AACE associated with excessive smartphone use
Reviewed by Fiona Rowe

The purpose of this study was to describe a series of cases of acute acquired comitant strabismus (AACE) in children attending online classes on smartphones during the pandemic. Eight children were included with a mean age of 12.5 ±4.2 years. All were male and all had recent onset esotropia within the past month prior to assessment. Mean total duration of phone use was 4.6 ±0.7 hours/day. Online classes >four hours/day were noted for all. Four also played video games for >two hours/day (mean 2 ±1.69). Pre-pandemic none had used phones for online learning. Carers reported viewing distances of <30cms for >one hour with phones averaging 5.5-inch size. Five were emmetropic, one myope, one pseudo myope and one hypermetrope. All had 20/20 visual acuity. With refractive error corrected, angle for near fixation was 48.1 ±16.4PD esotropia, and for distance was 49.3 ±15.9PD. Near and distance angles were within 5D of each for all cases. Seven children complained of horizontal diplopia and one was unaware of subjective diplopia. One had accommodative spasm. All other assessments were normal. Phone use was discontinued for one month but did not alter the esotropia. The authors conclude these cases are likely caused or precipitated by prolonged near work on smartphones for online learning and/or for play. Online classes >four hours appear to be an associated factor. They advise restricted duration of smartphone use.

Series of cases of acute acquired comitant strabismus in children associated with excessive online classes on smartphone during the COVID19 pandemic digital eye strain among kids (DESK) study-3.
Mohan A, Sen P, Mujumdar D, et al.
STRABISMUS
2021;29(3):163-7.