Digital eye strain and myopia progression in the digital age: A preventive ophthalmology approach to screen-related ocular health

Abstract The ubiquitous integration of digital devices into modern life has created unprecedented challenges for ocular health, particularly regarding digital eye strain (DES) and myopia progression. DES, affecting 50%–90% of digital device users, manifests as ocular discomfort, visual disturbances, and associated systemic symptoms following prolonged screen exposure. Concurrently, myopia prevalence has reached epidemic proportions, particularly in East Asian populations where rates exceed 80%–90% among young adults, with digital device use implicated as a modifiable risk factor. This narrative review examines the epidemiology, pathophysiology, and preventive strategies for screen-related ocular disorders from a public health ophthalmology perspective. We synthesize evidence on mechanisms linking prolonged near work and reduced outdoor time to myopia progression, including accommodative stress, peripheral hyperopic defocus, and dopamine-mediated retinal signaling. DES pathophysiology involves reduced blink rates causing tear film instability, sustained accommodation inducing ciliary muscle fatigue, and blue light exposure potentially affecting circadian rhythms and retinal health. Preventive interventions including the 20-20-20 rule, environmental modifications, optical corrections, pharmacological approaches with low-dose atropine, and public health campaigns promoting outdoor time are evaluated. Implementation challenges including behavioral modification barriers, workplace ergonomics, pediatric screen time guidelines, and healthcare system integration are addressed. Evidence-based recommendations for clinicians, parents, educators, and policymakers are provided to mitigate the growing burden of screen-related ocular morbidity in an increasingly digital world.