Musculoskeletal consequences of refractive errors: posture, cervical joint position sense, neck disability, musculoskeletal discomfort, and quality of life

BACKGROUND: Refractive errors (RE) affect posture, musculoskeletal health, and quality of life due to compensatory head and neck adjustments. However, their specific musculoskeletal effects remain unclear. This study aims to investigate the impact of RE on posture, cervical joint position sense (CJPS), neck disability, musculoskeletal discomfort, and quality of life to identify their distinct effects. METHODS: This cross-sectional study included 71 participants (mean age 35.67±10.78 years) : 20 controls, 20 with myopia, 14 with hyperopia, and 17 with astigmatism. Posture was assessed using forward head posture (FHP), pectoralis minor tightness, thoracic kyphosis, lumbar lordosis, and the New York Posture Rating Scale (NYPR). CJPS was measured with a CROM device. Neck disability was evaluated using the Neck Disability Index (NDI), musculoskeletal discomfort with the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), and quality of life with the Short Form-36 (SF-36) survey. RESULTS: All RE groups showed increased FHP (p = 0.003), lower NYPR scores (p = 0.001), and greater neck discomfort (p = 0.004) compared to controls. Myopia had higher neck disability scores (p = 0.002, Cohen’s d = 1.21), while hyperopia (p = 0.006, Cohen’s d = 1.21) and astigmatism (p = 0.003, Cohen’s d = 1.12) exhibited greater thoracic kyphosis and CMDQ back scores compared to controls. Hyperopia also had elevated CMDQ low back scores (p = 0.004, Cohen’s d = 0.74). Hyperopia had lower general health perception (p = 0.005, Cohen’s d = 1.03), while both myopia and hyperopia showed greater role limitations due to physical problems (p = 0.002, Cohen’s d = 1.04; p = 0.001, Cohen’s d = 1.16, respectively). No significant differences were found in CJPS (p > 0.05). CONCLUSIONS: All refractive RE groups experienced postural changes and musculoskeletal discomfort, with distinct effects depending on the type of impairment. Interventions should be tailored to address neck disability in myopia, thoracic alignment issues in astigmatism, and musculoskeletal adaptations extending to the lower back in hyperopia. A multidisciplinary approach, combining ophthalmology, physiotherapy, and ergonomics, is crucial for developing effective rehabilitation strategies and understanding the long-term musculoskeletal impact of RE.