (I²=85.2%). The 95% prediction interval (1.010-1.163) indicated that future studies would likely observe a similar positive association. Subgroup analyses demonstrated that the effect was consistent across continents, with the strongest correlation observed in Asian populations (OR, 1.177; 95% CI, 1.116-1.240) and the weakest in North America (OR, 1.098; 95% CI, 0.859-1.403). These patterns were confirmed by mixed-effects analysis. Meta-regression revealed no statistically significant moderators, and leave-one-out sensitivity analyses supported the stability of the results. Visual inspection of the funnel plot and quantitative tests pointed to minor publication bias, but the effect remained statistically significant after adjustment. In conclusion, higher levels of near-work activity are significantly linked to an increased risk of myopia in children. These findings highlight the importance of limiting prolonged near-work behaviors during childhood as part of comprehensive strategies to reduce myopia risk.