PURPOSE To subjectively evaluate the degree of visual fatigue in children attending online classes during the coronavirus 2019 (COVID-19) pandemic and objectively evaluate accommodation and vergence dysfunction in these children. METHODS Children aged between 10 and 17 years with recent onset of asthenopia symptoms were included. Symptoms were evaluated using the Convergence Insufficiency Symptom Survey (CISS) questionnaire. A CISS score of 16 or greater was considered symptomatic. Binocular vergence and accommodation parameters were objectively evaluated. For ease of comparison, children were divided into two groups: children using digital devices for less than 4 hours/day and children using digital devices for 4 hours/day or more. RESULTS A total of 46 children with a mean age of 14.47 ± 1.95 years were evaluated. The mean duration of online classes during the COVID-19 pandemic was 3.08 ± 1.68 hours/day, which is higher than before the COVID-19 pandemic (0.58 ± 0.71 hours/day, P < .00001). The mean CISS scores were 21.73 ± 12.81 for children using digital devices less than 4 hours/day and 30.34 ± 13.0 for children using digital devices for 4 hours/day or more (P = .019). Mean near exophoria (P = .03), negative fusional vergence (P = .02), negative relative accommodation (P = .057), and accommodation amplitude (P = .002) were different between the two groups. The Spearman correlation between the symptomatic CISS score and the duration of online classes showed a linear association (coefficient rs = 0.39; P = .007). In the multivariate analysis, only the duration of online classes longer than 4 hours was a significant risk factor (P = .07) for the symptomatic CISS score. CONCLUSIONS Online classes longer than 4 hours were more detrimental to abnormal binocular vergence and accommodation parameters than online classes shorter than 4 hours. [J Pediatr Ophthalmol Strabismus. 2021;58(4):224-231.].

中文翻译：

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在 COVID-19 大流行期间参加在线课程的儿童的双眼调节和聚散功能障碍：儿童数字眼疲劳 (DESK) 研究-2。

目的 主观评估在 2019 年冠状病毒 (COVID-19) 大流行期间参加在线课程的儿童的视觉疲劳程度，并客观评估这些儿童的适应和聚散功能障碍。方法 包括最近出现视疲劳症状的 10 至 17 岁儿童。使用收敛不足症状调查 (CISS) 问卷评估症状。16 或更高的 CISS 评分被认为是有症状的。客观地评估了双眼聚散度和调节参数。为了便于比较，将儿童分为两组：使用数字设备少于 4 小时/天的儿童和使用数字设备 4 小时/天或以上的儿童。结果 共评估了 46 名平均年龄为 14.47 ± 1.95 岁的儿童。COVID-19 大流行期间在线课程的平均持续时间为 3.08 ± 1.68 小时/天，高于 COVID-19 大流行之前（0.58 ± 0.71 小时/天，P < .00001）。使用数字设备少于 4 小时/天的儿童的平均 CISS 分数为 21.73 ± 12.81，使用数字设备 4 小时/天或以上的儿童的平均 CISS 分数为 30.34 ± 13.0 (P = .019)。两组之间的平均近外隐斜 (P = .03)、负融合聚散度 (P = .02)、负相对调节 (P = .057) 和调节幅度 (P = .002) 不同。症状性 CISS 评分与在线课程持续时间之间的 Spearman 相关性显示出线性关联（系数 rs = 0.39；P = .007）。在多变量分析中，只有超过 4 小时的在线课程持续时间是一个显着的风险因素（P = . 07) 用于有症状的 CISS 评分。结论 与短于 4 小时的在线课程相比，超过 4 小时的在线课程对异常双眼聚散度和调节参数的危害更大。[J Pediatr Ophthalmol 斜视。2021;58(4):224-231.]。