Computer vision syndrome among high school students using digital versus printed textbooks: prevalence and associated factors

The increasing implementation of digital textbooks in schools raises concerns regarding their potential impact on the ocular and visual health of adolescents. However, the effect of this educational shift on computer vision syndrome (CVS) has not yet been assessed using validated measurement tools.

This study analyses the prevalence of CVS in adolescent students, comparing the use of printed versus digital textbooks, and considering sociodemographic, visual and digital devices exposure factors.

A longitudinal observational study with repeated assessments of the same participants and estimation of CVS at four time points was conducted during the second academic semester in two high schools in Alicante, Spain (n = 231 students, 15-17 years old). One high school used printed textbooks, whereas the other implemented digital textbooks. An initial visual examination was performed, assessing visual acuity, objective and subjective refraction, eye movements, pupillary reflexes, and the cover test. At each visit, participants completed a questionnaire on digital device exposure and together with the validated CVS-Q© teen questionnaire. Generalized Estimating Equation logistic regression models were used to estimate crude and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI).

CVS prevalence was 56.7% among students using printed textbooks and 58.7% among those using digital textbooks to study, with no significant differences between groups (aOR = 1.0; 95% CI, 0.6-1.7). Being female and having an uncorrected refractive error were associated with a higher likelihood of CVS.

CVS prevalence was similar among students using digital and printed textbooks, and this pattern remained after adjustment for relevant covariates. However, appropriate optical compensation should be used when necessary to prevent an increase.